Introduction to Physiotherapy

Physiotherapy is as old a medicine itself, dating back to Ancient Greece in the era of Hippocrates. Since then, physiotherapy has evolved from simple massage to a complex portfolio of therapies with many specialized applications. In Ancient Greece circa 460 BC, Hector practiced a physiotherapy technique called "hydrotherapy" - which is Greek for water treatment. Physiotherapists today still employ hydrotherapy, now evolved and adapted specifically to various patient conditions. In 1894, the UK recognized physiotherapy as a specialized branch of nursing regulated by a Chartered Society. In the succeeding two decades, formal physiotherapy programs were established in other countries including New Zealand (1913) and the USA (1914). In the USA, physiotherapy is usually referred to as Physical Therapy. The first record of American physiotherapy was at Walter Reed College and Hospital of Portland, Oregon where nurses with physical education experience worked as "reconstruction aides". These "reconstruction aides" contributed vitally to the recovery and rehabilitation of many WWI vets. In 1921, Mary McMillan formed the Physical Therapy Association in the USA. Subsequently renamed the APTA, this organization profoundly influenced development of physiotherapy in America. The polio epidemic of the 1920's was a landmark turning point for the physiotherapy profession. Sister Kinney, of the Mayo Clinic achieved national reknown for work with polio victims. The Georgia Warm Springs Foundation was established in 1924 in response to the polio epidemic and provided physiotherapy for these polio patients. After the polio epidemic subsided, physiotherapy treatments comprised mainly exercise, massage and traction. From 1950, chiropractic manipulations were also introduced, most commonly in Great Britain initially. The Orthopedics specialty within physiotherapy also emerged at about the same time. From that date, physiotherapy expanded from hospitals out to other areas of medical care. Physiotherapists now work also in clinics, nursing homes, private practice and schools. Research has long been a feature of modern physiotherapy, dating from the first USA research study publication in 1921. Research continues actively today in a wide range of specialties. A significant force in the recent evolution of physiotherapy has been the International Federation of Orthopaedic Manipulative Therapy. Notable individuals driving change in technique and training have included Mariano Rocabado (Chile); Freddy Kaltenborn (Norway/USA); and Geoffrey Maitland (Australia). During the 1980's, technology became the focus of change in physiotherapy. Novel

procedures featured computers, electrical stimulation, ultrasound and other new equipment. However, led by Freddy Kaltenborn, interest reverted to manual therapy in the following decade. Throughout development of the Physiotherapy profession, training and technique have continued to change and improve. Gifted pioneers have contributed richly to the profession's literature and field organizations. In consequence, Physiotherapy now commands wide recognition and well-earned respect, with many young people expressing interest in making their career in the profession.

At least as early as the days of Hippocrates, massage was used and the history of physiotherapy was begun. The practice of physiotherapy has evolved through the centuries from the earliest forms to the complex system of treatment it is now. In 460 B.C. Hector was using a type of physiotherapy called hydrotherapy, or water therapy. Professionals use this type of therapy today, although it is more specialized for each type of condition that the patients have. In 1894, there is the first evidence of a group of nurses in the history of physiotherapy with a Chartered Society. Within twenty years, physiotherapy programs were set up in other countries. New Zealand's started in 1913 and America's in 1914. The first American professionals in the history of physiotherapy were from the Walter Reed College and Hospital in Portland Oregon. Rather than being called physiotherapists, they were called reconstruction aides. These aides were nurses and they had a physical education background. They were important in the recovery of many World War I veterans. Research has been done throughout the modern history of physiotherapy. In fact, right near the very beginning, a research study was done in the US. It was published in 1921. Physiotherapy research continues today in a myriad of specialties. Also in 1921, the Physical Therapy Association was formed by Mary McMillan. This group later became the APTA, arguably the most influential organization in the American history of physiotherapy. The Georgia Warm Springs Foundation was started in 1924 to deal with the ever-growing epidemic of polio. The foundation offered physiotherapy for these patients. Sister Kinney was known nationally for her work with polio victims. She practiced at the Mayo Clinic. The polio epidemic was a turning point in the history of physiotherapy. After the polio epidemic had waned, the treatments of choice were massage, exercise, and traction. In about 1950, chiropractic manipulations came on the scene in the history of physiotherapy. This was most common in Great Britain.

