A handful of muscles are responsible for the majority of musculo-skeletal pains.
At least 50% of MSK pains origin from its enthesis.
Larger the enthesis, usually greater the pain.
Deeper the muscle, more symptomatic it can be.
A primary lesion often develops secondary lesions on muscles, tendons and ligaments that share same or neighboring function.
An acute pain of 1-2 month has a greater chance to heal if treated early to prevent chronic pain.
Chronic pain often involves the secondary development of central and peripheral neuropathic pain.
Sciatic and Brachial plexus radiculopathy are often mimicked by coxal myofascial and scapular syndromes.
A chronic multi-factorial pain treatment will often fail if not addressed with a multimodal therapy.
Anatomically referenced Perifacettal infiltrations, in my opinion, are more effective than facettal blocks because facettal pain is more often myoenthesopathic in origin.
A lesion that chronicises will do so with myofascial, inflammatory and neuropathic (central and peripheral) responses. That is why an aggressive therapy is indicated after 4-8 weeks.
Arthrosis and osteoarthritis are often primary lesions that develop secondary myofascial and enthesopathic lesions. A joint infiltration can fail because of ignored secondary lesions. This is also often true of epidurals failing due to secondary lesions.
An efficient pain control treatment by infiltration will significantly reduce the need for pharmacology.
Pharmacology, even when respecting guidelines can cause cognitive, emotional and sexual side-effects.
With both anatomically referenced infiltrations and ultra-sound guided infiltrations one requires many years of experience to be considered an expert.
The art and expertise of the technician determines the success; there is not a superior technique.
I was trained in 2 UltraSound Guidance courses (Harvard and Toronrto U) and I will adamantly declare my anatomical referencing as superior.
My experience
One infiltrates correctly only if he knows perfectly the anatomy involved in the infiltration. A non-guided infiltration by an expert is not a blind infiltration. It is a anatomically referenced infiltration. This means the finger and needle searches and moves according to anatomical references till it hits its target.
I have had two 2 day trainings in ultra-sounded guidance at Harvard and U of Toronto. They were not able to show me their technique was superior to my anatomical referencing.
I can assure you that, in my opinion, with my 25 years of experience, my anatomical referencing is more accurate than what I have witnessed in these trainings.
I can assure you that both technics require many years of experience that evolve over 10-15 years of progressive improvement. It is misguided to think technology can eliminate or surpass experience.
