Gender is an issue that has become increasingly important in physiotherapy scholarship in recent years. The first time research by a physiotherapist that specifically addressed this question was a paper by Anne Parry with what must still be the best title for any research paper ever written: Ginger Rogers did everything Fred Astaire did backwards and in high heels (pdf). The paper still resonates strongly with me and has some important things to say about our professions gendered history.
Anders Ottosson’s seminal work on the ‘feminization’ of physiotherapy in 19th century still stands as one of the most important works on the subject, but there are other important works too, and these three theses are worth consideration.
(En) gendering body politics: Physiotherapy as a window on health and illness (*click on the titles of each of these theses to access a full pdf version)
Tobba Therkildsen Sudmann
The aim of this study is to gain knowledge about what patients do to negotiate possibilities and constraints for recuperative encounters with physiotherapists. The historical tenets of Norwegian physiotherapy are recapitulated and contemporary gendered specialisation and work division are presented.
The theoretical underpinning of the study, critical hermeneutics and the sociology of everyday life, are tied together by coining play as pivotal for understanding and interaction, and by embedding small behaviours as part of language. Hermeneutic understanding depends on the interpreters’ background, comprised of symbolic, structural and subjective aspects.
A focus group method is applied, construed as situated social gatherings: 4 groups of men, 4 groups of women, 26 women, 20 men, aged 18-77, comprising experiences with sports related injuries, chronic pain, heart or lung diseases, physical disabilities or medical unexplained disorders.
Knowledge proposals: According to the participants, bodily changes and well-being depends on verbal, bodily and hands-on dialogues, and an attentive present therapist. The dialogical situation is precariously constructed; self presentation is planned to details and carefully enacted. Social institutions as gender imprint interaction, understanding and treatment. Pain is construed as action, and is a paradigmatic exemplar of how verbal, bodily and hands-on communication, self presentation and gender intersect in physiotherapy. Independent of age, gender or bodily concerns the participants challenge and negotiate cultural, medical or personal boundaries to enhance well-being and/or to reach personal objectives e.g. increasing pain for a greater good. The participants’ accounts are interpreted as intentional human agency, and reconstructed as body politics. Construing vulnerability as strength, the participants appreciate some of the benefits gained from living with bodily constraints and challenges. Their actions and enactments create new body idioms and new accounts of health/illness.
Physiotherapy represents a field of practices where contradictory and covert social expectations reside. When social expectations are not met, patients may experience embarrassment, and recuperative interaction may be at risk. Social disruption may be ignored, remedied or laughed at. Laughter may be interpreted as a sign of embarrassment due to fragile interaction. By studying embarrassment and laughter we can listen for social dissonance, and imply some conditions necessary for the interaction to come off. Some necessary conditions are implied above; the participants, as patients, try to avoid embarrassing situations by asserting a personal body politics and warranting amendments to the interaction order of therapeutic encounters.
Doing Gender in Physiotherapy Education: A critical pedagogic approach to understanding how students construct gender identities in an undergraduate physiotherapy programme in the United Kingdom
John A Hammond
Gender in physiotherapy education is somewhat ambiguous. Physiotherapy is historically a women’s profession, yet in recent decades there has been a growing proportion of men. The mass media portrays a masculine sporty image of physiotherapy, which notably ignores the presence of women. Previous research in physiotherapy education has shown gender differences in student preferences for work and career pathways. Gender differences in attainment in practice components of the course have also been demonstrated, with men doing less well than women and more likely to fail. As a physiotherapy educator faced with these issues, the aim of this study is to explore the significance of gender in students’ constructions of identity.
Social constructionism was adopted as an underpinning theory in this professional practice research involving students from one cohort of undergraduate physiotherapy students at a university in the south east of England. Nine male and female participants were interviewed at the beginning of their second year and were asked to record stories about their experiences both on and off campus throughout the academic year using a digital recording device. Data from the interviews and audio-diary narratives were analysed using Judith Butler’s theorisation of gender as ‘performative’ to understand how gender identities were constructed. Foucauldian and critical pedagogical perspectives were employed to further interrogate the gender discourses that emerged.
