The post read:
Therapeutic exercise can often literally suck out all the motivation to do it.
It can be so meaningless & monotonous.
We exercise because it makes us feel good or we want to look good.
We play sport because we enjoy the social engagement or the game.
We engage in meaningful activities that use our bodies because we can switch off from the world or they provide fulfilment.
We need to tap into the things that inspire people to move rather than just tell them to exercise (link).
Notice how in each case Ben argues that we do things for other reasons. And as Ben said, “We need to tap into the things that inspire people”.
Now I don’t think we have to limit this just to exercise – in fact we’ve argued elsewhere recently that our current obsession with activity and exercise is quite a problem (Nicholls et al 2018) – but I think we can take something important from the idea that the power of physiotherapy lies not in what we do, but what that doing does.
I’ve thought for a long time, that the reason many of our clients and patients come to physiotherapists and keep coming back to us, is not because of our technical skill, or even our ability to engage with them personally, it’s because what we do can be transformative.
By transformative, I mean that a simple intervention, action or idea changes something fundamentally for that person. It may be about the relief of pain, or regaining lost movement, but it could also be more existential things likr regaining a sense of purpose, control or hope.
The power of this idea can’t be understated, not least because it offers an implicit critique of our professional fascination with technique and measurable outcomes. This stuff – the things that really drive the business of physiotherapy – is far too ephemeral, fuzzy and obscure to be captured by outcome measures and customer value statements.
A couple of years ago, Barbara Gibson, Jo Fadyl and I co-wrote a chapter for a book titled Rethinking Rehabilitation, in which we tried to think of a way to push this envelope and get people to think beyond the narrow technical confines of their practice (Nicholls, Gibson & Fadyl 2015).
We tried to do it in a playful way, by taking words that were common to the profession and messing with them; re-defining them in new more expanded ways.
You can try this for yourself. It’s also quite a fun thing to do with students and colleagues if you want them to think ‘outside the box’. Here’s what you do:
- Take a word that you’d find in the index of a standard professional textbook
- Write down it’s ‘official’ definition (as defined by the profession)
- Then think about what the word means to the general public; it’s older established meaning
- Now think about how your practice might be different if you applied that older meaning rather than the narrower professional one
Here’s an example:
- Balance is something that physios talk a lot about and do a lot with.
- To us it’s about the person’s centre of gravity and base of support; it’s about biomechanics and bodily displacement and stepping/saving strategies.
- But as we know, balance has a much older, richer meaning. It can mean a situation in which different elements are equal or in the correct proportions – like a balance of opinions; it can mean mental or emotional stability; harmony; a mechanism for weighing things; a counteracting weight or force; Libra; a predominating amount or a preponderance, where the balance of opinion was that work was more important than leisure, for example; the difference between credit and debt; an act of compensation; equality…
- Now think about any one of these older meanings and think how it might apply to a new, bigger idea of physiotherapy. Every day, patient and clients bring these things into our lives and ask for our help. Sometimes we can’t find a way, and so we offer them something practical that does a job but misses the bigger question being asked. At other times we stumble upon a transformative moment without even knowing it was there. All too rarely though, we actively engage in transformative work consciously and creatively.
Whatever the reason, if physiotherapists can continue to find transformative moments for our clients and patients, we can be confident that people will always find a place for us in their lives.
Nicholls, D. A., Gibson, B. E., & Fadyl, J. K. (2015). Rethinking movement: Postmodern reflections on a dominant rehabilitation discourse. In K. McPherson, B. E. Gibson, & A. Leplège (Eds.), Rethinking rehabilitation: Theory and practice (pp. 97-116). Boca Raton: CRC Press.
Nicholls, D., Jachyra, P., Gibson, B. E., Fusco, C., & Setchell, J. (2018). Keep fit: Marginal ideas in contemporary therapeutic exercise. Qualitative Research in Sport, Exercise and Health, 0(0), 1-12. doi:10.1080/2159676X.2017.1415220