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Traditional bone-setting is a type of a folk medicine in which practitioners are engaged in joint manipulation. Before the advent of chiropractors, osteopaths and physical therapists, bone-setters were the main providers of this type of treatment. [1] Traditionally, they practiced without any formal training in accepted modern medical procedures. [2] Bone-setters would also reduce joint dislocations and "re-set" bone fractures.
The practice of joint manipulation and treating fractures dates back to ancient times and has roots in most countries. The earliest known medical text, the Edwin Smith papyrus of 1552 BC, describes the Ancient Egyptian treatment of bone-related injuries. These early bone-setters would treat fractures with wooden splints wrapped in bandages or made a cast around the injury out of a plaster-like mixture. It is not known whether they performed amputations as well. [3]
In the 16th century, monks and nuns with some knowledge of medicine went on to become healers and bone-setters after the dissolution of monasteries in the British Isles. However, many bone-setters were non-religious and the majority of them were self-taught. Their skills were then passed on from generation to generation, creating families of bone-setters. Notable families include the Taylor family of Whitworth and the Matthew family of the Midlands. [4]
With the advancement of modern medicine beginning in the 18th century, bone-setters began to be recognised for their efficiency in treatment but did not receive the praise or status that physicians did. Some of these self-taught healers were considered legitimate, while others were perceived as "quacks". In Great Britain, one of the most famous was the bone-setter Sally Mapp (d. 1737). [5] Known as "Crazy Sally", she learned her skill from her father and was known for her arm strength [6] and ability to reset almost any bone. Though she lacked the medical education of physicians, she successfully treated dislocated shoulders and knees, among other treatments, at the Grecian Coffee House in London and in the town of Epsom. [5] [6] In the United States, the "Bone-setter" Sweet family carried the skill for generations, with Charles Sweet being one of the most famous bone-setters in all of New England. [7] In Italy, Regina Dal Cin, a bone-setter who learned the skill from her mother, is considered to be an expert in the reconstruction of the congenital and antiquated dislocations of the femur. [8] [9] [10]
Bone-setters treated the majority of the population since they were cheaper than licensed physicians. Royal families would employ bone-setters when the court physicians were inadequate or inefficient. [11]
The Apothecaries Act 1815 in Great Britain called for surgeons to take courses similar to physicians, a move that would raise the status of surgeons to be more in line with that of the elite physician. This allowed for some bone-setters to transition into the medical profession and encouraged interest in bone and joint surgery. As a result, surgical instruments and tools for bone-related injuries were then developed. [4]
In some developing countries, traditional bone-setters are popular and can be the only address for treatment of bone-related injuries. Most often it will be the case that there is a shortage of orthopedic doctors and surgeons in the country and so the two practitioners coexist in the same setting. In parts of South America, Asia and Africa, traditional bone-setters treat musculoskeletal injuries in general, not just fractures and dislocations. [12] Traditional bone-setters are also known to offer cheaper services and allegedly faster treatment options. [2]
In Japan, bone-setting is known as sekkotsu . In India, practitioners are known as haad vaidyas . In China, it is known as die-da , and is practiced by martial artists. In Portugal it is known as endireita. [13] [14]
In a 1932 book on the subject, A. S. Blundell Bankart defined manipulative surgery as "the art and practice of moving joints for therapeutic purposes". [15] In an address delivered to the Royal Society of Medicine in 1923, R. C. Elmslie described the "use of manipulative methods in surgery" as having grown in recent years. He said that "formerly such practitioners were called 'bone-setters'". [16] A book review in Nature in 1934 said that manipulative surgery was "almost a monopoly of the bone-setter". [17]
A subluxation is an incomplete or partial dislocation of a joint or organ. According to the World Health Organization, a subluxation is a "significant structural displacement" and is therefore visible on static imaging studies, such as X-rays. Unlike real subluxations, the pseudoscientific concept of a chiropractic "vertebral subluxation" may or may not be visible on x-rays.
Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteopaths.
Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.
A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.
A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.
Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, and others recommending a short course in those who do not improve with other treatments.
Hugh Owen Thomas was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery".
The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. Palmer claims to have had principles of chiropractic treatment passed along to him during a seance by a long-dead doctor named Dr. Jim Atkinson. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel H. Weed coined the word "chiropractic" by combining the Greek words cheiro (hand) and praktikos.
Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.
A dislocated shoulder is a condition in which the head of the humerus is detached from the glenoid fossa. Symptoms include shoulder pain and instability. Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve.
A Bankart lesion is a type of shoulder injury that occurs following a dislocated shoulder. It is an injury of the anterior (inferior) glenoid labrum of the shoulder. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head.
A Hill–Sachs lesion, or Hill–Sachs fracture, is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. MUA is used by osteopathic/orthopedic physicians, chiropractors and specially trained physicians. It aims to break up adhesions on or around spinal joints or extremity joints to which a restricted range of motion can be painful and limit function. Failed attempts at other standard conservative treatment methods, over a sufficient time-frame, is one of the principal patient qualifiers.
Sarah "Crazy Sally" Mapp was an English lay bonesetter, who gained fame both by performing impressive bone-setting acts in Epsom and London, and by being a woman in a male-dominated profession. Bone-setting was a medical practice used to manipulate and fix musculoskeletal injuries using manual force. Mapp grew up in Wiltshire, England, and learned about the practice from her father, who was also a bone-setter. She frequently fixed horse racing injuries, but her most famous case was fixing the spinal deformity of Sir Hans Sloane's niece.
In medicine the Holdsworth fracture is an unstable fracture dislocation of the thoraco lumbar junction of the spine. The injury comprises a fracture through a vertebral body, rupture of the posterior spinal ligaments and fractures of the facet joints.
The Hume fracture is an injury of the elbow comprising a fracture of the olecranon with an associated anterior dislocation of the radial head which occurs in children. It was originally described as an undisplaced olecranon fracture, but more recently includes displaced fractures and can be considered a variant of the Monteggia fracture.
Dislocations occur when two bones that originally met at the joint detach. Dislocations should not be confused with subluxation. Subluxation is when the joint is still partially attached to the bone.
An ulna fracture is a break in the ulna bone, one of the two bones in the forearm. It is often associated with a fracture of the other forearm bone, the radius.
The treatment of broken bones and dislocated joints can be traced as far back as the Ancient Greeks. Hippocrates is credited with a method of reduction of a dislocated shoulder. 16th century Spanish texts talk about the Aztecs use of reduction of fractures using fir branches. The modern discipline of orthopaedics in trauma care developed during the course of World War I, but it was not until after World War II that orthopaedics became the dominant field treating fractures in much of the world. Today, the discipline encompasses conditions such as bone fractures and bone loss, as well as spinal pathology and joint disease.
A medial epicondyle fracture is an avulsion injury to the medial epicondyle of the humerus; the prominence of bone on the inside of the elbow. Medial epicondyle fractures account for 10% elbow fractures in children. 25% of injuries are associated with a dislocation of the elbow.