Musculoskeletal dysfunction refers to pain that arises from the way muscles, joints, tendons, ligaments, discs, bones, and nerves move, bear load, compensate, and break down over time. At Manhattan Pain Medicine, we evaluate mechanical pain by identifying where the pain is coming from, why that structure became stressed, and what biomechanical pattern needs to change for more durable relief.
Musculoskeletal pain can affect your spine, joints, muscles, tendons, ligaments, and nerves. Dr. Siefferman explains how expert care can help.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, and I would like to speak with you about one of our zones of expertise: musculoskeletal pain. Musculoskeletal pain is an intentionally broad zone because it includes anything related to the skeleton, which includes the spine, joints, muscles, ligaments, bones, and nerves. Any source of pain or discomfort from the musculoskeletal system is something we diagnose and treat.
97% of pain is mechanical, meaning it relates to how we use our bodies. And this specifically relates to the musculoskeletal system. If we are bending a certain way, if we’re holding our heads a certain way, if we sit at our desks a certain way, with time those structures will develop pain. That’s when patients come in; we identify the reason, the location, and the main treatment is to adjust how people use their bodies.
Part of diagnosing musculoskeletal pain is recognizing that the pain that brought the patient in is not always the reason for its pain. So, for example, the patient may come in with back pain, and there may legitimately be pain in the back, but the question is why is there pain in the back?. Well, they bent over and picked something up and they herniated a disc, or there was a car accident and they hurt their back. That’s pretty straightforward. But more often, it’s chronic repetitive overuse that led to this pain. And in those situations, we really have to identify the biomechanical pattern that led to the overuse of the back.
It’s pretty standard treatment at pain management offices to get an injection in the back for back pain, but we really want to understand why that pain is in the back. A good example: often the hips will be a driver of back pain without there being pain in the hip itself. If we don’t treat that biomechanical pattern that led to the pain in the back, we’re really doing the patient no favors. If you come to us, you will see a team of providers who will identify the biomechanical source of the pain and endeavor to treat that so that the pain that brought you in is ultimately more robustly treated.
During the discovery phase for musculoskeletal pain, our approach starts with building a clear mechanical understanding of what’s happening. Why does that pain exist?. When we think of treatments, we think of them in four buckets. The first bucket is medications. Medications are rarely the treatment. They provide some level of comfort while we diagnose and treat the primary source of the pain.
The second bucket is physical modalities. This may include acupuncture, chiropractic care, physical modalities. These generally help re-educate the body, retrain the body.
The third bucket are injections, and injections may be steroids. Other times it’s regenerative medicine. We can do this with a variety of approaches either in the office with ultrasound guidance or at a surgical center with fluoroscopic guidance and sedation if it’s necessary.
And then the final bucket of treatments is psychological because pain takes a toll. Losing one’s sense of self, one’s identity. Recognizing how that impacts your decision-making through the treatment journey is an important part of the treatment.
Through this process, we learn what’s going on in the body. There’s generally a cascade of mechanical events; we try to unwind that. And through the process of unwinding that, we gain a better understanding of how it happened, why it’s persisting, why it’s not getting better on its own. And you take that knowledge with you. That’s an essential part for the patient to learn. So ultimately, when we treat musculoskeletal pain, we’re not just treating the pain. We’re helping you understand what went wrong and how you can recognize it and prevent it from progressing.
Musculoskeletal pain is often mechanical, meaning it is related to how the body moves, loads, protects, and compensates. A painful structure may be obvious, such as an arthritic joint, disc herniation, tendon injury, or nerve entrapment, but the deeper question is why that structure became painful in the first place.
Many patients develop pain through a cascade. One joint becomes irritated, unstable, compressed, or overused. The body changes posture or movement to protect it. Muscles tighten, other joints take on extra stress, nerves become irritated, and a new layer of pain develops.
At Manhattan Pain Medicine, we work to identify both the pain generator and the biomechanical pattern behind it. The goal is not simply to quiet the painful area, but to understand what is driving the stress so treatment can be more targeted and durable.
Musculoskeletal dysfunction may require collaboration across pain medicine, rehabilitation, regenerative medicine, rheumatology, pain psychology, and other clinical perspectives. At Manhattan Pain Medicine, care is coordinated around the patient’s full mechanical pattern, including joints, muscles, tendons, ligaments, discs, nerves, posture, movement, and compensation.
Patients may benefit from evaluation when pain worsens with movement, posture, sitting, standing, bending, lifting, walking, exercise, or specific positions. Evaluation may also be helpful when pain is focal, recurring, associated with stiffness, weakness, nerve symptoms, trigger points, joint instability, tendon pain, arthritis, disc pain, or a history of injury that never fully resolved.
Musculoskeletal pain is not treated as a generic symptom. We work to understand the mechanics behind the pain, including how the body loads, protects, compensates, and breaks down. Each exam finding, imaging result, injection response, therapy response, and flare pattern helps clarify what needs to be treated next.
