An Introduction to Environmental Physiotherapy

Original Editor - Pierre Roscher Top Contributors - Pierre Roscher, Tarina van der Stockt and Kim Jackson


Environmental Physiotherapy (EPT) started as an idea that encompasses a new field of physiotherapy, where key aspects of the environmental impact is considered, and respected to mutually benefit the physiotherapist and the patient. EPT covers areas of clinical practice, research and education, and bridges the various clinical specialities within Physiotherapy (Musculoskeletal, Cardiology, Neurology etc.).

What EPT is About

The field of EPT is rapidly developing and will expand greatly in the future, but a few key areas of EPT have been identified so far.[1]

1.     Physiotherapy as an environmentally friendly practice

Environmentally friendly physiotherapy practice utilises a "low tech", hands-on and interpersonal approach to managing patients. This minimises the negative impact on the environment to make physiotherapy eco friendly.[1]

2.     Environmental cost of Physiotherapy practices

The use of non-renewable resources like paper records and disposable products being used to run a physiotherapy service may also contribute to the environmental cost. This also includes aspects such as the amount of unnecessary electricity being used, and ways to use less electricity (e.g. Sun/air drying linen and towels instead of using a dryer).[1]

3.     Transportation costs related to Physiotherapy.

Looking at how patients reach our services may be a simple way to reduce our environmental footprint. Incentives may be offered to patients who are able to walk or cycle to appointments where possible and appropriate. Patients may be encouraged to adopt this principle with other appointments or errands too where appropriate. We also need to look at transportation for clinicians to attend meetings, congresses and functions relating to our own clinical upskilling, and implement and adopt ways of reducing the impact on the environment.[1]

4.     Environmentally friendly clinical setup

Most physiotherapy practices are indoors and require additional lighting and air-conditioning, but what if there was a way to incorporate natural light and airflow into our setups, without compromising patient privacy and care?

Each of these aspects may seem too small to create change, and you may be thinking "how much can an individual really do to save the environment". It is true that generally speaking, the major contributors to negative environmental change are big industries, but it is the collective effort of any individual that has a meaningful impact on the environment.[1]

The Big Global Issue

Nature provides us with essential resources to sustain human life such as air, water and food. As the human race advances and expands, our need to consume resources has increased, but we have not replenished and rehabilitated the eco-systems that we have damaged in our quest to develop industries and technologies. We have destroyed natural habitats to build cities, burnt down forests to create grazing lands for our cattle, and have mined the earth to extract minerals and precious metals for advancing technologies. All of these activities have had the negative effect of harming nature through air, water and land pollution. Some animal and plant species have been wiped off the earth and the biodiversity of some ecosystems are sensitively hanging on an edge. If we look at creating electricity, there is a certain amount of pollution that is created and released into the atmosphere to create this energy source. In the creation of industry and technology, we have sacrificed planetary health and wellbeing[2]. It is unfortunately the poorer communities with the fewest resources that suffer most, as planetary health highlights inequality among populations[2].

Case Example of the Impact of a Warming Climate

A warming climate affects human health directly and indirectly[3]. This increase in temperature affects maize crops around the world, and created more suitable conditions for infectious diseases. Extreme weather is also linked to mental health issues die to sleep irritation and lack of sleep caused by extreme heat.

The Global Move Towards Change

Approaches such as EcoHealth, OneHealth, Planetary Health and Sustainable Healthcare are all based on the understanding that there is a symbiotic relationship between human health, flourishing and a sustainable environment. The UN Agenda 2030 Sustainable Development Goals are closely related to these approaches in that human health and wellbeing cannot be achieved without a natural and social environment that supports it[4].

Self-reflection on Current Physiotherapy Practice

In order for us to change, we first need to look at our own current practices, and we need to reflect on ways that we can align ourselves with a more environmentally friendly way of practising. Change may take some time to occur, but the following basic steps may guide the process of crossing over into an environmentally friendly Physiotherapy practice.[1]

1.      Step 1: A willingness to make a change.

2.     Step 2: Understanding the relationship between health and the environment.

3.     Step 3: Identifying the aspects of our Physiotherapy practice that needs to change.

4.     Step 4: Expanding on this new field of Physiotherapy, and inspiring others to do the same.[1]

Active Transport: A Simple Way for Physiotherapists to Encourage Change

As Physiotherapists, we have a unique opportunity to contribute to planetary health and wellbeing. We can advocate for and encourage active transport concepts such as cycling to and from work. There are of course challenges and barriers to active transport, but European countries like the Netherlands, Denmark and Germany have successfully implemented this concept by ensuring that the infrastructure and other necessary facilities are set up for this initiative.[5]

Watch this video on Active Transport:

Possible Theoretical and Philosophical Foundations of EPT that may develop?

