2010 Paulatim Magazine - RAAMC Association

The role of physiotherapy in war
Physiotherapists have been serving with the Australian Defence Force
(ADF) since 1915 when the first contingent of masseurs and masseuses
left Australian shores to serve with the Australian Imperial Force (AIF)
in Egypt. (Physiotherapy in war; H. C. Wilson; Gillingham Printers Pty
Ltd 1995: pg 1).
Masseuses had the rank of private, with the privileges of an officer
rank but were not allowed to treat officers. Masseurs held
commissioned rank. In 1915 masseuses & masseurs became part of the
medical establishment and authority was given to establish an Army
Massage Service, having an establishment of 6 honorary Lieutenant
Masseurs who worked in the Command Posts and 48 Masseuses with
the rank of Staff Nurse, who worked in the Auxiliary Hospitals in
England. Interestingly, it was not until 1919 that the UK Army got a
similar service.
In 1915 the Director General of Medical Services (DGMS) recognised
the valuable service that Masseur/ses could provide as he advised that
ìjoint injuries can be set at once, provided they are transported on ships
with facilities for massage Öî.Staff Sergeant Beck, a masseuse, wrote in
1916 from Mena House in Egypt ìthere were plentiful supplies of
injuries to knees, ankles, and lumbagoî. The range of treatment
included massage and hot air baths to open wounds treated with zinc or
copper ionization. (Physiotherapy in war; H. C. Wilson; Gillingham
Printers Pty Ltd 1995).
Much like the advancement of medicine through war, a wider concept of
physical therapy emerged towards the end of WW1. This being the
recognition and incorporation of remedial exercises aimed at the
attainment of a functional result. From this concept, ìPhysiotherapyî
and its philosophy in the restoration of movement and function through
manual and exercise therapy were born.
During WW2, there were several different treatment approaches that
were developed. For burns saline baths were provided, whereby the
physiotherapistís role was to prevent joint stiffness by graduated
movements in the heated solutions. Numerous pinch grafts were
applied, once taken the physiotherapist applied.Open wounds were
initially treated using the closed procedure, which involved primary
excision and enclosing in plaster until healing occurred. This caused
very stiff joints which needed passive & active movement and remedial
physiotherapist exercises. For orthopaedic injuries patients were moved
to Cairo. From the initial onset, the physiotherapistís role has been two
fold. To rehabilitate ADF members and return them to active duty, thus
maintaining the fighting force in the Area of Operation (AO), and to
rehabilitate ADF members who are required to leave the service
through injury to facilitate their transition to civilian life.
The Vietnam War demonstrated the need for a physiotherapist to be
well forward in the battle space. Physiotherapist LT H. Skewes was the
only physiotherapist deployed with the 1st Australian Field Hospital in
Vung Tau and undertook chest care to soldiers in ICU following mine
explosions; minor gun shot wounds or fragment wounds requiring short
term rehabilitation. LT H. Skewes worked close to the fighting, so
different to physiotherapists of WW1 and WW2 who were in the rear
echelons.
The work of physiotherapists has been no more aptly demonstrated
than from my deployment with Special Operations Task Group (SOTG),
Afghanistan. This presented a unique challenge where not only is the
physiotherapist required to adapt to the environment to effectively
apply techniques.
SOTG members are highly specialised and physically fit. Muscularskeletal
injuries whilst out side the wire (OTW) present as lower neck,
mid back, rib, lower back, or shoulder strains, with the occasional ankle
The before and after result of a localised Grade V manipulation to L4/5 to restore Lumbar extension.
9 0 P A U L AT I M – M A GAZINE O F T HE R OYA L A U S T R A L I A N A R M Y M E DICAL C O R P S – 2 0 1 0