Editorial

Philosophy is not something that features strongly in physiotherapy literature. There is no lack of theoretical work available, especially in the practice and mid-range theories that have come to dominate debates around how approach ‘X’ is better than approach ‘Y’, but philosophically informed practice is something quite different. Until the 1980s, few university faculties had physiotherapy departments. Most of our training was vocational, and opportunities for research and higher degrees were few. Scholarly output was limited and the theoretical underpinnings of physiotherapy adhered to a model that had been stable for much of the twentieth century.

Over the last three decades, however, academics and clinicians have begun to ask: what is physiotherapy? Is it art, science, craft, or all of these things? What should it be or do to enable and support our clients within the changing world of health care (Belanger, 1997; De Souza, 1998; Riddoch, 1982; Roberts, 1994; Sim, 1985; Tyni-Lenne, 1989; Wilson, 1984)? In response, a number of models have been formed that have sought to capture the ‘essence’ of what it is to be a physiotherapist and do physiotherapy, and writers have begun to provide greater definition of key concepts like the body, movement, independence, participation, and function (Broberg et al, 2003; Cott et al, 1995; Hislop, 1975). Physiotherapists have become more aware of their role in society, not only as rehabilitation professionals with an interest in assessing and treating individuals, but as practitioners with a larger role to play in the physical and social wellbeing of populations.

Nevertheless, this emerging work has largely been undertaken in the absence of strong philosophical foundations. Papers that question or advance the underpinnings of physiotherapy through a philosophical focus are largely absent from physiotherapy journals. Furthermore, it is only in recent years that our students have been introduced alternatives ways of understanding health and illness.

So how might physiotherapists individually and collectively benefit from a greater engagement with philosophy? Philosophy attempts to provide conceptual clarity in a complex world. Thus, at a minimum, philosophy serves as a tool to gain greater understanding of physiotherapy's assumptions, goals, and commitments, and what these might be in the future. In simple terms, we are asking what is it we are doing, and why does it have to be so? What assumptions are built into our assessment tools, the way we construct clinical problems and how we conceive of patient wellbeing? How might the practice of physiotherapy change if these assumptions were questioned? The value of philosophy is that it provides the tools to think differently about ingrained assumptions. By challenging long-held beliefs about how things should be done, and by exposing the ways that power, knowledge, and truth have become entrenched, we can access new opportunities for professional growth.

The papers in this collection all explore the intersection between philosophy and physiotherapy and demonstrate how applied philosophy can inform an array of practice areas and issues. Central issues in the practice of physiotherapy including: movement; walking; rehabilitation; disability; normality; and touch are discussed in new ways that destabilize and disrupt common understandings. These disruptions serve to enhance our perceptions of what physiotherapy is and might be, allowing us to consider multiple innovative and creative ways of approaching the complexity of physiotherapy care.

Epistemology (ways of knowing) and ontology (the nature of phenomena) are keys areas for the philosophical exploration of physical therapy and feature strongly in this collection. Shaw and Ryan explore what counts as physiotherapy knowledge and introduce the notion of physiotherapist as bricoleur. They suggest the bricoleur is open to and utilizes multiple epistemologies, learning not only through observation and assessment, but through investigation of patients' emotional, social, and political experiences of injury or illness to provide a more holistic approach to practice. Wikström-Grotell draws from Gadamer's hermeneutics to explore the ontology of human movement, suggesting that in physiotherapy, movement is mostly understood through a biomedical perspective but has socio-cultural and existential dimensions that have been underexplored.

Three papers draw on post-modern approaches to re-imagine and re-interpret physiotherapy and its objects of interest. Situating physiotherapy within the broader history of Western medicine, Eisenberg examines how relations of power perpetuate hierarchal divisions between patients and physiotherapists. She suggests that questioning these relationships opens the possibility for alternative ways of engaging in fruitful therapeutic relationships. Nicholls also draws on the work of Foucault to explore a seemingly benign device; the physiotherapy treatment bed, to examine how technologies convey meanings that mediate relationships. He presents the example of a physiotherapy clinic space deliberately designed to counter the sterile, clinical atmosphere of the typical treatment spaces and how this has helped to reorient practices. In another paper, Nicholls and Holmes radically re-consider the notion of therapeutic touch, and how current ‘heavily disciplined’ approaches to touch constrain physiotherapeutic possibilities.

The papers by Trede and Gibson and Teachman demonstrate how critical philosophical approaches open up new areas of physiotherapy research. Trede draws on Habermas' theory of communicative action to deepen conceptualizations of person-centered care and the implications for shared decision-making. Gibson and Teachman outline how Bourdieu's sociology of practice informed a study exploring how socially ingrained notions of ‘normal’ and ‘disabled’ are reflected in rehabilitation practices and taken up by disabled children and their parents.

What these papers collectively show is that physiotherapy is a complex assemblage of concepts, ideas and practices that demands much more philosophically informed examination. More than anything, these papers promote the idea that there is a place for philosophy in physiotherapy, and we commend the journal and its editorial team for supporting this venture. We believe that this is the first edited collection that has brought together writers from around the world to engage explicitly in writing about philosophy and physiotherapy. We hope that this volume serves to encourage other writers, researchers, thinkers, and practitioners to use these papers as the impetus to open a space in their professional lives to think differently about their practice.