Physical activity

Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure.
Physical inactivity (lack of physical activity) has been identified as the fourth leading risk factor for global mortality (6% of deaths globally). Moreover, physical inactivity is estimated to be the main cause for approximately 21–25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease burden.
Regular and adequate levels of physical activity in adults:

• reduce the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, depression and the risk of falls;
• improve bone and functional health; and
• are a key determinant of energy expenditure, and thus fundamental to energy balance and weight control.

The recommended levels of physical activity for health benefits and prevention of noncommunicable diseases are available for download here.http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf
The term "physical activity" should not be mistaken with "exercise". Exercise, is a subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. Physical activity includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities.
Increasing physical activity is a societal, not just an individual problem. Therefore it demands a population-based, multi-sectoral, multi-disciplinary, and culturally relevant approach.

Age group: 5-17 Years old

For children and young people, physical activity includes play,games, sports, transportation, chores, recreation, physical education, or planned exercise, in the context of family, school, and community activities. In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers:

• Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
• Amounts of physical activity greater than 60 minutes provide additional health benefits.
• Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone, at least 3 times per week.

More information about Physical Activity in Young People

Age group: 18-64 years old

 

In adults aged 18–64, physical activity includes leisure time physical activity, transportation (e.g. walking or cycling), occupational (i.e. work), household chores, play, games, sports or planned exercise, in the context of daily, family, and community activities. In order to improve cardiorespiratory and muscular fitness, bone health, reduce the risk of NCDs and depression:

• Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
• Aerobic activity should be performed in bouts of at least 10 minutes duration.
• For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
• Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

More information about Physical Activity in Adults

Age group: 65 years old and above

In older adults aged 65 years and above, physical activity includes leisure time physical activity, transportation (e.g. walking or cycling), occupational (if the individual is still engaged in work), household chores, play, games, sports or planned exercise, in the context of daily, family, and community activities. In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:

• Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
• Aerobic activity should be performed in bouts of at least 10 minutes duration.
• For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
• Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
• Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.
• When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

More information about Physical Activity in Older Adults

 

Facts on physical activity

The concept of physical activity covers all forms of muscular work which boosts energy conversion. Exercise covers both unstructured activity and more conscious, targeted and regular training. Here, the concepts physical activity and exercise are used synonymously. Training is planned, structured physical activity which is performed regularly to maintain and/or improve your physical condition and sense of well-being. In contrast, inactivity describes a life without any movement. Inactive people are not physically active in any way and engage in neither structured nor structured physical activities.

Effect of physical activity Current research into the effects of physical activity on the body shows that:

• People who are normally inactive can improve their health and physical well-being by engaging in regular exercise. 
• People of all ages – children, adults, older people, women and men – all benefit physiologically from physical activity. 
• Physical activity does not have to be exhausting for it to benefit your health. 
• Physical activity has many positive effects on the bodily functions. Its effect on the heart, circulation and muscles has been recognised for many years. However, it is also worth noting the positive effect of exercise on your metabolism and on the hormone and immune systems. 
• Many of the positive effects of physical activity – both from endurance training and from muscle-strengthening exercise – diminish after a few weeks. If you stop being active altogether, the effect disappears completely within 2-8 months. 
• Physical activity leads to socio-psychological benefits in the form of feeling happy about life, higher energy levels, social well-being, self-confidence and decisiveness. Moreover, it has been demonstrated that there is a positive connection between physical activity and cognitive processes which are necessary for children's learning.

Why 30/60 minutes?

Regular physical activity can help to keep your body fit and healthy and prevent a number of illnesses and ailments.
Physical activity prevents the following lifestyle and widespread chronic diseases:

• Circulatory diseases (cardiovascular diseases, raised cholesterol, triglyceride and blood pressure levels, overweight, obesity, insulin resistance and type II diabetes) 
• Stress 
• Muscular and skeletal illnesses 
• Certain cancers (colon cancer and breast cancer) 
• Mental illnesses (depression, anxiety and dementia) 
• Osteoporosis

Physical activity improves your health:

• Helps to reduce blood pressure for people who already have high blood pressure
• Helps control weight
• Helps older people become stronger and better able to move about without falling over
• Improves mental and social well-being, including feeling happy about life, energy levels, social well-being, self-confidence and decisiveness
• Regular physical activity can prevent the above diseases while promoting the beneficial conditions

If you already suffer from one of the above illnesses, physical activity can help reduce the risk of the illness developing or your condition deteriorating.

