This document provides a retrospective analysis of the concept of pathokinesiology in physical therapy from its introduction 10 years prior. It examines how the concept was originally described and questions whether it remains a valid and useful concept for the profession. The document analyzes whether the concept is valid based on authoritative declaration, transformation from an existing concept, deduction, or scientific induction. It ultimately argues the profession must critically examine the concept to ensure it has a scientific basis and helps establish the identity and goals of physical therapy.

1. Definitional Issues in Pathokinesiology−−A
Retrospective and Look Ahead
Ruth B Purtilo
PHYS THER. 1986; 66:372-374.
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2. Definitional Issues in Pathokinesiology—
A Retrospective and Look Ahead
RUTH B. PURTILO
Key Words: Pathokinesiology, Physical therapy.
Ten years have passed since the con- my friends, if not we ourselves, is to its having been declared "the essence of
cept of pathokinesiology was introduced speak for the spirit and essence (italics physical therapy"1 by a respected and
added] of physical therapy?1
into physical therapy. Examining it revered member of the profession?
from a philosopher's perspective, this In her description of it, pathokinesi- Clearly, Hislop did not intend to bring
article provides a brief retrospective on ology was viewed as critical to the it into being solely by saying that it was
how the concept originally was de- uniqueness of physical therapy. Today, so. In fact, she solidly grounds her
scribed, poses some questions about the a decade later, pathokinesiology still statements in evidence derived from an-
type of concept it has become, and sug- seems to be accepted as a fundamental atomic and physiologic substrates, in-
gests what it might now be able to help physical therapy concept. But because cluding exercise physiology, pathokinet-
the profession of physical therapy the profession of physical therapy has ics, biomechanics, and neuropathology.
achieve. become developed and refined further Those who have used the term in the
in the 10 years since the concept was decade since it was introduced, however,
INITIAL DESCRIPTION introduced, it is timely to reevaluate the may not have been as judicious as His-
concept in light of today's profession. lop in developing a personal under-
What was the initial description ofthe No one would encourage this spirit of standing of the nature and utility of the
concept of pathokinesiology! Many critical inquiry more enthusiastically concept. Today, this places the profes-
physical therapists in the audience ex- than Hislop herself. sion in danger of treating the concept as
perienced a swell of excitement—like a
a reality simply because for 10 years it
wave that had been approaching and VALIDITY OF CURRENT has been among us as a "given" (and, of
suddenly broke at the shore—when His- CONCEPTS course, has a very scientific "ring"). Un-
lop introduced the term pathokinesiol- critical acceptance of any concept even-
ogy into physical therapy during her On what basis today does the concept
of pathokinesiology rest its validity in tually coerces persons using the concept
presentation as a Mary McMillan lec- to point solely to the authority of the
turer stating, "What is physical therapy? physical therapy! Any entity, including
person who introduced it to validate that
Physical therapy is knowledge. Physical a concept, can become "real" or "be-
the concept is real. If physical therapists
therapy is clinical science . . . pathoki- lieved in" as having its own validity. For
do not examine critically the concept of
nesiology is the distinguishing clinical instance, in many religious groups the
pathokinesiology, future generations of
science of physical therapy."1 presence of an afterlife is accepted as a
physical therapists are at risk of having
Even though she went on to develop reality. In physics, the formula E = MC2
to accept its validity on the basis that
other postulates and ideas, with this par- is accepted as real. There are several "Hislop [and others promoting the con-
agraph Hislop had taken a bold leap. methods by which humans "validate" cept] said so." Hislop, herself, warns that
She intended that the concept of path- that something is real. Some common such persons will "become victims of
okinesiology would provide physical methods are 1) someone in authority self-made delusions."1
therapy with a much needed identifying declaring it to be real, 2) transforming
one real thing into another, 3) deductive Is a concept that has become real only
characteristic. because an authority declared it to be so
methods, and 4) induction. In examin-
Physical therapy today is in the midst of any utility? A concept created solely
of a crisis of identity; it is, indeed, a ing the concept of pathokinesiology, it
profession in search of an identity is important to discern which of these by declaration out of nothing may have
This, of all times in our history, is a methods most accurately describes the a rhetorical utility for a time by persuad-
time for strong identification. We basis by which pathokinesiology can be ing users of the term that they rest their
must ask ourselves if in our attempt said today to have validity in physical identity on a solid conceptual founda-
to develop in multiple directions we tion. Some declarations of this sort (eg,
have assumed a cloak of unidentifia- therapy.
