When was physiotherapy born?

I’ve recently been reading quite a lot of new historical writing around the early history of physiotherapy.  Much of it has concentrated on the effect of the First World War on the profession in North America, Britain and the Antipodes, but I’ve also been reading Anders Ottosson’s excellent, and provocative recent papers.

Many of you will know of Anders’s work, especially his paper The manipulated history of manipulations of spines and joints (pdf) and his thesis Sjukgymnasten – vart tog han vägen?: En undersökning av sjukgymnastyrkets maskulinisering och avmaskulinisering 1813-1934, which argue that physiotherapy originated with the mechano-therapy and medical gymnastics of Pehr Henrik Ling (1776–1839) and the Royal Central Institute of Gymnastics (RCIG) which ‘became world famous and, as such, the normative centre of Physical Therapy in the 19th and on into the 20th century’ (Ottosson 2011, 88).  Anders argues that it was physiotherapists who taught doctors about orthopaedic medicine, and that this story has been obscured by strong biomedical discourses, influenced by the de-masculinisation of the physiotherapy profession in the 20th century.

This gendered analysis of the history of the profession has been picked up recently in two papers Anders has in press (Ottosson, 2015; Ottosson, in press).  In both papers, Anders makes a clear argument that the gendered nature of physiotherapy has played an important role in the development of the profession.  Similar arguments have been made elsewhere (see Heap 1995a,b; Linker 2005a,b; Miles-Tapping, 1989; Nicholls & Cheek, 2006; Owen, 2016), but all of these authors promote the discourse of the gendered struggle of women within the profession.  Anders, on the other hand, argues that (and apologies for quoting this section in full);

‘The difficulty involved in seeing physiotherapy’s history is, I believe, due to the fact that its consensus herstories corroborates so well with our understanding of the history of professional medicine and its allied fields of knowledge. Firstly, the herstories of physiotherapy as a semi-skilled servicing sector align well with the grand history of the medical profession’s monopoly over, and intellectual developments in science. Secondly, it also fits in snugly with the equally convincing history of male physicians suppressing women’s medical or scientific knowledge and work. These two factors combined have succeeded in effectively tuning out the voices of skilled, autonomous physiotherapists of the nineteenth century, male and female alike, in both Swedish and English contexts. Instead, the notion of the profession as a genuinely female occupation has become firmly established and analyses invariably operate from out of this framework. 1894 is not only viewed as the start of the profession, for example, but also as an effort to ‘legitimize massage’ instead of an effort to re-legitimize massage/physiotherapy, which better describes the course of events.  The reason that women originally entered the field of physiotherapy, practising massage and medical gymnastics, was precisely because it was regarded as respectable. But a certain sort of historical myopia has in turn reduced all men and women (including physicians!) practising physiotherapy in England prior to the ‘massage scandal’ into an irrelevant historical footnote, as insignificant others. But, as I hope this article has illustrated, they are still there, hidden in plain view. They might be forgotten, but perhaps not necessarily invisible forever?’ (Ottosson 2015, 19, emphasis in original).

This argument makes a number of very important points, not least questioning the date that physiotherapy began.  Anders asserts that physiotherapy began long before the ‘massage scandals’ of 1894, but what remains uncertain for me in all of these arguments is the question of what exactly constitutes physiotherapy?  Is it the use of particular modalities of treatment (massage, mechanotherapy, electrotherapy and exercise), because many others have used these modalities for centuries?  Is it in the name, because the therapists at the RCIG were called medical gymnasts and it remains unclear when the term ‘physiotherapy’ came into common use.  (This is true in many other histories of physiotherapy, for example, Wendy Murphy’s history of the American Physical Therapy Association shows liberal use of the terms ‘physiotherapy’ and ‘physical therapy’ in America prior to the 1920s).  For me, physiotherapy must be seen to begin when the question of organisation and regulation around a particular professional code becomes necessary.  The history of ‘physiotherapy,’ as opposed to the history of physical therapies (including all the various modes of assessment and treatment practiced by myriad practitioners from hundreds of different professional groups), is a history of the struggle for legitimacy and orthodoxy and relates closely to the societies and registration bodies and their various actions.

It would be very interested to hear other people’s thoughts on this thorny question.

References

Heap, R. (1995a). Training women for a new “women’s profession”: Physiotherapy education at the university of toronto, 1917-40. History of Education Quarterly, 35(2), 135. doi:10.2307/369630.

Heap, R. (1995b). Training women for a new “women’s profession”: Physiotherapy education at the university of toronto, 1917-40. History of Education Quarterly, 35(2), 135-158.

Linker, B. (2005a). The business of ethics: Gender, medicine, and the professional codification of the american physiotherapy association, 1918-1935. Journal of the History of Medicine and Allied Sciences, 60(3), 320-354.

Linker, B. (2005b). Strength and science: Gender, physiotherapy, and medicine in the united states, 1918-35. Journal of Women’s History, 17(3), 106-132. doi:10.1353/jowh.2005.0034.

Miles-Tapping, C. (1989). Sponsorship and sacrifice in the historical development of Canadian physiotherapy. Physiotherapy Canada. Physiothérapie Canada, 41(2), 72-80.

Nicholls, D. A. (2006). From pandemoniums of vice to a ‘profession for british women’: The future of physiotherapy through a historical lens. In New zealand society of physiotherapy conference. Auckland, New Zealand.

Ottosson, A. (2005). Sjukgymnasten – vart tog han vägen?: En undersökning av sjukgymnastyrkets maskulinisering och avmaskulinisering 1813-1934. Thesis. Göteborg University, Sweden.

Ottosson, A. (2011). The manipulated history of manipulations of spines and joints? Rethinking orthopaedic medicine through the 19th century discourse of european mechanical medicine. Medicine Studies, 3(2), 83-116. doi:10.1007/s12376-011-0067-3.

Ottosson, A. (2015). One history or many herstories? Gender politics and the history of physiotherapy’s origins in the nineteenth and early twentieth century. Women’s History Review. doi:10.1080/09612025.2015.1071581.

Ottosson, A. (in press). The age of scientific gynaecological masseurs. Non-intrusive male hands, female intimacy, and women’s health around 1900. Social History of Medicine. doi:10.1093/shm/hkw013.

Owen, G. (2014). Becoming a practice profession: A genealogy of physiotherapy’s moving/touching practice. PhD. University of Cardiff, Wales.