October ushers in more than just the changing of the leaves and the start of the holiday season—it kicks off National Physical Therapy Month. So don some wool socks, grab your hot cider, and sit back as we catch up on where PT has been, and where it’s headed.
Where we began.
Physical therapists have come a long way since Hippocrates started prescribing manual therapy, massage, and movement exercises to his classical era patients. From these BCE beginnings, numerous other practitioners pioneered the science of movement as a means to health, picking up steam in western societies in the 1800s with many physiotherapy registries and schools coming to fruition.
But our PT history in the US starts a little over a century ago with the polio epidemic in 1916, when medical professionals were investigating treatments to combat physical ailments associated with the disease. Trailblazers in this burgeoning field included Wilhemina Wright and Janet Merrill, who were working with polio survivors to restorate limb position. Their practice—along that of other PTs in the polio epidemic—relied heavily on splints and casting to straighten any deformities caused by the disease. The early inroads to rehabilitation these therapists made would be further relied upon with the outbreak of World War I.
With regard to WWI and PT’s role in rehabilitation, there is one person who stands out—Mary McMillan, the mother of modern physical therapy. Similar to her contemporaries, Mary McMillan started her work during the polio epidemic. She combined these skills with those learned in European physiotherapy training to become the first Reconstruction Aide of the US Army Medical Corps. This new role was used to describe non-physician healthcare professionals practicing physical therapy within military hospitals. With a growing support base, Mary McMillan further championed the profession by joining her fellow aides in founding the American Women’s Physical Therapeutic Association in 1921. This organization would later become the American Physical Therapy Association (APTA) in 1947.
Physical therapists Florence P. and Henry O. Kendall also received training in a military background and recognized the growing physical deficits the polio epidemic had created. They developed a treatment approach that focused heavily on the use of frames, splints, and casts to prevent further deformity in addition to very gentle exercise. They used their expertise and years of research to publish a textbook, “Muscles Testing and Function,” in 1949. This text has assisted many physical therapy students—myself included—in evaluating normal vs. abnormal postures and movements. Now in its fifth edition, this text has been translated into seven different languages since its original publication.
As a profession that embraces free thought and challenges medical norms, other physical therapists during this time noted the negative results of immobilization and began to push the positive effects of exercise and heat. One such physical therapist was Alice Lou Plastridge, who crossed paths with President Franklin Delano Roosevelt (a polio survivor) at a clinic in Warm Springs, GA. Here, President Roosevelt was able to rehabilitate in aquatic therapy environments and regain much of the function he previously lost. In 1926, he created the Georgia Warm Springs Foundation to assist in combating polio.
Thanks to the power of vaccine technology, the polio virus was largely rendered preventable and treatable, and physical therapy turned its focus to a larger swath of the population affected by various physical ailments.
Educators and Accreditors
Working to gain more autonomy and establish a permanent place in western medicine, the APTA started working to credential and accredit physical therapists and educational institutions independent of the American Medical Association (AMA). This push began in 1960, and finally, by 1978, the APTA achieved full control over credentialing and accrediting the physical therapy profession in the US. Today, there are 220 PT programs in the country accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).
Training in physical therapy has undergone numerous changes of its own, starting as a certificate program that evolved into a four-year bachelor program by the 1960s. New York University established the first four-year program in 1927 (and also went on to establish the first PhD PT program in 1973). Additionally, in 1976, Howard University established the first PT program at a Historically Black College or University, marking another momentous change for the industry’s growth and development.
In the 1990s, Industry leaders recognized the growing need for more clinical education and the profession was advanced further to a masters level of education. A couple of decades later, and with some increased controversy, the APTA spearheaded the Vision 2020 program where all graduating PTs would be of a clinical doctorate level. The reasoning? The APTA explained that as the volume of doctors of physical therapy in the workforce increases, healthcare trends like direct access and health equity will lead to further growth of the profession.
Where we are now.
Today, there are more than 300,000 physical therapists in the US which equates to 95 physical therapists per 100,000 US citizens. Often rated as a top profession to enter, the physical therapy industry is expected to grow 20.5% from 2020 to 2030 due to factors like the aging population and a desire for patients to not be so reliant on pharmaceuticals or surgeries.
No longer confined to hospital basements, physical therapists can be found nearly anywhere from:
- privately owned practices
- outpatient clinics
- health, wellness, and sports clinics
- rehabilitation hospitals
- skilled nursing facilities (SNFs)
- extended care facilities
- private homes
- research centers
- and hospices.
And with the numerous practice settings comes a multitude of specialties and niches.
Where we will go.
Having come such a long way from the early 1900s, and with such a large cohort of PTs now in the US, one may be content to sit back and reap what Mary McMillan and company sowed. However, there is work yet to be done! As Heidi Jannenga, PT, DPT, ATC, co-founder and Chief Clinical Officer of WebPT states, “physical therapists have not only struggled to gain respect and autonomy in practice from the public, but also been slow to step out from physicians’ shadows.”
To exit the shadows and increase PT’s footprint, consider the following ways to celebrate National Physical Therapy month now and well into the future:
- Take a scroll through Instagram or TikTok and endorse the latest and greatest PT influencers in the world at large.
- Be a mentor to future physical therapists and nurture their passion for the profession.
- Participate in #ChoosePT and link with the APTA in pushing physical therapy to the forefront in primary care and answering the call to solve the opioid epidemic.
- Hold the profession accountable and use the wealth of data supporting PT to leverage fair contracts from payers and recognition of the profession’s value to healthcare.
- Jump on board with PT Day of Service, and give back through the PT community.
- Stay at the forefront of healthcare change by embracing diversity, equity and inclusion in patient care and as well as within your clinic using strategies the APTA and other industry leaders have outlined.
- Light a fire under regulators to invest in Americans’ health by urging local and national politicians to enact legislation that is PT centric. For example, HR 8800 will help provide a reprieve from the Medicare reimbursement cuts. Visit APTQI’s “Take Action” webpage to submit your own advocacy statement—and encourage others in your circle to do so as well.
From the earliest beginnings until now, physical therapists have worked tirelessly in the trenches to improve patients’ lives. And as with any field in health care there is always a new horizon and a new victory to celebrate, so take a moment to thank a fellow PT, while we here at WebPT would like to thank all our PT Members for the good work they do that makes ours all the more rewarding. Happy National Physical Therapy Month!