Musculoskeletal medicine is an emerging specialty in Australia dealing with pain and dysfunction in the musculoskeletal system. It is accepted as a specialist qualification in New Zealand, but not yet in Australia. Musculoskeletal Physicians are trained and regulated by the Australasian Faculty of Musculoskeletal Medicine (AFMM).
Dr Victor Wilk is a founding member and past president of the AFMM. 15% of all general practice consultations relate to aches and pains and loss of use of the musculoskeletal system. The most common aches and pains in the body are the back, neck, shoulder, elbow, hip and knee. Although sometimes labelled as arthritis:, there are other possible causes of pain. For instance in arthritis of the hip, as well as pain arising from within the joint, there may be additional pain related to surrounding muscles cramping up. Two people may have similar looking X-rays but vastly different pain experiences. In many cases the exact source and cause of pain are unknown and are not evident using common tests. The term “musculoskeletal pain” or “dysfunction” is used to describe these conditions. The pain is real, but may not evident on x-rays and even MRI scans. It means that the problem lies somewhere in the bones, joints, nerves, muscles of the affected part of the body. Sometimes the pains are “referred from a nearby area of the body and have been misdiagnosed by a less thorough examination”.
Musculoskeletal medicine complements other existing specialties such as rheumatology, orthopaedic surgery and rehabilitation medicine. Some patients are told that surgery is the only option to manage their chronic pain. One example is disc prolapse where many doctors are not aware of the benefits of specific injection techniques such as transforaminal epidural injections which have reduced the need for surgery by 50% in one recently published study. Some injections use cortisone to reduce inflammation, while in other cases cortisone is not needed. Recently there has been increasing interest in the use of “regenerative therapy” involving injections of the persons own blood (Autologous blood injections and Platelet Rich Plasma) or glucose (prolotherapy) to stimulate tissue repair.
Musculoskeletal Physicians specialise in these injection techniques and also Radiofrequency Nerve Ablation for the management of chronic lower back, neck pain and associated headache. More information can be found on these various injection techniques under each section on this website.
The site of injection is into the sacro-coccygeus muscles, which are the remnants of the tail muscles of animals. Animals use their tails to help them with balance. As we don’t have a tail, one theory is that these muscles may go into spasm in response to an injury. The pain from these deep muscles may be difficult to localise and can be felt in the lower back, buttock or spreading down the leg.
A quite common, painful disorder of the spine, in which the outer layer of an intervertebral disc ruptures and part of its pulpy core protrudes, causing painful and sometimes disabling pressure on a nerve. About 95% of disc prolapses occur in the lower back, but they can affect any part of the back or neck.
Fibromyalgia itself is not a disease in itself, but the term is used to describe people complaining of widespread aches and pains in the muscles and joints throughout the body, combined with sleep disturbance and fatigue. The problem is four times more common in women than in men, and the age of onset is between 30 and 40.
Pentosan polysulfate sodium (PPS) has had coverage in the media lately as an effective option for people with disabling osteoarthritis. It is still in the experimental phase of development – but is available for suitable patients here at Brighton Spine and Sports Clinic.
Otherwise known as dextrose prolotherapy, this technique involves injecting of a mixture of Dextrose (glucose) and local anesthetic into painful ligaments and joints. The idea was to cause thickening, tightening and strengthening of the tissues through scarring. Studies confirm that indeed the results lead to about a 40% increase in collagen fibre strength and cross sectional area of tendons and ligaments. Dextrose prolotherapy has also been shown to reduce pain in arthritic joints.
Dr Victor WilkMusculoskeletal Medicine
MBBS Grad. Dip. Musculoskeletal Med.
Victor Wilk is a Musculoskeletal Physician and Medical Director of the Brighton Spinal Group. He is a past president of the Australasian Faculty of Musculoskeletal Medicine. From a background originally in sports medicine in the early 1980s, Victor has over 20 years of experience in dealing with acute and chronic back pain problems. He has completed a post graduate diploma in Musculoskeletal Medicine and a masters degree in Pain Medicine. In addition to his work at Brighton, he has developed guidelines for managing low back pain for the Royal Australian College of General Practitioners, and regularly gives lectures and seminars to doctors and allied health professionals in Australia and overseas. He maintains an open minded holistic approach in diagnosing and managing difficult spinal problems. At Brighton he oversees pain management programs utilising the onsite gymnasium. Specific treatments used also include prolotherapy, platelet rich plasma and cortisone injections for muscle and tendon problems. Dr Wilk also performs x-ray guided injections and denervation techniques for chronic spinal pain, headaches and sciatica at the Alfred Centre, Melbourne.