My diagnostic and treatment model today includes:
- functional biomechanic-based diagnosis
- joint releases
- trigger point therapy
- postural re-education
- pain management
Musculoskeletal pain can originate from various different anatomical structures. Ligament laxity can lead to joint dysfunction and eventual osteoarthritis. Overloading of a particular joint can lead to muscle dysfunction with the formation of active myofascial pain trigger points causing muscle shortening and pain. Vertebral spinal pathology can also be a cause of pain.
The skill of the musculoskeletal medicine doctor is to identify the biomechanical origin of the pain and have the necessary treatment models to normalise the affected anatomical structures.
Pain can be the end point of a chronic series of biomechanical failures. Whilst treating the source of the pain is important, as usually that is what the patient presents with, detecting and treating the biomechanical failures (which may be pain free) is equally important.
A patient presents with lower back pain. The pain is from a nerve irritated by a joint dysfunction over the right L4/5 lumbar vertebral facet joint. Manipulation or mobilisation of the affected joint will improve the pain. However, why did the joint malfunction?
Further findings indicate
- shortening of his back lumbar muscle with palpable trigger points
- malfunction of his right sacroiliac joint due to previous trauma causing ligament laxity
In general, I treat:
- ligament laxity using prolotherapy techniques with Dextrose or Platelet Rich Plasma
- trigger points using local anaesthetic injections and releases to normalise muscle function
- joint dysfunction using advance osteopathic releases
For more information on my treatment techniques, please view the other sections on this website.
In the latter half of the 20th century, a new medical specialty known as musculoskeletal medicine began to develop within the offices of inquiring clinicians and beyond the walls of academia and the traditional Cartesian model of medical practice. This nonsurgical approach to treating joint injury has incorporated components of classic functional anatomy, osteopathy, internal or family medicine, physiatry, anaesthesiology and pain management, and medical aspects of orthopedic surgery. If has amalgamated well-established medical practices with contemporary clinical research. This new specialty has evolved primarily in the United States and Canada; yet it has also absorbed ideas from around the world.
Over the past fifty years, musculoskeletal diagnostic and therapeutic techniques have become more sophisticated. Many new orthopedic clinical tests have emerged that demonstrate the presence of ligamentous laxity and have provided strong documentation for the diagnosis of joint instability.
The traditional medical model continues with difficulty to explain, for example, the cause of low back pain and its diverse presentations. The current medical and surgical approaches to low back pain persist in focusing on the intervertebral disc and the associated neurological pain while neglecting the soft tissues.
In England after World War II, James Cyriax, MD, began to systematically evaluate the soft tissues of the musculoskeletal system. (Cyriax 1982) By the late 1950s, he was accurately diagnosing theh cause of specific injuries based on the application of functional anatomy. He created a coherent treatment paradigm by addressing soft tissues structures in a functional way. Cyriax wrote several books that became important in England and Canada and, to a lesser degree, in the United States. His work became a significant element in the foundation upon which modern musculoskeletal medicine is based.
At the same time that Cyriax was developing his system in England, Janet Travell, MD, was following up on her pre-World War II pain studies, developing her concepts of somatic pain referral from myofascial trigger points, which are palpable, well-circumscribed, hyperirritable foci of tissue within taut bands of muscle. Travell's studies, teaching, and writing culminated in a milestone text that opened a key conceptual door by explaining many pain complaints and offering a simple, safe way to treat them. (Travell, Simons 1983) She pointed out that frequently many painful muscular points can be secondary to other musculoskeletal system problems such as ligamentous laxity and joint dysfunction. Although these observations were often well hidden within the text, they documented the failure of trigger point therapy alone to solve complex pain problems, foretelling the significance of ligament and tendon injury.
In Germany in the 1930s, another facet of musculoskeletal medicine emerged when two physician brothers, Ferdinand and Walter Huneke, discovered neural therapy. (Dosch 1984) They empirically observed that scars could generate pain both locally and remotely. They discovered that injecting local anesthetic into scars, in and around autonomic ganglion of intravascularly, could create significant and far-reaching therapeutic effects on this type of pain. This important piece of the musculoskeletal pain puzzle remained localised in Germany until the early 1980s when it began to spread worldwide.
Another significant piece of knowledge that would bring the elements of musculoskeletal medicine together was the concept of tensegrity, which Buckminster Fuller first introduced in explaining how geodesic domes remain standing in strong winds. His physical model integrated the opposing forces of compression and tension.
In the 1980s, an orthopedic surgeon, Steven Levin, MD, used the Buckminster Fuller concept of tensegrity to explain why an injury to a single ligament can create devastating and far-reaching dysfunctional musculoskeletal effects. (Levin 1986)
In the late 1980s, academic wound healing and tissue repair research addressed the basic mechanisms of prolotherapy, scienctifically explaining how prolotherapy promotes therapeutic healing. This research elegantly explained the intricate processes of inflammation, tissue repair, and wound healing. (Clark 1996) Throughout the 1990s, musculoskeletal medicine has continued to mature and become more refined.
Dr Philip Lim
Dr. Michael Mock
Dr. Sue Leong
- diagnostic model
- trigger point injection & muscle energy release
- ligamentous & fascial release
- joint manipulation & release
- platelet rich plasma
- joint injection
- muscle scar tissue hydrodissection
- shoulder joint hydrodilation
- real-time ultrasound core training
- prescriptive exercises
- breathing dysfunction & capnotrainer