We know that in our world today, uniforms are ubiquitous and continue to define who we are and where we work. As examples, uniforms in the military stemming back to Napoleon Bonaparte, uniforms of the Church (think about the Pope’s regalia and the red robes of his cardinals), Police and Security Guards, Boy Scouts and Girl Guides, various uniforms of First Responders, in Hospitals, on Cruise Ships, commercial services like airlines; the list goes on and on. Uniforms can define our occupation and place in the world.
There have been few research articles written about the history of uniforms worn by physiotherapists over the last 100 years. Originally, physiotherapists in Canada were not called “Physiotherapists”. They were qualified in massage, hydrotherapy and remedial gymnastics and called Massage Therapists. Later, there was the addition of Electrotherapy and ever more sophisticated treatments over the decades. In 1920, the Canadian Association of Massage and Remedial Gymnastics was founded and in 1935, with the change of name to Canadian Physiotherapy Association (CPA), we became known as Physiotherapists. As our profession and type of workplaces have continued to evolve and over time, the scope, breadth and depth of physiotherapy treatments has grown and flourished, and with that growth there came an ever-changing uniform
Methods used by physiotherapists date back to Ancient Greece at the time of Hippocrates in 460 B.C. Back in those days, the main forms of health treatment were massage and hydrotherapy usually centered around spas and according to the depictions on ancient friezes, it is likely that the healers wore flowing robes.
A tug-of-war match between nurses (left) and physiotherapists (right) at Tuxedo Park Hospital, Winnipeg, 1917.
It is interesting to note that in the early days, many of the hospitals were founded and run by the Catholic Church, so that the early uniform dresses of Physiotherapists and Nurses were patterned after those of the habits worn by Nuns. There is a likeness between the photos of the uniforms of those early Massage Practitioners and Nurses in Canada, as you can see in the photo of the Tug of War taken in 1917.
The uniforms of Physiotherapists in the early days were long white dresses, caps, white stockings and white shoes. Our uniforms were laundered, pressed and starched by the hospitals. Our dresses and caps were initially made from cotton, as it washed well in hot water so helping to prevent the spread of infection.
WWI Masseuses
The role of physiotherapy in the military is not new. For decades, Canadian physiotherapists have been providing rehabilitation both to veterans and civilians. Our uniforms also mimicked the military uniforms to some extent, as we wore badges, belts, and epaulets, signifying the hierarchy of staff within the clinical setting. Initially, Physiotherapy uniforms were a way of identification and helped to provide a sense of belonging.
Over the years, physiotherapists have worn their metal badges proudly to signify membership in the CPA (or from other countries e.g. the UK Chartered Society of Physiotherapy) and often another badge from their specific Physiotherapy training school
In the military, as far back as the 1800’s, the Uniforms of the Napoleonic Wars were both colourful and ornate. Napoleon Bonaparte was considered a great leader and administrator as he was so well organized. He was the first military leader to use colourful uniforms to clearly divide his army into groups and organized his armies into formations so that they could conquer an area faster. In the past, hospitals continued this tradition, making it easier for patients to recognize the many occupations who provide services to them.
In a Sociology of Health & Illness article written in “Deep Dyve” by Stephen Timmons and Linda East, we are told that a British hospital may well have had 20 different uniforms designating professional or occupational groups, with each uniform further subdivided to indicate status. Within groups, hierarchy has traditionally been signified by another complex set of symbols (including hats, badges, collars, cuffs, belts and piping). In the study done by Timmons and East in the UK in 2011, instead of the up to 20 different hospital uniforms all hospital employees were asked to wear the same uniforms, quoted as a kind of “McDonaldisation”, and the results of the study were somewhat mixed. Patients apparently preferred to distinguish who was at their bedside by their uniform.
We know that Physiotherapy uniform, like all uniforms, has had several functions: it acted as a symbol for membership in a group, it provided identity and legitimate certification both inside and outside the group, delineated occupational boundaries by signifying profession and rank thus establishing hierarchy, provided protection from infection, and secured identity.
