Physiotherapy ( ancient Greek φύσις phýsis , German 'nature' , 'body' and θεραπεία therapeía , German 'serving' , 'care', 'healing', thus roughly 'restoring the natural function'), formerly also physiotherapy , is a form specific training and the external use of remedies , with the main aim of restoring, improving or maintaining the ability of the human body to move and function.
The treatments are carried out by physiotherapists and, in some areas, by masseurs and medical pool attendants . Physiotherapist is not an independent medical profession in Germany , but belongs to the health professions (formerly auxiliary professions). The medical need for treatment is only determined by doctors and prescribed on a prescription, except for preventive measures. Sports therapists, scientists and teachers do not meet the admission requirements as a physiotherapist and may use physiotherapeutic remedies such as B. Neither provide nor account for physiotherapy.
Physiotherapy orients itself in the treatment to the complaints and the functional, movement or activity restrictions of the patient, which are determined during the physiotherapeutic examination. It uses both diagnostic and clinical reasoning- based as well as pedagogical and manual skills of the therapist. If necessary, it is supplemented by natural physical stimuli (e.g. heat, cold, pressure, radiation, electricity) and promotes the patient's own activity (coordinated movement and conscious perception). The treatment is adapted to the anatomical and physiological, motivational and cognitive conditions of the patient. The treatment aims on the one hand at natural, physiological reactions of the organism (e.g. motor learning , muscle building and metabolic stimulation ), on the other hand at an improved understanding of the functioning of the organism ( dysfunctions / resources) and on responsible handling of one's own body . The aim is to restore, maintain or promote health and, very often, to be free from pain or to reduce pain.
In the English-speaking world, pathokinesiology / kinesiopathology, among other things, is seen as a distinctive science that plays a central role in the professional identity of physiotherapy and its differentiation from other professions which, in contrast to it, do not deal professionally with the human movement system. Publications by researching physiotherapists are published internationally in medical and scientific journals and are subject to peer review .
Concrete application find z. B. the work of a US research group on the establishment of specific diagnostic categories for the purpose of the cause-related and targeted therapy of pain syndromes of the human locomotor system.
Synonyms and related fields
The English term physical therapy should not be confused with the term “ physical therapy ” in German . Physiotherapy and physical therapy are sometimes viewed as synonyms or common areas of expertise; Physiotherapy is also viewed as a sub-area of physical therapy. With a view to financial accounting modalities, the areas of physiotherapy and physical therapy are to be separated again in the next draft (the Diagnosis Related Groups ) upon the intervention of various specialist groups . B. a physiotherapeutic treatment and a heat application can be counted individually. "
Antiquity to modern times
Many physiotherapy procedures have their origins long ago. Archaeological finds show that thermal and mineral springs were used in prehistoric times. Various forms of massage and medicinal baths were known in China around 4000 years ago.
Specific gymnastic and dietary educational ideals have been handed down from antiquity . The athletes of the ancient Olympic Games had specially trained coaches who watched over the so-called "body hygiene" of their protégés. In doing so, they often did more than any doctor for the health and vitality of young people .
The Greek doctor Hippocrates also represented different medical views that can be found in physiotherapy today. He understood the living body as an organism, health as equilibrium and illness as a disturbed physical and psychological overall condition. He was convinced that nature has healing powers. Hippocrates and his later Roman counterpart Galen emphasized the health effects of all "physical exercises".
The ancient yoga can also be classified here, with its precise asanas as a passive massage . In China, Qigong can be found as a practice method for self-regulation and Tuina- Anmo therapy as a manual treatment method.
The positive observations were used early on to advise the population on health . Regular exercise in the form of walks , swimming , running , horseback riding , games, and dancing was recommended . The relaxing and healing effects of massage and spas has been known since ancient times. The dietetics not only related to a healthy diet . A balance between waking and sleeping was also ensured.
Little changed in this until the high Middle Ages , the "recipes" remained the same. It was more likely that the body was forgotten due to the influence of the Church ; u. a. God-fearing creatures would have to regard life and suffering as fateful. This only changed with the Renaissance , when the ancient ideals reawakened.
Humanism and enlightenment
Influenced by humanism , women, children and handicapped people with their special needs and illnesses are now the focus of medical considerations. In the 18th century, the French doctor Nicolas Andry founded orthopedics (freely: "Education for an upright posture"). He systematically observed the frequent poor posture and deformities in children. He prescribed special gymnastic exercises for therapy and prophylaxis . The Swiss doctor Jean-André Venel (1740–1791) opened the world's first orthopedic clinic in Orbe / Canton of Vaud in 1780 .
