Off the Treadmill, Into the Field How might nature shape the future of MSK care?

Observing clinicians across the landscape of musculoskeletal care, I see the relentless effort poured into every consultation. Everyone is doing their best in the healthcare system, be that public or private, but as we know, the workload and complexity have increased. The total number of people living with an MSK disorder globally sits at approximately 1.68 billion representing a 95% increase in total cases since 1990 [1] and are on a trajectory to expand by more than half by 2050 [2]. While physiotherapists have significantly increased their scope of practice over the last 40 years, in particular into areas of practice that were historically occupied by medicine, how are we managing this continuing and increasingly challenging future? Recent research suggests that physiotherapists in the UK are struggling with burnout [3–6], work related stress [7] impacting on wellbeing resulting in moral distress and injury [8,9]. It appears that the profession is stretched holding the professional duties, roles, responsibilities and obligations in one hand and trying to adapt to growing and multiple patient, societal and system related influences in the other. This can make clinicians feel trapped, stagnant, and stuck in a healthcare system that itself is struggling to adapt.

In a way, we feel like we are on a treadmill, walking, running, even sprinting, but never getting anywhere.

Dave Nicholls captured our current predicament beautifully in his 2024 IFOMPT presentation in Basel, titled ‘The post-professional futures for the physical therapies’ [10]. He articulated the profound global and specific challenges facing our profession, pointing to three forces that are actively accelerating them: late-stage capitalism, the unbundling of expertise, and digital disruption. Dave asked penetrating questions about what comes next, concluding that we must uncover what truly lies beneath the surface of physical therapy. Only by doing so can we open up opportunities to adapt to this rapidly unravelling landscape.

Before we attempt to answer this question let’s briefly take a history of the present of MSK physiotherapy.