Fri. Sep 18th, 2020

Hankering for History

Hanker: To have a strong, often restless desire, in this case for–you guessed it–history!

The History of Physical Therapy

8 min read

Physical therapy, as a science, can be found in every sector. From the hospital to the spa to sports routines. However, there was once a time patients needed a full referral before they could seek help from a physical therapist. And although we begin with Hippocrates, physical therapy only became a widely accepted science in the 1900s.

Ancient Greece, Hydrotherapy, and Gymnastics

Hydrotherapy, although it only forms a part of today’s physical therapy, is the first to put therapy, massage, and medical treatments together. Gymnastics, although it is the basis of muscle rehabilitation and development treatments we know today, was not used medically until the 1700s. This is why many accounts of physical therapy begin with hydrotherapy rather than gymnastics.

Hippocrates and hydrotherapy

Hippocrates (born around 460 BCE) is known as the Father of Medicine. He was born on the island of Cos in Greece. Plato, one of the younger philosophers at this time, hints that Hippocrates was descended from, and the member of, a family of physicians.

Hippocrates is known for two things: his philosophies of medicine, and his writings on different medical issues and some cures. He is also the supposed writer of the “Hippocratic Oath,” an oath of ethics taken by medical personnel around the world today.

Both Hippocrates and Plato write about a specific therapy called hydrotherapy. Simply put, water therapy. The Ancient Greeks noticed that natural hot springs seemed to have healing properties. Specifically, the qualities of the water helped relieve skin diseases, and relax swollen joints and muscles. For this, they built Thermals around hot springs.

Hippocrates believed that “all the human diseases started in an imbalance of the bodily fluids.” Hot and cold baths were considered a form of treatment, with an after-bath oil massage as a form of relaxation therapy for the patient. (Also as a form of early skin care.)

Gymnastics

Gymnastics is also from Ancient Greece, designed to develop the physical body. It was centered less in joint- or muscle-specific exercises, and more in what we would call sports today, like running, swimming, and wrestling. They also built buildings for training, called gymnasiums. The Olympic Games were the ultimate displays of these exercises.

When the Roman Empire replaced the Greek Empire, they did what they do with so many other things: they redefined and formalized what was called the gymnastics. They also took the gymnasiums and integrated them into the Roman Baths, or Thermae.

Rome and the Golden Age of Hydrotherapy

The Sanus per Aquam (SPA)

However, the famous gymnasiums and baths were created in the Roman times. Rosemary Sutcliff, an author of historical fiction specializing in the Roman part of British history, writes in her novel The Eagle of the Ninth about a gymnasium and hot bath even in a small garrison town.

One reason hydrotherapy had its golden age in the Roman times was because of the aqueducts. Aqueducts were one of the earliest engineering devices that could basically “pipe in” water from a dam or river to the cities. So while the Greeks needed to find hot springs to build their Thermals, Romans just needed to pipe in the water and use furnaces for their Thermae. Massage centers were also an important part of these structures.

These Sanus per Aquam, or SPA, became rest and relaxation centers that went far past the water treatments and massages. They were places to meet up and hang out, or even to carry out some informal work or political conversations. They had gardens, places to read, and places to go shopping together (sort of like a mall today).

The gymnasiums, as the Greeks knew them, became part of these large SPA, also known as the Roman Baths. So one could exercise, rest in a hot bath, get a massage, go shopping, and end with a good book—all in the same place.

The military aspect

Because Rome was a militaristic empire, the gymnasium was used for exercise and training for its soldiers. Roman soldiers at rest also used the Thermae to recuperate and recover. While it was not used in the sense of today, where therapy is used to help wounded soldiers regain physical functions, this is one of the uses that has definitely survived until today.

At this time, the only uses of this early form of physical therapy were to train the body or relieve joint and muscle inflammation. The “water therapy” was the main focus, with massage and focus on the muscles only part of the routine.

The Roman empire ended in 1453. It would be over 300 years before the earliest documented origins of physical therapy, as a combination of gymnastics and medicine, became part of the modern medical world.

Sweden and the Father of Physical Therapy

Modern gymnastics began and spread in Europe from 1774 all the way through the 1800s. Per Henrik Ling, a Swede, was born in 1776. He graduated from Växjö gymnasium (the Swedish term for high school) in 1792, and traveled around Europe after graduating university. In his travels, Ling learned fencing, and noticed how the exercise helped him manage his rheumatism, lung disease, and gout.