Recommendations for the overweight

• All overweight and obese people must engage in moderate-intensity physical activity for at least 30 minutes, ideally seven days a week. The 30 minutes can be split into shorter periods, for example 15 minutes in the morning and 15 minutes later, or three 10-minute periods in the course of the day.

• If you want to lose weight, the Danish National Board of Health recommends a combination of regular physical activity and reducing the number of calories you consume.

Preventing overweight and obesity
Physical inactivity increases the risk of becoming overweight and obese, which has further implications for your health. You can prevent a number of lifestyle diseases related to overweight and obesity by following the Board's recommendations regarding physical activity. The effect is greatest if you combine physical activity with lower calorie consumption. Physical activity prevents the following conditions which can be triggered by overweight and obesity:

• Type 2 diabetes (improving the insulin effect)
• Dyslipidemia (elevated concentration of triglyceride and cholesterol in the blood)
• Raised blood pressure

Physical activity for pregnancy

Physical exercise during pregnancy is beneficial for both mother and child, and there are only a few important precautions. Several studies have shown that women who are physically active before they become pregnant can certainly continue being active while pregnant, as long as they feel comfortable. Pregnant women who have not previously been physically active can benefit from being physically active and taking exercise while pregnant.
Physical activity covers all forms of movement which boosts energy conversion. Examples include moving at work and around your home, active transport (e.g. cycling and walking) or athletics and sport in your leisure time etc.

Physical activity when pregnantThe Danish National Board of Health recommends that pregnant women engage in moderate-intensity exercise for at least 30 minutes a day. The 30 minutes can be split into shorter periods, for example 15 minutes in the morning and 15 minutes later, or three 10-minute periods in the course of the day.
What is moderate-intensity exercise

Physical activity which is not recommended when pregnant
Contact sports and team sports which involve a risk of collision with fellow players and/or opponents are not recommended for pregnant women as there is considerable risk of unexpected jolts. Likewise, skiing and riding should be avoided as falls can lead to serious injury. Suitable forms of physical exercise include walking and hiking, swimming, running, muscle-strengthening exercises (in a seated position and not heavy weight training), cycling, spinning, aerobics etc.
Pregnant women are advised not to engage in high-intensity physical activity where their blood circulation is pushed to the limit if they have not engaged in high-intensity exercise prior to becoming pregnant. Pregnant women who are used to high-intensity exercise are advised not to do long-distance running and other fatiguing activities, and to refrain from intensifying their training while pregnant. Moreover, pregnant women are advised to listen carefully to their bodies if they engage in high-intensity physical exercise. Respect pain.

Recommendations for older people

• The Danish National Board of Health recommends that older people, like younger adults, spend at least 30 minutes a day engaged in moderate-intensity physical activity.

What is moderate-intensity physical activity? Moderate-intensity physical activity involves all types of activity/exercise which increase the pulse rate, and where you can continue talking at the same time. Examples of moderate-intensity physical exercise: cycling and walking to and from the supermarket, gardening, walking up and down stairs, going jogging and other types of exercise. The bottom limit for moderate-intensity physical exercise corresponds to walking at an average speed of 4 km/h.
Many of the problems faced by older people in their daily lives can be prevented through physical activity.

The benefits of being physically active are:

• less risk of falling ill
• improved quality of life
• less risk of falling over
• longer life-span

Older people can benefit further by:

• performing activities at least twice a week which maintain or increase their muscle strength and fitness
• being physically active in ways that exercise their sense of balance
• maintaining their mobility by performing stretching exercises

http://www.sst.dk/~/media/Sundhed%20og%20forebyggelse/Fysisk%20aktivitet/The%20Toronto%20Charter/The%20Toronto%20Charter%20for%20Physical%20Activity%20and%20Health.ashx

Physical activity and energy consumption

Increased physical activity in connection with daily activities can lead to increased energy consumption. The table shows how much energy you normally burn when performing various activities.
It is important to emphasize that increased energy consumption does not necessarily lead to weight loss. Being active can reduce the amount of fat on your body, but it can also result in more muscle mass – in which case the scales show the same weight. An important aspect of exercising is, also in relation to weight regulation that it helps to restore and maintain balance within the body, benefiting your appetite and metabolism. From a health point of view, it is better to be physically active and weigh a couple of kilogrammes too much than being slim and physically inactive.

