This is a question I have always struggled to answer. What exactly is physiotherapy? And what does it mean to you? To the client in front of you it will mean something completely different to what it means to you. Potentially equally as fulfilling, but with complete different reasons. To the physio in the next room it will also mean something else. So ask yourself, what does physiotherapy mean to you?

To me physiotherapy is a profession, it is a job, but mainly it is a passion. It is an area I have nearly always wanted to work in. And that is why 4 years in to my career it saddens me to be so confused. It is so far from what I had expected. I am confused that a profession whose primary focus should be to care for and help people, isn’t always acheiving that. It has confounded me that in the effort to help people, we as a profession and as individuals can, at times, cause more harm than good. As professions go, it is no walk in the park. It comes with good days, bad days, emotional times, exciting times, heartbreaking moments; it is always teetering along the fine line between helping and not; the grey area between right and wrong. When we get it right, we can make the world of difference to people and yet, it strikes me how wrong we can sometimes get it.

“It has confounded me, that in the effort to help people, we as a profession and as individuals can, at times, cause more harm than good.”

The World Confederation of Physical Therapy defines Physiotherapy as being “concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation”

I think at times when you lose your way, it is important to revert back and think about what our role actually is. So let’s break that down first. “Identifying, and maximising quality of life”. To identify Quality of life, what should we be doing? Should we be assuming we know what quality of life means to them? No. We should enquire, discuss, learn. How can you maximise quality of life if you have not identified and pictured it? We all have an idea of what our own good quality of life looks like. But how many different ideas of quality of life do you think there are across the globe? Maybe your idea of quality of life is being able to do Ironmans a few times a year. Maybe mine is being able to sit with my friends for a cup of coffee.

If we do not identify the goal and the quality of life pictured by the individual sitting in front of us, then how can we maximise it? How are we in any better position than Joe Soap to maximise quality of life and to attain functional and meaningful goals, if we do not know for sure what we are aiming for? How can we see what they see? How can we reach for the stars through a cloudy sky, you might get lucky eventually, but maybe you won’t. We cannot assume. We need to enquire. We need to learn through questioning, through striving to understand. And without that, I feel that we are doing a disservice to the individual who has walked into our clinic.

And so, once we have identified the quality of life to be maximised, what next? We need to identify movement potential and maximise it? To me movement potential is any movement possible for an individual. How can you identify that? Can you test it? Is the potential movement limited to the way you feel they should move? Or does it encompass any which way or form? Should we be working within the realms of capacity or the realms of potential? Should we as therapists only work with what we can see a client can do? Or should we push the boundaries and test the limits? Do we need to thread within the limits of the system, or expose them and expand them?

Does movement potential differ from client to client? Of course. Is our goal to highlight and focus on the differences in movement potentials across individuals, or is it to assess, promote and maximise the potential standing in front of you? Convert this potential to capacity?

Have we as physiotherapists become too restrictive in our programming for habilitation and rehabilitation? A common question I get asked is “What can’t I do?” or “What should I avoid?”. How can we reframe that. How can we eliminate and banish the idea that our role, as physiotherapists, is to stop people from moving, when in actual fact it is to facilitate and promote movement to maximise potential. How can we reframe the thought process? How can we move toward a more movement inclusive framework so we’re being asked what should they be doing? And how can they remain as active and fit as possible throughout their rehabilitation?

I have found that people come to me for help, months after the first onset of symptoms. They didn’t come to me from the get go because they were afraid I was going to tell them to stop walking, hiking, golfing etc. Afraid I was going to tell them to stop running. Afraid I was going to tell them not to lift their 6 month old baby for she is too heavy. Why is it that a profession who’s role is to help and care for others is instilling fear into clients? To me, that is not what physiotherapy should be?

So why is it that we are restricting movement when in fact our role is to promote it? “Maximise movement potential in the spheres of promotion…”. If a client would prefer to push through pain for months, than to seek help with the potential of having their movement restricted, we need to be asking ourselves why we’re doing what we’re doing and the effect it is having on the person in front of us.

To me, physiotherapy isn’t stopping people from doing what they love. It’s about adapting and adjusting things to ensure they can do it. I do not want to be known as the one who stops people from pursuing the things they are passionate about. But unfortunately on a whole, as a profession, this is becoming the norm.

How can we do better by the individual in front of us? How can we work on “prevention”? Is good preventative physiotherapy prescribing 3 sets of 10 reps exercises with a red theraband for the rest of their lives? Maybe. Or maybe it is promoting early intervention. Encouraging people to come to us sooner, without fear we are going to tell them to stop doing what they love? Can we alter their activity to facilitate them to continue? If we take a movement promotion approach (as we are being advised by our International Confederation), will people seek our help more readily and willingly? Can we help their system to recover quicker? Can we help prevent the onset of chronic pain conditions. Can we support individuals to continue to do as much as they can do while recovering from an injury? To me that is what physiotherapy is about.

I like to believe, my role as a physiotherapist is to help individuals to reach their physical goals. To move in the way they would like to move comfortably and confidently. What that looks like is very different for everyone. And the methods by which we get there will change. Is there a right way to do everything? Or is there more than one way to skin a cat? Is a good physiotherapist one who has the best hands-on skills? Is a good physiotherapist one who has the best listening skills? Or is a good physiotherapist the one who helps an individual acheive their goals and move by any matter or means?

“Empowering someone to move in the way they want is special. Freeing someone to test the limits is exciting.”

To me the body is fascinating. It is strong and resilient. It copes with all sorts of weathers. It heals fractures, repairs torn muscles, tells you when enough becomes too much, tells you when enough becomes too little. And so, I feel privileged to say that my role as a physiotherapist is to work with numerous different fascinating and amazing bodies, to help them maximise their movement potential and to maximise their capacity.

You only get one body in this life, and I want to facilitate others in minding theirs. Empowering someone to move in the way they want is special. Freeing someone to test the limits is exciting. And to me, that is what physiotherapy is about. More than a job. More than a profession. It’s something I enjoy doing, and something I want to continue to enjoy. But in the last four years, I have found I have temporarily lost the joy and thrill through conforming to some the restrictive processes in the profession.

We should be releasing our inner child. Exploring. Trying things out. If they don’t work out try again. A fear of failure gets worse over time. But, what is failure? What if we are failing by not promoting movement? What if restricting individuals is failing them? Why don’t we fear that?

And so as physiotherapists, what exactly are we? Manual therapists? Exercise prescriptors? Rehabilitators? Or are we facilitators of movement and promoters of health and fitness, through injury, health conditions, diseases, and in the healthy population? Is our job to help people to move, and promote continuous movement, comfortably, confidently and for as long and as well as their potential will allow? All the while facilitating a fulfilling and meaningful life.

To me, the role of a physiotherapist is to promote movement and quality of life. How can we do something that is meaningful to the individual, to encourage them to continue to move? How can we incorporate their vision of quality of life into our treatment and interventions? Physiotherapists often get a bad rap for giving out, or blaming when a client isn’t compliant to an exercise program. But I would argue, if compliance is an issue, why are we providing that specific program in the first place. If compliance is an issue we are misunderstanding the individual, their goals and their needs. How can we get them doing what they love to do again? I think it starts with asking and understanding. And without that, we’re failing!

So have a think about what physiotherapy means to you. Are you still helping people the way you dreamed about as a budding new physio? Are you enjoying getting people back moving? Are you the physiotherapist you have always dreamed of becoming? Are you helpig people reach for the stars and above?

Or is change on the horizon?

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