How can we help you?

Your questions answered about muscles, bones and joints


Who are you?

Hi, I'm Mike Livesey.

I'm a specialist MSK physiotherapist

and clinical lead at Bupa.

Come and ask me a question about MSK conditions

and injuries

What does MSK stand for and what are some examples of conditions?

So MSK stands for musculoskeletal, so

that's anything to do with our body.

So we're looking at the joints in our body,

the muscles in our body, and anything that acts on it.

So it's looking at your function and how that's adapted.

So classically in clinic, we'll see lots

of problems coming in with back pain, neck pain, shoulder

and knees, and they're our top four.

The main sort of breakdown of injuries we tend

to see is more acute injuries,

so they may be traumatic sprains and strains,

or more chronic persistent issues like arthritis.

What's the difference between a ligament and tendon?

A ligament is a structure that fastens bone to bone.

So we'll see these around joints

to help stabilise the joint.

These are inert structures so they don't move.

They're set at a limit

and they have a limit at what they can work to.

So what I mean by that is if you stretch the ligament more

than it can tolerate, it'll break down and cause an injury.

So for example, we'll see that regularly with ankle sprains.

If you roll your ankle off a curb,

the ligament will be overloaded

and it will go beyond what it can tolerate and it will tear

and you'll start to get pain, injury and loss of function.

Now, tendons are structures that fasten muscles

to bone, and these are more contractile structures,

so they're more active structures with the muscle.

They act upon the joint

and allow the joint to move for you to be functional

or do the desired exercise that you want to do.

These injuries

or the injuries with tendons we see tend to be more

with overload injuries.

When you do too much too soon

and the body can't cope with it and it breaks down.

What's the difference between a fracture and break?

So we do get asked this a lot between fractures

and breaks, and there is no difference.

They're exactly the same.

It's just a mix in terminology

and clinically, we'll use fractures as the word,

and these can be categorised into a

few different subcategories.

So the least bony injury we see is a stress fracture,

and that might be caused from more repetitive strains.

Maybe with running a more impact exercise,

you'll also get an undisplaced fracture.

These maybe could be known as a green stick fracture

or a hairline fracture, worsening fractures.

You can get a displaced fracture

where the bone actually has moved out of position

and may need realigning surgically,

and we get even worse from that is a communed fracture

where we find that the bone breaks into several pieces

and very often that does need surgical repair in order

to reduce the bone back into position for the body to heal

and repair.

What's the difference between a tear and rupture?

So tears can be really, really simply in sort

of three categories.

So a grade one tear is

where we tear a small number of fibres.

So that's normally about less than 10%

of fibres in the structure that are damaged and torn.

So functionally, this doesn't have loads of impact on us.

It can cause pain. It'll cause maybe some mild swelling,

but it's rare that it impacts your function

apart from causing pain.

These are injuries that tend to resolve quickly with rest

with activity modification.

And it's rare that you need

to see a professional for support with this.

A grade two strain

or tear, it's something that

causes more disruption to the tissue.

And we'll see that between anywhere between 10%

and 90% of our tissue is damaged.

So that can cause, as you can imagine,

significant amounts of functional change.

And with that, we see swelling, we'll see bruising,

we'll see inability to move

or even inability to load that structure

because of the pain.

And as you can imagine, with more tissue damage, it's going

to take longer for those tissues to heal.

They should still heal because there are structures

or the part of the structure is still attached.

However, you may find that it takes a little bit longer.

You may need a little bit of professional support

through a physiotherapist to aid your recovery

so you can get back to your function or your sport.

And then finally, we can have a complete rupture,

which would be a grade three tear,

and that's where the structure is completely parted

and we're left with two parts of the structure.

Classically, if that's caused with a trauma, we'll go

and see an orthopaedic surgeon to get advice

and support on that as to see whether they feel

that they should repair that surgically

or whether it could be managed conservatively

with physiotherapy.

Why is my desk setup at work important?

Desk setups are really important

because we can spend between 30 and 50% of our day working.

And so if your work is inactive

and you are desk-based, it's a lot

of time potentially in a sitting position.

What we need to look at is we need

to look at the equipment that we've got around us.

You should be sitting comfortably

with our feet flat on the floor.

