The Unavoidable influence of Race on Rehabilitation

The standard of patient care practice has an unsaid truth: not all patients are equal.

There is no such thing as a one-size-fits-all approach.

It’s like asking an African auntie and a Scandinavian snow hiker to share the same skincare routine—someone’s going to end up shiny, and someone’s going to end up burned. Yet, that’s exactly what health science often does when it ignores the obvious: race influences health. Pretending otherwise is like ignoring the elephant (or the ACL tear) in the room.

Neel Salami's article, "Race Science for Non-Racists," dives into why health science needs to stop pretending everyone’s the same. Somani—an Indian man who spent years discovering he’s at risk for cardiovascular disease, is vitamin D deficient, and has carb metabolism quirks—concludes, “In other words, I’m Indian.”

This got me thinking: what if physiotherapy embraced these differences instead of shying away from them? What if your treatment plan wasn’t just about your injury but also about you—your genes, ancestry, and even your Spotify playlist?

Physiotherapy is all about movement, but let’s get real—our bodies move differently. Those differences aren’t just about lifestyle; they’re baked into our genetics. For example:

Bone Density and Black Athletes: Black athletes often have denser bones and more fast-twitch muscle fibers, making them powerhouses in sprints.

This also makes them more resistant to certain types of fractures. Understanding this could improve osteoporosis screening protocols and fracture risk assessments.

ACL Tears in East Asians: East Asians are more prone to ACL tears because of unique bone alignment patterns.

Tailoring rehabilitation to address these biomechanical predispositions can prevent further injury.

Vitamin D and Indian Patients: Indian patients may require more sun exposure or vitamin D supplementation in their rehab plans for optimal recovery, given their higher risk for vitamin D deficiency.

These aren’t just trivia—they’re blueprints for how we should be tailoring treatment. Why rehab a ligament tear the same way for a Nigerian sprinter and a Swedish skier?

Let’s not forget the cultural layer. Remember my article about using Afrobeats to improve coordination?

That wasn’t just for fun (though it was definitely fun). Coordination exercises rooted in rhythm—like dance-based therapies—might resonate more with populations whose cultures place a premium on rhythmic movement. It’s not just cultural relevance; it’s physiological optimization.

Physiotherapy isn’t just about the what but the how. For example:

Keloid Scarring in Black Women: Post-surgical rehab for Black women should focus on minimizing skin tension during healing to reduce the risk of keloid scars.

Hydration in East Asians: Patients with ALDH2 deficiency (common in East Asians) might need tailored hydration protocols post-workout to optimize recovery.

Carb Sensitivity in Indian Men: Carb-heavy diets during recovery might need adjustments to prevent blood sugar spikes in Indian men, who are more predisposed to metabolic conditions.

Addressing race in health science is not without its ethical challenges. Historically, race science was used to justify discrimination and dehumanization. It’s essential to draw a clear line between tailoring care to ancestry and perpetuating harmful stereotypes.

Here are some key ethical considerations:

1. Avoid Overgeneralization: While genetic predispositions can guide care, they are not absolute. Not all Black patients have denser bones, and not all East Asians are at risk for ACL tears. Care must be individualized beyond race.

2. Educate Without Bias: Physiotherapists should receive training to understand the biological nuances of different populations without reinforcing prejudice or bias in clinical practice. Meaning Further studies and discussions have to happen.

3. Focus on Equity: The ultimate goal of integrating ancestry into care is to achieve better health outcomes for everyone, not to create divisions. Recognizing genetic differences should complement, not replace, addressing systemic health inequities.

4. Patient Consent and Awareness: Patients should be informed about why certain treatment decisions are being made. Transparency fosters trust and ensures ethical practice.

By applying these principles, physiotherapy can navigate the fine line between precision and prejudice, ensuring every patient receives optimal, respectful care.

Yes, it’s a tricky topic. Somani warns of the ethical pitfalls, reminding us that the first version of race science wasn’t just bad—it was evil. But tailoring care based on ancestry is about precision, not prejudice. It’s about respecting individuality while dismantling bias.

For example, Black women have the highest maternal mortality rates. Is it purely systemic bias? Likely not. Genetics plays a role, too. Ignoring these nuances in health—and yes, physiotherapy—means we’re doing a disservice to patients.

As movement specialists, we can’t rehab an ACL tear in a Nigerian woman the same way as we would in a Japanese man. Physiotherapy can lead the way in applying these principles. Imagine clinics where Black women’s hyperpigmentation risk informs post-surgical treatments, or where Indian men’s predisposition to cardiovascular disease shapes cardiac rehab protocols.

Physiotherapy needs to be “racist”—not in the “old white men measuring skulls” way but in the “let’s tailor care to your ancestry” way. This isn’t about dividing patients; it’s about serving them better. So next time you see a Black woman, an Indian man, or an East Asian patient walk into your clinic, remember: their bodies tell stories. It’s time health science—and physiotherapy—started listening.

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