Back Pain Doctor
Patients regularly arrive having been quoted several thousand dollars for a treatment they have read about online. Sometimes the treatment is reasonable and the evidence is genuinely uncertain. Sometimes the evidence barely exists. This page explains how we tell the difference, and where each of the commonly promoted treatments currently sits.
How to read this page. “Not enough evidence” is not the same as “does not work”. It means the studies that would tell us are small, short, unblinded or absent. Some of these treatments may turn out to help. Until they do, we think you should know what you are paying for.
Marketed as regenerating cartilage. Randomised trials are small, protocols and cell sources differ between clinics, and reviews consistently conclude that certainty is low and long-term outcomes are unknown. In Australia these products also sit under strict regulation. We do not offer them, and we would want considerably better evidence before doing so.
Laboratory work is interesting. Human musculoskeletal trials are close to absent, product composition is not standardised, and claims are frequently made well ahead of the data. There is no reliable way to tell a patient what they are buying.
More invasive than PRP, considerably more expensive, and not shown to be better than it. Trials are small and comparisons against a placebo injection are rare. Where a needle-based injection is reasonable, we would rather use the option with the most data behind it.
A newer procedure with early-stage published data, mostly case series without a control group. The idea is plausible; the evidence that it changes outcomes for osteoarthritis is not yet there.
Bone marrow lesions seen on MRI are associated with osteoarthritis pain, so the reasoning is sound. Injecting into the bone to address them remains investigational, with small studies, real procedural risk and no guideline support.
Ozone is a reactive gas, not a medicine with an established musculoskeletal role. The published trials are small and of low quality, there is no accepted dosing standard, and safety concerns have been raised by regulators internationally. We do not use it and we do not recommend it.
One of the better-studied questions in orthopaedics, and the answer is reasonably clear: for degenerative knee disease without a mechanical block, arthroscopy has not outperformed non-surgical care in randomised trials. Multiple guidelines recommend against it.
Effects reported in trials are small, short-lived and inconsistent. The concern is less the treatment itself than what it displaces: a course of passive treatment instead of the strength work that has the strongest evidence.
A single well-targeted injection has a place. Building a plan around repeated injections does not. In tendon problems the early advantage can reverse by a year, with worse outcomes than exercise alone, and repeated joint injections have been associated with cartilage loss. Our approach to this is set out on every condition page.
No. It means the studies that would tell us are small, short, unblinded or absent. Some of these treatments may turn out to help. Until they do, we think you should know what you are paying for.
Sometimes because the reasoning is genuinely plausible and the clinician believes it. Sometimes because patients ask for it and it can be charged for. We distinguish evidence from opinion, and where evidence is mixed we say so rather than choosing the more marketable answer.
A staged pathway of twelve non-surgical treatments, worked through in clinical order, with the strength of the evidence marked against each one for your specific diagnosis — including where it is limited.
Every condition page sets out the treatments we offer for that problem, in the order we would work through them, with the strength of the evidence marked against each one — including where it is limited.
Ready for a clearer plan for your back or musculoskeletal pain?
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
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