The History of Physical Therapy

Physical Therapists play an important role in today’s healthcare system.  As trusted healthcare experts in restoring and improving motion, they contribute to their patients’ quality of life by keeping them healthy, fit, and active and, in many instances, avoiding surgery and long-term use of prescription medications. In work-related injuries, physical therapy is often the last course of treatment utilized before the patient is released to return to work and placed at Maximum Medical Improvement.  Although most people are familiar with the term physical therapy, few know of how this very important profession came to be.

The Past

Today’s common practices of using exercise, massage, heat, cold, water, and electricity, date back to Greek culture and Hippocrates’ influence as the father of Western medicine. In Europe during the 1500s – 1700s, the use of exercise to treat muscle and bone disorders and disabilities continued to progress. By the 1800s, exercise and muscle re-education were utilized for a variety of orthopedic diseases and injuries.

When the polio epidemic became widespread in the United States in 1916, the need for muscle testing and muscle re-education to restore function grew dramatically. In 1917, the United States entered World War I, and the Army recognized the need to rehabilitate soldiers injured in battle.  As a result, a special unit of the Army Medical Department, the Division of Special Hospitals and Physical Reconstruction, developed 15 “reconstruction aide” training programs to respond to the need for medical workers with expertise in rehabilitation. The profession of physical therapy, as it was later termed, had begun.

During the 1920s the partnership of physical therapists with the medical and surgical communities grew, and the profession of physical therapy gained public recognition and validation.  The polio epidemic continued into the 1930s, and the United States’ involvement in World War II at the end of the decade resulted in additional wounded soldiers to rehabilitate. Wounded veterans who returned home with amputations, burns, fractures, and nerve/spinal cord injuries required the attention of physical therapists. In 1946, Congress adopted the Hill Burton Act to build hospitals across the country to increase public access to health care facilities. This legislative action resulted in an increase in hospital-based practice for physical therapists and an increased demand for physical therapy services.

 PT practice in the 1950s continued to be influenced by the start of the Korean War and the continued polio epidemic. Although a vaccine was finally developed to end the disease, individuals who had contracted polio prior to the vaccine continued to need physical therapy treatment.

The 1950s decade was a critical time for the profession in terms of gaining independence, autonomy, and professionalism. The APTA urged its state chapters to seek licensure through the states to replace the registration system created by the American Medical Association.  By 1959, state regulations for the physical therapist existed in 45 states. While this was a positive step toward autonomy, the issue of how to assess competency continued to challenge the profession, resulting in the first national examination in 1954. The efforts to gain state licensure undoubtedly influenced the addition of outpatient physical therapy in the Medicare program in 1967 and 1968, as the majority of states had licensure laws by this time.

Physical therapy practices in the neuromuscular area expanded significantly during the 1960s, with development of techniques for adults with stroke, cerebral palsy, and other disorders of the central nervous system. The cardiovascular/pulmonary area of practice also developed during this time, as advancements in medicine such as open heart surgery became more commonly practiced. In the orthopedic practice arena, total joint replacements developed in the 1960s created an additional need for postoperative physical therapy and introduced new options for patients with severe joint restrictions to live more independent and pain-free lives.

Physical therapists found new opportunities and more options to improve patient function with developments in interventions between 1950 and 2000. Technological advances provided new testing methodologies with more objective outcome measures, and new intervention methodologies expanded practice and the types of diseases and conditions that physical therapy could positively influence. Congress adopted the Education of All Handicapped Children Act (now known as the Individuals with Disabilities Education Act (IDEA) in 1975, creating new avenues for physical therapists within the public school system. In the early 1980s APTA adopted a policy indicating that physical therapy practice independent of practitioner referral was ethical as long as it was legal in the state. Having taken small steps over the previous 50 years to become more independent of the physician, this courageous step punctuated the professionalization of the physical therapist and resulted in states changing their practice acts to provide for the ability to practice without referral.

Significant changes in our country’s health care delivery system throughout the 1990s, influenced the practice of physical therapy in ways that continue today. Managed care, the role of insurers in determining care, corporate and physician ownership of physical therapy services, the Balanced Budget Act of 1997, the Medicare Prospective Payment System (PPS), and the Medicare cap on physical therapy services implemented in 1999 challenged and continue to challenge physical therapists to provide quality services to patients.

The Present and Future

In the 21st century, the profession has continued to grow substantially, by further developing the scientific basis for its services, and by creating entry-level education standards to meet the demands of today’s health care system. This vital work will continue as the health care system is reformed.

Today’s physical therapy profession boasts confident, accomplished, professional practitioners on the cutting edge of health care, and it consistently ranks as one of the nation’s most desirable careers.  These practitioners help individuals of all ages to have optimal functioning and quality of life, while ensuring patient safety and applying evidence to provide efficient and effective care. Extensive education, clinical expertise, and "hands on" approach give Physical Therapist a unique, individualized approach. When you are in the hands of a physical therapist, you have a plan of care that is safe and appropriate and customized to meet your individual needs.