Special Issue Article

Postmodernism and physiotherapy research

David A. Nicholls
School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand

Postmodernism is a notion that causes as much confusion as it does consternation, yet in recent years it
has become one of the most widely debated philosophies in health care research. Based on skepticism of
grand narratives and an opening towards diversity and inclusiveness, postmodern research provides a set
of tools and some distinctive ways of thinking that encourage researchers and practitioners to critically
analyse the taken-for-granted obviousness of life. What is more, postmodernism offers a way to liberate
people to think differently about their experiences, ideas and practices. In this paper I provide a brief
review of postmodernism as a philosophy and as an approach to research. Taking as my starting point the
need for reform in the physiotherapy profession, I explore some of the key principles underpinning
postmodern research. Drawing on a case study of a recently published postmodern study, I offer a critique
of the modernist assumptions underpinning physiotherapy, and present an example of how a postmodern
study may be undertaken. Postmodernism has much to offer physiotherapy. It encourages us to ask
questions of those things that normally pass unnoticed beneath our gaze, and it calls us to examine the
discourses that have made the present possible. In examining how postmodern research may be applied
to the study of physiotherapy practice I hope to encourage readers to move away from ossified ways of
thinking and consider what might be possible if physiotherapy were otherwise.
Keywords: Postmodernism, Grand narratives, Physiotherapy, Research

Introduction be of use to physiotherapy practitioners, researchers,

There has been an explosion of interest in qualitative
research in health over the last 30 years, with a vast
array of methodologies and methods emerging.1,2
Phenomenology, critical theory, ethnography, dis-
course analysis, ethnomethodology, narrative analy-
sis, grounded theory, and a host of other approaches
cater for many of the ways in which the world has
come to be known and understood by individuals and
groups in society. Some approaches are concerned
with how individuals make sense of their world,
others with the way the world is socially constructed;
some are concerned with culture, others with power,
oppression and marginalization. Postmodernism is
concerned with critiquing the power that resides
beneath the things we take for granted in our
everyday world. It challenges our assumptions about
what we understand to be true, and questions what
we know and how we go about our lives, and it asks
how the present has become historically and socially
possible. It is one of the most recent philosophical
and methodological influences in qualitative research
and it offers some stimulating and potentially
valuable ways of thinking and practicing that may
Correspondence to: D. A. Nicholls, School of Rehabilitation and
Occupation Studies, Auckland University of Technology, A-11, 90
Akoranga Drive, Northcote 0627, Private Bag, 92006, Auckland, New
Zealand. Email: davidnicholls@me.com
students and teachers. In this paper I explore some of
the principles underpinning postmodernism in health
research and offer an example of how postmodern
research may be undertaken.
Background
The roots of postmodern thinking can be found in the
writings of late nineteenth and early twentieth-century
German philosophers like Friedrich Nietzsche, Max
Weber and Martin Heidegger. What we now know of
as postmodernism, however, owes more to a radical
movement among French intellectuals in the 1960s
that sought to break with traditional forms of philo-
sophy. Drawing extensively from architecture, design,
performance and visual art, music, theatre and cinema,
philosophers like Michel Foucault, Gilles Deleuze,
François Lyotard, Jacques Derrida and Georges
Battaille began to explore the relationships between
language, power, truth and subjectivity in new ways.
These ways saw people not as sovereign, autonomous
originators of meaning in the world – the prevailing
view in Western philosophy since the Enlightenment –
but rather as the effect or result of social and historical
processes.3 This approach began to find favour with
other writers and theorists who were attempting to
engage with the rapidly changing world around them
in the latter part of the twentieth century.

