Back Pain | Orthotics

What Is Orthopaedics?

Orthopaedics (also ‘Orthopedics') is the medical specialty and branch of physical therapy concerned with correction of deformities, injuries, disorders or functional impairments of the musculoskeletal system. A complex system, it includes the extremities, spine, and associated structures (bones, joints, ligaments, tendons, muscles and nerves).

How Did It Develop?

Orthopaedics developed out of a necessity to restore function, correct deformity and alleviate pain. Going back to ancient times, we learn from fossils of primitive man that the same orthopaedic problems we have today were present in pre-historic times. While no written record exists, we have evidence of bone fractures, crude amputations and skull trephining. 

In the more advanced culture of ancient Egypt, we have written and physical evidence of early orthopaedic practices, focusing on fractures and surgery. While the cause of disease was not known, knowledge of anatomy and physiology was relatively advanced. There are three main categories of study of medical practices in ancient Egypt: the study of medical papyri, artistic representation, and the study of human remains.

Mummies have been found with splints on, made of bark, wood, bamboo and reeds, padded with fine linen. A carving on the entrance on an early tomb shows use of primitive crutches. Several drawings and ceramic figurines have been found depicting hump-backed individuals and those with other spinal deformities. And the Edwin Smith surgical papyrus, dated around 1600 BC and allegedly written by the genius Imhotep, records how an assortment of orthopaedic conditions should be treated (e.g. dislocated joints, spinal injuries, fractures).

The Greeks, taking orthopaedics and medicine a step further, were the first to document the scientific approach to injury, incapacity and deformity. In Homer’s account of the tenth and last year of the Trojan War, in the epic poem The Iliad, we are given details leading to an understanding of treatment of injuries sustained during the battles and to other deformities of the ancients. 

During the 3rd century B.C. anatomy was being studied in Alexandria and details of ligaments, joints, the nervous and circulatory systems recorded. Hippocrates (460 BC – 370 BC), father of Medicine, describes joint dislocations (knee, hip, elbow, mandible) corrections of club foot, treatment of fractures, and more. Hippocrates was the first to separate the practice of medicine from that of philosophy.

The ancient Romans continued the progress of the practice and study of orthopaedics and surgery. Galen (199 BC – 129 BC), the father of sports medicine, was surgeon to the gladiators. This was his first professional appointment in his home city of Pergamon., one of the great centers of culture with a library second to that in Alexandria. In his written accounts are details of how skeleton and muscles work together, how nerve impulses go from the brain to the muscles, how scoliosis and similar deformities could be corrected and much more. When he left for Rome four years later, his reputation as a brilliant practitioner and anatomist followed him.

During Galen’s period, there is documentation of the creation and use of artificial limbs, treatment of injury by compressions, identification of rickets, suturing, and rudimentary surgical instruments (drills, saws, chisels). Galen summarized the definitive works of all the Greek medical schools which preceded his time. For almost a thousand years, his works remained undisputed and all anatomical research stopped. The Renaissance scholars, by reading these works, learned about ancient Greek medical practices, as well as the developments and advances of his day. 

When the Moslems invaded Alexandria, home of the greatest library in the ancient world, they took with them many, many books, including those based on the Hippocratic texts dealing with medicine of the time. Understanding and stressing the importance of knowledge, they hungered for the wisdom of Galen, Hippocrates and their peers. Just as the Romans learned from and further developed Greek practices, so the Moslems did with Roman practices. By the tenth century, all essential Greek medical texts had been translated into Arabic. A discovery most significant to orthopaedics occurred in the 10th century --- the discovery and use of plaster of Paris for fractures and other bone injuries.
Centuries went by, with Europe in the Dark Ages. During the 12th century, medicine and science resumed to develop. Ancient texts were now being translated into Latin, with the Hippocratic school dominant until the 16th century. Between then and the early 1900’s, many great doctors and scientists added to the growing body of orthopaedic knowledge and treatment.

One of the major turning points of orthopaedics was the discovery of the x-ray in the early 1900’s. Bone structures could now be studied without invasion. This, coupled with recognition of orthopaedics as an individual specialty, led to an explosion of growth and discovery. And unfortunately, all new knowledge was put to extensive use during World Wars I and II. From Homer and the Iliad to today’s state-of-the art technology, the goals have remained the same – improvement of the human condition.

Back Pain | Orthotics


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