Dr. Damien Nevin

MBBS (Hons), Dip.musc.med.(Otago), FACRRM, DRANZCOG (Advanced)
General and Musculoskeletal Medicine

Dr Damien Nevin is a medical practitioner new to the Sunshine coast working at the highly reputable Noosa clinic ,practicing general and musculoskeletal (MSK)medicine .He has been practicing medicine for nearly forty years since graduating in 1979 and gained post graduate qualifications in rural medicine,obstetrics and gynaecology,and musculoskeletal medicine through Otago university . He has also practiced anaesthetics most of his life resulting in a deep understanding of pain ,injection techniques and pharmacology.

He has worked extensively in city and rural based general practice, Queensland rural hospitals in emergency, obstetrics,anaesthetics, internal medicine, paediatrics and neonatology.

His philosophy in MSK medicine is to spend time ,be thorough,find the right diagnosis and apply the best evidence based treatment.He will not waste your time and money with treatments which have no benefit

Very few doctors have qualifications in musculoskeletal medicine and the subject is not taught to medical students so there is a paucity of knowledge amongst many GP’s about the subject.

Dr Nevin will always be based on good evidence, be cost effective and considerate of your time .

Even a 50% improvement in pain and function is good.

What is Musculoskeletal Medicine?Book Online
What is Musculoskeletal Medicine?

It is a sub-specialty of medicine which treats pain and restriction of our bones, joints, tendons, ligaments and muscles commonly just called arthritis.

Initial assessment involves taking a good history, accurate examination and investigations to help identify the cause of the pain or restriction.

Pain generators are bone, joint capsules, discs, tendons, nerves, ligaments, muscles and psychological factors.

 

Problem areas are painful and tender, have muscle wasting, skin changes, sometimes altered sensation, and have restrictions in range of movement.

A dysfunction occurs when there is injury to a section or sections of the musculoskeletal unit (i.e. the joint and all around it.) causing an imbalance in the highly engineered unit.

Treatment aims to rectify the imbalances using as many evidence-based interventions as possible such as joint mobilization, manipulation, treating trigger points (painful muscle knots), specialized exercise regime, appropriate medication, joint injections and other modalities

 

Doctors performing MSK have extra qualifications in this specialty and the benefit of a deep understanding of the malfunctioning of the human body, training in pharmacology, and the more serious causes of MSK pain.

— Contact Dr Nevin for specific service information —

Dr Damien Nevin’s Services

Dextrose (Glucose) Prolotherapy

This therapy has been used for decades and involves the use of concentrated solution of sugar ( 5-25%) injected into or around joints or into damaged tissues. It is easy and relatively inexpensive to administer especially compared to platelet rich plasma injection and has more robust evidence especially for knee osteoarthritis, one of the most common and disabling and accessible joints to treat.

Theoretically it stimulates the healing cascade and induces connective tissue regeneration. Because of it’s low cost , good evidence of efficacy and low side effect profile it is a preferred treatment method of many musculoskeletal practitioners, including Dr Nevin.

These injections are highly recommended for knee arthritis to help defer surgery or while awaiting a knee replacement. The cost of intra-articular glucose injections now is the normal consultation fee plus $15 for the disposables.

Contact Noosa ClinicBook Online

Sports injuries

Training in musculoskeletal (MSK) medicine readily enables a doctor to readily identify and treat sports injuries because the tissues and pathological processes are the same as injury from any cause. Dr Nevin is able to diagnose and treat most sports injuries .They usually are overuse injuries, sprains, microfractures, persistent trigger points, ligaments and muscle tears.

A doctor trained in MSK medicine has a large “toolbox” containing many treatment methods and skills and can combine accurate medical diagnosis with physical ,exercise, postural ,injection and  pharmacological therapies. Treatment can be conducted in conjunction with a physiotherapist.

Contact Noosa ClinicBook Online

Steroid Injections

This treatment utilises low dose injections of steroids (strong anti-inflamatory substances) into and around joints to control inflammation and alleviate pain. It is often and successfully used for shoulder tendonitis with excellent results. It can be used for acute gout and osteoarthritis flare ups to give temporary relief  and is a useful adjunct for pain control.

It is not a healing therapy and can rarely have adverse side effects when used repeatedly intra-articularly (in particular the hip joint) and if injected directly into tendons may cause rupture. Injections are always around the tendon sheath to avoid this.

