Physiotherapy / Physical Therapy

Physiotherapy (also Physical Therapy) is a health care profession concerned with human function and movement and maximising potential. It uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status.  It is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery.  The exercise of clinical judgement and informed interpretation is at its core.

Physiotherapists and Physical Therapists (PTs) work in a wide variety of health settings to improve a broad range of physical problems associated with different 'systems' of the body. In particular they treat neuromuscular (brain and nervous system), musculoskeletal (soft tissues, joints and bones), cardiovascular and respiratory systems (heart and lungs and associated physiology).

Physiotherapists work autonomously, often as a member of a team with other health or social care professionals. Physiotherapy practice is characterised by reflective behaviour and systematic clinical reasoning, both contributing to and underpinning a problem-solving approach to patient-centred care.

People are often referred for physiotherapy by doctors or other health and social care professionals. Increasingly, as a result of changes in health care, people are referring themselves directly to physiotherapists without previously seeing any other health care professional.

History

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physiotherapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C. 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 physiotherapy.

Shoulder Massage: Relief at Museum in Cyrene Libya thought to be 2000 years old

The earliest documented origins of actual physiotherapy as a professional group date back to Per Henrik Ling “Father of Swedish Gymnastics” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. 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. 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."

Research catalyzed the physiotherapy movement. The first physiotherapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). 

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Later that decade, PTs started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings, rehabilitation centers, hospitals, and medical centers.

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed, which has played an important role in advancing manual therapy worldwide since.

Clinical Specialities

Because the body of knowledge of physiotherapy is quite large, PTs tend to specialize in a specific clinical areas. These include:

• MSK / Ortho
• Cardiopulmonary
• Neurology
• Paediatrics
• Sports Medicine
• Rheumatology
• Older People / Geriatrics
• Medical Conditions
• Pain
• Womens Health
• Oncology
• Extended Scope
• Public Health

Regional Differences

UK (Physiotherapy)

All Physiotherapists in the UK have at least 3-4 years training and are members of the  Health Professions Council (HPC).  They can also choose to become a member of Chartered Society of Physiotherapy (MCSP). Physiotherapists work in a variety of settings including hospitals, health centres, private clinics, GP practices, schools, work places and also by visiting people at home.

There are three main treatment routes if you are resident in the United Kingdom and wish to see a physiotherapist, these are via the NHS, private practitioners or the independent sector: 

• If you go via the NHS, depending on where you live, you will first need to make an appointment with your general practitioner (GP) and then ask to be referred to see a physiotherapist. Onward referral will be at the discretion of the GP.  A number of hospitals are now offering self-referral to physiotherapy. If your hospital is offering this service, you can make an appointment to see a physiotherapist without needing to see your GP first.
  
• If you are in a position to pay for your own treatment, there are a large number of physiotherapists across the UK offering treatment in dedicated physiotherapy and sports injury clinics as well as many who will treat people in their own homes.
  
• Via the independent sector, some large employers run occupational health schemes for their employees that may include provision for physiotherapy treatment or private medical insurance schemes for individuals through the independent healthcare sector will often include physiotherapy treatment.