ß W. S. Maney & Son Ltd 2012

360 DOI 10.1179/1743288X12Y.0000000045 Physical Therapy Reviews 2012 VOL . 17 NO . 6

Since the 1960s a host of new writers and theorists
have explored postmodernism.4–12 One of the most
fertile areas of postmodern scholarship has been in
health, where traditional practices, values and beliefs
have come under sustained critical scrutiny.13–19
Among other areas, researchers and theorists have
focused on dominant discourses [The word discourse
is used commonly in postmodern research where it
refers to ideas and ways of thinking and practicing
that cohere around a particular meanings.20 Thus
the discourse of biomedicine embodies certain ways
of thinking and certain specific practices that dis-
tinguish it from other discourses in health care.] like
biomedicine and on the power this has afforded
elite professions like medicine and nursing;21,22 on
patients as health care consumers and producers;23,24
on ways of speaking and practicing health care;25,26
on disability and the limits of language;27–29 and on
the changing meaning of bodies and embodiment
in an age of uncertainty and seemingly boundless
possibility.30
Such is the depth of interest in postmodernism, that
it has become one of the most important influences
on contemporary health research.31 Postmodernism is
a philosophy not a methodology thus it cannot be
categorized as either quantitative or qualitative. Rather,
its tenets can be applied across methodologies or
methods. Its focus is on an unrelenting criticism of
any particular claim to truth, whatever its origins. Thus,
every view held by patients or practitioners, every
practice with its underlying belief systems, and every
structure and operation that is undertaken is fertile
territory for the postmodern researcher.
Postmodern is not nihilistic, however. It is not
criticism for its own sake. It is, in many ways, a very
positive approach to philosophy, since it also seeks to
create space for diversity and inclusiveness. In the
place of traditionally dogmatic views of the world,
postmodernists attempt to install creative uncer-
tainty; an openness to new ideas, innovations and
creativity; a playful acceptance of the productive
possibilities of irrational, illogical, even seemingly
stupid ideas.32 Regardless of this, postmodernism has
been accused of being little more than cynical, eso-
teric and relativistic.5,18,33 Given the novelty and
uncertainty of postmodern research, it is useful to
unpack the principles that underpin postmodernism a
little more before exploring how postmodern research
in health care might be undertaken.
Principles of Postmodernism
Two of the main principles of postmodernism research
are:
1. a skepticism towards metanarratives;
2. an opening towards diversity, inclusiveness and
doing things otherwise
Nicholls Postmodernism and physiotherapy research
Skepticism towards metanarratives
If we take these in order, the phrase ‘skepticism
towards metanarratives’ derives from French post-
modern philosopher Jean-François Lyotard whose
ground-breaking book The Postmodern Condition34
synthesized much of our present understanding of
postmodernism. Lyotard expressed a growing interest
in the way knowledge, power and truth operated in
society: particularly those grand truths that had such
powerful, yet subtle influences on our lives. These
were the meta- or grand-narratives that are referred
to so often in postmodernism.
For centuries, metanarratives like science and
religion have dominated people’s views of the world
and their place within it. They have guided how we
organize our worlds, what we believe to be true, how
we function during the day, and how we organize our
social relations, and they play an important part in
defining our moral compass. We have come to believe
in the wisdom of experts, we have learnt about logic,
reason and faith, and we value our autonomy and
freedom. All of these are highly practical and com-
monplace hallmarks of the effects of dominant dis-
courses upon our every-day lives.
Biomedicine is a metanarrative that has had a
powerful influence on physiotherapy’s professional
identity. Biomedicine is a broad term for certain ways
of thinking and acting towards the body and disease
that have emerged in Western civilizations since the
Enlightenment.35 Among other things, biomedicine
emphasizes the virtues of scientific objectivity, the
separation of the body and mind (Cartesian dualism),
specific aetiology (or the belief that illness can be
traced to a malfunction within the body, rather than
in ‘society’ per se), reductionism (the dividing up of
the body – and consequently health care – into
separate bodily systems), and the pervasive view
of the body-as-machine.36,37 Biomedicine privileges
certain ways of thinking (reason, objectivity, value-
neutrality) and certain ways of practicing (assess-
ment, diagnosis, treatment), it defines what is normal
and abnormal, who is sick and who is well, who is
mad and who is sane. It is also largely responsible for
the day-to-day working of the health system (the
design of hospitals around medical sub-specialities),
the language of health care, and the way that health
care is taught.