Many steroid injections can often be done in the medical practice without xray or ultrasound guidance.

Contact Noosa ClinicBook Online

Questions & Answers

Frequently asked questions

Click on a link below to read more.

Persistent pain in the neck, upper and lower back, chest, knees, hip and feet.

Headaches, these often arise from neck problems, so called cervico-genic headaches.

Osteoarthritis of the knees. These are treated with prolotherapy and exercise advice to strengthen the quadricepts muscles. Knee arthritis is debilitating and common and we are lucky to have prolotherapy as a well researched treatment, easily available and affordable.

Osteoarthritis of the hip. Relief can be given by reducing the forces within the joint by stretching and relaxing its muscles, improving range of movement as well as advice on ways to move which reduce pain. Also prolotherapy can be administered.

Sciatica management.

Facial pain syndromes

Tennis and golfers elbow

Levator ani syndrome

Coccydynia

Hand arthritis joint mobilisation

Patello-femoral syndrome (pain around the knee cap)

Shoulder pain including rotator cuff syndrome, bursitis and acromioclavicular joint dysfunction

Tenosynovitis of the hands and feet ( tendon inflammation.)

Achilles tendon pain. Good evidence for prolotherapy.

This therapy uses a centrifuged( spun down) specimen of your own blood ,ie with the blood cells removed ,injected back into damaged tissue based upon the theory that it contains growth factors which will assist in healing .It is popular in the world of elite athletes. Despite a few encouraging studies, overall systematic reviews of evidence indicate marginal effectiveness at a very high cost and it is not used by Dr Nevin.

Therapy is performed as gently as possible, but there may be some discomfort at times when treating restrictions. Your feedback during treatment is always sought to stay in touch with your comfort zone. Sometimes the area treated is temporarily aggravated after treatment, but this responds to simple pain killers and cool packs. Local anaesthetic is used to reduce the discomfort.

No forceful manipulations will be performed without explanation and consent.

Injection therapy can occasionally cause localised bruising or minor bleeding with haematoma formation.

Infection is a rare event because of sterile equipment and aseptic technique.

Injections around the chest and lower neck can rarely lead to a collapsed lung which usually resolves with observation and rarely leads to a drain inserted into the chest . Dr Nevin will always remind you of this rare complication if working in at risk regions.

A contraindication to the use of anaesthetic agents is allergy.eg lignocaine allergy.

A relative contra-indication to injection therapy is if the patient is taking some types of blood thinners .The doctor will always ask you about this.

Musculoskeletal therapy does not always achieve complete resolution of pain but gives you the best chance of success. Even a 50% improvement can be worth it.

A musculoskeletal (MSK) doctor will often prescribe specific exercises as therapy and will often work in conjunction with another physical therapist to achieve results. The aim of exercise is to strengthen, balance and stretch muscle groups to stabilise and “fine tune” the musculoskeletal unit. When the musculoskeletal unit is well balanced ,and moving well ,abnormal forces and pain are reduced. Muscle stretching is also an important part of the treatment

Exercises include, isometric( tension/loading but with the same muscle length),  isotonic ( muscle length changes but muscle tension /loading is constant).Isotonic exercises may be concentric ( muscle is shortening during loading) or eccentric(muscle is lengthening while loaded)and this type has good evidence for tendon rehabilitation.eg Achilles tendinosis.

Initially short-term exercises will require some motivation and self-discipline but ultimately long term prescribed exercises aim to be enjoyable and incorporate leisure or productive activity. Eg Walking, cycling, yoga, gardening and even housework and labouring. Any physical activity is good for you in maintaining musculoskeletal health.

Colours are used in MSK medicine to remind the practitioner of other factors to take into consideration especially when symptoms indicate a serious cause for symptoms. A doctor is trained to be aware and detect these conditions

Red flags are serious other causes of pain. eg cancer, trauma

Orange flags are psychiatric issues occasionally influencing pain

Yellow flags are social and emotional factors changing perception of the pain which may impede recovery.

Blue flags are work related issues having an influence. Eg .a workcover claim pending can prolong recovery.

Black flags are system related issues affecting recovery. Eg lack of access to proper therapy, insurance or legislation issues interfering with return to work.

Musculoskeletal doctors are trained to identify and manage these factors.