Energy consumption with a passive lifestyle versus an active lifestyle:  

Daily energy consumption
Passive	(kJ/day)	Active	(kJ/day)
Work
Take the lift up three floors and down three floors	3	Walk three floors up and down the stairs	45
Email colleagues	25	Go down and talk to colleagues	35
Transport
Drive children to and from kindergarten/school	50	Spend 20 min. cycling or walking children to and from kindergarten/school	600
Drive to and from work	75	Walk to catch the bus/train to and from work	450
Home - indoors
Spend 30 min. a day sitting and chatting on the phone	45	Stand up while talking on the phone	75
Use the remote to change TV programmes	3	Get up and change TV channel manually	15
Wait for the pizza delivery	45	Spend 30 min. cooking	225
Use the dishwasher	75	Wash up by hand	195
Tumble-dry your clothes	0	Hang up the washing	35
Employ a cleaner	0	Do the cleaning once a week	187
Emply a window-cleaner once a month	0	Clean the windows every three months	16
Home - outdoors
Let your dog run around the garden	8	Take the dog for a 30 min. walk	450
Cut the grass using a motorised lawnmower	26	Cut the grass with a hand-powered lawnmower evey 10 days during the summer	56
Take the car to a car wash	3	Wash the car by hand once a month	35
Leisure activities
Sit in front of the TV/computer	68	Go for a walk or play with your children for 45 min.	675
Total energy consumption	426		3.094

Exercise your Shoulder Pain Free

What Causes Shoulder Pain?
Many of us will experience shoulder pain at some point in our lives, and it is a
very common problem. It is vital to accurately diagnose the pain so the shoulder
can be rehabilitated and treated as soon as possible. Here are some of the more
common causes of shoulder pain, with a brief explanation of each cause.
The following conditions are treatable using my book:
Shoulder impingement syndrome – this is where the supraspinatus tendon
(one of the rotator cuff muscles) gets trapped underneath the acromioclavicular
joint (ACJ). Other names for shoulder impingement syndrome are clinical
impingement syndrome and painful arc syndrome.
Bursitis – inflammation of the bursa (fluid filled sac) that sits underneath one of
the shoulder joints, known as the acromioclavicular joint.
Supraspinatus tendonitis – this is tendonitis of the supraspinatus muscle, one
of the rotator cuff muscles. Most often caused by abrasion underneath the ACJ.
Rotator Cuff Tear – this is where one of the rotator cuff muscles tears. You may
suffer a full thickness tear, or a partial thickness tear. The rotator cuff attach all
around the shoulder and help to stabilise it.
Calcific tendonitis – this is where the rotator cuff tendon becomes calcified due
to a prolonged period of abrasion.
Shoulder Arthritis (of the acromioclavicular joint) – wear and tear changes
under the acromion of the shoulder leading to shoulder impingement syndrome.
This includes bone spurs.
Frozen shoulder – also known as adhesive capsulitis, this is where the shoulder
joint capsule hardens usually in response to trauma or surgery. This results in a
widespread stiffening of the shoulder. Commonly over-diagnosed.
Shoulder Dislocation – the arm bone (humerus) is forced out of the shoulder
joint, usually by trauma.
Shoulder instability – a loose shoulder joint which usually results after dislocation.
Acromioclavicular (AC) Dislocation – the clavicle (collar bone) is forced out of
joint. Usually results from a fall on an outstretched hand.
Labral tear – the rim of the shoulder joint is torn during trauma. Most common in
contact sports such as rugby.
Shoulder Arthritis (of the glenohumeral joint) – degeneration of the head of the
humerus.
Biceps Tendon rupture – the biceps (upper arm muscle with two heads) tendon
pulls off the bone as a result of trauma.