As well as making certain ways of thinking and
acting possible, biomedicine makes other thoughts
and practices impossible, or at least inappropriate. A
whole raft of ‘other’ ways of thinking about health
and illness are currently marginalized by orthodox
biomedicine. Thus, complementary therapies like
homeopathy and naturopathy are discredited, while
other approaches that place a premium on cultural,
ecological, mental and metaphysical understandings
Physical Therapy Reviews 2012 VOL . 17 NO . 6 361
Nicholls Postmodernism and physiotherapy research
of health and illness are considered ‘fringe’ medicines.
Biomedicine is powerful not only because of what it
makes possible, therefore, but also for what it denies.
Postmodernists are sceptical of metanarratives like
biomedicine, believing that their claims to elite status
are, in fact, highly contextual and historically specific.
In other words, they believe that the ability of a
metanarrative to offer the ‘truth’ about anything is
contingent on a specific set of social and historical
conditions and that metanarratives are therefore
much less ‘stable’ than they seem. Even our beliefs
in what we think of as true or false, right or wrong
are the ‘effects’ of these metanarratives and are likely
to change as old narratives are replaced by new ones.
To go even further, postmodernists question whether
people are actually the autonomous, independent
originators of thought and action, as science has
taught us to believe, and not themselves the histori-
cally and socially contingent product of metanarra-
tives. Thus, rather than humans being the originators
of knowledge and understanding, we become ‘our-
selves’ as the result or effect of a wide range of
competing and overlapping discourses.
Not surprisingly then, postmodern research has
had a mixed reception among researchers, orthodox
scientists and social commentators who find some of
its principles unpleasantly destabilizing. Postmoder-
nism represents a significant challenge to ideas that
many of us take for granted, such as our beliefs in the
value of logic and reason, rational ideas and the
objectivity of empirically-supported evidence. Post-
modernism sets out to question all of these assump-
tions and bring to the surface ideas that run counter
to biomedicine and modernism.
Importantly, postmodernists do not attempt to
decide whether metanarratives like biomedicine have
been merely good or bad for us. They do not seek to
resolve the question of whether the discovery of germ
theory, for example, has been a social bane or a boon,
or whether hospitals have improved our health or
made it worse. Arriving at such conclusions would
only serve to replace one metanarrative with another.
The task of the postmodernist is not to resolve or
conclude anything, because to do so would risk
closing off options for thinking otherwise, which
brings us to the second principal or postmodernism.
Openness towards diversity, inclusiveness and
doing things otherwise
The second principal of postmodernism derives from
a belief that there are no absolute truths; that
knowledge is unstable, historically and socially con-
textual, and thus likely to be different tomorrow to
what it is today. While certain forms of knowledge
can become dominant and seen as both obvious and
necessary (as biomedicine has been seen for much of
the last century), postmodernism reminds us that this
362 Physical Therapy Reviews 2012 VOL . 17 NO . 6
need not be the case and that all knowledge is
temporary. Drawing on lessons from history, all
present forms of accepted knowledge are paradigms
that will be challenged and replaced by ideas and
understandings that will seem obvious and necessary
to the culture that is defined by them.
To take a postmodern position, therefore, requires
an openness to the possibility of thinking otherwise;
of thinking in new ways about different things; about
creativity and innovation; about purposely thinking
against the received or conventional wisdom; of be-
ing open to the impossible, the antithetical, even the
ridiculous. In contemporary Western societies, this
means acknowledging our debt to reason and logic
and sometimes thinking against the constraints they
impose. In biomedicine this may involve critiquing
evidence-based practice, randomized controlled trials
and the other hallmarks of reductionism, positivism
and Cartesian dualism that operate so powerfully in
health care, and promoting new directions with a new
imagination.
At times, postmodernism has been criticized for
being nihilistic – for only promoting criticism (and
a particular form of criticism that never wants to
propose solutions because they themselves might
imply a fixed position that draws the critical gaze of
other postmodernists).38 However, it may be argued
that this is a misreading of the philosophy. The
postmodernism of Foucault, Deleuze, Derrida and
others is not nihilistic. Indeed in destabilizing pre-
viously taken-for-granted assumptions, postmodern-
ism may represent one of the most significantly
positive forms of philosophy. It opens space for a
thousand alternatives and places no arbitrary restric-
tions on the appropriateness or suitability of these
alternatives. It makes no claims to any moral authority
to judge whether something is right or wrong. As
Gilles Deleuze and Felix Guatarri wrote in their book
Thousand Plateaus, our task is to create the condi-
tions where it might be possible to bring ‘something
incomprehensible into the world’.39 How, then, might
this relate to physiotherapy?