Your evaluation may include a detailed review of where the pain is located, what movements trigger it, how it behaves during sitting or standing, what prior injuries occurred, what imaging shows, and how the body compensates. The team may assess joint motion, muscle tone, nerve tension, posture, strength, stability, gait, tendon health, and whether diagnostic blocks or dynamic imaging may help clarify the source.
The place that hurts is not always the reason pain developed. Back pain may be driven by hip mechanics. Neck pain may be driven by shoulder position. Nerve pain may be worsened by muscle guarding or scar tissue. Understanding the mechanical sequence helps determine whether the next step should target the joint, tendon, nerve, muscle, disc, or movement pattern.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Musculoskeletal dysfunction refers to pain or impaired movement involving the muscles, joints, tendons, ligaments, discs, bones, or nerves. It often develops when a structure is overloaded, injured, unstable, compressed, inflamed, or forced to compensate for another area of the body.
Mechanical pain is pain that changes with movement, posture, load, position, or activity. It may worsen with sitting, standing, bending, lifting, walking, turning, or using a specific joint. Mechanical pain often points toward a structural or biomechanical driver.
The body compensates when one area is painful or unstable. A hip problem may change the way the back loads. A shoulder problem may affect the neck. A disc issue may irritate a nerve and create pain down the leg or arm. This is why evaluation needs to look beyond the place that hurts.
Muscle guarding occurs when muscles tighten to protect a painful, unstable, or irritated structure. Guarding can be helpful in the short term, but when it becomes chronic, it may create stiffness, trigger points, fatigue, restricted movement, and nerve irritation.
Trigger points are painful, tight areas within muscle that may develop after overuse, guarding, injury, or poor mechanics. They can create local pain, referred pain, stiffness, and restricted movement. Trigger point injections or dry needling may be used in selected cases to help release the muscle and restore better movement.
Tendinitis usually refers to active inflammation of a tendon. Tendinopathy refers to chronic tendon breakdown, irritation, or impaired healing from repetitive overload. Many long-standing tendon problems are more consistent with tendinopathy than simple inflammation, which is why treatment often focuses on tissue repair and load management.
Discogenic pain comes from the spinal disc itself, often from irritation or damage to the outer ring of the disc. It may cause deep back or neck pain, stiffness after prolonged positioning, and difficulty tolerating sitting or standing.
Radicular pain occurs when a spinal nerve is irritated or compressed, often by a disc herniation, inflammation, narrowing, or scar tissue. Sciatica is a common form of radicular pain that travels from the low back or buttock down the leg.
Double crush syndrome occurs when a nerve is irritated in more than one location. For example, a nerve may be affected by a cervical disc problem and also compressed at the wrist, elbow, shoulder, pelvis, or leg. Multiple points of irritation can amplify symptoms.
Evaluation may include a detailed history, physical examination, movement assessment, nerve tension testing, imaging review, ultrasound, dynamic imaging, and image-guided diagnostic blocks. The goal is to identify the pain generator and understand the mechanical pattern that created it.
Diagnostic blocks are targeted injections of local anesthetic used to temporarily quiet a specific nerve, joint, disc-related pathway, or soft-tissue structure. If the patient’s familiar pain improves during the numbing window, the response helps confirm that structure’s role in the pain pattern.
Treatment depends on the structure involved. Care may include physical therapy, medication support, trigger point injections, dry needling, epidural procedures, nerve blocks, regenerative medicine such as prolotherapy or PRP, viscosupplementation, radiofrequency ablation, rehabilitation, and pain psychology when chronic pain has affected function or confidence.
Regenerative medicine may be considered when pain is related to ligament laxity, tendon injury, joint instability, or impaired tissue healing. Dextrose prolotherapy and platelet-rich plasma may help stimulate a controlled healing response in selected patients.
Procedures may reduce pain or stabilize a structure, but the body still needs to relearn better movement. Rehabilitation helps retrain posture, strength, coordination, joint control, and load tolerance so the same mechanical stress does not keep returning.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Musculoskeletal dysfunction includes pain arising from muscles, joints, tendons, ligaments, discs, bones, and nerves. It is a broad zone because the musculoskeletal system is how the body bears weight, moves through space, absorbs force, protects itself, and adapts to injury.
At Manhattan Pain Medicine, we view mechanical pain as pain with a reason. A joint may be arthritic, a tendon may be overloaded, a disc may be sensitized, a nerve may be compressed, or a muscle may be guarding. But the deeper question is why that structure became painful and what pattern is keeping it from getting better.
Musculoskeletal pain often develops through a cascade. One structure becomes injured, irritated, unstable, or overloaded. The body then changes how it moves to protect that area. Posture shifts, muscles guard, joints take on new stress, and previously healthy structures may begin to hurt.