Low back pain may be acute, persistent or chronic and although all can have the same tissue generating the pain they are different entities. Many variables determine the outcome. A doctor will always exclude obvious causes, such as a crush fracture from osteoporosis, slipped disc or spinal stenosis. Sometimes it is not possible to identify the exact cause

Pain sensitive structures include bone ,joint capsules , ligaments, tendons muscles ,intervertebral discs, menisci, nerves and fascia ( collagen connective tissue bands linking generally the outside of muscles).Injury to any of these structures can lead to low back pain and by history and examination the most likely cause identified. Not all are easily amenable to treatment and treatment methods vary depending on the tissue affected.

Pain is modulated(interpreted) in the spinal cord and brain and we all have differing reactions to it.

Acute pain can be due to sprain ( a tear in the muscle ) or injury to an anatomical structure such as a ligament or tendon or site of insertion of a tendon into a bone, a cartilage tear, a disc injury or bone fracture to name a few . Commonly acute pain is due to a sprain in the erector spinae, gluteal and small muscles close to the spine such as the rotatores and multifidi.

Pain for more than three months is classified as chronic and incorporates different factors perpetuating the pain. These factors can include sensitisation of the central nervous system, ie “winding up” local nerve centres making the pain more sensitive to other factors . Chronic pain can often due to damaged discs, dysfunction in facet joints and sacroiliac joints ,chronic trigger points.

A lot of acute, persistent and chronic pain syndromes are due to myofascial (muscle and fascia) dysfunction which are very amenable to treatment. In this situation a muscle has been sprained and resulted in a “knot” or tight area of the muscle which restricts the range of motion of the muscle and leads to referred pain to its origin or insertion. They are identified as unusually tender points in the muscle and refer pain in well documented patterns around the body. Trigger points can be secondary to other pain generators which need to be identified addressed if possible.eg a damaged disc.

These so called trigger points can be treated with dry needling ie insertion of acupuncture needles or “wet” needling , employing the use of a hypodermic needle and injection of a small amount of anaesthetic agent to deactivate and breakdown  the pain generator ,followed by muscle stretching to return the muscle to it’s normal state. This is considered by most musculoskeletal practitioners as the most effective method .The needling is slightly painful. Once the needle enters the muscle, the therapist identifies the trigger point with the tip of the needle by finding the most sensitive area, which usually twitches in response, and injects a small amount of local anaesthetic to help reduce the discomfort. Then the trigger point is mechanically disrupted .

Pain down the leg needs to be assessed fully and is less than 50 % of the time true sciatica.

The same principles apply to treating pain in other areas of the body like the neck, chest, upper back, shoulder and limbs.

For chronic pain there may be several pain generators so even if some of these can be addressed, relief can be given.

Arthritis is inflammation of a joint or joints and includes a wide spectrum of disease processes.

The most common type and cause for pain and disability worldwide is osteoarthritis. This condition was once considered to be non-inflammatory and a result of wear and tear which is now known to be inaccurate and simplistic.

New concepts in osteoarthritis include the effect of whole body inflammation (eg caused by excessive fatty tissue and pro-inflamatory diet).Of course other factors such as excessive joint loading, injury and genetic predisposition play a role.

Musculoskeletal pain can due to osteoarthritis but this is only one of the many causes. Often , all MSK pain is labelled osteoarthritis leading to over-prescription of anti-inflamatory drugs, and underutilization of physical and other therapies.

Arthritic pain can be treated with joint mobilization, exercise therapy, prolotherapy, steroid injections, anti-inflamatory medication and postural therapy.

Sciatica is refers to a pains that is usually sharp, electric or lancinating, and travels from the lower back and buttock down the back of and sometimes the outer side of the leg to below the knee and often to the foot. This pain syndrome is due to irritation to part of the sciatic nerve which arises from lumbar nerve roots four and five and sacral nerve roots, one to three. It is a type of radicular pain, ie pain arising from a nerve due to compression and inflammation. The pain is theorized in some cases to be due to irritant chemical leaking from a damaged disc as sometimes there is no nerve compression seen on scans.

It occurs in about 2% of the general population and 90% of the time is due to a herniated intervertebral disc.5-10% of people with low back pain have sciatica.

It is a clinical diagnosis based on the symptoms and physical examination. The pain follows the dermatomal pattern of the sciatic nerve. (ie the skin pattern innervated by the nerve).

Immediate scans are not required (they won’t make it better or change the diagnosis) but are usually done after 6-12 weeks if pain is severe or associated with a nerve deficit.