After that time, the history of physiotherapy moved from hospitals into other arenas of service. There were, and are, physiotherapists working in clinics, private practices, nursing homes, and schools. The Orthopedics specialty of physiotherapy was born about this time, also. The International Federation of Orthopaedic Manipulative Therapy came onto the scene, and began making changes and has influenced the profession ever since. Mariano Rocabado was a physiotherapist who had a profound impact. Freddy Kaltenborn, from Norway, influenced physiotherapy on the east coast of the US. At the same time, Geoffrey Maitland of Australia changed the way training was done in the history of physiotherapy. The focus during the 1980s history of physiotherapy was on technology. New procedures came about that used computers, ultrasound, electrical stimulation, and other devices. By the 1990s, interest had shifted to manual therapy, with Freddy Kaltenborn again leading the way. During the history of physiotherapy, training and practice have changed and improved. Many brilliant pioneers have left their marks in the literature and organizations of the field. Physiotherapy is a well-respected profession as a result.
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Physiotherapy's History In Methods, Treatments & Aids

Physiotherapy's History started way back in time when the Hippocrates took to massaging. Since then physiotherapy practice has gone through many stages, the earlier form being simple to today's complex yet effective means of treatment. Hydrotherapy was the first known form of physiotherapy that Hector used way back in 460 B.C., also termed water therapy. And even today, professionals make use of this therapy, certainly it's become more specialized and for each condition there is a different application of this therapy. The first ever proof of there being a nurse group involved in imparting physiotherapy was seen in 1894 in the form of a Chartered Society. By 1913 New Zealand and then in 1914 America started running their physiotherapy programs. In Portland Oregon's Walter Reed College and Hospital is where the 1st evidence of there being an American professionals physiotherapist. Instead of being termed as physiotherapists, reconstruction aides was the favored term. Nurses form the aide's part and had as background, knowledge of physical education. The aides played an important role in the revival of several veterans from World War I. All through physiotherapy's new history research has been an integral part. Actually from the start of physiotherapy US was involved in a research study that was out in 1921. Under various branches and specialty areas research is underway.

Mr. Mary McMillan founded the Physical Therapy Association in 1921. The group afterwards became known as APTA, unquestionably American history's most powerful and dominant organization for physiotherapy. To do something about the catastrophic rise in polio numbers the Georgia Warm Springs Foundation was initiated in 1924 so that the crisis could be dealt with. This foundation helped patients via physiotherapy. Sister Kinney was a person known all over for the incredible work she did for polio sufferers. In the long history of physiotherapy polio endemic turned out to be a turning point. Once polio numbers diminished, massage therapies, traction & exercises became popular. During 1950's, physiotherapy's history witnessed chiropractic manipulations. Great Britain was the one who took to it most. Thereafter physiotherapy was not just limited to hospitals it took a whole new meaning for different people. Previously too & today too physiotherapists are practicing in nursing homes, private practices, clinics & schools. Started around this period was the physiotherapy's Orthopedics specialty. The influential International Federation of Orthopaedic Manipulative Therapy burst onto scene, and ever since had made new breakthroughs of monumental proportions. One physiotherapist who left a lasting impression was Mariano Rocabado. On the east side of US, Norway's Freddy Kaltenborn made a deep impact. While Australia's Geoffrey Maitland can be credited with introducing newer and more effective ways the training of physiotherapist. With regards to physiotherapy's history during the 80's the focus shifted to greater use of technology. There were newer techniques & newer procedures that started surfacing using electrical stimulation, other devices, ultrasound and computers. During the 90's people wanted a switch to manual therapy, leading the way was Freddy Kaltenborn. All over encompassing physiotherapy's history, there have been vast improvements on practice & training. A lot of great pioneers have done great things to help people by the way of physiotherapy and therefore as a result of the their endeavor this profession is well-respected.

Physical therapy is noted in history since ancient times. But, irrespective of the period, the main goals of physiotherapy have always remained the same- to restore the rehabilitation and mobility of the patient.

