To the Editor.—
Physiotherapist Robert King (231:137, 1975) is simply describing the American version of what James Cyriax in England calls "the vacuum in orthopedic medicine."
This describes the area between the prescription of drugs on one border and orthopedic surgery on the other. It is largely out of the control of anyone with a medical degree and involves the activities of a number of health care professionals including physiotherapists, podiatrists, osteopathic physicians (who are still interested in manipulation), kinesiologists, and others.
The close working relationship that Mr. King speaks of has not been my experience. Few physicians see specialists in this area as colleagues treating the same patient. And many therapists, accepting a subordinate, nonresponsible role, are willing to dispense hot packs and ultrasound instead of getting to the total regimen Mr. King provides.
Until the primary physician develops a working relationship with the true professionals in these fields
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