Diagnosis-first musculoskeletal care

Non-surgical treatments for musculoskeletal pain

Persistent pain is not a reason to choose a treatment before the diagnosis is clear. We start by identifying the likely source of your pain, then compare rehabilitation, injections and device-based options against the evidence, risks, cost and your goals. Not every treatment suits every condition.

Start with your condition Book an assessment

Dr Joshua Hatch discussing a diagnosis and treatment plan with a patient — Assessment comes first. Options are then compared against the diagnosis, evidence, risks, cost and your goals.

Foundation — diagnosis, education and rehabilitation

The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.

Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. See how assessment works

Muscle and symptom-modifying options

Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.

Wet needling and trigger point injection A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. View treatment details Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. View treatment details V-ACTOR vibration therapy Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. View treatment details

Energy-based treatment options

Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.

Radial or focused shockwave? Read the overview

Radial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. View treatment details Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. View treatment details EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. View treatment details

Biologic and joint injection options

Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.

Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. View treatment details Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. View treatment details Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. View treatment details

Nerve-targeted options

Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve—not simply because pain is present.

Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. View treatment details Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. View treatment details

Where cortisone fits

Corticosteroid injection is reviewed separately for each diagnosis. It is an occasional tool, used sparingly.

Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.

So we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.

When we would still consider it

Pain severe enough to block rehabilitation
A clear inflammatory or bursal target on imaging
A specific short-term goal — a trip, a procedure, a return to work
Diagnostic use, where the response tells us where the pain is coming from

When a cortisone injection is worth doing, and when it is not

This is general information only and suitability is assessed individually. Not every treatment suits every condition — each condition page sets out where these options sit for that specific diagnosis. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

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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