Physiotherapy: The Impossible Profession

‘Is this counselling or physiotherapy?’ she asked and she wasn’t joking. I had erred and allowed ‘the subjective’ to take up too much of our time. Yes, there was a lot going on in Marie’s life, but I hadn’t contained her narrative and I wasn’t quick to respond to her piercing question either.

‘Well…it’s YOU,’ I blurted, turning my palms upwards, as if surrendering.

Hers was not an uncommon story. A few months of pain, no history of trauma. It was a story littered with those stopgaps of clinical practice that ricochet from the walls of hospitals and clinics the world over, never coming to rest: ‘of course I don’t get much sleep,’ ‘I don’t have time to exercise (although I used to),’ ‘I’m on antidepressants and feeling much better’ but ‘feeling run down the last few weeks’. Work situation ‘complicated’ (there had been some redundancies). Her son was being bullied at school. Her mother had recently moved into a nursing home.

This style-of-life, this lifestyle, it cuts through generations and it cuts through class and geography and sometimes it spills over into the body. There’s none of us living the perfect life, but from where I’m sitting, some days it feels like the plague is back, but in a different guise.


How active are we? Half the population walk less than a mile a day during the week, with a fifth walking less than a quarter of a mile. That is just 500 steps a day. What is it that stops us walking? It’s bad weather. Or we ‘don’t feel safe.’ Or there’s ‘nowhere nice to walk’ (ref).

Sixty percent of us will not have taken any exercise in the previous month (ref) with recent work suggesting that physical activity declines from seven years of age (ref).

What about our diet? Sixty percent of us don’t eat breakfast and 60% of us are obese or overweight, with 30% of 11 year olds obese or overweight (ref). Youngsters living in the most deprived areas are twice as likely to be obese, than children in least deprived areas (ref).

Stress? Thirty percent of working parents feel burnt out regularly (ref) and one in six adults have a mental health problem (ref), with a quarter of young women experiencing problems with anxiety and depression (ref). Nearly half of working fathers (47%) want to downshift to a less stressful job because they cannot balance the demands of work and family life (ref).

Sleep? Most of us under-sleep by about an hour a night, losing the equivalent of an entire night’s sleep a week and sleeping just under seven hours a night (ref). Only eight percent of us wake feeling refreshed and 60% of us are unhappy with the amount of sleep we’re getting (ref).

When we get neck or back pain? Five to ten percent will consult with a physiotherapist (Côté et al 2001, Chevan & Riddle 2011, Woodhouse et al 2016).

Back in the room I ask Marie if she could see the link between her ‘story’ and the pain. She said, ‘of course stress must play a part…but I see that.’ She turned square on and said, ‘I thought I was going to get some physiotherapy today.’

I was ready this time. ‘It is often helpful to look at the bigger picture…we’re not machines.’ I paused. ‘You can see the link between the stresses and your pain, but not everyone can. Sleep, exercise, how you feel…these all have an effect on your body and your pain. We can talk through these things at a later date, if you choose. Are you happy for me to examine you now?’

And so we withdrew to the relative safety of the body, to where she had so plainly wanted to remain from the start, the two of us now surveying her skeletal machinery, at arms length, moving and stretching and applying pressure on and about the surface of her.

And as the therapy turned ‘physio,’ I recalled a memory from decades ago. It’s not pleasant I warn you – but it is relevant.

I am at the head of a plinth upon which a man so pale he might be dead, is stripped to his white Jockey underwear. He is supine. I am knelt upon one knee with my arms above my head. I’m in a grey prefabricated room-within-a-room, lit by flickering fluorescent light. There are no windows.

The backs of my thumbs are touching and in turn I am contacting – with the farthest tips of my thumbs – the skin on the back of the man’s shoulder. My neck is aching as I struggle to look up at my hands. I allow my head to drop occasionally I am so uncomfortable. I am performing a grade one postero-anterior mobilisation of the right shoulder. The only sound is the click of the convector’s thermostat as it turns on and off.

Peripheral Manipulation GD Maitland 3rd Edition

A more reductive and absurd biomechanical vision it is simply not possible to manufacture. But alas: that was I – back there – genuflect in blue piping, barely scraping the epidermis of this man’s problems.

I make no apologies, for we had no research and we had just a handful of distant gurus and the painstakingly typeset word. And it kind of made sense. Much the same way things do now, you know?

But now! Oh now! This biomechanical nightmare has split wide open to reveal a ruddy, person-centred world underneath and it is a world that well and truly floods us all.

And what of ‘the research’? Is it nothing but a thin veneer, a weak numerical façade, repeating on a loop? ‘YOU’RE NO BETTER THAN PLACEBO. YOU HAVE A SMALL EFFECT SIZE. YOU’RE NO BETTER THAN PLACEBO…’

Aye it’s messy, it’s confusing and it’s easy to sink, as I did when Marie asked if the session was ‘counselling’ or ‘physiotherapy.’ All this science and all this human-ness. HOW ON EARTH AM I SUPPOSED TO CONNECT ALL THESE THINGS SINGLE HANDEDLY!?

Because every day I am reminded of the split in our culture between the physical and the psychological, the body and mind, the psyche and soma. Is it counselling or is it physiotherapy?

And every day I am reminded of how so many of us live imperfect lives, brimming over with sleepless nights, sedentary days and mental health problems.

Take a look around you. Perhaps it has become an impossible profession, this physio-therapy.

But you know, when I look upon my days, it’s a rare one indeed when I don’t see with my own eye – and yes sometimes a tear-filled eye –  that we make a difference to people’s lives through this physio-therapy.

The impossible profession? Perhaps. But it’s far, far more possible than it ever has been before.


Chevan, J., & Riddle, D. L. (2011). Factors Associated With Care Seeking From Physicians, Physical Therapists, or Chiropractors by Persons With Spinal Pain: A Population-Based Study. Journal of Orthopaedic & Sports Physical Therapy, 41(7), 467–476.

Côté, P., Cassidy, J. D., & Carroll, L. (2001). The treatment of neck and low back pain: who seeks care? who goes where? Medical Care, 39(9), 956–67. Retrieved from

Woodhouse, A., Pape, K., Romundstad, P. R., & Vasseljen, O. (2016). Health care contact following a new incident neck or low back pain episode in the general population; the HUNT study. BMC Health Services Research, 16, 81.