Anatomy and physiotherapy

Our esteemed Roger Kerry (@RogerKerry1) asked a great question on Twitter last week.

Is a detailed knowledge of anatomy (e.g. muscle structure/innervation; bone form; neural plexi structure; lung structure; etc) necessary to be a good clinician? (Here's a link to the full Twitter conversation).

Interestingly, peoples' responses broadly polarised into two binary positions with roughly two-thirds of respondents arguing a qualified "yes", that anatomy was essential, with a third arguing "no".

The posted comments also make for interesting reading.  But it felt to me that one of the things missing from the debate was a discussion of what anatomy does for physiotherapy, beyond giving us a body of knowledge to use in practice.

Anatomy has had a powerful historical influence on the profession.  It's always been one of the most important ways of aligning the profession with the medical profession, but it's also been used as a gatekeeping tool.

Having a detailed knowledge of structural anatomy has been one of the most powerful ways of deciding whether students will become physiotherapists or not.  Often considered to be a core subject and given enormous amounts of attention at the outset of our training, failing the anatomy exam was often the most taxing first hurdle a student had to overcome.

Many students failed.  I know many stories of students who had the human touch but couldn't turn their brains quickly enough to the rigours of anatomy in order to pass the end-of-year exam.  These poor students were told in metaphorical terms that they had failed as physios.

Perhaps then anatomy feels so central to us because we survived this test?  We were the achievers; the ones who successfully demonstrated the same kind of mental aptitude to learn whole chapters of Gray's Anatomy as the people who told us that anatomy was important to the profession in the first place?

That anatomy is important to the identity of the physiotherapy profession is beyond doubt.  But much of this is socially constructed.  It's important to us because we've made it important.

Given that we can't change anatomical structures with our mobilisations and manipulations, there's nothing inherently necessary about knowledge of anatomy.  It helps to know the structure of a vein to understand a DVT, or the structure of deep hip flexors when performing a Thomas Test, sure, but is that sufficient to call anatomy a 'core' subject?

Anatomy has clearly had an important effect on positioning physiotherapy close to medicine, and it makes so much else possible.  Would we place so much emphasis on objective clinical tests, for instance, if we didn't have to find a use for all that anatomy knowledge?

And is a detailed knowledge of anatomy really the best gatekeeper of whether you're going to become a good physiotherapist?

It has always seemed to me to be a poor test of a person's physio-ness.  But this is hard to prove because all of the people I see in practice have already met the threshold and succeeded.

I do know though, that there are legions of physiotherapists who rely very little on their knowledge of anatomy, and the semi-deliberate act of forgetting anatomy has been liberating for them.

As always, it's not the doing, it's what the doing does.