One of the biggest challenges facing the physiotherapy profession, for much of its history, has been the necessity of defining what it is and what it isn’t. Prior to World War I, masseuses struggled to show that they could provide a legitimate, trusted and affordable alternative to the poorly trained hacks, prostitutes and doctors who practiced a few rudimentary physical therapies. After WWI the focus shifted to being an ally to doctors in the development of rehabilitation. By the middle of the 20th century, definitions of physiotherapy became embedded in legislation that gave us access to publicly funded health care and some protection of title.
By the 1960s, people were agitating for more expansive definitions of physiotherapy. First came Helen Hislop’s pathokinesiological model (Hislop, 1975), then Cheryl Cott et al’s movement continuum (Cott et al, 1995). Later, WCPT endorsed ‘A Conceptual Framework for Curriculum Design in Physiotherapy Education’ that offered a model of a more ‘holistic’ practice (Broberg et al, 2003). What was common with these approaches is that they problematised the often narrow, biomechanical definitions of physiotherapy that anchored it to anatomical and patho-physiological ways of thinking and practicing.
So it was a surprise to read that APTA’s Board of Directors have endorsed a ‘Human Movement System’ (HMS) model that does little more than re-establish physical therapy’s affinity with the body-as-machine.
There is a fabulous discussion of the HMS model on Kyle Ridgeway’s PT Think Tank blog, accompanied by links to a podcast on Conatus (link). There’s a part in the podcast interview where the group discuss whether the authors of the model really expect physical therapists to be experts in all body systems – as is suggested in the APTA’s background to the model and vision statement. Kyle asks “If we claim to be experts in the human movement system, then we claim to be experts in all of the structures and physiologic functions that interact to move the body and all its component parts”. This is true, and a really valid point, but I wondered whether we couldn’t go even further than this with our critique?
How does the HMS model explain everything that defines physiotherapy that is not simply about biomechanics or the anatomy and patho-physiology of movement? Models can enable much, but they can also deny important facets of our professional roles, identities, behaviours, influences, responsibilities, attitudes and values. Not least, if they claim to be ‘all-encompassing’ but are, in fact, only all encompassing of a very narrow functionalist definition of a profession, they can be the source of a dramatic miscommunication about what physiotherapy is or can be. (And thereby undermine the very purpose of the HMS in the first place which is to provide clarity and a communicable message about who we are and what we do).
There is now a growing body of literature on physiotherapy identity, but much more is needed, and a serious critical review of the overly biomechanical discourses pervading the profession is long overdue.
Broberg, C., Aars, M., Beckmann, K., Emaus, N., Lehto, P., Lähteenmäki, M. -L., . . . Vandenberghe, R. (2003). A conceptual framework for curriculum design in physiotherapy education – an international perspective. Advances in Physiotherapy, 5(4), 161-168. doi:10.1080/14038190310017598.
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.
Hislop, H. J. (1975). The not-so-impossible dream. Physical Therapy, 55(10), 1069-1080.