Physiotherapy, movement, and action

ABSTRACT

Movement has always been central to physiotherapy practice and theory. But physiotherapists have largely focused on forms of human bodily movement governed by the neuro-mechanical body system in illness or injury. Many other forms of movement exist though, and we argue here that the exploration of these other movements might give physiotherapists new language, concepts, and tools, to guide its adaptation to forms of healthcare that are becoming increasingly complex, diverse, and inclusive. Drawing on Hannah Arendt’s concept of vita activa (or “active life”), we examine how physiotherapists have traditionally captured and defined movement. Critiquing past practices for over-emphasizing what Arendt called labor, and work, we suggest that an approach governed by her concept of action, might offer physiotherapists a way to give movement greater significance. We explore what active life might mean for a revised approach to movement, and highlight examples of vita activa already emerging in physiotherapy. We close the paper by calling for a reevaluation of what movement means for the profession and its clients.

KEYWORDS:

• Movement
• labor
• work action
• physiotherapy
• Arendt

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. A glossary of all key terms used in this article is included at the end of the paper (T able 1).

Glossary of key terms (arranged in order of complexity).

Labor: Everyday, mundane and repetitive activity, performed by all animals to maintain their biological existence, the most basic form of human activity: finding food and water, warmth and shelter, toileting, etc. In physiotherapy, labor is the work done to keep people alive and restore their ability to perform basic tasks and functions: range of motion, strength and balance, lung function, etc.

Work: World-building, creating enduring artifacts and objects to shape the “man”-made world. Gives stability to life and shapes culture. Not necessary, like labor, but performed with specific goal in mind. Takes two forms: fabrication and artisan work. Defining feature of physiotherapy, focusing on objectivity, measurable goals and task performance, consistency and predictability, overcoming barriers to bodily efficiency and productivity.

Fabrication: Most basic form of work. Production line-like repetition. Lacks creativity, choice or discrimination. Work performed to reproduce to an existing design or pattern. In physiotherapy, seen in repetitive tasks, routines, exercises, assessments, treatments, which follow pre-defined standards, where the goal is consistency and predictability.

Artisans: Highest form of work requiring high levels of craft skill and training. Like artists, artisanal work is hand-made, but unlike artists, still based on reproduction and repetition. Conforms to standard patterns. Less risk and greater consistency than pure artistry. Most professionals are artisans, including physiotherapists. Rely on shared standards, repetition and consistency, enhanced by years of craft skill and experience.

Artists: Fullest expression of human creativity and innovation. Less concerned with craft skill than the artisan, more concerned with using creativity to respond to social problems. Can be replicated by artisan, but artisan cannot initiate and create like an artist. Rejects conformity, standardization, consistency, reproducibility, frequently challenging convention. No role within current physiotherapy practice, although increasingly being debated in theory.

Action: Uniquely human. Expression of higher freedom. Human responsibility to care for others through speech and activism. Requires human relations and risks inherent in expressing oneself truthfully and with courage. Cannot achieve full subjectivity through labor and work alone; can only become ourselves through action. Limited scope for action in physiotherapy, but increasingly being explored in theory.

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Funding

The author(s) reported there is no funding associated with the work featured in this article.