Historic Background

Physical therapy originated as a professional group that dated back to Per Henrik Ling, who is known as the “father of Swedish gymnastics.” He founded the royal Central Institute of Gymnastics in the year 1813 for massage, manipulation and exercise. In 1851, the term “Physiotherapy” first appeared in its German form “Physiotherapie” in an article written by Dr. Lorenz Gleich, a military physician from Bavaria. [1]  

In an English article published in Montreal Medical Journal in the year 1894, Dr. Edward Playter used the word “Physiotherapy.”[2],[3]  With time, the word “Physiotherapie” changed to “Physiotherapy” and then to “Physical therapy.”

Physical therapists (PT) who were once known as reconstruction aides evolved through a series of changes to become the present ever-growing confident and accomplished professionals in the health care system. They play a very important
role of providing rehabilitation and habilitation services as well as prevention and risk reduction training. In Sweden, PTs were called “sjukgymnast,” which translates to “someone involved in gymnastics for those who are ill”.

The world in the year 1916 witnessed the devastating polio epidemic. It was in this period that young women began treating polio patients with residual paralysis by using passive movements. Realizing the need of the hour, PTs developed Manual Muscle Testing for assessing the strength of the muscle and thereby implementing muscle re-education techniques for weaker muscles. In the United States (US), the polio epidemic continued to ravage to such an extent that it even afflicted a man who would become the future President of the US- Franklin D. Roosevelt. He went through various therapies, including hydrotherapy for which in 1926 he purchased a resort at Warm Springs Georgia, which was used as a Hydrotherapy Center for polio patients. This center presently operates as Roosevelt Warm Springs Institute for Rehabilitation. [4] The First World War marked the start of the profession. Throughout the world, 16 million people were engaged in the battlefield. In 1917, the US entered the war and the need to rehabilitate injured soldiers was recognized by the army.

This led to the formation of a special unit of the army medical department. They also developed 15 ‘reconstruction aide’ training programs in 1917 to meet the demand of medical workers who were specially trained in rehabilitation. [5]  In the 1920s, a partnership grew between PTs and the medical and surgical community, which boosted public recognition and validation. In 1930s, the polio epidemic was still continuing, and in the year 1937 the National Foundation for Infantile Paralysis was established, which gave major support to the growth of Physical Therapy as a profession. The world entered the Second World War and the Physical Therapy continued to show its dominance by treating the individuals who sustained injuries during the war. In the first half of 1940s with World War II at its peak, the world required the attention of PTs for wounded soldiers who returned home with amputations, burns, cold injuries, wounds, fractures, and nerve and spinal cord injuries. [5],[6]  The investigation about the application of electrical stimulation gave a new direction to the Physical Therapy treatment. They realized it’s not just to retard and prevent atrophy but to restore muscle mass and strength. The “galvanic exercise” was given by the PTs on the atrophied hands of patients who had an ulnar nerve lesion from surgery upon a wound. [7]

By the year 1942, the therapists started getting their relative military rankings. Hospital-based practice for PTs was increased by 1946. The main reason for this was the Hill Burton Act passed during 79  th US Congress, to build hospitals across the country. It increased the public access to hospitals and health care facilities and the demand for Physical Therapy services increased [5]

After the war, the need for PTs declined and the training of new PTs was suspended. The PTs already on active duty were included in the newly established Women’s Medical Specialist Corps (WMSC) in 1947. Male therapists were accepted into the Corps in 1955 and the name of the Corps was changed to the Army Medical Specialist Corps (AMSC). The post war era brought an increased awareness of the need for rehabilitation. During this time ‘proprioceptive neuromuscular facilitation’ (PNF) emerged as a part of the armamentarium of skills of the PTs. Dr. Bobath, neurologist and Mrs. Bobath, physiotherapist together developed the Bobath concept for the treatment of children with cerebral palsy and adults with neurological conditions. In their lifetime they travelled extensively, in teaching and training tutors around the world. They both received many honors for their pioneering and innovative work. [8]

In 1950s gaining independence, autonomy and professionalism was the need of the hour for the profession when PTs progressed from technicians to professional practitioners. Two events that took place in 1950s contributed to this; in 1954, American Physical Therapy Association (APTA) developed a 7-hour-long professional 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. [9]

The role of PTs in Cardiac Rehabilitation started expanding. In 1952, Levine and Lown openly questioned the need for enforced bed rest and prolonged inactivity after a myocardial infarction, which was put forward in 1930s by two physicians, Mallory and White. Based on the work performed in a Boston hospital during the 1940s, they concluded that the long, continued bed rest “decreases functional capacity, saps morale and provokes complications.” [10]  Their highly published report caught the attention of many and raised numerous clinical questions about the management of cardiovascular diseases. At the 13th Scientific Session of the American Heart Association (AHA) in Chicago in 1953, noted physician Louis Katz told the medical community that “physicians must be ready to discard old dogma when they are proven false and accept new knowledge.” [11]  The need to continue research on physical activity and to assimilate this new information into the practice scheme for cardiac patients was emphasized. [12]

