Rodney Schlegel discusses the concept of pathokinesiology and its relationship to physical therapy. While he agrees pathokinesiology is important, he does not think it should be considered synonymous with or restrictive to the definition of physical therapy. Defining physical therapy solely based on pathokinesiology and exercise could overly restrict the profession's scope of practice. Instead, Schlegel argues physical therapy should focus on developing clinical specializations and demonstrating competence to expand into new areas of health care.

1. Is Pathokinesiology Synonymous with Physical
Therapy?
Rodney Schlegel
PHYS THER. 1986; 66:366-367.
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2. Is Pathokinesiology Synonymous with
Physical Therapy?
RODNEY SCHLEGEL
Key Words: Pathokinesiology, Physical therapy.
Hislop, in her 1975 Mary McMillan I believe that such a definition, in fact, With regard to prevention, we as
Lecture, presented a conceptual frame- would be restrictive. I believe that forc- physical therapists have relied on medi-
work for the role of pathokinesiology in ing the focus on pathokinesiology and cal referrals for the care of ill and injured
physical therapy.1 I find it somewhat therapeutic exercise would hinder our persons. We have, within this model,
difficult to address the implications of efforts to expand into other areas of practiced preventive care primarily in
theory and research in pathokinesiology health and wellness programs. Those terms of preventing future or recurring
as it pertains to physical therapy because people operating at the political-legisla- injuries or illnesses of those persons re-
I have not accepted totally the concept tive levels who are defining our legal ferred to us. We have, as a profession,
as it has been presented. I agree with privilege to practice will not be able to been slow to respond to the emerging
Hislop that physical therapists need a understand the concepts as they have area of wellness.
strong identification to survive the di- been presented in the pyramid structure Ifinddifficulty in accepting the label
lution of health care occupations by or in a multifaceted description of what "unique" in light of activities performed
newly emerging ones. I further believe motion is. We must be able to speak the by those in other professions. By saying
that pathokinesiology and its construed language of those individuals who are that we are unique in our application of
synonym movement dysfunction should responsible for legislating our practice. exercise, do we mean that certified ath-
be a major part of our profession. Path- These legislators, who are plumbers, letic trainers do not practice preventive
okinesiology may represent, in fact, lawyers, delicatessen proprietors, and care for athletes to decrease injuries re-
what the majority of physical therapists such by trade, for the most part, are sulting in motion disorders? Does it
do. I do not agree, however, with His- extremely busy during legislative ses- mean that the graduate exercise physiol-
lop's statement that "establishing a sions and have insufficient time to sit ogist does not work to increase the mo-
strong identity is not a question of re- and listen to rhetoric about phagocytosis bility of the patient with a cardiovascu-
striction."1 My disagreement is based on at the cellular level. I believe that we lar disorder? Does it mean that persons
descriptions and definitions presented in need to be very careful how we word the
working in special education do not
her lecture, including 1) the concept of definition for physical therapy because
work to improve the physical capabili-
the pyramid structure of physical ther- of the ultimate restrictions that will be
ties of children with movement dysfunc-
apy with the apex being therapeutic ex- placed on us. For example, physical
tion? Does it, in fact, align us with some
ercise and pathokinesiology and 2) her therapy traditionally has been defined
of the new faces on the block who refer
statement that "motion is a concept that to include physical agents. Thus, the
to themselves as kinetic therapists or
must be viewed beyond the purposeful federal reimbursement regulations re-
quire even physical therapists who pro- movement therapists? I think that the
contractions of skeletal muscle initiated
by a complex nervous system mo- vide only home health care to have an answer to all of these questions is no.
tion occurs at every level in the human office with whirlpool, ultrasound, and To me, it is less important to know
organism."1 She then provides examples other modalities, even though those mo- who can provide certain health care
of motion that occurs at various levels: dalities may never be used and the office services, including pathokinesiology,
at the cellular level, phagocytosis; the will never be used to see a patient. It is than it is to know that those providing
tissue level, blood flow; the organ level, conceivable to me that, should we press the services have competence in the
muscular contraction; the personal the definition of our discipline as being area. I believe that the "bottom line" of
level, locomotion; and the systems level, pathokinesiology and exercise, we in the delivering health care is competence.
reflex activity. She then defines physical end may be restricted, at least in terms We should strive in every specialized
therapy as a "health profession that em- of reimbursement, to only therapeutic area of physical therapy to develop the
phasizes the sciences of pathokinesiol- exercise or increasing musculoskeletal highest level of competence possible. Al-
ogy and the application of therapeutic motion. though in my lifetime I probably will
exercise for the prevention, evaluation, Hislop also related that "physical ther- not see competence as being the sole
and treatment of disorders of human apy can claim the unique privilege of determining factor for allowing or dis-
motion."1 placing the role of exercise in health and allowing practitioners to provide health
disease in a proper scientific focus and care services to the public, I believe that
perspective."1 I believe some key words a step in therightdirection is to provide
in Hislop's statements regarding our recognition to those who demonstrate
Mr. Schlegel is Director of Rehabilitation, The
Union Memorial Hospital, 201 E University Pkwy, care of motion disorders are the words advanced clinical competence in a de-
Baltimore, MD 21218 (USA). "prevention" and "unique." fined area of practice.
