Musculoskeletal medicine (MSK) is the examination, diagnosis and treatment of non-surgical problems of the musculoskeletal system including disorders of joints, ligaments, muscles and tendons.
Orthopaedic Medicine, as a distinct speciality, was the culmination of more than 50 years work by Dr James Cyriax who founded the speciality at St Thomas’ Hospital, London. He developed a logical system of assessment, aiming to identify MSK disorders accurately and quickly.
The important point here is that Dr Cyriax developed this entire system of examination for structures and conditions that don’t show on X rays. This includes the discs between the vertebrae in the spine, as well as all the muscles, ligaments and tendons.
With the advent of MRI, we can now actually see these structures. What is not always appreciated is that although damage to a particular structure can now be seen on an MRI, it still doesn’t tell you which structure is actually causing the pain and problem. It is movement, or loading of these structures that is far more accurate in diagnosing the problem.
Dynamic MRI has been developed to try and overcome this problem, but they are very expensive and few and far between as yet.
Another useful tool is the dynamic ultrasound scanner. These are considerably cheaper than MRI and don’t need specially designed rooms etc, but again the most accurate diagnostic tool is a detailed clinical examination. X rays and scans are there to identify any really serious pathology. Within our clinical examination are tests that will indicate serious pathology if present, but not give the precise detail. If we have any concerns then patients are referred to their GP for further medical tests.
In 2016, we will be starting our own research projects to provide even more evidence of the benefits and value of the treatments we now offer.
Physiotherapists treat dysfunctions of the body, whereas doctors treat the diseases