Physical therapy's first documented account is from the old master of medicines- Hippocrates. In the year 460 BC, Hippocrates introduced the idea of manual manipulation like hydrotherapy and massage for pain relief. From early time the advantages of such activities was understood and this understanding continues till date. But it wasn't until the nineteenth century that a cohesive group of physical therapy practitioners was formed. In England, the Chartered Society of Physiotherapy established itself followed by other similar organizations dedicated to providing the best care to people who required it. Physical therapy in the United States is the same as physiotherapy in other countries. Irrespective of what term is used, the idea, procedure and practice are all the same. While World War-I was going on, people trained in providing physical therapy (also called reconstruction aid), helped wounded and injured soldiers relieve their pain. but it wasn't till the year 1921 that first physical therapist organized group came into being. It was formed by the famous Mary Mcmillan, and was called the American Women's Physical Therapeutic Association. Soon, the group turned into he American Physical Therapy Association which included even men. The name change brought about a curriculum change and physical therapists had to meet a different set of requirements. This occupation gained more professionalism and formality and the medical community began to recognize it as a viable treatment for pain and injury. Another landmark in the history of physiotherapy was during the breakout of the polio epidemic. These physiotherapists did groundbreaking work in the rehabilitation and treatment of the polio patients. Although the primary procedures include massage and exercise during the time, physical therapy benefited the polio patients to a large extent. The focus on joints and use of manipulation started gaining popularity in the 1950's. The first example of specialized practice by a group of physiotherapists happened in the 70's with the orthopedic practice being formed by the Association of American Physical Therapy. The history of physiotherapy has grown and changed a lot over time. By now therapists had begun practicing in different places including nursing homes, outpatient clinics and hospitals, where most modern day specialists practice today. After the 80's, with the invention of the computer and different technologies, many advances were made in the field of physical therapy. Electric stimulators and ultra sounds became common technologies used in the medical field. New technologies dramatically changed the face of physical therapy and now therapists were able to use far more advanced machines and tools to help their patients. The history behind physical therapy has grown and evolved a lot over the years and its evolution is an ongoing process. With each new innovation, technique and procedure, the capability of the craft that therapists use to treat t heir patients keeps getting better. Physical therapy has come a long way since its beginning and with a lot of success. ABOUT PHYSIOTHERAPY
History of Physiotherapy: Physiotherapy is dedicated to the restoration of the human function which has been impaired due to

disease, trauma or injury. It is practiced in India since the last fifty years. It plays a big role in preventive aspects and pain management. Physiotherapy dates back to 250 AD, when gold fish-electric fish was used for pain relief in gout and headache cases. Physiotherapists today use certain type of currents to give pain relief. In prehistoric era, buddhists and hindus recognised "pain as a sensation" but gave greater importance to its emotional aspects. Non-invasive methods were used for pain relief. Today's physiotherapists also use non-invasive, electro-therapy modalities for pain relief. Physiotherapy is "tending to the cure or providing relief from disease or injury." It involves rehabilitating the patient from "bed to job". Be it acute or intensive care, respiratory and cardiac rehabilitation, pain management, Arthritis, headache, post-operative pain, heel pain, fitness, or sports injury, physiotherapy has a role to play in restoring the patient to normalcy or atleast a functional capacity. Physiotherapy Today: Physiotherapy today is an independent health care profession for all the age groups from neonatal to geriatrics. (from birth to old age.) The task of early intervention in neonatal cases is taken over by a physiotherapist, new born babies with birth defects are evaluated and treated, which helps in minimizing disabilities and helps in early ambulation. Women's wellness, maintaining healthy lifestyle after menopause needs attention. Common problems are: obesity, Arthritis, incontinence of urine, fatigue, aches & pains in joints etc Pain management in acute & chronic cases are managed by physiotherapists. Sports physiotherapy is becoming popular amongst the young physios. In fact special post-graduate courses are conducted by the association, to promote this new emerging avenue of physiotherapy. Industrial physiotherapy deals with ergonomics and safety measures. Guidance on work positions etc. is given by physiotherapists. Manipulative Therapy is gaining momentum due to its instant relief in pain and increase in range of motion. Special training is required before practicing this technique. All these have gained immense popularity for today's Physiotherapists. Physiotherapy Tomorrow: There is scope for physiotherapy even in space, where there is a high possibility of gravity related injury. Backpain, muscle strain and headache is common in space-craft. Micro-gravity induces calcium loss from

bones. Assessment of the limbs or back are difficult in space. The future of physiotherapy for the astronauts in space is promising. Physiotherapists can help "body positioning", and exercises for micro-gravity posture.

