Late last year we lost a true pioneer in pain management, in fact THE pioneer who started to get physios and other professions to embrace pain, pain physiology, pain philosophy and pain treatment. Max was also a NOI supporter. He spoke at our first international conference in Nottingham and taught via the NOI network. Among his many writings, there was a critical paper for me in 1997 called “Instigators of Activity Intolerance” (Man Ther 2:75-86). It is still great reading and it has helped many to make those tentative steps to broader neuroscience based biopsychosocial thinking. Max’s writings are also reminders that you don’t have to be a researcher to write – just get out and tell the story. He was first to do that and he never stopped. Martina Egan Moog, who worked extensively with Max has written a tribute to him below.
Tribute to Max Zusman (*1934-+2013)
It is with great sadness that we need to tell you about the death of Associate Prof Max Zusman who passed away in his home town of Perth, Western Australia on the 28th December 2013.
Max was a worldwide accepted authority on the physiology of pain. For decades he had been involved in teaching physiotherapists, occupational therapists and other allied health professions about the significance of pain mechanisms for clinical practice.
Since the early 80s Max was a pioneer who believed that a profound knowledge of neurological pain mechanisms strongly supports our understanding of associated muscular and functional disorders as well as our choice of treatment strategies.
During the last 30+ years there have been significant advances in pain sciences – from evidence that has highlighted the role of central mechanisms in the dorsal horn to the growing recognition for changes at cortical and subcortical level. Max has been continuously keeping a sharp eye upon the scientific publications in this field and hardly an article that could be of potential use to therapists would go unnoticed to him. However he did not just follow the ‘nitty-gritty’ of the pain science involving ion channels and receptor changes, he also carefully observed research advances in areas that did not seem to have an immediate association with the medical professions, such as memory and learning mechanisms. It was one of his great strengths to pull together evidence from various fields of research and to put the thoughts together in a way that illustrated its usefulness in the therapeutic context.
Max began his physiotherapy training 1953, in only the third course that had been running at the Western Australian Institute of Technology. The course finished with a Diploma of Physiotherapy. In the following years Max contributed much that the recognition of physiotherapy in Australia was raised to a Bachelor status. He then continued his studies with a Bachelor of Applied Science in 1981, a Graduate Diploma in Health Science (Neurology) in 1984 and finally with a Master of Applied Science in 1988. He started his clinical career 1956 in the field of neurology and worked from 1959 to 1988 in his own private practice with orthopaedic and neurological patients. In the last two of those years he joined a rehabilitation programme for chronic patients with Brian Edwards in Perth.
Since 1988 he has been teaching at Curtin University, and was supervising students both clinically as well as in research projects. For many years he worked closely together with Bob Elvey on topics such as mobilisation of the nervous system and helped now well recognised lecturers such as Toby Hall and Peter O’Sullivan (to name only a few) in their early research studies. Max became an associate professor at Curtin University and continued to teach until his retirement from University in 2008 but remained a sought-after ‘conscience’ of clinical research at Curtin. Since 2000 Max had also been teaching regularly in Europe – amongst his commitments was the course ‘The Problem Pain Patient’ that pulls together up-to-date knowledge of pain science and cognitive-behavioural strategies for dealing with chronic pain patients. His legacy is still vivid in this course today. The course aims to foster both clinical reasoning for physiotherapy interventions as well as a common language for a constructive interdisciplinary working relationship amongst medical professionals in a biopsychosocial framework.
Max was never in favour of any exclusive physiotherapy model of pain or even ‘technical’ manual therapy terms that would only mean something to the ones who would have been trained in the same way. In this context the following paragraph written by Max in 2011 in his article: ‘The Modernisation of Physiotherapy ‘International Journal of Clinical Medicine, 2011, 2, 644-649 – available as a free text at: http://www.scirp.org/journal/PaperInformation.aspx?paperID=8531&) might become more understandable:
‘Research indicates that, despite physiotherapists’ comprehensive training in the basic sciences, manipulative (currently “musculoskeletal”) therapy is still dominated in the clinical setting by its original, now obsolete, structure-based “biomedical” model. This is further inexplicable in the light of evidence that not only the underlying “philosophy” but also several of the fundamental requirements of the clinical process itself which has the structural-mechanical model as its basis, have been shown to be flawed or at least irrelevant. The apparent inability of the profession to fully abandon outmoded “concepts” (and embrace the acknowledged science-based “best practice” biopsychosocial model) may have potentially undesirable consequences for both patients and therapists engaged in the management of (chronic) musculoskeletal pain and disability.’
However, Max was not just passionate about pain physiology. He was happily married to Barbara Zusman for over 34 years and an enthusiastic golf and pool player. A keen advocate for AFL, he supported the West Coast Eagles and also followed the European soccer league – getting up early to watch the big games regardless of which side of the planet he was on. Once teaching was done he was always keen to share banter and drinks and as such maintained many friendships with former students all over Europe. Max’s high professional standards were an inspiration to pain research and his liveliness and typically Aussie humour an inspiration to many.
He will be greatly missed.
Martina Egan Moog