An Interview with Dr Geoff Harding
Dr Geoff Harding
Dr Geoff Harding is a Fellow of the Australasian Faculty of Musculoskeletal Medicine and a Fellow of the Australian College of Physical Medicine. To say Geoff has an extensive education in Musculoskeletal Medicine is an understatement.
Geoff completed his undergraduate medical degree at the University of Queensland in 1982. His education then took him overseas to Paris were he completed short-term courses in Musculoskeletal Medicine at the Hotel-Dieu, Universite de Paris with Professor Robert Maigne, and Dr Jean-Yves Maigne. He then pursued his post-graduate award of Musculoskeletal Medicine and Pain Management at the University of Otago in 1995.
Geoff continued his studies and completed his Diploma in Musculoskeletal Medicine and then his Masters in Pain. He then spread his MS passion the most effective way possible by teaching other Doctors in post-graduate medical education, as an Australian academic coordinator at the University of Otago. His passion didn’t stop there as he actively pursued knowledge in Musculoskeletal Ultrasonography.
He remains involved in further education on the musculoskeletal system and pain which is why he has agreed to head up the AMSN multi-professional seminar on Saturday 18th of April at the Summit conference rooms in Paddington, Brisbane.
Geoff practices his medicine as the Director at the Sandgate Spinal Medical Clinic and Sandgate Surgeries and continues his leadership in this field as the President of the Australian Association of Musculoskeletal Medicine (AAMM)
AMSN asked Geoff a few questions:
AMSN: What does your role as the president of the Australian Association of Musculoskeletal Medicine involve?
GH: I was responsible for the on-going positioning of the AAMM as an educational leader for Medical Practitioners who have a special interest in MS Medicine. I also have the joy of organizing the yearly Scientific conference.
How long have you been teaching for?
Since 1989 when I was involved in the teaching the Queensland section of the Spinal Manipulation for Doctors course organized by Prof John Murtagh and Dr Clive Kenna.
What makes you an expert in assessing and managing patients with disc lesions?
I don’t consider myself an expert in managing patients with disc lesions because we haven’t actually solved the problem yet. What I offer is years of clinical experience combined with the awareness of the pathophysiology of the disc and the evidence (for and against) for certain interventions in the management of ‘discogenic’ pain.
What parts of assessment will you be covering?
The history, and the physical examination and the MRI findings I look for.
What methods of management will you be covering?
The complete bio–psycho–social approach including medications, exercise, interventions such as injections and some discussion with respect to the place of surgery.
What percentage would patients with disc lesions are on your client list?
Most of the new patients I see present with a chronic pain problem and I believe that in that population they represent the single largest segment.
Do you have any protocols you use to decide whether to send a patient for a MRI?
Yes, especially where a diagnosis needs to be made to exclude ‘red flags’ or to establish a tissue diagnosis where the diagnosis will lead to a change in the management.
How do MRI results change how you manage a patient?
Having a diagnosis takes the “guruism” out of the equation and often results in stopping interventions which have not led to any substantial improvement up to that point in time. But even MRIs have their limitations in the investigation of pain and that has to be remembered as well.
Why would you send a patient for a standing MRI over the conventional MRI?
Where I suspect that the signs are subtle and that an MRI, without gravity–load, will not demonstrate, for example, a disc causing compression of a nerve root. Also where a patient is claustrophobic and is not suitable or interested in having sedation.
What are the dangers of not sending for an MRI?
I don’t see it as dangerous to not send for an MRI. In most cases a good history and clinical examination will raise the suspicion of a ‘red flag’ condition. I just think it is more a question of utility in leading to more appropriate management of a significant pain problem.
What clinical pearl can you share in relation to disc pathology?
Disc lesions can cause both neuropathic and nociceptive symptoms – it’s not all about disc protrusions causing nerve root compression.
What do you personally think is often missed when diagnosing or assessing the disc lesions? Do you have any tips you can share about not missing this or will this be covered? (I thought this could be a taste tester to entice people)
A good understanding of somatic referred pain patterns and the tissues affected.
How important do you think it is for manual/musculoskeletal practitioners to have a sound understanding of MRI’s?
They should have some knowledge of the anatomy and the appearances of the common pathologies seen on the different sequences. Also to understand the limitations of MRIs.
In your opinion what benefits can be gained from going to a multidisciplinary workshop?
One is exposed to the clinical expertise and experiences of others and that is always a learning experience.
Last but and probably most importantly, what do you play in the Rural Redneck Band?
I provide vocal harmonies, play rhythm guitar and play tenor sax at times.
Rudi Gerhardt Interview
By Jaymee Howell
Rudi’s background as a health practitioner is extremely well-rounded.
He has studied in both Europe and Australia. His qualifications include Sports-Physiotherapy in Munich, graduating in 1984; Osteopathy in Belgium (IAO), graduating in 1998; B.Sc. Anatomy UNSW, graduating 2001. In Australia he is registered as an Osteopath.
