Like many others, I started out in traditional physiotherapy settings with white clinic rooms, adjustable treatment tables and a gym. But over time, I began to feel increasingly disconnected from the people I was trying to help. Patients come into our world with their problems and leave with an explanation and colorful elastic bands. It’s a joke – and it’s not.
The clinical environments didn’t match the messy, beautiful realities of their lives. In physiotherapy we talk about evidence-based practice, the BPS-model, shared decision-making, and patient-centered care (Engel, 1977; Hoffmann et al., 2020; Sackett et al., 1996; Schuttner et al., 2022; Wijma et al., 2017). But I found myself asking: Can patient preferences be truly expressed if they’re always asked outside their own environment?
The settings haven’t really evolved from an outdated approach to physiotherapy and aren’t neutral. The table, the desk, the dead person without skin on the white walls still frame the encounter as one of the old days where something is broken and must be fixed. Even though we’re trying to really understand and meet the person in front of us it is challenging to grasp what their life is like. So I was thinking if these spaces are helping us move forward or holding us back?
I had to put my money where my mouth was
The idea was born from experience and a professional restlessness. I have a background in sports physiotherapy, where we naturally adapt rehabilitation to context. A footballer needs to move on the pitch, not merely in a rehab room. So why not take that same logic and apply it to everyone else?
So, I opened a private practice with no fixed location. Instead, patients chose the setting. Sometimes we walked or ran other times we met at a workplace, in a gym, or at home. The only rule: it had to be somewhere meaningful to the client.
Samuel Krogh Pedersen (PT, MSc)
Department of Physiotherapy, University College of Northern Denmark
Sam is a physiotherapist, educator, and researcher from Denmark. He’s concerned with person-centred care, environmental physiotherapy, and how challenging traditional clinical settings can create more meaningful and sustainable practices.
Working while walking
All big thinkers like Aristotle, Kant, Nietzsche praised walking. There’s something powerful about moving side by side. It softens hierarchy and it allows pauses and silences without awkwardness. It turns the therapy session into a shared journey – literally.
Instead of being separated by a treatment table and a computer screen, I was beside my client. Sometimes we talked, sometimes we moved, sometimes both. And sometimes, that’s exactly what they need: not a diagnosis or a protocol, but a person to help them in the environment where they are challenged.
One woman with prolonged heel pain told me that our walks around a lake made her feel like she was “rejoining the world of hiking.” Another man, recovering from lumbar radiculopathy, said our sessions by the track helped him feel like a runner again.
This way of working reflects James Gibson’s concept of affordances – the idea that environments offer opportunities for action, depending on who we are and what we bring (J. J. Gibson, 2015; Vaz et al., 2023). NOTE: Read the blog post from April 3rd. A curb becomes a balance challenge or a trail invites motion and reflection. The environment is alive with therapeutic potential, if we let it be. And it may lead to different affordances or action possibilities for both the patient and the therapist. Still, are the current physiotherapy settings fit for modern physiotherapy or are they pointing backwards?
Sustainability in practice
This is also about sustainability. Clients are more likely to adhere to rehabilitation when it happens in environments they enjoy and feel ownership of (Vallerand, 2000). It reduces travel, stress, and time away from their everyday life. For me, it reduced overhead costs, emotional fatigue, and gave me fewer days that felt like work. For the healthcare system, it encourages prevention and patient empowerment by embedding care in real-world settings. For the planet, it’s a small step away from resource-heavy infrastructures and towards more relational and low-impact models of care.
To me, sustainability in physiotherapy is not just about carbon footprints – it’s about restoring meaningful and context-sensitive relationships between people, environments and care.
Challenges and questions
Of course, this way of working comes with complications. The Danish weather doesn’t always cooperate. I have to be more flexible, and I may have to bring some equipment. Some gyms and sports clubs will not allow external practitioners. And yes, documentation becomes a bit trickier.
But what I’ve learned is that the most valuable tools in physiotherapy are not pictures of skeletons on the wall or resistance bands – they’re listening, presence, and adaptability.
This practice has also made me question some of our profession’s assumptions. Why is the clinic seen as the default setting for care? What messages do we send when we ask people to enter our spaces on our terms? The setting and context itself communicate something long before we say a word.
Stepping outside, literally and professionally
This isn’t a call for all physiotherapists to abandon their clinics. Clinics are valuable. But it is a call to reflect on how settings and contexts shape care and how care might look different if we let it breathe.
Physiotherapy doesn’t have to mean helping people within controlled environments. It can also mean accompanying them in their own context, trusting that healing often begins not with treatment, but with connection.
So yes, my clinic has no walls.
And sometimes, it has ducks.
References
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science (New York, N.Y.), 196(4286), 129–136. https://doi.org/10.1126/science.847460
Gibson, J. J. (2015). The ecological approach to visual perception. Psychology Press.
Hoffmann, T. C., Lewis, J., & Maher, C. G. (2020). Shared decision-making should be an integral part of physiotherapy practice. Physiotherapy, 107, 43–49. https://doi.org/10.1016/j.physio.2019.08.012
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: what it is and what it isn’t. BMJ, 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71
Schuttner, L., Hockett Sherlock, S., Simons, C. E., Johnson, N. L., Wirtz, E., Ralston, J. D., Rosland, A.-M., Nelson, K., & Sayre, G. (2022). My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity. Journal of General Internal Medicine, 37(16), 4189–4196. https://doi.org/10.1007/s11606-022-07533-1
Vallerand, R. J. (2000). Deci and Ryan’s Self-Determination Theory: A View from the Hierarchical Model of Intrinsic and Extrinsic Motivation. Psychological Inquiry, 11(4), 312–318. https://doi.org/10.1037/a0012801
Vaz, D. V., Stilwell, P., Coninx, S., Low, M., & Liebenson, C. (2023). Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management. Brazilian Journal of Physical Therapy, 27(5), 100554. https://doi.org/10.1016/j.bjpt.2023.100554
Wijma, A. J., Bletterman, A. N., Clark, J. R., Vervoort, S. C. J. M., Beetsma, A., Keizer, D., Nijs, J., & Van Wilgen, C. P. (2017). Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies. Physiotherapy Theory and Practice, 33(11), 825–840. https://doi.org/10.1080/09593985.2017.1357151
A salient and beautifully written piece – thank you Samuel. I agree that our profession needs to evolve towards more human and egalitarian connection.
Thank you so much for the support, Rachel. It’s so nice to know that there is an answer for clients who likes something else than everyone else.
what a fantastic thought provoking piece of writing – thank you
It inspired me to delve a bit more into the concept of affordances.
Always great to learn and be inspired to take that learning further!!
Much appreciated