Interesting Information On Background & Origin Of Physiotherapy The ancient form of modern physical therapy, or physiotherapy, dates back to 460 BC, when Hippocrates and Hector used massage and hydrotherapy (water therapy) to treat their patients. However, the actual physical therapy, which is practiced today, was formulated in 1894, when a group of four nurses in Great Britain established the Chartered Society of Physiotherapy. Formal training programs were soon started by other countries, following the treatment formulated by the Chartered Society. The School of Physiotherapy, established by the University of Otago in New Zealand in 1913, and Reed College in Portland (Oregon), founded in 1914, are the early examples of the institutions that taught physical therapy. From 1917 to 1918, the therapy was performed widely, to cure people injured in the World War I. The treatment was considered as 'rehabilitation therapy' during that time. The people who were employed to provide aid to the injured patients were named 'reconstruction aides'. They were trained nurses' who had the knowledge of physical education and massage therapy. The year 1921 holds significance in the history of physical therapy. A research paper on the therapy was published in the PT Review, in March 1921, in the United States. It was during this time that Mary McMillan, the first physical therapy aide, established the American Women's Physical Therapeutic Association. The organization's name was later on changed to the American Physical Therapy Association (APTA). Due to her significant contribution in the reconstruction aide services, Mary McMillan came to be known as the 'Mother of Physical Therapy'. More and more research papers were published about physiotherapy in the following years. The treatment was further promoted by the Georgia Warm Springs Foundation. The foundation, in the year 1924, proposed the therapy as a treatment for polio. Massage, exercise and traction were the common practices carried on in physiotherapy in the 1940s. In the following decade, the British Commonwealth countries started the practice of undertaking manipulative therapy for spine and joint pains. Until the early 1950s, physical therapy was performed only in hospitals. It was only in the late 1950s that physical therapists started treating the patients beyond hospitals. Public schools, universities, skilled nursing facilities, medical centers and rehabilitation centers were chosen by the physiotherapists to treat their patients. In 1974, many doctors in the United States specialized in physical therapy. A separate division - the Orthopedic Section - was formed in the APTA, for the physical therapists who had specialized in Orthopedics. The manual therapy was popularized worldwide in 1974, when the International Federation of Orthopedic Manipulative Therapy was established. Further development in the field of physiotherapy was recorded in the 1980s, when the use of computers became prevalent in Medical Science. Various devices, such as electrical stimulators, were introduced for practicing physiotherapy, which increased the effectiveness of the treatment. In the present time, the therapy is practiced for curing a number of disorders and injuries, ranging from the most common back pain to musculoskeletal and sports injuries.

Physical therapy
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Physical therapy
Classification and external resources

This physical therapist from the 1950s is assisting two children with polio who are holding on to a rail while they exercise their lower limbs.

Physical therapy (British English: physiotherapy) is a health care profession that provides treatment to individuals to develop, maintain and restore maximum movement and function throughout life. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. It involves the interaction between physical therapist (PT), patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.[1] Physical therapy is performed by either a physical therapist (PT) or an assistant (PTA) acting under their direction.[2] PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies.

Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be of assistance.[3] Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic, orthopedic and pediatrics, to name some of the more common areas. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.[4] Education qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others requiring masters or doctoral degrees.
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History
Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C.[5][verification needed] After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.[6] The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling Father of Swedish Gymnastics who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is sjukgymnast = sick-gymnast. In 1887, PTs were given official registration by Swedens National Board of Health and Welfare. Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy.[7] The School of Physiotherapy at the University of Otago in New Zealand in 1913,[8] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."[9] Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio.[10] Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.[11][12] Later that decade, physical therapists

started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers. Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed,[13] which has played an important role in advancing manual therapy worldwide ever since.

[edit] Education
Main article: List of physical therapy training

World Confederation of Physical Therapy (WCPT) recognises there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. [2] WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners in collaboration with other members of the health care team.[7] Physical therapist entry-level educational programs integrate theory, evidence and practice along a continuum of learning. This begins with admission to an accredited physical therapy program and ending with retirement from active practice.[2] 202 of 211 accredited physical therapy programs in the US are accredited at the doctoral level.