Our knees should be around 90 degrees,

maybe a little bit less,

and our hips slightly higher than our knees. When we're

sitting, sit in a supportive chair to make sure

that you've got the ability to rest your back

and sit back at the back of the chair.

And what we want is we want your elbows

to be relaxed comfortably by your sides,

your shoulders relaxed,

and your forearms being able

to rest comfortably on the desk in front of you.

Try and avoid reaching out in front of you to your keyboard

and make sure your screen height is looking at about eye

level when you sat at the desk.

I think the main thing though for me is movement is

don't stay at your desk for too long.

There's several studies

that say actually just being inactive,

whether you're in a good posture

or a bad posture, can lead

to musculoskeletal pain and injury.

So it's really important that we get up

and we move regularly.

Movement is medicine. Don't sit for too long.

Keep your joints moving and keep yourself healthy.

How often should I move when I work at my desk?

I think the take home message

for when we're sitting at our desk

and how often we move is move regularly

and keep it flexible.

If people are tied to their desks,

we definitely recommend moving every 30 to 40 minutes

to make sure that you're changing your posture regularly,

but it's safe to slouch.

Don't be worried about sitting in an awkward position.

Just make sure you're not there for too long.

Make sure you stand for a short period.

If you've got the ability to be able to have a sit

to stand desk, to stand for a short period, then

that's great and sit.

Use the front of the chair, use the back of the chair

and vary your position.

I think the take home message is the next posture is your

best posture.

What are the best ways to prevent muscle stiffness?

So muscle stiffness is often seen after exercise.

So if you overload

or you do too much with exercise,

you can develop muscle soreness, which can lead

to muscle stiffness.

Now, delayed onset muscle soreness is very common,

and if you don't manage that well, that can lead

to more persistent stiffness problems.

So how do we negate that?

Now, the best thing to do is make sure you manage your

exercise with adequate warmup and adequate cool down.

So what we want to look at doing with a warmup is we want

to gradually increase the heart rate.

We want to put the body through more dynamic movements.

The aim of a good warmup is

to get the blood flow into the muscles,

get the muscles switched on, get that link between brain

and body firing really quick, so we're reducing the risk

of the body not performing well,

and we know that that's going to mean

that you're less likely to fall or trip

and you're going to have better control of your movement.

The best way after exercise to cool down is

to gradually reduce your heart rate back to a resting level

and calming the tissues down.

So when we're performing,

movement muscles will naturally shorten to provide you

with movement and get the joints moving

so you can move forward or jump higher or move quicker.

What we want to do after that is we want

to return those muscles back to their normal length.

So that's where you can put in your static stretches,

stretching out all the muscle groups that you've used during

that activity to make sure it's specific to your sport

or to your activity,

and that will massively reduce the risk of

post-exercise stiffness and muscle stiffness.

Now, there's other things alongside managing exercise well.

So hydration's really important.

We tend to find when people are dehydrated,

they have a higher incidence of muscle cramps

and they're more likely to develop muscle

stiffness following that.

So keep yourself well hydrated if you know you've got a

performance or an activity or an event coming up.

There's a lot of research behind the effectiveness

of hyper hydrating, so putting plenty of fluid in your body

so it's able to perform well,

and the nutrition is supplied regularly through the body.

We classically see sort of muscle cramps at nighttime,

so good advice is to try

and keep flexible if you are prone to getting muscle cramps,

which we do see with people in later life is maybe look at

stretching before bed and waking up and trying to stretch it

and keep it moving in the morning.

But I think the main thing is adequate warmup,

adequate cool down, and keeping strength and flexibility.

How much should I exercise to prevent joint problems?

It is difficult to give you a generic answer on this

because we're all different.

So exercise is really individual.

Somebody who exercises regularly will need

to challenge their musculoskeletal system more in order

for it to adapt and get strong, as opposed

to somebody who's maybe more sedentary in their lifestyle,

who maybe will only have to exercise at a lower level.

The most important thing I think, is listen to your body.

If you start to exercise where you've not done before

and your body starts to give you signs of distress by pain

or getting aches, or you find it's affecting your function,

then modify your activities

and reduce what you're doing at that time.

Let your body build up slowly.

It takes about six to twelve weeks for our muscles

to get strong, and it's important that we have strength

around our joints to help keep them healthy.

