RAF CONTRACTOR SUES PHYSIOTHERAPIST HE CLAIMS LEFT HIM PARALYSED

This entry is part 1 of 1 in the series In The News
  • RAF CONTRACTOR SUES PHYSIOTHERAPIST HE CLAIMS LEFT HIM PARALYSED

 

(Orignal Telegraph article available by clicking here)

Patients have been advised to demand proof of their physiotherapist’s experience and qualifications after an RAF contractor alleges he was paralysed following massage therapy on his neck.

Jason Davidson, formerly a fit and active 39-year-old, will spend the rest of his life in a wheelchair after physiotherapy treatment at a high street practitioner appeared to go disastrously wrong.

Mr Davidson had suffered neck pain after lifting a heavy power strip at work. His GP diagnosed muscular strain and after administering an anti-inflammatory injection and pain medication Mr Davidson was advised that physiotherapy might help relieve the pain.

The married father of two claims his rugby-playing physiotherapist used “considerable force” when manipulating his neck and that this continued after he asked him to stop.

The practitioner, Will Cooper, who practises in Brackley and claims to employ a “hands on” approach, boasts an undergraduate degree in physiotherapy and is a member of the Chartered Society of Physiotherapists.

Neck manipulation is not commonly taught at undergraduate level

Mr Cooper and his lawyers declined to comment given the impending legal proceedings. Neck manipulation is not commonly taught at undergraduate level, although students are shown how to recognise the circumstances in which giving the treatment might be unsafe.

It is unknown whether he had specific training in neck manipulation, or whether he undertook relevant post-graduate training.

 Mark Bowman, Mr Davidson’s lawyer and a partner at Field Fisher, told the Sunday Telegraph: “I would urge anyone seeing a physiotherapist for pain in the neck to ensure that they are suitably qualified to treat them and explicitly ask for proof of their qualifications before allowing them to commence treatment.”
 

doctors found a severe acute injury to spinal discs which had caused blood flow to the spinal cord to cease

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Mr Davidson was rushed to the John Radcliffe Hospital in Oxford, where doctors found a severe acute injury to spinal discs which had caused blood flow to the spinal cord to cease.

He has been told not to expect to walk again and is likely to remain incontinent for the rest of his life. His wife, Sandy, has had to give up her job in order to look after him.

The former facilities engineer is suing Mr Cooper, who graduated with a 2:1 from Coventry University in 2011, for negligence.

The claim for damages, if successful, is likely to be worth millions to account for decades of pain, suffering and lost earnings Mr Davidson now faces.

The incident is understood to be under investigation by the Health and Care Professions Council, which regulates physiotherapists, although the organisation did not comment.

Newly-qualified physiotherapists have traditionally undertaken a series of hospital rotations where they shadow more experienced practitioners, as well as undertaking specialist courses in various manoeuvres.

 Mr Cooper’s website states that prior to setting up his own practice he worked for “a large national Physiotherapy company” where he was “further trained in the effective management of joint and soft tissue injuries”.

Discussion

There are a number of very interesting points raised in this article and I will try to address them in the order in which they arise in the article.

Firstly the original injury. All we know from the article is that it was sustained in a lifting accident at work. What interests me is the diagnosis and treatment given by the GP- a “muscular strain” that was treated with an “anti inflammatory infection”. In my experience, this is not the first choice treatment for a simple mechanical neck pain regardless of severity. A course of non-steroidal anti-inflammatory tablets and analgesics (painkillers) tends to be the go to treatment in these instances. So why was an injection given? We have to assume that the GP ruled out any red flag symptoms that could have indicated that there was a serious underlying pathology before suggesting physiotherapy which for me is very important to note and will be touched on later in my discussion.

If a patient does not give their consent or removes it at any stage the treatment MUST stop

The next part of the article is a little disappointing on two fronts. Firstly the author felt it necessary to mention that the physio plays rugby. Why exactly, I’m not too sure. Is it because rugby is known to be a rough, aggressive sport, and is he insinuating that he would be in some way rough or aggressive in his professional life too? The second is the physio allegedly used “considerable force when manipulating his neck and that this continued after he [the patient] asked him to stop”. If this is true, there is no justification or defence for the physiotherapist’s actions. An absolute contra indicator for ANY intervention, be it from an osteopath, physiotherapist, dentist or doctor is patient consent. If a patient does not give their consent or removes it at any stage the treatment MUST stop. Manipulation is considered a robust form of treatment but any treatment can be performed strongly or gently with the patients’ comfort and safety in mind. Excessive force can be used in even gentle treatment modalities and increases the risk of side effects.

the absence of any red flag symptoms is not necessarily a green light to what is considered a robust treatment modality

The article goes on to say that “neck manipulation is not commonly taught at undergraduate level, although students are shown to recognise the circumstances in which giving the treatment might be unsafe”. These circumstances relate to the red flags that I mentioned previously. If the GP didn’t notice any the chances are that they weren’t present at that stage and potentially they weren’t present when he visited the physio. That said, practitioner discretion is vitally important in these situations. Patient comfort, safety and consent are paramount and the absence of any red flag symptoms is not necessarily a green light to what is considered a robust treatment modality. Manipulation is taught at undergraduate level in Osteopathy and Chiropractic courses. The reason for this is that physiotherapy has a much broader scope of practice compared to the other two which are musculoskeletal (MSK) specialities. The depth of knowledge and experience of muscle, joint, nerve and other soft tissue injuries will be greater in a newly qualified osteopath and chiropractor than it would be in a newly qualified physiotherapist. Some might debate this but MSK represents the majority of osteo’s and chiro’s undergraduate training where as it represents a module in a physiotherapy degree alongside other areas like oedema care, respiratory care stroke rehab and other hospital based therapies that osteopaths and chiropractors are not going to use and therefore are not trained in.

Speaking from experience of my training, a 4-year masters degree at the UK’s oldest and largest university, The British School of Osteopathy, the first two years laid the foundations for manipulation techniques without them actually being performed until the final term of 2nd year. Then over the final 2 years, these skills are honed and refined under the guidance and supervision of qualified osteopathic lecturers and clinical staff. The risks of the techniques and importance of informed consent were drilled into us. This developed a healthy respect for these robust techniques. Some of the postgraduate courses that are available to physios, sports massage therapists and others aim to teach spinal manipulation techniques over a two-day course. I firmly believe that this is not long enough for someone with no experience to safely apply them. Others will disagree with me but this is my belief. Knowing the potential harm that could be caused I don’t think I would let someone who has been on a weekend course manipulate my low back, never mind my neck.

The patient in this article ended up needing to go to the hospital where doctors found “a severe acute injury to spinal discs which had caused blood flow to the spinal cord to cease”. Poorly performed or excessively forceful manipulation could exacerbate the scale of already injured discs, but then again I would argue that so could a violent sneeze or a sudden movement. It’s not clear if he was rushed to the hospital from the physio clinic or sometime later but saying that the physio caused the injury might be difficult to prove.

These types of events, thankfully, are very rare. Spinal manipulation is still a very safe and effective technique as long as it is used responsibly in cases where it is appropriate. I will do a follow-up blog post on the risks in the weeks to come. What can not be excused, if found to be true, is a practitioner continuing with a technique when consent has been removed.

 

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