The Rise of Physical Therapy: A History in Footsteps

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Archives of Medicine and Health Sciences / Jul-Dec 2014 / Vol 2 | Issue 2 257
Medical History
Abdul Rahim Shaik, Arakkal Maniyat Shemjaz
Department of Neuro Physiotherapy, Yenepoya Physiotherapy College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
The Rise of Physical Therapy: A History in Footsteps
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
Corresponding Author:
Dr. Shaik Abdul Rahim, Yenepoya Physiotherapy College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka, India.
E-mail: shaikarahim11@gmail.com
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DOI:
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Shaik and Shemjaz: The rise of physical therapy
258 Archives of Medicine and Health Sciences / Jul-Dec 2014 / Vol 2 | Issue 2
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 79th 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
Figure 2: Lois “Burnsie” Stevens, a Physical Therapist who has been
involved with polio patients
Source:http://www.pinetreesociety.org/media_02222011.asp
Figure 1: ‘Reconstruction Aide’ treating the amputated soldier
Source:http://blogs.chapman.edu/magazine/2014/05/16/world-war-one/
Figure 3: Duchenne, the founder of modern electrotherapy, faradizing
the frontalis muscle (1847)
Source: http://theredlist.com/wiki-2-16-601-798-view-pioneers-profi le-duchenne-
de-boulogne-1.html
cardiovascular diseases. At the 13th Scientific Session of
the American Heart Association (AHA) in Chicago in 1953,

Shaik and Shemjaz: The rise of physical therapy
Archives of Medicine and Health Sciences / Jul-Dec 2014 / Vol 2 | Issue 2 259
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 17th 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
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Figure 4: The Patient Gymnasticon, an early exercise machine
resembling a stationary bicycle, invented in 1796 by Francis Lowndes
Source:http://en.wikipedia.org/wiki/Gymnasticon#cite_note-Pantologia-1
Figure 5: The Physical Therapist with wheelchair-bound patients
Source:http://www.mandevillelegacy.org.uk/page_id__17_path__0p4p14p21p.
aspx

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How to cite this article: Shaik AR, Shemjaz AM. The Rise of Physical Therapy:
A History in Footsteps. Arch Med Health Sci 2014;2:257-60.
Source of Support: Nil, Confl ict of Interest: None declared.