The Evolution of Physiotherapy: A Century of Impact from WWI to Today

Instructor helps patient to exercise on simulator in military hospital

One hundred years ago, the world was engulfed in World War I, a conflict that would dramatically transform many aspects of society, including the profession of physiotherapy. What began as a practice known as massage, established in the UK in 1894, evolved significantly due to the war’s demands for advanced rehabilitation methods.

David Nicholls, an associate professor at AUT, emphasizes that World War I was a turning point for physiotherapy. Prior to the war, physical rehabilitation was rudimentary. Migrants in New Zealand, for example, dealt with injuries without formal rehabilitation. An injury such as losing an arm in a threshing machine meant adapting and continuing without structured support.

The advent of World War I necessitated a different approach. Governments, including New Zealand’s, were motivated to rehabilitate injured soldiers to avoid the economic burden of long-term pensions. This created a critical need for physical rehabilitation to restore soldiers to active duty or adapt them for other productive roles in society.

At the start of the 20th century, advances in antibiotics and antisepsis allowed physicians and surgeons to focus more on medical treatments, leaving a gap in physical rehabilitation. Physiotherapists stepped in to fill this void, taking on responsibilities that included massage, movement, and handling of injured limbs. The goal was to maximize the soldiers’ physical capabilities, whether by returning them to service or integrating them back into civilian life in new roles.

The war also spurred significant institutional changes. The School of Massage, founded at the University of Otago in 1913, saw a surge in enrollment as the war progressed. A notable shift was the inclusion of men in the profession, which had previously been dominated by women. Additionally, societal norms changed as women began to practice on men, driven by the necessity of treating a large number of male soldiers returning from the front.

Post-WWI, the physiotherapy profession continued to evolve, playing a crucial role in addressing the aftermath of polio, influenza, and tuberculosis epidemics. By the mid-20th century, physiotherapists had become the principal providers of physical rehabilitation, a status solidified by their contributions during subsequent global conflicts and public health crises.

The techniques developed during the war, including those for managing respiratory conditions resulting from gunshot wounds and gas inhalation, laid the foundation for modern practices. These advancements have had lasting impacts, not only improving patient outcomes but also elevating the profession’s status.

Today, physiotherapy remains integral to military and civilian healthcare. In the New Zealand Defence Force, physiotherapists like Captain Anna Wylie work alongside other medical professionals to treat musculoskeletal injuries and ensure soldiers are fit for duty. The role involves not just physical rehabilitation but also preventive measures and close coordination with military hierarchies to manage soldiers’ health effectively.

Wylie’s experience highlights the rewarding nature of military physiotherapy, with opportunities for adventure and professional growth, such as deployments and advanced training. This reflects the profession’s ongoing evolution and its critical role in supporting both physical and mental health.

The impact of war on physiotherapy continues to be evident in modern conflict zones. For example, in Israel, the Sheba Medical Center has become a leading institution for war-related rehabilitation. The center has expanded its facilities to accommodate the increasing number of patients with complex injuries resulting from conflicts. Their multidisciplinary approach integrates physical, occupational, and mental health therapies, providing comprehensive care for injured soldiers and civilians alike​ .

Innovative technologies, such as virtual reality systems used in Project Mobility, have been introduced to enhance rehabilitation. These systems engage patients in interactive therapeutic exercises, making the rehabilitation process more effective and enjoyable. Such advancements underscore the continuous evolution of physiotherapy in response to the needs of war-torn populations​ .

The influence of WWI on physiotherapy has had a global ripple effect, fostering advancements that benefit not only military personnel but also civilian populations. Techniques developed during wartime, such as those for managing respiratory conditions and severe injuries, have been adapted for use in various medical settings worldwide. Physiotherapists have become key players in public health systems, contributing to the treatment of chronic conditions and recovery from surgeries and injuries.

The profession’s adaptability and commitment to improving patient outcomes have solidified its importance in healthcare. Physiotherapists are now integral members of multidisciplinary teams, working in hospitals, clinics, and community settings to provide holistic care.

To summarize, the impact of World War I on the physiotherapy profession cannot be overstated. The war catalyzed significant advancements in rehabilitation techniques and institutional practices, establishing physiotherapy as a cornerstone of modern healthcare. Today, the profession continues to evolve, building on a century of innovation and dedication to improving patients’ lives.

Physiotherapy’s journey from its nascent stages to its current status as a vital healthcare profession is a testament to the resilience and adaptability of those who practice it. As we commemorate the centenary of WWI, it is fitting to reflect on how far physiotherapy has come and the profound impact it has had on countless lives. The profession not only gained from the experiences of wartime but also provided invaluable support to those who served, shaping the future of rehabilitation for generations to come.

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