Just like in the previous World Wars, the Korean War also produced a large number of war causalities for which the services of Physical Therapy once again proved vital. During the Vietnam War, a female PT was first among the members of AMSC to volunteer for Vietnam duty posting at Fort Belvoir, Virginia. She arrived with the 17  th Field Hospital, Saigon, in March 1966. In South Vietnam, 43 army PTs, 33 of whom were women, served between 1966 and February 1973. Physical Therapy restored the use of damaged arms and legs, rehabilitated surgical wounds, increased range of motion, and restored flexibility and strength following serious burns, and it speeded patient recovery
and repaired the wounded soldier. [13]

A major change occurred after the Vietnam conflict. The huge army population with neuro-musculoskeletal problems was managed by very few orthopedic surgeons. The performance record and the scope of practice required in Korea and Vietnam led to the identification of PTs as “Physician Extenders,” who were credentialed to evaluate and treat neuro-musculoskeletal patients without physician referral. [13][14]

During times of peace, PTs worked in a prescriptive environment prior to the early 1970s. Due to the increased need for PTs and the discontinuation of the army-based schools after the war, APTA recognized the need to educate more PTs. The Schools Section of APTA made recommendations about admissions, curricula, education and administration of Physical Therapy programs. Also, APTA embarked on an effort to encourage more universities and medical schools to create programs and expand existing programs, including creating opportunities for graduate-level education. [9]

The decade 1967-1976 saw the expansion of the profession into the management of orthopedics and cardiopulmonary disorders. With the advent of open heart surgery, Physical Therapy began to be practiced in preoperative and postoperative units. The care to individuals with severe joint restrictions altered with the increasing practice of joint replacements. [12] Associations for the promotion of the practice of animal Physical Therapy by PTs have been in existence since 1984 and are continuing to expand. Small numbers of PTs are currently engaged in animal Physical Therapy especially for racing horses. [15]

In the 21st century, the profession has continued to grow substantially. Patients are able to refer themselves to a PT without being told to refer themselves by a health professional. [16]  New generation PTs consider movement as an essential element of health and well-being, which is dependent upon the integrated, coordinated function of the human body at a number of levels. Movement is purposeful and is affected by internal and external factors. So today’s Physical Therapy is directed toward the movement needs and potential of individuals and populations. Though we are in a more scientific and research-dependent era of our evolution, let us not forget those practitioners of the past, from all professions and doctrines, who have given so much throughout the centuries of history in Physical Therapy.

REFERENCES

1.Terlouw TJ. The origin of the term “physiotherapy.” Physiother Res Int 2006;11:56-7.
2.Korobov SA. Towards the origin of the term physiotherapy: Dr. Edward Playter’s contribution of 1894. Physiother Res Int 2005;10:123-4.
3.Playter E. Physiotherapy first: Nature’s medicaments before drug remedies; particularly relating to hydrotherapy. Montreal Med J 1894;xxii:811-27.
4.Burns JM. Roosevelt: The Lion and the Fox: Vol. 1; 1882-1940.
5.Moffat M. The history of physical therapy practice in the United States. J Phys Ther Educ Winter 2003;17:15-25.
6.Murphy W. With vision, faith, and courage, 1920-1929. In: Healing the generations: A History of Physical Therapy and the American Physical Therapy Association. Lyme: Greenwich Publishing Group Inc; 1995. p. 70-103.
7.Licht SH. “History of Electrotherapy”. Therapeutic Electricity and Ultraviolet Radiation, 2  nd ed. New Haven, Conn.: Licht; 1967.
8.History of Bobath. Available from: http://www.bobathwales.org/our-history/. [Last accessed on 2014 July 6].
9.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.
10.Levine SA, Lown B. Armchair treatment of acute coronary thrombosis. J Am Med Assoc 1952;148:1365-9.
11.Katz LN, Burch GE, Dorfman A, Ernstene C, Hecht HH, Parker RL. Symposium: Unsettled clinical questions in the management of cardiovascular disease. Circulation 1958;18:430-46.
12.Certo CM. History of cardiac rehabilitation. Phys Ther 1985;65:1793-5.
13.In: Anderson RS, Lee HS, McDaniel ML, editors. Army Medical Specialist Corps. Washington: Office of the Surgeon General, Department of the Army; 1968.
14.Neel, Spurgeon. Medical Support of the U.S. Army in Vietnam, 1965-1970. Washington, D.C.: Department of the Army; 1973