77 So, what can be done?

How can physiotherapy advance the cause of the physical therapies in an increasingly interconnected world? How can we improve society’s stores of knowledge and practices of the physical therapies, so that communities are more resilient and able to cope with adverse events in the future? How can we release the truly transformative potential of physical therapies, not just in the interests of human flourishing and social justice, but the planetary health of all things? In other words, how can we re-root the physical therapies?

Any viable alternative to the existing systems and structures must, at the very least, reflect and respond to the criticisms levelled at professions like physiotherapy in this book. It must do at least five key things:

Secure the best possible physical therapies for people, even if this is at the detriment of the physiotherapy profession’s own power and prestige;

Reflect the fact that we are entering a post-professional era, where all orthodox professions are being displaced as the controlling voice at the centre of contemporary healthcare. It must anticipate the unbundling of the health professions’ privileged social enclosures, whilst re-imagining how people access the physical therapies in the future;

Help break Western hegemonic notions of health and illness, embracing much broader cosmologies. It must put intersectional social justice and social action at the forefront, rejecting the patriarchal normalisation and othering of Western healthcare;

Address the alienation of therapists from their communities and themselves, using the physical therapies as a tool for healing and re-connecting, not only with other people, but with the entire ecosystem. To do this, it must offer a revised understanding of the physical therapies that is adequate to the task;

And it must be able to function without defaulting to the controlling and exploitative interests of ‘the state’ and the late capitalist exploitation of ‘the market’.

Until recently, it would have been hard to imagine how this might be possible. But new social theories and philosophies are emerging that point to myriad viable alternatives. In the final chapter of the book, I show one way in which the above five goals might be achieved.

But before doing this, there is an important question that needs to be answered, and that is why should physiotherapists, or any profession for that matter, even contemplate doing this? Even if all of the arguments set down in this book are accepted, what would make a prestigious, seemingly buoyant profession, relinquish the very thing it has worked for decades to capture, especially when, in doing so, it will lead to its demise?

There is a principle known as Chesterton’s Fence, which argues that you should not take a fence down unless you know why it was put there in the first place;

‘There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it’ ^[1]

So, any argument in favour of dismantling physiotherapy’s enclosure should be based on a clear understanding of how the profession’s territorial claim was constructed, and what would be lost by taking it down. And I believe we do now know enough now about physiotherapy’s professionalisation project to know what will happen if we do, and if we don’t, make the necessary changes.

I believe all of the evidence now points to the dramatic de-centring of the professions from Western healthcare, whether they want it or not. So even the most cynical practitioner should see some advantage in exploring feasible alternatives. But I also believe that most physiotherapists care deeply about their craft and want to see the physical therapies available to the widest possible audience. Unfortunately, the systems that they are forced to operate within often make it impossible to act in the best interests of the wider public whilst remaining registered and employed. As Marx put it, we are often alienated from the essence of our humanity and slaves to our labour.

But the two fundamentally important aspects of physiotherapy that mean I believe this alternative approach is both desirable and feasible, are that the physical therapies are ideally placed to play a key role in future healthcare, and that there is nothing fundamentally complex about them. The physical therapies have been practiced for thousands of years and are likely to be practiced for many years more. In most cases, they do not possess the same complexity as neonatal cardiac surgery, kidney dialysis, or the development of new vaccines, so they should be a powerful resource for people to use in their pursuit of health and wellbeing.

But the primary reason why I believe physiotherapists will be able to radically change their practice, is because they will do so from a position of strength. As I pointed out earlier, physiotherapy has the advantage of being an established, loyal, and trusted orthodox profession; a respected ally to doctors, nurses, other professions; a diagnostician, whose work focuses on activity — and one of the most important conservative approaches to health and wellbeing. Physical therapies require little expensive equipment and are highly mobile, with most therapists needing just their heads and hands, and so it is the model of a low-carbon profession. So in the immediate future, physiotherapists need not worry about their job security while they transition to a new way of working.

Students in the 1968 French street protests used to chant the slogan — “Sous les pavés, la plage!”, or, “Under the paving stones, the beach!” — meaning that if we just lifted up the paving stones and used them against those who had laid them down, beauty and freedom await. The sentiment is very much of its time, but as Judith Butler said much more recently; ‘Sometimes you have to imagine in a radical way that makes you seem a little crazy, that puts you in an embarrassing light, in order to open up a possibility that others have already closed down with their knowing realism’ ^[2].

But imagining radical alternatives has not, traditionally, been part of physiotherapy’s métier. So, we will need allies if we are going to be able to think radically. Our knowledge, systems, and ways of working will need to be opened up to as wide a community as possible, so that new forms of cultural capital can be developed. Walter Benjamin believed that it was the students that should be the ‘authors of a transformation’ for a profession ^[3], but even this may be too narrow for the kind of transformation being called for here.

So, what can be done? If doing nothing, or taking a modern heritage, renaissance, or hybrid approach amount to the profession acceding to the stifling bureaucracy of the state and the bleak market logic of late capitalism, then what is possible? Well, what follows is an argument that once we start to imagine the physical therapies beyond the narrow confines of the profession, their truly transformative potential begins to reveal itself.