Exercises
I have categorised these exercises in levels 1 – 4. You should perform the levels
in order, and only progress to the next level when you have achieved the
previous level.
In the photographs, Jon has a painful RIGHT shoulder.
You may use the periodisation table in the appendix as a guide to likely time frames
of shoulder exercise progression, but don’t be tempted to rush ahead. Go
at your own pace, and perform the exercises gently and as described.

Level 1 Exercises – Passive Mobilisation:
Level 1 is designed to improve the range of mobility in your stiff shoulder.
Perhaps you want to read that again! Yes, these exercises will finally allow you to
move your arm in a comfortable range of mobility. Great for any stiff shoulder.
The exercises start assisted, so the muscles of the painful shoulder can remain
relaxed while the shoulder is mobilised. We call these passive range of mobility
exercises. Alternatively at this point, if you have a good osteopath or
physiotherapist, they can assist by lifting your arm for you.
When you do these exercises, move the joint slowly, and gently. Avoid the ranges
of movement that give you sharp pain, although feeling minor discomfort should
be expected in certain ranges.
Take the shoulder to the point of mobility which feels comfortable, and then take
it just a fraction further to increase the range of motion. At this point, return the
arm to its resting position.
You will find that every couple of days you will notice some improvement in the
range of mobility of that shoulder and arm. You can compare the movement to
that of the good shoulder to give you an indication of how far you have to go with
the mobility.


1. The Pendulum
• Keep the shoulder completely relaxed
• Let momentum and gravity move it in circles
• Go anti-clockwise and clockwise
• Keep the circles within your comfort zone
• Perform for 2 minutes, 3x per day

2. Rock the baby
• Keep the bad arm relaxed…
• The good arm holds the bad arm
• Keep the movement within your comfort zone
• Rock 15x each side, 3x per day

3. Passive flexion
• The affected shoulder should be relaxed during the movement
• The left arm lifts the right arm
• Keep the movement within your comfort zone
• Perform 15 repetitions, 3x per day.

4. Passive extension
• The right arm stays relaxed during the movement
• The left arm pushes the right arm backwards
• Keep the movement within your comfort zone
• Perform 15 repetitions, 3x per day.

5. Passive abduction 30°
• The right arm stays relaxed during the movement
• The left arm lifts the right arm
• Make sure the arm is lifted at 30°
• Perform 15 repetitions, 3x per day

6. Towel exercise for internal rotation
• The active arm is the left arm, the right arm stays completely
relaxed except to hold the towel
• Straighten the left arm, thus allowing the right arm to come up
the back
• Move up and down within your comfort zone
• Perform 15 repetitions, 3x per day

Level 2 Exercises – Stabilisation:

1. Sitting stabilisation
• Sit on a bench or chair
• Rest your hands by your side
• Gently lean from one hand to the other hand, putting gentle but
increasing weight through the shoulder
• Do not put all your weight through the right shoulder, just lean
into it
• Rock 15x onto the right shoulder, 3x per day.

2. Standing stabilisation
• Start around 1½ feet from a wall
• Lean forwards onto the wall, resting the palms flat against the
wall with the elbows bent (in a standing press-up position)
• Rock gently from side to side, applying pressure to one shoulder
and then the other.
• You can make the exercise more challenging by moving the feet
further away from the wall.
• Hold for 30 seconds, 3x per day

3. Stabilisation in 4 point kneeling
• Start in a 4 point kneeling position
• Rock gently from side to side, applying pressure to one shoulder
and then the other.
• Hold for 30 seconds, 3x per day

Level 3 Exercises: Active Mobilisation:

Level 2 exercises are a natural progression from level 1, because they now rely
on your shoulder muscles to move the joint.
Again, work within your comfort zone… don’t push the shoulder through the pain
barrier. Take it to its comfortable end of range, and then just a fraction further to
get the required mobility.