We can avoid injuries to the joint

or problems to the joint by monitoring our weight as well.

There's a lot of strong research to say that people

that are overweight put more load through their hip

and their knee, and that can lead

to more degenerative conditions like osteoarthritis.

Should I avoid weight training exercise?

So weight train exercise is really important

in our weekly exercise routine, we talked about

physical activity recommendations, working aerobically,

but also there's evidence to say that we need

to be working with strength training.

Our bodies adapt to strength training by becoming stronger,

which means we can move our joints more effectively

and we become more functional.

The research shows that after the third

and fourth decade in life, we start

to lose muscle mass if we're inactive,

and that can range between three to 5%

of our muscle mass per decade.

So it's really important

that we keep regular strength training within our exercise

regime, and it's not too late to start.

There's research to show

that in later life if you still engage

with a strength programme, you can still

show strength improvements.

The key of it is ensuring that you do enough

that you do the high enough intensity in order for your body

to adapt and for it to change.

So take home message is stay strong.

Can too much exercise be bad for me?

So exercise is really important.

Too much exercise of course is bad for you,

but regular exercise isn't.

So when we get to a point

where we've done too much exercise,

our body start to tell us about it.

So what we find is we start

to get more post-exercise soreness

that doesn't resolve quickly.

So instead of your exercise soreness lasting maybe an hour

after exercise and having a little bit

of stiffness the following day, that you are in pain

for two days, three days,

and that recovery is taking longer then absolutely,

you've overloaded your body.

And that's when we tend to start seeing injuries

and people start to get pain,

and that affects their function.

So listen to your body as the take home message.

If you find that you're starting to get aches

and pains, adapt your exercise, modify it and reduce it.

Give your body time to adapt

and give your body time to recover.

I think the most important thing

with musculoskeletal adaptation is just being aware

that it is slow to respond.

Give your body time to respond, let it adapt,

and then we'll massively reduce the risks

of you developing any aches and pains from exercise.

Will repeated bending and twisting lead to a problem?

We get a lot of these questions,

particularly when people come in with back pain,

and that myth of bending

and twisting can cause pain, so I mustn't do it.

The problem with that is those myths create a fear,

and that fear prevents people from moving.

And the best way

and the strongest research behind managing back pain

is exercise.

So if we avoid exercise

and we stop bending, we stop twisting, we stopping provide

that rehabilitation that gets our bodies better.

So there's no link between bending and twisting

and recurrent injuries.

Is joint/muscle pain hereditary?

There's no consensus on this, whether the joint

and muscle pain is hereditary.

Age-related changes like osteoarthritis aren't hereditary.

However, there are certain autoimmune inflammatory

conditions that can be so for example,

rheumatoid arthritis is one of those.

So if you are close family members, if your mother

or father has rheumatoid arthritis,

you do have an increased predisposition to developing this.

The older I get, the more likely I'll develop a condition, is this true?

It is not completely true.

What you tend to find is there are age-related conditions

like osteoarthritis, which typically we'll see

the prevalence increases, age increases.

However, there are studies to suggest

that actually back pain reduces in prevalence in later life,

perhaps as our judge start to stiffen a little bit more,

they move less, so less likelihood of overloading them.

However, what we do see as we get older is

that our body's condition and our body's ability to move

and function and balance certainly does deteriorate.

Now, it's important that we help provide the body

with enough stimulus to stop that from happening.

So in later life, as our muscle strength reduces,

keep providing that your body

with enough resistance training, enough strength training

to prevent that deterioration.

It's really important as well,

that in later life you work on regular exercise

to help improve flexibility, to help improve balance.

Because if you are mobile and if you are more strong

and flexible, you're going to have less likelihood of slips,

trips, and falls, which can easily occur in later life

and cause significant impact to your function.

Can I prevent conditions like Osteoarthritis?

Osteoarthritis is typically an age-related condition

and a degenerative condition.

So as our bodies get older on the outside,

they also get older on the inside.

So what we can see in a mirror is grey hair and wrinkles.

And what we see on the inside is that smooth,

slippery cartilage that we have over our joint surfaces

that when we're in our younger years, is sort of glass like

and smooth becomes a lot more roughened,

a bit like a sandpaper.

And it can go through that gradings

of sandpaper as we get older.

