Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists. It focuses on promoting, maintaining, or restoring health through patient education, physical interventions, disease prevention, and health promotion. The term physical therapist or physiotherapist is used to represent the trained person providing physical therapy.
The profession has many specialties including musculoskeletal, orthopedics, cardiopulmonary, neurology, endocrinology, sports medicine, geriatrics, pediatrics, women's health, wound care and electromyography. PTs practice in many settings, both public and private.
In addition to clinical practice, other aspects of physical therapy include research, education, consultation, and health administration. Physical therapists provide primary care patient management in conjunction with other medical services. In some jurisdictions, such as the United Kingdom, physical therapists may have the authority to prescribe medication.
Overview Physical therapy addresses illnesses or injuries that limit a person's ability to move and perform functional activities in their daily lives. PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies like X-rays, CT scans, or MRIs. Physical therapists can use sonography to diagnose and manage common musculoskeletal, nerve, and pulmonary conditions. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be used.
PT management commonly includes the prescription of, or assistance with, specific exercises, manual therapy, and bodily manipulation. Additional treatments include mechanical devices such as traction; education; electrophysical modalities which include heat, cold, electricity, sound waves, and radiation; assistive devices; prostheses; and orthoses. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, and providing services to individuals and populations to develop, maintain, and restore maximum movement and functional ability throughout life. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease, or environmental factors. Functional movement is central to what it means to be healthy.
Physical therapy is a profession which has many specialties including musculoskeletal, orthopedics, cardiopulmonary, neurology, endocrinology, sports medicine, geriatrics, pediatrics, women's health, wound care and electromyography. PTs practice in many settings, such as privately owned physical therapy clinics, outpatient clinics or offices, hospitals, health and wellness clinics, rehabilitation hospitals, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.
Physical therapists also practice in non-patient care roles such as health policy,Initiatives in Rehabilitation Research, health insurance, health care administration, and as health care executives. Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.
Education varies greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post-doctoral residencies and fellowships.
Regarding its relationship to other healthcare professions, physiotherapy is typically one of the allied health professions. World Physiotherapy has signed a "memorandum of understanding" with the four other members of the World Health Professions Alliance "to enhance their joint collaboration on protecting and investing in the health workforce to provide safe, quality and equitable care in all settings".
History
Physicians like Hippocrates and later Galen are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 BC.Wharton M. A. Health Care Systems I, Slippery Rock University. 1991.
In the book "De Arte Gymnastica" (The Art of Gymnastics, published in 1569), the Italian physician Hieronymus Mercurialis (1530–1606) introduced the term "medical gymnastics," highlighting one of the meanings of "gymnastics" as a dedicated rehabilitative tool for disabled subjects of any age.Conti A. A. (2014). "Western medical rehabilitation through time: a historical and epistemological review". TheScientificWorldJournal, 2014, 432506. https://doi.org/10.1155/2014/432506
The Italian physiologist and mathematician Alfonso Borelli (1608–1679) achieved significant scientific results in the field of animal and human biomechanics. His tractate "De Motu Animalium" (On the Movement of Animals), published in 1680, just after his death, provided a practical framework for understanding disordered and pathological movement patterns in ill and disabled people.
In the 18th century, the French physician Nicolas Andry de Bois-Regard (1658–1742) established a solid link between the health of the musculoskeletal apparatus and physical exercise, and in his book "Traité d'orthopédie" (Treatise on Orthopaedics, 1741), he introduced the new term "orthopaedics". After Nicolas Andry de Bois-Regard, this knowledge became fundamental for understanding correct exercises in physical rehabilitation. After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.
The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, the "Father of Swedish Gymnastics," who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for joint manipulation and exercise. Up until 2014, the Swedish word for a physical therapist was sjukgymnast, or someone involved in gymnastics for those who are ill, but the title was then changed to fysioterapeut (physiotherapist), the word used in the other Scandinavian countries. In 1887, PTs were given official registration by Sweden's National Board of Health and Welfare. Other countries soon followed. In 1894, four nurses in Great Britain formed the Chartered Society of Physiotherapy. Other early associations of physical therapists include the School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides." Since the profession's inception, spinal manipulative therapy has been a major component of the practice of physical therapy.
Modern physical therapy was established towards the end of the 19th century due to events that affected bodily health on a global scale, which called for rapid advances in physical therapy. Following this, American orthopedic surgeons began treating children with disabilities and employed women trained in physical education, and remedial exercise. These treatments were further applied and promoted during the polio outbreak of 1916.
During the First World War, women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized. In 1918 the term "Reconstruction Aide" was used to refer to individuals practicing physical therapy. The first school of physical therapy was established at Walter Reed Army Hospital in Washington, D.C., following the outbreak of World War I. Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and joints of the extremities began to be practiced, especially in the British Commonwealth countries, in the early 1950s.
Around the time polio vaccines were developed, the presence of physical therapists became normalized in hospitals throughout North America and Europe. In the late 1950s, physical therapists started to move beyond solely hospital-based practices to outpatient orthopedic clinics, public schools, college/university health centers, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers. The specialization of physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Physical Therapists was formed, which has ever since played an important role in advancing manual therapy worldwide.
An international organization for the profession is the World Confederation for Physical Therapy (WCPT). It was founded in 1951 and has operated under the brand name World Physiotherapy since 2020.
Education
Educational criteria for physical therapy providers vary from state to state, country to country, and among various levels of professional responsibility. All U.S. states have physical therapy practice acts that recognize both physical therapists (PTs) and physical therapist assistants (PTAs), and some jurisdictions also recognize physical therapy technicians (PT techs) or aides. In many countries, physical therapists are required to obtain licensure or registration from the appropriate regulatory authority before they may practice independently, although the specific requirements vary by jurisdiction.
Canada
The Canadian Alliance of Physiotherapy Regulators (CAPR) permits eligible program graduates to apply for the national Physiotherapy Competency Examination (PCE). Passing the PCE is one of the requirements in most provinces and territories to work as a licensed physiotherapist in Canada. The members of CAPR are physiotherapy regulatory organizations recognized in their respective provinces and territories: Government of Yukon, Consumer Services College of Physical Therapists of British Columbia College of Physiotherapists of Alberta Saskatchewan College of Physical Therapists College of Physiotherapists of Manitoba College of Physiotherapists of Ontario Ordre professionnel de la physiothérapie du Québec College of Physiotherapists of New Brunswick/Collège des physiothérapeutes du Nouveau-Brunswick Nova Scotia College of Physiotherapists Prince Edward Island College of Physiotherapists Newfoundland & Labrador College of Physiotherapists
Physiotherapy programs are offered at fifteen universities, often through the university's respective college of medicine. Each of Canada's physical therapy schools has transitioned from three-year Bachelor of Science in Physical Therapy (BScPT) programs that required two years of prerequisite university courses (a five-year bachelor's degree) to two-year Master's of Physical Therapy (MPT) programs that require prerequisite bachelor's degrees. The last Canadian university to follow suit was the University of Manitoba, which transitioned to the MPT program in 2012, making the MPT credential the new standard entry to practice across Canada. Existing practitioners with BScPT credentials are not required to upgrade their qualifications.