Advancing the profession.

The Mary McMillan Lecture is the highest honour awarded annually by the American Physical Therapy Association (APTA). We are privileged this issue to be able to reprint the transcript of Professor Stanley V. Paris's 2006 Mary McMillan Lecture, delivered at the APTA conference June this year.

Professor Paris earned this honour for a career of service and innovation in physical therapy since emigrating to the US in 1966. There he founded the Orthopaedic Section of the APTA in 1974 (he was also, surprisingly, a founding member of the Section for Women's Health), and served on the APTA Board of Directors and Task Force on Clinical Specialisation. He previously has been honoured as a Fellow of the APTA, and the Paris Distinguished Service Award of the Orthopaedic Section has been permanently named in his honour.

Son of Dunedin physiotherapist Stanley V. Paris Sur, Stanley Jr graduated from the New Zealand School of Physiotherapy in Dunedin in 1958. Soon after graduating, Stanley set off to the UK on a scholarship to learn advanced manual therapy skills. There and in Europe he worked with and learned from leading figures such as Freddy Kaltenborn, Dr Alan Stoddard, and Dr James Cyriax (legend has it that Stanley, perhaps frustrated at not initially being able to secure a job working as closely as he had hoped with Dr Cyriax, did the next best thing: he married one of Cyriax's 'physics'!). As he developed into an outstanding clinician, Stanley was appointed physiotherapist to the New Zealand Olympic Team twice (Rome 1960 and Mexico City 1968) and the Commonwealth Games once (Edinburgh 1970).

Not uni-dimensional by any means, Dr Paris has lead an exciting and adventurous life outside of physiotherapy: setting a point-to-point speed record across the Indian sub-continent in his Volkswagen Beetle named 'Dreadnought'; volunteer service in Afghanistan; swimming the English channel (twice); completing the Boston Marathon and the Hawaii Ironman; sailing the Atlantic and Pacific Oceans in his series of yachts, also named 'Dreadnought'; and earning line honours in the 1998 Spain to St Lucia yacht race, among many adventures.

Stanley returned to New Zealand in the early sixties to a position teaching at the New Zealand School of Physiotherapy, and soon authored his first book The Spinal Lesion (Paris 1965). Since emigrating to the US in 1966, Dr Paris has authored many of professional and scientific articles (only a few of which I have cited here), including a very informative history of manipulative therapy (Paris 1983a, Paris 1983b, Paris 1985, Paris 1990, Paris 2000).

Stanley Paris, PT, PhD, FAPTA, FNZSP is now, almost without doubt, the most recognised figure in physiotherapy in the US (America's most loved PT, Florence Kendall, who passed away earlier this year was the only US-based PT to rank higher in a recent poll of APTA members on "The Seven Most Influential Persons in Orthopedic Physical Therapy Today"). New Zealand physiotherapists are held in very high regard in the US, due in large part to the efforts and excellence of Dr Paris, Robin McKenzie, and Brian Mulligan--all of whom appeared on the Seven Most Influential list.

One of Dr Paris's main legacies is the introduction of manipulative physical therapy into the US. Dr Paris was advocating manipulative therapy in the US at a time when very few US physiotherapists had knowledge of these skills--indeed, at time when it was outside the scope of practice of physical therapists according to the laws of many states. Dr Paris has been an advocate of physical therapists' right to provide this mode of therapy for decades, through very challenging times when chiropractors were lobbying strongly to make manipulation, particularly spinal manipulation, their legal preserve in states' legislation. In doing so he changed the very language of physiotherapy in the US--he strongly advocated all forms of manual therapy and mobilisation be called manipulation: the skilled passive movement of a joint or soft tissue. This struck me as much more sensible than the artificial definitions of mobilisation (meaning non-thrust manipulation) and manipulation (meaning thrust manipulation) because it reflected the true meaning of 'manipulation': a manos--by hand. His pioneering series of manual therapy courses, taught across the US, were all named as such: S1--Introduction to Spinal Manipulation (followed by S2, S3, ... et cetera), through E1--Introduction to Extremity Manipulation (E2, et cetera), and even MF1--Myofascial Manipulation. This was to firmly emphasise the point that physical therapists manipulate: an important rod underpinning success in thwarting the chiropractors, and gaining (or regaining) in many states the legal right of physiotherapists to manipulate.

Dr Paris has also been hugely influential at the international level, not least as founding Chairman and later President of the International Federation of Orthopaedic Manipulative Therapists (IFOMT). His continuing education courses are offered in Iceland, Japan, Chile and Bermuda. In fact, Dr Paris helped kick-start the profession of physiotherapy in Burmuda, and has the professional registration number to prove it: 001.

