What is MSK?

The term musculoskeletal covers any injury, damage or disorder relating to the joints, bones or muscles. Musculoskeletal disorders are very common and the risk increases with age. The severity of MSK conditions can vary dramatically from patient to patient giving mild discomfort to some and interfering with everyday activities for other patients. Early diagnosis is essential to help ease the pain and assist patients in living a relatively normal pain free life. Factors that can affect symptoms in MSK conditions include age, occupation, activity level and lifestyle.

How the service works

Your GP will send us a referral outlining the problems you have been having. This is then assessed and triaged by our experienced clinical team, and you will be assigned to the most relevant professional for your initial assessment appointment. This is likely to be to:

  • A physiotherapist
  • An extended scope practitioner (ESP)
  • A general practitioner with a special interest (GPwSI) in musculoskeletal problems
  • A hospital consultant (orthopaedics, neurosurgery/spinal orthopaedics, rheumatology, chronic pain)
  • A podiatrist, occupational therapist or hand therapist

Extended scope practitioners (ESPs) are experienced physiotherapists who have undertaken further postgraduate training to work beyond the scope of standard physiotherapy practice. For example, they can request investigations such as ultrasounds or MRIs, interpret the results of investigations to plan management with you, and many are trained in the administration of steroid injections; some can also prescribe medications. At your initial assessment with an ESP, you may not receive any specific physiotherapy input (although they may give you exercise advice or leaflets), but they may subsequently refer you on for formal physiotherapy.

General practitioners with a special interest (GPwSI) in musculoskeletal medicine have undertaken further training and assessment to develop the expertise to deliver a high quality clinical service to patients with musculoskeletal problems, beyond the scope of their core professional role, and to carry out advanced treatments such as ultrasound-guided injections, not normally offered by other GPs.
Your GP may already have arranged x-rays or other imaging, but if further tests are needed to better assess your situation, this will be arranged with you.

Shared decision-making

At this initial assessment, a preliminary management plan will be agreed with you. We want you to be involved in the decisions about your healthcare, all the way through your treatment pathway, at any point where a decision needs to be reached.

We are committed to the principles of shared decision making, so that there is “no decision about me, without me” and it is therefore important for us to know what factors matter most to you so that we can collaborate with you to plan the best course of action for you. Your experience of your symptoms, your social circumstances, your attitude to risk, your values and your preferences are just as important in reaching a plan as the clinical information that your healthcare professional can provide.

There is good evidence that involving you fully in decisions about your healthcare often leads to better results for you, and you will hopefully feel more invested in your treatment.

The Advancing Quality Alliance (AQuA) have suggested that patients ask these three questions:

  1. What are my options?
  2. What are the pros and cons of each option for me?
  3. How do I get support to help me make a decision that is right for me?

In addition, if the triage decision is to refer you on to a hospital service such as orthopaedics or rheumatology, we will call you to discuss the referral options which are open to you.


Orthopaedics covers the diagnosis and treatment of all musculoskeletal problems and sports injuries.
If appropriate, you will be referred to an orthopaedic consultant specialising in the affected area, if you may require surgery.

We will contact you to ask you if you have a preference of hospital to be referred to, and we endeavour to ensure that you are seen in the location which is most convenient for you. Please note that certain hospitals are unable to accommodate patients with complex medical problems, and there may be some limitations to suitability for surgery in view of other ongoing medical problems.

Pain management

Advice on, and sometimes prescription of, relevant painkillers if these have not previously been used to full effect.

Certain procedures can be carried out in clinic for pain relief, such as:

  • Acupuncture
  • Steroid injection (often using ultrasound guidance) to peripheral joints eg. shoulder
  • Transcutaneous electrical nerve stimulation (TENS)
  • Trigger point injections

Others may be performed under sedation in the operating theatre, such as:

  • Facet joint injection
  • Lumbar sympathetic block and chemical sympathectomy
  • Radiofrequency thermocoagulation
  • Sacroiliac joint injection
  • Stellate ganglion block

Information leaflets are given to patients at their outpatient consultation, with careful consideration given to the likely risk and benefit of each. Experienced professionals perform these procedures.

If you have been referred due to chronic pain, you will likely be seen by a consultant or a specialist nurse in the first instance.


In order to ensure that we can provide access to physiotherapy services across the whole of Bedfordshire, we have a number of physiotherapy providers working with us. We aim to provide quick access to high quality physiotherapy at a location which is convenient to you. We are working with physiotherapists based in hospitals and local clinics in order to provide excellent quality NHS services to patients.

Chartered physiotherapists are experts in human movement with professional training in anatomy, biomechanics and physiology. The team is proactive in ongoing clinical development with a wide range of postgraduate specialist skills enabling them to provide the appropriate assessment and treatment for a wide variety of clinical conditions. Their practice is regularly audited and our treatments are monitored by outcome measures to ensure we are effective in our treatment techniques.

Our musculoskeletal physiotherapy services are dedicated to helping you get back on your feet quickly and back to doing things you enjoy.

Treatments available

Following your initial consultation a treatment programme will be specifically developed for you and may include:

  • Manual therapy
  • Postural advice/ergonomics
  • Gait assessment and re-education
  • Tailor-made exercise regimes
  • Gym/swiss ball regimes
  • Preventative exercise regimes
  • Accelerated rehabilitation
  • Electrotherapy
  • Acupuncture
  • Pilates
  • Taping
  • Sports rehabilitation
  • Soft tissue massage
  • Advice about self-management

*Please note not all treatments will be available at all sites


Podiatrists provide some services to musculoskeletal patients, such as gait assessment and orthotics. If this is appropriate for you the musculoskeletal service will arrange for you to be referred.

Radiology and imaging

We offer a variety of imaging services including:

  • X-rays
  • Ultrasound imaging- MRI scans
  • CT scans
  • Bone scans
  • Bone density scans
  • Nerve conduction studies

We are often able to offer a choice of locations for imaging, and will arrange the most convenient/appropriate choice for you.


Rheumatologists manage joint, bone, muscle, skin and connective tissue diseases which are classified as rheumatic diseases, which may be inflammatory or non-inflammatory.

These include:

  • Rheumatoid arthritis- Fibromyalgia
  • Gout
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Polymyalgia rheumatica
  • Inflammatory arthritis
  • Reactive arthritis
  • Scleroderma
  • Connective tissue disease
  • Systemic Lupus Erythematosus (lupus)
  • Osteoporosis

If we feel that you would benefit from input from the rheumatology team, we will try to ensure that you have had relevant blood tests performed prior to being seen by the specialist.

Spinal and neurosurgery

If you need back or neck surgery, this may be undertaken by a spinal orthopaedic surgeon or a neurosurgeon. If you need surgical input for your back or neck problem, then we will arrange the most appropriate referral for your needs.