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Musculoskeletal Therapy / Physical medicine is the management by medical practitioners of acute or chronic musculoskeletal injury, disease or dysfunction. Its aim is to address somatic dysfunction — impaired or altered function of related components of the somatic (body framework) system. This involves skeletal, arthrodial and myofascial structures with related vascular, lymphatic and neural elements. (Adaptation of International Classification of Diseases, 2nd Edition, 1973). Treatment includes the application of physical modalities including manual therapy. Other therapies, such as pharmaceuticals ,or injection techniques, are also used to restore normal function. The “Blomberg” technique, prolotherapy & platelet rich plasma (see below) are examples of the injection techniques utilised.

Physical Medicine involves detailed history and examination in order to localise a complaint to a specific region and, if possible, a specific anatomical structure, and to define its relationship to movement and function.

The purpose of Musculoskeletal Theraphy/ Physical medicine is to correctly manage musculoskeletal dysfunctions, including restricted joint motion, muscles which are in spasm or which are hypotonic, altered muscle firing patterns and tight connective tissues such as ligaments or fascia. Such dysfunctions typically cause joint restrictions, pain, and nerve or vascular entrapment.

A biopsychosocial assessment is made , particularly with an emphasis on avoiding the development of chronic pain syndromes by appropriate early intervention. There is a greater emphasis on the “bio” in biopsychosocial. Highly skilled manual examination and postural examination skills are used as part of an integrated management. Patients are instructed in self management of their condition using very specific exercises to mobilise and release shortened musculature, and to strengthen weakened musculature. The prescription of medication plays a reduced role as gentle manual therapy, injection of normal saline or lignocaine to muscle tender points and specific exercise prescriptions are the mainstay of most treatments. Rarely would a referral to a psychiatrist, pain clinic, rheumatologist or other practitioner or therapist be required. At times advanced imaging is required to exclude serious disease. Accurate diagnosis by clinical examination including palpation (scientifically supported eg palpation to find a symptomatic facet joint) does not require diagnosis by exclusion using multiple often expensive investigations (also scientifically supported).

Diagnosis is made by taking a thorough history, noting the severity and location of the symptoms. Examination takes into account posture, gait and muscle behaviour patterns, followed by detailed examination to reproduce the symptoms by palpation and joint motion testing. Care is taken to exclude possible underlying disease.

Some of the problems that can be treated:

Treatment will depend on examination findings, and may include

Mobilisation employs rhythmical oscillations of a joint to encourage freer motion.

Manipulation involves applying a short thrust to a restricted joint to remove a dysfunction.

Muscle energy technique can be used to find and treat the causes of all types of pain. It relies on the concept that joints may be held out of place by muscles which have excessive tone. The technique uses a series of gentle coordinated muscle contractions, coordinated with breathing, to recalibrate the precise muscle spindles which cause the muscles to hold the bones in less than optimal position.

Counterstrain is an indirect technique which involves placing the spasmed muscle or dysfunctional joint in a position of maximum comfort, holding this position till the tissues relax and then gradually re-positioning the body to a normal neutral position.

Facilitated positional release is another indirect technique which involves positional placement towards a direction of freedom and away from restriction barriers. Positional placement involves a balance in flexion, extension and side-bending and then applying either compression or torsion which then induces release of tight or restricted tissue.

Ligamentous release works on the ligaments or connective tissue sheets (fascia) that surround a tight joint. It aims to rebalance tight or loose ligaments to return a joint to its normal physiological position. It involves compressing or decompressing tight tissues until a balance is found allowing a release into normal functional position.

Myofascial spray and release technique involves using a vapo-coolant spray (ethyl chloride) being applied to tight or painful muscles before using muscle energy technique to release them. This is useful for acute or chronic conditions and is especially valuable where a body region has become too sensitive.

Other modalities may involve the injection of a short acting local anaesthetic (1% xylocaine) into chronic painful muscle tender points before applying some of the above techniques. Likewise low-level infrared laser (830 nm Ga-Al-As) or ultra-sound may be used to augment the therapy.

Exercise prescription is one of the most essential principles of our treatment regime. Once your key problems are identified, specific exercises can be taught to help alleviate your problems. Photocopied sheets of these exercises will be provided and you will be encouraged to undertake an appropriate exercise or stretch program. For chronic or recurrent problems, treatment by experienced practitioners is not enough to keep pain at bay. A daily release program is required for this; for example, home exercises augmented by weekly yoga, Pilates or Tai chi classes. Regular swimming, walking or gym classes may be prescribed.