The continuing education courses Dr Paris offered, beginning in 1966, lead to the first post-graduate Masters degree in orthopaedic manipulative therapy in the US in 1979. This degree was offered by the Institute of Graduate Health Sciences, originally with the support of the Medical College of Georgia, but by 1997 Dr Paris had built the Institute into a large, successful organization that offered four degrees at the Masters or Doctoral level. That year he founded the fully accredited University of St Augustine for Health Sciences.

In funding the University of St Augustine Dr Paris had created the first private university in the US exclusively offering physical therapy degrees. It is now the largest physical therapy programme in the US, and also offers occupational therapy degrees. His university graduated the first Doctor of Physical Therapy in US history.

I'm sure, as a reader, you are seeing a pattern here: Dr Paris is an innovator, a risk-taker, a leader, a visionary. He is a man with a passion for life, sharp intelligence, and huge reserves of determination to achieve his goals. But it all got off to a shaky start, as Stanley was, it appears, something of a challenging student--he takes great delight in retelling the tale that, despite failing anatomy during his undergraduate training, he now has a PhD in anatomy. That story gave me great heart, as a young Masters degree student, and it's a story I now share in common with my mentor, Dr Stanley Paris. It gives me great personal pleasure to have the privilege of reprinting this lecture, as Dr Paris has had a strong influence on my career. I first had the privilege of working with Dr Paris as a student in his Manual Therapy Certification classes, then as a candidate in the Master of Science degree in orthopaedic manual physical therapy, and later as a faculty member at the University of St Augustine for Health Sciences.

To deliver the Mary McMillan Lecture is the greatest of many ways the APTA honours--and learns from--the hardworking heroes and giants of the profession in America. That the honour go to a New Zealander is extraordinary. So what can we, as New Zealand physiotherapists, learn from the climax of a Kiwi's career overseas? In the Mary McMillan Lecture reprinted in this issue, Professor Paris begins by reflecting on the past, but as always he has his sights set firmly on the horizon--and in this lecture he gives us much to reflect upon in terms of a vision for the profession of physiotherapy.

What is our vision for the future of the profession here in New Zealand? Perhaps those who attended the NZSP Biennial Conference in May this year were, like me, astounded and dismayed when, at the final panel session entitled "Advancing the Profession", neither the chair nor the panellists nor the floor addressed key topics addressed in Professor Paris's lecture such as: higher professional degrees; research (and the responsibility of the profession to fund research and the development of research capacity); clinical residencies; clinical specialisation; professionalism; and professional identity. We had the benefit of having Professor Marilyn Moffat, former APTA president and leader in a top US physical therapy school on the panel, but did not discuss the pros and cons of moving the profession to higher degrees, such as the Doctor of Physical Therapy (DPT) in the US. As a profession. I feel we fuss too much about present problems and failings, and focus too little on forming a vision of the future.

The APTA has a SMART (specific, measurable, achievable, realistic, timebound) set of goals for the enhancement of the physical therapy profession in the US: it is encapsulated in their "Vision 2020" (APTA). Their goals are truly transformational: they portray a compelling landscape for a profession much different to this decade or last. What is our vision for a transformed, genuinely advanced profession? Where could our profession possibly be in the year 2020--if we really stretch or minds and our wings? In the best interests of the patient.

ACKNOWLEDGEMENTS:

Thanks to Barbara Hetherington for taking the initiative to approach the new Editor of Physical Therapy, Dr Rebecca Craik, in June this year following Dr Paris's lecture, to request permission to reprint thistranscript in the New Zealand Journal of Physiotherapy. Many thanks to APTA, publishers of Physical Therapy, for extending to us the privilege of reprinting this article.

REFERENCES:

Paris SV (1965): The Spinal Lesion. Christchurch, NZ: Pegasus Press.

Paris SV (1983a): Anatomy as related to function and pain. Orthopedic Clinics of North America 14: 475-489.

Paris SV (1983b): Spinal manipulative therapy. Clinical Orthopaedics & Related Research: 55-61.

Paris SV (1985): Physical signs of instability. Spine 10: 277-279.

Paris SV (1990): Effect of feedback on learning a vertebral joint mobilization skill. Physical Therapy 70: 103.

Paris SV (2000): A history of manipulative therapy through the ages and up to the current controversy in the United States. Journal of Manual and Manipulative Therapy 8: 66-77.

American Physical Therapy Association. http://www.apta.org/AM/Template.cfm?Section=Vision_20201&Template=/ TaggedPage/ TaggedPageDisplay.cfm&TPLID=285&ContentID=32061. Accessed 26 October, 2006. (or go to www.apta.org and click on Vision 2020 at the bottom right corner)

J. Haxby Abbott, PhD, MScPT, FNZCP

Editor, New Zealand Journal of Physiotherapy