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History of Physical Therapy

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 the last century, now able to treat problems successfully better than ever before.Here is a small look at the history of physical therapy.

Physical Therapy has an rich, international history. In any other country the profession of "Physical Therapy" is called "Physiotherapy."  Upon travel out of 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."

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 The earliest documented origins of actual physical therapy as a professional group date back to 1894 when nurses in England formed the Chartered Society of Physiotherapy.²  Other countries soon followed and started formal training programs, such the School of Physiotherapy at the University of Otago in New Zealand in 1913.⁷

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.⁸  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.⁸   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. ⁸

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 began to be practiced, especially in the British Commonwealth countries, in the early 1950's.  Up until this point, there was no known practice of combination of exercise and manipulative therapy in existence. ^4,5

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 finally 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.

REFERENCES

1. American Physical Therapy Association.
   M Moffat. Three quarters of a century of healing the generations. Physical Therapy 1996 76: 1242-1252.
   
   
2. Chartered Society for Physiotherapy.  United Kingdom.
   
   
3. Kaltenborn FM.  Manual Mobilization of the joints: the Extremities.  6^th Ed.OPTP. 2002
   
   
4. McKenzie R.   The cervical and thoracic spine: mechanical diagnosis and therapy.   
   Spinal Publications Ltd.   New Zealand.  1998   pp: 110
   
   
5. McKenzie R.   Patient Heal Thyself. Worldwide Spine & Rehabilitation2(1) 2002;  pp 16-20
   
   
6. Paris S.  The Paris Story.   Worldwide Spine & Rehabilitation 2(1) 2002  pp 8-14
   
   
7. University of Otago.   New Zealand.
   
   
8. Wharton MA.   Health Care Systems I;  Slippery Rock University.  1991

OTHER LINKS

CANADA
Canadian Academy of Manipulative Physiotherapy History

Canadian Physiotherapy Association History