FTCA: What made/helped you decide on chiropractic as a career?

TLR: I'd like to say that I decided to become a chiropractor because of some fantastic experience that changed my life. I'd like to, but I can't. I was at university doing a BSc and uncertain of the direction I wanted to take. I was contemplating transferring to medicine when my girlfriend needed to visit a chiropractor. I was impressed by him and wondered what it was all about. I had no prior knowledge of chiropractic so I read a couple of books. Then I had an injury from football - the proper Australian kind of football - that needed treating and went to the chiropractor. That was when I decided to apply to chiropractic.

FTCA: What is chiropractic to you?

TLR: Chiropractic is a profession made up of extremely well trained, first point of call experts in musculoskeletal health care, particularly of the spine. Many people may be frustrated that I leave out the prefix "neuro" from musculoskeletal, but for me it is implicit. All professions recognise the role of the nervous system in musculoskeletal health and as such it is superfluous. By sticking to MSK we speak the same language as the rest of the health care team.

FTCA: How did you decide on PIT/RMIT for education?

TLR: I grew up in Melbourne so for me there wasn't really much choice. In the early 80's in Australia there was one school in Melbourne and one school in Sydney. Phillip Institute of Technology as it was called then provided a very good education and was proudly one of the best programmes in the world at that time.

FTCA: How did you initially get involved with COCA?

TLR: COCA has had several incarnations up through the years. In the early 90's we were a group of practitioners that met from time to discuss cases, listen to invited speakers, and so on. From informal lunch meetings it gradually grew to larger and more organised evening gatherings and adopted the name COMSIG - Chiropractic and Osteopathic Musculoskeletal Interest Group. After a while COMSIG morphed into COCA - Chiropractic and Osteopathic College of Australasia - where the focus was on producing high quality post-graduate education seminars and conferences. I was a member of the Executive committee and enjoyed playing a small role in a team promoting evidence-based chiropractic in the early 90's even though we probably didn't know that was what we were doing. I left Australia towards the end of '95 to travel and finished my association with them when I decided to settle down in the UK.

FTCA: How did you get involved with the functional rehab world?

TLR: While living in the UK in 1997 I was fortunate to start an MSc in Clinical Chiropractic at AECC. The focus was the functional rehab model in a biopsychosocial framework. It was all very new and pretty much ahead of its time. We were lucky enough to have icons such as Craig Liebenson, Don Murphy, Clayton Skaggs, Janda and Lewit among others involved in the programme. Suddenly things started falling into place with clinical practice and I was finding a model of care that made sense to me and to my patients. The MSc taught me how to assimilate the research findings that had always interested me into my daily practice and really was a huge step for me in adopting evidence-based practice.

It was during the MSc at AECC that I met my wife Lise. Since that time we have shared our interests in clinical practice, research and academic matters. When I had completed my MSc I was privileged to have the opportunity to teach with Craig trying to spread the functional rehab model of care to anyone who would listen.

FTCA: What are the pros/cons of utilizing functional rehab?

TLR: The pros of the functional rehab model; quick progression to active care, within-visit test / re-test for response to intervention, patients like it, it's patient centred and biologically plausible.

The downside of the functional movement/rehab approach is that there is still not enough supporting research. The evidence-base for functional rehab is gradually growing.

FTCA: Can you tell us a bit about the research you’ve been involved in?

TLR: I'm part of a small research team investigating the properties of motoneurons supplying lumbar and cervical multifidus muscles. The team includes my wife Lise Lothe and our supervisor Torsten Eken. The inspiration for the work came from Torsten's investigations, primarily with rats, that demonstrated the intrinsic property of motoneurons to maintain tonic muscle activity without control from higher centres. Lise and I wondered whether this phenomenon, known as self-sustained firing, played a role in neck and back pain. The work is funded mainly by the Norwegian Research Council and is based at the University of Oslo.