1. Side-Arm pendulum
• Swing the arm in a pendulum as shown
• Go clockwise and counter-clockwise
• Perform for 30 seconds, 3x per day

2. Shoulder shrugs
• Upwards: lift the shoulders towards the ceiling, and hold for a
couple of seconds, before relaxing.
• Backwards: pull the shoulders backwards by squeezing the
shoulder blades, and hold for a couple of seconds before
relaxing.
• Perform 10 repetitions, 3x per day.

3. Chicken wings
• Resting the hands on the hips, pull the shoulders backwards
and forwards
• Perform 10 repetitions, 3x per day

4. Flexion
• Raise your bad arm as far as is comfortable, then try and take it
just a fraction further
• Hold for a couple of seconds, then lower.
• Perform 10 repetitions, 3x per day

5. Internal rotation “The Brastrap Exercise”
• Reach behind your back, and take the hand as high up the back
as comfortable, then just a fraction further.
• You should feel a gentle pulling feeling at the front of the
shoulder. Hold this position for a couple of seconds
• At first you may find this exercise difficult and uncomfortable,
but persevere, and over a few days you will achieve greater
mobility
• Perform 10 repetitions, 3x per day

6. Stroke the shoulder blade
• Reach behind the opposite/good shoulder and try to stroke the
shoulder blade.
• This is another movement that is likely to be quite painful, but
again keep practising; go to your end of comfort zone, and just
a fraction further.
• Perform 10 repetitions, 3x per day

7. 30° wall crawl
• Make sure the arm is not directly to your side
• Leave it at a 30° angle, as shown in the picture
• Crawl up the wall to your end of comfortable range, then just a
fraction further, and back down the wall.
• Perform 10 repetitions, 3x per day

8. The Drawing of the Sword
• The thumb starts facing downwards, and at the end of the
movement, faces upwards
• Imagine you are drawing a sword out of its sheath
• Perform 10 repetitions, 3x per day

9. Pec Stretch
• A lovely shoulder exercise, great for posture; it will improve
mobility in the anterior capsule of the shoulder
• Rotate the torso, and lean forward, creating a stretch to the
shoulder
• Perform 10 repetitions, 3x per day

10. The Football Supporter
• One of my favourites, but the hardest in this level, so don’t do it
unless you feel comfortable with it
• Holding a towel above your head (imagine it’s a scarf of your
favourite football team), gently move the arms from side to side
• Perform 10 repetitions, 3x per day

Level 4 Exercises: Advanced Stabilisation

1. Swiss Ball Stabilisation 2 hands
• Kneel down, place the hands on a Swiss ball
• The instability of the ball will help the small stabiliser muscles of
the shoulder strengthen
• Progress the exercise by moving the knees further from the ball
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

2. Swiss Ball Stabilisation 1 hand
• The same exercise as the previous, but one handed
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

3. 2-point Kneeling
• Adopt a 4-point kneeling position
• Lift opposite arm and leg 2 inches from the floor, so that your
weight is put through the bad shoulder
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

4. Prone Cobra
• This is a great exercise for scapular stability, and back extensor
strength, helping to keep those shoulders back, thus helping to put the
shoulder in a mechanically advantageous position
• Make sure the thumbs are facing upwards, with the arms turning
outwards (n.b. not inwards). You will notice that turning the arms
outwards opens the chest and shoulders (=good), inwards closes the
chest and shoulders (=bad)
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