[edit] Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy,[14] the American Board of Physical Therapy Specialties list seven specialist certifications, including Sports Physical Therapy and Clinical Electrophysiology.[15] Worldwide the six most common specialty areas in physical therapy are:[16]
[edit] Cardiopulmonary

Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions

experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit[citation needed] from cardiovascular and pulmonary specialized physical therapists.[16][verification
needed]

[edit] Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapy helps[citation needed] those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.[16][verification
needed]

[edit] Neurological

Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, speech and loss of functional independence.[16]
[edit] Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations. Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting.[17][verification needed] Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining.[18][19][20] Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit[citation needed] from assessment by a physical therapist specialized in orthopedics.
[edit] Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of

congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis, may be treated[citation needed] by pediatric physical therapists.[16][verification needed]
[edit] Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments
Specialization for Physical Therapy in the United States Specialization for Physical Therapy in the United States occurred in 1974, with the Orthopaedic Section of the APTA being formed for those Physical Therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy (IFOMT) was formed, which has heralded change and progress in manual therapy world wide ever since. During this period, the eastern United States were greatly influenced by the training of Norway's Freddy Kaltenborn (Osteopathic Physician, Chiropractor, Physical Therapist, and Athletic Trainer. 3 Mariano Rocabado, PT of Chile, who specialized in treatment of Temporomandibular disorders, also brought much new information and continues to contribute to our profession. 6 Australia's Geoffrey Maitland, PT initially influenced the training of manual therapy on the west coast. In the 1980's, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which finally gained FDA approval in the United States in 2002. Other advances, such as electronic resistive exercise known as Isokinetics, have fallen out of popularity for various reasons, despite having their place within the profession. The 1990's brought much attention to manual therapy, with formal residency programs becoming more numerous. During the summer of 1991, Norwegian manual therapist Freddy Kaltenborne helped create the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). Dr. Stanley Paris, PT and Ola Grimsby, PT were among the founding members. This organization was a means for physical therapists to band together with a common specialization in manual and manipulative therapy. in 1974, with the Orthopaedic Section of the APTA being formed for those Physical Therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy (IFOMT) was formed, which has heralded change and progress in manual therapy world wide ever since. During this period, the eastern United States were greatly influenced by the training of Norway's Freddy Kaltenborn (Osteopathic Physician, Chiropractor, Physical Therapist, and Athletic Trainer. 3 Mariano Rocabado, PT of Chile, who specialized in treatment of Temporomandibular disorders, also brought much new information and continues to contribute to our profession. 6 Australia's Geoffrey Maitland, PT initially influenced the training of manual therapy on the west coast.

In the 1980's, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which finally gained FDA approval in the United States in 2002. Other advances, such as electronic resistive exercise known as Isokinetics, have fallen out of popularity for various reasons, despite having their place within the profession. The 1990's brought much attention to manual therapy, with formal residency programs becoming more numerous. During the summer of 1991, Norwegian manual therapist Freddy Kaltenborne helped create the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). Dr. Stanley Paris, PT and Ola Grimsby, PT were among the founding members. This organization was a means for physical therapists to band together with a common specialization in manual and manipulative therapy. Specialization for Physical Therapy in the United States occurred in 1974, with the Orthopaedic Section of the APTA being formed for those Physical Therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy (IFOMT) was formed, which has heralded change and progress in manual therapy world wide ever since. During this period, the eastern United States were greatly influenced by the training of Norway's Freddy Kaltenborn (Osteopathic Physician, Chiropractor, Physical Therapist, and Athletic Trainer. 3 Mariano Rocabado, PT of Chile, who specialized in treatment of Temporomandibular disorders, also brought much new information and continues to contribute to our profession. 6 Australia's Geoffrey Maitland, PT initially influenced the training of manual therapy on the west coast. In the 1980's, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which finally gained FDA approval in the United States in 2002. Other advances, such as electronic resistive exercise known as Isokinetics, have fallen out of popularity for various reasons, despite having their place within the profession. The 1990's brought much attention to manual therapy, with formal residency programs becoming more numerous. During the summer of 1991, Norwegian manual therapist Freddy Kaltenborne helped create the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). Dr. Stanley Paris, PT and Ola Grimsby, PT were among the founding members. This organization was a means for physical therapists to band together with a common specialization in manual and manipulative therapy.