Page 2 P H Y S I O T H E R A P Y September, 1964 M IS S JEN N IFER H IC K L IN G , M.C.S.P. M iss H ic k lin g has th e q u ie t co n fid e n ce o f a n e x p e rt in her c hosen field o f p h y sio th e ra p y , w hile re ta in in g a sincere in te re s t in th e view s o f o th e rs d e sp ite th e fact th a t th ey m ay conflict w ith her o w n. T h e s e q u a litie s, a m o n g o th e rs , e n ­ a b le d her to gain th e co n fid e n ce o f her p a tie n ts a n d the d o c to rs a n d p h y s io th e ra p is ts w h o w o rk e d w ith her o r a tte n d e d her c o u rse s d u rin g her b rie f sta y in th e R e p u b lic . Je n n ife r H ic k lin g w as tra in e d a t St. T h o m a s ’ H o s p ita l, L o n d o n , w h e re sh e first le a rn t th e tec h n iq u e s o f e x a m in a tio n a n d tre a tm e n t o f so ft tissu e s ta u g h t by D r. Ja m e s C yriax, P h y sic ian to th e D e p a rtm e n t o f P hysical M e d icin e there. A fte r sh e qualified in 1948 sh e w o rk e d o n th e sta ff o f his p riv a te c linic, a n d h as been his se n io r p h y sio th e ra p ist since 1950. S he served as a C o u n c il M e m b er o f th e C h a rte re d S ociety o f P h y s io th e ra p y fo r tw o years. B esides ru n n in g p o s t-g ra d u a te c o u rse s a n d le c tu rin g to stu d e n ts in L o n d o n a n d o th e r p a rts o f th e U n ite d K in g d o m , she has in tro d u c e d her w o rk a b ro a d in N e w Z e a la n d , F ra n c e , Belgium a n d H o lla n d . She has a lso read a p a p e r on M a n ip u la tio n a t th e T h ird C o n g re ss o f th e W o rld C o n ­ fe d e ra tio n fo r P hysical T h e ra p y . W ith these q u a lific a tio n s a n d ex p erien c e she seem ed the o b v io u s c h o ic e w hen n e g o tia tio n s w ere in itiate d to invite a p h y sio th e ra p ist to S o u th A fric a to teach m an ip u la tiv e tec h n iq u es, b ut it w as w hile M iss S avin w as d isc u ssin g this w ith M iss H ic k lin g in E n g la n d th a t it b ecam e a p p a r e n t th a t sh e h a d th e ideal p e rso n a lity to in tro d u c e the w o rk here. S h e w as su b s e q u e n tly a p p ro a c h e d a n d said th a t she w ould be de lig h ted to com e. T h e visit p ro v e d to be a n u n q ualified success, fo r w hich p h y sio th e ra p ists in the R e p u b lic w ould like to ex p ress th eir g ra titu d e a n d sincere th a n k s . An Appreciation by Dr. I. S. DE W E T , S en io r O rthopaedic Surgeon, P retoria O rthopaedic H o sp ita l I t gives m e p lea su re to m a k e th e follow ing sta te m e n t in c o n n e c tio n w ith M iss H ic k lin g ’s tea c h in g o f th e C yriax tec h n iq u es, w h ic h she lec tu re d on a n d d e m o n s tra te d d u rin g her th re e -m o n th visit to P re to ria . I have had th e p le a su re o f a tte n d in g som e o f her lectures a n d o b se rv in g the te c h n iq u e s she a d o p ts in m a n ip u la tin g the spine, in clu d in g th e c ervical v e rte b ra e , fo r c e rta in lesions | involving th e p a ra v e rte b ra l jo in ts . T h e o n e m o st o u tsta n d in g fa c to r in her a p p ro a c h to th is m o st difficult p ro b le m — na m e ly th a t o f h a n d , s h o u ld e r o r neck p ain a nd o f low er b a c k a c h e w ith o r w ith o u t sc iatica — is th a t a sincere a tte m p t is m ad e to a p p ro a c h th e s y n d ro m e o n a scientific and m ed i­ c ally so u n d basis. N o a tte m p t is m a d e unless the p a tie n t has been seen by a m ed ical p ra c titio n e r o r a n o rth o p a e d ic su rg e o n a n d re liab le X -ra y s have been ta k e n . F u rth e rm o re , th e m eth o d o f e x a m in a tio n c arried o u t by th e p h y sio th e ra p ist in o rd e r to e sta b lish th e exact site o f the lesio n s to be trea te d is, in m y o p in io n , a scientifically so u n d m e th o d and d o e s lead to v a lu a b le in fo rm a tio n in loca lisin g the pa th o lo g y . A s re g a rd s th e m eth o d o f m a n ip u la tio n , it a p p e a rs to be safe a n d h a rm less. T h is is d u e to th e fa ct th a t m a n ip u la tio n is c a rrie d o u t w ith o u t a n a e sth e tic s , a n d the m o v em en ts c arried o u t a re very gentle. So fa r n o cases a re on record w h e re de fin ite h a rm has been d o n e . T h e m ed ic al p ro fe ssio n as a w h o le is q u ite a w a re o f our sh o rtc o m in g s in so far as c o rre c t d ia g n o s is o r p in -p o in tin g o f th e lesion in m an y o f these cases is c o n c e rn e d , a n d th ere ­ fo re w elcom es a n y in d iv id u a l o r c o m b in e d a tte m p t to im p ro v e on o u r w ays a n d m ea n s o f d iag n o s in g and tre a tin g th ese cases. I p e rso n a lly have supervised a t le a st half-a- d o z e n cases tre a te d by M iss H ic k lin g , a n d m u st fran k ly a d m it th a t in th ese selected cases m ark e d im p ro v e m e n t and to som e e x te n t la stin g im p ro v e m e n t has re su lte d . ^ I n disc u ssin g th e m a tte r w ith o th e r o rth o p a e d ic surgeons in P re to ria , e v e ry b o d y seem ed to be in a g ree m e n t th a t this m eth o d h as a d efinite p lace in th e a rm a m e n ta riu m o f o rth o ­ p a ed ic a n d p h y s io th e ra p e u tic m eth o d s o f tre a tm e n t, a nd it c a rrie s o u r a p p ro v a l as a m eth o d o f tre a tm e n t in selected cases. L a stly , I m ig h t m en tio n th a t late ly th e m edical profession a s well as th e p h y sio th e ra p ists have been lo o k in g fo r som e c o u n te r-m e a s u re s to e lim in a te th e w id e sp rea d p ra c tic e o f lay m a n ip u la to rs , w here tre a tm e n t is given w ith o u t a ny scientific basis a n d w ith o u t p ro p e r e x a m in a tio n o f p atients. T h is , we all k n o w , is a n evil t h a t has to be e lim in a ted . T he m e th o d d e m o n s tra te d by M iss H ic k lin g seem s to be a de fin ite ste p fo rw a rd in o u r a tte m p ts to e lim in a te unscientific and in m an y c ases d a n g e ro u s m ea n s o f tre a tin g the public, w h o a re c o m p le te ly ig n o ra n t as re g a rd s the real facts con­ c ern in g th is m o st difficult m a tte r. I w o uld th e re fo re s tro n g ly re co m m e n d th a t we c a rry on on the basis e x p o u n d e d to us by M iss H ic k lin g , b earing in m in d th a t p ro p e r p re -tre a tm e n t e x a m in a tio n is essential, a n d th a t m a n ip u la tio n sh o u ld be c a rrie d o u t in the m ost g entle w ay. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )