Physical therapy
In 460 BC, the physician Hippocrates advocated massage and hydrotherapy to treat people with physical ailments. This early approach laid groundwork for what would become a distinct healthcare profession over two millennia later. The Italian physician Hieronymus Mercurialis published De Arte Gymnastica in 1569, introducing medical gymnastics as a rehabilitative tool for disabled subjects of any age. Alfonso Borelli followed with his tractate De Motu Animalium in 1680, providing a practical framework for understanding disordered movement patterns in ill and disabled people.
The French physician Nicolas Andry de Bois-Regard established a solid link between musculoskeletal health and physical exercise in his 1741 book Traité d'orthopédie. He introduced the term orthopaedics, which became fundamental for understanding correct exercises in physical rehabilitation. Machines like the Gymnasticon were developed to treat gout through systematic joint exercise. Per Henrik Ling founded the Royal Central Institute of Gymnastics in 1813, marking the earliest documented origins of actual physical therapy as a professional group.
Sweden granted official registration to physical therapists through its National Board of Health and Welfare in 1887. Four nurses formed the Chartered Society of Physiotherapy in Great Britain in 1894. The School of Physiotherapy at the University of Otago opened in New Zealand in 1913. Reed College in Portland, Oregon graduated reconstruction aides in 1914. Modern physical therapy institutionalized during World War I when women were recruited to restore physical function to injured soldiers. The first school of physical therapy was established at Walter Reed Army Hospital in Washington, D.C., following the outbreak of that conflict.
Educational criteria for physical therapy providers vary from state to state and country to country. In Canada, fifteen universities offer physiotherapy programs through their respective colleges of medicine. Most Canadian schools transitioned from three-year Bachelor of Science in Physical Therapy programs to two-year Master's of Physical Therapy programs. The University of Manitoba became the last Canadian university to follow suit in 2012, making the MPT credential the new standard entry to practice across Canada.
Quebec requires prospective physiotherapists to complete a four-year college diploma program in physical rehabilitation therapy before entering graduate school. Students must then enter graduate school to complete a master's degree in physical therapy, which normally requires one and a half to two years of study. Graduates who obtain their M.Sc. must successfully pass the membership examination to become members of the Ordre Professionnel de la physiothérapie du Québec. Physiotherapists can pursue education in specialized fields such as rehabilitation sciences, sports medicine, kinesiology, and physiology.
Scotland offers physiotherapy degrees at four universities including Edinburgh Napier University and Robert Gordon University in Aberdeen. Students qualify by completing a four-year Bachelor of Science degree or a two-year master's degree if they already have an undergraduate degree in a related field. To use the title Physiotherapist, students must register with the Health and Care Professions Council on qualifying. Many physiotherapists are also members of the Chartered Society of Physiotherapy, which provides insurance and professional support.
In the United States, physical therapist education curricula culminate in a Doctor of Physical Therapy degree. This typically takes three years after completing a bachelor's degree. The Master of Physical Therapy and Master of Science in Physical Therapy degrees are no longer offered. According to CAPTE, there were 39,448 students currently enrolled in 322 accredited PT programs in the United States while 10,077 PTA students were currently enrolled in 390 PTA programs.
Physical therapists practice in many settings including privately owned clinics, outpatient offices, hospitals, skilled nursing facilities, private homes, schools, hospices, industrial workplaces, fitness centers, and sports training facilities. The American Board of Physical Therapy Specialties lists ten current specialist certifications. Most physical therapists practicing in a particular specialty will have undergone further training such as an accredited residency program.
Cardiovascular and pulmonary rehabilitation practitioners offer therapy for cardiopulmonary disorders or pre- and post-cardiac surgery. Manual therapy assists in clearing lung secretions experienced with cystic fibrosis. Geriatric physical therapy covers issues concerning people going through normal adult aging but focuses on older adults dealing with arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, and incontinence.
Neurological physical therapy works with individuals who have neurological disorders like stroke, chronic back pain, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, facial palsy, and spinal cord injury. Orthopedic physical therapists diagnose and treat disorders of the musculoskeletal system including rehabilitation after orthopedic surgery, acute trauma, and injuries of insidious onset. Pediatric physical therapy assists in early detection of health problems using modalities to provide therapy for infants, children, and adolescents with congenital, developmental, neuromuscular, skeletal, or acquired disorders.
Sports physical therapy encompasses athletic injury management under five main categories: acute care assessment, treatment application, rehabilitation progression, prevention identification, and education sharing. Women's health and pelvic floor physical therapy address female reproductive system issues, child birth, and post-partum conditions including lymphedema, osteoporosis, pelvic pain, urinary incontinence, and pelvic organ prolapse.
Physical therapy-related jobs in North America have shown rapid growth in recent years but employment rates and average wages vary significantly between different countries and regions. A study from 2013 states that 56.4% of physical therapists were globally satisfied with their jobs. Salary, interest in work, and fulfillment are important predictors of job satisfaction. In a Polish study, job burnout among physical therapists manifested by increased emotional exhaustion and decreased sense of personal achievement.
According to the United States Department of Labor's Bureau of Labor Statistics, there were approximately 267,200 physical therapists employed in the United States in 2024 earning an average of $101,020 per year. The bureau projects 11% growth in employment by 2034. There were approximately 128,700 physical therapist assistants and aides employed in the United States in 2014 earning an average of $42,980 annually. The bureau projects 40% growth in employment for these roles by 2024.
Many healthcare facilities hire travel physical therapists who work temporary assignments between eight and twenty-six weeks for much higher wages around $113,500 a year. O-Net reports that in 2015 PTAs earned a median wage of $55,170 annually while aides and techs earned a median wage of $25,120 annually. The American Physical Therapy Association reports vacancy rates as 11.2% in outpatient private practice, 10% in acute care settings, and 12.1% in skilled nursing facilities. Turnover rates reach 10.7% in outpatient private practice, 11.9% in acute care settings, and 27.6% in skilled nursing facilities.
Physical therapy has been found to be effective for improving outcomes both in terms of pain and function in multiple musculoskeletal conditions. Spinal manipulation by physical therapists is a safe option to improve outcomes for lower back pain. Several studies suggest physical therapy combined with stretching exercises may be equivalent or even preferable to surgery for carpal tunnel syndrome. While spine manipulation and therapeutic massage are effective interventions for neck pain, electroacupuncture and ultrasound therapy are not as effective.
Physiotherapy treatment may improve quality of life, promote cardiopulmonary fitness, reduce symptoms and medication use by people with asthma. Early progressive mobilization for adult intubated ICU patients on mechanical ventilation is safe and effective. Psychologically informed physical therapy helps improve patient outcomes especially before and after spine, hip, or knee surgery.
However, obstacles affect effectiveness in the United States such as racial disparities among patients. Studies show non-white and Hispanic patients may receive lower standards of care compared to white patients. Hispanic patients were found to have difficulties receiving physician referrals despite sufficient insurance coverage. Raising awareness of these racial disparities is crucial to improving treatment effectiveness across all demographics. Physical rehabilitation can prevent deterioration in health and activities of daily living among care home residents.
Telehealth represents a developing form of physical therapy responding to increasing demand for treatment online communication between clinician and patient either live or in pre-recorded sessions. It receives mixed reviews when compared to usual in-person care. Benefits include improved accessibility in remote areas, cost efficiency, and convenience for bedridden or home-restricted individuals. Some downsides include limited evidence for greater effectiveness than in-person therapy, licensing issues, payment policy problems, and compromised privacy.
Studies remain controversial regarding telehealth effectiveness in patients with more serious conditions like stroke, multiple sclerosis, and lower back pain. The interstate compact enacted in March 2018 allows patients to participate in telehealth appointments with medical practices located in different states within the United States. During the COVID-19 pandemic, telehealth came to the fore as patients became less able to safely attend in-person visits particularly if elderly or having chronic diseases.
Platform licensing or development are found to be the most substantial cost in telehealth implementation. Telehealth does not remove the need for the physical therapist as they still must oversee the program. Physical decline in at-risk groups is difficult to address or undo later making telehealth a proactive step to prevent deterioration in those unable to attend classes.
Common questions
When did physical therapy begin as a distinct healthcare profession?
Physical therapy began as a distinct healthcare profession when Per Henrik Ling founded the Royal Central Institute of Gymnastics in 1813. This event marked the earliest documented origins of actual physical therapy as a professional group.
What is the standard entry to practice for physiotherapists in Canada after 2012?
The Master of Physical Therapy credential became the new standard entry to practice across Canada in 2012. The University of Manitoba was the last Canadian university to transition from three-year Bachelor of Science programs to two-year Master's of Physical Therapy programs that year.
How many physical therapists were employed in the United States in 2024 and what was their average salary?
There were approximately 267,200 physical therapists employed in the United States in 2024 earning an average of $101,020 per year. The Bureau of Labor Statistics projects 11% growth in employment by 2034.
Which countries require specific degree lengths or registration steps for physiotherapists?
Quebec requires prospective physiotherapists to complete a four-year college diploma program before entering graduate school for a master's degree. Scotland offers degrees at four universities where students must register with the Health and Care Professions Council on qualifying to use the title Physiotherapist.
What are the current educational requirements for physical therapists in the United States?
Physical therapist education curricula in the United States culminate in a Doctor of Physical Therapy degree which typically takes three years after completing a bachelor's degree. The Master of Physical Therapy and Master of Science in Physical Therapy degrees are no longer offered.