The Breathing Works Study
To illustrate how these two principles can be applied
in research, I have outlined below an investigation
into the work of a pioneering clinic that was looking
to practice physiotherapy in some interesting and
innovative ways.40
Background
In 1999, a private clinic was set up in Auckland, New
Zealand with a focus on the treatment of breathing
pattern disorders. The clinic, called Breathing Works
[Permission from the founders of the clinic and ethic
approval has been given by the *** Ethics Committee
to use the real names of the clinic in this paper.], was

remarkable in a number of ways. Firstly, the clinic’s
focus was on a relatively new and hitherto largely
unknown clinical problem. Breathing pattern disor-
ders (BPDs) – commonly known as hyperventilation
syndrome – are very common problems in the general
public, but in the late 1990s it was rare for a re-
spiratory physiotherapist to encounter them in prac-
tice. Patients with BPDs often present with diffuse,
non-specific symptoms, including pain, anxiety, head-
aches, palpitations, a sense of being ‘spaced out,’ chest
pain sufficient sometimes to believe they are having a
heart attack, and shortness of breath. Patients often
spend a great deal of time and money investigat-
ing their symptoms and find the condition deeply
debilitating.
Conventionally, patient assessment and treatment of
people with breathing problems takes place in large
tertiary care centres, and to a lesser extent in commu-
nity clinics, and focuses on either acute respiratory
problems like asthma, lung infection and post-operative
pulmonary complications, or chronic disorders like
chronic bronchitis, emphysema or cystic fibrosis. Typi-
cally, respiratory physiotherapists see patients with pre-
existing organic lung disease on hospital wards as part
of a large respiratory care team. Thus when BPDs
began to appear more frequently in the late 1990s, most
patients were seen alongside patients with organic lung
diseases within the tertiary health care system. The
founders of Breathing Works recognised early, how-
ever, that these patients were different and sought a new
model of practice that became the focal point for this
study which explored how new practices were emerging
in physiotherapy.40
Firstly, the patients attending the Breathing Works
clinic were outwardly healthy. They bore none of the
cyanosis, thoracic deformity or respiratory muscle
fatigue seen in patients on the medical wards. Indeed
patients coming to Breathing Works rarely had an
organic lung disease, and if they did, it was not the
principal reason for attending. The clinic they came
to was located in a converted house in a very wealthy
suburb of Auckland, and a deliberate attempt had
been made to design the clinic with a different
aesthetic to that found in hospital. The clinic rooms
were bright, relaxing and colourful.
While the practitioners in the clinic used some
traditional assessment methods (questioning, palpa-
tion, spirometry and pulse oximetry, for example),
there was no undressing to auscultate the chest, or
blood gas analysis. In fact it seemed that efforts had
been made to dilute some of the more ‘clinical’ dimen-
sions of assessment. Technical equipment, where used,
was concealed from view and many of the signs of
clinical practice (anatomical wall charts, mechanical
treatment beds, etc.) had been removed or covered
up.
Nicholls Postmodernism and physiotherapy research
The founders of the clinic had promoted them-
selves aggressively through local and national media
and had been very successful. It was normal for them
to see more than 1000 new patients each year and
clients ranged from elite sports people and company
executives, to child performers and stressed middle-
aged men and women with very rigid abdominal
walls. Patients often went from having quite debili-
tating symptoms to being ‘cured’ within 3–5 visits.