Mrs. Ruth Fortune began her physiotherapy training at Guy’s Hospital in the UK on the third day of the third month in 1933. She writes:
We were very strictly disciplined. Every morning we would have to parade in front of the principal of the school, a lady by the name of Hester Angove. She was well known in the physiotherapy community as a “dragon”. She would inspect our hands (no nail polish), our faces (no makeup) and she would sniff us (no perfume or perfumed soap)! We wore white starched uniforms that had to be pristine. One of the students, I can still remember her name – Maurene Gillies, had a beautiful natural complexion and nice tidy well shaped eyebrows. Old Angove would routinely tell her to go and wash that makeup off and to stop plucking her eyebrows!”
Mrs. Fortune’s Principal, Miss Hester Scudamore Angove OBE, was made an Honorary Fellow of the Chartered Society of Physiotherapy (CSP) in 1948. Pride about appearance and cleanliness for Physiotherapists has continued to this day, although this degree of discipline for students would probably not be tolerated today.
After coming to Canada, Mrs. Fortune went on to work first at the Canadian Arthritis and Rheumatism Society (CARS) as one of the first of the “Bluebird Team”. Their uniforms were designed to identify them in the communities they visited and consisted of a smart blue suit and hat. The vehicles they drove had a bluebird logo on the side and so they were always recognizable
Several early BC Physiotherapists trained at Army and Navy schools in the UK as the Chartered Society of Physiotherapy (CSP) did not initially accept male students at that time. In the clinical setting they wore surgical gowns which tied at the back. After qualifying, they were allowed to wear white coats
Jim McGregor writes:
…we were all in gowns, all one size, may I add. Luckily, we were all lean in those days. I wore the same gown for about 6 years then at the Army rehab centre I wore mostly just our khaki army shirt. I was promoted to warrant officer about 1965 and was chief of rehab and wore a white coat for the final two years of my service. In my private practice in Edmonton and the Vancouver area, I wore an above the knee short sleeve white jacket, with a cinch at the back and with a round neck.
On the steps at VGH the physiotherapists are seen dressed in white, long uniform dresses with short sleeves, white nylons and shoes and wearing caps.
Henry Tumaitus is wearing a long white coat and Bill, the Porter, a lab jacket.
In BC, male physiotherapists in private practice usually chose to wear dress pants with white shirts or jacket length lab coats with or without mandarin collars. For the female physiotherapy uniforms in Canada, the shorter white dresses made of cotton, caps, white stockings and white shoes continued in some form in hospitals until the end of the sixties.
Dorothy Glover tells us,
In 1963 I was hired at Shaughnessy Hospital, which was a federal government hospital at that time. New staff were issued with umpteen yards of heavy-duty white cotton fabric to sew a couple of uniforms yourselves or have made at our expense. I bought some ready-made uniforms and turned these yards of fabric into heavy duty sheets with seams down the middle. When I bought regular sheets, I turned the old sheets into a liner for a double sleeping bag, very cozy! Now the old sleeping bag liner is a cover for a foamy that during COVID is a home exercise mat. This fabric is still going strong after 57 years, I wonder what its next reincarnation will be. In addition, physiotherapists were issued with stiff white caps like nurses, rather difficult to keep on one’s head when treating patients. When the boss at the time was preoccupied with other matters the caps collected dust at the bottom of our lockers but had to be dusted off once in a while when the boss would rant, ‘Girls, where are your caps?’!
Rhona Burslem writes,
I was actually at Kings…. but the ‘inspections’ were much the same … even in the 60’s. We were not allowed to wear ‘trousers’ to lectures… far too avant garde! … and our white coats (worn with starched caps that never used to sit straight and always got swept askew by the curtains around a bed) had to be of a length that did not show the backs of your knees when you bent over… this in the age of the mini skirt!
In the 1930s, according to Vogue, designer Elsa Schiaparelli “created the revolutionary divided skirt, a forerunner of shorts, which was worn by Lili de Alvarez at Wimbledon in 1931 and shocked the tennis world,” essentially bringing culottes to the world.
It was not until much later that culottes allowed physiotherapists to get into the swing of 1960s youth style when culottes and skorts even appeared in Twiggy’s fashion line.
