Services
What is Musculoskeletal (MSK)?
MSK conditions are those which affect bones, joints, ligaments, muscles, tendons and nerves
What does MSK Physiotherapy provide?
MSK Physiotherapists are specialists in providing rehabilitation for all MSK conditions. They are able to assess and manage those with specific (i.e. osteoarthritis, tendinopathy, post operative) and non specific (i.e. non specific back pain, non specific neck pain) MSK conditions.
MSK Physiotherapists focus on the individual using a biopsychosocial framework. They work with the individual to understand their needs, goals and lifestyle. MSK Physiotherapists enable people to help resolve the problems where possible, prevent recurrence and support those with long term conditions to live life to the full in the way they wish to. MSK Physiotherapy services across Lothian have a wide range of other highly skilled staff including physiotherapy assistants and exercise specialists.
MSK Physiotherapists work within both primary/ community care and acute settings each with their individual line management structure. For further information regarding each specific service please click on the link above “MSK services”.
Where indicated MSK Physiotherapists are able to escalate patients for opinion with the team of MSK Advanced Practice Physiotherapists (APPs) (Spinal & Peripheral) within integrated MSK services (iMSK). These clinicians work closely with Orthopaedic Consultants, Consultant Neurosurgeons, Neurologists and radiologists and hold regular joint virtual clinics. They are able to arrange investigations, interventional radiology and if necessary onward referral to secondary care.
The primary care workforce is expanding. Primary care clinicians include advanced practice physiotherapists and advanced nurse practitioners. These clinicians work in a similar way to GPs and will refer patients to MSK Physiotherapy for rehabilitation and use this ref help guidance to support the process. Please consider your local practice arrangements. These primary care clinicians based within GP practices do not provide ongoing rehabilitation or management which, if required, happens within the MSK physiotherapy service.
Self Referral form – for patients within Edinburgh HSCP – Edinburgh Health and Social Care Partnership – Musculoskeletal Physiotherapy (nhslothian.scot)
| Who not to refer/red flag presentations | Serious pathology as a cause of MSK conditions is considered rare, but needs to be managed either as emergency or urgent referral to relevant secondary care service. Consider below & also see relevant body area tab for further specific information and advice. Please make sure all red flag concerns have been managed prior to any MSK Physiotherapy referral |
| Emergency Conditions | Cauda equina syndrome- suspected Metastatic spinal cord compression (MSCC) – suspected Spinal infection- suspected Acute foot drop Septic arthritis- suspected Deep vein thrombosis- suspected |
| Urgent Conditions | Cervical spondyltic myelopathy- suspected Major spinal related neurological deficit/ worsening neurological deficit- suspected Insufficiency fracture Primary and secondary cancers- suspected New inflammatory arthritis/ myositis- suspected Inflammatory spinal pain – suspected |
| Consider serious pathology as a differential diagnosis if person presents with: | escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected systemically unwell (fever, weight loss) night pain that prevents sleep due to escalating pain and/or difficulty lying flat |
Who to refer-Routine
- Non specific MSK conditions i.e. non specific back pain
- Specific MSK conditions i.e. tendinopathies, osteoarthritis
- Soft tissue injuries
- Undifferentiated MSK complaints
- Chronic MSK pain disorders without significant psychological/ psychiatric/ drug addiction element (see specific service for further detail)
- via MSK pathways and iMSK services- people requiring diagnostics/ interventional radiology / neurosurgical/ orthopaedic opinion (see iMSK/ relevant body area for further detail)
- Pelvic health i.e. continence (Edinburgh & Mid Lothian- see specific services for detail as services vary across Lothian)
- Mobility assessment/ walking aid assessment
Please provide as much detail as possible to help the triage process
Who to refer-Urgent
- Off work/study due to the current MSK episode
- Main carer where current MSK episode impacting significantly on ability to provide care
- Living alone where current MSK episode severely limits ADLs & additional support required from others
- Severe radicular pain – Spinal pathways criteria satisfied (see spine tab for further information)
- Armed forces & veterans- in line with NHS Lothian policy
- Post operative / Post fracture/ significant soft tissue injury- typically referred from Emergency Department/ Minor Injuries Department/ orthopaedic trauma clinic
- Following interventional radiology procedure- typically arranged at time of referral for procedure by orthopaedics/ iMSK
Please provide as much detail as possible to help the triage process. Above criteria considered as part of triage process. Decision of priority remains with triaging clinician
Advice Only
- This service is intended to offer Primary care clinicians, MSK Physiotherapy advice on clinical problems, which may not require a formal referral/ assessment if simple advice or tips would suffice- accessed via SCI referral
- The MSK Physiotherapist has the option to put the patient on to the relevant waiting list if it is felt an appointment is necessary
- Please do not use the advice service for appointment queries- please contact the relevant MSK Physiotherapy service via tel 0131 536 1060
How to refer:
- Adults (Aged 16 or over at the date of referral)
- SCI Gateway – see below for detail
East Lothian Health & Social Care Partnership
AHP Physiotherapy East Lothian- East Lothian Community Hospital LI Physiotherapy
Edinburgh Health & Social Care Partnership
AHP Physiotherapy Edinburgh-Community MSK Hub (Slateford) LI Physiotherapy
Midlothian Health & Social Care Partnership
AHP Physiotherapy Mid Lothian – Bonnyrigg Health Centre LI Physiotherapy
Western General Hospital
AHP Physiotherapy Edinburgh- Western General Hospital LI Physiotherapy
West Lothian Health & Social Care Partnership
AHP Physiotherapy West Lothian- St Johns Hospital LI Physiotherapy WL
Please consider the detail provided within the specific body region to help support initial primary care management and referral process. Clinicians are asked to follow the Primary Care Management guidance on RefHelp whenever possible prior to making any referral. The more detail you are able to provide with regard to the history, presentation and impression, will allow for appropriate timely triage.
Refer to each body area tab for specific guidance to support primary care management
NHS Inform – Scotland’s National health information service- contains a range of self management information, tools and exercises for supporting people to make informed decisions about their health and MSK problems www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints
Versus arthritis have a range of resources to support clinicians and patients https://www.versusarthritis.org/. Versus arthritis have a professional network you can join, which gives monthly up-date on MSK. They also have a range of training programmes and resources designed to improve MSK care. You might also be interested in their Clinical Assessment Guide and Decision Support Tools
NHS Education for Scotland- MSK Evidence Base Hub http://www.knowledge.scot.nhs.uk/musculoskeletal.aspx
Self Referral form – for patients within Edinburgh HSCP
MSK Outpatient Physiotherapy Services https://weare.nhslothian.scot/musculoskeletal/where-to-find-us/
New NHS Lothian MSK Physiotherapy website coming soon
