The Word

History of the Word ‘Physiotherapy’

by Glenn Ruscoe, Sandra Schiller, Robert Jones, Cameron MacDonald and Ryan McGrath

with assistance from Elisavet Anastasiadi, Carl Banks, Magda Fourie, Kurt Jacobsen, António Manuel Fernandes Lopes, Sarah Marshall, Ken Miller, Marilyn Moffat, Tim Nemeth, Remi Remondière, Snjezana Schuster and Giuseppe Verde.

Introduction

This article seeks to present a focused review of the known etymology and history of the term physiotherapy. It is with this aim that we seek to demonstrate an understanding of the word as it was used to describe interventions, as well as by those who pursued professional recognition through applying the term physiotherapy to their own area of interest/expertise and those who sought to use the word as a means to define the actions of others. This is not an attempt to present the historical genesis of the practice of physiotherapy in detail, but rather to present the known timeline and influences, including new discoveries, around a specific word that has a complex history and interpretation.

Despite the uniqueness and powerful contemporary recognition of the word physiotherapy, the adoption of the name by the current profession is not complete. Based on the names of national association membership of the world body for the profession, approximately 70% of the world’s national professional associations use the word physiotherapy (including language derivations) to describe themselves, whereas 20% use the alternative term physical therapy and 10% use kinesitherapy or a combination/variation of the term; and in the unique case of Iceland, ‘sick trainer’ (sjúkraþjálfun) (“Our Members”, undated).

Achieving a respected name for a profession requires internal consensus and external acknowledgement, up to and including government legislation. This story explores where the word physiotherapy came from and how the national professional associations, as the leading collectives of practitioners in their respective countries, progressively came to name and know themselves. While this article discusses some of the history of the profession that we know today, its primary focus on the word necessarily includes external contextual events and sometimes skips, downplays and re-orders significant known internal events. In this manner it provides a unique opportunity to view the history of the physiotherapy profession through a different lens; by its name.

The best stories have a clear beginning and a neat ending. This story has neither, for its beginning is nebulous and the ending is yet to happen. This review explores how a fledgling profession that evolved from a series of disconnected practices (manipulation, massage, hydrotherapy, electrotherapy, exercise, etc.), performed by a range of non-physician occupations (bonesetters, masseuses/masseurs, nurses, midwives, electrotherapists, remedial gymnasts, etc.), battered by powerful forces (war, epidemics, patriarchy, scandal, economics, etc.), successfully, but not completely, came to claim a name invented by, and for the medical profession.

Timeline Highlights

1831	German physician Friedrich Julius Siebenhaar first used the word ‘physiotherapie’.
1851	German physician Lorenz Gleich expanded the description of the word ‘physiotherapie’.
1894	Canadian physician Edward Playter coined the anglicised version ‘physiotherapy’.
1895	Istituto Fisioterapico Gabbrielli-Bacci is founded in Florence, Italy.
1899	French neurologist Louis Théophile Joseph Landouzy advertised a course with a session on physiothérapie.
1903	The Journal de Physiothérapie is published in France.
1905	The first International Congress of Physiothérapie is held in Belgium.
1912	A loose group of alternative health practitioners formed the first Australian Physiotherapy Association.
1914	The American Electrotherapeutic Association claimed the practice of physiotherapy and the title physiotherapist, but by 1920 had replaced them with physical therapy and physical therapy physician.
1917	The Military School of Orthopaedic Surgery and Physiotherapy is formed in Canada to train army medical personnel and female civilians.
1921	A group of former US rehabilitation aides (non-physicians) formed the California Association of Physiotherapists.
1922	The nascent American Women’s Physical Therapeutic Association, made up of former rehabilitation aides, changed its name to the American Physiotherapy Association.
1925	The American Medical Association formed a Council of Physical Therapy, so named in response to the non-medical use of the term Physiotherapy.
1930	A British ‘Society of Physical Medicine’ is formed, specifically having rejected the word physiotherapy.
1932	The South African Chartered Society of Massage and Medical Gymnastics changed its name to the South African Society of Physiotherapists.
1934	The Canadian Association of Massage and Remedial Gymnastics changed its name to the Canadian Physiotherapy Association.
1936	The sixth International Congress of Physiothérapie changed its name to the International Congress of Physical Medicine
1939	The Australian Massage Association changed its name to the Australian Physiotherapy Association.
1943	The UK’s Chartered Society of Massage and Medical Gymnastics changed its name to the Chartered Society of Physiotherapy.
1944	The American Congress of Physical Therapy (previously the medical electrotherapeutists) dropped their claim to the term ‘physical therapy’ and adopted ‘physical medicine’.
1945	Iran has the first non-physician national physiotherapy association named from its’ inception.
1947	The American Physiotherapy Association changed its name to the American Physical Therapy Association.
1951	The World Confederation for Physical Therapy (for non-physicians) is formed.
1953	The Danish General Massage Association changed its name to the Association of Danish Physiotherapists. The first European association of non-physicians to do so.
1993	The European Union adopted the term Physiotherapy as the regulated generic name for the autonomous, non-physician profession.
2002	The Mexican Association of Physical Therapy and Rehabilitation changed its name to the Mexican Association of Physiotherapy.
2014	The internet domain name extension .physio is created exclusively for the non-physician profession.
2019	The World Confederation for Physical Therapy changed its name to World Physiotherapy.
2020	Russia and Ukraine are the last nations to abandon the word physiotherapy as a medical specialty and adopt the alternative term physical and rehabilitation medicine.

Genesis

The word ‘physiotherapy’ is identified as a combination of two Greek terms (Playter, 1894). The first part, ‘physio’, comes from ‘physis’ meaning nature. The second part, ‘therapy’, comes from ‘therapia’ meaning healing. Thus, in this context the word physiotherapy has a literal translation to mean natural healing.

Europe

The origin of the word physiotherapy can be first traced back to Germany where in 1831 Dresden physician Friedrich Julius Siebenhaar wrote an article called, “Zur Lehre über die Erblichkeit der Krankheiten überhaupt, und die in Bezug auf die Orthopädie insbesondere” [On the doctrine of the hereditary nature of diseases in general, and in relation to orthopaedics in particular] in the Journal der Chirurgie und der Augen-Heilkunde [Journal of Surgery and Ophthalmology]. He wrote,

…I would prefer to say, physiotherapie be used to describe the science of the relationship between the entire nature and external world to the human body. (Siebenhaar, 1831)

Without further illustration of his proposition it was an unremarkable beginning and the word physiotherapy remained enigmatic. Two years later the word was again published, by fellow German physician Gustav Wilhelm Gross (1833) when referencing Siebenhaar’s writings. But again no further explanation or development.

It was not until 1851 that the word physiotherapy reappeared, in the writings of Bavarian physician Lorenz Gleich. Beginning his career as a military physician (Terlouw, 2006), Gleich became a proponent of hydropathy and naturopathy (Beer, et al, 2013). His writings were part of a movement commenced in the late eighteenth century battling against the dubious and dangerous practices of bloodletting, purging and drugs that were a primary feature of allopathic medicine of the time.

Through three of Gleich’s writings from the middle of the nineteenth century we gain an understanding of how the word physiotherapy was to be used. Gleich (1851a) began by providing a context for the use of the word physiotherapy. This was through two lenses, one, primarily an articulation of physiotherapy as an individual component (or “science”) of the overall management of the individual with natural healing/naturopathy. The second lens is, as complementing the technical aspects of surgery, obstetrics and ophthalmology. Specifically he wrote, “further treatment after the technical act has been completed falls under the heading of physiotherapy” (Gleich, 1851a). This definition illustrates the beginning of the understanding that physiotherapy was a critical aspect of the natural sciences as they were understood in naturopathy at the time, and essentially partnered to technical acts within healing but in a more overall and expansive role.

Another “science” mentioned by Gleich (1851a) identifies some of the components of physiotherapy:

Physiopharmacology (the natural remedies are partly taken from dietetics, partly from other natural sciences and are food, water, movement*, air, light, heat, electricity, magnetism, etc.), insofar as they can be used for healing purposes.

* He added the following note to the word “movement”: “Medical gymnastics is an important branch of physiotherapy for chronic illnesses”.

In another talk given in the same year, Gleich (1851b) specified:

However, the instruction on how the various natural remedies, e.g., water, air, light, heat, diet, etc. are to be applied ..is most correctly designated by the term “physiotherapy”, also “palingenesitherapy” – natural healing, rebirth teaching – and not “hydrotherapy” – water healing. Consequently, the term “hydropath”, “hydrotherapist”, “hydriatrician” – water doctor – is no longer used, but “physiotherapist”, “physiatrist”, “physiurg” – naturopath, naturopath.

Five years later Gleich (1856) further described physiotherapy (here understood to be synonymous with natural healing) to consist of various natural remedies and natural healing methods and not just hydrotherapy alone:

It is not taught at any Bavarian university, those who are interested in medicine do not even hear its name, let alone more, which is probably why not only old but also young doctors display an astonishing ignorance of natural healing – physiotherapy – to the lay public on various occasions, which, as is well known, consists of all conceivable natural instinctive dietary natural remedies and natural healing methods, but by no means of cold water alone.

By the end of the nineteenth century, however, naturopathic medicine could no longer match the allopaths increased hold on science, education and legislation, and its proponents were generally relegated to the fringes of the medical field. Nevertheless, the results brought forth by the natural healing methods of the ‘water cures’ of medical laymen like peasant farmer Vincenz Priessnitz and the clergyman Sebastian Kneipp (Beer, et al, 2013; Kerckhoff, 2020; Moss, 2010; Rothschuh, 1981; Sharma, 2014) progressively shifted the focus of attention in parts of the medical world to mobilising the patient’s own healing powers through physical agents like water, air, light, movement, electricity, heat and cold (Lohff, 2001; Terlouw, 2006).

In his historical review of the healing power of nature through the ages German physician Max Neuberger (1928) explained,

As far back as we can trace the history of medicine, there has been a natural healing procedure which, since the suggestion by L. [Lorenz] Gleich, we also refer to synonymously with its literal, internationally common translation as ‘physiotherapy’.

Neuberger (1928) went on to provide a simple structure for physiotherapy within, and equal to, medicine by saying,

Physiotherapy is a part of the overall medicine. If we divide medicine horizontally rather than vertically into individual disciplines, then we have physiotherapy, psychotherapy, surgery and pharmacotherapy, which stand next to each other as equal healing methods, complement each other, but are not interchangeable or substitutable.

North America

Also in the mid nineteenth century, but in the United States of America, a similar homeopathic medical reform movement began. Focussing on local botanicals, it was called Thomsonism, after its New England founder Samuel Thomson. Thomsonism gained significant popularity due to its more gentle approach compared to that of allopathic medicine and the prevailing

…culture of self-help that also informed and shaped voluntary associations, evangelical religion, Jacksonian democracy, and laissez-faire economics in the era. (Haller, 1997).

Alva Curtis, a disaffected and ambitious follower of Thomson, sought to progress the cause with formal education and clinical training, and renamed it physio-medicalism or physiopathy (Haller, 1997). At its peak, thirteen physio-medical colleges were opened between 1836 to 1911 throughout cities of the mid-West, East and South of the United States. Whilst the focus of the movement was botanical medicines, physical agents like heat/cold were also used and it was strongly associated with the German hydropathy movement (Haller, 1997).

American physio-medicalists were in personal communication with British colleagues (Ward, 1936), but equivalent practitioners were known by the alternative term herbalists (Brown, 1985). There was a claim to the term physio-medicalism by English osteopaths in the early twentieth century with reports in the British Medical Journal of a British Physio-Medical Association and a Physio-Medical Council of Great Britain and Ireland (“Osteopathy in England”, 1906).

The full, anglicised spelling of the word physiotherapy first appeared in English writings in 1894 when Canadian physician and public health advocate Dr Edward Playter presented to the Rideau and Bathurst Medical Association and later that year published in the Montreal Medical Journal, saying,

The application of these natural remedies … may be termed natural therapeutics. Or, if I may be permitted to coin from the Greek a new term, for I have never observed it in print, … I would suggest the term physiotherapy” (Playter, 1894).

Playter’s paper titled, “Physiotherapy First: Nature’s Medicaments Before Drug Remedies; Particularly Relating to Hydrotherapy” explored the physical agents of pure air and sunlight, diet, rest, mental influence [psychology], electricity, massage, kinesitherapy and what he considered most important, water. He thoroughly investigated the history and described the benefits of hydropathy, including particular reference to the German “Schott method of treating chronic heart disease by the use of warm baths and muscular exercises” (Playter, 1894).

The word physiotherapy was subsequently confirmed in the 1901 edition of The American Illustrated Medical Dictionary (Dorland, cited by Korobov, 2005) with the definition “the use of natural forces, such as light, heat, air, water, and exercise, in the treatment of disease” (Dorland, cited by Zampolini, et al, 2022).

A New Medical Specialty

Europe

The successful outcomes from the application of the physical agents, particularly hydrotherapy but including massage, exercise, electrotherapy, light, etc., caused allopathic medical interest to rise across Europe in the late nineteenth century (Contet, 1903; Grasset, 1900; Roman, et al, 2017). The motivation, however, may have been less than pure.

The damage wrought by the Naturärtze [naturopaths] on the status and on the income of the medical profession created great alarm (Pratt, 1913).

Medical societies and institutions formed around the enthusiastic use of the physical therapies (Monet, 1997). While several terms were proposed to describe the agents, including the names of each modality, combinations of their names, and collective descriptors, the word physiothérapie became common parlance in, at least, Belgium and France (Audollent 1903; Berthenson, 1899; Broudel & Gilbert, 1901; Harpe, 1895; Moeller, 1894; Morice, 1897).

Thanks to the initiative of a few doctors who had the courage to break away from old routines, France has finally firmly entered the path of natural treatments, which involve therapeutics through hygiene, physical agents, and methods, excluding chemical medications and harmful poisons. It is undeniable that these chemicals, administered in small doses, have weakened our population, especially over the past century. The “Carnet Rose” aims to introduce its readers to the various methods of this natural medicine, which has been given the name “Physiothérapie” by enthusiasts of scientific terminology who simply translated its French name from Greek (Audollent, 1903).

Language variations of the word also existed, such as in the names of the Italian Istituto Fisioterapico Gabbrielli-Bacci, founded in Florence in 1895 (Conti & Lippi, 2007), and the Istituto Fisicoterapico founded in Turin in 1898 (Mondo, 2023). Both were hospitals and teaching institutions for medical physiotherapies.

Courses in the new physiothérapie specialty were offered, for example in 1899 French Neurologist Professor Louis Théophile Joseph Landouzy advertised a course that included a session on physiothérapie, which covered the therapeutic use of air, water, climates, electricity, light, heat, cold and movement (mechanical therapy) (“Supplement and Errata”, 1899). The new medical societies began to publish journals, newspapers, annals and gazettes (Monet, 1997). The Journal de Physiothérapie was founded by Dr Emile Albert-Weil, a French physician and electrotherapist, and first published in January 1903 (Gazette des hôpitaux de Toulouse, 1903; “Information and news from the chronicle,” 1903; Monet, 2003). The journal served as a platform for sharing information about the various applications of physical agents, such as massage, gymnastics, hydrotherapy, and electrotherapy, and was published monthly (Monet, 1997; 2004).

This period also marked the organisation of several national and international congresses, which were held in the hope of establishing physiothérapie as a medical discipline equivalent to surgery and pharmacy (Faure, 1910). The first of these congresses took place in Liège, Belgium in 1905 and was attended by more than one hundred representatives (“The First Congress of Physical Therapeutics”, 1905). Participants came from eighteen countries including Belgium, France, Germany, Italy, Holland, Sweden, the United Kingdom, Austria, Russia, Romania, Denmark, the United States, Hungary, Spain, Switzerland, Luxembourg, Greece and Bulgaria (“The International Medical Congress”, 1906). In the context of the congresses, the breadth of physiothérapie had grown to include diagnostic and interventional rehabilitation approaches such as,

electrotherapy, kinesitherapy.., the light treatment, the x-rays, heat, aeropathy, hydrotherapy, electro-diagnosis, [&] radiography (“International Congress of Physiotherapy,” 1905).

Around the same period an alternative term physicothérapie was added as a medical specialty in a major French medical directory, the Annuaire Roubaud (Weisz, 1997). An anglicised version of the word is used in a sub-title, “The Physico-therapeutic Cure” in a disparaging editorial titled “The Borderland of Quackery” published in the British Medical Journal in 1902 (“The Borderland of Quackery”, 1902). During the first International Congress of Physiotherapy debate occurred over whether physicotherapy was the more appropriate name than physiotherapy. The issue was considered by the organising committee and they decided to stay with physiotherapy as it encompassed all elements of nature (climatherapy, aerotherapy, dietotherapy, etc.), whereas the narrower physicotherapy would limit them to the physical agents alone (water, electricity, movement, heat) (Vassilides & Dünzbo, 1905).

Reporting on the second International Congress of Physiotherapy held in Rome in 1907, Henry Gustav Beyer (1908), Medical Inspector of the United States Navy, provided a definition of exclusion, saying that physiotherapy,

..would include the treatment of disease and disease processes by all physical agencies, as distinguished from pharmacological means and methods.

Also discussed at the first International Congress of Physiotherapy, and the second (Rome) and the third (Paris) congresses, where representatives from 24 countries participated, were prophetically accurate concerns that “…physiotherapy is largely left to laymen for exploitation” (“British Medical Journal,” 1910a).

We see people turning to bone-setters and charlatans, whose numbers seem to increase as the field of physiothérapie expands (Maeinel, 1905).

The promise of physiotherapy as a new medical specialty gained such attention that some enthusiasts were claiming it to be a “turning point in the history of medicine” and therefore it “must become the common property of medical practitioners” (Fox, 1911). A driving force behind the congresses, Belgian Professor Isidore Gunzburg (1909), drew parallels with medicine’s earlier coalition with surgery by saying,

In physical therapeutics the situation is almost the same as that of the chirurgical [surgical] art some fifty years ago, when a physician considered it below his dignity to handle the lancet, and abandoned the most fertile part of his acquired knowledge to men (barber-surgeons) more used to handle a razor than a surgical instrument.

It was therefore, hoped that the Congresses,

…would in time lead to the rescuing of all branches of physical therapeutics from the hands of empirics [lay people] and of establishing them on a firm scientific basis in the hands of medical men (“The First Congress of Physical Therapeutics”, 1905).

Indeed it seemed to be the very r’aison d’être of the Journal of Physical Therapeutics, that, in the introduction to the first edition in 1900, the Editor addressed the importance of rescuing the agents of the physical therapeutics from “…the incompetent and unworthy hands into which they have sometimes fallen” (Editor, 1900).

As identified, the term physical therapeutics had also been used as an alternative to physiotherapy, such as in the title of articles in the Journal of the American Medical Association in 1901 (“The Teaching of Physical Therapeutics”, 1901) and 1912 – “A Plea for the More Frequent Scientific Employment of Physical Therapeutics” (Marvel, 1912), as well as the Lancet in 1904 – “Some Simple Expedients in Physical Therapeutics” (Wynter, 1904). In a 1904 Boston Medical and Surgical Journal article, titled “The Present Status of Hydrotherapy and Other Forms of Physical Therapeutics”, American physician Joseph Pratt (1904), who had worked in Germany, references the 1901 German book “Handbuch der Physikalischen Therapie” [Handbook of Physical Therapy] and his admiration of the German leadership in the field. Previously in 1898, German pathologist and professor Ernst von Leyden, and the neurologist Alfred Goldscheider, began publishing the Journal for Dietary and Physical Therapy (Sharma, 2011).

German professor Theodor Schott (1900) (the Schott Method was explored at length by Dr Edward Playter’s 1894 article on physiotherapy) used the term physical therapy to describe his combination of balneology and medical gymnastics in the treatment of angina pectoris. In a later article, Schott (1907) used the term physical therapeutics to also include the Swedish Method or Movement Cure of Per Henrik Ling and Oertel’s Mountain-Climbing Cure. Completing the circle, medical gymnast Ernst Flodin (1902), a graduate of Ling’s Royal Central Institute of Gymnastics in Sweden and an Edinburgh-based practitioner, published an article on medical gymnastics and massage titled “Physical Therapeutics”; possibly the first, albeit tentative, connection between that term and the non-physician profession that would later own it.

In 1913 the permanent committee of the International Congress of Physiotherapy organised a fourth congress in Berlin (JB Baillière & Fils (Eds), 1913, after which the British Medical Journal (1910b) enthusiastically hoped for a fifth congress to be held in London. However the First World War prevented that from occurring and a fifth congress was not held until 1930; once again in Liege, Belgium (Gazette des Hopitaux, 1929).

North America

One attendee of at least the second (Annual Report of Harvard University, 1907) and the fifth International Congresses of Physiotherapy (“Fifth International Congress of Physiotherapy”, 1930) was the powerful American physician William Benham Snow, editor of the American Electrotherapeutic Association’s journal and member of its board of trustees (Linker, 2005a). Snow is credited by Gritzer & Arluke (1985) for having coined the term ‘physical therapeutics’, having organised the New York School of Physical Therapeutics and of being referred to as “the dean of physical therapy”.

The American Electrotherapeutic Association had formed in 1890 and was made up of physicians who specialised in medical electricity (Optiz, et al, 1997). By the early 1900’s, they felt they were fighting a losing battle in changing the attitudes of medical doctors toward electricity as a legitimate therapeutic practice (Gritzer & Arluke, 1985). Struggling to become an American Medical Association approved specialty, the electrotherapeutists began to incorporate other therapies into their base, including thermotherapy, hydrotherapy, psychotherapy, phototherapy, mechanical vibration therapy, climatology, exercise, radiology and dietetics (Gritzer & Arluke, 1985). By 1914, with even further declining interest in medical electricity and the loss of the x-ray to the radiologists the ‘physical therapies’ became the core of their field, and to better reflect this change the American electrotherapeutic-physicians lay claim to the practice of physiotherapy (Stewart, 1923; Swisher & Page, 2005) and the title physiotherapist (Gritzer & Arluke, 1985; Moffat, 2003; Sampson, 1923).

First World War

The grouping in large hospitals of injured and diseased men, who had to be returned to functional ability in the shortest possible time, provided an extraordinary opportunity to test the physical therapies on an industrial scale.

..the war sent practically the whole medical profession into the army, and concentrated the best medical thought of the age upon the problem of the reconstruction of the crippled soldier. Only then did the great value of treatment by physical means receive general recognition (Watkins, 1921).

Nevertheless, the overwhelming number of soldiers with war-related trauma plus the relative laboriousness of applying the physical therapies, created the need for a labour force to assist in the rehabilitation process (Nicholls, 2018). Thereby the actual combined practices of the physical therapies, and ultimately the tailoring of treatments, moved from that of the physicians to the domain of their assistants.

The results of their efforts changed the practice of medicine. For example, at the post-war International Congress of Military Surgeons held at Brussels in 1921, among the unanimous official conclusions,

Regarding the principles for fracture treatment learned by experience in the war, the congress emphasizes the primary importance of directing treatment from the first day with regard to the functional future of the limb, and of resorting in this behalf to physiotherapeutic measures, and especially
to the earliest possible mobilization of the limb (Kovacs, 1924).

Europe

The word physiothérapie continued to be used by the medical profession in Europe into the First World War, particularly with the rehabilitation of injured soldiers in temporary hospitals in France and Belgium (Clark, 1918; Fox & McClure, 1918; “Manual Curative Workshops”, 1916; “Reeducation of Belgian War Cripples”, 1918; Remondiére, 2014; “The War”, 1916). The tailored combinations of physical agents occurring in the “French centres of physiotherapy” were highly innovative and exceedingly effective, and were reported enthusiastically and at length in the medical literature around the world (Poate, 1918). Great Britain, Italy, Canada, Australia, New Zealand and the United States of America were reportedly keen to learn more about physiotherapy; and even their enemy,

Germany is devoting much thought and energy to the subject, and has made several ingenious attempts to secure ideas and appliances from France (Poate, 1918).

North America

In Canada, deciding on a name for the combined practice of the physical therapies produced options such as physical reconstruction, functional re-education, physiotherapeutic work, or just ‘the therapies’ (Evans, 2010). Ultimately physiotherapy was the term most used and the word officially appeared in 1917 upon the formation of the Military School of Orthopaedic Surgery and Physiotherapy, in Toronto. The term was inclusive, as,

Here both medical officers and army medical personnel, physical training instructors, and female civilians are being trained (Wilson, 1918).

In the United States of America, prior to the First World War, many orthopaedic surgeons and physiotherapists (nee electrotherapeutic-physicians) employed women trained in physical education, corrective exercise and/or massage as assistants in their private offices (Elson, 1964; Heap, 1995). This situation was neatly summed up in an article, titled “Corrective Work in Physical Education as an Occupation for Women”, where physician RW Lovett (1906) advocated for higher quality training for such medical assistants. Ten years later, preparing for war these women and many others were trained and organised to do this same work in the military (Wrynn, 2014).

Initially called women’s auxiliary aides when under the auspices of the US military Division of Orthopaedic Surgery, they were later renamed reconstruction physiotherapy aides when placed under the Division of Physical Reconstruction and the control of the physiotherapists (nee electrotherapeutists) (Gritzer & Arluke, 1985).

The name Physiotherapy was adopted when the United States Government gave its endorsement to the value of physical measures for the treatment of disease, and when thoroughly equipped departments for this work were established in the army and the navy hospitals (McFee, 1931).

Physiotherapy was defined by the Surgeon General of the US Army as the amalgamation of,

Physical measures such as .. hydro, electro, mechano therapy, active exercises, indoor and outdoor games, and passive exercises in the form of massage (Granger, 1923).

The reconstruction aides worked in the military physiotherapy departments under medical supervision using physical therapies (Stewart, 1923). Note the specific use of the words: ‘reconstruction aide’ to denote job title, ‘physiotherapy’ to denote their function and ‘physical therapies’ to denote the interventions (Watkins, 1921). Post-war these words were also used by the United States Civil Service Commission, advertising to recruit reconstruction aides to fill vacancies within the public health service for returned servicemen (“Civil service examinations”, 1921; Greene et al., 1922), where they were divided into the functions of physiotherapy and occupational therapy (“Civil service examinations”, 1921).

Their military experience brought together a large number of previously isolated, semi-professional women who formed communication links, social bonds and a strong belief in the potential of their work (Linker, 2005a). Their successful use of condition-specific combinations of massage, exercise and electrotherapy on an industrial scale also helped diminish any of the medical profession’s remaining skepticism of the value of the physical therapies (Granger, 1923, 1927; Wrynn, 2014 ).

At the end of the war, several isolated groups of former war reconstruction aides formed local clubs, primarily “in the spirit of auld lang syne” (Hazenhyer, 1946a), whilst others formed associations in California, Oregon, Illinois, Connecticut and Washington DC (Moffat, 2003). For example, in 1921 the California Association of Physiotherapists, based in San Francisco, was officially accepted by the state’s medical association as an adjunct service. The intended relationship between the medical profession and the newly named physiotherapists was clearly articulated in the preamble to their Constitution,

Physiotherapy is defined as a group of physical therapeutic procedures to be prescribed by doctors of medicine and administered under the physician’s direction by specially educated and trained technical assistants…
Physiotherapists, therefore, in the meaning of this organization, comprise the educated, trained technical assistants to the members of the medical profession. (California State Journal of Medicine, 1921)

Also in 1921 the national American Women’s Physical Therapeutic Association was formed, but within the first year in an Editorial of the Association’s Journal, ‘The P.T. Review’, under a heading titled “Important”, it was stated, simply,

There is a general feeling that American Women’s Physical Therapeutic Association is not the best name for our organisation (Editorial, 1921).

Four alternative names were offered, three with the word “physiotherapy” and one with “physical therapy”; all without the word “women’s”. Early the following year, an almost unanimous vote of the membership indicated their preference for the word physiotherapy and the Association’s name was changed to the American Physiotherapy Association. Soon after, their journal became ‘Physiotherapy Review’.

Whilst the reason for the name change has been ascribed to the desire to admit men (Lohne, 1925; McMillan, 1925; Moffat, 2003; Rathbone, 1933), specifically members of the American Medical Association who were almost uniformly male, the reason is likely more complex (Linker, 2005a). The early, female physiotherapists, as non-physician practitioners, were buffeted by the competing and more powerful, masculine, electrotherapeutists/physiotherapists. Facing their own relevance issues within the medical profession and desiring to differentiate themselves from their non-physician competition the medical men had changed their designation in 1920 from physiotherapists to physical therapy physicians (Gritzer & Arluke, 1985; Johnson & Abrams, 2005; Moffat, 2003). The members of the American Women’s Physical Therapy Association adopted the abandoned term physiotherapy to avoid the perception that they were merely an “arm” of the medical profession; a designation that would have automatically disqualified them from being a profession in their own right (Linker, 2005a).

The battle of naming was far from over however, for in 1925 the nascent American Physiotherapy Association came under strong pressure from groups of the medical profession to change their name again (Editorials, 1925). The American Electrotherapeutic Association wrote to the American Physiotherapy Association, saying,

..the title of your organisation as it stands now strikes the average layman or even physician as one of an organisation of physicians, whereas it is not. (Kovacs, 1925).

The word physiotherapy and more so, its concomitant title physiotherapist, threatened the primacy of the physical therapy physicians, some of whom sought only partially trained helpers (Rathbone, 1933). The American Academy of Physiotherapy (an incorporated society of physicians) also wrote to the American Physiotherapy Association, saying,

..it would be of advantage from a standpoint of avoiding confusion, to have the term “Physiotherapist” reserved specifically for graduates in medicine who have become expert in the department of therapeutics. (Price, 1925).

Prescriptive in demands for change to the American Physiotherapy Association’s name was that their members add the trailing term ‘operative’ or ‘technician’ so as to clearly identify their subordinate role (Editorials, 1925; Hazenhyer 1946c). Physician Norman Titus, ‘doctorsplained’ the concept in the journal of the American Physiotherapy Association,

This term “Technicians” incidently [sic] is the title for those who help us do our work. The term “Aides” is comparable to a Nurse’s Aide in a hospital, which implies an amateur not ranked as high as a probationer nurse. We have X-Ray Technicians, Laboratory Technicians and others, so why not Physiotherapy Technicians?” (Titus, 1925).

Whilst the non-physician physiotherapists sought only to work under medical supervision, some of the “mature, cultured, and highly trained” Association founders led a strident objection to the technician proposal (Rathbone, 1933). Letters from the American Physiotherapy Association’s past presidents Mary MacMillan and Inga Lohne advocating for ongoing use of the singular term physiotherapy were published in the Association’s journal. To quote MacMillan (1925),

Are we not worthy of our name? Why should we give up the one word that gives us any particular identity? Have we not earned the right to the name, and fought constantly for its protection, in order that the future members of our Association might realise that our vision was large enough to foresee an honourable and useful profession, which should be a strong adjunct in the field of medicine.

The following year, at the 1926 Convention of the American Physiotherapy Association, the membership, by an overwhelming majority, voted to maintain their Association’s name (“Report of Convention”, 1926).

One strident commentator throughout the nomenclature debate of the 1920s and 1930s was AB Hirsch, physician and editor of the The New York Medical Week. Whilst celebrating Dr William Benham Snow’s quarter century editorship of the journal Physical Therapeutics he lamented the loss of the word physiotherapy when he said,

Physiotherapy, by the way, is older, more euphonious and universal than the recently coined cumbersome term, physical therapy. (Hirsch, 1927)

Hirsch’s preference for the word physiotherapy likely negatively influenced his opinions regarding its adoption by non-physician practitioners. He also wrote,

The contention was that such use of the term [physiotherapist] would deceive an otherwise uninformed public—the suffix “ist” usually indicating a medical graduate—as otologist, neurologist, psychiatrist. (Hirsch, 1930)

Later, when the term physiotherapy was well lost to medicine he derided it as inferior, by reporting,

The officials of the American Medical Association accordingly dropped the terms physiotherapy and physiotherapist, as applicable to medical graduates, properly substituting those of physical therapy and physical therapist. (Hirsch, 1934)

Continuing his derision, Hirsch (1934) quoted Swiss Professor Otto Verraguth who said, in his 1934 Presidential address at the annual meeting of the International Society of Medical Hydrology, that the word physiotherapy was,

too ill defined … inadequate, illogical and presumptuous … whereas the adjective ‘physical’ refers to the most exact of the natural sciences, physics.

Nevertheless, these quarrels were on the periphery of the practice of the majority of physicians, as their focus was firmly on new, more powerful pharmaceuticals and advanced surgical techniques, rather than the physical therapies (Wrynn, 2014). Subsequently many of the physical therapy physicians painfully morphed into the specialties of radiology, rheumatology and orthopaedic surgery (Burgher & Essex, 1998; Dijkers, 2020).

British Empire and Commonwealth

The first claim to the term physiotherapy in Britain occurred in 1918 with the formation of the British Association for the Advancement of Radiology and Physiotherapy by the medical profession (“The British Association of Radiology and Physiotherapy”, 1918). The physiotherapy part of their name was dropped in 1924, demonstrating the narrowing of the association’s focus. Nevertheless the word physiotherapy remained in use as a field of medicine.

Specific hospital departments for the delivery of massage, gymnastics and electricity evolved from the turn of the nineteenth century but the name physiotherapy was not used until after the First World War (Quin, 2017). For example,

The Westminster Hospital recently opened by His Majesty the King has among its many innovations a fine Physiotherapy Department (Beaumont, 1939).

Whilst managed by physicians, the hospital physiotherapy departments were staffed primarily by masseuses and masseurs. The first affirmative mention in the British Medical Journal of physiotherapy as a practice connected with non-physician practitioners is in an article titled “Physiotherapy in the Treatment of Arthritis” where the Medical Officer in charge of the Physiotherapy Department of the Royal United Hospital, Bath referred to “those skilled in massage and physiotherapy are available almost everywhere…” (Gordon, 1922).

In London in 1930, a meeting of physicians was called to discuss forming a Society of Physiotherapy (“A Society of Physiotherapy”, 1930; “Organisation of Physiotherapy”, 1930). The meeting’s organisers felt that such a society would help meet the needs of those who were not provided for by the Electro-Therapeutic Section of the Royal Society of Medicine or the British Institute of Radiology (“A Society of Physiotherapy”, 1930). Whilst the meeting concluded in the affirmative for the creation of a Society, it chose an alternative name, The Society of Physical Medicine. The rationale for their decision is summed up in the words of Dr Fortescue Fox who simply said, “Physiotherapy would not do” (“Organisation of Physiotherapy”, 1930).

In 1935 Australian orthopaedic surgeon EB Vance single-handedly gifted the name physiotherapy to the masseuses. In opening a discussion in the Section of Orthopaedics at the Annual Meeting of the British Medical Association held in Melbourne, Australia, and later published in the British Medical Journal, he reviewed the role of physiotherapy and proposed the alternative designations “myologist or physiotherapist” because they were “more representative of the complexity of the modern masseuse’s tasks” (Vance, 1936). Whilst Vance preferred myologist, the physiotherapy component of his proposal was supported in a responding Letter to the Editor by W Gordon Rich (1936), a New Zealand radiologist. No dissenting opinions were published.

The sixth International Congress of Physiotherapy was held in London in 1936, but by this time had adopted a name change to Physical Medicine (Licht, 1964). At the inaugural meeting of the British Association of Physical Medicine in 1938, physiotherapists were described as being “…regarded of as minor importance” (“An Association for Physical Medicine”, 1938). Irrespective of the patronising nature of this comment, of most import was the unintended recognition by the physical medicine physicians that physiotherapists were a discrete and recognisable non-physician group in Britain. Medicine’s connection with the word physiotherapy was by now severed in the anglosphere. Concurrently, throughout the 1930s the word physiotherapy, to describe non-physician practitioners, was in common parlance within Government and Parliamentary circles, royalty, and importantly, the masseuses and masseurs themselves.

The Society of Trained Masseuses

The first association of non-physician practitioners, a forerunner to physiotherapy in Britain today, was the Society of Trained Masseuses, founded in London in 1894 by four nurses and midwives skilled in massage. Formed in response to the ‘Massage Scandals’ their aim was to provide trained and respectable masseuses for the care of the injured and infirm (Nicholls & Cheek, 2006; Wicksteed, 1948). In 1900 the Society became Incorporated, achieving the legal and public status of a professional organisation. And in 1920 the Society was granted its Royal Charter from King George V and changed its name to the Chartered Society of Massage and Medical Gymnastics. This change occurred in conjunction with the amalgamation of the Society with Manchester’s Institute of Massage and Remedial Gymnastics (Barclay, 1994a), and was seen to better reflect the broadened scope of the masseuse’s practice that occurred in response to the First World War. But the process of name change was not easy,

Considerable difference of opinion arose as to the name under which the Charter should be granted to the Society. It was pressed on all sides that the name must denote the scope of the work undertaken and that the passive implication of massage alone must not be allowed to persist. On the other hand the word ‘massage’, for which such a glorious fight had been put up for a quarter of a century, must be retained at all costs. The final selection, as everyone knows, was the Chartered Society of Massage and Medical Gymnastics, despite the fact that more and more time was being devoted to electrotherapy. (Wicksteed, 1948)

Nevertheless, ‘whispers’ of the word physiotherapy were occurring around the periphery of the Society, beginning immediately in the newly named Journal of the Chartered Society of Massage and Medical Gymnastics with an advertisement, for “the new physiotherapy faradic wave apparatus” manufactured by the Medical Supply Association Ltd, of London (“Advertisement”, 1920). Two years later in the Journal, under the heading “Lectures” (1922), was written:

The Secretary of this Centre announces that by kind permission of the Medical Superintendent arrangements have been made for a visit to the physio-therapeutic Department at Beckett’s Park Hospital, Leeds, on Saturday December 9^th.

Still in the Society’s journal, in an article, “Notes from Abroad” (1923) the title of “physiotherapy aide” was used as a tentative descriptor of the role of an international colleague, and in the Society’s Congress Report of 1926 the word physiotherapy appears in the title of a lecture given by physician RG Gordon, “Physiotherapy in the Treatment of Rheumatic Disease” (Barclay,1994a).

According to Bentley & Dunstan (2006) (without reference to a primary source) in 1927 the Chartered Society of Massage and Medical Gymnastics discussed a variety of alternative names such as physiotherapy, medical massage and massotherapy, but all were dismissed for their perceived ungainly sound. When the issue of title was raised again later in the 1930’s, physiotherapy alone was now the sole favoured title but it was rejected again because of fear that the general public would confuse the title with psychotherapy (Barclay, 1994a).

Over time the word physiotherapy appeared with increasing frequency and strength in the Society’s journal articles, reports, correspondence, meeting minutes and activities, and was being used by others to describe the work of the profession. The Minutes of the Association of Teachers of the Chartered Society of Massage and Medical Gymnastics between 1922 and the 1940s refer several times to physiotherapy and various physiotherapeutic treatments and techniques. The Alfred Eichholz Institute of Massage and Physiotherapy by the Blind was opened by the Prince of Wales (later King Edward VIII) in July 1934 (Jones, 2021). And in a 1935 an article titled “Physiotherapy in Sport”, JW Mowles (1935) pointedly said,

The growth of physical medicine has been so rapid that many consider that the title of chartered masseur or masseuse is hardly satisfactory to the member who is qualified in all forms of physiotherapy.

Discussions around title became louder. A report on the 1937 Annual Congress of the Chartered Society in the British Medical Journal under the subheading “Too Narrow a Title” said,

The enlarging scope of the Chartered Society was instanced again by a debate which followed the annual meeting, in the course of which it was pointed out clearly that the activities of members included various modern forms of physiotherapeutic assistance under the supervision of medical practitioners, and that such electrical and other work was not indicated by the present rather misleading title by which the society was at present known. Great difficulty was experienced, however, in deciding on a title which would be adequate as well as reasonably brief,.. (“Congress of Massage and Medical Gymnastics”, 1937)

Notably the medical profession was also beginning to use the word physiotherapy as a descriptor of the non-physician profession. In 1938 Dr EB Clayton, Director of the Department of Physiotherapy, King’s College Hospital London published a paper “Massage in General Practice” in the widely read medical journal “The Practitioner”, in which he said,

Physiotherapy in general practice now includes massage, manipulation, remedial exercises, thermotherapy, electrotherapy and actinotherapy. (Clayton, 1938).

The onset of the Second World War saw government use of the word physiotherapy significantly increase, particularly in relation to the rehabilitation of its servicemen. The Minutes of the Society in February 1941 refer to a letter from the Government Ministry of Labour,

I am directed to refer to your letter of 16^th of April regarding the position under Registration for Employment Order of members of your Society and of students in training wishing to enter the profession of physiotherapy…

In a further example another letter in the Minutes headed “Physiotherapy in the Hospital Services”,

The Minister of Health, in July last year, promised all hospitals with two hundred beds and over should be afforded facilities for massage and electrotherapy, but according to various reports received by us, this ruling does not appear to be put into practice. We know of a case in which a hospital with five hundred beds, mainly war casualties, was recently refused massage and electrotherapy facilities. Such limitation of Physiotherapy indirectly affects…

Also, in 1941 a letter from the Private Secretary to Queen Mary, who at the time was Patron of the Society, was received stating,

Her Majesty was very much interested and pleased to hear that members of the Chartered Society of Massage and Medical Gymnastics and their friends are presenting a number of mobile Physiotherapy Units to the British Red Cross.

Furthermore, with the Chartered Society of Massage and Medical Gymnastics becoming accountable for the standards and training of electrotherapy, over the competing Society of Apothecaries, the ‘officially’ broadened scope of practice demanded recognition with a name change (Bell, 1994). And the existence of alternative non-physician professional organisations using the term, such as the Incorporation of Physiotherapists, the Society of Physiotherapists, the Faculty of Physiotherapists and the Physiotherapists’ Association, added to the pressure (Barclay, 1994b).

Discussions regarding a name change by the Chartered Society of Massage and Medical Gymnastics resumed in earnest in 1941. Within the Society’s Council meeting, it was said, by Lieutenant Colonel Philip Wiles, eminent orthopaedic surgeon, author of the book “Essentials of Orthopaedics” and co-opted Member of the Council,

The general feeling … was that massage conveyed little while physiotherapy was understood all over the English speaking world. (Barclay, 1994a)

It was an acknowledgement of the name changes that had occurred previously elsewhere in the anglosphere. However, the process was not simple, and it was not until 1943 that the Society’s Council agreed and application made to the Privy Council for the title change to ‘The Chartered Society of Physiotherapy’; which was approved later that year (“Medical Notes in Parliament”, 1944).

In January, 1944 the first issue of the newly titled Journal of the Chartered Society of Physiotherapy said,

‘Massage’ to ‘physiotherapy’ is more than a change of name. It tells in brief the history of the growth of a profession. (Editor, 1944).

The medical profession’s general endorsement came via The Lancet, who said that the name change was an “apt” decision because the field of practice was widening, and passive massage and “electric lights and sparks” were no longer preferred treatment options (“Passive Masseuse, Active Patient”, 1944).

The Chartered Society of Physiotherapy and its predecessors also serviced Irish practitioners. In 1908 two of the founding members of the Incorporated Society of Trained Masseuses travelled from London to Dublin to carry out their first examination of students from the Irish School of Massage (Eastern Health Board, 1997). The school later became known as the Irish School of Massage and Medical Electricity and in 1942 the Dublin School of Physiotherapy. The independent Irish Society of Chartered Physiotherapists was formed in 1983.

The Empire and Commonwealth

With many women from overseas travelling to England at the turn of the nineteenth century to train in this new profession and then return home (Pettman, 2007), and large scale emigration by British masseuses and, to a lesser extent, masseurs looking for new opportunities in the colonies and beyond (Graham, 1940; McFarlane, 1985) the Society of Trained Masseuses and its subsequent iterations successfully exported its systems and beliefs (Heap, 1995; Nicholls, 2018; Pynt, et al., 2009; Twomey & Cole, 1985). Nevertheless, the masseuses and masseurs of the colonies of South Africa, Canada and Australia preceded the British in adopting the term physiotherapy.

Following the First World War many members of the Chartered Society of Massage and Medical Gymnastics migrated to South Africa (McFarlane, 1985). The expatriates’ connection with their homeland was of such strength that in 1921 a group from Durban formed a South African branch of the Chartered Society of Massage and Medical Gymnastics rather than creating their own Association (McFarlane, 1985). Their motivation to form an Association was political, specifically to ensure inclusion of masseuses in a Medical Bill soon to be read in Parliament for the proper status of the Medical, Dental, Pharmacy and Nursing professions. Around the same time, but independently, a similar group of Cape Town masseurs, but including, “…acceptable persons with qualifications from places other than Britain”, formed the Certified Masseurs Association for the same political purposes (McFarlane, 1985).

In 1924 the Durban branch and the Cape Town association united to form the South African Society of Massage and Medical Gymnastics, modelling the name of the Chartered Society in Britain. Central Executive Committee member ME Catt (1975) recollected,

We soon realised that our Society’s name was wrong. It did not embrace Medical Electricity for one thing. We wanted to call our Society by its present name, but the doctors who specialised called themselves Specialists in Physiotherapy. It was hard work to persuade them to call themselves Specialists in Physical Medicine. However, as you know we won in the end.

In 1932 the name was changed to the South African Society of Physiotherapists (Irwin-Carruthers, 1988), but it was not a smooth process. Within the profession there had been talk of the word physiotherapeutician being used and there was also strong opposition to any change at all, on the basis that, at the time, the highly regarded British Chartered Society still used the terms massage and medical gymnastics (McFarlane, 1985).

Before the First World War masseurs and masseuses in Canada were few and mostly had been immigrants trained in the United Kingdom, and to a lesser extent in Sweden and the United States of America (Heap, 1995). There were also a few Canadians who had trained under the Society of Trained Masseuses in the United Kingdom and subsequently returned home (Graham, 1940).

In 1915 the Toronto Society of Trained Masseuses had formed, and three years later a similar association was established in Montreal, both seeking to create standards for massage (Cleather, 1995). The two associations agreed in 1919 to establish a national organisation (Heap, 1995) and the Canadian Association of Massage and Remedial Gymnastics was formed. Again we note the modelling of the name of the Chartered Society in Britain.

Nevertheless, the term physiotherapy was well known in Canada, not least with the female civilian graduates of the Military School of Orthopaedic Surgery and Physiotherapy during the First World War (Wilson, 1918). By 1929 the training had evolved into a two-year Diploma of Physiotherapy course at the University of Toronto (Heap, 1995). In 1931 a proposal to change the name of the Canadian Association of Massage and Remedial Gymnastics to the Canadian Physiotherapy Association was made, but was initially met with disapproval (“The Roots”, undated). It was not until 1934, following a census of its members, that the Association’s name change occurred (Cleather, 1995).

In Australia, in 1905, Sydney-based masseurs and masseuses concerned about massage standards had formed the Australasian Massage Association; with the name suggesting aspirations well beyond their city (Evans, 1955). Around the same time, Victorian masseurs and masseuses also met to organise an association and so the two groups, together with practitioners from South Australia, united in 1906 using the original Australasian Massage Association name (Bentley & Dunstan, 2006). With a New Zealand-based founding member they immediately reconciled their aspirational name with their membership (McMeeken, 2014).

It was not until their 1933 Conference that the Australasian Massage Association officially considered a name change; the New Zealander members had been let go during the First World War due to political difficulties within their branches. The possible addition of medical gymnastics and medical electricity to the title to better reflect their fuller scope of practice had been investigated, but the totality of the combination was considered unwieldy (Bentley & Dunstan, 2006). The shorter title ‘massage and physio-therapy’ had also been rejected for the same reason. Nevertheless, in 1939 the association moved to adopt the singular term physiotherapy in line with similar moves worldwide (Forster, 1975). It was a stuttering start for the profession’s new name in Australia with the University of Queensland just previously advertising a course of physico-therapy and shortly after physio-therapy (Hill, 1974), and the newly named professional association originally listing the title as Physio Therapy before quickly connecting the words (Bentley & Dunstan, 2006).