The two founders of the clinic grappled with the
desire to retain their physiotherapy identity and to
take advantage of the benefits of their orthodox status
(by continuing to take medical referrals, for example),
but at the same time, they actively pursued appro-
aches that allowed them to benefit from markets more
familiar to alternative and complementary thera-
pists. They published some very successful self-help
books, for example, rarely mentioning that they were
physiotherapists.41–46 They defined new terms for
classical breathing techniques and colonized practices
from Tai Chi, yoga, Zen meditation and a range of
other breathing techniques. They still used evidence to
support their practices, and published widely in this
area too, but this took second place to a much wider
view of what physiotherapy was. Not unexpectedly,
they came into conflict with elements within their
profession, who found it difficult to recognize many of
the new practices they espoused. And yet in recent
years a growing body of practitioners have sought to
explore similar territory to Breathing Works and test
the margins of orthodox practice.47–51 The clinic,
therefore, represents a growing trend within the pro-
fession, which raises some interesting questions about
what these clinics are doing, and what they are
deviating from.
Purpose of the study
Given the innovative and interesting deviation from
the norm being offered by the Breathing Works
clinic, I was interested to investigate how the clinic
was different; what discourses were influencing the
founders to branch out from conventional respiratory
physiotherapy practice and do things differently; in
what ways were they resisting ‘traditional’ modes of
practice; and what might their innovative approaches
might now make possible for others in the profession.
Almost as interesting, however, was the question of
what it was that they were deviating from? If
Breathing Works was resisting traditional practice,
what was it that defined traditional practice in the
first place? In other words, by examining something
that deviated from the norm, could we not learn
something about ‘the norm’ that had previously been
hidden from view? By examining how Breathing
Works was different, could we establish something
about what had come to constitute orthodox
Physical Therapy Reviews 2012 VOL . 17 NO . 6 363
Nicholls Postmodernism and physiotherapy research
physiotherapy practice in the first place? These
questions formed the basis of a study that drew
extensively on the writings of postmodern philoso-
pher Michel Foucault to provide the analytical lens
with which to ‘read’ the data. A more detailed
summation of the study can be found here.40
Methods of data collection
Because postmodern research is concerned with the
way discourses influence how we think and practice,
it often begins with an examination of what currently
constitutes the ‘real world’ for the person or group of
people being studied. Postmodernists believe that the
traces of powerful discourses can be found in the
way we go about our day-to-day lives, and so data
collection often begins with an interrogation of things
that form the common fabric of our lives. The key is
to maintain a sceptical attitude towards the world
one is examining. Postmodern researchers are con-
stantly questioning the things that seem obvious to
the participants in their study. A participant might
use a stethoscope and believe this to be the most
obvious and natural way to listen to lung sounds, for
example, but the researcher must ask why is this so
obvious (as Foucault did when he critiqued René
Laennec’s invention as a means of keeping patients
‘at arms length’ in his book The Birth of the Clinic).52
Or they may have unconsciously designed their clinic
to be less sterile and ‘clinical’ without realizing that
their actions express powerful forms of resistance.
Gathering data in postmodern studies often begins,
therefore, with everyday practice. Many Foucauldian
studies make the complexities of this a little easier by
focusing on four main aspects of everyday life:
subjects, objects, concepts and strategies.
Subjects
Foucault was interested in how people became
‘subject’ to particular discourses and the machinery
of power that made this possible. Foucault radically
redefined how people thought about power, arguing
that it was not simply a form of oppression that one
person could possess at the expense of another.
Rather, power was a positive, all-pervasive influence
on us all; a force that defined what we thought and
how we acted. This revised notion of power is a part
of most, if not all Foucauldian studies. Foucault
believed that people go through their lives making
decisions and doing things as a result of competing
discourses. We can study underlying discourses, and
the mechanisms of power that make them possible,
by beginning with how people act and what they
choose to do. Postmodern studies often start by
asking who are the subjects in this study, and how is
their subjectivity being expressed by the way they
think and act?
364 Physical Therapy Reviews 2012 VOL . 17 NO . 6
Objects
There are two meanings of the word object that we
must consider here. There are the objects that form
the everyday fabric of our lives that tell us so much
about the discourses that define ourselves (stetho-
scopes, treatment beds, street signs, etc.), and there is
a second, equally important notion of an object being
the target of someone’s interest. When a physiothera-
pist sees a patient, for instance, they become the
object of the therapist’s gaze; they are what the
therapist observes and takes interest in. The patient
(or their swollen knee, diseased lung, or dysfunctional
arm) becomes the object of interest. Postmodern
researchers constantly question why the participants
in the study privilege some objects and not other.
