Eco-Friendly Physio - Lessons from the Lorax
By: Nataliya Zlotnikov, MSc, HBSc; Maggie Bergeron, BSc, MScPT, Co-Founder of Embodia

Introduction

Recently, I attended a fascinating presentation by National Geographic called ‘Designed by Nature’. The presenter, Kakani Katija, took us on a journey through the deepest parts of the ocean and tied her teams’ discoveries to the development of new technologies that have the potential to make a big impact on some of our world’s most critical problems. 

By gathering data from observing and studying natural species we can develop technologies for and imagining—and creating—possibilities for the future.

Designers and engineers have drawn inspiration from our natural world for hundreds of years, creating innovations as groundbreaking as manned flight, and as seamlessly used in our everyday life as velcro. 

This is known as biomimicry or biomimetics.

Nature-Inspired Design

What is nature-inspired design? 

Biomimicry or biomimetics is the examination of nature, its models, systems, processes and elements to emulate or take inspiration from to solve human problems.  

The terms biomimicry and biomimetics come from the Greek words bios, meaning life, and mimesis, meaning to imitate.

“In healthcare, biomimicry means the emulation of features found in plants and animals to provide both protection and treatment from illnesses and bacteria, as well as disease management.” (source)

This is not a new discipline.  

For thousands of years, our ancestors have looked to nature for inspiration. The Chinese are thought to have tried to make artificial silk some 3,000 years ago, and Leonardo da Vinci (born 1452 – died 1519) studied the flight of birds and proposed designs of flying machines.

We are currently seeing a new wave of potential medical devices tapping into nature. 

A Few Bio-Inspired Medical Examples

Bio-inspired innovations are changing the way we think about medicine and how best to treat patients. 

Evolution is the best problem-solver. Innovation often encounters barriers that appear to be insurmountable, but sometimes answers can be found in the most obvious place: nature itself.

Though it will take years for many to be introduced into clinical practice, engineers are hopeful that their designs will lead to a revolution in medical procedures.

Electric Fish-Inspired Catheter

Johns Hopkins University is developing a catheter that can navigate through complex blood vessel pathways that minimizes the need for fluoroscopic dyes and radiation.

 The design is inspired by an electric fish and its ability to generate an electrical field to navigate. This method would expand possibilities for those who are unable to undergo a fluoroscopy procedure.
 

Gecko-Inspired Glue

The stickiness of a gecko’s feet has formed the basis of waterproof glue. The adhesive might be used by surgeons to seal holes in organs and other tissue.

Shark-Inspired Medical Devices

Shark skin is composed of denticles that overlap in a diamond-shaped repeating pattern that inhibits bacteria from growing. The shark skin has been mimicked to create surfaces that prevent bacteria on medical devices. 

What Does This Have to Do With Climate Change?

To be inspired by nature, we need to preserve it. Kakani shared her concerns over environmental changes as well as limited/poor fishing restrictions (that lead to overfishing) and consequently the depletion of biodiversity.

Environmental Impacts of Healthcare 

On the healthcare pollution spectrum, physiotherapy tends to reside on the lower end; our focus on low-tech and hands-on approaches keeps us pretty eco-friendly. However, as all healthcare becomes more technologically sophisticated (something which became evident during COVID-19), utilizes more natural resources, and generates increasing amounts of pollution, greater attention must be paid to what we can all do to offer more environmentally-conscious healthcare (Maric & Nicholls, 2019).

What I Can Do to Help

‘. . . unless someone like you, cares a whole awful lot, nothing is going to get better, it’s not.’ (The Lorax by Dr. Seuss)

The Lorax has the right idea, one that we should keep at the forefront of our minds as we consider how we can decrease our profession's environmental impacts.

Below are some ideas that you can apply in practice and/or personal life. This list is, of course, non-exhaustive, and we look to you, the healthcare professional, to use your expertise, knowledge and environmental stewardship to generate, find and apply the ideas that best fit your business and lifestyle. 

1. Examine Your Practice's Environmental Costs

Can you reduce any of your businesses' (or professional associations') negative environmental impacts?

The items listed below may only be a drop in the bucket of the overall environmental costs of healthcare, but even reducing some of these might make an impact, especially if everyone in the profession makes the changes (Maric & Nicholls, 2019):

• Paper clinical records
• Disposable products (e.g. paper towels)
• Electricity used to run clinics
• Electricity used to manage patient care 
• Technologically dependent diagnostic procedures in place of our traditional hands-on clinical skills 
• Petition to move any print material provided by professional associations within your field to virtual-only
  
  

2. Transportation

Transportation carries major environmental costs. Seeing clients from a short distance is easier on the clients and the environment (Maric & Nicholls, 2019). Whenever possible, we can also consider seeing clients using telerehabilitation to decrease the environmental impacts caused by travel. 

To learn more about our telerehab system visit this link. 

Furthermore, we can consider our own travels for continuing education and professional gatherings (Maric & Nicholls, 2019), opting instead to attend virtually, or petition to have the conferences organized virtually, even after COVID-19.

