Health Professions

Development of the Field of Physical Therapy

The field of physical therapy in modern times was established in Britain in the latter part of the 19th century. Shortly thereafter American orthopedic surgeons treating crippled and deformed children began employing young women trained in massage, remedial exercise and physical education. Frequent and intense outbreaks of poliomyelitis, particularly the great epidemic of 1916 in the mid-Atlantic and New England states, promoted the application of physical therapy techniques and the further recruitment of women as assistants in the treatment of patients. The First World War was the major turning point in the institutionalization of physical therapy. Women were recruited to assist orthopedic surgeons in restoring physical function to injured soldiers. In 1918 they were assigned to the newly formed Division of Special Hospitals and Physical Reconstruction in the U.S. Army’s Office of the Surgeon General. These “Reconstruction Aides” served in a civilian capacity in military hospitals both in the U.S. and overseas. The first school of physical therapy was established at Walter Reed Army Hospital, Washington, D.C., after the outbreak of World War I, and 14 additional schools were established soon afterward. The first was at Teachers College, Columbia University. The largest was at Reed College in Eugene, Oregon. Before the end of the war, the schools and colleges had trained almost 2000 women, about 300 of whom served overseas.

The recognized success of physical therapy techniques in the treatment and rehabilitation of the wounded ensured the continued growth of the field. After the war, the efforts that had gone toward restoring and maintaining a fighting force was redirected toward restoring and maintaining a working force in a growing industrial society. In addition, the treatment of crippled children was still a humanitarian concern. Several groups of Reconstruction Aides formed local associations and in 1921 a national organization, the American Women’s Physical Therapeutic Association, was formed. The name was changed the following year to the American Physiotherapy Association to reflect the inclusion of qualified men (two joined in 1923). In 1947 the name was changed once more to the American Physical Therapy Association.

The American Physiotherapy Association began with 245 members in 1921 and to grew to about 1,000 members by the end of the 1930s. With the advent of World War II and a nationwide polio epidemic during the 1940s and 1950s, physical therapists were in greater demand than ever before. The American Physiotherapy Association’s membership swelled to 3,000 by 1946, and the number of physical therapy education programs across the United States increased from 16 to 39. The U.S. Congress passed legislation in late December 1942 authorizing the inclusion of physical therapists in the Medical Department of the Army, thereby granting them military status during the war. By June 1946 over 680 physical therapists had seen overseas duty and the largest number on duty overseas at any one time was 570.

Physical therapy at a WWII army hospital
Physical Therapy at a WWII army hospital

In its earliest days, physical therapy was an occupation consisting almost entirely of women acting in a supportive role to physicians. The American Physical Therapy Association defined physical therapists as "educated trained assistants to the members of the established medical profession" guided by policy to “practice only under the prescription of a licensed physician.” The subordinate role was clear from the start – one of the original objectives of the American Women’s Physical Therapeutic Association was “to make available efficiently trained women to the medical profession.”

Similar to developments in the nursing profession, leaders in the field of physical therapy sought to professionalize the occupation through the establishment of national organizations. Furthermore, the establishment of state registration and licensing laws, higher and uniform training standards, and the formation of academic programs based in colleges and universities rather than in hospital schools further drove the field toward a more professional status.

Physical therapists have evolved over the years from physician’s assistants to autonomous health care practitioners. Though still a female-dominant field – approximately 2/3 of the members of the APTA are women – physical therapists now often serve as the entry point in the health care system for evaluation, treatment, preventive programs and consultation.