The Queering of Physical Therapy Education

Activists are reshaping physical therapy into a field that prioritizes queer ideology over science and patient care.

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About the Author

James L. Nuzzo, PhD, is an exercise scientist and men’s health researcher. Dr. Nuzzo has published over 80 research articles in peer-reviewed journals. He writes regularly about exercise, men’s health, and academia at The Nuzzo Letter on Substack. Dr. Nuzzo is also active on X @JamesLNuzzo.

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Physical therapists are healthcare professionals who examine, diagnose, and treat movement dysfunction. In the United States, modern physical therapy arose out of the poliomyelitis epidemics and two world wars. During wartime, soldiers returning from the front lines often suffered from physical injuries and impairments that required rehabilitation. The primary goal of physical therapy was to restore physical function—either to return soldiers to combat or to help them reintegrate into civilian life as fully as possible. Because these soldiers were men, physical therapy began as a predominantly female profession.

Female physical therapist in the 1940s overseeing male soldiers performing abdominal strengthening exercise. Photo publicly available at the AMEDD Center of History & Heritage

Following the wars, physical therapy techniques were expanded to serve the broader disabled population. As demand grew, the need for trained professionals increased. To meet this need, university programs and license exams were developed to credential practitioners.

Today in the United States, physical therapy is primarily a doctoral degree program. The number of students earning doctorates in the field has increased substantially over the past 20 years. In the early 2000s, fewer than 4,000 physical therapy doctorates were awarded annually. By the 2021–22 academic year, that number had risen to over 13,000—with approximately 62 percent of those degrees awarded to women.

The American Physical Therapy Association (APTA) is the professional organization responsible for setting competency standards and learning objectives for the tens of thousands of physical therapy students enrolled in doctoral programs across the nation. Like many allied health organizations, the APTA has embraced “identity politics” and the broader diversity, equity, and inclusion (DEI) movement.

The application of DEI and identity politics to health education, clinical practice, and policy is what I refer to as “Woke medicine.” I define Woke medicine as a philosophy of healthcare, rooted in critical theory, which holds that individual health is largely—if not entirely—determined by unjust power structures in society. According to this view, certain social and environmental factors disproportionately affect individuals based on their demographic identity, leading to unequal health outcomes among different groups. The goal of Woke medicine, then, is to raise awareness of these perceived injustices and to improve health outcomes among DEI-designated groups by addressing “structural factors” or the “social” and “political determinants” of health.

The APTA is no newcomer to DEI or Woke medicine. Earlier this year, Do No Harm—an organization dedicated to keeping identity politics out of medical education, research, and clinical practice—reported that APTA scholarships discriminated against applicants based on race and ethnicity. They also noted that the APTA offers a “DEI certificate” and that its continuing education content is “replete with lessons in DEI principles and strategies for physical therapists to advance DEI in their workplaces.”

Based on its investigation, Do No Harm concluded that the APTA “envisions itself as a political actor, and uses its position with the physical therapy profession to advance a radical racial ideology through its initiatives, courses, and scholarships."

That conclusion is difficult to dispute, especially considering two papers published last year in the APTA’s flagship journal, Physical Therapy, which focused on the “queering” of the profession.

The first author of the papers was Joe Tatta—CEO of the Integrative Pain Science Institute and an advocate for “health equity,” “disability justice,” “social justice,” and what he calls “pain liberation.” According to Tatta, improving care for painful conditions is “nothing short of a liberation movement.”

One of his papers, titled “Queering the Physical Therapy Curriculum: Suggested Competency Standards to Eliminate LGBTQIA+ Health Disparities,” outlines resources to “develop and implement competency standards in [Doctor of Physical Therapy] programs while providing an overview of LGBTQIA+ health disparities.” In a supplementary file not included in the print version, Tatta categorized 28 student competency standards and their related learning objectives into four broad areas of LGBTQIA+ healthcare: theories and concepts, physical health concerns, mental health concerns, and physical therapy specific concerns.

Tatta encourages educators to use these standards and objectives to “queer” their physical therapy curricula—something he defines only vaguely as “an approach educators use to implement culturally responsive teaching pedagogy.” He also notes that the competencies are “in accordance with the American Physical Therapy Association’s online resources on diversity, equity, and inclusion; cultural competence in physical therapy; and the PT Proud Introduction to LGBTQ+ Competency: Handbook for Physical Therapy.”

Tatta’s second paper titled, “A Call to Action: Develop Physical Therapist Practice Guidelines to Affirm People Who Identify as LGBTQIA+,” calls on the APTA to develop guidelines for affirming LGBTQIA+ patients. The paper proposes guidelines for physical therapy practice with LGBTQIA+ patients, along with a glossary of LGBTQIA+ terms. However, the glossary was again not included in the print version of the paper but was instead presented in an online supplementary file.

Here, I aim to highlight some of the specific problems with Tatta’s ideas. These include a misguided focus on health “disparities,” taking non-evidence-based cheap shots at other physical therapists, coercing physical therapists into practicing affirmative care, promoting biological denialism (e.g., in the case of transgender athletes), and unnecessarily injecting political activism into the physical therapy profession.