The Historical Context for the Alabama Board of Physical Therapy has been posted from the Records Disposition Authority (RDA) approved by the State Records Commission on October 15, 2025. The RDA establishes disposition requirements by designating records as either temporary records which may be destroyed after a specified retention period, or permanent records, which must be preserved in perpetuity. The complete RDAs for close to 175 agencies can be found on the Alabama Department of Archives and History website.
Alabama began regulating the practice of physical therapy following passage of the 1965 Medicare and Medicaid Act. This federal act validated physical therapy as an approved and covered medical treatment, sparking the need for a state registration and licensing authority to regulate practitioners. As a result, state legislators passed Alabama Act 1965-476, or the “Physical Therapy Practice Act” to create the state Board of Physical Therapy. While provisions of this act have since been updated to reflect new terminology and licensing privileges, much of it remains intact.
Physical therapy as a medical specialization in the United States grew out of World War I-era rehabilitation programs for wounded soldiers. Although medical pioneers already employed physical therapy principles to treat conditions like polio, palsies, and orthopedic injuries, physical therapy saw limited use outside of these contexts. That changed when the United States entered World War I. To prepare for the demands of a modern conflict, the American military undertook widespread modernization initiatives. Some leaders, like U.S. Surgeon General William Crawford Gorgas, achieved this by studying their allies’ military successes. After learning how the British used physical therapy to treat combat injuries, Gorgas endorsed the creation of a new Division of Special Hospitals and Physical Reconstruction within the Surgeon General’s Office in 1917.[1] The division’s mission “was, through the use of mental and manual work, to restore to complete or maximum possible function, any military person disabled in line of duty.”[2]
Captain Frank Granger, a medical maverick and a Harvard professor of physical therapeutics, led the new division alongside Marguerite Sanderson, an instructor at the Boston School of Physical Education. The two quickly established the division’s administrative apparatus and began recruiting personnel. Sanderson supervised the recruitment process.[3]
As no universal curriculum for physical therapy yet existed within the United States, recruitment proved necessarily flexible. To help, in early 1918 the Surgeon General’s Office coordinated with six universities to establish “emergency physical therapy training programs.” While half of these schools were in Boston, the program at Reed College in Portland, Oregon actually boasted the largest single enrollment of 200 students from 31 states.[4] Alongside these emergency training programs, the Surgeon General’s Office appended new physical therapy clinics to existing military hospitals. These clinics provided the space and tools for program graduates to later treat injured soldiers.
Recruits who passed their emergency physical therapy training programs became known as “reconstruction aides.” [5] For these roles, the division recruited strong, single women between 25 and 40 years of age, 60-70 inches in height, and between 100 and 195 pounds who could pass the same physical examination as Army Nurse Corps members.[6] Prime candidates included women trained in gymnastic and physical health programs, as their existing anatomical knowledge provided a strong foundation for physical therapy studies. [7]
Holding a civilian rather than military appointment, reconstruction aides received neither a commission nor post-war benefits. They served under and at the discretion of military surgeons who would direct courses of therapy. Dismissive surgeons allowed aides to treat only those patients “whose condition could not possibly be impaired by the application of the new therapeutic measures.” [8] However, these women’s resounding success with patients soon silenced most detractors. Indeed, after the war, Granger reflected on the aides’ performance proudly; addressing the first graduates of the United States Army Medical Department’s new physical therapy program in 1923, he recalled that:
[Reconstruction aides’] loyalty, their enthusiasm, their painstaking care, their professional ability, and their personality, not only were mighty factors in raising the morale and hastening the cure of the wounded in the hospitals, but also in providing to the too-often skeptical medical officer the value of scientifically applied physical measures. […] You are heiresses to this high heritage.[9]
Granger’s remarks proved prophetic, as the women of this WWI heritage indelibly shaped the future of the American physical therapy profession, not least by elevating leaders like Mary McMillian from among their ranks.[10]
During WWI and the interwar years, American Physical therapy pioneer Mary McMillan earned her reputation as a healer and leader. Having studied trailblazing physical therapy techniques in England before the war, she served as the U.S. Army’s first physical therapist at Walter Reed Hospital starting in early 1918. During the war, she served in both clinical and administrative roles, earning commendations from supervisors and respect from her peers. After the war, McMillian and fellow reconstruction aides retained a powerful comradery. In order to maintain the momentum of the profession and the collaboration they built during the war, these colleagues established the American Women’s Physical Therapeutic Association and promptly elected McMillian its first president in 1920.[11]
The AWPTA worked to establish standards for the physical therapy profession. In addition to outlining professional expectations, these standards also clarified the boundaries between physical therapists and medical doctors. Clearer boundaries fostered respect between the two professions, eventually earning physical therapy validation and support from the American Medical Association.[12] That professional recognition and alliance grew as the AMA established the first standards and training body to evaluate physical therapy programs in the U.S. in 1926. [13]
