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Physiotherapy History And Applications

Physiotherapy (aka Physical Therapy in USA) dates back to the birth of medical science in Ancient Greece and Rome, thanks to the bravery of early physicians such as Hippocrates of Kos (460 BC – 370 BC), and Galenus in Rome (129 AD - 200 AD).

Poor old Hippocrates spent 20 years in prison for daring to challenge the vested interests of the era, who were little more than witch doctors.

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy.

In 460 BC, Hector practiced Hydrotherapy - which is Greek for water treatment.   Physiotherapists today still employ hydrotherapy, now evolved and adapted specifically to various patient conditions.

During the Dark and Middle Ages medicine was kept alive by Arabs in the Middle East until it was revived in Europe following the Renaissance.

Otherwise little changed until the 19th century, since when physiotherapy has evolved from simple massage to a complex portfolio of therapies with many specialized applications.

The first emergence of Physiotherapy as a specialist discipline was in Sweden in 1913 when Per Henrik Ling founded the Royal Central Institute of Gymnastics (RCIG) for massage, manipulation, and exercise. In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

In 1894, Great Britain recognized physiotherapy as a specialized branch of nursing regulated by the Chartered Society of Physiotherapy.

In the succeeding two decades, formal physiotherapy programs were established in other countries, led by the School of Physiotherapy at the University of Otago in New Zealand (1913).

The first record of American physiotherapy was at Walter Reed College and Hospital of Portland, Oregon where nurses with physical education experience worked as Reconstruction Aides  These reconstruction aides contributed vitally to the recovery and rehabilitation of many WWI vets.

In 1921, Mary McMillan formed the Physical Therapy Association in the USA.  Subsequently renamed the APTA, this organization profoundly influenced development of physiotherapy in America.

The polio epidemic of the 1920's was a landmark turning point for the physiotherapy profession.  Sister Kinney, of the Mayo Clinic achieved national reknown for work with polio victims.  The Georgia Warm Springs Foundation was established in 1924 in response to the polio epidemic and provided physiotherapy for these polio patients.  

After the polio epidemic subsided, physiotherapy treatments comprised mainly exercise, massage and traction.

From 1950, chiropractic manipulations were also introduced, most commonly in Great Britain initially.  The Orthopedics specialty within physiotherapy also emerged at about the same time.

From that date, physiotherapy expanded from hospitals out to other areas of medical care.  Physiotherapists now work also in clinics, nursing homes, private practice and schools.

Research has long been a feature of modern physiotherapy, dating from the first USA research study publication in 1921.  Research continues actively today in a wide range of specialties.

A significant force in the recent evolution of physiotherapy has been the International Federation of Orthopaedic Manipulative Therapy.  Notable individuals driving change in technique and training have included Mariano Rocabado (Chile);  Freddy Kaltenborn (Norway/USA); and Geoffrey Maitland (Australia).

During the 1980's, technology became the focus of change in physiotherapy. Novel procedures featured computers, electrical stimulation, ultrasound and other new equipment. However, led by Freddy Kaltenborn, interest reverted to manual therapy in the following decade.

Throughout development of the Physiotherapy profession, training and technique have continued to change and improve apace. Gifted pioneers have contributed richly to the profession's literature and field organizations.

In consequence, Physiotherapy now commands wide recognition and well-earned respect, with many young people expressing interest in making their career in the profession.

Looking to the future

Two trends seem set to continue:
  1. Stratification

    Physiotherapy is no longer a single tiered nursing specialty.

    Skills, education and qualifications now range from diploma qualified PT Assistants to post-graduate licensed physicians.

  2. Specialization

    The American Board of Physical Therapy Specialties currently certifies 8 specialities. This is a moving feast, as existing specialties continue to subdivide, and new technologies and techniques evolve creating entirely new specialist areas of therapy. Below are links to brief explanations of 12 current specialties.

  1. Cardiovascular & Pulmonary

  2. Clinical Electrophysiology

  3. Geriatric

  4. Integumentary

  5. Neurological

  6. Orthopedic

  7. Pediatric

  8. Sports Medicine

  9. Women's Health

  10. Pain Management

  11. Public Health / Health Promotion

  12. Multi-disciplinary Care Groups

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