Universidad Nebrija

revista.la@nebrija.es | ISSN 1699-6569 | Publicación semestral

English for physiotherapy, physiotherapy for english
A synergistic approach
Lindsey Bruton y Monika WoZniak
Universidad San Jorge
labruton@usj.es , mwozniak@usj.es

Este trabajo describe el proceso que conduce a la planificación e impartición de un curso de inglés basado en contenidos para los estudiantes universitarios de primer curso de Fisioterapia. Nuestro enfoque se basa en una estrecha colaboración entre especialistas en idiomas y profesores de contenidos dentro de un programa de AICLE (Aprendizaje Integrado de Contenidos y Lenguas Extranjeras), y la sinergia resultante entre sus asignaturas en el campo de Fisioterapia. Comenzamos con una descripción general del Inglés para Fines Específicos y AICLE en el contexto de la educación superior y una breve descripción de los dos enfoques en nuestra universidad. Posteriormente nos centramos en nuestra asignatura, Inglés Científico, y las interconexiones, las influencias y beneficios mutuos, así como los problemas que surgen, con especial atención a la asignatura de los Fundamentos de Fisioterapia.

Palabras clave: Inglés para Fines Específicos, AICLE, Educación Superior, Fisioterapia


This paper describes the process leading to the planning and teaching of a content-based English course for first year Physiotherapy university students. Our approach is based on close collaboration between language specialists and content subject lecturers within a CLIL (Content and Language Integrated Learning) programme, and the resulting synergy between their subjects in the field of Physiotherapy. We begin with a general overview of ESP and CLIL in the context of Higher Education and a brief description of the two approaches at our university. Later we focus on our course, Scientific English, and the interconnections, mutual influences and benefits, as well as problems that arise, with special attention to the subject of Fundamentals of Physiotherapy.

Keywords: ESP, CLIL, Higher Education, Physiotherapy



English for Physiotherapy is a sub-category of English for Medical Purposes, as are, for example, English for Nursing or Pharmacy. As Shi (2009: 207) puts it, the aim of English for Medical Purposes is to “facilitate both the practice of the medical profession and the acquisition of medical knowledge” and in our case it is the profession and knowledge related to the field of Physiotherapy. However, this aim can be very difficult to attain as the design and development of any ESP (English for Specific Purposes) course requires content knowledge and the language specialist often does not have any formal training in the particular discipline.

(T)he ESP approach requires a willingness on the part of the language educator to enter (not unlike ESP students themselves) as a stranger into strange domains (…) and to engage in a degree of reflection that attempts to sort out the extent to which learners purposes are actually served when the language practices of any target discourse community are taught (Belcher, 2009: 2).

However, nowadays ESP courses are not the only means of learning field related languages, especially English. English-medium instruction is viewed as a way of internationalising European universities (Doiz et al., 2011). Apart from that, research shows that CLIL (Content and Learning Integrated Learning) positively contributes to developing students' language skills and increases their motivation in target language and subject learning (Dalton-Puffer, 2008; Lasagabaster, 2008, 2009). As a result, a growing number of Spanish universities opt for this approach and offer subjects within their degree studies in English. The CLIL approach encompasses a series of methodologies in which non-linguistic subjects are taught through the medium of an L2. The following definition of CLIL would suggest that CLIL exists along a cline and that the relative emphasis on either of its components, language and content, shifts according to needs and objectives. Thus, teaching and learning both in a language and a content class may be considered CLIL.

Content and Language Integrated Learning (CLIL) is a dual-focused educational approach in which an additional language is used for the learning and teaching of both content and language. (…) Each is interwoven, even if the emphasis is greater on one or the other at a given time (Coyle, Hood and Marsh, 2010: 1).

In spite of the above-mentioned dual focus of CLIL on both content and language, Fortanet-Gómez (2010: 259-260) notes that university content subjects in English are usually taught by content teachers and even if their competence in the L2 is sufficient, they may lack the knowledge and experience in foreign language pedagogy to be able to reinforce their students’ learning and contribute to improving their language proficiency.

Due to this dual focus in CLIL and since content knowledge is so important in LSP (Language for Specific Purposes) courses, the difference between these two approaches may be difficult to define (Fernandéz, 2009; Poręcka, 2011). As noted by Poręcka (2011: 5), “tertiary level teachers (…) find it extremely difficult to distinguish between some varieties of CLIL and LSP”. Consequently, we may not be sure if what we teach is in fact ESP or if it is a variety of CLIL and if that is so, are we really prepared for this?

