EPIC Environmental physiotherapy in the clinic

Why physiotherapy is good for you and the environment


On this page, you will find relevant literature, background information and further details expanding on the different points made on the EPIC poster: ‘Why physiotherapy is good for you and the environment.’ Under each point you will find:

(1) Explanations for or why physiotherapy is good for your own health and the health of our planetary ecosystem

(2) Literature and pointers to reputable sources. Here, we consider authors who rely on recognised scientific knowledge and who can be proven to act independently (e.g. independently of companies or their interest groups) to be reputable sources. Commercial providers are not excluded in principle, as long as they work independently. In principle, despite the great care taken in our research, we cannot assume any liability for the correctness of the information provided by third parties. If in doubt, we hope you will research further yourself and inform us how we might improve what we are presenting here.

The EPIC poster ‘Why physiotherapy is good for you and the environment’ and the additional information provided on this page were developed as a collaboration between the Physiotherapists for Planetary Health organised under Health for Future in Germany and the Environmental Physiotherapy Association.

The examples and explanations we have collected here are meant to help you understand how physiotherapy can improve your individual health and simultaneously help address today’s interconnected social, ecological and health crises. The need to address these crises quickly and consistently requires action from all people, institutions and organisations, as outlined in the UN Agenda 2030 Sustainable Development Goals. Understanding how physiotherapy and other healthcare services can help us do so is critical for making good choices for health and our planetary ecosystem. To help us further develop and improve our EPIC posters and associated background information please see the information at the bottom of this page.

1. Physiotherapy saves energy and resources

Today’s health care relies on a multitude of processes, materials and interventions that must be reassessed in view of their environmental sustainability (Pierce & Jameton, 2004). These include a variety of production processes, building maintenance, waste management and many more (Jameton, 2009). In order to minimise negative environmental impacts resulting from the health system, recognition and urgent, large-scale implementation of good alternatives is urgently needed (UNEP, 2018).

With its focus on natural treatment modalities, physiotherapy is a highly relevant healthcare service on the road to greener healthcare systems (Maric & Nicholls, 2019). Through further research and involvement in the multidisciplinary health team, it would be logical for physiotherapy to play a major role in the development of good healthcare practice in the face of ecological disruption (Kind, Buth, & Peters, 2015). The German Alliance for Climate Change and Health and the Environmental Physiotherapy Association already offer some good practice examples in this regard (Maric et al., 2021).


Sources and information

Pierce, J., & Jameton, A. (2004). The Ethics of Environmentally Responsible Health Care. New York, NY: Oxford University Press.

Jameton, A. (2009). Medicine’s Role in Mitigating the Effects of Climate Change. AMA Journal of Ethics11(6), 465–469. https://doi.org/10.1001/virtualmentor.2009.11.6.msoc1-0906

United Nations Environment Program, UNEP (2018). The Emissions Gap Report 2018. United Nations Environment Programme, Nairobi. Retrieved from https://www.unenvironment.org/resources/emissions-gap-report-2018.

Maric, F., & Nicholls, D. (2019). A call for a new environmental physiotherapy – An editorial. Physiotherapy Theory and Practice35(10), 905–907. https://doi.org/10.1080/09593985.2019.1632006

Kind, C., Buth, M., & Peters, M. (2015). Gute Praxis der Anpassung an den Klimawandel in Deutschland. adelphi. Berlin (Climate Change). Retrieved from https://www.umweltbundesamt.de/sites/default/files/medien/378/publikationen/climate_change_22_2015_gute_praxis_der_anpassung_an_den_klimawandel.pdf

Maric, F., Chance-Larsen, K., Chevan, J., Jameson, S., Nicholls, D., Opsommer, E., Perveen, W., Richter, R., Stanhope, J., Stone, O., Strimpakos, N., Vieira, A., Williams, M., Zuber, S., & Söderlund, A.. (2021). A progress report on planetary health, environmental and sustainability education in physiotherapy – Editorial. European Journal of Physiotherapy23(4), 201–202. https://doi.org/10.1080/21679169.2021.1932981

2. Physiotherapy uses natural remedies such as movement, touch, and communication

Movement, communication and touch-based interventions are used for the majority of the health issues in the purview of physiotherapy. Additionally, natural remedies like electricity, light, heat and water can be used to support treatment. All of these modalities are not very resource-intensive, have a long history in healthcare through their abundance and proximity to nature and can therewith contribute to human health and the health of the environment alike (Bjorbækmo & Mengshoel, 2016; Salvo et al., 2021; Sanders et al., 2013; Stewart & Loftus, 2018).


