Some treatments can harm patients as they cause delays and deformities to worsen
16
THE HEALTH | OCTOBER , 2023
| Column |
BONE TO PICK
THE very title of my column means I have somewhat of a grievance to settle with someone or a particular group . Sometimes , one must get their hands dirty or grind some gears . In medicine , and when I say medicine , I mean modern medicine backed by extensive research and training . Then , there is very little you can find to criticise your colleagues with . However , much goes on outside modern medicine in the name of treatment .
While some are legitimate alternative or traditional medicine , there is one group that I can ’ t seem to wrap my head around . These are the so-called “ bone-setting ” experts .
To begin with , the very term “ bonesetting ” is wrong . These people don ’ t do anything to “ straighten out ” your bones . It is impossible to . Not unless they break it .
In their so-called manipulation , they merely move your joints a little bit . With this slight movement , they claim to be able to set your bone back to its original position .
But hold up . Was the joint even displaced , to begin with ? In orthopaedic surgery , joint displacement is generally described in two ways . It is either partially displaced , which we term “ subluxation ”, or wholly displaced ( whereby the two bones that are supposed to be articulating are no longer in contact ), which we term “ dislocation ”.
These conditions are diagnosed through meticulous examination and imaging as well . If any subluxation or dislocation of joints is diagnosed , reduction of the said joint is done with sedation and painkillers .
Some patients present with stiffness in joints that are not displaced . These , again , can be treated with manipulation but are always done under anaesthesia .
These and only these are the reasons for any medical practitioner to perform any manipulation of the joints . So , how these “ bone-setters ” are , first of all , diagnosing any joint dislocation is beyond me . And for them to perform any manipulation is baffling .
THE DANGERS OF DELAYING TREATMENT
Some treat postural problems like
Limb shortening should be objectively measured using a ) true limb length and b ) apparent limb length .
Bone-setters – bane or boom ?
Some treatments can harm patients as they cause delays and deformities to worsen
Scoliosis treatment depends on severity of deformity and child ' s age .
scoliosis , shortening of the leg or even foot deformities . Scoliosis is a condition commonly seen in young teenage girls , whereby there is an S-like deformity of the spine . This condition needs to be treated promptly with either bracing or surgery , depending on the child ’ s age and the severity of the deformity .
There have been countless times when these patients , unfortunately , sought help from bone-setters before visiting the doctors . Any manipulation of the spine by them is not only useless but , worst still , could harm the patient as it delays the treatment and could cause the deformity to worsen .
I have also seen cases of patients who had differences in the length of the legs and were cured after a visit to a bone-setter . In orthopaedic surgery , we define limb length as true or apparent and do it with objective measurement .
Apparent length means the length of your limbs in a natural position to the patient . Images that these bone-setters show can be easily manipulated by
Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ).
Knee joint subluxation that requires manipulation to reduce it .
simply repositioning the body . In no way can manipulative adjustments of any joints cure true limb length discrepancy in one visit to these people .
And just FYI , it ’ s normal for the general population to have a difference in the length of their lower limbs of about one to two centimetres .
Some may argue that they have seen videos of patients in great pain and couldn ’ t move their joints . And after treatment , they can miraculously move , apparently pain-free . Have you noticed that in every video , the bone-setters always cause pain to the patient beforehand ?
ALTERNATIVE MEDICINE SHOULD NOT BE RECKLESS
There ’ s a straightforward explanation for this . It is called the pain gate theory . A simplified explanation of this theory is pain receptors send signals to your brain , and in response , the brain sends signals back to the receptor to inhibit these pain signals .
This will cause the patient to feel like they have a reduced pain sensation . But in fact , excessive pain has caused the brain to close the gate to more pain signals . It is the body ’ s natural defence mechanism , and the pain relief will last only momentarily .
There are so many other examples I can give . I had an unsuspecting patient who visited such a bone-setter for back pain and became paralysed after some manipulation .
It turns out she had cancer that she wasn ’ t aware of that had spread to her backbone , making her bone soft and vulnerable to fractures . The manipulation broke her bone , and the broken bone then pressed onto the spinal cord and paralysed her . I have also read cases of neck manipulations causing patients to have a stroke and become paralysed .
As medical graduates , we take an oath . The first thing we pledge is not to harm . Alternative medicine has a role , but it cannot be reckless . If you have bone pain or sore muscles , visit your doctor .
Physiotherapists will do a way better job of relieving some of your symptoms . One should be aware of the treatment you are receiving . But please , get it from qualified professionals . - The Health