What is Musculoskeletal medicine

Musculoskeletal medicine is a branch of medicine that aims to find and treat the sources of pain arising from the muscles, bones, joints and ligaments. Often pain is felt in areas distant to where the problem is. People are generally familiar with the concept that pain from a heart attack can be felt in the arm or jaw – distant from where the heart lies in our body. The same is true for lower back, neck, and other muscular pains. Through knowledge of pain referral patterns and careful examination for tender points an assessment can be made as to the most likely cause for the painful problem. Imaging is also used to aid assessment but the aim is always to treat the patient and not the scan or xray.

Common painful conditions treated include lower back pain, neck pain, shoulder pain, lateral hip, osteoarthritis, and lower leg.

Chronic pain is a major health problem in Australia and the world with up to 20% of people living with pain daily and 80% having at least one significant episode of lower back pain.

Doctors who practise musculoskeletal medicine usually employ a range of techniques and treatments to try to improve movement, strength, flexibility and most importantly function. These can include medications, manual therapies such as mobilisations and muscle energy techniques, and injections. Individualised exercise and movement is a key component of treatment. Physiotherapists and exercise physiologists may be used to assist with developing a personal plan. Understanding and addressing the psychosocial aspects of chronic pain is also central to management. If the patient’s condition requires then referral to other specialists such as orthopaedic or spinal surgeons can be made.

Common Injections used for musculoskeletal pain include:
Cortisone (steroid) – probably the most commonly used injection for musculoskeletal pain, cortisone is a powerful anti-inflammatory drug that helps to reduce pain and swelling of the affected area. Usually acting very quickly, its effects tend to last for several weeks to several months giving a window of opportunity for physical rehabilitation to be performed. It does have some effects on the rest of the body, however, and repeated injection can have adverse effect that need to be considered.

Prolotherapy – Prolo stands for proliferative. The concept and treatment arose in the 1950s using various irritant substances to create inflammation and stimulate repair around damaged ligaments and tendons. The solution now used is a concentrated glucose that is strong enough to stimulate repair but being a natural sugar is not otherwise toxic. Despite being a sugar solution, prolotherapy has less effect on diabetes than cortisone. Repeated injections 4 to 6 times several weeks apart are usually required with the aim of providing longer term improvements in joint, tendon, and ligament function.

Peri-neural Injection Therapy (PIT) – Developed from prolotherapy and sometimes known as neural prolotherapy, PIT uses a weaker solution of glucose injected to tender points and nerve fibres under the skin using very fine needles. The glucose at this concentration has an effect on conduction channels in the fine nerve fibres that carry pain signals. In chronic pain these fibres can become overactive and sensitive. Use of PIT can help to reduce the sensitivity of these nerves and increase movement that has been inhibited. Early treatment sessions are usually close together and spread out over time.

Platelet Rich Plasma (PRP) – PRP uses similar principles to prolotherapy to stimulate repair of tissue. In this case blood is drawn from the patient just like having a blood test. The blood is then separated in a centrifuge to remove the plasma portion that contains higher concentrations of platelets. Platelets are tiny cells in the blood that are the body’s first responders to injury. When activated they release cytokines and other substances which signal the body’s repair mechanisms and stimulate tissue repair. Because of special equipment required to separate the platelets this is often more expensive but there is increasing evidence of its effectiveness, particularly for mild to moderate knee osteoarthritis. Two to three injections are usually required depending on response.

Most injections can be given at Redlands General Practice without the need for ultrasound or imaging guidance. Dr Eivers is an experienced practitioner having performed injections for musculoskeletal pain for over 15 years. If necessary for deeper or more delicate injections referrals can be made to radiologists to have the injections under imaging.

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