Sustainable Physiotherapy Practice – Building the future

Context

The School of Health Sciences of Lausanne (HESAV – Haute École de Santé Vaud) is part of the University of Applied Sciences and Arts Western Switzerland (HES-SO). Among its academic offerings, HESAV provides a full-time professional training programme in physiotherapy: a six-semester Bachelor of Science HES-SO in Physiotherapy (3 years, 180 ECTS). In Switzerland, this degree is required to practice as a physiotherapist. It can be followed by a Master of Health Science HES-SO/UNIL with a specialization in physiotherapy, and eventually by a doctoral programme.

The course described here takes place in the sixth and final semester of the Bachelor’s programme, within a compulsory module titled Professional Contexts. It was co-created with a colleague—an experienced physiotherapist and lecturer in musculoskeletal (MSK) physiotherapy—who has since transitioned to a new profession as a market gardener.

The course spans eight periods and is delivered over two half-days. It is titled “Environmental Physiotherapy – Building the Future”. Its overarching aim is to challenge conventional MSK physiotherapy practice, particularly regarding its operational model and its interaction with patients, insurers, the state, and financial structures.

Part 1: Rethinking the Future – Reflections and Testimonial Utopia

The first half-day focuses on broadening students’ perspectives. Through a series of thought-provoking inputs, students are encouraged to explore the role of imagination in shaping desirable futures, the urgency of reconciling humanity with the natural world, and the need to re-evaluate our relationship with money and economic models (inspired by thinkers such as Cyril Dion, Rutger Bregman, Healthpunk, and Timothée Parrique).

A key feature of this session is a testimonial by Benoît, a former physiotherapist and lecturer, who shares his personal journey toward professional reinvention as a market gardener according to the organic microfarm concept. His story serves as a springboard for discussion, particularly in drawing parallels between the resilience and sustainability of a new and innovative agricultural systems and those of the healthcare sector.

Part 2: Designing the Future – Creating a Sustainable Physiotherapy Practice

The second half-day shifts from reflection to action. Students work in small groups to design a sustainable physiotherapy practice, resulting in a physical 3D model and a realistic financial plan. Only low-tech materials are used—cardboard, glue, wooden sticks, etc.—to emphasize creativity over technical sophistication. The financial plans are based on simplified but realistic accounting templates for a physiotherapy clinic.

Projects must meet the following criteria:

The clinic’s operations must integrate systems beyond the conventional biomedical model. This new perspective seeks to forge connections among diverse sectors-such as health, education, skilled trades, food provision, and agriculture-to foster a more autonomous, locally driven, and cyclical system that encompasses all aspects of community life. For example, a practice located near a forest might involve the physiotherapist also engaging in woodworking or foraging activities that contribute to the clinic’s self-sufficiency and reduce utility costs.

The natural environment must play an active role in the clinic’s operation—not merely as a backdrop. Nature-based therapy, renewable cooling systems using ocean water, and other ecological integrations are encouraged.

The architectural design should prioritize ecological responsibility, including the use of renewable energy sources, natural or recycled materials, and water harvesting solutions.

The economic business plan must prioritise income diversification, ensuring that revenue is generated not only through healthcare insurance system, but also through varied local partnerships.

To guide the process, each group was assigned specific financial and operational constraints and asked to choose a natural setting for their practice. Possible locations included a volcano, ocean beach, lake, mountain, abandoned football stadium, wild forest, or riverbed. For example, one group situated in the wild forest (location) had to ensure that no more than 50% of their revenue came from physiotherapy services (financial constraint) and needed to create partnership with at least two sectors other than medical (operational constraint).

Fanny Poget (MSc)

Maître d’enseignement, HESAV Lausanne

Fanny enseigne en physiothérapie principalement dans le domaine musculo-squelettique, avec un intérêt particulier pour le raisonnement clinique, l’autonomisation des patients, l’activité physique, ainsi que par les enjeux futurs de la profession en lien avec la santé publique, tels que durabilité et efficience thérapeutique.

Sarah Thouvenin (MSc)

Maître d’enseignement, HESAV Lausanne, HESAV Lausanne

Sarah enseigne principalement le raisonnement clinique et en simulation. Spécialisée dans la santé de la femme et du nourrisson, elle favorise une approche globale du patient et attache une grande importance à l’intégration des principes de durabilité dans le développement de la physiothérapie de demain.

Benoît Girardin (PT OMT svomp, Mas TherMan, maraicher CFC)

Lecturer and market gardener, Villarsiviriaux, Switzerland

Benoit pratique la physiothérapie dans un cabinet privé et intervient dans divers cours notamment en thérapie manuelle. Il est aussi maraicher et exploite une microferme maraichère et arboricole. Il est président de l’association suisse des microfermes et est actif dans la défense d’une agriculture durable et dans les enjeux futurs en physiothérapie.

Outcomes

The course led to a wide range of innovative and inspiring projects. Students created visions of physiotherapy practices they would genuinely aspire to work in. Many projects combined physiotherapy with broader health promotion activities such as school-based interventions, paddleboarding classes, gardening, or nature-based therapies.

Others extended far beyond traditional physiotherapy. Some students imagined ventures such as growing and distributing vegetables, producing wine or goat cheese, delivering produce to elderly patients during home visits, or managing eco-tourism and bed-and-breakfast accommodations. These creative expansions demonstrated a deep understanding of sustainability, interdisciplinarity, and community engagement.

Working with low-tech materials and engaging in hands-on, creative processes pushed many students beyond their comfort zones—an experience they found both enjoyable and rewarding.

Conclusion

Adopting a broader perspective on the future of physiotherapy helped strengthen students’ resilience and sparked genuine enthusiasm. Several students highlighted the value of engaging with the financial and organizational realities of running a physiotherapy practice. Others expressed surprise and encouragement at discovering that it is not only possible but entirely acceptable to diversify one’s professional activities while staying true to the core of physiotherapy.

By the end of the workshop, it was moving to see how fully the groups had envisioned their ideal future practices—with concrete, detailed ideas. Some even invited us to visit or join their imagined practices, a testament to their engagement and motivation.

Learning to adapt, think differently, and go beyond traditional boundaries is a skill we must nurture more intentionally, particularly as we prepare future professionals to face the complex and evolving challenges of our world.

References

Dion C. Petit manuel de résistance contemporaine. Arles: Actes Sud; 2018.

Parrique T. Ralentir ou périr: l’économie de la décroissance. Paris: Seuil; 2022.

Senn N, Gaille M, del Rio Carral M, Gonzalez Holguera J. Santé et environnement: vers une nouvelle approche globale. Genève: RMS Éditions / Médecine et Hygiène; 2022.

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