Physiotherapy, Orthopedics, Osteopathy

Surprising Historical Detail of Conservative Treatment Methods

The Influence of Swedish Physiotherapy

Physiotherapy was significantly shaped in Sweden. Its founding father is considered to be Pehr Henrik Ling (1776-1839), who led the RCIG in Stockholm, an institute that taught physiotherapy to doctors and other students and was renowned worldwide at that time. Ling was influenced by the German gymnastics movement in developing his therapy form. Many of Ling’s graduates traveled extensively, spreading the idea of physiotherapy as a science for human rehabilitation and recovery with missionary zeal. A well-known RCIG graduate was the London-based doctor, Cyriax.

The Development of Orthopedics

During the same period, at the beginning of the 19th century, orthopedics began to take shape. Orthopedic doctors at that time treated children with scoliosis or leg deformities, utilizing techniques taught by the RCIG.

The name “orthopedics” originates from the Greek words “ortho” (straight) and “paideia” (child).

Financial and Professional Challenges

Physiotherapists back then apparently earned significantly more than orthopedic doctors, as they generally treated wealthy citizens and nobility. Due to some extreme tendencies within the RCIG (some followers believed they could cure everything with physiotherapy), orthopedists managed to question the scientific validity of this method and politically weakened the status of physiotherapy until the early 20th century, making it a less attractive profession for men (back then).

Contemporary Re-Evaluation

Efforts to re-establish physiotherapy academically in the 21st century are ongoing. Increasing insights from biopsychosocial medicine, which provides a holistic yet scientifically grounded perspective on complex bodily changes, will likely play a significant role in this endeavor.

Conservative orthopedics is now rarely practiced and was even described as an “outdated model” at the last GHBF Congress in Munich in 2017. Today, most orthopedists are specialized surgeons, as outlined by the training regulations of the German Medical Association.

And What About Osteopathy?

At the end of the 19th century, osteopathy was developed by A.T. Still, allegedly without influence from European movements of the time. It emerged as a counter-movement to the growing dominance of conventional medicine in the USA, which was still in its infancy. In the USA, osteopathy has since become a regular medical study with additional qualifications in osteopathic treatment techniques.

In Germany, osteopathy is still not a recognized profession, although some insurance companies now partially cover treatment costs due to its popularity and demand.

Commonalities Among Orthopedics, Physiotherapy, and Osteopathy

In my opinion, these three conservative methods share:

  • Massage-like pressure techniques on body tissues.
  • Incorporation of the patient’s daily life and habits into a pain analysis.
  • Recommendation of gymnastic exercises.

Evaluating treatment success is always challenging, as two complex systems (the practitioner and the patient) interact in their unique individuality, leading to potentially opposite effects even when dealing with the same issues using identical techniques by different individuals.

Therefore, I consider the experience of the practitioner, their knowledge, and their own bodily awareness as crucial quality criteria, which are mainly developed through years of (self-)study and honest engagement with the problems.

I am grateful to biopsychosocial medicine for scientifically examining and explaining these “soft” factors of interdependencies.

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