Frequently Asked Questions
Want to learn about musculoskeletal medicine and what you can expect when you visit our clinic? Please browse our frequently asked questions and answers, or contact our team for more information.
The musculoskeletal system provides form, support, stability, and movement to the body. It is comprised of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue.
All parts of the musculoskeletal system are linked, so an arm problem, for example, may require back examination.
Musculoskeletal disorders are generally very common conditions that can affect your muscles, bones, and joints, and include conditions such as osteoarthritis, carpal tunnel syndrome, rheumatoid arthritis, tendinitis/ tendinopathy and fibromyalgia.
Certain types of activities (sports training, sitting at the same position at a computer every day, engaging in repetitive motions at work, lifting weights, having poor posture) can cause wear and tear on your musculoskeletal system, leading to musculoskeletal disorders or injuries.
You risk of developing musculoskeletal disorders can increase with age, but can also be impacted by your occupation, lifestyle, activity level, and family history.
Symptoms can vary widely from person to person, but general musculoskeletal disorder symptoms may include recurrent pain, stiff joints or swelling, affecting any major area of your musculoskeletal system, including the neck, shoulders, wrists, back, hips, legs, knees and feet.
Musculoskeletal medicine specialists treat pain and disorders of the musculoskeletal system. It is a vocational branch of medicine under the New Zealand Medical Council. Doctors undertaking this work are either registered Musculoskeletal Specialists like Dr Jenny Keightley, or general practitioners who have first level extra training in this area and are practicing Musculoskeletal Medicine as a special interest.
Assessment and management of musculoskeletal pain disorders by specialists includes accurate diagnosis and a variety of treatment options based on best available evidence. These may be pain management strategies, cognitive therapy, manual therapy, trigger point treatment, soft tissue or joint injections, drug therapy and teaching of remedial exercises and stretches. Treatment needs to be individualised, so each patient’s active involvement is vital.
Musculoskeletal Health NZ can undertake a wide range of investigations to ensure an accurate diagnosis and to determine the best course of treatment to meet your unique needs. It is often necessary to order basic x-rays and blood tests if these have not already been done, and if they will help us determine diagnosis and treatment. All tests have their limitations and are only a guide to the cause of the pain.
Other possible tests include:
MRI: Magnetic Resonance Imaging is very useful for analysing ligaments, joints and discs. There are no damaging x-rays involved and MRI is safe for most people. You will need to be able to lie still for 20 minutes in a narrow space with a loud mechanical noise around you. Headphones and sedation can help.
CT Scan: CT is similar to MRI, but uses x-rays. It is better for looking at bones.
Ultrasound Scans: These are very useful for checking tendons of the shoulder, groin and ankle. They use sound only and can be combined with treatment injections.
Medial Branch Blocks: These tests are undertaken by an Interventional Pain Specialist on referral. They are designed to see if blocking of a sensory nerve to a joint in the neck or low back would be successful in stopping a radiating pain. Usually they need to be repeated twice to confirm a positive test. If they are positive, a Radiofrequency Neurotomy
(burning the nerve within it’s covering) can be used to interrupt the pain for 18 months.
Dr Jenny Keightley specialises in a wide range of treatment options – including manual treatments, exercise, cognitive behavioural therapy, trigger points and soft tissue injections, prolotherapy, joint injections, and more. You can read specific details and benefits of each of the treatments available via the dropdown options below.
Manual treatments involve mobilisation or manipulation to help with pain and improve range of movement. The idea is that joints are meant to move, and helping a joint through its range of movement (or, in some cases, to the end of its range) will help to restore natural movement and function. Techniques can include gliding, and mobilization with or without movement.
The body must move and work to maintain optimum function. Exercise helps to keep cartilage, bone and muscle strong by continually remodelling and building structure. When some part of the musculoskeletal system becomes painful or loses range of movement, lack of use creates a cycle of weakness and imbalance. When in pain, people naturally fear that exercise will harm them, and they restrict their activities further – inadvertently making the problem even worse.
Exercise can help to build strength, flexibility, symmetry, muscle balance, and restore function. Dr Jenny Keightley can help you learn and master stretches and exercises that can be done with less pain, while moving towards your long-term goals. Exercise can be done at every age, and by everybody. No more excuses – exercise works!
Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Mindfulness Practice
Long-term pain may persist because the pain is a disease which has developed in the tissues, spinal cord and different levels of the brain, and cannot be treated by one method alone.Cognitive Behavioural Therapy, Acceptance and Commitment Therapy and Mindfulness Practice are research-based methods of pain management used by many musculoskeletal medicine practitioners, and can prove vital in helping you take charge of your recovery while using the ability of the nervous system to change. There is good evidence that they are an effective form of treatment for people with chronic pain – particularly when combined with other treatments.
Both positive and negative experiences can impact the nervous system. Negative experiences include injury, disease and stressful situations. Positive experiences include senses, thoughts, emotions, beliefs, positive memories and movement. Becoming aware of the process of neuroplasticity (how the nervous system works and changes) and being mindful of how thoughts, emotions and beliefs can impact pain allows us an opportunity to change our relationship with pain.
CBT, ACT and mindfulness training can be performed as part of a pain management consultation or by referral to a psychologist.
Trigger Points and Soft Tissue Injections
A trigger point is a portion of the muscle that has become a source of pain and spasm. It usually can be felt as a tender nodule or band and may cause pain elsewhere.
Trigger points occur in predictable patterns for every muscle in the body, and injecting a trigger point can help to eliminate it. Without injection, it may last weeks, months or become chronic. There are many ways to treat trigger points. Massage or exercises to stretch the involved muscle/s also helps.
While the trigger point is being injected, you may briefly experience the same pain that has been aching. This pain may be quite sharp, but very brief. Immediately afterward, there’s often a marked reduction in the typical pain pattern. There may also be more freedom of movement of the involved muscles with less stiffness. A series of injections may be required to eliminate pain completely.
Other Soft Tissue Injections
Scar tissue and other painful tissue can be treated with local anaesthetic, based on the theory that scars can produce long-standing pain and malfunction. Local anaesthetic has a beneficial effect on the nerve endings in the skin that register chronic pain, and can often break a self-perpetuating pain cycle.
It is thought that scar tissue can cause abnormal electrical signals that can disturb the nervous system and cause pain – sometimes even at distant sites. This means that, if you have continuing pain since an operation, a local anaesthetic injection may help.
Prolotherapy may be used as a treatment for tendinopathy, neuropathic pain, osteoarthritis, and is a low cost and safe injection treatment that is thought to provide increased strength in joints, ligaments and tendons to improve pain in these areas.
Developed by American surgeon Dr George Hackett in the 1940s, prolotherapy has been refined and researched by many other doctors since then. When prolotherapy reduces pain, mobility increases (because stiffness is often due to protective muscle spasm) and once the pain from the ligaments is relieved the muscles relax.
Research evidence for the effectiveness of prolotherapy is not yet at a point where it can be recommend for everyone, but it can be used as an option. Please note that, due to a lack of research evidence, ACC does not cover prolotherapy treatments.
Joint injections can be an effective means of treating certain joints and ligaments disorders caused by inflammation, such as osteoarthritis, inflammatory arthritis, and shoulder or hip bursitis.
Various injectable medications can be used (depending on your diagnosis and unique health requirements) though the most common medication used is cortisone. This relieves pain, swelling and stiffness by its direct anti-inflammatory effects within only a couple of days, however, pain relief from cortisone also diminishes over three months and the overuse of cortisone injections can be detrimental. Cortisone injections are best followed by a rehabilitation exercise programme.
More recently, hyaluronic acid injections (called viscosupplements) have been used in the treatment of knee osteoarthritis.Though the cost of hyaluronic acid injections is not covered by the pharmaceutical benefit, studies show an average reduction in pain of 28-54%.Time to improvement is longer (around five weeks) and there will be a need to repeat in about a year.
Epidural Steroid Injection
Lumbar caudal epidural injections for low back and leg pain
Epidural steroid injections can be used for the treatment of inflammation associated with lower back-related leg pain. Cortisone placed into the space outside the spinal cord, and between the cord and the bone, can decrease pain and allow patients improved function. Studies have shown that 30-50 % of patients with leg pain due to spinal stenosis have significant improvement in their pain for up to 6 months.
While cortisone does not change the underlying condition, it can break the cycle of pain and inflammation and allow the body to heal or strengthen. In this way, these injections can provide benefits that outlast the effects of the steroid itself.
