1.8.

2016

ATributetoMaxZusman

ATributetoMaxZusman

IwasluckyenoughtobetaughtPainPhysiologyandMechanismsbyMaxZusmaninthesecondyearof
myundergraduatephysiotherapydegree.Maxhadanaurabeinginhispresenceyoufeltcompletely
inferioryetutterlymotivatedandenlightenedatthesametime.Thereareararefewwhohavechangedthe
directionandreputationofphysiotherapytosuchanextent,butMaxZusmanisunquestionablyoneof
them.Itwasanhonourtobetaughtbysuchanadvancedmind,withhislessonsonperipheral
sensitisation,noxiousstimuliandhyperalgesiasuretostaywithmeforlife.
ThenewsofMax'spassingledtomerereadinghismostrecentarticles.Zusman(2012)focusesonthe
necessityforphysiotherapiststocorrectlyusepainterminology.ThosewhoattendedtheVictorianAPA
breakfastandlistenedtoDavidButlerwillunderstandtheimportanceofcorrectlyemployingthisjargon.
Astatementwhichunderpinsphysiotherapyis"(physiotherapy)deliveryentailssubjectingpatientsto
graduatedexposuretomechanicalstimuli"throughemployinga"meansofmechanicalstimulus
inducedpaininhibition"(Zusman,2012).Althoughmanytechniquesareutilised,most,ifnotall,are
simplythe'graduatedexposure'toanociceptivestimulus.
Thearticlehighlightsthedifferencebetweenvarioustypesofpain,whichwillbeelaboratedfurther.
NociceptivePainpaindesignedasawarningsignal,regularmechanicalorthermalstimuliwhichdoesn't
evoketissuedamage,islocalised,intermittentpainwhichdoesnotsensitisethearea,itisnotapathology,
justanormalpainmechanism
InflammatoryPainconsistsofperipheralsensitisation(chemicalexcitationofperipheralnociceptors
duetoloweringofpainthresholdstomechanicalorthermalstimuli)andchemicalsensitisation,both
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ATributetoMaxZusman

resultinanonnoxiousstimulinowcausingpain.Painmayoccurspontaneouslyandcontinuesalthough
thestimulusisnolongerpresent,withpainoftenexceedingbeyondthelocalisedareaoftissueinjury.
Centralsensitisationheightens,spreadsandperpetuatesperipheralpainwhichcanbecomewidespread
causing"functionalpain"(oftenassociatedwithpsychosocialissues).
NeuropathicPainpainarisingasadirectconsequenceofalesionordiseaseaffectingthe
somatosensorysystem(Zusman,2012),adiagnosisofneuropathicpainrequiresaxonalorfascicular
damageresultinginthedevelopmentofspecificsitesof"nerveimpulsegeneration"which
spontaneouslyemitneuralimpulsesinadditiontoreactingtonormal"mechanical,thermalandchemical
stimuli".Theseimpulsesinstigatecentralsensitisationinthecentralnervoussystemusingthesame
mechanismsasinflammatorypain,with'functionalpain'beingtheenduringdisabilityoftheseinhibitorypain
systems.
"Physiologicalandanatomicalchangesaffectingmechanismsofendogenouspaininhibitionfollowing
peripheralnervedamagerendermanycommonmethodsfortheinductionofpainreliefonlypartially
effective/ineffective."(Zusman,2012)
FunctionalPaincollectionofwidespread,chronicpaindisorderswithnoperipheralpathology
discovered,includingfibromyalgia,tensiontypeheadaches,chronicfatigue,irritablebowelsyndrome,
temperomandibularjointdisorders,individualsdisplayincreasedsensitivitytomechanical/thermalstimuli,
evidentofcentralsensitisation.
Inconclusion,Maxprovidedasuccinctarticleto"inform(musculoskeletalphysiotherapists')clinical
reasoninganddecisionmakingprocessandsmooththewayformutualunderstandingwithfelloworthodox
healthcareprofessionals".
ValeMaxZusman
Alicia
ReferencesZusman,M.(2012).Anotetothemusculoskeletalphysiotherapist.Journalofbackand
musculoskeletalrehabilitation,25(2),103107.

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