366 Downloaded from http://ptjournal.apta.org/ by guest on April 14, 2012 PHYSICAL THERAPY

3. PATHOKINESIOLOGY
I would like to see specialization de- I believe that the movement toward sented in a logical order. The model of
veloped in a prospective manner. To specialization will encourage necessary pathokinesiology with its subsciences of
date, specialization has evolved in re- research in physical therapy. One issue anatomy, physiology, pathology, bio-
sponse to conflicts between members of that has been and is still being debated chemistry, chemistry, and psychology
disciplines over the right to provide and is the educational level that a physical and a physical therapy practice system
be paid for certain services. Examples therapist should attain to conduct designed to intervene purposely at the
are specialization in sports physical ther- meaningful research. There are those appropriate level of the human orga-
apy in response to conflicts with certi- who hold that only those therapists hav- nism movement system may serve best
fied athletic trainers, certification in ing a Master of Science degree or a as a consistent framework for the phys-
clinical electrophysiologic physical ther- doctorate have the requisite back- ical therapy education curricula, thus,
apy following conflicts with physiatry, ground. Hislop related in her lecture providing a closer common bond be-
and certification in cardiopulmonary that we must support doctoral education tween the young therapists entering the
physical therapy following conflicts with in pathokinesiology or physical therapy profession.
respiratory therapy. I hope that we can or we will be reduced to mental pick- In summary, I believe that physical
expand, as necessary through education, pockets of others outside our profession therapy is a business, a health trade if
training, and experience, those clinical who are developing the knowledge that you will, with complex interactions with
areas wherein physical therapists need supports advances in our field. I agree other disciplines in an era of fierce com-
to demonstrate a high level of compe- that we should support doctorate pro- petition for recognition as the experts in
tence. I also hope that great effort will grams in physical therapy, but I also providing certain types of health care
be exerted by the physical therapy com- recognize that many physical therapists services. We could be wasting our time,
munity to incorporate into state practice without a doctorate have the ability to and I emphasize "could," by promoting
acts provisions for those with docu- exercise their intelligence and, in fact, a definition of physical therapy in terms
mented advanced clinical competence demonstrate a high level of intuitive of pathokinesiology and movement dys-
so that those individuals may provide thinking. These clinicians, experienced function that is not understood clearly
nontraditional care. I share the dream in the healing arts, are in an optimal by legislators and that could result in a
with Hislop that "clinical specialists, position to identify areas of patient care practice restricted to exercise and mus-
born in science, nurtured in reason, sea- and wellness needing research. They are culoskeletal motion.
soned in practice, and blended with in a position to develop hypotheses. At I believe that it is less important to
compassion will begin to deal in physical the same time, some "pure" researchers emphasize the uniqueness of the services
therapy with questions that have chal- who have the highest level of expertise that we provide than it is to demonstrate
lenged the human intellect and the hu- in the methodology of research either 1) the quality and worth of our services.
man spirit."1 I further hope that we will do not know what questions need to be We need to have available published
provide the numbers of physical thera- asked to improve patient care or 2) do results of valid research that answer im-
pists with clinical specialization that will not have access to a population of pa- portant clinical questions about the in-
be necessary to make an impact on the tients having various disorders. My ex- dications for, and the worth of, our serv-
American health care system. Frankly, perience suggests that development of a ices. Such documentation absolutely is
we have lost some battles and some cooperative relationship between the essential to justify the trust of our pa-
areas of responsibility because of our two parties is not demeaning to physical tients and our communities and to sub-
small numbers. On the one hand, it is therapy, nor does it reduce the non-PhD stantiate the compensation we deserve
nice to say that the demand for physical therapist to a mental pickpocket. In- for our services.
therapists is greater than the supply. On stead, it should be viewed as a coopera-
the other hand, we have not been able tive interdisciplinary project, a sym-
to expand into certain areas or even to biotic relationship.
maintain certain areas of responsibility Despite the problems just discussed, I REFERENCE
(other than by a select few) because of believe that the concepts of pathokine-
the unavailability of qualified physical 1. Hislop HJ: Tenth Mary McMillan lecture: The
siology as expressed by Hislop are con- not-so-impossible dream. Phys Ther 55:1069-
therapists. ceived reasonably and have been pre- 1080,1975
Volume 66 / Number 3, March 1986 367
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4. Is Pathokinesiology Synonymous with Physical
Therapy?
Rodney Schlegel
PHYS THER. 1986; 66:366-367.
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