Back pain, neck pain, pins and needles, numbness, weakness or pain that seems to travel from one part of the body to another are all symptoms that may lead someone to seek physiotherapy. But understanding what is contributing to those symptoms isn’t always as simple as identifying where it hurts.
This is where neuromusculoskeletal physiotherapy can play an important role. Neuromusculoskeletal (NMSK) physiotherapy focuses on assessing and managing conditions involving the musculoskeletal and nervous systems and understanding how these systems interact to influence pain, movement and function.
At the heart of an NMSK assessment is an important question: ‘What may be contributing to this person’s symptoms and functional limitations?’
What does neuromusculoskeletal mean?
The term can sound complicated, but it becomes much simpler when we break it down. ‘Musculoskeletal’ refers to the structures that help us move, including muscles, joints, bones, tendons and ligaments. ‘Neuro’ refers to the nervous system, including the brain, spinal cord and peripheral nerves that carry information between the brain and the rest of the body.
These systems don’t operate independently. The nervous system plays an important role in movement, strength, sensation and pain experiences. This means that symptoms involving pain, movement, sensation or strength sometimes require us to consider both systems rather than looking at one structure in isolation.
What symptoms might an NMSK physiotherapist assess?
People may seek physiotherapy for back or neck pain, pain extending into an arm or leg, pins and needles, numbness or altered sensation, weakness, joint or muscle pain, reduced movement or mobility, difficulties with everyday activities, work or sport, or symptoms following an injury or surgery.
Not everyone experiencing these symptoms has a problem involving the nervous system and similar symptoms can have different causes. This is why comprehensive assessment matters. It helps the physiotherapist build a clearer clinical picture and determine what may be contributing to an individual’s symptoms.
Why am I getting pins and needles?
Pins and needles are a type of altered sensation, and there are many possible reasons why they can occur. Sometimes the sensation resolves quickly, such as when temporary pressure on a nerve causes an arm or leg to “go to sleep”. In other cases, pins and needles may be more persistent or recurring and could be associated with ongoing pressure on a nerve or irritation from the structures surrounding it.
Where you experience the sensation, when it occurs, how long it lasts and whether it is accompanied by pain, numbness, weakness or other symptoms can all provide useful clinical information. Rather than assuming what is causing the sensation based on where you feel it, an assessment helps build a fuller picture.
Why does my leg hurt when the problem might involve my back?
This is a good example of why the location of a symptom doesn’t always tell the whole story. Nerves that supply the legs connect back to the lower part of the spine. In some presentations, irritation or sensitivity involving these structures can contribute to symptoms experienced further along a nerve’s pathway.
This is why a physiotherapist may assess your lower back when the symptom that brought you in is actually in your leg. It doesn’t automatically mean that your back is causing the problem. It means the back may be one of several possibilities worth considering as part of the clinical picture.
Why isn’t treating the painful spot always enough?
The area that hurts is important, but it may only be one part of the picture. A painful shoulder, for example, doesn’t necessarily mean that every factor contributing to the symptoms is located within the shoulder itself. Similarly, pain experienced in the leg may sometimes require assessment of the lower back or nervous system.
There can also be factors beyond anatomy that influence symptoms and recovery. Movement, physical demands, previous injuries, general health and the activities someone needs or wants to return to can all provide relevant information. The aim isn’t to search for problems everywhere; it’s to gather the information needed to understand the individual presentation and make appropriate clinical decisions.
Why is my physiotherapist asking questions that don’t seem related to where I hurt?
The conversation you have with your physiotherapist is part of the assessment. They may ask how and when your symptoms started, what makes them better or worse, whether you’ve experienced changes in sensation or strength, previous injuries or medical conditions, your work and activity levels, medication and other aspects of your health.
Some of those questions may initially seem unrelated to the painful area, but patterns within your history can provide important clues about what may be contributing to your symptoms. They can also help identify whether something falls outside the expected presentation and may need further investigation.
Why is my physiotherapist checking my strength or reflexes?
If your symptoms suggest that the nervous system may be involved, neurological testing may form part of the assessment. A neurological assessment considers a number of factors and will include assessing strength, sensation and reflexes.
No single result provides the entire answer. These findings are considered alongside your symptoms, history, movement and the rest of the physical assessment. Together, they help the physiotherapist build a clearer clinical picture and decide what should happen next.
How does a physiotherapist work out what is contributing to my symptoms?
By this point, you can probably see why there isn’t one standard neuromusculoskeletal physiotherapy assessment that looks exactly the same for everyone. The assessment is guided by the individual presentation and by what the physiotherapist learns as the assessment progresses.
It usually starts with understanding what you’re experiencing: when your symptoms started, how they behave, what makes them better or worse and how they affect your everyday life. The physical assessment may then look at relevant areas of movement, mobility, strength and function, with neurological testing included where appropriate.
Each piece of information adds to the clinical picture. The goal isn’t simply to identify what hurts, but to understand what may be contributing to the symptoms and functional limitations so that the next step can be determined accordingly.
How is a neuro-musculoskeletal condition treated?
There isn’t one treatment for an NMSK condition because there isn’t one NMSK presentation. Treatment is informed by what is identified through the assessment, the individual’s presentation and what they need or want to return to.
Depending on the condition and the person, management may include education and advice, mobility exercises, progressive strengthening, strategies to support self-management and hands-on physiotherapy where appropriate. Treatment may also change as recovery progresses, with reassessment helping the physiotherapist understand how symptoms and function are responding and whether the treatment plan needs to be adapted.
When might another healthcare professional need to be involved?
Understanding the bigger clinical picture also means recognising when physiotherapy may not be the only, or the most appropriate, next step. Certain symptoms or findings may warrant further investigation or assessment by a doctor, specialist or another healthcare professional.
There are also situations where physiotherapy forms one part of a broader treatment plan. Communication and collaboration between healthcare professionals can help ensure that different aspects of a person’s condition and recovery are considered, rather than approaching the problem through a single clinical lens.
Looking beyond where it hurts
Neuromusculoskeletal physiotherapy recognises that pain, sensation, strength, the nervous system, movement and function are interconnected. Understanding those relationships helps answer the question at the centre of a neuromusculoskeletal physiotherapy assessment: What may be contributing to this person’s symptoms and functional limitations?
Sometimes the painful area provides much of the answer. Sometimes understanding the bigger picture requires looking beyond it. A thorough assessment helps determine the difference and helps guide what happens next.
Ready to understand what may be contributing to your symptoms?
If you’re experiencing pain, changes in sensation, weakness or difficulty with movement or function, you can book an appointment with the Lamberti Physiotherapy team for an individual assessment.
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