Journal Special Issue

In 2018 the International Physiotherapy History Association put out a call for people interested in helping compile a special issue on the history of physiotherapy for the journal Physiotherapy Theory & Practice.

As a result there are seven full papers and one editorial in the journal’s special issue volume 37(3), 2021. The articles provide a small but wonderful insight into the history of the physiotherapy profession.

Abstracts and links for all of the papers are provided below.

Where history is concerned: an editorial for the special issue on physiotherapy history

David A. Nicholls

Over the last few years, we have seem much more interest in the history of physiotherapy from within the profession.  With the publication of several centenary commemorations, it seems the profession has begun to consider how physiotherapy became historically possible.  And although it lags behind the enormous industry that is medical and nursing history, physiotherapy can now claim at least a modest appreciation for the conditions, events, and people that have established physiotherapy as the profession it is today.

It is timely, then, that we offer the first special issue of Physiotherapy Theory and practice dedicated to physiotherapy history.  Perhaps it would have impossible to compile a particular issue before now because it is only recently that the community of physiotherapy histories has come together and began to discuss the breadth of historical studies currently going on in the profession.  The formation of the International Physiotherapy History Association (www.history.physio) has meant that physiotherapy historians, researchers, students, and teachers now have a growing and viable community, and a forum to promote what has always been a very small and niche subspecialty with the profession.

 

The emergence of physiotherapy in Germany from the mid-19th to the mid-20th centuries: A “female profession” concerned with movement in the health care arena

Sandra Schiller

Background: The history of physiotherapy in Germany dates back to the mid-nineteenth century, when German physicians discovered Swedish medical gymnastics as a therapeutic treatment modality. From the early 20th century onwards, physiotherapy slowly began to establish itself as a field of activity specifically for women of the middle classes who provided assistive services to medical doctors. Method: Extensive overview of published and unpublished research on the history of German physiotherapy as well as select primary sources from the 19th and 20th centuries. Additionally reference is made to historical research regarding the emergence of the physical culture and life reform movements, as well as on gender research regarding upper and middle class female employment opportunities in the social and health care sector. Findings: This study outlines the two leitmotifs of physiotherapy’s incorporation into the medical sector (i.e. medicalisation) and its (self-)image as a “female profession” (i.e. feminisation) as two intertwined historical phenomena shaping the critical period when physiotherapy assumed its role as a health profession in Germany. These developments from the mid-19th to the mid-20th centuries resulted in the emergence of a “female profession” with a distinct focus on the role of movement as a treatment modality. Discussion: Critical engagement with a handed down professional self-image is needed. On the basis of my historiographical overview, I suggest a future research agenda which would result in a more appropriate understanding of early physiotherapists in Germany as historical agents.

 

The role of neurasthenia in the formation of the physiotherapy profession

David A. Nicholls

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19^th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the massage and electricity so vital to the success of the Rest Cure, used the opportunity to develop approaches to treatment that would form the backbone of the physiotherapy profession in England after 1894. Methods: Extensive primary and secondary texts were drawn from a wide range of sources and critically reviewed. Findings: This study argues that the management of neurasthenic cases in the 1880s and 90s created the conditions necessary for the development of the profession’s relationship with medicine and the establishment of new practice roles for women, and that these would play an important role in shaping the physiotherapy profession in Britain after 1894. Read through the critical sociological writings of Magali Sarfatti Larson and Anne Witz, I argue that the work of the nurse-masseuses can be seen as a complex gendered negotiation between the need to be deferential to the dominant male medical profession; distinct from emerging notions of the angelic, motherly nurse; obedient, technically competent and safe. The creation of a space in the clinic room for a third practitioner who could deliver a different form of care to the doctor or the nurse, established an approach to practice that physiotherapists would later adopt almost without amendment. Discussion: I argue that this approach owes much to the work done by nurse-massueses who established and tested its principles in treating cases of neurasthenia.

 

The history of light therapy in hospital physiotherapy and medicine with emphasis on Australia: Evolution into novel areas of practice