Postmodern studies, therefore, often focus on objects
as the things that give meaning to our practice.
Concepts and strategies
People have ways of working and ‘performing’ their
practice that are at times unique and at other times
stereotypical. Postmodern researchers are always look-
ing for the discursive influences on people’s conduct and
are particularly concerned with the kinds of knowledge
that people valorise and the truths that they hold to.
Again, postmodernists believe that what some people
called the truth are the effects of historically and socially
contingent discourses, and it is the interrogation of
these discourses that is the real purpose of our
investigations.
Returning to the Breathing Works study, I used
some very familiar methods of data gathering to
identify the subjects, objects, concepts and strategies at
play. Non-participant observation, document analy-
sis and interviews are all well-established qualitative
methods, and, as with all qualitative studies, the
variations in the ways these methods are used lies in
the underlying philosophy that drives the study. The
non-participant observations I undertook involved
spending a number of days watching different ther-
apists within the clinic during their assessment and
treatment sessions. I spent time observing the client/
patients interacting with the other staff – particularly
in the reception area. I spent time exploring the
environment of the clinic and its surrounding area. I
also worked for the clinic for a time as a respiratory
physiotherapist and undertook participant observa-
tions based on my experiences as part of the staff team.
The documentary analysis was probably the largest
and most time consuming aspect of data collection.
I tried to find any and every form of text through
which the clinic and its founders consciously or
unconsciously expressed their purpose. I looked at
the seven self-help and professional books produced
by the founders; more than 50 promotional inter-
views and media pieces either written by or about the

founders and the clinic; I looked at promotional
flyers, clinical notes and information sheets, and any
other form of text generated by the clinic that might
speak about their difference with conventional
physiotherapy.
I also undertook semi-structured interviews with
all the staff in the clinic and kept field notes of
conversations and verbal remarks made by the clinic
staff. The interviews were focused on the individual
practitioner’s beliefs about their practice and the
purpose of the clinic. All of the data from the
observations, document analysis and interviews were
converted to texts in the form of field notes,
transcripts or text copies and data analysis began as
the texts began to accumulate.
Methods of data analysis
While the methods of data collection may be
common to many forms of qualitative research, the
methods of analysis used by postmodern researchers
are quite particular to the particular philosophical
position one is taking. For this study, I drew heavily
on Michel Foucault’s work on governmentality and
technologies of discipline. There is not space to
explore these concepts in detail here, other than to
say that I drew heavily on particular strategies such
as examination, normalization and surveillance that
Foucault argued had become important means of
disciplining and governing the population over the
last three centuries53 [For a general introduction to
Foucault’s work, see Ref. 17]. Defining the philoso-
phical lens through which one ‘reads’ the data serves
at least two purposes: firstly, it enriches the analysis,
allowing the researcher to explore themes and ideas
that go beyond the obvious and everyday, and
secondly, it helps the reader understand how the
author arrived at their particular conclusions. Because
qualitative research is so diverse, there should always
be some clear statement of the researcher’s philoso-
phical standpoint.