Lack of funds sent him back home to Sweden. But the connection of exercise to healing, instead of just health, fascinated him. Ling started to use repetitive body movements, combined with massage, to treat his own conditions as a form of physical rehabilitation. He also learned further gymnastic exercises. Ling’s skill in fencing found him a job as a fencing master in Lund University, where he worked even more on his theories.

Eventually, Per Henrik Ling founded the Royal Gymnastics Central Institute (also known as the Royal Central Institute of Gymnastics) in Stockholm, Sweden. This is the first time that gymnastic exercises and healing were actively put together. He and his school eventually developed more advanced massages, calisthenics, and tools for exercises (what we would now see as gym equipment). His primary focus was physical rehabilitation. He was also a great advocate of hands-on therapy, what would later be known as manual therapy. 

The Spread of Physical Therapy

Physical therapy, as physiotherapy, was first formally adopted outside Sweden by four British nurses, who founded the Chartered Society of Physiotherapy in 1884. Until today, many British physiotherapists are members of this society. Physical therapy education was the next to grow and spread. New Zealand started in 1913 with a School of Physiotherapy, and the United States created one at Reed College in 1914. The later schools coincided with two very important events: the polio epidemic, and the first world war.

Physical therapy and the polio epidemic

The first polio epidemic in the United States was in Vermont, in 1894. However, the real start of the fight against polio was 1916, in the middle of World War I (1914-1918). In New York, 2,000 people died of polio. Across the nation, 6,000 died. Polio attacks the spinal cord and paralyzes the muscles, including those powering the lungs. Those who survived its grip found themselves with weakened muscles or paralyzed limbs. 

Because it was a medical condition specifically related to evaluating damage and restoring function back to weakened muscles, physical rehabilitation through therapy naturally stepped in. In the absence of a preventative vaccine, physiotherapists focused instead on understanding just how much polio had damaged the patient’s bodies, and how they could use their remaining muscle functions to regain movement and mobility.

Physical therapy and World War I

It was during and after World War I that physical therapists were recognized as part of the medical profession in the United States. While war-torn Europe was already using therapy to bring soldiers back to the front lines or install them in civilian life, the United States did not yet have that kind of experience. 

In 1917, “physical reconstruction” became part of the rehabilitation process of wounded soldiers. The idea was to restore them to the highest possible level of health. At rehabilitation centers, they used hydrotherapy, massage, exercises, and electrotherapy to restore health. However, the scientific foundations were not complete. Massage, more than any other treatment, was prescribed because it was the least technical, the least costly, and the most soothing.

Those trained to do physical reconstruction were called “reconstruction aides,” and also “physical therapists.” Centers for physical therapy education like Reed College graduated reconstruction aides. Graduates of these courses continued to find work in restoring health to those affected by the war even throughout World War II. 

Modern Physical Therapy 

Modern physical therapy shows itself in different forms. There is developing and promoting health systematically, in physical education. There is the diversification of the kinds of therapies, such as manual therapy and neurological physical therapy. And there is also, in a kind of cycle back to Ancient Greece, sports medicine. 

Physical education

Physical education reentered schools as modern gymnastics took hold of Europe in 1820. The motive was partly healthy occupation and pastimes for young men, but another one was in preparation for possible military service. However, eventually, physical education became primarily a health-related program. Colleges in particular started to take physical education programs more seriously, and began to give out sports scholarships. 

Until today, physical education is incorporated into curriculums at all levels of education. It is the side of physical therapy that promotes health and strengthens bodies, to lessen sickness and vulnerability to disease. 

Manual therapy and neurological physical therapy

In a sense, manual therapy was one of the oldest forms of physical therapy. Per Henrik Ling was a strong advocate of hands-on therapy, or the process of applying therapy manually with the intent of rehabilitating tissues and affected muscles. It is often differentiated from massage by being more medical in nature. Massage is usually more for relaxation.

Neurological physical therapy, on the other hand, is one of the most advanced forms of physical therapy. It is specifically designed to help those with neurological injuries who suffered loss of muscle movement and function as a result. Neurological injuries even include those who suffered oxygen-deprivation through a condition such as COVID-19, for example. Oxygen-deprivation can lead to many issues, not least the loss of strength and muscle mass in the recovery period. 

Sports medicine

To take the wheel of history all the way around, physical therapy is very often used as a part of sports medicine. Athletes of every level rely on physical therapy to restore strength and functionality after any injury. It is its own unique branch of physical therapy because the aim is not everyday functionality, but high-powered performance. It also deals with very specific injuries to each sport, such as “tennis elbow” for professional tennis players. Sports medicine is one of the most sophisticated developments of modern physical therapy. 

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