Surprisingly, soon after taking its new name the Australian Physiotherapy Association discovered there was already another such named organisation (Bentley & Dunstan, 2006). This ‘other’ Australian Physiotherapy Association was a loose group of alternative health practitioners active in Queensland and New South Wales. The new Australian Physiotherapy Association was alarmed, particularly as the other Association ran a small training academy which issued diplomas under their title. The first-named Australian Physiotherapy Association was asked to change their name but refused, having been founded well before, in 1912 (Bentley & Dunstan, 2006). Legal advice indicated that law relating to associations differed from that applying to companies, and that the only way to obtain exclusive use of the word physiotherapy would be to have it defined by an Act of Parliament. This inspired the New South Wales branch of the new Australian Physiotherapy Association to seek state registration. Now armed with the requisite definition by an Act of Parliament they took the matter to the Equity Court. Faced with inevitable defeat the rival organisation offered to change their name to the Consulting Physiotherapists Association of Australia, to which the new Australian Physiotherapy Association surprisingly agreed. However, nothing more is recorded of the rival organisation so it can only be assumed that as the term physiotherapy gained greater usage in its new form the original owners likely retreated.

Whilst New Zealand led the world with first university-level School of Massage, opened at the University of Otago in 1913, the New Zealand Trained Masseurs Association, formed in 1923, was a relative laggard in adopting the term physiotherapy. It took their government and an Act of Parliament to effectively force their hand. With the introduction of the Physiotherapy Act 1949, superseding the previous Masseurs Registration Act 1920 (Grbin, 2013), the Trained Masseurs Association swiftly updated their name to the New Zealand Society of Physiotherapists in 1950.

..it was recognised that there was a need to differentiate between those persons providing massage and exercise for therapeutic reasons and those who provided massage for a range of other reasons. The change in title reflected international and local changes in the practice of massage therapy/physiotherapy.” (“Physiotherapy Act 1949”, undated).

That the New Zealand government was a driver in use of the term physiotherapy is suggested by their intention that the Trained Masseurs Association would not see the Bill until its second reading (“Physiotherapy Act 1949”, undated). And perhaps their prior use of the word in the first issued massage certificates under the Massage Registration Act 1920 which made reference to the bearer having passed an,

…examination in both theoretical and practical massage (including medical electricity, remedial exercises and other branches of physio-therapy) (Nicholls, undated).

Physical Therapy

Whilst the adoption of the name physiotherapy was progressively occurring for the non-physician profession across the anglophonic world during the 1930’s and 1940’s, the issue of name repeatedly and exhaustingly raised its head for the naming-pioneers in the United States of America (Hazenhyer 1946c). In 1925 the increasingly powerful American Medical Association had formed a Council of Physical Therapy, to

..investigate and report on the merits of non-medicinal apparatus and contrivances offered for sale to physicians or hospitals.. and .. inquire into methods of massage, manipulation, hydrotherapy, and remedial exercises.. (“The Council of Physical Therapy”, 1925; Desjardins, 1928).

According to physician William McFee (1931), in creating the Council, “..the American Medical Association coined the name Physical Therapy..” to directly counter, “..those not having medical degrees, who called themselves Physiotherapists”.

The Council’s first report noted that physical therapy should only be prescribed by an appropriately trained physician, and expressed concern over the “unscrupulous, so called ‘physio-therapist’”, but did not distinguish between cultists (chiropractors, osteopaths and poorly/un-trained lay people) and technicians (masseurs/masseuses, gymnasts or nurses who had received training in physical therapy) (Gritzer & Arluke, 1985). The physical therapy physicians, who were seeking not to destroy the technicians but to control them, were quick to point out that ethical technicians (i.e., members of the American Physiotherapy Association) should not be confused with the cultists. Control was achieved when the American Congress of Physical Therapy (the newly named association of physical therapy physicians) established formal relations with the American Physiotherapy Association, and was empowered to create and maintain a registry of non-physician practitioners who met or exceeded their designated standards (Moffat, 2003). Named the American Registry of Physical Therapy Technicians; listed registrants were provided the opportunity to use their medically-endorsed credentials via the title Physical Therapy Technician.

As indicated, during this period a wide range of people were offering treatments under the name physiotherapy. For example, a group of osteopaths and chiropractors, who called themselves The Physiotherapists Society, invited American Physiotherapy Association members to join their effort in becoming independent of the medical profession. As reported in the Association’s journal, S Rock, secretary of the Society wrote,

The main objective and avowed intention of this society is to procure the passage of a bill … making osteopaths, chiropractors, physiotherapists, and drugless therapists independent of the medical profession insofar as the prescribing and administering of physical therapy is concerned. (“Chapter News”, 1935).

The offer was declined. The medical profession’s support was considered too great an asset to risk losing and mutual benefits were available (such as the exclusion of chiropractic) by strengthening ties further with medicine (Linker, 2005b).

The primary link with the medical profession was via the American Medical Association’s Council of Physical Therapy (Hazenhyer, 1946b). The Council reignited the earlier drive to assert medical dominance over the members of the American Physiotherapy Association through the use of title, and this time it was less of request and more of a pronouncement. The Executive Director of the Council, HJ Holmquist, wrote,

At a recent meeting of the council, a definite motion was made and carried that as the suffix ‘ist’ in such words as roentgenologist, etc., has been by long custom associated with the holders of degrees of medicine, this council does not approve the use of the term ‘physiotherapist’ or ‘physical therapist’ except by graduates of medicine. (Furscott, 1928).

The American Physiotherapy Association paid the demanded price of affiliation with the medical profession and adopted the extra term technician for its members (Hazenhyer, 1946c). The new technicians, primarily as aides to the physical therapy physicians underwent a cultural transition toward the name of their patrons by progressively adopting the title physical therapy technician and practising physical therapy. However, the American Physiotherapy Association did not change its name due to its earlier 1930 incorporation in Illinois (Hazenhyer, 1946b).

In 1944 the American Congress of Physical Therapy dropped their claim to the term physical therapy and created a new preferred term, physical medicine, to better distinguish themselves from the physical therapist technicians and their association (Burgher & Essex, 1998; Dijkers, 2020; Moffat, 2003). Following a further two years of deliberation the physical medicine physicians settled on their new title physiatrist. After over twenty years of unrelenting cooperative competition the higher ranked term physical therapist was available to be secured by the non-physician profession in the United States (Gritzer & Arluke, 1985). The hierarchy was clear since the term had earned status having been used by medical practitioners for many years, but was now deemed surplus.

Subsequently non-medical workers who for some years had fretted under the title of Physical Therapy Technician were now free to use that of Physical Therapist (Hazenhyer 1946d).

Also, just previously the US Congress had passed a bill, in response to the Second World War, stating that graduates of the Emergency Training Courses, the equivalent of the reconstruction physiotherapy aides during fhe First World War, should be called physical therapists (Fornasier, 2017; Hazenhyer, 1946d). Military procurement of physical therapists became the responsibility of the Officer Procurement Service of the Army in 1943 and its nationwide publicity network reached high schools and colleges, such that, “people throughout the country became more aware of the term ‘physical therapist'” (Vogel cited by Gritzer & Arluke, 1985).

It naturally followed that an association of physical therapists should be thus named, and the title secured (Moffat,1996, 2003). In 1947, after consultation with its State Chapters, the American Physiotherapy Association’s House of Delegates voted to change its name to its current iteration, and the American Physical Therapy Association was born (or re-born, in a non-gendered form).

Reaching Out

The Second World War saw 1,600 United States Army physical therapists treating soldiers from many countries, including prisoners of war and local civilians; at home and where they were stationed all over the world (Cole, 1947). With this experience the post-Second World War era provided a favourable climate for the American Physical Therapy Association to strengthen relations globally (Murphy, 1995). Individual members reached out to the international community and worked as consultants, clinicians and teachers, with some accepting lengthy Red Cross assignments in Morocco; serving with the International Refugee Organisation and UNESCO; and providing shorter training missions in Belgium, Cuba, Egypt, Haiti, Italy, Saudi Arabia, Czechoslovakia, Thailand and Japan (Murphy,1995). It is not surprising therefore, that the American term physical therapy was subsequently adopted by some of these nascent national professional associations.

Nations who were impacted by burgeoning United States’ geopolitical interests as the new global power flexed its muscles, also tended to adopt the term physical therapy. For example, Geraldine Lindberg, an American who worked in the US Army hospital from 1945, was the first physical therapist in Korea (Lee, et al, 2010) and Thelma Maw, another American, in 1949 started a Physical Therapy Department at Severance Hospital, Seoul (Hunn, 1974). Physical therapy rapidly grew with the onset of the Korean War in the early 1950s to assist with the many resultant casualties (Lee, et al, 2010). “Maw began a discussion group of Western physical therapists in 1961” and by 1963, “the Korean physicians and physical therapists conducted their own meetings, utilising the Western physical therapists as advisers” (Torp, 1965). The Korean Physical Therapy Association was subsequently formed in 1965.

A trend is discernible between the location and timing of the establishment of new national ‘physical therapy’ associations coinciding with preceding American political, military and aid interventions. Physical Therapy Associations sprang up in the Asian nations of the Phillipines (1964), Japan (1966), Thailand (1973) and Taiwan (1975); in African nations of the Congo (1975) and Rwanda (2007); in Central American nations of Barbados (2003), Costa Rica (2011) and the Dominican Republic (2016); and the Middle Eastern nations of Syria (2000), Saudi Arabia (2003), Kuwait (2005), Bahrain (2007), Pakistan (2008) and Yemen (2020). But perhaps nowhere was the influence of the American Association’s decision to transition from physiotherapy to physical therapy more widely felt than the birth of the world confederation of national professional associations.

World Confederation of Physical Therapy

The formation of an international organisation was a joint Anglo-American initiative with its genesis likely in1943 where, at that year’s Chartered Society of Physiotherapy’s annual congress, fifteen US Army physical therapists attended. First Lieutenant Olena Cole (1946) reported,

During the conference a closer cooperation between American and British physical therapists was suggested by Miss D. Worsfold, Director of the Chartered Society, and plans were formulated for accomplishing this mutual desire.

In 1946, at the cessation of the Second World War, MJ Neilson, Secretary General of the Chartered Society of Physiotherapy, travelled to the United States of America to meet with Executive Director of the American Physical Therapy Association, Mildred Elson, for further planning (“WCPT: the first 50 years”, 2001).

The Chartered Society of Physiotherapy invited international participation at their annual congress in 1948. Representatives from the national non-physician professional associations of thirteen countries held a meeting to discuss global collaboration (“WCPT: the first 50 years”, 2001). A provisional committee was elected, including American physical therapist Mildred Elson as Chair, a British physiotherapist, a Dutch heilgymnastiek, a French masseur-kinesitherapeute and a Swedish sjukgymnastik (Elson, 1948). The provisional committee met in Paris in 1950 to determine the new organisation’s bylaws and plans, including its name (APTA, 1950a; Remondière, 2021).

The Americans and the British referred to the international organisation by a number of different names during its conception. Preceding the 1948 congress the leadership group of the Chartered Society of Physiotherapy referred to it as an International Association of Physiotherapists (“Annual General Meeting”, 1947). And whilst reporting on the provisional committee’s meeting held in Paris in 1950 the project was referred to as an International Collaboration in Physiotherapy (“Proceedings of Council”, 1950). Meanwhile the American Physical Therapy Association initially referred to it as the International Confederation for Physical Therapy (APTA, 1950b) and later the World Confederation of Physical Therapy. These names may have been simply placeholders for their specific audiences. Nevertheless, in the British Chartered Society of Physiotherapy’s “Annual General Meeting” (1950) report and thereafter, it was referred to as the World Confederation for Physical Therapy, without further comment. In 1951 at the inaugural meeting in Copenhagen, Denmark the World Confederation for Physical Therapy was officially founded.

