Torticollis - Scoliosis - Contractures of Joints - Paralytic Joint Deformities - Congenital Luxation of the Hip - Flat-Foot - Congenital Club-Foot.

By Patrik Haglund, MD.

In orthopaedics, the study of the deformities of the human body and their treatment, mechanotherapy plays a great part. And in reference to medical gymnastics and massage it is no exaggeration to say that very few orthopaedic cases can be treated with the best results without the use of these forms of treatment. The orthopaedist does well to make use of many other means for the correction or improvement of deformities, those which lie outside the region of mechano-therapeutics, as, for example, surgical operations, forced correction with or without narcosis, and subsequent fixation in plaster, as well as purely mechanical expedients such as fixation apparatus; but each of these methods of treatment is in most cases insufficient by itself if it is not combined with others, and with suitable gymnastic and massage treatment. On the other hand, it must be strongly emphasised that gymnastics and massage alone in orthopaedic cases very seldom gain the object in view, viz., the greatest possible diminution of the deformity, or in the most fortunate cases its cure. In opposition to the gymnastic school which attaches too great importance to medical gymnastics and massage in connection with orthopaedics, stress must be laid on the fact that these methods of treatment comparatively seldom form the chief factor in orthopaedic treatment.

This fact, that it is only in combination with other expedients, surgical or non-surgical, that medical gymnastics and massage can accomplish anything in the treatment of orthopaedic cases, limits their use in these, in contrast to their use in many other cases, such as the chronic rheumatic and many slighter affections, where medical gymnastics and massage are often quite sufficient to produce a restitutio ad integrum, or the greatest possible improvement. For this reason collaboration between the medical gymnast and the doctor is even more necessary in orthopaedic gymnastics than it is in perhaps any other department of medicine, and independent work on the part of the medical gymnast * is of very little use in these cases, and is even detrimental to the patient, since it often leads to the neglect of other methods of treatment which are frequently successful when used in combination with medical gymnastics and massage. The medical gymnast's collaboration with, or rather complete subordination to, the orthopaedic specialist is therefore imperative for the sake of the patient.

There are other conditions peculiar to the medical gymnast's work in connection with orthopaedics. Thus orthopaedic treatment is often characterised by its long duration, which may be months or years, and the medical gymnast during this time takes part in quite different phases of treatment with quite different aims. At one time medical gymnastics and massage may be treatment preparatory to surgical handling, or again may serve as a necessary after-treatment to the same, or lastly may go on simultaneously with the no less important treatment by fixation apparatus. Sound knowledge of the various aims of orthopaedic treatment and patience are therefore necessary for those who give medical gymnastics and massage in orthopaedic cases, and the necessity for this last characteristic is all the greater since many of these cases are met with in children.

Further, it may be stated that the result in orthopaedic cases seldom consists of a real restitutio ad integrum, but is generally only a greater or less improvement, which, however, may be of very great value to the patient. Many orthopaedic cases may well be reckoned amongst the most hopeless, as the more severe cases of infantile paralysis and many others; but such a remarkable improvement in the condition of these patients can often be produced by perseverance, and varied expert treatment, that it plays a very great part in the whole future of the unfortunate individual.

Another condition which distinguishes gymnastic and massage treatment used with an orthopaedic aim is the relation between medical gymnastics - I mean by this exclusively the performance of movements used with a practical medical aim - and massage. In other branches of practical medicine among the various means of physical treatment the balance of power often lies with massage; in orthopaedics, on the contrary, the predominant role is played by gymnastics, especially in the form of muscle exercise. It must also be stated that in orthopaedics medico-mechanical gymnastic apparatus play a great part, so great that the use of these for whole groups of orthopaedic cases is indispensable to obtaining the best possible results, and in all cases their effect is much superior to that of manual medical gymnastics.

* N.B. - Persons untrained in medicine.

All these conditions which characterise the use of medical gymnastics and massage in orthopaedics seem to supply a good reason why a chapter devoted specially to their use in orthopaedics should find a place in a manual on medical gymnastics and massage. In orthopaedic practice I so often find evidence of great ignorance concerning the commonest orthopaedic cases and their treatment, not only among medical gymnasts, but among medical men, that I gladly acceded to the request of the author of this book to write a chapter on the subject. It is unavoidable that my work should touch on subjects already dealt with.

In such a chapter it is obvious that a detailed account cannot be given of all orthopaedic cases in which medical gymnastics and massage play a part worth mentioning; space alone would forbid. Such a detailed description of the different deformities and their treatment belongs to the instruction of medical students in orthopaedics; rational instruction in this by no means unimportant subject is unfortunately still lacking in our medical schools. The writer must confine himself to giving an account of the general aims of medical gymnastics in the treatment of deformities and the application of the general principles to certain of the largest and most important groups of deformities.