Apart from specific training for content teachers, if it is possible to implement in a given educational institution, the collaboration between teachers of non-linguistic content and language teachers seems to be the best solution, which has been emphasized by various authors (for example, Mehisto et al., 2008; Graddol, 2006: 86 for CLIL contexts; Dudley-Evans and St John, 1998: 44; Shi, 2009: 220-221 for ESP contexts). As language teachers need particular subject knowledge and teachers of non-linguistic subjects need help with the linguistic and methodological aspects of their subjects, this collaboration can be beneficial to both parts and we would argue that it is even more vital at university level. Language teachers involved in teaching ESP courses within degree programmes may find it difficult to identify their student's specific language learning needs and competences to be developed as well as to access valuable and trustworthy authentic materials of a given discipline and indeed to understand the relevant content to be able to incorporate it in the language course successfully. On the other side, content teachers may feel that language teachers trespass on their discipline in their language courses and working together may help overcome this sort of misunderstanding. All in all, there is a big gap between content and language teachers’ competence that needs to be bridged and for which this collaboration is crucial and on which our approach is based.


San Jorge University (Universidad San Jorge, USJ) has developed and implemented a Language Policy according to which English is progressively integrated in all degree programmes in 3 ways. Firstly, obligatory ESP courses in 1º and/or 2º year are designed for each degree programme which focus on discipline specific themes and genres and the development of the degree programme’s specific competences. Secondly, a CLIL programme facilitates the integration of 1 credit of English in at least 3 different subjects in the first and second years of each degree. This number of credits is increased in the third and fourth years to include entire subjects given in English. Finally, the IML offers workshops on CLIL for all content teachers involved in the CLIL project, as well as general English courses and EAP (English for Academic Purposes) workshops for all members of the university community.

These three approaches obviously provide considerable language support and input to both subject lecturers and students but the CLIL programme in particular also provides invaluable support of a different kind to both subject and English lecturers. Lecturers teaching on content subjects selected to participate in the CLIL programme are assigned a CLIL facilitator from the Institute of Modern Languages. The content and the language expert work together in weekly sessions to prepare and rehearse activities and their evaluation in English. During these sessions the subject teacher first explains the structure and contents of his/her subject using the course syllabus as a guide. Specific areas of the course are then selected and described by the content teacher and activities and evaluation rubric are designed. The role of the language lecturer is not exclusively that of language provider, but also of methodological advisor. CLIL teaching requires changes in methodology and “an open mind to teaching” (Pavón and Rubio, 2010: 50). The lecture format is still widely used in Higher education in Spain. CLIL classrooms require interaction and dialogue that permits students to be actively involved in the processing of language and content and to construct their own meanings and thus learn at a deeper level. We thus perceive our role in moving subject teachers away from this type of teaching dynamic as equally, if not more important, than providing lecturers with the language support they need.

These CLIL sessions also provide English lecturers with insights into the organisation and the basic content in terms of genres and language in a degree programme. The sessions also enable us to find out more about the competences to be developed during students’ studies as well as their communicative needs in academic and professional settings. The wide gap mentioned above between English lecturers’ knowledge of content and subject teachers’ grasp of language and teaching methodology at this level of education, coupled with the absence of any suitable ready-made teaching materials renders CLIL sessions essential to the planning of a coherent English course. Our circumstances and opting for a CLIL-oriented way of teaching English for Specific Purposes require an open mind from language teachers too. We need to be willing to learn new, non-linguistic content that at university level is highly specialized and difficult to access, and to understand with minimal help from specialists in the field. This collaboration through CLIL sessions helps us, at least partly, to have some general view of the field of physiotherapy and helps us to design and organize the sequence of the syllabus in a way that best combines with the syllabi of content subjects on the degree programme.


This paper focuses on the results of such a collaborative process from the perspective of English lecturers and its implications for the design and development of a CLIL-oriented course of Scientific English for Physiotherapy students. As this collaboration is two-fold, both content and language teachers learn from each other. We refer to our course as CLILed ESP because this close collaboration and its influences on the design of the course may cause some doubt as to the character of our course, as it has resulted in a considerable amount of overlap between language for specific purposes and new non-linguistic contents. Although students’ cognitive level is in advance of their linguistic level in English, their knowledge of Physiotherapy, as first year students, is not developed. This means that it is possible to include new and relevant content in our course and our students can rarely be used as sources of content knowledge (Belcher, 2009: 13). This appears to be what differentiates our Scientific English course from ESP, where the student profile is often professional or post graduate and language tends to be perceived as a tool for expressing what students already know in their L1. Scientific English is a 6-credit course delivered during both semesters of the first year of a four-year Physiotherapy degree and it is an obligatory subject for all students. Classes are of about 20-25 students. Most of them come directly from secondary school and their English language skills range from A2 to C1. Additionally, groups are made up of both Spanish and French students in approximately equal numbers, which adds to the variety of language learning experience and attitudes to learning languages.