With the introduction of polyester and other man-made fabrics in the 70’s and 80’s, uniforms became much easier to care for. As private practices evolved in BC, more freedom was given to choose one’s own uniform. Physiotherapists were often wearing their own clothes by the late 80’s. With the increase in availability of exercise clothing, many options from which to choose became available, including scrubs for acute care areas.
As our scope of practice evolved to include more exercise related treatments (e.g., Bobath and P.N.F.), our uniforms also changed to allow better ease of movement. In the sixties, long (and then shorter and shorter) culottes with white shirts were worn and skorts, which were shorts with a front panel, became the ideal uniform for treating patients in the gym.
Navy blue was the colour of choice for physiotherapists and green for occupational therapists. Hitherto, hospitals had both supplied and laundered the uniform dresses. Now, the physiotherapists were issued their culottes and white shirts and over time became responsible for their own laundry.
Janice Masur explains,
Somewhere along the line we changed to navy blue culottes and white shirts…somewhere, we had to launder our own uniforms and in mid 1980’s I was told my shirt was not white enough… I guess I needed a new washing machine…our own clothes maybe 1990’s and or 2001…HFH in the 1990’s we wore culottes or shorts in the summer……. and there was a whole staff meeting devoted to “how short was decent” above the knee……… and I said until we had air conditioning, we should wear at whatever length to be cool and do a good physio job!!
According to Wendy (Webb) Smylitopoulos, in Montreal in the late 60’s, one of the PT’s was part of the CPA trial for grey culottes and worn with white blouses. The therapists were divided by under 30’s very much in favour, over 30’s very much against – it was a sign of the changing times.
Wendy goes on to tell us,
When I was a student, the exception to wearing caps was at GF Strong where we all wore pants, staff wore grey with white tops, students whatever they had. Pants were not as common everyday wear as now. UBC grads wore green ribbons on their caps to denote the OT part of our training. Only another OT ever recognized it!
In hospitals in BC, the emphasis for the kind of clothing worn by physiotherapists continues to be on professional appearance, freedom of movement and ease of care
During the Covid pandemic, at a time when physiotherapists needed to become front-line workers, they began to wear PPE over their uniforms.
Age of clients and previous exposure to physiotherapists appears to influence the perceptions and preferences for various forms of attire by physiotherapists.
Today, different fabrics and styles abound in the many different settings in which we work. As always, professionalism remains key and physiotherapists tend to choose their uniforms both for functionality and appearance. For several decades now, physiotherapists have chosen to wear scrubs in acute care and gym attire or “Street Clothes” both in the public and the private sector.
When asked about the current uniform trends, Jane Burns, Regional Physiotherapy Practice Lead for Vancouver Coastal Health writes,
Physiotherapists in the hospitals and community/LTC sites do not wear a uniform anymore but always wear a name tag to identify themselves to patients and other staff. With COVID, many are wearing scrubs now for infection control both in acute and community care. They will also wear scrubs depending on the activity that they are doing (i.e., wound care) or the specific site they are working in (i.e., ICU).
Physiotherapy uniforms have come a long way from the days of the long white dresses and caps, but our physiotherapy practice remains grounded in the principles of good care, even if we dress differently today than we did 100 years ago.
References:
Erin Mercer, BScPT. Perceptions of Outpatients Regarding the Attire of Physiotherapists Physiotherapy Can 2008 12;60(4):349-57. Epub 2008 Nov 12.
Evans, S. (2010). Coming in the Front Door: A History of Three Canadian Physiotherapists Through Two World Wars. Canadian Military History, 10(2), Article 5. Uniforms, status and professional boundaries in hospital – Timmons – 2011 – Sociology of Health & Illness – Wiley Online Library
I remember when I was a student and also when I first started practicing at Lions Gate Hosiptal in North Vancouver we had to wear navy pants and white tops. A radical change happened at Lions Gate and we could wear pink shirts as well! The shirt had to have a collar, and your hair could not touch your collar. I continually got in “trouble” because my hair was just long enough to touch my collar but not long enough to tie up – meant time for a haircut 🙂 This continued until I left the hospital setting in 1989.