Associate Dean Gordon on the Evolution of Physical Therapy

Image Caption: “Actualized Ability:” Physical Therapy Evolving to Meet Societal Needs. Q+A with Dr. James Gordon, EdD, PT, FAPTA.

For more than 60 years, USC’s Division of Biokinesiology and Physical Therapy has been leading innovation in the physical therapy profession through excellence in education, research, and practice. The faculty are among the field’s top clinicians and researchers, passionate about defining the future of physical therapy and educating tomorrow’s leaders.

In order to continue to advance the field, the division is expanding its influence by offering DPT@USC, a hybrid Doctor of Physical Therapy (DPT) program, to aspiring physical therapists across the country. The division faculty and leadership are excited to launch a hybrid DPT program that will be both innovative — leveraging the best elements of online and experiential learning — and accessible, making USC’s DPT experience available to students nationwide.

At the helm of the program is McMillan Lecture Award recipient Dr. James Gordon, associate dean and chair of USC’s Division of Biokinesiology and Physical Therapy. In anticipation of the hybrid DPT program launch, we sat down with Dr. Gordon to learn about his observations of how physical therapy has responded to the needs of society over time, and USC’s unique contributions to the discipline as it approached its 100th anniversary.

In 2021, the physical therapy profession will be celebrating its 100th anniversary. How has the field of physical therapy changed since its early beginnings?

Although physical therapy is almost a century old, it is still a very young and dynamic profession. It was born of necessity after World War I to help wounded veterans, and there was even more demand during and after World War II. Physical therapy really gained currency among Americans during the 1930s and 1940s, as polio outbreaks increased in frequency and severity. President Franklin Roosevelt had been diagnosed with polio and essentially ran early efforts to fund a polio cure out of the White House through the March of Dimes. Physical therapy developed an identity as a caring profession by helping those living with polio to regain the ability to walk and giving hundreds of thousands of veterans the opportunity to resume productive lives despite suffering terrible wounds.

Fifty years ago physical therapy would have been defined in terms of the kind of therapies we administered — the use of physical agents, manual therapy, exercise, and movement education to restore health after disease or injury.

Today, physical therapy has evolved to one in which doctors of physical therapy are experts in diagnosis and management of movement dysfunctions. There is as much focus on preventing injury or forestalling degeneration as there is on remediating dysfunction.

What has changed is the profession’s development of a rich scientific body of evidence and research about how we educate, diagnose, and treat patients. We have earned a professional identity as doctors — through both the rigor of our practice and the evidence upon which it is grounded.

Today, the primary societal challenges physical therapists address relate to the aging of the population and the long-term impact of chronic disease. We live longer and medical discovery has beaten back many infectious and life-threatening diseases, which is great. Now, physical therapists focus on the opportunity to help people be active throughout their lives, and especially later in life. More years of life means more years of productive movement and livelihood.

What is so important about the shift from physical treatment of disease or injury to an understanding of movement?

Physical therapy has brought about two decisive changes in the way medical professionals, and really all Americans, think about physical capability. The first change was to instill and then demonstrate that rehabilitation of lost function after injury or disease is possible. Second, was the shift to re-conceptualize physical therapy in terms of the science of movement.

Before physical therapy, few people believed it was possible to restore lost musculoskeletal function. Severely wounded veterans, too often, were effectively written off as being incapable of becoming productive workers. Few in the 1930s or 1940s believed children partially paralyzed by polio could regain the ability to walk. Proving that rehabilitation was possible — painstaking though that work could be — was a breakthrough.

More recently, advances in neuroscience and insights from physical therapy have helped us understand movement as an integrated process; a continuum of neurological and physical processes.

USC’s approach is not purely clinical in the sense that we approach restoration of motion by making a particular muscle or joint functional. Movement is about helping people perform activities to the best of their ability, or in the case of injury and disease, to recapture the ability to perform key activities. Movement is about actualizing ability, and that is as true for an Olympic athlete as it is for anyone who has been in a bad car accident, or had knee replacement surgery, or suffered a stroke. Successful physical therapists — and this is the way we approach education at USC — have a human-centered approach to their work, understanding the goals and motivation of the people they treat.

It’s interesting that the first professional organization for physical therapy was the American Women’s Physical Therapeutic Association. What more can you tell us about that?

Physical therapy was founded as a profession, really, by an amazing woman, Mary McMillan in 1918 during World War I. The Army recruited her, along with Marguerite Sanderson, to create a group of specialized physical therapists, called the Reconstruction Corps, to work with American soldiers wounded in the war. She established the first group of Reconstruction Aides to establish a training center that ultimately qualified over 800 aides, mostly women, to administer therapies to wounded soldiers. In 1921, she and about 30 other former Reconstruction Aides created the American Women’s Physical Therapeutic Association. The next year, they changed the name to the American Physiotherapy Association, inviting men and women into the profession.

Women have been pioneers and leaders in establishing and growing USC’s Division of Biokinesiology and Physical Therapy as well. Dr. Helen Hislop led the division from 1975 until 1998. Working closely with her was Dr. Jacquelin Perry, a USC faculty member and leader in gait analysis. Dr. Perry wrote the definitive textbook on gait analysis and became the world’s leading expert on post-polio syndrome.

What’s interesting about Mary McMillan and Drs. Hislop and Perry is that they created and reinforced the ethos of the profession of solving societal needs, even as these changed over the years, from working with wounded soldiers, to children and adults who had been infected by polio, to those who had strokes.

You lead the top ranked DPT program in the United States. Where do you see DPT education heading?

Just as the physical therapy profession has evolved to meet changing societal needs, so too, has our approach to education. We need to develop leaders for a rapidly changing health system. We need to integrate research and practice to advance human health. And, we need to influence local and global practice to ensure discoveries are available anywhere.

This month we initiated a hybrid online/on-campus DPT program at USC, to run in tandem with our residential DPT program. We believe it is possible to deliver many aspects of USC’s globally recognized curriculum using innovative approaches including high-quality online instruction. We have the ability to reach qualified DPT students where they live, students who are as qualified in every respect as students in the residential program, but who cannot move to Los Angeles. The hybrid DPT program will have the same curriculum, the same faculty, the same learning objectives, the same rigor, and the same clinical requirements as the residential DPT program.

Evolution and innovation always seem obvious in retrospect. Our USC faculty, staff, and students are extremely proud of our hard-earned position and reputation. We are committed to meeting the challenges of changing societal needs and improving professional education, to continue to advance, as USC’s physical therapy program always has, human health and our patients’ trust.