Physiotherapy and the zone of play

I'm doing a public lecture next week on physical therapies in the 19th century (you will be able to see a live feed or delayed broadcast of it here if you're interested in hearing about it), and the whole project has been fascinating.

One thing that occurred to me doing the preparation for the talk was how many images there are of people sitting in mud baths and hot springs.

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There was never any real proof that these things did anything other than warm you up, but there was a lot of anecdotal evidence that they were used to treat all sorts of diseases, from syphilis to sciatica, asthma to psoriasis.  Suffice to say, in 19th century New Zealand, hot pools were a natural phenomenon, and an exotic and very popular experience for weary travellers, warriors and the sick and injured alike.

Today, the popularity of ideas (or the Facebook 'like' factor) has become an important test of the truth value of an idea.  This is a different kind of 'truth' to the one that health professionals are encouraged to value.  It does not assume that there is some independently verifiable reality outside of people's consciousness, but is a more pragmatic truth that is largely socially constructed.  Ironically, this alternative notion of truth is overpowering the one that scientists would like to promote simply by dint of its own popularity.  Physical therapies like massage and hyrdrotherapy simply won't go away, despite what the advocates of evidence-based medicine might like.

But the popularity of ideas, as a concept, is as old as mud baths themselves.  Likability has always been an important determinant of what people are prepared to accept as the truth, and advocates for new ideas about the nature of truth argue that the emergence of the scientific method has only replaced one set of ideologies with another.  And anyway, it doesn't seem to matter that scientists would like to dictate how we should all think about the truth, people have always voted with their feet and chosen to take a dip in the mud bath anyway.  After all, what harm can it do?

And this points to an interesting phenomenon about truth.  Seemingly, the popularity of a particular idea matters more when the person doesn't place too much stake on the effect of the particular truth.  So things that people are happy to negotiate over, let go of, or change, are much more fluid than truths that people hold on to dearly.

We see this in truths that people hold about their health, their families, politics and religion, work, etc.  One of the best examples of this is in health care itself, where people are increasingly experimenting with unconventional health care practices.  That is until they become really ill, at which point they return to the things that have a strong scientific basis to them and are established or orthodox (like conventional medicine).  So people are much more relaxed about the truths they engage with when their lives don't depend on it.

The question for physiotherapy then is which zone do we occupy?  Do we sit within what I'll call the 'zone of certainty' where truths are much more likely to be fixed, conventional and orthodox?  Or do we reside within the 'zone of play' where people will more readily treat truths with much more subjectivity and indeterminacy?

If it's the former, then evidence-based practice and establishing the profession's orthodoxy may well be the best way forward.  But few people have ever argued that physiotherapy is essential to life.  Rather we have traded off our orthodox status to legitimise our place within the public health system.  Popularity wasn't an issue for many physiotherapists because patients were either already lying on the ward waiting for us, or came to us because their insurance company or state-supported funder allowed it.  But times are changing.

Now that choice and personal responsibility are becoming much bigger drivers of health care, and people are seemingly eager to express their subjectivity through endless body 'projects,' we may find that ideas like evidence-based practice become less important drivers for people than the popularity of the idea itself.  This may have significant implications for a profession that sits firmly within the Zone of Play.