The History of Physiatry
an Overview

Physical means of healing have been practiced since prehistoric times, but Physiatry did not become recognized as a separate medical specialty until 1947.  Most widely known as the field of Physical Medicine and Rehabilitation, the medical specialty of modern-day Physiatry comprises the related disciplines of Physical Medicine, Rehabilitation Medicine and Electromyography.

The term Physiatry derives from the Greek words physikos (physical) and iatreia (art of healing).  A Physiatrist is a physician who creatively employs physical agents as well as other medical therapeutics to help in the healing and rehabilitation of a patient. Treatment involves the whole person and addresses the physical, emotional and social needs that must be satisfied to successfully restore the patient's quality of life to its maximum potential.

Since the beginning of time, people have used physical means for treatment of illness and injury.  Such physical agents for healing have included water, heat, cold, massage, light, exercise and electricity.  Throughout history, water has functioned as a primary means of physical healing. Written accounts of physical techniques for healing can be traced as far back as the writings of Hippocrates in 400 B.C.

Rehabilitation involves the restoration of a diseased or disabled person to optimal physical, psychological and social functioning.

During and after World War I, empirical trials indicated that various physical methods were useful to augment medical care and convalescence of patients. Physicians began practicing "physiotherapy" in "reconstruction hospitals" to rehabilitate injured and disabled soldiers.  Therapeutic tools and methods were developed or improved to apply heat, massage, exercise, electrical stimulation, heliotherapy and diathermy.  Physicians pioneered new medical applications of electrotherapeutics and x-rays.  Functional activities of occupational therapy to provide exercise, retraining of coordination and reassurance that useful performance could be regained, were extensively practiced in Army Hospitals.

Beginning in the 1920's, medical organizations such as the AMA Council on Physical Therapy and the American Society of Physical Therapy Physicians were formed.  These organizations later were changed and renamed a number of times to reflect the evolving specialties of physical medicine, physical therapy, electrotherapeutics, radiology, and rehabilitation.  The major organizations for physicians in the field of physiatry today include the American Academy of Physical Medicine and Rehabilitation (AAPM&R), the Association of Academic Physiatrists (AAP), the American Board of Physical Medicine and Rehabilitation (ABRM&R), the International Rehabilitation Medicine Association (IRMA), and the American Congress of Rehabilitation Medicine (ACRM). These organizations represent seven decades of development of the field of physiatry.  Two major medical journals have evolved to publish research in the field of Physiatry. The Archives of Physical Medicine and Rehabilitation is published by the AAPM&R and the ACRM, and the American Journal of Physical Medicine and Rehabilitation is published by the AAP.

Formal education for Physiatry had its beginning in 1926 when, after service in the U.S. Army during World War I, Dr. John Stanley Coulter joined the facility of Northwestern University Medical School as the first full-time academic physician in physical medicine.  He became the leader of the educational development of the practice of physical medicine over the next two decades. He initiated the first continuing teaching program in physical medicine, consisting of short courses of three to six month's duration, later extended to one year for physicians in practice.  Prior to that time, training in Physical Medicine had been by short preceptorship with a practitioner of some aspect of physical medicine.  During that period, Dr. Coulter gained recognition as the leader of the developing organizations for physical medicine physicians.

The decade of the 1930's brought further organization and purpose to the field of rehabilitation.  Only a few training programs for physical therapy technicians existed, but these were standardized by the formation of The American Registry of Physical Therapists.  Likewise additional opportunities for training physicians began to develop, and groups began to form to represent specific interests within Physical Medicine and Rehabilitation. Frank Krusen, M.D., established the Physical Medicine Program at the Mayo Clinic in 1936 and initiated the first three year residency in Physical Medicine. Drs. Coulter and Krusen led the organization of the American Academy of Physical Medicine in 1938, and Dr. Coulter is credited with being its Organizational President. In that year, Dr. Krusen coined the word "Physiatrist" to describe the small group of physicians who were dedicated to the approach of adding physical medicine to medical therapeutics to treat neurological and musculoskeletal disorders.  Krusen wrote the first widely used textbook on Physical Medicine in 1941. He is recognized as the "Father of Physical Medicine." In 1946, the AMA Council on Physical Medicine voted to sponsor the term "physiatrist" (fizz-ee-at'-trist) and physiatry (fizz-ee-at'-tree) with the accent on the third syllable.  This is how the pronunciation appears in most American dictionaries.

It was not until after World War II, however, that society began to understand the necessity for more advanced treatment and rehabilitation for the disabled.  The public became mroe aware of the rehabilitation effort due to the substantial numbers of debilitation war injuries plus the thousands of individuals disabled by a poliomyelitis epidemic that sent fear into every American home.  The influence of radio, movie newsreels, and later television brought home the reality of polio in the person of President Franklin D. Roosevelt, who had regained his capacity to return to public life after physical therapy at Georgia Warm Springs.

These events created an increased demand for physicians trained in a comprehensive approach to rehabilitation, including the physical, mental, emotional, vocational and social aspects.

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