Why was the profession’s international umbrella organisation named the World Confederation for Physical Therapy, and not Physiotherapy? According to O’Hare (1994),

The answer is simply that .. when the constitution was drafted, the North American terminology was used and the constitution was subsequently agreed by the founding members using this name.”

O’Hare (1994) goes onto to say, “As readers can imagine, this terminology has been well debated over the years,..”. One oft-quoted, but unsubstantiated, explanation is that the name was a negotiated exchange by the Americans to allow the English to have the World Confederation headquartered in London.

Europe

Two of the key progenitors of physiotherapy were the early 19th century Swedish theologian and fencing master Pehr Henrik Ling’s system of gymnastics and Dutch remedial gymnast, and later physician, Johan Metzger’s system of massage (Pettman, 2007; Ottosson, 2015). Central to their success was their systemisation, allowing for the application of scientific principles (Lucas-Championnière, 1909; Ottosson, 2011). Both physicians and non-physician practitioners used the systems, and their many progressions and variations. With livelihoods on the line, competition between the two groups was strong, and thus the physicians sought primacy via the claim,

“Remedial gymnastics and massage in themselves were thus not … quackery; only so, when practiced by non-physician practitioners” (Vossen, 2019).

With their alignment to laboratory science, higher education and the pharmaceutical industry, plus growing political support, allopathic medicine grew increasingly powerful, causing non-physician massage and/or remedial gymnastic practitioners to unite in professional associations to fight for legitimacy and market share (Nicholls, 2018).

The word physiotherapy continued to be tightly held by the European medical profession after the First World War, until they began to follow the American lead toward the name physical medicine and rehabilitation, albeit some forty to sixty years later (Dijkers, 2020). For example, the Medical Association for Physiotherapy and Hydrotherapy Physicians Association (Ärztliche Gesellschaft für Physiotherapie Kneippärztebund e.V.) has existed in Germany since 1926, later exchanging the word physiotherapy to medicine. The International Association of Physical Medicine and Physiotherapy (L’Association Internationale de Médicine Physique et de Physiothérapie) existed in Belgium from 1930 to 1941. The Bulgarian Scientific Institute of Balneology, Physiotherapy, and Rehabilitation, associated with the Sofia School of Medicine, was established in 1949 (Vassileva, 1996). And as late as 1963 a Physiothérapie section of the Union Européenne des Médecins Spécialistes was founded, with a name change not occurring until 1974 (Bertolini & Delarque, 2008). In some European nations the naming conflict between physicians and non-physicians continued well into the twenty first century, as illustrated by the title of the Zampolini, et al, (2022) article,

Time to replace the inappropriate old name of Physiotherapy for the medical specialty of Physical and Rehabilitation Medicine in official EU documents.

As part of their argument Zampolini and colleagues reported that the final holdouts of Ukraine and Russia have only just recently converted the name of their two-year post graduate medical speciality of physiotherapy to physical and rehabilitation medicine.

Non-physician massage and gymnastics had proved itself reliable and beneficial across two world wars and polio epidemics in the first half of the twentieth century, and governments were ready to support its growth as they took on greater responsibility for rehabilitation (Nicholls, 2018). The rise and recognition of non-physician physiotherapy throughout European nations occurred progressively across the continent. Simplistically, the timing followed the familiar pattern of the South Eastern spread of industrialisation in the eighteenth and nineteenth centuries, and democratisation, welfarism and development of national health services in the twentieth century. The Northern European nations instituted national health services in the 1940s – 1970s and the Southern nations in the 1970s – 1990s (Toth, 2010). However Eastward progression hit the hard wall of the post Second World War “Iron Curtain”, where the Central and Eastern European nations’ centrally-planned economies facilitated medical hegemony (Grant, 2022; Healy & McKee, 1997).

Northern Europe

The first claim to the term physiotherapy by non-physicians in Europe occurred in 1953 when the Danish General Massage Association (Almindelige Danske Massageforening), founded in 1918, became the Association of Danish Physiotherapists (Danske Fysioterapeuter). The drive to adopt the term physiotherapy can be traced back to their borders re-opening, on the departure of German occupation troops of the Second Word War in 1945. Travel allowed foreign physiotherapists in and Danish masseuses went abroad to study, mainly to England and the United States of America. The high standards and new techniques practiced by the members of the Chartered Society of Physiotherapy and the American Physiotherapy Association (as it was known at the time) stimulated the Danish profession, including the desire to express their resultant clinical progression in the form of a new name. The editor of the association’s journal (and two-time chairman of the association), Rudie Agersnap, wrote,

The title [masseuse] might have been good enough 25 years ago, but we must gradually understand that what we deal with, is physiotherapy, and we are therefore physiotherapists, even if both we ourselves and our patients in the first years will think it sounds strange (Danske Fysioterapeuter, 2018).

The name change required permission from the Danish Medical Association, who regulated the massage profession and its education. Fortunately there was little resistance, as physicians in Denmark had a long history of rehabilitation provision using the alternate terms physical therapy and physiatry (Biering-Sørensen, et al, 2018).

Soon after, in 1958, the Norwegian Nurse Gymnasts Association (Norske Sykegymnasters Landsforbund), originally founded in 1936, became the Norwegian Physiotherapy Association (Norske Fysioterapeuters Forbund) (Bergerud Buene, 2021).

Other Scandinavian countries were slower to change, and in multiple respects. In Sweden the Women’s Legitimate Sick-Gymnasts National Association (Kvinnliga Legitimerade Sjukgymnasters Riksförbund) was founded in 1943 and and did not admit men until sixteen years later. In 1953 the association chairman proposed a name change to physiotherapist, but it was not ratified until nearly sixty years later in 2012 (“Var Historia”, undated). Government legislation to protect the title of physiotherapist facilitated the name change of their association to the Swedish Association of Physiotherapists (Fysioterapeuterna) in 2014.

Finland experienced an only slightly swifter process, with calls for a change from the title medical gymnast (lääkintävoimistelijain) to physiotherapist first occurring in 1961 (Puro, 2023). Multiple, small, progressive changes over thirty-one years eventually overcame the determined resistance of some members of the Finnish Medical Gymnasts Association (Suomen Lääkintävoimistelijain Yhdistyksen), founded in 1943, to be renamed the Finnish Physiotherapy Association (Suomen Fysioterapeutit) in 1992. By this time competing Sports Massage Therapists had begun to use the title physiotherapist, causing some consternation, but the government’s Professional Practice Act in 1994 swiftly resolved the issue.

Western Europe

The world’s oldest non-physician physiotherapy professional association, was founded in 1889 in the Netherlands as the Society for the Practice of Healing Gymnastics (Genootschap van Heilgymnasten) and later, as a result of a merger with the masseurs, it became the Dutch Society of Healing Gymnastics and Massage (Nederlands Genootschap voor Heilgymnastiek en Massageas). The Society responded to governmental protection of the title ‘physiotherapist’ in the Paramedical Professions Act 1965 by immediately changing its name to the Dutch Society of Physiotherapy (Nederlands Genootschap voor Fysiotherapie) (Vossen, 2019). The title Royal (Koninklijk) was granted in 1989, as the Society celebrated its 100th anniversary.

Friendly mergers between remedial gymnasts and masseurs did not occur in every nation and claims to the name physiotherapy were litigious in West Germany. The gymnasts for the ill (Krankengymnast*innen), supported by the orthopaedists, argued with the masseurs about scope of practice and rights, including who was allowed to call themselves physiotherapists (Hüter-Becker, 1999; Schiller, 2021). In 1965 the masseurs, represented by the Association of Medical Auxiliary Professions (Verband Medizinischer Hilfsberufe), unilaterally changed their name to the Association of German Physiotherapists (Verband Deutscher Physiotherapeuten), much to the anger of the gymnasts for the ill (ZVK, 2009). This lead to a ten-year legal battle. Ultimately the Hanseatic Higher Regional Court recognised that the professional title physiotherapist for masseurs could lead to confusion and declared their new association name inadmissible. In response, the masseurs changed their association name yet again, this time to the Association of Physical Therapy (Verband Physikalische Therapie). The judge also stipulated that neither could the gymnasts for the ill call themselves physiotherapists. His decision was based on an extensive public survey where more than half of the respondents said that they imagined a physiotherapist to be similar to a medical practitioner, but only fourteen percent a gymnast for the ill. The Association of Gymnasts for the Ill responded by changing its name to the German Association for Physiotherapy – Central Association of Gymnasts for the Ill (Deutscher Verband für Physiotherapie Zentralverband der Krankengymnasten) in order to,

express that they are internationally recognised, that their field of activity is physiotherapy, and that they will continue to fulfil these tasks reliably as gymnasts for the ill (Hüter- Becker, 1999).

Unification of the two Germany’s in 1991 ended any further action and the German Association of Physiotherapy – Central Association of Gymnasts for the Ill/Physiotherapists (Deutscher Verband für Physiotherapie – Zentralverband der Krankengymnasten/Physiotherapeuten) was formed (Grosch, 1996). The East German gymnasts for the ill had previously been given ministerial approval in 1964 to be known as physiotherapists.

Naming conflict also occurred in Switzerland but this time with the medical profession, who were early and persistent users of the title physiotherapist. The Swiss Professional Association of State-Certified Masseurs and Masseuses (Schweizerischer Fachverband staatlich geprüfter Masseure und Masseusen) had formed in 1919 (Welti Zwyssig & Hasler, 2016). In 1945, subsequent to several mergers, particularly with the medical gymnasts (heilgymnast*innen), the association renamed itself to the more inclusive, but even more lengthy, Swiss Federation of Practitioners in Massage, Medical Gymnastics and Physiopractitioners (Schweizerischer Verband staatlich geprüfter Masseure, Heilgymnasten und Physiopraktiker) (Hasler, 2011).

Internationalisation of the profession, particularly the formation of the World Confederation for Physical Therapy in 1951, stimulated a desire for greater professionalisation, including an updated name. The medical profession favoured physiotherapy technician, in order to maintain their dominance. This was similar to the earlier American experience since the strong physical medicine presence in Switzerland was used as an exemplar by the American physical medicine practitioners during their own naming saga twenty years earlier (Hirsch, 1934). Meanwhile the masseuses and masseurs wanted the title masso-physiotherapy practitioner, and later physiopractitioner. Regulations in 1957 confirmed the designation physiotherapy technician, however the professional association persisted and from 1959 held the title of physiopractitioner. The singular word physiotherapist was first used in 1963 and because the medical physiotherapists in the meantime had moved on to the name physiatry, negotiations were not necessary and the title physiotherapist was officially adopted in 1966 for the non-physician practitioners. Their professional association underwent a few subsequent name changes, ultimately becoming known as, the very succinct, PhysioSwiss in 2007.

In Austria trained non-physician practitioners were called Assistants to Physicotherapy (Assistentin für Physikotherapie) with the founding of their first training college in 1916 (Fialker-Moser, 1999). However, the Association of Certified Physical Medicine Assistants of Austria (Verband der diplomierten Assistentinnen und Assistenten für physikalische) was not founded until 1961 (Physio Austria, 2016). Note that they remained assistants to the physicians who had updated from physicotherapy to physical medicine. A decades long battle with the physicians ensued, and it was not until 1995 that the non-physician association became the Federal Association of Certified Physiotherapists in Austria (Bundesverband der Diplomierten PhysiotherapeutInnen Österreichs), and in 2004 Physio Austria (Wolf, 2004).

The physicians of France were even more steadfast, holding tightly onto the name physiothérapie, the practices of electrotherapy and manipulation, and the training of non-physician practitioners well into the twentieth century (Quin, 2017; Remondiére, 1998, 2021). Subsequently the non-physician practitioners struggled to move beyond the provision of massage and exercise therapy (kinésithérapie) (Trudelle, 2010), uniting in 1946 to become masseur-kinésithérapeutes (Remondiere, 2017). But whilst the current peak French professional association is the Conseil national de l’ordre des masseurs-kinésithérapeutes, a competing association, the Société de Kinésithérapie, founded in 1936, changed its name to the Société Française de Physiothérapie in 2009 “to better match international norms” (“Historical Reminders from SDK to SFP”, undated). Despite strong attachments to existing names, and political tensions within and external to the profession a drive for change of name to physiothérapie is currently occurring (Remondiere, 2017).