The Physiotherapy degree programme, the Scientific English course and CLIL sessions with Physiotherapy lecturers all date back to 2009. Our brief in 2009, as language teachers helping subject teachers in the CLIL project, was often frustratingly one-way: to assist subject teachers to integrate English into their subjects. This entailed familiarizing ourselves with their study guides, helping them to scaffold texts, develop tasks, plan assessment and evaluation. In short, a mixture of language, language learning and general teaching methodology were all involved. As it was often the case that the language lecturer did not teach in the same degree program as her assigned subject lecturers, benefits were largely one way. The subject lecturer gained methodological and linguistic insights while the language lecturer continued to plan subject specific language courses with little idea of how they fit in with and complemented other subjects in the degree program. It was not until last year (2010-2011) that the CLIL and the Scientific English coordinator became one and the same person. This was the key to enabling the synergy that will be described, with particular reference to the content subject Fundamentals of Physiotherapy.

The subject of Fundamentals to Physiotherapy (Fundamentos de Fisioterapia) briefly introduces students to the field of Physiotherapy, its history and aims. The main aim of the course, however, is to study the location of muscles, bones, nerves and tendons in all parts of the body working down from the shoulder on to the arm, wrist and hand and progressing to other parts of the body. The first 8 hours of the course are devoted to theory. A large part of the course consists of practical sessions where lecturers explain and demonstrate palpation of different parts of the anatomy, and then students practise the same in groups and are monitored by teachers. Some basic manual therapy techniques are also taught. Figure 1 shows the evolution of CLIL activities in this subject from 2009 to 2012.

Figure 1. The evolution of CLIL activities in the subject ‘Fundamentos de Fisioterapia’, 2009-2012

In 2009- 2010 ‘Fundamentos’ lecturers had translated all their slides into English but gave Master classes in Spanish. Students were expected to demonstrate and comment on palpation and manipulation techniques in English. They received no model or assistance apart from the slides in English. In this way, subject lecturers managed to avoid speaking in English and students had little or no idea of how to comment on palpation and manipulation techniques in English. In the course of the following year (2010-2011) the steps outlined in box 2 were taken to ensure a methodology that was more conducive to the active learning of both content and language. The resulting CLIL activities (box 3) involved more active participation on the part of students who are now asked to research, present and demonstrate palpation techniques in English. However, now they receive adequate support in the form of previous model demonstrations in English by lecturers, audio-visual models on the learning platform, guided research, extended tutorial time to consult with subject lecturers and finally, related language practice in their Scientific English course.


The English for Physiotherapy or Scientific English course has undergone substantial changes since 2009. Most of the changes are a result of CLIL sessions and the growing understanding of content subjects that they have provided to the CLIL facilitator who is also responsible for the planning of the English course. The approach to syllabus planning that is now used for this course and indeed for other first and second year obligatory English courses can be seen in table 1 below.

Table 1. An example of the syllabus planning process.

Table 1 refers specifically to how elements of the subject ‘Fundamentos de Fisioterapia’ are incorporated into a small part of the syllabus for ‘Scientific English’. A similar process is followed for other subjects within the degree programme. The syllabus is divided into thematic blocks which are selected in terms of their relevance to the Physiotherapy degree programme and the professional, academic and linguistic competences that students are required to develop. These topics are then broken down into basic genres and functions. The specific language necessary for the production of these genres and functions is identified and activities are created which permit students to work towards the ‘performance’ of an end of block task where the language and content that has been carefully scaffolded during the unit or block is used to create a group presentation, recording, interview or text; the final task for the block. In the case of this block the final task consists of presenting the location and function of a muscle group and the explanation and demonstration of four exercises to strengthen it.


This process is time consuming for both language teachers and subject teachers. Timetabling makes meetings difficult to organize, particularly when various teachers give the same subject. Meetings must be held, activities planned and sometimes rehearsed, information and explanations must be relayed to teachers who are unable to attend meetings. Modifications in one course may entail modifications in another. The amount of integration of English into other subjects is increasing from year to year.

The English course is taught by 4 teachers who often differ in their approaches to language teaching and particularly to the place of content in a language course, in ESP and in CLIL. Negotiations on the amount of new content to be included in each class were a regular occurrence at weekly coordination meetings.

However, we believe that many of these difficulties are temporary and that the advantages of this system outweigh the disadvantages. Subject teachers are becoming increasingly confident about using English in the classroom and more aware of teaching methodology. Language lecturers are becoming more confident about their grasp of content matter and more convinced about the utility and coherence of the syllabus for Scientific English.


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