If, after a particularly physical rugby match, you have ever experienced, first the pain and, later, the blissful relief of an expert massage, you will have no trouble understanding why some bone specialists hold the belief that good general health is the direct result of a balanced musculoskeletal system. Consisting not only of bones, the system also includes the tendons that connect them to the muscles, the muscles themselves, and the ligaments that serve to stabilise the joints. An injury or disease that may affect any one of these components will often tend to have a secondary impact on the others.
Whereas most branches of medicine tend to fall under the purview of just a single expert, such as a cardiologist or a neurosurgeon, the musculoskeletal system has managed to draw the attention of several types of bone specialists, some of whom hold a medical degree, whilst others may have an alternative qualification. In the former category, of course, is the orthopaedic surgeon. In addition to the required undergraduate degree and internship, he or she will have obtained a higher qualification in orthopaedic medicine and/or surgery.
Some orthopaedic specialists may tend to focus their attention on the repair of traumatic injuries to the musculoskeletal system, such as fractures, dislocations, tendon injuries, and torn cartilages, plus methods to correct various skeletal deformities, such as club foot, scoliosis, and kyphosis. Others, however, might prefer to concentrate on performing elective procedures, such as the total or partial replacement of the hip and knee joints – procedures that are known collectively as arthroplasty and the exclusive province of this type of bone specialist.
Regarding the earlier reference to massage, this is a tried, tested, and approved form of therapy, and one that is embraced by a number of healthcare professionals, including those trained in sports medicine. Physiotherapists also employ various massage techniques, often combining it with an appropriate exercise routine as part of a post-operative recovery programme. Because the focus of a physiotherapist is most often on the soft tissues, it is perhaps a little misleading to describe him or her as a bone specialist. In practice, rheumatologists, osteopaths, and chiropractors all conform more closely with this description, although each of these healthcare professionals tends to adopt a different approach to the treatment of their patients.
In the case of the rheumatologist, the title itself is something of a giveaway. As implied, it is the treatment of pain, swelling, and deformities of the musculoskeletal system that are the result of various rheumatic diseases that is the speciality of these doctors. Many of these conditions, such as rheumatoid arthritis, multiple sclerosis, lupus erythematosus, and polymyalgia rheumatica, are autoimmune diseases and will be treated medically by this type of bone specialist who, in most cases, will not have undergone the additional training required of an orthopaedic surgeon.
The osteopath does not hold a medical degree per se but, instead, will have gained a qualification such as Doctor of Osteopathic Medicine (DO). Their role is primarily one of providing pain relief through the manipulation of muscles and bones, notably in the neck and lower back regions. In this way, they are often able to reduce a patient’s dependence upon painkillers and the attendant risk of side effects, including addiction. Justifiably described as a bone specialist, the osteopath often relies on X-rays and lab tests to establish a diagnosis before either treating patients or referring them to an alternative specialist, where this may be more appropriate.
Like osteopaths, chiropractors are not medical doctors but must hold a relevant degree. They employ methods similar to those used by physiotherapists, focusing on the use of spinal manipulations, relaxation techniques, and temperature treatments to ease pain and to reduce muscle stiffness. Choosing the right bone specialist can be confusing, so discussing your symptoms with your family doctor should probably be the first step.