bility; if in our rhetoric we have trans- religious concepts) also are useful in
mogrified our ideals; and if in our Declaration helping to sustain belief systems that
desire for acceptance we have become provide meaning and coherence to a
victims of self-made delusion. Who, Probably the most famous example of person's existence. But by no means can
something becoming real by an author- a concept validated by authoritative dec-
itative declaration is, "Let there be light, laration alone pass scientific scrutiny—
Dr. Purtilo, is Professor and Chairman, Depart- And there was light!" To what extent a test many users of the concept of path-
ment of Medical Jurisprudence and Humanities, has pathokinesiology become a valid okinesiology have contended it should,
University of Nebraska Medical Center, 42nd and
Dewey Ave, Omaha, NE 68105 (USA). concept in physical therapy by virtue of and hoped it would, pass. Consequently,
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PHYSICAL THERAPY

3. PATHOKINESIOLOGY
the danger of disutility is greater than cept—which other authors in this series circumstantial evidence that would sup-
the promise of usefulness if pathokine- propose has had validity since its intro- port the phenomenon of a land mass
siology is simply such a concept, leaving duction by Hislop—into something less exhibiting the various characteristics he
the profession potentially holding the essential, or totally nonessential, to the described.
proverbial empty bag. definition of the physical therapy profes- To what degree today might the con-
sion. cept of pathokinesiology be a deduced
Alchemy An example of one distortion taking phenomenon? It is a not-so-well-kept
place is that today some writings about secret that we proceed by deduction in
Some concepts gain recognition as
pathokinesiology make no mention some physical therapy procedures, rely-
being real by being transformed from an
whatsoever of the context in which this ing less on hard science than on com-
existing concept. That is, such a concept
concept necessarily and integrally was pelling circumstantial evidence.
is made from something else that al-
ready exists rather than being created placed by Hislop. The writers are guilty The utility of a concept arrived at by
from nothing. of quoting out of context. According to deduction is that it may embrace many
Hislop, the concept should be discussed more perspectives than one very nar-
In his seminal book The Discovery of and understood only within an over- rowly culled out by traditional inductive
Nature, Albert Bettex describes in fetch- arching pyramidal framework that re- methods used in science as we know it
ing detail how for almost 2,000 years quires several levels of physical therapy today. Hislop's creative use of existing
investigations of many phenomena were intervention and has its foundations in practice concepts and methods to dis-
governed by the principal of alchemy.2 social and cultural needs. Pathokinesi- cern that pathokinesiology is an impor-
Most alchemists worked with minerals ology, then, as Hislop meant it to be tant identifying characteristic of physi-
and material elements. They also understood, should not be considered cal therapy exemplifies the best use
worked tirelessly to produce "the philos- outside of a scientific and larger social of deductive reasoning, though she also
opher stone" from what they believed cultural framework. attempted to substantiate the scientific
to be the basic substances of phosphorus In summary, the alchemist developed basis of the concept. She was wise in
and moisture. The philosopher stone and refined by working with existing attempting to use both methods in the
would hold sway over metals and give entities, attempting always to improve development of the original concept be-
the human being power over the process the substance. The profession of physi- cause physical therapy today increas-
of transformation in matter. Many an cal therapy will benefit by examining ingly is required to substantiate its meth-
alchemist's life was spent in pursuit of the extent to which transformation into ods and the basis of its results scientifi-
transforming tin, arsenic, or other com- a refined concept might be replacing the cally. A concept of pathokinesiology
mon substances into the much hoped original understanding of pathokinesi- based solely on deduction cannot assist
for gold. ology. Mere distortion of the concept the profession in meeting such a require-
One motivation of the alchemist was will lead to disutility, thwarting the goal ment.
always the hope that there would be a of helping the profession establish its
progression toward a more precious sub- identity by reference to the concept of
stance; for instance, salt had been ob- pathokinesiology, but refinement can Induction
served coming out of water. By way of benefit the profession greatly.
