What could possible be more important in life than physical health? If you are reading this post, then some part of you agrees that physical training and rehabilitation is a vital part of your well-being. But where did it all begin and how did it develop into what is today known as physiotherapy / physical therapy?
Physiotherapists historically have sported many titles; physiotherapists, physical therapists, remedial gymnasts, and reconstruction aides are all titles that have been used to described professionals working under the rubric of physical rehabilitation.
Like many branches of medicine, physical rehabilitation developed and thrived tangentially around the world throughout history. Several paralleled philosophies regarding physical health developed in Greece, Rome, India, and China, just to name a few places. Herodicus, a Greek physician, from around 500 BC, is often credited with establishing one of the first documented systems of exercise called Ars Gymnastica, meaning The Art of Gymnastics. His professional and clinical philosophies sprouted from experimenting with his own ailments. He strongly believed that he was able to treat physical malaises with wrestling, walking, and massage. The ancient Greeks would use halters (weights that resemble dumbbells), and riding (sitting or lying down) in a horse-drawn carriage over rough roads to cure them of physical troubles. Herodicus understood the principles of inactivity and the atrophying consequences this had on muscles, ligaments, and bones. Following the wisdom of Herodicus, ancient Greeks and Romans have long been known to use prescriptive exercise, massage, joint mobilizations, hydrotherapy, and light therapy to keep their various humours in check.
There is scriptural evidence predating Herodicus from China and India, sometime before 1000 BC, that described a type of exercise called Cong Fu; which consisted of body positioning and breathing routines. Perhaps this sounds familiar?
The ancient development of medicine, and consequently, physical therapy could easily be the subject of a lengthy dissertation on its own. But what is of most interest is how our beloved profession has risen and demonstrated its resilience, relevance, and adaptability. Physical therapy, as an all-encompassing term, includes everything from wound care, respiratory therapy, orthopedics medicine, and everything in between. Everyone from premature babies, to our cherished grandmothers, can, and many do, benefit from the knowledge and experience of physiotherapists; stemming, in large part, from the evolution of our long-standing profession.
Like all fields of medicine, physiotherapy thrived on chaos. It is well document and well known that both the First and Second World Wars had catalytic effects on the development and support of physical therapy. Military physicians, overwhelmed by waves of wounded and dying soldiers, needed all the help they could get with convalescent care. Commensurate with other medical advancements and improved casualty evacuation systems, a greater number of soldiers survived the effects of war, but many were left with crippling limitations. Britain, the United States, and Canada for example, simultaneously developed short-termed training programs aimed at the further development of health care individuals from all walks of life, to enable them to perform physical therapy services. Reconstruction aides, originating from the United States, were the first physical therapists to graduate from Reed College and Walter Reed Military Hospital to help with the war efforts during WWI. Canada was not far behind and developed the Canadian Association of Massage and Remedial Gymnastics (CAMRG) in 1920, which later developed into the Canadian Physiotherapy Association (CPA) in 1935. Many of the manual therapy, respiratory, and exercise prescription techniques that are still used today grew from the treatments given by health care professionals of all backgrounds during and after the war. The ground-breaking efforts of physiotherapy could not have been possible without the determination and tenacity of our wounded military personnel.
Between, and after the world wars, the focus of physical health shifted towards the polio epidemics and the push for industrialization. Polio, or poliomyelitis, had a globally crippling effect on our young population causing limb deformities, respiratory limitations, paralysis, and in extreme cases even death. The invention of the Salk vaccine in 1952 essentially eliminated polio and consequently threatened the livelihood of physical therapy as a profession. It was thanks to the need of restoring a fighting force in a growing industrialized societies, after the great wars that maintained the need for physiotherapy. Physical therapy treatments in the 1940s through the 1950s, in countries such as the U.S., Canada and Great Britain, mainly focused on massage, exercise prescription, and manipulations of the extremities and the spine for the treatment of work related injuries.
It was during the 1950s that physiotherapy as a practice began to move away from hospital based treatments. Therapists could now practice in a wide range of settings, including in orthopedic outpatient clinics, public schools, college and universities, convalescence and rehabilitation centers, and of course hospitals and medical centers. Physiotherapy was really coming into its own in a multitude of disciplines and with a wide variety of populations. I am sure that each and everyone one of us can associate an encounter with a physiotherapist that in turn inspired our own choice of becoming a health care professional.
Now that we have a brief overview of how we came to be, the question that naturally arises is: Where are we going? Like other areas of medicine, physiotherapy has always grown to meet the demands of current societal needs; whether it be in the realm of armed conflicts, epidemics, work related injuries, or increasingly musculoskeletal (MSK) injuries influenced by technological advancements.
If we take a moment to reflect, what are our current societal needs?
Today it is common practice for physiotherapists in many countries to be considered “front line” health care professionals. Physicians and other health care workers are increasingly comfortable writing referrals for rehabilitation that clearly states “evaluation and treatment as indicated”. Not only are we able to evaluate, diagnose, and treat a multitude of conditions and functional limitations, patients and clients are free to consult directly, on a walk-in basis. This fully encourages self-directed autonomy and a blank slate for our professional development as physical health experts.
Over the years, with great effort from our predecessors, we have evolved into a profession founded in evidence-based practice and regulating bodies. We are also currently taking baby steps towards legislative support for controlled practices around the world. We continue to have obstacles to face and our challenges are not the same for every sub-discipline of physiotherapy. Nor are our battles comparable across countries or continents. But a wise person once said ““Our future will be shaped by the assumptions we make about who we are and what we can be”, Rosabeth Moss Kanter.
My question to you becomes: knowing who we are, what do you think we can be?
Let me know your thoughts on the future of physiotherapy / physical therapy in your country, or globally. Feel free to contact me directly at [email protected].
Echenberg, D. (2007) A history of internal medicine: medical specialization: as old as antiquity. Rev Med Suisse Nov 28;3 (135) 2737-9.
Chapter 1: The Evolution of Physical Therapy. Jones and Bartlett Publishers. Retrieved (30 March 15) from: www.jblearning.com/samples/0763740691/40691_CH01_FINAL.pdf
CPA Pratice and Research Department (Revised Jan 2011). Canadian Physiotherapy Association Scope of Practice Briefing Note. Retrieved (30 March 2015) from http://www.physiotherapy.ca
American Physical Therapy Association (APTAP) (2015). Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision. Retrieved (30 March 2015) from http://www.apta.org/Vision/