A Brief History of Physiotherapy in The Netherlands

Rise of Remedial Gymnastics and Massage in the 19th Century

Physiotherapy, as it is now known, in the Netherlands has its origins in the first half of the 19th century.  The forerunners were healing gymnasts and masseurs who came from Sweden and Germany.  Initially separate professions with separate training, they were often practiced in combination by the ‘remedial gymnast-masseur’.

Providing health services was difficult for the remedial gymnast-masseur as the Medical Profession’s authority had been cemented in the Medical Practice Act of 1865, which declared medicine (health service provision) off-limits to unauthorised persons.  Medical training was also regulated by Universities thereby preventing any other health professions receiving support for their training courses.  Specific opposition to gymnastics teachers who engaged in massage and remedial gymnastics is evidenced in the document The domain issue in the medical world (1880-1889): opposition to the remedial gymnast and statements by the Netherlands Society of Medicine (NMG), such as:

The practice of orthopaedics and massage by unauthorised persons must be prevented.

A fierce battle between medical practitioners and ‘quacks’ like remedial gymnast-masseurs continued through to the end of the 19th century, but total medical ownership was not achieved, rather control.  For example the remedial gymnast JG Milo (1840-1921), doyen of the Dutch remedial gymnasts, was summoned for consultation with physician Dr J van der Hoeven, first surgeon of the Municipal Hospital in Rotterdam, before any remedial gymnastics treatment of a spinal curvature could take place.

The forerunners of todays physiotherapists were therefore both medical practitioners and remedial gymnast-masseurs who worked under their supervision.  As per the quote from J Schoondermark in 1886:

Today, the methodically performed massage has already become common practice among all doctors, and those who do not already practice it themselves, at least prescribe it, because it can no longer be missing in the therapeutic repertoire.

Remedial gymnastics and massage in itself was thus not seen as quackery;  only so, when practiced by non-medical practitioners.

The remedial gymnast Dr Johan Mezgar (1838-1909), later a medical practitioner, is regarded as the founder of the current physiotherapy in the Netherlands. He obtained his doctorate in 1868 on The treatment of distortion pedis with frictions.  In 1889, the remedial gymnasts founded the Society for the Practice of Remedial Gymnastics in the Netherlands.  The new, self-confident professional group increasingly clashed with medical practitioners who saw increasing numbers of non-medical practitioner entering the field.  

Ironically, the turning point for the profession was the emergence of orthopaedics in surgery, and medical practitioners increasingly calling on the knowledge and skills of the remedial gymnast-masseur. 

In 1912 J van Essel founded the first vocational school for remedial gymnastics and massage in Amsterdam – the Genootschap van Heilgymnasten.

Development of Remedial Gymnastic-massage in Hospitals

Initially the remedial gymnast-masseur was a loner, working in their own private practice,  In the early 1930’s, remedial gymnast-masseurs cautiously entered hospitals in the Netherlands. In 1934 Eijkman from Zeist noted in the Dutch Journal for Heilgymastics that the Netherlands was lagging behind neighbouring Germany, where remedial gymnastics (“Krankengymnastik”) had long been propagated in hospitals because of the many victims of the First World War. 

In the later 1930’s remedial gymnasts became better known in hospitals and their relation to doctors written about.  Eijkman wrote: 

He had to get used to the hierarchy.  He was humble towards the doctors because of the doctor’s unfamiliarity with remedial gymnasts.  Nevertheless he found a pleasant working atmosphere and his work was highly appreciated by the doctors.

In 1942 the remedial gymnast received legal recognition.

From Remedial Gymnastics to Physiotherapy

The pioneers in remedial gymnastics contributed to improving the relationship with the powerful medical profession but the most important thing to arrive was legal regulation of the profession of physiotherapy.  

In the course of the 1950’s the Genootschap van Heilgymnasten wanted to upgrade the vocational education of medical gymnastic-masseurs, partly because of increasing applications to the schools and the increasing possibilities of the field of physical technology (electro-physical agents).  Physiotherapy would then consist of three components: remedial gymnastics, massage and physical techniques (electrotherapy).  An important source for this development was the Manual of Physical Therapy for Physiotechnical Assistants, published in 1957, written mainly by medical practitioners but published by the Dutch Association for Healing Gymnastics and Physiotechnics.

In 1965 the field of Physiotherapy was officially referred to in the Paramedical Professions Act and regulations were developed in relation to training, protection of the title of ‘Physiotherapist’ and the addition of physical technique (electro-physical agents) as a recognised intervention.  The decision also meant that the remedial gymnast-masseur could also call himself a Physiotherapist after passing the physical technique (electro physical agents) exam.  

Concurrently in 1965 the Dutch Society of Healing Gymnastics and Massage was renamed the Dutch Society for Physiotherapy (NGF). 

In 1969 the first physiotherapists graduated at HBO (Applied Bachelors) level.

In 1986 the BIG law (Law on the Professions in Individualised Health Care) literally meant that healthcare, under specific conditions, was no longer the exclusive domain of the Medical profession, thereby allowing greater access by other professions including physiotherapy.

In 1989 the NGF celebrated its centenary and the then head of state, Queen Beatrix, granted the society the predicate ‘Royal’- now the KNGF.

Emergence of Evidence Based Practice and Other Forces

In the 1980’s a different wind was blowing in healthcare and physiotherapy.  Health insurers wanted to see scientifically proven treatments and physiotherapists had to provide evidence for the effectiveness of their colourful collection of treatments.  Science was new and difficult for physiotherapy and decisions were sometimes made hastily.  Without research evidence to support them many interventions were discarded, possibly preventing research ever being conducted on them.

The Dutch Institute for Allied Healthcare (NPI) set up the Physiotherapy Science Foundation to back up the profession with science and to provide tools to demonstrate the effectiveness of treatments.  There were also other changes such as social and cultural norms, and values such as the assertive citizen as consumers, the ageing of society, the rise of sport and market forces in health care.

Specialisations in the profession occurred such as sports physiotherapy and manual therapy.

The Nineties to the Present

In the 1990’s in addition to the ‘scientification’ of physiotherapy, ‘quality’ became an issue.  In 1991 Prof. Dr. Helders was appointed as the first professor of Physiotherapy in the Netherlands and ten years later the first university degree program in Physiotherapy Sciences started.  

As a result of the Leidschendam Quality Conferences in 1989 and 1990 physiotherapy had to deal with uniform treatment, guidelines, compulsory refresher training, a central quality register and compulsory registration. 

Another major change was on 1 January 2006 when the Direct Access to Physiotherapy Act came into effect.

References

Summarised from Vossen H. 2019. De opkomst van de fysiotherapie in Nederland in vogelvlucht. (Vossen HPLM. Physios, 2019, Edition 3; p. 4-13).  The original text was translated by Google Translate, accessed from

https://www.physios.nl/sites/physios/uploads/tekstblok/physios_2019_03_geschiedenis.pdf on 30 December 2022.