Musculoskeletal Medicine

Dr Chris Bowman specialises in Musculoskeletal conditions ranging from back pain and sciatica to shoulder, elbow and knee problems. His patients include elite athletes as well as men and women who just want to keep as active as possible.

Treatments include:

Epidural Injection
Often helpful for Sciatica, Spinal Stenosis (spinal narrowing) and Lumbar Spondylosis. Steroid (Cortisone) and a little local anaesthetic are injected into the base of the spine into the epidural space. The medicines work over the next 2 to 4 weeks removing inflammation and swelling, so allowing natural healing to occur. Approximately one third of patients report a very good result, one third a worthwhile improvement whilst one third report temporary musculoskeletal injectionor no lasting improvement.

Steroid (Cortisone) Injection
Useful for Shoulder Impingement and Rotator Cuff injuries, Tennis Elbow, Golfers Elbow, Knee and Thumb Arthritis, Hip Bursitis. The injection is given in the trigger areas.

Hyaluronate (Ostenil) Injection
This injection is used in the treatment of pain and restricted mobility in degenerate and traumatic conditions (injuries) affecting the knees, shoulders and other synovial joints.
Synovial fluid lubricates and nourishes most joints in the body. In degenerative joint disorders such as osteoarthritis, the viscoelasticity of synovial fluid is markedly reduced thereby decreasing its lubricating, shock absorbing and possibly nutritional functions. This increases biomechanical loading of the joint and cartilage destruction which ultimately results in pain and restricted mobility of the affected joint. Supplementing this synovial fluid with intra-articular injections of highly purified hyaluronic acid can improve the properties of synovial fluid so enhancing its lubricating and shock absorbing properties and removing overload of the joint. Generally, this results in a decrease in pain and an improvement in joint mobility which can last for several months following a treatment course of 5 injections.

Listen to Dr Bowman discussing steroid, hyaluronate and epidural injections in The Tonbridge Clinic Injections Podcast:

Low Dose Naltrexone

For sufferers of fibromyalgia, their condition is not just painful but made doubly worse by the lack of proper treatment for it and the uncertainty over the condition in the medical community. A recent study indicates that Low-Dose Naltrexone does indeed ease the pain of fibromyalgia. It is also used in chronic fatigue syndrome and several auto-immune conditions.


Ligaments help to provide stability in the joints. They prevent the joint from moving outside the normal range. Some people have lax ligaments that allow more than normal movement, known as hypermobility. In the spine, there is a complex arrangement of ligaments which allow flexibility in some directions and restraint in others. Sometimes ligaments can be overstretched or torn (as in a sprained ankle). The ligaments may then not control the joint adequately, leading to instability which may put abnormal stress on the joints or discs in the spine, thus causing pain.

Prolotherapy works by stimulating the body to make new fibres within the ligaments so thickening and strengthening them. Chemicals are mixed with a local anaesthetic and a small amount is injected into the ends of the ligaments close to where they attach to the bone. This provokes an inflammatory response that attracts cells to make collagen fibres in the area. Over the ensuing weeks, these fibres are incorporated into the existing ligaments making them stronger and tighter. Several treatments are usually needed to get the full benefit. Prolotherapy is particularly helpful in patients who are hypermobile, have joints that click or where osteopathy, chiropractic or physiotherapy has helped in the short term but does not seem to produce a long lasting effect.

Prolotherapy injections are commonly given in the lumbar region, sacroiliac region and thoracic and cervical spine. They are also useful in the ankle and shoulder region. The patient is given Entonox (nitrous oxide and oxygen as used during labour) to ease the discomfort of the injection.

Listen to Dr Bowman discussing prolotherapy injections in The Tonbridge Clinic Prolotherapy Podcast:

Autologous Blood Injection
Sometimes ligament injuries, sprains and sporting injuries are slow to heal or remain painful. In this case blood is taken from the patient’s vein and injected into the ligament. This causes a bruise which seems to speed the healing process.

Acupuncture is often an effective treatment in Musculoskeletal Medicine.