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James Cyriax, Father of Orthopaedic Medicine

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30/06/2013

By | From the Collections

X-ray image of spondylitis in scoliosis, Wellcome Images N0025577

James Henry Cyriax was a controversial figure often seen as an outsider in terms of the British medical establishment. His personal papers were acquired by the Archives and Manuscripts department of the Wellcome Library in 2009, and have recently been catalogued.

The collection is split into personal and biographical material, clinical notes and photographs, publications and material relating to the Cyriax Foundation. Very little personal material has survived, but this is unsurprising as Cyriax himself admitted that his personal life suffered as a result of his dedication to his career.

Often described as the father of orthopaedic medicine, Cyriax was the son of two doctors, both of whom treated musculoskeletal disorders, and grandson of a practitioner of Swedish medical gymnastics and a chemist. James Cyriax could be said to have medicine in his blood.

Upon qualifying as a doctor in 1938, James Cyriax was appointed to the post of house surgeon to the department of orthopaedic surgery at St. Thomas’ Hospital, London. It didn’t take long for him to realise that surgery alone was not suitable for most of his patients, and that there was a need for a corresponding department to deal with non-surgical issues.

He was particularly concerned that the x-rays used to diagnose musculoskeletal problems were inadequate for the purpose, which meant many patients were not receiving the correct treatment for their conditions. He also saw that the lack of communication between different specialists treating a patient (physicians, surgeons, and physiotherapists) could be detrimental to their healing.

Physiotherapist assessing range of motion and stability of the hip and knee joints in a male athlete at the British Olympic Medical Centre. Wellcome Images N0023708

Cyriax won the Heberden prize in 1943 for his essay on the pathology and treatment of chronic sprains of the elbow. He published extensively, his best known publication being the Textbook of Orthopaedic Medicine, first published as a two volume work in 1954, it has since been through over ten editions.

The same year the Textbook was first published, Cyriax was elected as a Member of the Royal College of Physicians. He never became a Fellow, possibly because of his difficult relations with his peers, who alleged that he was unable to produce scientific verification for his often controversial ideas.

Although not a mainstream figure in Britain, Cyriax and his ideas found more favour abroad. He became visiting professor of orthopaedic medicine at the University of Rochester, Medical Center, New York in 1975, and also taught in Australia, Canada, South Africa and New Zealand, as well as most countries in Europe.

Given that Cyriax’s main contributions to medicine arose because of his direct experience with patients, and that he continued to see patients up until his death in 1985, it is unsurprising that a large amount of the archive is closed due to Data Protection considerations. In time this material will provide a rich resource for researchers such as family historians, those interested in the history and treatment of conditions such as sciatica, scoliosis, and lumbago, and those researching the relationship between the patient and the medical profession.

Thermogram of acute inflammation of the right knee, Wellcome Images N0007905

James Cyriax was a prominent doctor during his lifetime, and as such attracted a number of illustrious patients. Those who sought out his services included members of prominent families such as the Mitfords, politicians including Enoch Powell, John Profumo and Oswald Mosley, and actors such as Anthony Quinn.

As a person, Cyriax was known for his strong personality, which attracted a fiercely loyal following whilst alienating the majority of his peers. It has been suggested that he relished the controversy he caused, as he saw it as the best way of disseminating his ideas.

Since his death there have been many changes in the field of orthopaedic medicine. For example, Cyriax believed that virtually all cervical, thoracic, and lumbar pain was caused by problems with intervertebral discs. This has been disproved, and today’s orthopaedic medicine practitioners have found that the ligaments play a much larger role chronic pain problems.

The catalogue of the personal papers of James Cyriax can be viewed and searched online via the Archives and Manuscripts catalogue.

Natalie Walters

Natalie Walters is Archives Project Manager at the Wellcome Library. She specialises in the management and curation of born-digital records, and has a worrying knowledge of the history of poisoning.

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3 comments on James Cyriax, Father of Orthopaedic Medicine
  • Viviane Maria Rocha Campolina

    08/07/2015

    An interesting insight into the most common sources of back pain and sciatic is provided by the progressive local anaesthetic studies performed by Kuslich et al. (1991) in patients undergoing surgery for decompression operations for disc herniations or spinal stenosis. The findings of this study accord with earlier work involving pain provocation studies around the time of surgery that identified the nerve root as the source of patients’ limb pain and THE INTERVERTEBRAL DISC AS THE SOURCE OF THEIR SPINAL PAIN (Fernstrom 1960; Smyth and Wright 1958; Falconer et al. 1948; Wiberg 1949; Cloward 1959). More recent studies have also shown THE MAJOR ROLE OF THE INTERVERTEBRAL DISC AS A CAUSE OF BACK PAIN ( Schwarzer et al. 1995). The first volume written by James Cyriax, MD (1954) attributed sudden and slow onset back pain respectively to tearing of the annulus and bulging or displacement of the nucleus. It was a rational explanation to support the Centalisation Phenomenon, the golden key for derangement syndrome describeb for Robin Mckenzie (1981, 1997) and Mckenzie R, May S (2006).
    “Cyriax believed that virtually all cervical, thoracic, and lumbar pain was caused by problems with intervertebral discs.” So HE WAS RIGHT! Not all, but many cervical, thoracic, and lumbar pain was caused by problems with intervertebral discs. It has been proved and NOT disproved in today’s orthopaedic medicine. Unfortunately Cyriax remains misunderstood by many even today .

    Reply

    • denys leclaire

      04/11/2016

      absolutely in agreement with you! Thank you for correcting that strange interpretation of the welcome library. The disc tissues are still considered some of the main structures that cause vertebral pain and derangement. Also, Cyriax was a pionneer to help us understand the difference between refered and neuropathic signs and symptoms. He had also a frontline role for the development of specific directional preference exercises for vertebral pain, what is known now as the Mckenzie method. He also had excellent clinical prediction rules for the use of traction…. After about 25 years of discrediting and putting aside traction, physiotherapists have come back to it more recently because it often works. But there has to be a specific clinical presentation for it to work and recent researches ( Fritz / Hébert /Stanton 2005/2008/2011) have just shown what Cyriax was already doing in the 70’s.

      Denys Leclaire pt Canada

      Reply

  • Darrell Skinner

    02/12/2015

    Although James Cyriax has been criticized for over attributing neck and back pain to the intervertebral disc he left a legacy in terms of orthopedic diagnosis. His contribution of our knowledge of capsular patterns, cervical and lumbar scanning exams, and system of diagnosis by selective tension was revolutionary at the time. He also reminded us to be consistently aware of possible serious pathology mimicking musculoskeletal problems and tests such as “sign of the buttock”. He was known for his strong opinions but was one of the first to put forth a systematic approach of examination.

    Reply

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