Musculoskeletal Pain Treatments

Non-surgical treatments for musculoskeletal pain

If you are living with persistent pain, injury or arthritis and want to explore your options before considering surgery, non-surgical musculoskeletal treatments may help. Our approach is to assess your problem carefully, identify the likely source of your pain, and tailor treatment to your individual needs, with the aim of reducing pain and improving function. The most suitable treatment depends on your diagnosis — not every treatment suits every condition, and this is discussed with you at consultation.

Evidence labels used on this site: Core care Good support Worth discussing Evidence mixed Only if relevant

Start here — getting the diagnosis and the plan right

Nothing further along the pathway works as well without this, and for many people it is enough on its own.

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. Core care

Settling pain enough to rehabilitate

Short-term pain control, used to open a window for the loading work rather than as a treatment in its own right.

Dry needling and trigger point therapy A fine needle into a tender band of muscle, with nothing injected. Only if relevant Wet needling (trigger point injection) The same target as dry needling, with a small volume of dilute dextrose solution injected. Only if relevant Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Good support V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Only if relevant

Energy-based treatment — no needles, no downtime

Delivered in the clinic over a short course of sessions. Often the next step when rehabilitation has stalled.

Radial or focused shockwave? Read the overview

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

Injection options where pain persists

All ultrasound-guided. Each carries a real cost and a genuinely uncertain benefit, so we go through the numbers with you before you decide.

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

If the nerves are part of the picture

Burning pain, hypersensitive skin, or pain that does not behave like joint or tendon pain. Relevant for a minority of people, and worth checking for.

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

Where cortisone fits

Corticosteroid injection is not a stage of this pathway. 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. Evidence in tendon problems suggests early relief can be followed by worse outcomes at a year than exercise alone, and repeated injections into a joint 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 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

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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Non-surgical Treatments