Epidural Steroid Injection
Transforaminal or interspinous epidural injections
These injections are used if a specific nerve from the lumbar spine is diagnosed as being the cause of persisting pain in the buttock or leg. You will need referral to an interventional pain specialist, and this treatment method will be undertaken under x-ray guidance. Under local anaesthetic, cortisone and local anaesthetic are introduced into the epidural space.
There is a 70% chance of good relief of pain lasting long enough for inflammation around the nerve to settle down and spontaneous recovery to occur.
When discs or osteoarthritic joints press on a nerve as it emerges from the spine, the nerve can become irritated and swell – causing pain that is usually felt in the area the nerve supplies (usually the leg or arm). A cortisone injection (often undertaken with x-ray guidance) can relieve the swelling and settle the pain within 2-3 days. Risks or side effects may include a pain flare up within first 24-48 hours, a red flushed face for 2-7 days, diabetes temporarily worse for 2-7 days.
Musculoskeletal Health NZ offers a wide range of treatment options, but can also offer referrals for additional benefits treatments where required. You can read specific details and benefits of each of the treatments available via the options below.
PRP (Platelet Rich Plasma) Injections
Platelets are blood cells that stimulate healing and the development of scar tissue. By spinning a sample of your own blood in a centrifuge machine, the blood is separated into its components to achieve a solution with a high concentration of platelets. Studies have shown that significant benefit can be achieved if PRP is used instead of normal blood. PRP is considered for use in tendon or muscle injuries. The healing process typically occurs over 4 to 6 weeks.
Musculoskeletal Health NZ does not offer acupuncture, however this treatment methods has long been used by musculoskeletal and other doctors, as well as Chinese acupuncturists, to manage pain. For more information on acupuncture please visit Acupuncture New Zealand.
Physiotherapy, Podiatry, Occupational Therapy, Psychology
These commonly available primary health clinicians are part of the teams we work with and can give valuable support and treatment.
Other Medical Specialists
Musculoskeletal Health NZ has relationships with Orthopaedic and Neurosurgeons, Rheumatologists and other Occupational, Pain and Rehabilitation specialists. If referral is indicated, you will be informed of what to expect.
Please wear comfortable clothing for getting undressed and dressed easily.
Please bring with you to your appointment:
- Prior faxed referral from your GP or Physiotherapist
- Additional medical information
- ACC information
- A support person is very welcome
A comprehensive history and examination will take place. This may require undressing, sometimes down to your underwear, in order to properly examine your spine and joints.
Diagnosis and treatments will be explained to you and your consent sought at each stage.
Please allow an hour and a half for your first appointment, to allow for a comprehensive history and examination. Follow up appointments will generally take one hour, though this will be confirmed during your initial consultation.
Most treatments are very gentle and cause very little pain. After treatment you may experience increased pain for a day or two and then an improvement in your condition. This happens as the body settles into new patterns of movement.
Any severe increase in pain should be reported to the doctor you have seen or your GP. You can access after hours care through the 24 Hour Surgery (365 7777) or Moorhouse Medical Centre (8:00am – 8:00pm, 7 days – 365 7900).
Our standard fees are listed on our website. Please refer to the Services and Fees page for a full breakdown. Please note that payment is required at the time of your appointment.
ACC appointments are FREE to our patients. For insurance cover, we will need your insurance company number and name. Please contact us for more information about ACC and insurance-related appointments.
Please ring to cancel unwanted appointments at least 24 hours before the time of your appointment. We can send text reminders. Failure to cancel may attract a charge of $50, or refusal to make future appointments.
Your privacy is important to us. Your medical information is confidential to ourselves and your GP, unless you are needing a referral or claiming ACC – in which case your Case Manager will receive information based on your signed declaration when you register the accident. All letters are sent via a health secure electronic program.
Information about Musculoskeletal Centre that does not identify you may be required from time to time by the Faculty of Musculoskeletal Medicine for professional audits of our work. You are welcome to review your own information at any time. A letter will be sent to your GP after each consultation and a copy will be provided to you after your first visit.
We share rooms with Physiosouth on the first floor above Moorhouse Medical Centre. There is a lift available, if required. Please visit our Contact page for a map.