Physiotherapists are trained to think holistically. We look beyond the presenting complaint, considering a patient’s physical, emotional and sometimes spiritual wellbeing. But when working with Aboriginal and Torres Strait Islander peoples, the quality of our care depends on something deeper than technical expertise: whether that care feels culturally safe.

What is Cultural Safety — and Why It Matters

The idea of “cultural safety” was first articulated in Aotearoa New Zealand in the 1990s by Māori nurse educator Irihapeti Ramsden. Her point was simple but powerful: good intentions are not enough. What matters is how care is received, and whether it feels safe and respectful to the patient.

In Australia, cultural safety is officially defined as the ongoing process of health practitioners reflecting on their knowledge, attitudes and behaviours, and addressing power imbalances in the healthcare relationship. Importantly, it is patients themselves who determine whether care is culturally safe. This distinction moves us away from ticking off cultural “facts” and towards a more honest recognition of history, systemic racism and lived experience.

This is not just professional best practice. Culturally unsafe care is now recognised as both unlawful and unethical, and the Physiotherapy Board of Australia expects practitioners to demonstrate cultural safety as part of safe, effective practice.

Key Principles in Everyday Practice

Cultural safety is grounded in reflection. For physiotherapists, this means examining how our own background and assumptions may affect interactions with patients, and recognising how broader power dynamics play out in the treatment room.

It also means accepting that safety is defined by the patient, not the clinician. If an interaction feels alienating or disempowering, then it is culturally unsafe — regardless of intent.

Finally, culturally safe practice involves building respectful partnerships. This is about honouring self-determination, avoiding tokenistic gestures, and fostering trust through listening and adaptability.

Other physiotherapy bodies internationally offer similar guidance. In Canada, clinicians are encouraged to “include time for relationship building,” “ask permission before touching,” and be attentive to physical, emotional, spiritual and cultural needs (Canadian Physiotherapy Association, 2024).

Why It Must Be Systemic, Not Optional

In Australia, the Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025 commits regulators and health professions to embed cultural safety across systems, with a goal of eliminating racism in healthcare by 2031. The strategy is clear: cultural safety is not an optional extra, but a core responsibility.

This expectation is filtering through every level of the profession. Physiotherapy programs must include cultural safety training for accreditation, and overseas-trained physios are now required to complete cultural safety education before registration.

Putting It Into Practice

So how do we start?

• Self-reflection: Take time to examine your own worldview and the ways systemic biases might influence your practice.
• Feedback: Invite respectful dialogue with patients and colleagues — sometimes the simplest question is, “Does this feel comfortable for you?”
• Lifelong learning: Commit to ongoing education through workshops, cultural awareness programs, and community-led learning.

Cultural safety also benefits clinicians themselves. When physios work in environments where cultural respect is prioritised, they often report stronger therapeutic relationships, reduced conflict, and a deeper sense of professional satisfaction. Over time, these shifts contribute not only to improved patient outcomes, but also to a more inclusive and resilient health system. In this way, cultural safety is not just about addressing past injustices—it is also about building a healthier, fairer future for the profession and the communities it serves.

In Summary

Cultural safety is more than a policy term — it’s central to providing physiotherapy that is effective, equitable and respectful. By committing to reflection, accountability and humility, we help ensure that care is not only clinically sound, but truly safe for the people and communities we serve.