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The History of Physical Therapy: The rise of movement as medicine

Updated: Jun 22, 2020

The practice of physical therapy originated as a professional group during the time of Per Henrik Ling, the "father of Swedish gymnastics." Ling founded the royal Central Institute of Gymnastics in 1813 which focused on massage, manipulation, and exercise. In 1851, the term "physiotherapy" which defined the practice as the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery; physical therapy. The term first appeared in an article by Dr. Lorenz Gleich, a military physician from Bavaria (1).


Physical therapists (PT) who were once viewed as rehabilitation aides progressed through a series of changes to become today's ever-growing healthcare professionals. PTs play a significant role of providing rehabilitation services in addition to prevention and risk reduction training.


Fun Fact: Around 1851, PTs were called "sjukgymnast," meaning "someone involved in gymnastics for those who are ill".


Lois "Burnsie" Stevens, a Physical Therapist who has been involved with polio patients


Polio Epidemic Calls for PT

In 1916, the world witnessed the devastating polio epidemic. During this time, nurses were treating patients with residual paralysis by using passive movements. In light of the situation, PTs developed Manual Muscle Testing for examining strength and introducing rehabilitation exercises for weaker muscles. In America, polio swept through the country affecting Franklin D. Roosevelt who would be the future President. In 1926, Roosevelt found relief in hydrotherapy and purchased a resort in Warm Springs Georgia for polio patients. The resort is now known as the Roosevelt Warm Springs Institute for Rehabilitation (2).


World War I marked the start of physical therapy due to the many causalities on the battle field. In 1917, the US recognized the need to rehabilitate injured soldiers leading to the creation of the army's physical therapy unit. In the 1920s, a partnership grew between PTs and the medical communities which boosted public acceptance. In 1937, the National Foundation for Infantile Paralysis was established due to polio and endorsed physical therapy as a medical career.


Wounded Soldiers Benefit from PT

In the early 1940s with World War II at its peak, the need for PTs was at an all time high since wounded soldiers were returning home with serious injuries. The exploration of electrical stimulation provided new insight to physical therapy. PTs discovered the "galvanic exercise" for patients with atrophied hands after an ulnar nerve lesion from surgery (3). After WWII, the need for PTs declined and the training of new PTs was suspended.



'Reconstruction Aide' treating the amputated soldier


In the 1950s, PT was gaining independence and technicians were now seen as professional practitioners. This resulted from the American Physical Therapy Association's (APTA) 7-hour-long competency examination in conjunction with the Professional Examination Service, which was made available to the state licensing boards. The Self-Employed Section formed as a component of APTA in 1955 as private practice expanded (4).


After the Vietnam War, PTs practiced in a sterile environment before the early 1970s. Due to the increased need for PT and the disbandment of military-based schools after the war, APTA recognized the need to train more PTs. The Schools Section of APTA made recommendations about acceptance requirements, subject matter, and administration. APTA also advocated for more universities and medical schools to prioritize PT programs including establishing graduate-level opportunities (4).


From 1967 to 1976, the profession advanced into overseeing orthopedics and cardiopulmonary issues. With the arrival of open heart surgery, PT was practiced in preoperative and postoperative units. The treatment of individuals with critical joint restrictions improved with the increasing practice of joint replacements (5).


The PT profession has continued to advance and grow across the world. Patients can now refer themselves to a practitioner rather than having to be referred by a medical professional. Today's PTs recognize movement as a vital aspect to good health and well-being. Physical therapy is now focused on individuals' needs and each person's rehabilitation potential. Though PT has advanced scientifically with research-based evidence, we must not forget the pioneers of PT who built the foundations of this holistic medical practice over the course of centuries.


References

1. Terlouw TJ. The origin of the term "physiotherapy." Physiother Res Int 2006;11:56-7

2. Burns JM. Roosevelt: The Lion and the Fox: Vol. 1; 1882-1940.

3. Licht SH. "History of Electrotherapy". Therapeutic Electricity and Ultraviolet Radiation, 2 nd ed. New Haven, Conn.: Licht; 1967.

4. Murphy W. "Progress Is a Relay Race," 1946-1959. In: Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association. Lyme: Greenwich Publishing Group Inc; 1995. p. 136-77.

5. Certo CM. History of cardiac rehabilitation. Phys Ther 1985;65:1793-5.


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