03:13pm Wednesday 13 December 2017

Musculoskeletal training could help millions

Photo of the Australian School of Advanced Medicine sign

An RACGP survey estimates six million people across
the country suffer from musculoskeletal problems costing the health
system and economy many millions of dollars every year. Many of these
people have soft tissue pain sources that are not always identified, in
their joints, muscles and ligaments.

“Soft tissue pain is a great
mimic,” says Macquarie University’s Associate Professor Michael
Creswick. “These disorders can mimic many other health problems and yet
are diagnosable and quite often very treatable if doctors are
appropriately trained. Early intervention can minimise chronic pain and
long term medication such as anti-inflammatories and opioids.” 

Creswick
and Associate Professor Rod Ayscough have helped establish the
country’s only Master of Medicine Degree in Musculoskeletal Medicine at
Macquarie University’s Australian School of Advanced Medicine. The
course specifically trains qualified GPs to better
identify and treat musculoskeletal disorders. Such training is also
growing in the United States and Europe as more is understood about
musculoskeletal conditions. 

Creswick believes that doctors,
after ruling out serious causes of pain, often refer patients to
therapists for treatment of soft tissue pain without a specific
diagnosis. This is because the source of pain is not always apparent
from the application of a standard medical approach.

“Our course
participants are trained in recognising pain referral patterns,
performing a detailed physical examination and applying advanced
physical medicine treatment skills. These include gentle manual therapy,
the injection of muscular “trigger points” if clinically indicated and
specific exercise prescription. 

“There has been a worldwide
medical trend towards treating pain as an entity in itself, and to
diagnose persisting pain as intractable, due to nerve damage. However
some people who have been told they have “neuropathic” pain have been
found to have ongoing unrecognised but treatable musculoskeletal, soft
tissue disorders, without nerve damage,” Creswick says. 

Ayscough
and Creswick train GPs to look for possible sources of pain from soft
tissues, including muscles, ligaments, the bony attachment points of
muscles, as well as associated nerves. “How these structures interact in
relation to each patient’s posture and movement is an important part of
diagnosis and treatment.”   

“GPs
already have an excellent overview of the whole patient and knowledge of
underlying serious diseases. We use a medical model of diagnosis, so we
only train experienced GPs. Often, with further training at ASAM, known
pain patterns will be evident on examination, and our graduates can
immediately treat a musculoskeletal problem. If the patient responds and
stays pain-free, then they can avoid expensive and sometimes
unnecessary tests. One of the great advantages of primary care is the
ability of the doctor to treat patients and observe progress over short
timeframes, and adjust management based on those observations. If a
patient doesn’t respond as expected, a revised diagnosis may be
apparent, or it may be appropriate to order radiological imaging or
blood tests to aid diagnosis,” says Creswick. 

“Many patients
have muscular and postural patterns that are leading to their pain, and
that’s what we train our graduates to identify and treat.”


Any enquiries from the media should be directed to:
Paul Wild

phone:(02) 9850 1055
email address: paul.wild@mq.edu.au


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