We use intramuscular fine-wire electrodes implanted in the cervical and lumbar multifidus as our window to the nervous system. (Not the Nerve system!) One of the things we're looking at is action potential interspike interval variability in pain-free and pain groups. This can be seen as a measure of smoothness of activity. We are also examining the effect of SMT on all aspects of motoneurons firing in the muscles under investigation. Lise defended her PhD in January 2015 and I'll be submitting Summer 2016. I wouldn't recommend this kind of work to anyone considering doing a PhD - the analysis is incredibly time consuming and a little tedious. There are easier ways to get a PhD but it really is a fascinating field.

FTCA: How did you initially become involved in the ECCE?

TLR: I think the best way to describe how I got involved in ECCE is to say that I showed an interest. There was a training day in 2005 for potential evaluation team members. I wanted to attend but ECCE's funding limited the number of people they could invite. So I asked if it was OK to attend as long as I paid for myself. What could they say? Once I had shown an interest it was a couple of years before a position opened up on Council and I was elected.

FTCA: Can you describe the leadership positions you’ve fulfilled?

TLR: Once I was elected onto Council I went straight into the central Executive where I had various roles including Chair of Quality Assurance Committee, Vice-President and four years as President. During my tenure with ECCE I was asked to help write the European Standard on "Healthcare provision by Chiropractors".

FTCA: What advice can you give those young chiropractors who want to do the same?

TLR: I think the best way for young chiropractors who are prepared to do the work to get involved is to show an interest. Whether it is politics, academia, research or accreditation, the chiropractic profession needs people who are willing to do the work, often poorly paid work, sometimes not getting paid at all. If you have an interest, make inquiries about how you can contribute. I see that FTCA is full of people who are willing to give back to the profession.

FTCA: What’s your crowning achievement from your tenure as the ECCE President?

TLR: The great thing about being involved in ECCE is that you get to work in a team of incredibly talented people. Any achievement is the result of hard work by many people. I think the biggest achievement for ECCE during my time as President was achieving membership in ENQA, The European Association for Quality Assurance in Higher Education. The Executive team did a great job preparing for that evaluation and it was a stamp of approval for the accrediting work done by ECCE. Membership of ENQA demonstrates that ECCE's processes and procedures are robust and open - we publish evaluation reports, we have students on Council and on evaluation teams. Those are just two examples of how ECCE has evolved in recent years.

FTCA: How do you balance your personal and professional lives?

TLR: I'm very fortunate that my wife, Lise Lothe, is also heavily involved in the chiropractic profession. In addition to us having the same research agenda, she is Dean of the European Academy of Chiropractic (EAC), the academic arm of the ECU. That means when one of us is travelling for conferences and meetings, the other person is often attending the same event. The fact that we're both involved in "extracurricular" professional activities means that there is understanding on both sides and the balance just happens naturally. I'm very privileged to have my best friend as my business partner, my research partner and my partner in life.

FTCA: Comparing all of the countries where you have spent any time practicing, which has the most restrictions and which has been the most enjoyable?

TLR: I have worked in Australia, Britain and Norway during my career. Norway is definitely the best and most enjoyable country to practice as a chiropractor. Don’t tell anyone. Privileges include partial government reimbursement for services, ability to refer for imaging, ability to refer to physiotherapy services, ability to refer to medical specialists and in all cases the patient pays the same as if their GP had referred them. Additionally, chiropractors in Norway can write sick leave for up to 12 weeks.

One of the greatest satisfactions of working in Norway is that 90% of the profession are members of the national association. That gives us a strong voice when lobbying for better conditions for chiropractic patients or the introduction of a chiropractic programme at the University of Oslo.

Chiropractic has a strong future in Norway. I see positive changes in Australia over the last couple of years and think the future there is brighter than I had thought five years ago. I enjoyed working in the UK because there were so many people who needed help in a society with a burdened healthcare system. Unfortunately I also felt professionally alone as collaboration between professions was limited. I believe it is changing.

FTCA: Do you have any professional regrets?

TLR: No.

FTCA: Has the FTCA been beneficial in any way to you?

TLR: The FTCA has shown me that there are many people who, like me, want to make a difference for the profession, denying the deviant minority an opportunity to grow at the same time as waking the silent majority into action. The FTCA has introduced me to potential collaborative partners. Most importantly, I think the FTCA has given me hope for the profession in the US.