When I asked if he has any areas of specialization Rudi replied, “I consider studying the human body and mind a life-long task and try not to specialize. But if there is one area I had to choose it is: Neuroscience”. He does however have a special clinical interest in the complex area of Vertigo, which he often lectures about.
Rudi’s employment history began in Germany. He spent 7 years working in a hospital, then 1 year in orthopedic rehabilitation and in his final 5 years in Germany he was self-employed in his own clinic. He also humbly noted that
“In my capacity as a Sports-physiotherapist I was often called in to support International events like Marathons or Triathlons throughout Europe”.
In Australia Rudi initially worked as a sole practitioner for 9 years in his clinic in Sydney and for the last 9 years in his multidisciplinary clinic in Murwillumbah. He admitted that he started his teaching career due to necessity, as he had to wait for his overseas qualifications to be recognized in Australia. A mans got to eat! I found this surprising, as he is a very passionate presenter. When I queried him on this he replied, “necessity became a passion”. He went on to say that he learns almost as much from teaching as he did from attending universities “I like to be prepared for my presentations, and therefore I do a lot of prior research”.
His passion has given him an extensive 19-year teaching background. At conferences he has spoken on vertigo and the sacroiliac complex. He has lectured anatomy, neuroanatomy, clinical reasoning, neuroscience, histology, embryology, master classes, osteopathic skills and more at various universities in Australia. I asked Rudi about his teaching approach, he was very modest and described his style, “I personally like to bring science and the clinic together”. In his clinic he often has students observing him and learning, they all comment on his passion and that he does practice what he teaches.
I tried to pry information about the wetlabs but he only made me want to go more by the taste testers he gave me. I asked him why he was involved with wetlab courses,
“Despite the advances in technology, the ‘Wetlab’ is irreplaceable as a teaching tool: First there is a lot of variation in anatomy, which we generally don’t see in books or animations. Secondly, one can appreciate and recognize anatomical relationships easier in the wetlab; e.g. you can lift up a muscle and see the nerve or blood vessel underneath!”
He also pointed out that wetlabs are a great learning tool because we are such visually dominant beings, and research shows that visualisation is a very important factor. He told me that he finds, if you can draw it, you can remember it.
Below are a few more questions that I asked him about the content of the wetlab and its relevance.
What information will you be sharing at the head and neck wetlab?
- Revising some often neglected Neuro-orthopaedics and relevant anatomy.
- Sharing some interesting case studies from my clinic.
- Reliability and modifications of stability tests in the CS.
How do you decide what to present?
That depends on the ‘forum’:
- If I present to students at the Uni, I’ll teach/present curriculum
- If I present to professionals in a seminar, I get a feel for the audience. As there is a wide spread of professions (Orthopaedic surgeons, GP’s, Physiotherapist, Osteopaths, Chiropractors) and background of knowledge, I have to gauge the content. It is often a fine balancing act; not to bore some participants on one hand, but also not presenting over some participants heads or passing on too much information.
Where do you usually go to access new information?
- Because of my involvement in education of the profession I have access to the latest journal articles in the Uni-library.
As an estimate what percentage of your clientele encompasses head and neck dysfunction?
What clinical pearl can you share in relation to the head and neck?
- A 31 year old female, stuntwomen and circus acrobat, presented with suboccipital pain, provoked only when returning the head to neutral from an extended position. Enquiring about past traumas and injuries during history taking, she replied: “I never had any serious injuries”. I thought that was hilarious, considering her profession!?
- To be continued in the upcoming seminar.
What do you personally think is often missed when diagnosing or assessing the head and neck?
- I frequently get referrals sent to my clinic, where the referring practitioner should have been able to diagnose the patient’s condition, if s/he would have followed a structured assessment procedure.
- What is often lacking is a proper Neuro-Orthopaedic assessment.
- I sometimes hear: I only do very gentle techniques and can’t do any harm. One can be prosecuted for actions of omission; meaning failing to diagnose.
How important do you think it is for manual/musculoskeletal practitioners to have sound anatomical knowledge and why?
- Just recently a patient presented with a constricted pupil on the right side only; why was one of my DD’s an IC arterial dissection? This question can be answered with knowledge of the appropriate anatomy. The solution will be presented in the seminar!
In your opinion what benefits can be gained from going to a multidisciplinary workshop?
- There are not many opportunities, where you can have a ‘chin wag’, with people from other professions in the musculoskeletal field.
- We all the treat the same kind of patients, maybe with different approaches, and we often get results.
- We often share techniques and ‘trade’ secrets.
- It is great to share knowledge and realise that we are not that far ‘apart’ after all.
Well that interview definitely made me excited for the upcoming head and neck wetlab! I hope to see you all there. I’m excited to learn what Rudi has to share that weekend and also what the other practitioners have to share.
If you would like to enroll in one of the AMSN’s upcoming wetlabs you can do so on the link below