And that can have more and more impact on

how your joint moves

and how your body functions,

which ultimately can result in pain

and you needing support to manage that.

So we can slow the progression of arthritis

by keeping good nutrition to our joint, keeping healthy

with a good weight.

So we know that people who are overweight

and carry more load have extra stress

thrown through their joints.

And there's a strong relation between high weight

and incidence of arthritis.

And can we ensure that our joints are kept active?

So regular exercise is another really good way

to help prevent the deterioration of the joint surface

and keeping the joint healthy.

And probably the best take home message with

that is strength training.

The stronger we can get our muscles around the joint,

the more that can offload the work

that the actual joint surface does and reduce that overload

and that deterioration in the joint.

So keeping an eye on weight,

making sure we keep our joints strong.

Also thinking about our other lifestyle choices.

So smoking, we know that has a deteriorating impact

of joint surfaces, so stopping smoking

and also excessive alcohol intake.

So try and make those lifestyle changes earlier on in life

and then we'll be able to keep our joints healthier in later


Can a physiotherapist advise me on avoiding pains and injuries?

Physiotherapists are perfectly placed

to advise you on avoiding and preventing injuries.

Their advanced knowledge on injury management

and rehabilitation helps give them enough ingredients

and enough knowledge to help guide you back.

I think the most important thing is making sure

that you grade your exposure to exercise,

build it up gradually allow the body to adapt.

The research suggests it takes between six

and twelve weeks for muscle tissue to adapt, for muscle fibres,

to become more numerous, numerous, and to become fatter.

And that's what generates strength

and that is what will help keep us healthy, happy,

and functional.

How long should I self-manage any aches and pains?

A lot of injuries can be successfully self-managed,

and as physiotherapists,

we don't see every injury everybody has.

What you'll typically see is small sprains

and strains will resolve quickly within a couple of weeks

as long as you modify your activity and are sensible

and listen to your body.

However, anything that lasts beyond two weeks

that isn't showing signs

of improvement is when you should start

to seek some more support and some more advice,

particularly if your symptoms are deteriorating.

I wouldn't leave symptoms that are getting worse

for longer than 10 days.

However, if there are signs

that you're getting significant changes in muscle power

and you're finding that you're extremely weak,

really quickly seek advice very promptly.

And if you're noticing any abnormal symptoms, pins

and needles, or numbness, you're having difficulty sleeping

because you're waking regularly through the night

because of your pain, then seek some

professional advice soon.

It may be that some early simple intervention can help

manage your condition really quickly

and get you back to activity.

And if you ever find yourself in that stage,

if you're a Bupa customer,

contact our MSK Direct Access service.

Or if you're not a Bupa customer, get into your NHS GP,

or perhaps you can access some self-referral

to physiotherapy.

Does applying hot or cold therapy to aches or pains work?

It's a good question and it's something

that we're asked a lot about.

There's no real significant research to say

that one is better than the other.

However, I do give advice about it,

and I think the easiest way

to look at it is if you've got an acute traumatic injury

where you can see swelling

or bruising, that's a sign

that there's significant inflammation in that tissue.

You'll often feel that it gets hot.

And what does your brain tell you?

Put some cold on it, and that's what I'd go with is listen

to your body, get some cold on it.

Swelling is healthy because it brings nutrients to heal,

but persistent swelling, swelling that stays

around the joint for longer periods can have a big impact on

your recovery and how you function.

So get some ice on it, manage it regularly,

try and get movement back to it.

But ice is great for acute injuries like that

where we can see that swelling.

I'd use heat when we tend to see maybe more muscle injuries.

So perhaps you've overloaded the tissue in the gym

or exercising and it's feeling tight.

Maybe you've got a cramp or a spasm in the muscle.

That's where heat's really good.

Can we relax the muscle to get it back

to its original length and can we calm it down?

So ice in the acute period for those first sort of seven

to 10 days, calm down that swelling, then heat on it

to help try and warm up the muscles around it,

help return those muscles back to their original length

and regain the flexibility and ultimately your function.

How can I stop pains returning?

So management of an injury is really important

to prevent pains from returning as you engage

with the rehabilitation exercise

and get yourself back to normal function.

There's definitely an aspect of maintenance that's required.