70-90 % of the time the pain settles and is managed by keeping active and taking pain killers, epidural steroid injections and medication to dampen nerve pain.

Sometimes surgery is required for severe unrelenting pain or loss of nerve function eg. progressive weakness or bladder symptoms.

Not all pain going down the leg is sciatica. It is sometimes due to trigger points in the gluteus minimus or piriformis muscles and in these cases the outcome and treatment are different.

Medicare rebates apply to Dr Nevin’s services. His fees are based on those recommended as fair by  the Australian medical association and medicare rebates about 40%-50% of the fee .Medicare does not provide for bulkbilling of these complex and often time consuming services. Medicare encourages low quality brief consultations and discourages being thorough and spending time with patients.

Medicare does not cover the cost of disposable items such as local anaesthetics and special needles required and these may be added to consultation costs.

Typical consultation fees are:   Standard   $80      about 15 mins

Long          $148     beyond 20 mins

Prolonged  $225    beyond 40 mins

A course of treatment usually involves 3-4 long consultations but may involve only one for a simple problem. My aim is to achieve a result in as few consultations as possible and teach the patient strategies to help themselves at home

Appointments are made through Noosa clinic by phoning 54497600 or through any online general practice booking app. It is best to at first request a double appointment so that the problem can be fully explored, diagnosis made, and some therapy instigated. Most people need about three visits excepting knee joint prolotherapy( dextrose injections into joints) which need about five ,four of which are usually standard visits.

Make an appointment

Get in touch with Noosa Clinic and take the first step to improving your quality of life today.

What does it do and how does it work?

The Musculoskeletal (MSK) doctor’s “toolbox”

Is multimodal utilising a broad range of therapies to achieve results.

 

1. The philosophy encourages staying active. By keeping as active as possible our joints and muscles move and faster healing occurs. Keeping mobile greatly increases our chance of living longer .

2. Education and explanation to create understanding.

3. Exercise therapy : preferably easy to follow ,fun and task based.

4. Manual therapy: massage ,joint mobilization and manipulation. Joints love to move ,and when moving well ,there is less pain .

5. Myofascial therapy:- Refers to the treatment of pain arising from skeletal muscle and related connective tissue as described by Travel and Simons in their epic textbook  “The trigger point manual” .Trigger points in muscle cause referred pain.Trigger points can be deactivated with “ wet needling “,ie using local anaesthetic to numb the trigger point then mechanically break it down with the needle tip followed by muscle stretching . Dry needling refers to the use of acupuncture needles to help deactivate trigger points.

Trigger points are small tender “knots” in muscles, developing after strain injuries . They cause the muscle to be shorter and tighter and refer pain to the origin or insertion of the muscle. They restrict joint movement.

6. Prolotherapy:-The use of high concentration dextrose( sugar) injected into  or around a joint, or an entheses( where the tendon or ligament attaches to bone) .It is believed that dextrose promotes healing through collagen regeneration and stimulation of growth factors . eg For treating achilles tendonosis, knee osteoarthritis,rotator cuff injury in the shoulder and tennis elbow.

7. Appropriate steroid injections eg. For shoulder pain due to subacromial bursitis.

8. Joint injections of dextrose or cortisone.

9. Home exercise prescription with self recorded phone video record .

10. Teaching a recruited partner or friend as home therapist to assist with exercises.

11. Cognitive behavioural therapy to treat negative attitudes which delay healing.eg, a patient may wrongly believe their pain will lead to them ending up in a wheelchair or that being active will make the problem worse.

12. Excluding diseases which may be mimicking musculoskeletal pain.

13. Informed consent and understanding any side effects of treatment

14. Collaboration with other health professionals. Knowing when to refer to a medical specialist, physiotherapist or exercise physiologist.

 

By spending time to localise the source of the pain and applying the most evidenced based range of treatment optimal results can be achieved.

These methods give the best chance of success but are not perfect. Sometimes it is not successful but the best chance has been given.

Any questions? or like to make a booking?

Contact Dr. Nevin at Noosa Clinic
07 5449 7600
info@noosaclinic.com.au
Address
Noosa Clinic General Medical Practice
306a/90 Goodchap Street Noosaville Qld 4566
Open Hours
Monday to Friday
8.00am to 6.00pm

Saturday
8.00am to 12.00 noon

Appointments Available
8.00am to 5.00pm

Contact Noosa ClinicBook Online