In this study, I was interested in how Breathing
Works was striking out against the particular forms
of discipline and governmentality favoured by ortho-
dox physiotherapy, and what their resistance revealed
about the metanarratives underpinning traditional
practice. As with most forms of qualitative data
analysis, the texts were read and an inductive process
of theory building was begun. As I generated texts
from my observations, interviews and documents I
began by identifying the subjects, objects, concepts
and strategies at play. Some texts spoke more power-
fully about the way Breathing Works was resisting
orthodox physiotherapy, and some texts revealed ways
in which the participants in the study and physiothera-
pists generally used disciplinary strategies to govern
their conduct. These texts were read in more detail and
Nicholls Postmodernism and physiotherapy research
links were made back to the writings of Foucault and
others who had used Foucault’s ideas. I drew heavily
on the work of people like David Armstrong, Julianne
Cheek, Dave Holmes and Sarah Nettleton, who had
done similar investigations in dentistry, medicine and
nursing.54–64
Slowly, analytical themes emerged that had their
origins in the practices of the therapists at Breathing
Works, but could be linked directly to particular
notions of discipline and governmentality articulated
by Foucault. What became clear was that Breathing
Works’ resistance was directed at orthodox phy-
siotherapy. What I needed to establish now was how
the discourse of orthodoxy functioned in mainstream
physiotherapy, and so a second, larger study was
undertaken to look at the ways that orthodoxy
influenced physiotherapy practice in the UK and
New Zealand during the twentieth century. This study
formed the basis of my doctoral thesis [More details of
the method of data analysis used in the study can be
found in a paper that reported the findings.65 And a
more detailed explication of Foucault’s methods of
data analysis can be read in the works of Hook,
Danaher et al, and Tamboukou].66268
Outcomes
The analysis of the study reflected the goals of
postmodern studies in a number of ways. Firstly, it
challenged some of the metanarratives that had his-
torically come to underpin physiotherapy practice. It did
this in two ways; by exploring some of the ways in which
the physiotherapists at Breathing Works were func-
tioning differently to mainstream physiotherapy, and
secondly, by uncovering some of the ways in which
orthodox physiotherapy was being discursively con-
structed as a profession. If we unpack these outcomes
in a little more detail, the study showed that the
physiotherapists at Breathing Works were influenced by
a rejection of traditional biomechanical discourses, and
operated their clinic as a form of resistance to orthodox
practice. Everything from the design of the clinic space
to the way patients were assessed and treated spoke of a
challenge to conventional ways of doing things.
Although many of the changes made did not operate
at a conscious level, an un-orthodox approach was
inflected in virtually every way in which the clinic
functioned, from the way that the practitioners thought
about breathing problems to the everyday operation of
the clinic.
Identifying Breathing Works’ resistance also served
a second purpose, however, and this was to make the
discourses that defined orthodox physiotherapy more
visible. There is an analogy here to the way in which
photographers sometimes view images. Sometimes a
photographer focuses on the object of the image in
the foreground, and at other times they focus on the
Physical Therapy Reviews 2012 VOL . 17 NO . 6 365
Nicholls Postmodernism and physiotherapy research
space around the object in the foreground. Because of
its resistance, Breathing Works stood apart from
orthodox practice and so came to the foreground.
Having defined the foreground and unpacked some
of the forces that were holding Breathing Works
there, my attention then turned to the ‘negative space’
around Breathing Works that was occupied by
conventional physiotherapy. In other words, conven-
tional physiotherapy becomes easier to see – more
obvious – by first examining those things that are in
direct resistance to it.
Foucault’s own writings emphasized the need to
focus on modes of resistance as a starting point for
inquiry, arguing that resistance exists in dynamic
tension with power, and that this tension makes it
possible for new forms of knowledge to emerge;
It is not the activity of the subject of knowledge that
produces a corpus of knowledge, useful or resistant
to power, but power-knowledge, the processes and
struggles that transverse it and of which it is made
up, that determines the forms and possible domains
of knowledge.53
As with most forms of qualitative research, the
aim is to generate theory that has relevance for
other contexts and other situations. In this study,
the primary outcome was a greater appreciation
of some of the discourses that had underpinned
physiotherapists’ orthodox approach to practice. It
became clear how historically stable physiotherapy
had been as a profession and how its orthodoxy
had been inscribed in every facet of its professional
identity. In time, it would become clear that some
of the disciplinary strategies and approaches that
Breathing Works was now resisting (like the
profession’s century-long affinity with biomechani-
cal ways of thinking about health and it’s close
relationship with orthodox medicine, for example),
had echoes in the very first actions of the founders
of the Society of Trained Masseuses back in
1894.69
As well as generating new theoretical understand-
ings that could be applied to other studies and other
contexts, postmodern studies also create a space in
which it is possible to think otherwise. By offering a
critique of orthodox physiotherapy, and by showing
one way in which new modes of practice may be
operating, postmodern research can serve to encou-
rage greater diversity in research and practice. There
is clearly a political motive here, since postmodern
research is constantly striving to create space to
think differently. As Foucault himself said, ‘I don’t
write a book so that it will be the final word; I write
a book so that other books are possible, not
necessarily written by me’.70 How, then, did this
study open a space for new ways of thinking in my
own practice?