Whilst discussing France, it would be remiss not to briefly explain the origin of the word kinésiethérapie. In the mid-eighteenth century, graduate of the Swedish Royal Central Institute of Gymnastics and Ling disciple, Carl August Georgii, had travelled to Paris which was at that time the centre of medical progress (Quin, 2017). Believing that the Swedish word ‘sick-gymnast’ (sjukgymnastik) lacked a clear scientific appeal to the physicians he was seeking to reach Georgii engaged Johan Friedrich Dübner, a famous German philologist living in Paris, to find a name with a better sound for the French ear. Thus kinésithérapie (kinesis = spontaneous or supervised movement) was born (Ottosson, 2010). The word kinésithérapie was subsequently adopted by the non-physician professional associations in France, nations within France’s colonial influence (eg., Congo, Ivory Coast, Mauritius) and/or nations where Ling’s ‘movement cure’ reached early and without competition (eg., Argentina and Chile).

Southern Europe

Just as the formation of democracy, welfarism and national health services occurred later in the Southern European countries of Spain, Portugal, Italy and Greece (Toth, 2010), so followed the rise and recognition of non-physician physiotherapy. With government support through funding for rehabilitation services, regulation and education, practitioner recognition came before or with the formation of their professional associations. This meant that politically the professional associations had little power to push for greater recognition sooner. Nevertheless, combined with the medical profession having increasingly moved away from physiotherapy as a title and towards physical medicine and rehabilitation, naming conflicts were minimal when the change did occur. Initially, whilst physiotherapy educational standards were at a technical level, the secondary term assistant or technician were used, but faded quietly as qualification levels rose.

In Portugal the term physiotherapy (fisioterapia) was officially decreed in 1918 (Fonseca, 2012) and remained a medical specialty until 1957 when it was replaced by physiatrist, or specialist in physical medicine and rehabilitation (“History of Physiotherapy in Portugal”, undated). Around the same time government supported rehabilitation courses for non-physician practitioners began with instruction from physiotherapists from the United States of America, Great Britain and Denmark, initially training physiotherapy assistants or technicians. The Portuguese Association of Physiotherapists (Associaçāo Portuguesa de Fisioterapeutas) formed in 1960, and in 1966 the title physiotherapist was claimed for non-physician practitioners.

Greece suffered through brutal German occupation, a civil war, famine, poverty, and outbreaks of tuberculosis and polio throughout the early 1940s, and its health system was in collapse. The United Nations Relief and Rehabilitation Administration and the Near East Foundation collaborated with the Greek Red Cross to bring American Physical Therapist Belle Grieve in to help in 1946 (Mpouzikakos & Marmaras, 2010). Grieve began working with nurses and gymnasts, and established a School of Physiotherapy in 1948. The Ministry of Health had difficulty accepting that the title of a therapist could be assigned to a professional who was not a physician, so it was initially named the School of Physiotherapy Assistants. After much pressure from the relief agency and foundation, and other prominent citizens of Greece, the school was officially founded in 1958. The Panhellenic Association of Physiotherapists was founded in 1964 by local graduates of the school of physiotherapy.

In Spain, the first half of the twentieth century saw non-physician physiotherapy as a specialisation of the nursing profession. Practitioners were known as medical auxiliaries until 1957 when the Spanish government separated physiotherapy into its own unique and independent profession (Martinez & Martinez, 2013). However, practitioners were subsequently titled physiotherapy assistants, able to practice only under medical supervision. In the absence of physiotherapy educational expertise, initial training was provided by experts outside the field, primarily medical practitioners, further conditioning physiotherapists to the norms of a subservient role (Merono-Gallut & Rebollo-Rodán, 2013). The Spanish Association of Physiotherapists (Asociación Espanola de Fisoterapeutas) was formed in1969 and access to the title physiotherapist occurred in 1970 when training moved to the university sector.

The first physiotherapeutic institutions in Italy were the Istituto Fisioterapico Gabbrielli-Bacci, founded in Florence in 1895, and the Istituto Fisicoterapico founded in Turin in 1898 (Conti & Lippi, 2007). Both were hospitals and teaching institutions for medical physiotherapies. In 1934 the first schools for Technicians of Physiokinesitherapy (Tecnici di Fisiochinesiterapia) were created and the title physiokinesiotherapist was regulated in 1942. Italy subsequently developed a rehabilitation therapy model where the education in early years was shared among physiotherapists, occupational therapists and speech therapists (Abeni, 2009). The Italian Association of Rehabilitation Therapists (Associazione Italiana Terapisti della Riabilitazion) was founded in 1959, updating its name to the Italian Association of Physiotherapists (Associazione Italiana Fisioterapisti) in 2020 to better match international standards and the new National law.

Central and Eastern Europe

Due to its geology, balneological (hot springs) spas proliferated in Central and Eastern Europe. With significant infrastructure in the region, extending from at least the Roman period, balneotherapy and rehabilitation combined into a single medical specialty (Sordu, et al., 2016). Complementary physical therapies, like therapeutic massage, were also provided at the spas as early as 1838 in Croatia, 1869 in Hungary, and 1888 in Romania (Eldar, et al., 2008; Roman, et al., 2017). In a treatise written by Felix in 1889 (cited by Roman, et al, 2017),

“those who performed massage, ..were supposed to be sub-surgeons, trained for this purpose, considering massage as a medical specialty that should not be performed by unauthorized individuals”.

Nevertheless, the medical profession took leadership in the provision of the physical therapies in Central and Eastern Europe, use of the word physiotherapy and maintaining tight control over their assistants.

Baneology was the progenitor of the medical specialty of rheumatology and in Central and Eastern Europe rheumatology and physiotherapy were entwined to the exclusion of any other medical specialty (Balint, 1993). Therefore the role of rheumatology was subsequently much broader than in the West to include nearly any musculoskeletal disorder.

Orthopaedics was the other root of physiotherapy and in Croatia modern physiotherapy emerged from the first orthopaedic institute in Southeastern Europe, founded in 1908 (Schuster, Miklić & Jurinić, 2014), and subsequent First World War rehabilitation hospitals (Schuster & Jurinić, 2012). In 1928 a public bath and the Institute for Hydrotherapy and Physical Therapy was established, and ten years later the Department for Physical Therapy and Rheumatism was founded for the further education of physicians. The term physical medicine emerged as a differentiator when the first secondary school for physiotherapist technicians was established in 1947 as the “School for Physical Medicine and Radiography” (Jurinić, 2007). The Association of Physio and Occupational Therapists in Croatia was formed in 1956, changing its name to the Croatian Association of Physiotherapists in 1998.

Similarly, the broader Yugoslavia saw the formation of the Association of Physiotherapists and Occupational Therapists (Savez fizio i radnih terapeuta Jugoslavijein) in 1956, with its last meeting occurring in 1988. Following the breakup of Yugoslavia in 1995 new physiotherapy-specific associations were formed in the new nations, such as the Association of Physiotherapists of Serbia in 1999, the Physiotherapy Association of the Federation of Bosnia and Herzegovina and the Association of Physio and Occupational Therapists of the Republic of Srpska in 2009, the Chamber of Physiotherapists of Kosovo in 2015, the Chamber of Physiotherapists of Montenegro in 2016 and the Macedonian Society of Physiotherapy in 2017. One exception is the Association of Physiotherapists of the Socialist Republic of Slovenia (Društvo fizioterapevtk Socialistične Republike Slovenije) having formed in 1954 and continued to this day but known since 1991 as the Association of Physiotherapists of Slovenia (Združenje fizioterapevtov Slovenije).

Further East and within Soviet nations during the Socialist regime, the over-medicalisation of the healthcare workforce saw medical practitioners performing tasks otherwise undertaken by other staff (Healy & McKee, 1997). For example, in Russia physiotherapy was a distinct medical post graduate specialty, albeit limited to passive interventions such as electrotherapy, ultrasound, diathermy and other physical agents, as well as spa therapy; whereas therapeutic exercise was provided by physical trainers (Michels, 1975; Remennick & Shakhar, 2003). The delay in adopting the Western specialty of Physical Medicine until the late 1970s and 1980s stifled innovation and change in all parts of the physical therapies (Elder, et al, 2008). According to Puzin, et al, (2017) this history is reflected in the transformations of the name of Russia’s leading scientific-research institute in the rehabilitation field:

1920 – The Physio-mechanoorthopedic Institute;
1922 – The State Institute of Physiatrics and Orthopedics;
1935 – The State Institute of Physiotherapy and Physical Education;
1938 – The State Physiotherapy SRI;
1958 – The Central SRI of Health Resort Therapy and Physiotherapy;
1988 – The All-Union Scientific Center for Medical Rehabilitation and Physical Therapy;
1991 – The Russian Scientific Center for Rehabilitation and Physiotherapy; and
1998 – The Russian Scientific Center for Rehabilitation Medicine and Health Resort Therapy.

It is difficult to find information on Warsaw Pact non-physician physiotherapy associations, but we are at least aware of a non-physician Polish Society of Physiotherapists formed in 1967 (Handkiewicz, et al., 2022).

The dissolution of the Soviet Union in 1991 was an impetus for, and/or the removal of impediments to, the formation of non-physician physiotherapy associations in Soviet and Eastern Bloc nations that moved away from Russia and toward Western Europe. This included the Bulgarian Association of Physiotherapists (now the Association of Physiotherapists in Bulgaria) and the Union of Physiotherapists of the Czech formed that same year, the Estonian Association of Physiotherapists formed in 1992, the Latvian Physiotherapy Association formed in 1995, the Slovak Chamber of Physiotherapists in 2008, the Albanian Association of Physiotherapists in 2012, the Polish Chamber of Physiotherapists in 2015 and the Order of Physiotherapists in Romania in 2018.

The European Union

Following the earlier founding of various European bodies after the Second World War, the European Union was formed in 1993 to oversee economic and political integration for its members. Amongst the politically independent executive arm, the European Commission’s, roles is the management of a database of regulated professions. Whilst highly respectful of the multilingual nature of member states, for simplicity, it has generic names for each profession. The title physiotherapist is used as the generic name for the non-physician profession.

In 2016 the Commission introduced a professional mobility card to make it easier for professional qualifications to be recognised throughout the European Union. Five professions, including physiotherapists, are in the program to assess its usefulness and potential impact. In the document for the implementation of this professional mobility, physiotherapy is defined, in part, as “an autonomous profession” (Zampolini, et al., 2022); thereby permanently severing any connection of the word physiotherapy with the medical profession within the European Union.

Latin America

Whilst the progenitors of physiotherapy arrived in Latin America in the late nineteenth century, the word physiotherapy did not follow until the second half of the twentieth century. In the South, early practitioners were heavily influenced by Swedish movement therapies, and adopted Ling disciple Carl August Georgii’s, term kinesitherapy (Bortz, 2019). Further North other nations were influenced by the United States of America, secondary to the mid-twentieth century growth of medical rehabilitation. Physicians played a primary role initially in the provision of the physical therapies (Sotelano, 2012) and their hegemony was supported by political/military power, religion and patriarchy (Giraldo-Pedroza, et al, 2021), but at no stage did the physicians of Latin America claim the term physiotherapy, instead commencing with physiatry. So when the non-physicians began to emerge as a distinct occupation following the Second World War and polio epidemics, the increasingly, internationally-used word physiotherapy was available; and ultimately predominated. As in the primary colonial powers of Portugal and Spain, when early educational standards did not match the needs of independent practice the subservient ‘technician’ title ensued, but it came and went with little fuss as the level of qualifications rose.

The Swedish ‘movement cure’ of Pehr Henrik Ling and the subsequent exercise machines of countryman Gustav Zander reached Latin America via Argentina in the second half of the nineteenth century and with them the word kinesitherapy (Escobar-Cabello, et al, 2022; Giraldo-Pedroza, et al, 2021). Introduced by immigrant Swedish physician Ernst Georg Åberg, who married into an elite Buenos Aires family and thereby gained access to the influential, wealthy and learned,

His work made Argentina one of the pioneering countries in the training of physical therapists in the region”. (Bortz, 2019).