Sources and information

Bjorbækmo, W. S., & Mengshoel, A. M. (2016). “A touch of physiotherapy” — the significance and meaning of touch in the practice of physiotherapy. Physiotherapy Theory and Practice, 32(1), 10-19. https://doi.org/10.3109/09593985.2015.1071449 

Salvo, D., Garcia, L., Reis, R. S., Stankov, I., Goel, R., Schipperijn, J., Hallal, P. C., Ding, D., & Pratt, M. (2021). Physical Activity Promotion and the United Nations Sustainable Development Goals: Building Synergies to Maximize Impact. Journal of Physical Activity and Health, 1–18. https://doi.org/10.1123/jpah.2021-0413

Sanders, T., Foster, N. E., Bishop, A., & Ong, B. N. (2013). Biopsychosocial care and the physiotherapy encounter: physiotherapists’ accounts of back pain consultations. BMC Musculoskeletal Disorders14(1), 65. https://doi.org/10.1186/1471-2474-14-65

Stewart, M. & Loftus, S. (2018). Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. The Journal of orthopaedic and sports physical therapy, 48(7), 519–522. https://doi.org/10.2519/jospt.2018.0610

3. Physiotherapy can reduce the need for medication and has few side effects for the body and the environment

For moderate musculoskeletal pain, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac are still the most commonly used interventions in medicine. Physiotherapy, in turn, can provide pain relief for patients through natural strategies such as movement, communication, and touch. Physiotherapy is better tolerated by patients than NSAIDs and has been shown to be at least as effective in treating moderate musculoskeletal pain (Babatunde et al., 2017). It is known that taking NSAIDs causes side effects on the human body, ecosystems and biodiversity alike, accounting for more than 15% of all drugs found in the ocean (Tyumina et al., 2020). Physiotherapy might prove itself an effective tool for reducing these detrimental effects of NSAIDs by reducing the overall use of medication (Banerjee & Maric, 2021).


Sources and information

Babatunde, O. O., Jordan, J. L., Van Der Windt, D. A., Hill, J. C., Foster, N. E., & Protheroe, J. (2017). Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLOS ONE12(6), e0178621. https://doi.org/10.1371/journal.pone.0178621

Banerjee, S., & Maric, F. (2021). Mitigating the environmental impact of NSAIDs – physiotherapy as a contribution to One Health and the SDGs. European Journal of Physiotherapy, 1–5. https://doi.org/10.1080/21679169.2021.1976272

Tyumina, E. A., Bazhutin, G. A., Cartagena Gómez, A. D. P., & Ivshina, I. B. (2020). Nonsteroidal Anti-inflammatory Drugs as Emerging Contaminants. Microbiology89(2), 148–163. https://doi.org/10.1134/s0026261720020125

4. By increasing mobility and fitness, physiotherapy enables active participation in social life and the natural environment

One of the goals of physiotherapy is to ensure people’s participation in their social and natural environment. This participation is supported by increasing mobility and physical functioning in physiotherapy treatment (Holm et al., 2015). As a result, patients can experience their natural environment again, for example during a walk through the forest, as well as participate in social life in activities with friends and family (Twohig-Bennett & Jones, 2018; Toner et al., 2021).