366 Physical Therapy Reviews 2012 VOL . 17 NO .
Significance
Postmodern studies look at the material effects of
discourses in the present and look to trace their
historical antecedents. In other words, they are
concerned with how it has become possible to think
and act the way we do. Physiotherapy has never
claimed to be a universal solution to people’s suffer-
ing. It is a partial response to a specific set of largely
physical impairments suffered by people, and it has
been remarkably successful in offering therapeutic
and rehabilitative solutions to a range of health
problems. However, it is only one solution among
many, and probably neither the best nor the most
appropriate in every case of bodily dysfunction,
injury or impairment, pain or movement disorder.
Where postmodern research comes into its own is in
asking how, given the myriad ways in which health
and illness are experienced by people, has physiother-
apy become such a dominant force in orthodox
physical rehabilitation? How has this become histori-
cally, politically and socially possible? And impor-
tantly, how is the profession being forced to change
in the early years of the new millennium?
Postmodern research is neither esoteric or engaged
in high-minded trivialities,53 but rather it is concerned
with the every-day practices that reveal the matrixes
of power, knowledge and discourse that are working
away silently behind our every action. As a result of
this study, we have made some pragmatic and highly
significant changes to the undergraduate physiother-
apy programme at AUT University in Auckland,
New Zealand; reconstructing the curriculum from the
bottom up and undertaking a root-and-branch review
of how we have traditionally taught students. We have
moved towards a more embodied view of health in
place of the traditional biomechanistic curriculum;
integrated pure sciences into clinically applied areas;
emphasized the humanistic and socio-political dimen-
sions of practice; made the students more aware of the
discourses that have driven the profession in the past;
and we have sought to do this without losing any of the
vital features of physiotherapy that have defined our
profession in the past. We began the curriculum review
process in 2007 and have spent more than 1000 hours
in debating, discussing and developing the pro-
gramme. Our first cohort of students in the new
programme will graduate at the end of 2013.
We have also begun a funded research programme
looking more widely at ‘bleeding edge’ physiotherapy
practices; using the Breathing Works study as a
methodological template for our methods of data
collection and analysis. We hope that this reveals
some new and interesting ways in which physiother-
apy practices are testing the margins of orthodoxy.
Our hope is that we challenge registration boards,
physiotherapy schools, and individual practitioners
6

to ask questions about their profession and the
boundaries they presently impose. Importantly, we
also want to show people that it might be possible to
develop physiotherapy practice in new directions that
are both acceptable to the public, legitimate in the
eyes of the state and our various funders and
stakeholders, and highly relevant to the needs of the
public in the twenty-first century.
Conclusion
Physiotherapy is a profession in which our very faith
in the virtues of a scientific and bio-mechanical view
of the body is well very established and often taken-
for-granted by its practitioners. And yet, as well as
being physiotherapists, we are also citizens of the
world and we exist in a time of greater skepticism
towards the grand narratives that our grandparents
took for granted. Not surprisingly then, the calls for
reform in the profession grow louder by the day.
Postmodernism can help us respond to these calls in a
number of ways. Firstly, it can teach us techniques of
critical thinking; of asking questions of those things
that normally pass unquestioningly beneath our
gaze. Secondly, it can help us reveal the discourses
that have made our present forms of physiotherapy
possible, and it can help us understand why physio-
therapy is as it is. Thirdly, it can open a space to think
differently about our practice in the future.
In this paper I have provided a very brief review of
postmodernism as a philosophy and as an approach
to research. In the paper I have outlined some of the
key principles and virtues of postmodern research
and shown how this approach may be a highly rele-
vant and interesting approach to research in phy-
siotherapy. The health care environment we operate
in is becoming increasingly diverse, and there seems
little likelihood that physiotherapists will retain their
professional relevance if they are not able to critically
examine the philosophical principles that underpin
their everyday practice and respond to the increas-
ingly complex and varied demands of individual
consumers of health care services and the health care
system at large. Postmodernism’s constant skepticism
towards metanarratives provide some innovative and
interesting ways to tackle this question, and the
openness towards diversity and inclusiveness may
create the space necessary within the profession for
new growth and innovation in practice in the future.
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