3. Go Outside!

Why are our Western clinical environments solely indoors and strictly separated from natural ecosystems? I mean, of course, subzero temperatures are not welcoming, but spring and summer (even fall maybe) are wonderful times to integrate nature into our practices.

Until recently, most Western healthcare has not paid much mind to people's lived experiences, instead, removing them from their environmental context. Contrary to what is done in complementary medicines and indigenous health practice, which see the person as connected to the health of the air, rivers, land, and place.  

Natural light and fresh air are known to combat many physical and mental ailments. As custodians of the planet, integrating the natural ecosystem into our healthcare would also allow us to foster a stronger relationship with nature for ourselves and our clients (Maric & Nicholls, 2019). 

4. Learn and Get Involved 

A PubMed search on "Physiotherapy and Climate Change" yields a total of 24 publications, many of which are not relevant. Moreover, these publications are recent, having only been published in the last 12 years - this area of thought and research is a new one. Being novel, this school of thought contains ample room for growth, improvement, and considerable impact by those of us on the ground. 

2019 saw the formation of the Environmental Physiotherapy Association (EPA), an association to advance environmentally responsible physiotherapy. Founded by Dr. Filip Maric of Norway (Founding Chair) and Professor David Nicholls of New Zealand (Co-Founder). You may have noticed that their publication is cited multiple times in this blog. 

The EPA is the first international collaborative network of academics, clinicians, practitioners, researchers, and students interested in exploring and advancing the field of environmental physiotherapy. 

Membership is free and there are no specific expectations for members. The EPA would simply love to have your support in developing and promoting a more environmentally aware and responsible physiotherapy profession. You can join them here.

The EPA website is also an excellent starting point for learning more about climate change and physiotherapy. Their resources section has a wide range of sources and references on environmental physiotherapy and a broad array of related fields, including Planetary Health, EcoHealth, One Health, Sustainable Healthcare and the Sustainable Development Goals. The EPA also includes resources from within traditional and indigenous knowledge, philosophy, the environmental humanities, and social sciences.

5. Give Back 

Only by giving are you able to receive more than you already have.

 If you are already doing all you can in your practice and would like to do more, here is a link of climate change organizations you can donate to brought to you by the Canada Helps charity.

Climate Change Will Impact Our Profession

Not only are we changing the climate, but the changing climate is also impacting our profession. We have already seen this happen with COVID-19; we have all had to adapt to a novel, global health crisis quickly. As the climate changes, health and environmental crises will continue to impact our lives and professions. 

Extreme weather fluctuations are predicted to occur with greater frequency and intensity due to climate change. Studies have shown that elevated temperature and humidity are accompanied by symptoms of increased musculoskeletal pain in patients. Additionally, reduced physical activity during extreme weather has been suggested in people with arthritis, this reduced activity potentially contributes to further pain.

The image below depicts a few more of the impacts of climate change on human health, and consequently on our professions.

Image from Centers for Disease Control and Prevention Climate Effects on Health  

Want to learn more about climate change and physiotherapy? Take a look at one of our wonderful CPA Virtual Summit Series online physiotherapy courses, Climate Change: A Contemporary Challenge to Public Health - Will Physiotherapists Sit on the Sidelines or Take Action? By clicking below:

Learn More About Climate Change and Physiotherapy 

The New Physiotherapy

In recent years, Western physiotherapy has begun to explore the therapeutic connections between people and environments, this has given rise to new therapies such as ecotherapy, adventure therapy, animal physiotherapy, physiotherapy with animals, and more (Maric & Nicholls, 2019).

The West is beginning to understand that we cannot treat patients as isolated from their environments. Our health is inextricably tied to our ecosystems. Realizing this is the first step to making a difference. 

It seems high time we made a more conscious effort to reconsider the relationship between physiotherapy and the environment in all of its facets.

There is always more that we can do. Your mind is your only limit and the world is counting on you, on us, to be the change. 

The David Suzuki Foundation has a wonderful list, Top 10 Things You Can Do About Climate Change, to get your mind working. 

Have more ideas? The Embodia team would love to hear about them! Let's start a conversation. 

References: 

Foo, R. (2015). The role of physiotherapy in climate change mitigation. Physiotherapy 102(e5). DOI: 10.1016/j.physio.2015.10.009

Jones, E.L. (2009). Physiotherapy and the Earth’s global climate: a need for cultural change. Physiotherapy Research International 14(2): 73-7. DOI: 10.1002/pri.441

Kulp, S. and Strauss. (2019). New elevation data triple estimates of global vulnerability to sea-level rise and coastal flooding. Nature Communications 10: 4844. DOI: 10.1038/s41467-019-12808-z

Maric, F. and Nicholls, D. (2019). Physiotherapy Theory and Practice: 35(10): 905-7. A call for a new environmental physiotherapy - An editorial. DOI: 10.1080/09593985.2019.1632006