In 1895 a ‘Gymnastic masseurs/masseuse’ qualification was made available in Argentina (Giraldo-Pedroza, et al, 2021). Cecilia Grierson, the first woman to graduate as a physician in South America, wrote a book titled ‘Practical Massage and its Complementary Exercises’ in 1897 to provide such education in Spanish, and taught the first kinesitherapy courses at the Faculty of Medicine of Buenos Aires in 1904 and 1905 (Mesa, undated). By 1922, the course was extended to two years with the founding of the School of Kinesiology at the University of Buenos Aires in 1937. The strong focus on movement therapy may explain why Argentinian non-physician practitioners maintain the name kinesiologists (Feldman cited in Giraldo-Pedroza, et al, 2021), despite multiple universities graduating students with degrees in physiotherapy.

The Argentine Association of Kinesiologists (Asociasción Argentine de Kinesiologia) was formed in 1935.

A similar focus on movement therapy occurred in neighbouring Chile beginning in 1912 with a kinesitherapy course, but this time originating in the Faculty of Physical Education (“History”, undated). In 1935 the title of ‘trainers and masseurs’ was created for the post graduate kinesitherapy course and in 1943 graduates became ‘kinesitherapy technicians’, ultimately becoming kinesiologists in 1947. In 1969 the kinesitherapy school moved under the auspices of the Faculty of Medicine (“History”, undated). In Peru, kinesitherapy also began under the Faculty of Physical Education (“Our History”, undated), however when transferred to the Faculty of Medicine in 1967, the title for graduates was changed to ‘physical therapy technologist’. Whilst this title, or variations of it, remain for practitioners today, in 2020, “following the current trend in nomenclature”, the Peruvian Association of Physical Therapy updated their name to the Peruvian Association of Physiotherapy (Asociación Perunauna de Fisioterapia) (Our History, undated).

Elsewhere in Latin America the physical therapies were used by the medical profession, as early as 1902 in Ecuador (Giraldo-Pedroza, et al, 2021) and by 1905 a service was started at the Hospital General de México, which included hydrotherapy, mechanotherapy, and electrotherapy (Sotelano, 2012). The work was subsequently undertaken by short-course trained nurses (Ugarte & Cortés, cited in Puc, 2015); similarly in Brazil in the 1930s and 1940s (Oliveira & Nunes, 2015), and other nations.

Significant growth in the field occurred with the rise of Physical Medicine and Rehabilitation following the Second World War and the polio epidemics of the 1940s and 1950s (Sotelano, 2012). In 1952 a Physiotherapy Technician course was created in Uruguay to supply qualified personnel for the Hospital de Clínicas in the capital Montevideo; one of the first such educational institutions in Latin America (AFU, undated). The first graduates founded the Association of Physiotherapy Technicians of Uruguay (Asociación de Técnicos en Fisioterapia del Uruguay) in 1955, becoming the Association of Physiotherapists of Uruguay (Asociación de Fisioterapeutas del Uruguay) in 2000.

Ecuador and Colombia were strongly influenced by American physical therapy in the 1950s (Giraldo-Pedroza, et al, 2021), but insufficiently to cause them to adopt the name physical therapy. The Columbian Association of Physiotherapy (Asociación Colombiana de Fisioterapia) was formed in 1953 and the Ecuadorian Society of Physiotherapy (Sociedad Ecuatoriana de Fisioterapia) was formed in 1982. Physical therapy arrived in Paraguay in 1954 with Adventist missionary María Triantafilo Argeropulo, a Bolivian-born graduate of Loma Linda University in the United States of America (Clemotte, 2021). She was later joined by two kinesiologists from Argentina. By 1980 both masseuses and kinesiologists were included in the government registry of physiotherapists. In 1991 the Association of Kinesiologists and Physiotherapists of Paraguay was formed. This dual nomenclature also exists with the Panamanian Association of Physiotherapy and/or Kinesiology (Asociación Panamena de Fisioterapia y/o Kinesiologia) previously formed in 1982, and the broader regional Latin American Confederation for Physiotherapy and Kinesiology (Confederation Latinoamericana de Fisioterapia y Kinesiologia) formed in 1967.

Puerto Rican born, American physical therapist Carmen Ostalaza (1963) was invited to train ‘physical therapy technicians’ and develop a hospital physical therapy department in Nicaragua in 1962, where the service was effectively non-existent. The Association of Physiotherapists of Nicaragua (Asociacion de Fisioterapistas de Nicaragua) exists today. Likewise for the Association of Physiotherapists of El Salvador (Asociación de Fisioterapeutas de El Salvador).

The Mexican Association of Physical Therapy and Rehabilitation (Asociación Mexican de Terapia Fisica y Rehabilitación) formed in 1955 (Suarez & Rodriguez ,2022). In 2001, with Bachelor level training of physiotherapy introduced to “achieve the social and professional recognition that the profession had in other countries”, it changed its name to the Mexican Association of Physiotherapy (Asociación Mexicana de Fisioterapa) (“About AMEFI”, undated). The Association became incorporated in 2013 as a professional college and was renamed the National College of Physiotherapy and Physical Therapy (Colegio Nacional de Fisioterapia y Terapia Física).

In Spanish the terms physiotherapy (fisioterapia) and physical therapy (terapia fisica) are used interchangeably, however there are slight differences. Fisioterapia emphasises the body-based nature of the treatment (the person), while terapia fisica focuses on the physical aspect or the intervention. In contrast, but for the same reason, the words,

physiotherapy and physical therapy in Portuguese language are not often used interchangeably .. because .. physiotherapy (fisioterapia) is a field of practice and formal knowledge, .. whilst .. physical therapy (terapia física) is a physical resource used by different occupational categories (Oliveira & Nunes, 2015).

Physiotherapy began in Brazil in 1929 when the first technical course was created at Santa Casa de Misericórdia in the State of São Paulo. The Brazilian Association of Physiotherapists (Associação Brasileira de Fisioterapia) formed in 1959 and subsequently closed. It’s successor the Physiotherapists Association of Brazil (Associação dos Fisioterapeutas do Brasil) formed in 2005.

Globalisation

The non-physician physiotherapy profession blossomed across the world from the second half of the twentieth century and into the twenty first century as more nations developed economically and their governments took greater responsibility for rehabilitation services (Nicholls, 2018). By this stage the term physiotherapy was less contentious with the medical profession; especially as governments regulated the health professions and their names. Nevertheless selecting a name for the non-physician profession in developing nations was still a decision to be made between the options of physiotherapy, physical therapy and kinesitherapy/kinesiology.

In most nations around the world the term physiotherapy was used. Most likely, secondary to the long legacy of the British Empire and Commonwealth, the leadership provided by the Chartered Society of Physiotherapy, and the global spread of returning and emigrating trained physiotherapists. For example,

the Iranian Physiotherapy Association was founded in 1945 from local physiotherapists, the first few having trained in Britain and returned (Hashemi, undated),
the National Union of Physiotherapists in Israel was founded in 1949 with twenty members, most of whom were British trained physiotherapists (Werner, 1987);
the Nigeria Society of Physiotherapy was founded in 1959 with eight members – four British and four Nigerian chartered physiotherapists (Nwuga, 1986); and
the Malaysian Physiotherapy Association formed in 1963 with British expatriate physiotherapists (Naicker, et al, 2019).

Drawing from the database of member associations from the world body for the profession (“Our Members”, undated), other national physiotherapy associations were established. Listed in decade order, those that are not discussed elsewhere, include:

1950s	India
1960s	Hong Kong, Singapore, Indonesia and Turkey
1970s	Jamaica, Zimbabwe, Kenya, Malta, Surinam, Trinidad and Tobago, Puerto Rico and Venezuela
1980s	Jordan, Zambia, Namibia and Cyprus
1990s	Cameroon, Lebanon, Tanzania, Mali, Eswatini, Bermuda, Fiji, Uganda, Senegal, Togo, Ethiopia, Ghana and Malawi
2000s	Bangladesh, Bahamas, United Arab Emirates and Morocco
2010s	Haiti, Niger, Papua New Guinea, Myanmar, St Lucia, Sudan and Angola
2020s	Sierra Leone

National physiotherapy associations whose exact establishment date is not provided on the database, but also likely occurred within the same time period include Guyana, Nepal and Sri Lanka.

Information Age

With the advent of the information age at the end of the twentieth century globalisation increased substantially. The explosion of use of the Internet at the turn of the twenty first century resulted in greater digital communications occurring all over the world. In response to the exponential growth of websites and subsequent overcrowding of the .com domain space the International Corporation of Assigned Names and Numbers approved over 1,400 new domain extensions in 2014. The physiotherapy profession became one of the few to have its own digital namespace with the domain extension .physio (Pearce, 2012); joining the pre-eminent professions of .law, .medicine, .pharmacy and .dental.

Astutely, the World Confederation for Physical Therapy was an active contributor to policy development for the .physio top level domain and is used as a reference point in the Eligibility Policy for domain registration (“Eligibility Policy”, 2021). Simplistically, the policy requires that to be eligible to register a .physio domain name a person must be entitled to be a member of the professional association in the country they reside or were educated, and that the professional association is a member of the Confederation.

With increasing globalisation, ten-fold membership growth since its inception and significantly greater business activity, the variations of name used for the profession become an issue for the World Confederation for Physical Therapy; reporting experiencing many examples of inaccuracies in the use of their name by other organisations, and even their own member organisations (“Name change for global physical therapy body”, 2020). With the great majority of its member organisations using the term physiotherapy, a new name World Physiotherapy – being “clear, simple and effective” – was ratified in 2019 at the Geneva membership meeting. As a part of their rebrand World Physiotherapy updated its website and changed the Uniform Resource Locator (website address) to www.world.physio the following year (Press Release, 2020).

Conclusion

As the 200th anniversary of the word physiotherapy approaches it is timely to review its history. The word was initiated and popularised by the homeopathic/naturopathic medical movement in Germany in the early to mid-nineteenth century in their dispute with allopathic medicine. Nevertheless the clinical successes of the physical therapies saw them subsumed by the dominant allopaths, and interest groups of physicians developed around the practices at the end of the nineteenth century, adopting the term physiotherapy in France and Belgium, the United States of America and Russia.

The mass casualties of the First World War provided a large scale opportunity to test the physical therapies. It also compelled the formation of an auxiliary workforce to provide them at scale. The predominantly upper/middle class female aides, drawn from nursing, massage and gymnastic/physical education backgrounds, were highly successful both clinically and politically. Beginning in the anglophonic world, the women slowly adopted the term physiotherapy post-war to more succinctly describe their broadened skillset. Meanwhile, with the lure of advancing pharmacotherapies and surgical techniques the medical profession gradually let go of the practice of the physical therapies and many of the medical physiotherapists split off into specialties of radiology, rheumatology, and orthopaedic surgery. The remaining medical physiotherapists reconciled with a new identity of physical medicine and rehabilitation, leaving the word physiotherapy exclusively to the non-physician practitioners. As nations around the world developed economically, their governments increasingly took responsibility for their citizens’ health and from the mid twentieth century regulated the education and practices of the health professions, including regulating the term physiotherapy for the non-physician practitioners.

Prior claims to the term physiotherapy by physicians in France and Belgium, the United States of America and Russia saw the adoption of alternative terms (physical therapy and kinesitherapy) by local non-physicians, and within their spheres of geopolitical influence. In the case of the United States of America, that influence extended to the name of the newly developed World Confederation of Physical Therapy. Nevertheless, the majority of the world’s non-physicians and their professional associations adopted the word physiotherapy due to the long legacy of the previous global superpower, Britain, and the leadership of its’ Chartered Society of Physiotherapy.

With the advent of the Internet and the resulting rapid globalisation of communications in the twenty first century naming differences became a potential cause for confusion and a perceived barrier to further growth for the profession. Subsequently the World Confederation changed its name, most notably by dropping physical therapy and adopting physiotherapy; to better match the majority of their member associations. Whether this was just another significant event along the word’s adventurous path, or the beginning of the end of varied use, only time will tell.

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