Connective Issues — Aches and Pains – Part 3 – The ‘Shopping Basket Approach’

the art of medicine consists in amusing the patient while nature cures the disease” – Voltaire

Greetings. I trust everyone is enjoying a summer of restored freedoms. This is the last segment in commemoration of the life of renowned British physical therapist Louis Gifford. Louis is the author of the three-book series called ‘Aches and Pains’. See

In part I we explored the mind of Louis Gifford, his background, and his frustrations with conventional physical therapy, which led to his re-thinking and re-imagining therapy for the treatment  of pain and dysfunction. In part II we delved into his concept of the ‘mature organism model’ to help we therapists and our patients know that everything below the brain stem are inputs which the brain has to scrutinize, make sense of and provide the appropriate output. We saw that the brain can get this wrong, based on many factors.

In this final segment we will explore Gifford’s clinical reasoning and therapeutic interventions that he describes as his ‘shopping basket’ approach.

To quote Louis: the ‘Shopping Basket Approach’ is; “the way I think and reason with patients given all the evidence base meshed with my own thoughts with regards biomedicine, healing and recovery, pain mechanisms, disability, function, impairments, fitness and the various ways of thinking about and dealing with pain”. 

This ties in nicely with the Pencheon definition of evidence-informed medicine; “Evidence-informed medicine involves integrating the best available external scientific evidence with individual clinicians’ judgments, expertise, and clinical decision making”

Compare this with the Sackett definition of evidence-based medicine; “‘The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’.

If you think about going to the grocery store and grabbing your shopping basket, when you get to the checkout your basket will contain items almost assuredly different to anyone else’s. The same applies to our various therapeutic trainings, our clinical reasoning, our clinical strategizing, treatment plan and implementation.

To re-emphasize Gifford’s shopping basket, it contains elements under six different headings; biomedical (think like a doctor), psychosocial (get inside their head), disability / functional restrictions (home, work, social, hobbies, sports), impairments (pre and post ROMS etc.), general health and fitness (self-explanatory) and lastly pain (what’s in your pain basket?). Over 230 pages of book three of Aches and Pains are devoted to fleshing out these six points, along with lots of great case studies.

We can also apply a shopping basket approach to the tools of our trade. Obviously, first-off we are bodyworkers. But we have so many options. Just read the latest (January) edition of JBMT. It contains lots of research on myofascial pain and trigger points, from many different angles. Remember that old adage that 80% of your customers buy 20% of your stock. Milk, bread, eggs. Those items compare to our favourite everyday techniques. Sometimes I forget less used stuff (old age), then I remember  “I haven’t skin-rolled for ages”. Then everyone gets skin rolled (or Kraftgunned, or gua sha’d, or spiky rolled, or jostled, or tapotemented. What’s in your technique shopping basket?

I want to conclude this blog trilogy by directly quoting some Louis Gifford nuggets from a cute YouTube video. I hope you understand why I’ve blogged-on about this man.

  • I hope you can see that the very nature of being human is adaptability
  • The notion of ‘bad’ movement patterns is a danger to the spontaneity of our existence
  • A great many of those with a complicated problem have a complicated life story to accompany it
  • Pain is a normal human experience, but also a powerful driving force to seek help
  • Effective reassurance is a bloody good painkiller
  • The weakness of the ‘tissue-based’ model for diagnosing and treating ongoing pain has been highlighted because there is a powerful evidence that it does not help, and that it may actually be making matters worse, and finally
  • If your therapist only does a ‘treatment’ and misses out the ‘get it moving, rehab, graded, functional recovery process’ – then it’s my opinion that your therapist is a complete waste of time

Cheerio for now, painkillers