IS PHYSIOTHERAPY ENDORSING AN INCOMPLETE VERSION OF HUMAN ANATOMY?

¹Wellpark College of Natural Therapies, Auckland, New Zealand

Background: Anatomists have long relied on dissection to develop the extensively used concept of a 'musculoskeletal' body structure. Fascia, the body's soft collagenous connective tissue fabric, is largely discarded during dissection to enable visual scrutiny of other parts, such as muscles and bones. Despite its pervasive existence, the body's fascial system is hypothetically omitted from this simplified ('musculoskeletal') conception of the body, hence cannot be logically included in downstream clinical reasoning and practice (including physiotherapy). This is troubling, as contemporary scientific reportage indicates fascia plays several key roles in the body's structure and performance. To date, no research has investigated how fascia is portrayed in the training of clinicians.

Purpose: This qualitative study used ethnographic fieldwork methods (semistructured interviews and participant observations) to determine how educators (study participants) anatomically explained fascia to New Zealand (NZ) health practitioners-in-training, including physiotherapists.

Methods: One-off, semi-structured face-to-face interviews were used to determine how fascia was portrayed during the baccalaureate-level anatomy instruction of 10 groups of health-professionals-in-training. Groups included the students at each of NZ’s two physiotherapy schools. Interviews were combined with participant observations of five separate, two to four daylong, introductory-level bodywork [1] seminars (e.g., Anatomy Trains, Kinesio Taping) attended by a variety of practitioners, including physiotherapists. Data (fieldnotes and interview transcripts) were analyzed inductively with thematic analysis techniques to discover how fascia was anatomically depicted, and some of the likely reasons behind this.

Results: Among its findings, this study indicates that NZ physiotherapy students’ anatomy education is broadly premised on traditional, yet theoretically unexamined, acceptance of a ‘musculoskeletal’ body structure.

Conclusion(s): This anatomical interpretation implies bodies are fundamentally composed of muscles and bones, and largely ignores the permeating presence of a dynamic fascial system. Notwithstanding its obvious utility, anatomy education that solely alludes to a musculoskeletal body form (hypothetically devoid of fascia) precludes students from learning about fascia’s complex three-dimensional structure, properties (e.g., continuity, mobility, sensitivity, adaptivity), and its contributions to the body’s integrated mechanical, neurological, metabolic, and bioenergetic processes. This inevitably limits what can be understood about the body’s morphology, functioning, and ultimately its remedial care. While the study context is limited to NZ, the findings signal a need to explicitly examine the anatomical presumptions that underpin global physiotherapy education and discourse.

Implications: Widespread reliance on a demonstrably abridged anatomical model is theoretically risky, and could inadvertently constrain future progression of physiotherapy’s wide-ranging praxis. It may therefore be timely for the physiotherapy profession to review its views on this subject. [1] Bodywork: General term for body centred treatment methods and techniques that use touch, massage, manipulation and/or movement to promote health and wellbeing. May be used as an adjunctive or stand-alone form of treatment.

Funding acknowledgements: A University of Otago Postgraduate Scholarship played a significant role in supporting this PhD study.

Topic: Education

Ethics approval: This research study was conducted with the approval of the University of Otago Human Ethics Committee.

All authors, affiliations and abstracts have been published as submitted.