The year 2013 is a very special year for the Physical Therapy profession marking our 200th birthday of our profession. 4
From the elite athlete, person with back or neck pain to someone having a spinal cord injury or stroke, the profession of physical therapy now treats a multitude of musculoskeletal injuries and disorders. Physical Therapy, like modern medicine, has constantly evolved over 200 years, now able to treat problems successfully better than ever before. Here is a current review of the HISTORY OF PHYSICAL THERAPY.
If you travel far back in time you will find forms of physiotherapy used centuries ago. Hippocrates advocated massage and Hector used hydrotherapy (water therapy) in 460 B.C.8 Recent travels throughout Europe led Dr. Cameron MacDonald to old archives to discover the evidence and origin of the profession of Physical Therapy. 4. In any other country the profession of "Physical Therapy" is called "Physiotherapy." Traveling outside the U.S.A., if you ask to see a "Physical Therapist" they may not know what you mean, as they would expect the term "Physiotherapist" or "Physio." Until recently, it was thought that the origins of Physical Therapy extended to 1894, when a professional group of nurses in England formed the Chartered Society of Physiotherapy.2 However, Dr. MacDonalds research throughout several countries in Northern Europe to an established profession that had a scientific basis. In Sweden, the Royal Central Institute of Gymnastics (RCIG) was founded in 1813, which was later referred to as “Medical Gymnastics” by 1865. Dr. Cameron’s research unearthed records of patient records in which conditions were tracked, manipulative therapy techniques combined with exercise to help patients overcome their physical problems and injuries. Surprisingly these records depicted illustrations of some of the same manual and manipulative we use currently today (i.e. “pubic symphysis manipulation”). Jonas Kellgren was a graduate of the RCIG in 1865 was found to be part of this group; he was the grandfather of James Cyriax, MD, known as the “grandfather of orthopedics”. The Cyriax family was found through the archives to continue to promote the growth of physical therapy throughout England in later years. Records described affluent Americans traveling to Sweden to seek out treatment that was not available in the U.S.A. with patient cases describing these patients as lacking exercise as they did not have manual labor jobs, or a harder physical life of putting food on the table than compared to the easy life of the upper class at that time. Ironically, even though most of the typical American population is living a far easier lifestyle than that of the typical American in the 1800’s, we find those individuals who lack in exercise routines or active lifestyles are ever prone to musculoskeletal problems, as was the case 200 years ago. Politically, these original Physical Therapists became so popular at the time, that this caused much problems within the traditional physician community. In the end, Dr. Cameron’s research showed that the physician community politically won out in the end, and the Medical Gymnastics were eventually forced into obscurity and forgotten. Physical Therapy, the original sole providers of physical rehabilitation utilizing exercise and manual therapy techniques, was lost until the 1894 Chartered Society of Physiotherapy in England.2
The next country to start formal training programs was the School of Physiotherapy at the University of Otago in New Zealand in 1913.9 In the United States, Physical Therapy began in 1914 at Walter Reed Hospital in Washington DC. At that time this hospital was known as the “Flagship” of the U.S. Army for its chief medical institution. At this prominent medical facility, Walter Reed Hospital graduated the first Physical Therapists, then called "Reconstruction Aides." These were nurses with a background in physical education needed to help manage the devastating effects of the First World War1 The development of the first true hospitals occurred 1850 and 1900; these institutions were devoted to and organized for only the sick. It was during this time of change that the scientific method was introduced into the field of medicine.10 The early 1900's brought formal rehabilitation to the hospital setting.
As with most medical professions, research is a part of the continued development of the field. Research has been a part of the profession since the its' early beginnings, seeing the first physical therapy research being published in the United States in March 1921 of the first edition of The PT Review. This was the year when Mary McMillan, PT first organized the Physical Therapy Association, which eventually changed its name to the American Physical Therapy Association (APTA). This was a landmark year as educational standards for university professional PT programs were instituted and programs became accredited by a national body. Scientific research and technology started to shape the profession.10 In 1924, the Georgia Warm Springs Foundation came into existence with emphasis of physical therapy treating Poliomyelitis ("Polio"), which physical deficits were at the time was a national epidemic. Sister Kenny, PT, who practiced at the Mayo Clinic, was an internationally prominent figure within the physical therapy profession and was well known for her progress with polio. Both polio and physical injuries to war veterans would dominate as the primary problems treated with physical therapy for the next 20-30 years. In this pre-World War II era, 80% of physicians were generalist, and only 20% specialized in a certain field of medicine. In the post World War II era, these figures completely reversed, with specialization dominating most physician's practices. 10
Physical Therapists joined the team for medical research with the American Physical Therapy Association (APTA) cooperating with the Salk vaccine trials, which lead to having a vaccine for Polio in 1956 that is now considered commonplace. 1
Treatment up through the 1940's primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints started to be practiced again, especially in the British Commonwealth countries, in the early 1950's. This art had been lost since Physicial Therapy’s end in the later 1800’s. Combining the art of exercise and manipulative therapy had been lost for nearly 70 odd years. 4,5,6
In the 1950's, Physical Therapists started to move beyond hospital based practice. The majority continued to practice in hospitals through the 1960's. Physical Therapists now practice in a wide variety of settings, including outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals and medical centers.
Specialization for Physical Therapy in the United States occurred in 1974, with the Orthopaedic Section of the APTA being formed for those Physical Therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy (IFOMT) was formed, which has heralded change and progress in manual therapy world wide ever since. During this period, the eastern United States were greatly influenced by the training of Norway's Freddy Kaltenborn (Osteopathic Physician, Chiropractor, Physical Therapist, and Athletic Trainer. 3 Mariano Rocabado, PT of Chile, who specialized in treatment of Temporomandibular disorders, also brought much new information and continues to contribute to our profession. 6 Australia's Geoffrey Maitland, PT initially influenced the training of manual therapy on the west coast.
In the 1980's, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which gained FDA approval in the United States in 2002. Other advances, such as electronic resistive exercise known as Isokinetics, have fallen out of popularity for various reasons, despite having their place within the profession.
The 1990's brought much attention to manual therapy, with formal residency programs becoming more numerous. During the summer of 1991, Norwegian manual therapist Freddy Kaltenborne helped create the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). Dr. Stanley Paris, PT and Ola Grimsby, PT were among the founding members. This organization was a means for physical therapists to band together with a common specialization in manual and manipulative therapy.
Since this time, formal residency and training programs have been formed throughout the United States, most of which are members of the American Academy of Orthopaedic Manual Therapy (AAOMPT), which is a national chapter of IFOMT. Our staff has been trained by the North American Institute of Orthopaedic Manual Therapy (NAIOMT), which is the predominant accredited training program in the Pacific Northwest.
Other such institutes include:
Ola Grimsby Institute, San Diego, California
University of St. Augustine for Health Sciences, St. Augustine, Florida
Kaiser Hayward Physical Therapy Residency, Hayward, CA
Kaiser LA Orthopaedic Physical Therapy, Los Angeles, CA
U.S. Army-Baylor University, Fort Sam Houston, TX
Clinical Residency and Fellowship Programs
Today, we take so much for granted. The great accomplishments we have made in the field of medicine and physical therapy has been made possible by those who have gone before us. For future generations, may we still yet contribute as our predecessors have.