This is why the area that hurts is not always the whole explanation. A patient may come in with back pain, but the back may be reacting to hip mechanics, pelvic position, gait, core weakness, disc irritation, or a pattern of compensation that has been building for years.
Gravity and repetitive movement place ongoing stress on the body. When alignment, strength, mobility, or joint stability is altered, that stress may concentrate in specific structures. A disc, facet joint, tendon, ligament, bursa, or nerve may be forced to absorb more load than it can tolerate.
Over time, this can create a trickle-down effect. A painful hip may change the low back. A shoulder injury may alter the neck. A knee injury may affect the ankle, pelvis, or spine. Treating only the most painful structure may help temporarily, but durable progress often requires identifying the mechanical sequence behind the pain.
Muscles often tighten to protect vulnerable or painful structures. This guarding can act like a temporary splint, helping the body avoid motion that feels unsafe. When guarding becomes chronic, the muscles may become painful, stiff, and overworked.
Trigger points can develop when clusters of muscle fibers remain contracted. These areas may lose normal blood flow, become metabolically irritated, and refer pain to other regions. A trigger point in one muscle may feel like joint pain, nerve pain, headache, pelvic pain, or spine pain depending on the pattern.
Not every tendon problem is simple inflammation. Many chronic tendon problems are tendinopathies, meaning the tendon has become overloaded, irritated, or structurally weakened over time. The problem is often impaired healing rather than a short-term inflammatory episode.
Tendinopathy commonly occurs where tendons attach to bone, known as the enthesis. Repetitive microtrauma, poor mechanics, instability, or inflammatory disease may all contribute. Treatment may need to focus on load management, tissue healing, regenerative strategies, and movement retraining.
Nerves may become painful when they are compressed, stretched, inflamed, adhered, or irritated along their path. Sometimes there is one clear compression point. Other times, the nerve is stressed in more than one location, creating a double crush pattern.
For example, a cervical disc herniation may combine with carpal tunnel symptoms, or a lumbar disc problem may overlap with a peripheral nerve entrapment in the pelvis or leg. When multiple sites contribute, the pain may be more intense, more confusing, and more resistant to isolated treatment.
Mechanical pain often has a predictable relationship to load, posture, or movement. Patients may be able to identify the exact motion, position, or activity that brings it on. This predictability helps guide the examination and diagnostic testing.
Discogenic pain comes from the disc itself. It may cause deep back or neck pain, stiffness after prolonged positioning, and difficulty tolerating sitting or standing. It may not always travel down the arm or leg, because the disc itself can be the source of pain.
Radicular pain occurs when a spinal nerve is irritated by inflammation, compression, narrowing, or disc material. Patients may feel sharp, electric, burning, zapping, or radiating pain down an arm or leg. Sciatica is one common form of radicular pain.
Peripheral nerves may become compressed or irritated as they pass through muscles, fascial planes, tunnels, or tight anatomical spaces. This can contribute to conditions such as thoracic outlet syndrome, cubital tunnel syndrome, carpal tunnel syndrome, meralgia paresthetica, tarsal tunnel syndrome, or pelvic nerve entrapment patterns.
Discovery begins with the mechanics. We ask where the pain is located, what movement triggers it, what position relieves it, how it started, what changed afterward, and what other areas began compensating.
The physical examination is central. The team may assess joint stability, range of motion, muscle tone, posture, gait, strength, nerve tension, trigger points, and the relationship between one painful region and another.
Dynamic ultrasound may be used to evaluate tendons, ligaments, bursae, soft tissues, and nerves during movement. Dynamic imaging may be considered when symptoms suggest instability that standard supine imaging may miss.
When multiple pain generators are possible, sequential diagnostic blocks can help isolate the source. By temporarily numbing a specific joint, nerve, fascial plane, or pain pathway, we can learn whether that structure is truly part of the patient’s familiar pain.
Treatment targets the structural deficit, pain generator, or biomechanical pattern identified during discovery. The goal is to reduce pain while also addressing the reason the tissue became painful.
Musculoskeletal dysfunction often involves more than one structure. A trigger point may be guarding a joint. A nerve may be irritated because a muscle is overactive. A disc may be painful because the pelvis or hip is altering load. Treating the loudest symptom first may not always address the driver.
MPM works to identify the order of care: what needs to be quieted, what needs to be repaired, what needs to be retrained, and what needs to be monitored. This helps treatment become more precise and less reactive.
Maintenance begins when the main pain generator has been identified, treatment has improved stability or comfort, and the patient understands the mechanical pattern behind the pain.
The goal is to help patients recognize early warning signs, adjust movement before a flare builds, continue strengthening, avoid repeated overload, and understand how to prevent the same cascade from returning. Musculoskeletal care is not only about reducing pain. It is about helping patients understand what went wrong and how to keep it from progressing.
