Phenomenological physiotherapy: extending the concept of bodily intentionality

Abstract

This study clarifies the need for a renewed account of the body in physiotherapy to fill sizable gaps between physiotherapeutical theory and practice. Physiotherapists are trained to approach bodily functioning from an objectivist perspective; however, their therapeutic interactions with patients are not limited to the provision of natural-scientific explanations. Physiotherapists’ practice corresponds well to theorisation of the body as the bearer of original bodily intentionality, as outlined by Merleau-Ponty and elaborated upon by enactivists. We clarify how physiotherapeutical practice corroborates Merleau-Ponty’s critical arguments against objectivist interpretations of the body; particularly, his analyses demonstrate that norms of optimal corporeal functioning are highly individual and variable in time and thus do not directly depend on generic physiological structures. In practice, objectively measurable physical deviations rarely correspond to specific subjective difficulties and, similarly, patients’ reflective insights into their own motor deficiencies do not necessarily produce meaningful motor improvements. Physiotherapeutical procedures can be understood neither as mechanical manipulations of patients’ machine-like bodies by experts nor as a process of such manipulation by way of instructing patients’ explicit conscious awareness. Rather, physiotherapeutical practice and theory can benefit from the philosophical interpretation of motor disorders as modifications of bodily intentionality. Consequently, motor performances addressed in physiotherapy are interpreted as relational features of a living organism coupled with its environment, and motor disorders are approached as failures to optimally manage the motor requirements of a given situation owing to a relative loss of the capacity to structure one’s relation with their environment through motor action. Building on this, we argue that the process of physiotherapy is most effective when understood as a bodily interaction to guide patients towards discovering better ways of grasping a situation as meaningful through bodily postures and movements.

How Do You Touch an Impossible Thing?

“…Some have argued that the best approach might be to take the best of the scientific and experiential philosophies, and think about touch more holistically. And we have seen some of this in both the emergence of pragmatic bio-psychosocial, integrative medicine, and motor intentionality approaches in physiotherapy in recent years (6)(7)(8)(9). This hybridization or slurring of philosophies suggests that physiotherapists have become dissatisfied with the way touch has come to be understood, both within and without the profession.…”

“…Deane Juhan's eloquent handbook for bodywork being perhaps the best example (29) 3 . But physiotherapy has always historically taken a narrower view, confining itself to bio-physical understandings of touch or, more recently, Nordic phenomenologies inspired, most especially, by the works of Merleau-Ponty and van Manen (6,(43)(44)(45). Of course, other theoretical aspects of touch are periodically discussed in the physiotherapy literature (46)(47)(48)(49)(50)(51)(52)(53), but the emphasis always remains firmly grounded in the humanistic.…”

A critical phenomenological investigation in the use of touch as “know how” in practical physiotherapy in primary care with children and adults

“…Other researchers have investigated the knowledge base of physiotherapy. Supported by phenomenological philosophy and enactive theory, Halak and Kriz ( 13 ) argue that physiotherapy is about physiotherapists' empathy with patients' bodily intentionality and that this involves reciprocal coordination and open-ended bodily dialogue, similar to that found in the context of dance. They suggest that along with using language to explain and apply theoretical knowledge of various kinds, physiotherapists should build on the reality of their own embodiedness and their previously acquired practical and bodily knowledge ( 13 ).…”

On the importance of a human-scale breadth of view: Reading Tallis’ freedom

“….] through different physical events"(Tallis, 2021, p. 124) but does not comment on the generality of bodily intentional activities.6 For a more extensive treatment of these topics in the context of physiotherapy, seeHalák & Kříž (2022).hum4-22_text.indd 447 hum4-22_text.indd 447 18. 10.…”