By the time the United States returned to war in 1941, physical therapy stood as a recognized part of military medical doctrine. However, physical therapists in the armed forces still lacked commissions. Like WWI reconstruction aides, WWII physical therapists initially retained a civil service classification. That changed in 1944 when Congress passed Public Law 78-350, granting full military commissions to physical therapists. By the end of the war, the Army Medical Department had deployed more than 1,600 commissioned physical therapists worldwide.[14] Women continued to dominate the physical therapy profession, making up nineteen of every twenty physical therapists in the United States.[15]
Following the widespread validation of physical therapy’s value during WWII, the practice gained momentum in the private sector, including in rural communities. A 1950 article in The Tuskegee Herald highlighted this growing exposure. Titled “Notes and News from VA Hospital in Capsule Doses: Physical Therapy Section,” the author explained to a predominantly rural Alabamian readership how the physical therapy unit at the Tuskegee VA Hospital functioned. The article not only describes typical physical therapy modalities, including heat, massage, hydrotherapy, and exercise, but even highlights the relationship between recommending physicians, physical therapists, and physical therapy aides. In so writing, the author introduced the basics of physical therapy to a readership likely unfamiliar with the practice, which, in turn, nurtured a growing appreciation and appeal for physical therapy.[16]
By the time President Johnson signed the Medicaid Act in 1965, physical therapy stood as a federally recognized medical treatment option. The nation at large, including Alabama, saw a surge in demand for physical therapy providers. In her book Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association, Wendy Murphy remarks that the “effects of the two programs [Medicare and Medicaid] were far-reaching. Many millions of people previously receiving little or no health care suddenly gained virtually unlimited access, with the result that the market, and the dollars available for health services and for expensive medical technology, expanded dramatically.” So great was the demand for physical therapy services that leaders within the profession feared those demands might outstrip the number of practitioners. In such a scenario, they feared patients might turn to enterprising, unqualified providers and, in so doing, devalue the professional standards the APTA had labored so long to establish.[17] Fortunately, rapidly growing numbers of accredited training programs coupled with state-level licensing requirements served to curb this issue.
In Alabama, stakeholders and legislators had actually weighed the importance of licensing physical therapeutics as early as 1963. Covering legislative updates for the Mobile Journal that year, Robert Edington remarked:
Until recently, this state did not have the facilities for proper use of trained, graduate Physical Therapists, but the construction of such fine centers of recovery as the Rotary Rehabilitation Center in Mobile County has brought to this state a number of excellent Physical Therapists. This fact is mentioned because of a pending bill in the State Legislature which will control and regulate the practice of Physical Therapy, and limit it to properly trained persons who are experienced and who have been graduated from approved schools.[18]
While the 1963 version failed to pass, Alabama lawmakers later approved Alabama Act 1965-476. This act provided for a state board to license and register physical therapists to ensure high standards of professional care for the state’s citizens. Since then, the Alabama Board of Physical Therapy has operated with remarkably few adjustments by state lawmakers. Those updates include, but are not limited to, enrollment of Alabama within the interstate Physical Therapy Licensure Compact and empowering limited patient direct-access to physical therapists without a physical therapy referrer.
The state’s enrollment within the Compact (Alabama Act 2021-115) meant that physical therapy practitioners licensed in Alabama could supplement their traditional single-state licensure with one or more additional privilege licenses. Privilege licenses enable holders to practice in other Compact member states without having to undertake additional licensure requirements in each of those states. The essence of the Compact is that member states agree to enforce a shared set of licensing criteria. Those shared standards, in turn, ensure reciprocal standards of care for all member states while easing cost and redundancy for multi-state practitioners.[19]
Subsequent to Compact enrollment, Alabama lawmakers passed Alabama Act 2024-385, providing for limited direct access of patients to physical therapists without a referral. Just as Compact membership streamlined licensing, this new law improves patient access to experienced physical therapists by removing referral requirements under certain conditions. To qualify for direct-access practice, physical therapists must have a doctorate in physical therapy or a master’s degree in physical therapy and at least 10 years of clinical experience and complete continuing education specifically focused on direct access.
Currently, there are two classes of physical therapy practitioner: the physical therapist (PT) and the physical therapist assistant (PTA). PTs undertake lengthier programs to achieve a Doctorate of Physical Therapy (DPT) degree. Their education focuses on examining, diagnosing, and treating movement dysfunction. Using these skills, PTs develop treatment regimens for their patients. Alongside PTs, PTAs fulfill clinically focused roles by implementing the physical therapy regimen devised by their supervising physical therapist; PTAs also observe and collect data on patients’ responses and progress during therapy sessions to inform their supervising PT’s treatment plans.
Today, the Alabama Board of Physical Therapy oversees licensing and continuing education for all physical therapy practitioners in the state. As a member of the Physical Therapy Compact, Alabama also recognizes multi-state licensure privileges, ensuring both professional mobility and patient access to regulated care.
