Stretching ahead

They were the forerunners of supervised exercise and they pioneered sport rehabilitation. Graham Clews reflects on the work of the remedial gymnasts

They effectively invented aerobics, then were subsumed into the CSP, and now their techniques are back in vogue. The remedial gymnasts, whose Association of Remedial Gymnasts and Recreational Therapists merged with the CSP 25 years ago, brought group instruction and a focus on exercise to the physiotherapy profession. Many young physios were not even born when RG was a profession all of its own, and former RGs say youngsters know little of its history. From a forces background (see box) RGs numbered no more than around 500 at their peak. But those relatively few practitioners had a significant effect on physiotherapy, particularly in sport rehabilitation. John Langridge was a graduate of the first remedial gymnast course for school leavers offered at Pinderfields Hospital in 1963 and he also trained as a physiotherapist. He credits RGs’ influence as the result of a pioneer spirit and the pride of existing as a minority working close to a much larger profession. ‘The training was based on exercise and the raison d’etre of RGs was class-taking,’ he says. ‘RGs therefore became confident in front of groups. The early RGs had a forces background, which gave them a natural authority.’

Positive influence

Helen Eales was one of the first civilian and female RGs, and she says RGs had a new way of approaching rehabilitation that often had a real impact on their colleagues in the health service. ‘It was not a passive therapy, we challenged the patients,’ she says. ‘It was very positive and we encouraged people to think that they can do it and they can get better. It was also fun and we used lots of adapted games. But the patients got a lot out of it, it wasn’t just fun and games for the sake of it. ‘We took the emphasis away from the injury and translated it into a positive back-to-work approach,’ she says. ‘RGs brought that approach to physiotherapy, but both professions learnt from each other.’ As the former Arsenal and England physio, and originally an RG by training, Fred Street says: ‘In the 40s and 50s the ex-service physical training instructors came out of the RAF and jollied people along and got them fit.’ He agrees that it was a move away from ‘passive’ physiotherapy. ‘It’s probably not very politically correct to say it, but a lot of the RGs were chaps who were a bit older than some of the physiotherapists. They had more experience of life in general, and consequently were a bit more confident’, he says. RGs’ real contribution, he says, was dealing with large groups of people, particularly in the days of rehabilitation centres. There were rehab centres for miners in the north, centres for dockers in port cities, and there was one just for Ford car workers in Dagenham. Many of the remedial gymnasts completed the full physiotherapy training and worked as physiotherapists in a wide range of fields.  Some became leaders in their respective fields with the most notable in the field of sport.  The nationally best known was Bertie Mee, who ran the Medical Rehabilitation Centre in Camden Road, north London, before he became the physiotherapist at Arsenal. He later took the role of manager of that club leading them to the league and FA Cup double in 1970-71.  Bertie Mee also helped to raise the standard of physiotherapy in the football league, setting up courses to train club ‘physios’ and later persuading all major clubs to employ chartered physiotherapists. Following him to Arsenal was Fred Street, and another major figure was Lawrie Brown, who initially worked in football with Manchester United, and later followed Bernard Thomas as England cricket team physio.

Coming together

Since the RG merger with the CSP, many former RGs went on to hold senior positions in the NHS, but they were not always given the credit they deserved by physios. In the early days, the profession thrived, but the NHS could not sustain training schools for two such similar professions. At the same time the job opportunities for remedial gymnasts were reducing as more physiotherapists became interested in progressive exercise therapy as a primary treatment.  CSP chief executive, Phil Gray, helped negotiate the arrangement to merge the RGs with the CSP. It was, he says, the bringing together of two equals. ‘The merger was carried out in a good spirit, although it wasn’t always that way,’ he says. ‘There had been an intense rivalry, but the work of the two groups overlapped so significantly that both parties decided the only sensible way forward was to join forces.’ ‘It sounds daft now, but in the 60s there was a lot of animosity and professional jealousy between the RGs and physios,’ says Fred Street. ‘When I did my physiotherapy training as an RG, I was seen as a traitor. Physios were seen as a benign threat, if I can put it like that. Even at a Whitley Council level there was tension because RGs were paid less.’ Qualification as an RG initially came from a six-month course, which was only available to qualified services physical training instructors, but then that increased to nine months, and then three years, the same as physiotherapy. ‘Two years was study and a final year placement,’ says John Langridge. ‘Physios slightly looked down on this and said it wasn’t a three year course. ‘There were huge problems between RGs and physios,’ he adds. ‘Some physios could see the great benefits, but the differences became indistinguishable, and the feeling was that the two professions should be brought together.’

Full circle

It’s been a quarter of a century since the RGs’ association disappeared, but John Langridge thinks the profession’s strengths may be on the way back. The drive to cut obesity, with campaigns such as the CSP’s Move for Health, political requirements to encourage people back to work, and a financial squeeze on the NHS could all play their part. Fitness instructors may well supervise exercise programmes that are prescribed for patients at sports and leisure centres. If given adequate training and supervision, John Langridge believes this could work. ‘If so, the remedial gymnast will return,’ he says. fl

Timelines

  Group Captain Charles O’Malley, who was in charge of rehabilitation of aircrew during the Second World War, changed the face of rehabilitation by using physical training instructors to encourage early movement and functional progression of all injured aircrew.  Prior to the war it had been estimated that 80 per cent of all injured aircrew would remain injured for the duration of the war.  By the active encouragement of early exercise and intensive rehabilitation, 80 per cent of all of those injured returned to active service.  These figures were mirrored in the other armed forces and this sent a shockwave through the previous concept of passive therapy where physiotherapy concentrated on machines and massage. The profession of physiotherapy was perhaps slow in embracing this new concept despite the government opening several rehabilitation centres across the country where the civilian population could be treated in the same way as forces personnel.  In 1945, a course was set up at Pinderfields in Yorkshire for forces personnel taking physical training instructors from all ervices and a few civilians with PE qualifications. The physical training instructors in the forces had become experts in this new approach and many of them obtained jobs in civilian rehabilitation centres and hospitals.  By the end of the 1950s, this source of what had then become known as Remedial Gymnasts (RG) was running out and the government was encouraged to set up a course for school leavers.  In 1960, the first course in Remedial Gymnastics and Recreational Therapy for school leavers started at Pinderfields Hospital, Wakefield. The courses already existing in the forces remained with the Army at Woolwich, the RAF at Halton and the Navy at Gosport until they all amalgamated into a combined services school at Halton. All these schools are now closed.

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Graham Clews

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