I have been a practicing clinician for over 40 years and more than ever, I love what I do. I am still invigorated and inspired to continue digging for and hoping to find more answers towards better solving back pain disorders. I continue to be fascinated by the relationship between altered movement and skeletal pain syndromes.

My quest has been to try and get to the nub of what spinal function is all about. Thirty years ago, I was the senior paediatric physiotherapist at a large teaching hospital working with adolescents with idiopathic scoliosis many of whom required horrific surgery to arrest the collapse in their spine. I was frustrated in not being able to offer my patients less drastic, more natural ‘physical therapy’ solutions for their problems. Thus began my journey to try to better understand spinal function, how and why it changes and what to do about it.

I left the hospital system and began working in general musculoskeletal private practice. A few years later I did a postgraduate course in Manipulative Therapy at Sydney University. This course was principally ‘Maitland’ and joint orientated with little reference to the interconnected function between the skeletal and the neuro-myo-fascial systems.

However, my prior background in rehabilitation and paediatrics looking at movement disorders meant that I was always concerned with ‘why’ musculoskeletal problems develop and or re-occur. This aspect is still an important part of my work.

I founded Edgecliff Physiotherapy Sports and Spinal Centre in 1985.

Being in private practice sharpens the need for speedy treatment success and so my striving for better understanding and answers has continued to this day.

Why describe myself as a neuro-musculo-skeletal physiotherapist?

In movement, the body functions as a whole through the interaction of the nervous, myo-fascial and skeletal systems.  As each system influences the other, changed function in one system will be also reflected in the others. In addition, ‘parts’ of the body don’t function in isolation but in relationship to each other, contributing towards our overall function. A problem in one of the ‘parts’ affects the functioning of the whole system.

A local musculoskeletal pain problem is usually related to both altered function in the neuro-myo-articular systems and changed function in adjacent parts of the body or elsewhere in the skeletal system.

Being an effective clinician is a bit akin to being like Sherlock Holmes – how to find the pain source and track down the altered functional mechanisms which ‘drive’ the pain and/or other symptoms.

Trying to simply distill cause and effect requires the therapist have an appreciation of the functional interdependence between the neuro-myo-articular systems hence my use of the term.


Josephine Key, Dip. Phys; PGD Manipulative Therapy; MPAA; Neuro-musculo-skeletal physiotherapist
Josephine Key, Dip. Phys; PGD Manipulative Therapy; MPAA; Neuro-musculo-skeletal physiotherapist