Supplement for the International Federation of Manual / Musculoskeletal Medicine

Introduction

In the treatment of locomotor pain, many conditions can be treated by manual methods alone, but invasive treatments are often used in combination with manual treatments, or are used on their own. This paper looks at the rationale for these invasive treatments and for evidence for or against their efficacy. The special skills of the doctor practising manual/musculoskeletal medicine (MMSM) are complemented by the general skills of a doctor treating general medical conditions, as many systemic conditions will influence or cause locomotor pain or dysfunction. The wide range of locomotor disorders can be divided, for the purpose of this paper, into conditions with structural disease causing pathomorphological change, and those with dysfunction (where there is a potentially reversible change of function). Certainly structural disease is itself likely to cause dysfunction as Lewit continues to remind us (39). A concern in treating locomotor pain is that delay in correcting dysfunction might result in non-reversible, structural change: since it was shown that results of treatment can be improved by avoidance of delay (40) and that good results can be obtained by combinations of manual and invasive treatments (4), there has been great interest in the efficacy of invasive treatments. In analysing the rationale for treatment, structural disease and dysfunction will be considered separately.

Key Words::

• invasive treatments
• injection
• steroid
• prolotherapy
• neural therapy