Dr. Robert F. Kidd    

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Orthopaedic Medicine

Orthopaedic medicine is the diagnosis and treatment of musculoskeletal pain and dysfunction. Practically speaking, it is that part of medicine that looks after the aches and pains of the back, neck, head and other moving parts of the body.

Orthopaedic medicine is not a recognised speciality, like orthopaedic surgery; nor is it taught as a special subject in medical schools. Physicians who take an interest in it always come from some other area of medicine, like general practice, physical medicine, or orthopaedic surgery. There are many reasons why they should gravitate towards orthopaedic medicine, but the most important one is recognition that patients with musculoskeletal problems have been poorly served by the existing medical system.

In fact physicians who limit their practice to orthopaedic medicine (orthopaedic physicians) obtain their extra training mostly through private study, by attending conferences of orthopaedic medical organisations, and by taking short practical courses. Physicians who take an interest in problems like backache find there is a great demand for their services and they are quickly busy.

Orthopaedic physicians attempt to find the causes of musculoskeletal pain. Simply prescribing analgaesics (painkillers), muscle relaxants and “physiotherapy” is considered by most, an admission of failure. Understanding where pain is coming from and how it started is a complex project, but can be rewarding if undertaken diligently.

The starting point is always to take a careful history: When and how did the pain start? What makes it better or worse? How has it changed since it started? etc. As in the rest of medicine, history gives 80% of the answer, so time invested in this part of the investigation is time well spent.

The next step is examination, especially of body mechanics. Careful attention is paid to posture and body symmetry. Any limitation of movement is important – and provides clues as to whether muscle spasm, arthritis, or some other problem is present. The relationship of posture and movement to pain is noted, as is weakness or signs of nerve irritation or compression.

Patterns extending throughout the body are looked for, because chronic (long-standing) problems rarely are limited to just one part of the body. A wise old teacher once said of chronic pain “Gentlemen, if you are treating the patient where it hurts, you are probably treating the wrong place.” The reason that mechanical problems spread through the body is that they follow the same reflex pathways that the body uses for maintaining posture and balance. Often the key to solving a long-standing pain problem is to treat some part of the body quite remote from where the pain is felt.

Orthopaedic physicians generally learn some form of manipulation to treat (some) mechanical problems. There are many varieties of manipulation: some quick, some slow, some forceful and some very gentle. Some resemble those of chiropractic; others come from osteopathy; yet others have been developed by medical doctors (Cyriax, Mennell).

Manipulation is an art form. The skill of the manipulator is more important than the type of technique chosen. Although manipulation is not entirely free of risk, it is still far safer than the usual alternative (medication). Even the few risky areas of manipulation, (i.e. the neck) can be treated safely using alternative techniques.

Manipulation treats places where there is not enough motion. In places where there is too much motion (hypermobility), another treatment is available. This is a technique of injecting a mildly irritating substance such as dextrose, into the ligaments that support the hypermobile joint (or joints). These substances (proliferants) provoke a thickening and tightening of the ligaments, which results in stronger, more stable joints.

This technique is called prolotherapy, (or alternatively sclerotherapy, and in some circles, joint reconstruction therapy). It is a safe and effective treatment for many cases of chronic musculoskeletal pain, particularly if the pain began with an injury.

Orthopaedic physicians also take into account the patient’s general medical condition. Reflexes from internal organs can sometimes upset the functioning of the musculoskeletal system. For example, stomach problems, even when there are no symptoms, can cause pain and instability of the spine in the mid-back region. In this sort of case, treating the stomach may be the key to curing the backache.

Abnormal reflexes (interference fields) sometimes develop from surgical scars. These can upset not only the musculoskeletal system but also internal organs and other parts of the body as well. Interference fields are usually overlooked by patient and physician alike, and should always be considered if a problem began soon after an operation.

Other musculoskeletal problems are caused by disturbance of energy flow or chi along acupuncture meridea. Knowledge of these connections can be helpful, even if the physician does not use acupuncture. A troublesome wisdom tooth is occasionally the cause of an unstable low back and a pain in the leg may be due to stress on the liver.

Orthopaedic physicians have observed that patients who are tired, depressed or anxious are difficult to treat using ordinary methods. Often it is necessary to address the causes of these symptoms before the musculoskeletal pain can be properly treated. This sometimes entails evaluating nutritional status, toxic factors and emotional stresses. Tired, achy patients often respond well to changes in diet, eliminating certain drugs, replacing amalgam dental fillings or treating unresolved emotional memories. It is not unusual for a musculoskeletal problem to disappear once these background issues are dealt with.