JENNY McConnell

Self-treatment system has got bad knees taped

By Derek Mortimer March 18, 2004

Flat strap: Jenny McConnell. Photo: Wade Laube

A simple and inexpensive self-treating program involving the application of tape can provide pain relief and increase mobility for the thousands of people who suffer from osteoarthritis of the knees, a new Australian study has found.
The taping, which can be taught by a physiotherapist in one or two visits, is combined with muscle-strengthening exercises.
The treatment involves taping the patella, or knee cap, which must be held in the correct position as it moves over the knee joint, and taping below the knee cap to take pressure off the fatty tissue. It involves two types of tape: a stretchable under-tape to prevent irritation of the skin, and a rigid sports tape. Both varieties are available from most chemists.
Osteoarthritis of the knees is one of the most common and debilitating diseases of ageing; more than 1 million Australians suffer from it. This number is increasing by about 8 per cent a year.
The World Health Organisation reports that 40 per cent of people over the age of 70 suffer osteoarthritis of the knees and that globally, osteoarthritis ranks fourth in women and eighth for men in terms of disease impact.
Osteoarthritis usually develops from 45 years of age onwards, and all forms of arthritis are increasing, says the Arthritis Foundation of NSW.
The finding on taping follows a study by physiotherapists from the University of Melbourne and claims to provide the first evidence of the effects of knee-taping in the treatment and management of osteoarthritis.
The randomised, blind-control trial involved 87 patients divided into three groups. One group received no taping, a second received placebo taping and the third received therapeutic taping.
The taping covered three weeks, with the the tape being replaced at the ends of the first and second weeks. The patients were then assessed three weeks after the tape was removed. The therapeutic tape group reported a decrease in pain of 38 to 40 per cent.
Dr Kim Bennell, associate professor and director of the Centre for Health Exercise and Sports Medicine at the University of Melbourne, says taping had previously been associated with younger people suffering patellofemoral (front of the knee) pain, generally caused by sporting activity.
She stressed that taping was one part of self-management and treatment of osteoarthritis, and was best combined with exercises to strengthen the quadriceps muscles and improve balance.
The exercises include step-ups, partial squats and similar movements that engage specific muscles of the thigh. They can be performed daily or several times a week, depending on the needs of the patient.
In 1986, Sydney physiotherapist Jenny McConnell pioneered a taping treatment for the management of patellofemoral pain that now bears her name.
McConnell, who was a member of the research team, says that when treating patients for patellofemoral injuries, she found that not only did the taping reduce that pain, it also reduced osteoarthritic pain in some people.
In osteoarthritis the pain comes from the soft tissue below the knee cap, rather than the bone, or cartilage, which has no nerves, says McConnell, although there is an association between lack of joint space - a symptom of osteoarthritis - and pain.
She says taping unloads pressure from the tissue, enabling inflammation to settle down.
The Australian Institute of Health and Welfare reports that the economic cost of musculoskeletal diseases such as osteoarthritis is $3 billion a year.
Editor's note: People shouldn't attempt strapping their knees until assessed by a physiotherapist. This treatment is not appropriate for all arthritis sufferers, and in some cases, can cause more pain.

History of Physical Therapy

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.[13][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.[14]

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 Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy.[15] The School of Physiotherapy at the University of Otago in New Zealand in 1913,[16] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."[17]

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.[18]

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.[19][20] 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,[21] which has played an important role in advancing manual therapy worldwide since.

PHYSIOTHERAPY DEVELOPMENT

Physiotherapy treatment has evolved over the last 110 years in the UK. It commenced in 1894 when ‘The Society of Trained Masseuses’ was founded by four nurses from The London Hospital. In 1919, this society amalgamated with ‘The Institute of Massage and Remedial Exercises’ established in Manchester and in 1920 the Royal Charter was granted and the two bodies became ‘The Chartered Society of Massage and Medical Gymnastics’. In 1944, the Society in the UK adopted its present name as the ‘Chartered Society of Physiotherapy’. In 1964, Vidler stated that ‘You needed a good educational background to train as a physiotherapist, but when qualifi ed it is wit and observation that give you the ability to judge the effect of your treatment and report on it or discuss it with the doctor’ (Vidler 1964). It was not until 1977 that Chartered Physiotherapists became autonomous clinicians in the UK, with the ability to take selfreferrals, assess, diagnose and treat without a medical referral.

In 1964, Rule 2 of the Code of Conduct stated that registered physiotherapists should confi ne themselves to the recognised fi eld of physiotherapy (Gardiner 1964). Physiotherapy was extremely protective of its core skills of massage, exercises and electrotherapy (added in 1929). At this stage, it lacked the foresight and courage to develop new skills in other areas. Physiotherapists
were generalists and expected to undertake all types of physiotherapy treatment. Gradually, physiotherapy skills have expanded to cover many specialist areas, such as continence. Now, physiotherapists confi ne themselves to areas in which they have had training and in which they are competent. In 1992, the profession became an all-graduate entry profession in the UK.