MSK Physiotherapy Service

Warning

Conditions Musculoskeletal Physiotherapy will see

Conditions likely to benefit

General

  • Acute soft tissue/trauma injury rehabilitation
  • Postural conditions
  • Post orthopaedic elective/trauma surgery
  • Post satisfactory united fractures


Spinal

  • Non-specific mechanical spinal pain


Peripheral

  • Patellofemoral Pain
  • Shoulder rotator cuff (impingement) duration less than a year
  • ‘Acute’ tendinopathy (less than approximately 6 months)
  • Degenerative joint problems
  • Musculoskeletal conditions are variable in ‘recovery’. Many ‘acute/mild’ sprains, strains and spinal conditions will improve naturally over a 4 to 6 week period with reassurance, pain control advice and simple guidance on a graduated return to normal activities

May benefit

Spinal

  • Spinal nerve root compromise
  • Whiplash Associated Disorder
  • Spinal stenosis


Peripheral

  • Peripheral nerve injuries (Including carpal tunnel)
  • Chronic tendinopathy (duration greater than 6 months)
  • Adhesive capsulitis (depends on stage)
  • Brachial plexus injuries
  • Complex Regional Pain Syndrome- early management and advice
  • Heel Pain Syndrome (Podiatry will also see this condition)
  • Cervicogenic headaches
  • Temporomandibular Joint problems
  • Tenosynovitis (rest, splinting, injection may be appropriate)

Conditions Musculoskeletal Physiotherapy Service does not see as a primary referral

General

  • Widespread chronic pain with previous failed physiotherapy (Consider referral to pain services if appropriate or Pain Concern classes)
  • Physiotherapy re-referral for same condition in past 12 months
  • Previous attendance at pain management services for same condition (Consider re referral to pain management only if change in condition)
  • Patients with suspected undiagnosed sinister or serious pathology (Consider investigation/onward referral to appropriate service)
  • Domiciliary – housebound visits (refer to local rehab team)
  • Fibromyalgia (Consider referral to local services e.g. third sector if available or to Centre for Integrated Care)
  • Referrals for wheelchair (Refer to Westmarc)
  • Recurrent shoulder dislocation more than 1 episode, especially in patients aged 20 years or less or involved in sports (Refer to orthopaedics)
  • Systemic neurological disorders (refer to appropriate neuro service e.g. Neurology; stroke team; local rehab services etc)
  • Hypermobility Joint syndrome/Ehlers Danlos (Consider referral to Rheumatology if diagnostic uncertainty or already under care of Rheumatology with follow up appointment)
  • Post surgical complications (Consider referral to surgical service if appropriate)
  • Diagnosed Complex Regional Pain Syndrome- Severe, not responding to first line management (Consider referral to Pain Services if appropriate)
  • Facial Palsy (Consider provision of appropriate self management advice/steroids for recent onset/ Maxillofacial for chronic if appropriate)
  • Referrals for GP specified interventions only (e.g. acupuncture, injection, braces; splints. Only Refer for MSK Physiotherapy Assessment)

 


Spinal

  • Cauda Equina (for suspected CES refer to A&E via local pathway).
  • Metastatic Spinal Cord Compression (refer to MSCC Pathway)
  • Pain with neuropathic referred leg or arm pain, duration longer than 2 years (consider referral to pain services if appropriate)
  • Back pain BMI>40 Kg/m2 (Consider referral to weight management if appropriate or to Live Active)
  • Cervical myelopathy (Refer urgently to Neurosurgery)

Other Specialist Rehab Services (refer instead to each Specialist Service)

  • Rheumatological disorders – e.g. peripheral inflammatory Arthritis, spondyloarthropathy, crystal arthritis, connective tissue disease, Ankylosing spondylitis, PMR (Polymyalgia Rheumatica)
  • Pelvic Floor Dysfunction (refer to Continence Service)
  • Pregnant patients or patients less than 6 weeks post partum for pregnancy related problems e.g. lumbar/pelvic pain (refer to Maternity Services)
  • Respiratory conditions
  • Vestibular Problems, Undiagnosed dizziness, vertigo- specialist service
  • Falls (unless under 65 and directly related to an MSK problem) e.g. rehabilitation and prevention, mobility (consider referral to Falls team or day hospital as appropriate)
  • Cardiac conditions, systemic cardiovascular problems

Editorial Information

Last reviewed: 31/01/2024

Next review date: 31/01/2026

Author(s): MSK Service.

Version: 1