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Treatment
Orthopaedic Medicine |
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Historically, musculoskeletal disorders (in particular,
those that originate in the spine) have been very poorly understood. Dr James Cyriax, an
English physician (1904 – 1985), recognised this and developed what he referred to as
orthopaedic medicine – a systematic method of examination and treatment designed to
address these problems. Since then, a number of specialists (in particular Geoff Maitland)
have built on this work.
The two basic principles of diagnosis (both developed by Cyriax) are that:
- Referred pain is common. This occurs when the brain (which receives and interprets pain
signals) is unable to identify the exact location of the problem – as a result, the
pain associated with a specific disorder is often not centred on the cause.
However, referred pain still obeys certain, clearly defined rules – if these are
understood (typically by a person skilled in orthopaedic medicine) an accurate diagnosis
is still possible. Note – referred pain is extremely important during the
diagnosis of spinal disorders.
- If the soft tissues associated with the musculoskeletal system (e.g. muscles; ligaments;
joint capsules; bursae) are damaged, the patient will experience pain – whether
it’s referred or not. The pain itself may be intermittent, but if the tissue is
pulled (that is, put under tension) the pain can be reproduced.
The different types of soft tissue produce pain in response to different types of tension
– and they do so reliably, allowing an accurate diagnosis to be made. This system of
diagnosis is known as ‘Examination by Selective Tissue Tension’.
Once the damaged structure has been correctly identified, the treatment is targeted,
specifically at that structure. This is important, because the underlying cause of the
problem is treated – as a result, not only are the symptoms addressed (such as pain
and stiffness), they are also far less likely to return.
Orthopaedic medicine encompasses several treatments. However, with respect to back pain,
mobilisation (which is notably different from osteopathic and/or chiropractic manipulation)
is by far the most effective. It is also extremely safe and widely applicable – up to
98% of all spinal conditions will respond favourably to this technique. |
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Mobilisation works by
restoring the passive mobility of the spinal joints – this is done via carefully
applied pressure and/or oscillatory movement.
However, the mobilisation that is applied to each region of the spine is subtly different.
For example, when applied to the lumbar region, the procedure involves a small oscillatory
movement, combined with some distraction (rotation and manual traction).
However, when applied to the cervical spine, pressure and distraction are applied
separately. |
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Joints in the human body
normally move in response to active, muscle contraction – this is referred to as active
mobility; however, they can also be moved by an external force – for example, by
a practitioner using physical procedures – this is referred to as passive mobility.
In theory, if a patient were trained in orthopaedic medicine, they could mobilise some of
their own joints; however, due to its location, it is physically impossible for anyone to
mobilise their own spine [without the intervention of the backrack]. |
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| All aspects of the treatment can be focussed very
precisely, and safely, on individual joints and soft tissue. Furthermore, the exact level
of force is carefully selected by the practitioner, depending on the nature and severity
of the patient’s condition (and the extent to which the patient has improved in
previous sessions). There are no sudden, violent movements. Contrast this, for example,
with osteopathic and/or chiropractic manipulations – in relative terms, these are
violent, clumsy and poorly targeted. |
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| Efficacy |
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In our opinion, orthopaedic
mobilisation is the most effective treatment for chronic back pain and serious,
spinal disorders. It is extremely safe and widely applicable – there are virtually no
contra-indications (that is, conditions where it shouldn’t be used) and up to 98% of
all back conditions will respond favourably.
Note – although the treatment itself is very effective, orthopaedic medicine is
particularly successful because (in skilled hands) it will produce a very accurate
diagnosis. This should not be underestimated – without an accurate diagnosis, any
form of treatment is largely futile.
Like any medical discipline, however, people can specialise – we therefore recommend
that you see an orthopaedic specialist who spends most, if not all, of their time treating
spinal disorders. |
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Note that orthopaedic
medicine does not rely on imaging techniques (including x-ray; MRI scans; and CT
scans) because they are largely worthless in determining the exact cause of pain. In
general, spinal conditions are very complex – so even when a scan reveals an
abnormality in bone or tissue structure, only a very limited diagnosis can be made.
For example, virtually all scans are taken with the patient in a fixed position – but
most conditions are difficult to assess without moving the spine through several degrees
of motion. The patient is asked to perform some of the movements (for example, bending
forwards and backwards), and the practitioner performs the rest (for example, straight leg
raising; pressure; and distraction). |
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| For those who wish to learn more about orthopaedic
medicine, a large number of medical reference books exist, devoted to this field of study.
For more details, please visit our bibliography.
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Conclusions
In our opinion, orthopaedic mobilisation is the most effective treatment for
chronic back pain and serious, spinal disorders. It is extremely safe and widely
applicable:
- there are virtually no contra-indications
- up to 98% of all conditions will respond favourably
For those people suffering from serious, chronic back pain, we recommend that you visit
Mr Luklinski, at his Back Pain Clinic (Harley
Street, London). However, for those people who can neither afford personal treatment, nor
make the trip to London, we recommend that you purchase a backrack.
The backrack is an orthopaedic spinal
device (invented by Mr Luklinski), designed to mobilise the spine. By lying on the rack
and performing a series of exercises, the patient can reproduce most of the effects of
orthopaedic, spinal mobilisation – please note, however, that the backrack cannot
apply distraction (rotation and traction), nor will it mimic other, specialised forms of
treatment that are available to Mr Luklinski. The backrack is, however, (in our opinion)
the best product on the market for the treatment of chronic back (and neck) pain. |
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Price
£200 for initial examination (full cost of treatment is estimated thereafter).
This treatment is relatively expensive. However, Mr Luklinski has over 30 years of
clinical experience: in 1973, he trained with Dr Cyriax (who first developed the
principles of orthopaedic medicine); four years later, he trained in Perth, Australia,
learning the techniques developed by G D Maitland (a seminal practitioner in the field of
spinal orthopaedic medicine). |
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In North America,
orthopaedic medicine is often practised by physiatrists, specialising in the diagnosis and
treatment of musculoskeletal injuries and pain.
Professional bodies, which encompass orthopaedic medicine, include:
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