analogy, concepts also can become real Some phenomena of great utility have
by alchemy. Over a period of time, an come into being as the result of the
Deduction
original concept can be applied to simi- inductive (ie, scientific) method of in-
lar but distinct situations so that even- Some concepts come into being as the quiry. The emergence of the "magic bul-
tually a new concept replaces the old. result of a deductive process. In deduc- let" is an example.4 The concept that a
The physical therapy concept of patho- tion, one begins with a basic set of prem- medicinal substance could be adminis-
kinesiology may have become trans- ises and draws from it an understanding tered to decrease general observable
formed in this manner in the past 10 of a given phenomenon. Much can be signs and symptoms long has been de-
years. If this has happened, its utility accomplished by this approach. For ex- duced. However, for antibiotics to be
could be that the concept as it originally ample, in the late 1800s John Murray discovered, developed, and understood,
was presented by Hislop, and which was deduced the existence of Antarctica. In the theories, tools, and methods of mod-
useful at the time, has been transformed 1893, he presented to the Royal Geo- ern scientific inquiry had to be used. In
into a new, yet more accurately ex- graphic Society a correct description of the justification presented to the Amer-
pressed and understood, concept. The the Antarctic continent, though he had ican Physical Therapy Association to
extent to which this has occurred should never seen it. Annie Dillard reports: hold the 1984 Pathokinesiology sym-
become more apparent in the course of In his presentation, the conclusions of posium, the planners said that despite
reading this series. which he had deduced, he posited a the movement to embrace pathokinesi-
A potential disutility exists in the large single continent. Remarkably, he ology as the science of physical therapy,
alchemist's approach, however. In al- described accurately the continent's there is no existing retrievable literature
typology, including its central plateau, in pathokinesiology; there is no theory
chemy, the result usually was distortion its high pressure system, the enormous
without refinement and sometimes also glacier which faces the southern in pathokinesiology; and without these
the loss of the scarce raw materials (in ocean, that it had volcanic ranges on two essential elements, there is no sci-
addition to the alchemist's life, should one coast, and its 3lowland ranges and ence of pathokinesiology. The concept
hills on the other. of pathokinesiology has the most poten-
he be hapless enough to be employed by
a king). Physical therapists, too, are ca- In other words, he deduced correctly tial for furthering the profession of phys-
pable of transforming the original con- knowing only the basic theories and the ical therapy if it can be demonstrated to
Volume 66 / Number 3, March 1986 373
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4. be a scientifically based concept. Be- ical therapists neglect to engage in a What is this enigmatic impulse that
cause this series in PHYSICAL THERAPY diligent search for its roots and appro- does not allow one to settle down in
the achieved, thefinished?I think it is
is devoted to examining the extent to priate shape in today's practice of phys- a quest for reality. I give to this word
which the science of pathokinesiology ical therapy. The charge to engage in its naive and solemn meaning, a
exists, nothing more will be said about continued scrutiny comes directly from meaning having nothing to do with
it here. Hislop. philosophical debates of the last few
centuries. It is the Earth as seen by
In summary, despite the pervasive use I believe that we have the power to Nils from the back of the gander and
of the concept of pathokinesiology as an shape the future in ways that will by the author of the Latin ode from
identifying characteristic of physical vastly improve our condition. On the the back of Pegasus. Undoubtedly,
other hand, we also have the power to that Earth is and her riches cannot be
therapy, it remains important to exam- destroy our profession as we know it exhausted by any description.5
ine the grounds for accepting the con- by wandering without a strong iden-
cept. Today, a decade after the concept tity. The value of physical therapy to Each physical therapist can be a part
was introduced, it might be considered the total health care of the public can of that enigmatic impulse that moves
valid solely because it was declared to be assessed only within its [the pub- the profession ahead in ways that will
lic's] value system.1
be, it might have become transformed serve both the profession and society
into something other than its original What does the public value? Hislop well. The examination of the concept of
meaning, it might be solely a deduced concludes that the public asks of any pathokinesiology is one small, but sig-
phenomenon, or it might be a scientifi- profession that the profession have sci- nificant, example of the profession's
cally derived phenomenon. Likely, it is entific merit, humanistic merit, and so- quest for reality.
some combination of the above. cial goals. It follows that the concept of
pathokinesiology cannot be evaluated REFERENCES
accurately outside of the scientific or the
1. Hislop HJ: Tenth Mary McMillan lecture: The
TODAY'S TASKS larger humanistic and social context. Not-so-impossible dream. Phys Ther 55:1069-
I hope that the 1984 symposium and 1080,1975
What, then, should physical therapists this series of articles are not the end but 2. Bettex A: The Discovery of Nature. New York,
NY, Simon & Schuster Inc. 1965, pp 9-16
concerned about the concept of pathoki- only an important moment in the 3. Dillard A: Teaching a Stone to Talk: Expedition
nesiology today do? Above all, physical profession's ongoing inquiry into path- and Encounters. New York, NY, Harper & Row,
Publishers Inc. 1983, pp 90-91
therapists must persevere in evaluating okinesiology as a guiding concept in the 4. Lyons AS, Petrucelli RJ: Medicine: An Illus-
the concept critically and thoroughly. profession. In his 1979 Nobel prize lec- trated History. New York, NY, Harry N Abrams
The concept of pathokinesiology surely ture, Czeslaw Milosz appeared to have Inc. 1978, pp 589-590
5. Milosz C: Nobel Lecture (translated from Pol-
will become chillingly vacuous or be characteristics useful to physical thera- ish). New York, NY, Farrar, Straus & Giroux
reduced to simply a shrill slogan if phys- pists. Inc. 1981, p 6
374 PHYSICAL THERAPY
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5. Definitional Issues in Pathokinesiology−−A
Retrospective and Look Ahead
Ruth B Purtilo
PHYS THER. 1986; 66:372-374.
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