The Back Pain Doctor
Soft-tissue injuries fall into two groups that behave quite differently. Acute injuries follow sudden trauma — a fall, a twist, a blow — and include sprains (ligament), strains (muscle and tendon) and contusions (bruising of muscle). Overuse injuries build gradually when an activity is repeated so often that the tissue never fully recovers between sessions; tendinopathy and bursitis are the common examples. Getting the category right matters, because early protection helps an acute injury while load management and progressive strengthening are what change an overuse problem.
Assessment focuses on the mechanism of injury, what structure is likely damaged, and whether anything more serious needs excluding — fracture, joint instability, a complete tendon rupture, or in the case of a deep contusion, compartment syndrome. Most soft-tissue injuries are diagnosed clinically and need no imaging. Investigations are ordered when they will change management, such as ruling out a fracture or characterising a suspected muscle tear or haematoma.
First-line care for an acute injury is relative rest, ice, compression and elevation in the first days, followed by graded exercise to restore movement and strength; bracing is used for moderate sprains and surgery reserved for severe ligament or tendon disruption. For overuse problems the mainstay is progressive loading under physiotherapy guidance rather than complete rest — repeated corticosteroid injection around a tendon is discouraged in current Australian guidance because medium-term outcomes are poorer. Where a tendon problem has not responded to a well-delivered loading program, adjuncts such as shockwave therapy may be considered, with the evidence discussed honestly case by case.
The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.
This is the starting point for most musculoskeletal conditions.
The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.
Evidence is condition-specific; it is not a universal pain treatment.
Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.
Read moreEvidence varies substantially by condition, tissue and preparation method.
PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.
Read moreBest used for specific inflammatory or irritable pain generators, usually for short-term relief.
An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.
Read moreClinical evidence is still developing and guideline support is limited.
EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.
Read moreEvidence is condition-specific and generally less established than exercise-based care.
Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.
Read moreMost relevant when focal myofascial pain is a clear contributor.
Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.
Read moreRelevant only when the history and examination support nerve irritation or entrapment.
Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.
Read moreThis is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
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