There has been a lot of interest on social media over the last few days in this promotional video from the Physiotherapy Associate of British Colombia (PABC) called Choose to move (see below).
[wpvideo A3Fy3aoW]What’s really striking about this video is that it’s all about movement; not the kind of movement defined by the American Physical Therapy Association as “a system of physiological organ systems that interact to produce movement of the body and its parts,” but rather a humanistic, social and deeply personal experience. As @AdamMeakins opined on Twitter, [this is a] ‘f**king awesome advert… No tape, needles, machines or manips in sight!’
The advert does a wonderful job of connecting physiotherapy to the bigger issues that really motivate people to make use of our experience and expertise. It makes extensive use of metaphor; ‘What moves you?’ and uses powerful visual images and sound to evoke the idea that movement is for everyone regardless of ability, gender, age, ethnicity, or any other cultural positioning.
But this raised an interesting question for me. Adam is right that there are none of the traditional markers of physiotherapy practice in the advert. All it states is that physiotherapists can help you move. But what specifically identifies physiotherapists as the agents people should turn to here? Why would someone look at this advert and think that a physiotherapist has something to offer? Why would they turn to us and not a personal trainer or practice nurse?
I find the same question when we teach primary health care and population health to our UG students. We do a lot of work to explain all the reasons for the shifts taking place in modern health care, but when it comes to how physiotherapists might take an active role as agents of change in this new world, we’re often left with the trite and simplistic message that people just need to lose weight, stop smoking and get more exercise.
We know that it doesn’t take a four year undergraduate training to tell people to lose weight and get more exercise. And equally, it take an extensive background in anatomy and physiology, differential diagnosis and the management of complex health problems to encourage people to move.
So what is the role of the physiotherapist here? How do we distinguish ourselves as experts in empowering people to move if we take away the traditional trappings of our practice?
My personal view is that there are a lot of people trying to position ourselves as experts in human movement on the basis of our knowledge of the body as machine (see, for example, Shaun Logan’s piece on ‘Physical therapy and the human movement system‘). But these offers a very paternalistic, reductive view of movement that situates the patient as a passive recipient of treatment – more of a 19th century idea of practice than a message for the 21st century.
So while I applaud the PABC for it’s humanistic and holistic interpretation of the importance of movement for physiothearpy, I want to know what the next two minutes of video might include; the part where they say exactly how physiotherapists will help to ‘move you.’
I am sure there are many people who would love the ‘choice’ to move and to be as healthy as the people or physiotherapists in this promotional video, which is very well done. However, from a critical perspective, I question whether ‘choice’ is a slippery slope towards neoliberal individualism that disregards the ways in which people’s lives are constrained in ways that are beyond their individual control and choice? Do physiotherapists have a role to play in addressing how broader structural factors influence people’s routine ability to move?
Couldn’t agree more Alison.
Individual choice is a really problematic discourse. It is one of those things that is so taken-for-granted these days that we have forgotten that it is a relatively recent ‘invention’ and one closely tied to the neoliberal project to reduce the burden of shared social responsibility.
We push everything to the level of the individual these days (smoking cessation, obesity and inactivity being just three examples), without questioning the more complex and nuanced structural issues that exist before people even arrive at the point where they feel able to make a choice.
‘Choosing’ to move is not an unmediated act. Whether a person chooses to move, and how they choose to do so is highly socialised and conditioned.
We privilege certain ‘normal’ movements over others (the video is a pretty good advert for the kinds of movements we are saying we would like to see people perform). At the same time we demonise people for either choosing not to move, or choosing to move in different ways – in wheelchairs, for example.
This becomes particularly significant when people choose to move using assistance rather than striving for upright, bipedal, unassisted free movement.
It is fine for physios to promote movement, but if movement is so central to our professional subjectivity, we should be engaging in a much deeper critical discussion about what our attitudes and values make possible and what they deny.
Doing this might radically alter how we choose to promote movement in the future.
Great comments.
I am curious as to how this will develop in future practice. Physiotherapy teaching of “normal” movement seems still to be dominant and has many guises; some of it well-intentioned I’m sure; some of it may be interpreted as crypto-fascist.
Discovering and rediscovering one’s movement repertoire (or to mix metaphors, expanding one’s movement vocabulary) is a frame of reference I’m currently trying out. “Normal” movement is way too loaded, and I’m looking for concepts that encompass the physiological and psycho-motor constraints on movement; something that will be as meaningful to the 45 year old with cerebral palsy as the adolescent with persistent pain. Hope to be able to discuss this more with you, Dave.
Love the idea of movement repertoires (plural) Blaise. Particularly if these decentre the sovereign human being as the origin and heart of all movements, and focuses more on the ways movement is always connected with other human and critically non-human entities. Repertoires could be used as a way to explore the plethora of movements available to us, and it would not be difficult to imagine the physical therapist’s role as an advocate for movement in all it’s forms – not just biomechanical. There is something of this in Cott et al’s analysis of movement continuums I think, but Cott’s proposed model remains vastly under-critiqued and in need of much closer analysis.
Cott, C. A., Finch, E., Gasner, D., Yoshida, K., Thomas, S. G., & Verrier, M. C. (1995). The movement continuum theory of physical therapy. Physiotherapy Canada, 47(2), 87-95.)
Haha! Did that model to death in my first year at uni (2001). It is indeed a thoughtfully constructed theory… And agree needs reappraising.
Interesting Piece Dave movement is definitely a key strategy to health that most societies have ignored. I love the question you raise what makes physiotherapy unique and why would someone seek a physiotherapist and not a peronal trainer. In South Africa we have huge challanges as a profession we a defnitely lack of knowledge from the public of what we do, and how in depth our knowledge of the musculoskeletal system is, one wonders sometimes why a physiotherapist is not a first stop practitioner for all MSK complaints. We also have the emergence of a new pseudo profession in South Africa known as biokinetics.
Im not sure what the publics interpretation of physiotherapy is in New Zealand but as far as im concerned we are medical professionals with extensive knowledge about pathology, systems pathology, movement and exercise. This profound medical base of knowledge is what differentiates us from any profession in the world in my opinion.
No other profession can work with critically ill patients in intensive care, rehabilitate someone post orthopeadic surgery then jump onto the sports field and supervise final phase rehabilitation of an athlete.
We are unique and social media and physiotherapy representing bodies around the world need to emphasise this more with special emphasis on our medical training and foundation.