Musculoskeletal medicine and the musculoskeletal doctor

The term 'musculoskeletale geneeskunde' is little known in the Netherlands. it is a translation from English of 'musculoskeletal medicine', where the name of the subject has been in use for a long time. We know what medicine is (science that focuses on the causes and cure of diseases). The word musculoskeletal is a composition of 'musculo' that is derived from the Latin musculus that means muscle. And skeletal that is derived from the ancient Greek and Latin skeletos that means bones/bone skeleton.

So musculoskeletal medicine is the science that focuses on the causes and curing of diseases of muscles and bones? That is the correct translation, but does not cover the load of what an musculoskeletal doctor does.

What does the musculoskeletal doctor do?

This doctor is looking for ways to improve musculoskeletal complaints. This means back pain, neck pain, complaints of shoulder, hip, arms, legs and headache. But not everything. To find that out, he conducts a good conversation and physical examination. Since all kinds of structures and factors can play a role in the development and maintenance of complaints, this can not be done in 10 minutes. In my practice, 60 minutes is planned for this. Depending on the problems found, the musculoskeletal doctor can treat this himself or he will refer to another suitable care provider. Since more factors play a role in chronic complaints in particular, treatment will often consist of more aspects ranging from advice to exercises to forms of joint mobilization to behavioral change. The broader the musculoskeletal doctor has focused on treatment options, the more he can offer.

Limits

As written: not everything is treatable with musculoskeletal medicine. It is therefore important to respect those limits. It prevents unnecessary treatments with possible damage as a result: loss of time, costs and risk of extra complaints. The musculoskeletal doctor will therefore also have to have a lot of knowledge at a high level and have knowledge of what other care providers can mean in the field of health care. For example, bone cancer is the field of the oncologist, the replacement of a worn hip belongs to the orthopedic surgeon, rheumatoid arthritis is the specialty of the rheumatologist.

Opportunities

The number of complaints of the musculoskeletal system increases. The aging population plays a role and probably also the increasing physical inactivity due to modern technology. The musculoskeletal doctor has his own place between general practitioner, orthopedist, neurologist, sports doctor, rehabilitation doctor, physiotherapist, remedial therapist amongst others. He combines that knowledge and skills and adds his own insights. This broad orientation makes him widely employable in the investigation and treatment of the complaints. The knowledge and skills translate into interventions that are aimed at the individual level and therefore limited in number of treatments. In our practice, the average is 3 treatments per patient.

The register of musculoskeletal doctors in the Netherlands

If you immerse yourself in the register of musculoskeletal doctors in the Netherlands and without filling in anything click on 'Zoeken'. Then you will get a list of musculoskeletal working doctors. If you click on 'Bekijk' at the beginning of the lines, you will enter the properties window of the doctor in question. In this properties window, the seventh line states: `behandelt volgens de methodiek (treats according to the methodology) ...`. You can find: manual medicine and/or orthomanual medicine. This does cause confusion. What does this mean and why is this important? Within the musculoskeletal medicine sub- or super-specialisms are again present. Roughly speaking, the doctors in 'manuele geneeskunde' examine and treat mainly on movement, and doctors in 'orthomanuele geneeskunde' examine and mainly treat the position of joints. Would you like to know more about this? Then go to the articles on manual medicine and orthomanipulation.

References
Jorritsma W, Jonquiere M, Deursen LLJM van, Hogezand MB van. Beroepsprofiel Arts Musculoskeletale Geneeskunde 2016. Dutch Society of Musculoskeletal Medicine. ISBN 978-94-90791-53-7.
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd edition. Edinburgh, Churchill Livingstone; 2000. Roberts C, Adebajo A, Long S. Improving the quality of care of musculoskeletal conditions in primary care. Rheumatology 2002;41(5):503–508.
Hutson M, Ellis R (Ed). Textbook of Musculoskeletal Medicine. Oxford University Press 2005.