Philosophical and intersectional foundations for environmental EPT

Possible philosophical and practical foundations for environmentally aware and responsible physiotherapy. 

  • Indigenous ways of life, the environment and physiotherapy (e.g.:)
    • Maori definitions of health and the body
    • Sami understandings of healthcare and related practices
  • Philosophical perspectives
    • Environmental ethics and physiotherapy
    • Environment and gender in physiotherapy
    • Environmental justice and physiotherapy 

Environmental foundations of human health, function and wellbeing

  • The ecological foundations of human life on planet Earth (Draw on earth evolution, nature’s contribution to people and ecological determinants of health)
  • Anatomy and Physiology: The environmental composition of the human body: Oxygen exchange, Cell composition, Nutrients, Molecules, Microbiome

Environmental issues and their health impacts

  • Global environmental issues and their health impacts: An introduction to global environmental changes and their health impacts
    • Biodiversity loss, Climate Change (NCDs)
    • Air pollution (COPD, Asthma)
    • Plastic pollution (Microplastics in food)
    • Extreme weather events (Climate migration and associated physical and mental trauma)
  • Local environmental issues and their health impacts
    • Subdivide by country or similar depending on contributors context

The causes of global environmental change and related health issues

Beliefs and values, colonialism, industrialism, capitalism, racism… 

  • How these relate to health and ill-health
  • How they relate to physiotherapy
    • How we perpetuate them, and
    • How we might help to address them directly

The environment in clinical practice

  • Patient perspectives and experiences of engagement with natural environments (CLBP, MS, Quadruplegia)
  • Nature-based interventions in physiotherapy (outdoor exercise, greenspace exposure): Benefits for mental and physical health
  • Physiotherapy clinical environments
    • Exclusion of nature
    • Natural environments as clinical setting
  • Urban planning, work environments and physiotherapy
  • Active transport as environmental physiotherapy intervention (Adam Toner)
  • Environmental care and restoration as a physiotherapy intervention 

The environment in physiotherapy specialty fields and related pathologies

  • The environment and musculoskeletal physiotherapy, mental health, neuro, paediatrics, cardio-pulmonary physiotherapy, occupational health and ergonomics

Physiotherapy and other-than-human

  • Animals in Physiotherapy
    • Animal-assisted physiotherapy
    • Animal physiotherapy (physiotherapy for animals)
  • Plants in Physiotherapy
    • Plants in clinic rooms and their role in physiotherapy and rehabilitation
    • Plants in client lives and living spaces and their contribution to health
    • Plants as nutrition, medicine, clothing, shelter, therapy
  • Tools and other objects in physiotherapy
    • Their contribution to the clinical environment of physiotherapy
    • As used resources
    • Digitalisation and sustainability 

Physiotherapy and sustainability

  • An introduction to sustainability and its relation to physiotherapy 
  • Environmental sustainability in physiotherapy
    • How PT is environmentally more sustainable than other approaches
    • How PT can be even more environmentally sustainable
      • In clinical practice
      • Education
      • Research 

*The fundamental motivation and belief underpinning this page is ultimately that it is now time we invested in clearly seeing the role of the environment in our daily lives, physiotherapy practice and more, and that we adjust our thinking and react accordingly.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Maric, F. & Nicholls, D.A. (2019) A call for a new environmental physiotherapy – An editorial, Physiotherapy Theory and Practice, 35:10, 905-907, doi:10.1080/09593985.2019.1632006
  2. 2.0 2.1 Myers, S. (2017). Planetary health: protecting human health on a rapidly changing planet. The Lancet, 390, 2860- 2868. doi:10.1016/S0140-67361732846-5
  3. Watts, N., et al. (2020) The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet, doi:10.1016/S0140-6736(20)32290-X
  4. Maric, F. & Nicholls, D.A. (2020). Paradigm shifts are hard to come by: Looking ahead of COVID-19 with the social and environmental determinants of health and the UN SDGs. European Journal of Physiotherapy. doi:10.1080/21679169.2020.1826577
  5. Toner A, Lewis JS, Stanhope J, Maric F. Prescribing active transport as a planetary health intervention–benefits, challenges and recommendations. Physical Therapy Reviews. 2021 Jan 19:1-9.