Johann Christoph Friedrich Guts Muths founded educational gymnastics in Germany and Franz Nachtegall (1777–1847) founded the “Gymnastics Society” in Copenhagen in 1798 . From their physical exercises, the Swede Pehr Henrik Ling developed targeted therapeutic gymnastics , which is still based on the "everyday movements of use" today. He combined his treatments with massages for specific muscle groups.
In the 18th century, the first drugs were popular, but they also brought with them dangers. Many doctors advocated the use of mineral waters, medicinal baths and hydrotherapy . This continued in the 19th century, the popularity of hydrotherapy increased.
Especially in Germany, hydrotherapy experienced a real boom: The forefather of hydrotherapy, Sebastian Kneipp , developed a simple way of life, combined it with the use of herbal medicines and health education.
Industrialization and modernity
The Berlin doctor Albert C. Neumann brought "Swedish therapeutic gymnastics" to Germany. He was the first to define the profession of “gymnast” and advocated the professional emancipation of women. In 1853 he opened the first gymnastics school for women. The Swede Gustav Zander developed from 1865 a system of gymnastics and massage apparatus, the medico-mechanical treatment . In Germany the devices were u. a. Used in " Zander Institutes " as training equipment in prevention and therapy, later further developments, plagiarism and simpler exercise equipment were added.
In addition, the need for treatment grew as a result of the wars ( 1870/71 , 1914–18 and 1939–45 ) and as a result of increasing work and traffic accidents . Johann Hermann Lubinus founded the “Lubinus Schools” , which are respected by many specialists . For the first time, physiotherapy made the acquaintance of patients from surgery and neurology ( poliomyelitis took on a high degree worldwide). For the treatment of heart and lung diseases and in rheumatology , there was a return to therapeutic baths and the Kneipp teaching . In 1941 Wolfgang Kohlrausch was appointed first professor for movement therapy at the National Socialist University of Strasbourg.
After the currency reform in 1948 , there were austerity measures in the health care system , which led to significant job cuts. It was only with the establishment of regional associations that the profession was able to re-establish and expand. Contracts with health insurance companies and a standardization of training made physiotherapy facilities profitable again. In the 1950s, the ZVK (Central Association of Physiotherapists) was formed, which is still the largest of all German associations. Through his work in 1959 a federal law differentiation of the "physiotherapist" from other medical auxiliary professions succeeded . In 1964, the term physiotherapy was adopted from the international nomenclature in the GDR .
In the course of reunification and adaptation to international language usage, the professional laws (see MPhG ) were amended in 1994 . From now on the physiotherapists are uniformly called "Physiotherapists".
Theory formation in Germany
Since the beginning of the 20th century, German physiotherapy has mainly endeavored to establish and anchor itself in the health care system. It has therefore developed along the lines of medicine and thus defined using the medical model of thought. Fundamental to the medical model at that time was the concept of “normalcy”, which the therapy was supposed to restore. Deviations were considered abnormal. Every disease therefore had a detectable trigger (for example a germ). Accordingly, medicine did not treat the individual, but the disease and tried to eliminate it.
A paradigm shift has only gradually taken place since the mid-1990s . The disease is no longer seen primarily as a functional disorder that is to be repaired, but a holistic perspective is in the foreground.
The theories of physiotherapy are primarily based on human anatomy and physiology or on the fundamentals of movement science (e.g. motor training, sensorimotor activation, perception training, posture training). The physical therapy is also based on the fundamentals of physics (e.g. electrical, ultrasonic, thermal, hydro, balneotherapy).
A variety of techniques are available for physiotherapy, including PNF (proprioceptive neuromuscular facilitation), manual therapy (mobilizing techniques for joint mobilization), soft tissue techniques ( therapeutic massage, connective tissue techniques , osteopathic techniques for fascial mobilization), sensorimotor activation (semota, cognitive training according to Perfetti) and therapeutic gymnastics (passive, assistive, active or resistive techniques).
However, the basic training does not automatically enable one to carry out these techniques. If a form of therapy with restricted authorization, such as manual therapy, PNF, neurophysiological techniques or the like , is prescribed to the physiotherapist by the doctor , the therapist must provide proof of qualification to the health insurance company in order to provide the remedy (prescription position) .
The training takes place at state or private vocational schools, but can also take place as a bachelor's degree at universities and conclude with a Bachelor of Science . The course can take place in three different variants: as a training-integrated or dual course , as a primary qualification course, or as a part-time course.
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- from the procedure classification in the DRG system
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