[1] Office of the Surgeon General, The Army Medical Specialist Corps, ed. Colonel Robert S. Anderson (Department of the Army, 1968), 41, Library of Congress (https://lccn.loc.gov/72602023), http://archive.org/details/DTIC_ADA291497.
[2] Office of the Surgeon General, The Army Medical Specialist Corps, 70.
[3] Office of the Surgeon General, The Army Medical Specialist Corps, 70.
[4] The six schools included the American School of Physical Education in Boston, MA; the Prose Normal School of Gymnastics, Boston, MA; the New Haven Normal School of Gymnastics, New Haven, CT; the Normal School of Physical Education, Battle Creek, MI; and Reed College, Portland Oregon. Office of the Surgeon General, The Army Medical Specialist Corps, 44.
[5] During WWI, physical therapists were originally termed “reconstruction aides” or “physiotherapy aides.” As the profession codified, so did titles of its practitioners. Office of the Surgeon General, The Army Medical Specialist Corps, 41.
[6] Wendy B. Murphy, Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association, with Internet Archive (Alexandria VA : American Physical Therapy Association, 1995), 47; Office of the Surgeon General, The Army Medical Specialist Corps, 72.
[7] Beth Linker, “The Business of Ethics: Gender, Medicine, and the Professional Codification of the American Physiotherapy Association, 1918-1935,” Journal of the History of Medicine and Allied Sciences 60, no. 3 (2005): 325.
[8] Office of the Surgeon General, The Army Medical Specialist Corps, 42, 46.
[9] Office of the Surgeon General, The Army Medical Specialist Corps, 60–61.
[10] Ruby Heap, “Training Women for a New ‘Women’s Profession’: Physiotherapy Education at the University of Toronto, 1917-40,” History of Education Quarterly 35, no. 2 (1995): 138, https://doi.org/10.2307/369630.
[11] “Mary McMillan Is Elected the First President of the American Women’s Physical Therapeutic Association. – APTA Centennial,” accessed June 12, 2025, https://timeline.apta.org/timeline/mary-mcmillan-is-elected-the-first-president-of-the-american-womens-physical-therapeutic-association/.
[12] Murphy, Healing the Generations, 74–75.
[13] Murphy, Healing the Generations, 82–85.
[14] Office of the Surgeon General, The Army Medical Specialist Corps, viii.
[15] “Here’s Girls’ Chance to Enter Uncrowded, Well Paid Profession,” Sumter County Journal (Sumter County, Alabama), July 12, 1945.
[16] “Notes and News from VA Hospital,” The Tuskegee Herald (Tuskegee, AL), October 3, 1950.
[17] Murphy, Healing the Generations, 193.
[18] Robert Edington, “Legislative Notes,” The Mobile Journal (Mobile, Alabama), June 7, 1963.
[19] “Frequently Asked Questions About the PT Compact Commission,” accessed June 27, 2025, https://ptcompact.org/Resources-News/FAQ.
Sources of Information
- Representatives of the Alabama Board of Physical Therapy.
- Alabama Act 1965-476
- Code of Alabama 1975 § 34-24-190 to §34-24-220.12
- Edington, Robert. “Legislative Notes.” The Mobile Journal (Mobile, Alabama), June 7, 1963.
- “Frequently Asked Questions About the PT Compact Commission.” Accessed June 27, 2025. https://ptcompact.org/Resources-News/FAQ.
- Heap, Ruby. “Training Women for a New ‘Women’s Profession’: Physiotherapy Education at the University of Toronto, 1917-40.” History of Education Quarterly 35, no. 2 (1995): 135–58. https://doi.org/10.2307/369630.
- Linker, Beth. “The Business of Ethics: Gender, Medicine, and the Professional Codification of the American Physiotherapy Association, 1918-1935.” Journal of the History of Medicine and Allied Sciences 60, no. 3 (2005): 320–54.
- “Mary McMillan Is Elected the First President of the American Women’s Physical Therapeutic Association. – APTA Centennial.” Accessed June 12, 2025. https://timeline.apta.org/timeline/mary-mcmillan-is-elected-the-first-president-of-the-american-womens-physical-therapeutic-association/.
- Murphy, Wendy B. Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association. With Internet Archive. Alexandria VA : American Physical Therapy Association, 1995.
- Office of the Surgeon General. The Army Medical Specialist Corps. Edited by Colonel Robert S. Anderson. Department of the Army, 1968. Library of Congress (https://lccn.loc.gov/72602023). http://archive.org/details/DTIC_ADA291497.
- Sumter County Journal (Sumter County, Alabama). “Here’s Girls’ Chance to Enter Uncrowded, Well Paid Profession.” July 12, 1945.
- The Tuskegee Herald (Tuskegee, AL). “Notes and News from VA Hospital.” October 3, 1950.
For the Record 