Prof Creswick is a medical practitioner who has a special interest and post-graduate training in musculoskeletal medicine. He sees patients directly or in consultation by referral from other doctors. This involves assessment and treatment of musculoskeletal dysfunction and pain in all regions of the body. Such problems may be associated with postural imbalance, sports or other injuries,or degenerative change. A broad range of treatment options is used including mobilisation, manipulation and specific exercise treatment. Sometimes injection techniques or oral medication are used.

Prof Creswick approached the University of Sydney in 1994 to create postgraduate courses in physical medicine, initially at Postgraduate Diploma level then Master of Medicine Degree level. He played the major role in syllabus development, teaching and assessment of these courses which began in 1996. In 2009 he was invited to teach at the Australian School of Advanced Medicine, Macquarie Uninersity, Sydney. He is Associate Professor in the Department of Musculoskeletal Medicine. Physical Medicine involves the study of the relationship between dysfunction and pain. Assessment of the patient relies upon a very detailed physical examination. Patients usually are required to undress, leaving just their underclothes on. The object of the physical examination is to try to localise a complaint to a specific region and if possible a specific anatomical structure and to define its relationship to movement and function. By relating the patient’s complaints to an anatomical structure the physical examination gives meaning to the patient's history and symptoms. The physician then makes a logical analysis and application of the information obtained from the patient’s history and physical examination to make a diagnosis. This allows for an appropriate plan of treatment, rehabilitation and proactive planning for the prevention of injuries.

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Prof Creswick might be able to assist with:

• migraine-like headaches
• migraine headaches associated with neck aches
• temperomandibular (jaw) pain
• atypical facial pain
• cervicogenic vertigo
• acute and chronic "whiplash" neck injury
• brachialgia (shoulder and arm pain) 
• unexplained chest abdominal or pelvic pain
• the conservative management of radicular (nerve root) pain
• upper or lower back pain and stiffness
• coccydynia (tail bone pain)
• sciatica 
• persisting pain syndromes not responding to therapy
• disturbance of gait or posture 

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WHAT SHOULD I EXPECT AFTER MUSCULOSKELETAL TREATMENT?

I have had mobilisation of my spine.

Gentle mobilisation of the spine can often give immediate relief from the pain and restricted motion due to vertebral segmental (spinal joint and muscle) dysfunction. This is not usually associated with any flare of pain. Follow-up exercises are usually required.

I have had manipulation of my spine (a firm, very short, quick movement of a joint)

When mobilisation is not helping enough Dr Creswick may use manipulation. He does not use manipulation in the neck. Sometimes when manipulation is used some minor flare of discomfort can be experienced over the remainder of that day and overnight. This usually then settles.

In the neck, Dr Creswick uses gentle mobilisation, never manipulation. The reason for this is to avoid the rare but recognised complications of manipulation of the neck, such as stroke.

What is a trigger point injection and what should I expect after one?

Trigger points are tender “knots” in muscles which radiate pain. Dr Creswick usually uses a weak solution of local anaesthetic to treat trigger points. He does not use cortisone injections into trigger points because this can sometimes cause a local toxic effect on the muscle at the point of injection. Trigger point injections are usually immediately painful as the needle hits a tender point in the muscle. Then pain is reduced as the local anaesthetic takes effect. This stretches the fibres and allows muscle stretching. The local pain relieving effect of the local anaesthetic usually only lasts 20 to 30 minutes. Then there can be of a flare of pain although this is usually mild. This flare of pain usually lasts 48 hours. Then significant pain relief from the initial presenting pain is expected.

What should I do after a trigger point injection?

Stretching exercises are important. Gentle stretching is very helpful to maintain improvements. The gentle stretching exercises in which you have been instructed should be applied twice a day. Avoid discomfort. Then, after stretching, gentle heat should be applied for 10 minutes over the painful muscle. Liniments should never be applied to the skin before the application of heat, as some can be toxic to skin.

What does it mean if pain goes away and then returns?

If pain responds significantly to specific physical medicine treatment that you have had, it usually means that the diagnosis of the problem is correct. If pain returns, try not to lose heart as further treatment by the doctor and home exercises should give increasingly lasting results.

How do I stop my pain from coming back in the future?

Carefully applying your exercises in which you have been instructed for several weeks can be very helpful and may be all that is required. Usually except with very recent problems, further treatment one to two weeks later is needed. With very established problems, instruction in postural exercises may be required. These may require coordination of your breathing pattern to help postural muscle control. Dr Creswick can instruct patients in exercises to aid posture and help prevent musculoskeletal pain in the future.