Perhaps one of the biggest points of difference in current debates around the future of physiotherapy involves the question of whether physiotherapy should be evidence-based. It is self-evidence – so some say – that physiotherapy practice should be based on the best available evidence, since to practice otherwise might put people at risk, or damage the reputation of physiotherapy as a science.
One of the less-well-often discussed issues with this argument is how much people – and by this I mean the public, our professional colleagues and peers, and the organisations that fund us and legislate for us – actually care whether some therapeutic practices are evidence-based.
An article today on touch by Steven Phelps, Associate Professor in the Department of Integrative Biology at the University of Texas, in the digital magazine Aeon, illustrates the point nicely. In the article, Phelps argues that ‘[p]erhaps we have become too easily ashamed of our wonder’ (link), and this got me thinking about our own relationship with touch.
There is very little support in physiotherapy for the idea that we should use our skills in touch simply because it feels nice, rather, physiotherapists should only be using modalities that have a strong evidence-base to them. Indeed, it would seem that for some in the profession, anything resembling the practice of therapeutic massage effectively labels the practitioner as a quack.
My argument is that this is a very shortsighted view. Not because we should ignore the need to be evidence-based (although there is mounting critical pressure on the EBM movement), but because by taking such a dogmatic view of touch, we miss the bigger point.
Touch is likely to be increasingly important to people in the future. There is an entire science of haptic technology telling us that people will use touch more than ever as a means of communication. Touch is also one of the things people with yearn for, particularly at times of mental anxiety and distress. Touch is pleasure and, for us, touch is diagnostic. Physiotherapists are one of only a handful of professions who have a license to touch, and one of only a very few who are trusted to use it for more than procedural reasons (putting on a BP cuff or using a scalpel, for example). Touch is one of the most powerful ways of breaking down barriers between people, and it has enormous potential for harm. And it is a metaphor for how we move through our lives (in touch with our relatives, feeling people’s suffering, handling difficulties, pressing people for more information, etc.).
The point is that touch is first and foremost a political, cultural, existential, social act that transcends the more prosaic and mundane questions about whether it works or not. Physiotherapists who decry it and claim that physiotherapists should go nowhere near it may well be missing the point. Touch is not going away. Touch is perhaps the oldest therapy known to human kind, and it is likely that people will always need skilled, thoughtful, caring and compassionate touch. We would be wise as a profession to embrace it, if we want to remain relevant as a profession into the future.