Ann Liebert & Hosen Kiat

Objective: The objective of this narrative review was to investigate the history of light therapy in hospital settings, with reference to physiotherapy and particularly in an Australian context. Types of articles and search method: A review of available literature was conducted on PubMed, Medline and Google Scholar using keywords light therapy, photobiomodulation, physiotherapy, low-level laser, heliotherapy. Physiotherapy textbooks from Sydney University Library were searched. Historical records were accessed from the San Hospital library. Interviews were conducted with the San Hospital Chief Librarian and a retired former Head Physiotherapist from Royal Prince Alfred Hospital. Summary: Historically, light treatment has been used in both medical and physiotherapy practice. From its roots in ancient Egypt, India, and Greece, through to medieval times, the modern renaissance in ‘light as therapy ’ was begun by Florence Nightingale who, in the 1850s, advocated the use of clean air and an abundance of sunlight to restore health. Modern light therapy (phototherapy) had a marked uptake in use in medicine in Scandinavia, America, and Australia from 1903, following the pioneering work of Niels Finsen in the late 19th century, which culminated in Dr Finsen receiving the Nobel Prize for Medicine for the treatment of tuberculosis scarring with ultraviolet (UV) light, and treatment of smallpox scarring with red light. Treatment with light, especially UVB light, has been widely applied by physiotherapists in hospitals for dermatological conditions since the 1950s, particularly in Australia, Scandinavia, USA, England and Canada. In parallel, light treatment in hospitals for hyperbilirubinemia was used for neonatal jaundice. Since the 1980s light was also used in the medical specialties of ophthalmology, dermatology, and cardiology. In more recent years in physiotherapy, light was mostly used as an adjunct to the management of orthopedic/rheumatological conditions. Since the 1990s, there has been global use of light, in the form of photobiomodulation for the management of lymphedema, including in supportive cancer care. Photobiomodulation in the form of low-level laser has been used by physiotherapists and pain doctors since the 1990s in the management of chronic pain. The use of light as therapy is exemplified by its use in the San Hospital in Sydney, where light therapy was introduced in 1903 (after Dr. John Harvey Kellogg visited Niels Finsen in Denmark) and is practiced by nurses, physiotherapists and doctors until the present day. The use of light has expanded into new and exciting practices including supportive cancer care, and treatment of depression, oral mucositis, retinopathy of prematurity, and cardiac surgery complications. Light is also being used in the treatment of neurological diseases, such as Parkinson‘s disease, traumatic brain injury, and multiple sclerosis. The innovative uses of light in physiotherapy treatment would not be possible without the previous experience of successful application of light treatment. Conclusion: Light therapy has had a long tradition in medicine and physiotherapy. Although it has fallen somewhat out of favour over the past decades, there has been a renewed interest using modern techniques in recent times. There has been continuous use of light as a therapy in hospitals in Australia, most particularly the San Hospital in Sydney where it has been in use for almost 120 years.

 

Blind and partially sighted physiotherapy in the United Kingdom. A century of development, success and challenge. Will it still belong?

Robert Jones

Background: In 2019 the Association of Visually Impaired Chartered Physiotherapists, originally the Association of Blind Certificated Masseurs, celebrated the centenary of its formation and becoming the first ever Specific Interest Group admitted to the Incorporated Society of Trained Masseuses which, later in the 20^th century, became the Chartered Society of Physiotherapy. These landmarks motivated the author to research for this chronological, descriptive, narrative review of the history of blind physiotherapy and its contribution to physiotherapy in the United Kingdom. Purpose: The early training and practice of massage by blind practitioners, the organizational milestones in mainstream and blind physiotherapy and the inter-relationship between the two is considered. Key developments, challenges, innovations and opportunities throughout the history are reviewed including the impact of World War 1 and contribution of blind physiotherapy to the profession. Conclusion:Significant changes in physiotherapy educational and training arrangements for blind students and changes in physiotherapy practice generally over the last four decades engender serious questions about whether blind physiotherapy will still “belong”, despite the increasing aspiration within society toward acceptance of diversity and inclusion. The author challenges the profession about whether it will facilitate blind physiotherapy to continue making its valuable contribution and be included. Will it still “belong?”

 

Boundary work: the Mensendieck system and physiotherapy education in Norway

Tone Dahl-Michelsen, David A. Nicholls, Jan Messel & Karen Synne Groven

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work, however, has emphasized the fluidity and collaborative nature of professionalization projects, and placed more emphasis on inter-professional negotiations and disciplinary coexistence. In this paper, we draw on this work to analyze the harmonization of the independent Mensendieck System of medical gymnastics in Norway, and the emerging state-sponsored physiotherapy system. Our contention is that over the course of the middle decades of the 20th century, advocates of the Mensendieck System and providers of orthodox, biomedically informed physiotherapy, came together and found a way to work collaboratively in a shared space without compromising their distinctive professional identities. We argue that this approach both points to ways we might revisit traditional conflict-based analyses of the history of physiotherapy, while also suggesting new ways of imagining how the profession might change in the years to come.

 

An inquiry into Kjølstad’s Self-straightening Orthopedics in 19th century Norway – one historical root of physiotherapy

Anne Langaas, Anne-Lise Middelthon & Anne Louise Lie

Enhancing and facilitating change or optimization of body awareness and movement behaviors have been sustained throughout history as central objectives in physiotherapy. Focus will be on the thoughts and practice of orthopedist Gunder Nielsen Kjølstad (1794–1860). He is, in a Norwegian context, one of the forefathers of physiotherapy. Kjølstad was unique for his time in the sense that he did not limit himself to medicine, but drew on vast array of disciplines, among them philosophy, geometry, physics, and dance. Fundamental to his treatment method was a pedagogy that rested on the active participation of the patient; an approach that stood in stark contrast to the established clinical practices. Through this approach, he developed a treatment for ‘crooked backs’ which constituted a historic break with the common treatment regimens of the nineteenth century.

 

Narrative histories of physiotherapy in Colombia, Ecuador, and Argentina

Alexandra Giraldo-Pedroza, Aydee Luisa Robayo-Torres, Alma Viviana Silva Guerrero & David A. Nicholl