The findings indicate that gender was rarely explicitly discussed; yet participants’ gender identities were constantly negotiated through relationships that were not limited to the university and clinical settings. A range of discourses of masculinity and femininity were identified illustrating a profound gender orthodoxy in physiotherapy education that simultaneously demanded acceptance, assimilation or resistance. As a consequence, students in this study used a number of discursive strategies in the struggle to be recognised within physiotherapy education and practice.
The implications from these findings raise questions about gender tensions and contradictions in the physiotherapy programme under scrutiny and about the pedagogic practices that reinforce them. In this context, there is a need to raise awareness amongst peers and managers of the possible sites of gender inequalities within this curriculum. Also, gender needs to come ‘out of the closet’ and be debated within the classroom and the wider social spaces inhabited by students in order to develop more nuanced understandings of gender within physiotherapy and healthcare. Finally this research indicates the need to provide more inclusive spaces within the curriculum for reflecting on the complexity of identity construction and for challenging its institutional forms.
This research responds to gaps in the literature about the evolution of physiotherapy practice and to uncertainties emerging from within physiotherapy about its professionalism and practice. It aimed to generate a theoretically informed understanding of the tensions present in contemporary physiotherapy practice by producing an embodied account of the process of becoming a practice profession.
The research aim was achieved by a genealogical study of existing literature, documentary data from physiotherapy’s qualifying curricula and oral accounts of practice generated by depth interviews with physiotherapists who qualified during the 1940/60s. These data were subject to a Foucauldian discourse analysis and a phenomenological analysis to explore the events, discourses and actions shaping physiotherapy practice over time.
Unlike existing historic accounts that trace the evolution of physiotherapy’s professional identity, this research prioritises the bodies doing physiotherapy over time so offers a fresh perspective on physiotherapy as a practice and as a profession.
From a ‘doing’ perspective, professionalism ceases to be an acquisition that is externally bestowed and becomes a dynamic process of experiencing/producing autonomous problem-solving in practice.
Physiotherapy’s professional practice can be traced back to the 1945 curriculum. It was enacted through the integration of physiotherapy movement/touch and by the discipline of movement, which generated autonomous problem-solving practices that cut across ward/disease boundaries established by medicine from the 1950s onwards. While still subject to medical supervision, physiotherapy’s movement/touch crossed the division of labour to develop capacity to produce diagnosis-inference-treatment once its technical autonomy was recognised in 1977. Once free of medicine, physiotherapy’s professional practices multiplied to provide moving/touching solutions for an increasing variety of movement disorders.
My research complements the existing (disembodied) critical histories of physiotherapy as a profession and demonstrates the value of embodiment as a lens for tracing movement in physiotherapy’s professional identities and practices over time. It adds to sociological understanding of the organisation of healthcare occupations and practices by offering an account of a body that is a moving part of a division of labour organised around the dominant profession of medicine.
Hammond, J. A. (2013). Doing gender in physiotherapy education: A critical pedagogic approach to understanding how students construct gender identities in an undergraduate physiotherapy programme in the United Kingdom. DEd. Kingston University, England.
Ottosson, A. (2005). Sjukgymnasten – vart tog han vägen?: En undersökning av sjukgymnastyrkets maskulinisering och avmaskulinisering 1813-1934. PhD. Göteborg University, Sweden.
Owen, G. (2014). Becoming a practice profession: A genealogy of physiotherapy’s moving/touching practice. PhD. University of Cardiff, Wales.
Parry, A. (1995). Ginger Rogers did everything Fred Astaire did backwards and in high heels. Physiotherapy, 81(6), 310-319.
Sudmann, T. T. T. (2009). (En) gendering body politics. Physiotherapy as a window on health and illness. PhD. University of Bergen, Norway.