Sources and information

Holm, I., Tveter, A. T., Moseng, T., & Dagfinrud, H. (2015). Does outpatient physical therapy with the aim of improving health-related physical fitness influence the level of physical activity in patients with long-term musculoskeletal conditions? Physiotherapy, 101(3), 273–278. https://doi.org/10.1016/j.physio.2014.11.005

Toner, A., Lewis, J. S., Stanhope, J., & Maric, F. (2021). Prescribing active transport as a planetary health intervention – benefits, challenges and recommendations. Physical Therapy Reviews, 26(3), 159–167. https://doi.org/10.1080/10833196.2021.1876598

Twohig-Bennett, C., & Jones, A.. (2018). The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environmental Research166, 628–637. https://doi.org/10.1016/j.envres.2018.06.030

5. Physiotherapy facilitates the use of active and emission-saving means of transport like walking and cycling

By restoring and maintaining mobility through physiotherapy, it becomes easier to use emission-saving means of transport in everyday life (Toner et al., 2021). This reduces CO2 emissions and fewer associated pollutants are released into the atmosphere. The greenhouse gas effect is counteracted and global temperature rise is reduced (Mizdrak et al., 2020). At the same time, physical activities such as walking and cycling improve cardiovascular health and help prevent osteoporosis and many other health problems (Toner et al., 2021, Rojas-Rueda et al., 2016).


Sources and information

Mizdrak, A., Cobiac, L. J., Cleghorn, C. L., Woodward, A., & Blakely, T. (2020). Fuelling walking and cycling: human powered locomotion is associated with non-negligible greenhouse gas emissions. Scientific Reports10(1). https://doi.org/10.1038/s41598-020-66170-y

Rojas-Rueda, D., De Nazelle, A., Andersen, Z. J., Braun-Fahrländer, C., Bruha, J., Bruhova-Foltynova, H., Desqueyroux, H., Praznoczy, C., Ragettli, M. S., Tainio, M., & Nieuwenhuijsen, M. J. (2016). Health Impacts of Active Transportation in Europe. PLOS ONE11(3), e0149990. https://doi.org/10.1371/journal.pone.0149990

Toner, A., Lewis, J. S., Stanhope, J., & Maric, F. (2021). Prescribing active transport as a planetary health intervention – benefits, challenges and recommendations. Physical Therapy Reviews, 26(3), 159–167. https://doi.org/10.1080/10833196.2021.1876598

6. By preventing physical illness, physiotherapy reduces the need for resource-intensive health care

In football, it has been clearly shown that targeted prevention programs developed in cooperation with physiotherapists can reduce injury rates by 30-70% (Sadigursky et al., 2017). Similar results have been confirmed in other sports, as well as outside of sport, where targeted programs can reduce the risk of cardiovascular diseases, stroke and many other health problems. In this way, mortality rates can be reduced by more than 30% alongside gains in life years and quality of life (Löllgen, 2008). Those suffering from fewer health problems also have a lower need for complex and resource-intensive healthcare examinations and interventions that can further harm the environment and come with a risk of side effects for human health (Witt & Brüning, 2017).


Sources and information

Löllgen, H. (2008). Neue Befunde zur Prävention. Deutsche Zeitschrift fur Sportmedizin59(10), 243.

Sadigursky, D., Braid, J. A., De Lira, D. N. L., Machado, B. A. B., Carneiro, R. J. F., & Colavolpe, P. O. (2017). The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Science, Medicine and Rehabilitation9(1). https://doi.org/10.1186/s13102-017-0083-z

Witt, D. & Brüning, C. (2017). CT, MRT & CO: Wieviel Strom verbrauchen Großgeräte? kma – Klinik Management aktuell, 22(10), 75. https://doi.org/10.1055/s-0036-1594872

Have we missed anything?

Tell us about other reasons why physiotherapy is good for our health and the environment!

Because environmental physiotherapy is still a very young field of research, education, and practice, there is a lot that still needs to be tested, trialled and further developed. For this reason, we hope that you will support the ongoing refinement of our EPIC posters and associated resources for clinical practice. Several kinds of support are needed virtually immediately:

1. We are in need of translations and contextual adaptations of existing posters and support materials into as many languages as possible. If you can volunteer your time and efforts for this purpose, please get in touch using the contact form below.

2. We would appreciate your feedback on the existing posters to help us add new suggestions, improve existing ones, and further strengthen the evidence-base to support what we are suggesting. Let us know which suggestions make sense, which are difficult to put into practice, how we can better adjust the posters and other recommendations to your specific context and anything else that comes to mind using the contact form below.

3. We are looking for a team of volunteers keen on creating another EPIC poster. If this sounds like you, please get in touch using the contact form below.

Thanks for your support!  🌍 🌏 🌎 🚑  #EnviroPT

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