Unfortunately, with musculoskeletal adaptations,

if we don't keep stimulating the body with that need

to get strong to help keep flexibility, then we can lose it.

So we hear the phrase that use it or lose it,

and there's definitely a bit of theory behind that.

So making sure you keep exercising regularly.

There are a few studies that say to maintain strength,

you can exercise a couple of times a week to help make sure

that the body doesn't deteriorate further.

So I always recommend when people have resolved their

injury, that there's an ongoing maintenance thing.

Now, that doesn't have to be continued with your exercises

that you've been given by your physio.

It may be get into an activity,

get into a sport that you want to do.

It's really important that you enjoy what you're doing,

and if you don't enjoy the exercise, it's very unlikely

that you're going to maintain it.

So enjoy your exercise.

Find something that you want to do

because you'll keep to it.

And if it's new, build yourself up to it.

Let the body adapt. Let the body change.

Try to listen to your body and don't overload it.

Give that body time to adapt and keep it strong

and that'll avoid any recurrence in your injuries.

What's the difference between acute and chronic pain?

So acute pain is pain

that typically will resolve within healing timeframes.

So what I mean by that is tissues responding

to the body's natural progression

and natural laying down of new fibres.

So that may be anywhere between six and twelve weeks timeframe.

Chronic pain is something that's classified as pain

that lasts beyond that timeframe,

and that's where it can become a little bit more complex.

Chronic pain isn't always linked to just the amount

of tissue damage that has occurred,

and chronic pain can be influenced by a lot

of bio-psychosocial issues.

So it may be your beliefs about your injury,

what your initial thoughts are of how to manage it.

It may be your consequences at home, at life,

your mental health at the time,

and all these very complex aspects

of pain can feed into your pain becoming more persistent

or becoming more chronic.

How long can back pain last?

Recovery for back pain can be really varied,

and this may be due to sort

of the amount of tissue that's damaged.

So if we are looking at a small injury, a sprain

or strain where not many fibres have been involved,

we expect those to resolve reasonably quickly

with modification of activities,

perhaps some pain relief in order to help get you back

to moving and functioning well.

Or maybe if there's more tissue damage

that has a more significant impact on your function,

that you need to let your body have a little bit

more time to adapt.

And those will normally occur between six and 12 weeks.

Now, after that 12 week mark, pain isn't always linked

to the amount of tissue damage that can occur.

And we can find that tissues are actually healing on the

inside, but there is no influence to our pain.

And so the research in the last five

to 10 years has very much looked at persistent

and chronic pain to say that there is no correlation

between pain and tissue damage.

And so what does that mean to you in your recovery?

Basically, listen to your body,

but don't be fearful of pain.

If we're fearful of pain, we're not going to move well,

which means we're not going to recover.

A movement is the best way to recover from back pain.

Our national guidelines recommend exercise

as the premier sort of activity in order

to manage back pain.

So exercising regularly is really important.

Understanding and taking on board that pain

and tissue damage at that stage

of your recovery isn't always linked.

So listen to your pain, but work with it.

Try and focus a little bit more on function.

If you are able to walk for five minutes, day one,

see if we can start to look at progressing that gradually.

And that's the important thing

with our musculoskeletal system.

Give it time to adapt.

So what we'd look at is say five minutes, day one,

let's try seven minutes at day three

and 10 minutes at day 10.

Build it up gradually let your body adapt.

You'll find that your function will improve

and in time your pain will start to reduce.

How can I keep my muscles, bones, and joints healthy?

So keeping our muscles, bones, and joints healthy.

The take home messages, keep active,

that's the most important thing.

Sit less and move more.

There are loads of physical activity guidelines.

The World Health Organisation recommends

we exercise around 150 minutes a week.

So that's looking at 20 minutes at least a day

of cardiovascular exercise.

So that's exercise of moderate intensity, getting you

to a level where you're slightly breathless, still able

to hold a conversation, but maybe having to take a breath

to continue that conversation.

And that should be done regularly

to help improve cardiovascular health,

to help improve muscle and joint health as well.

And I think one thing that's often forgotten

with exercise is strength training.

As we get older in later life, we tend to lose muscle mass

and we tend to lose strength.

So keep in part of that strength programme during your week

and during your exercise is so important.

So keep active, move more, stay less,

and that's the best way to keep your bones

and joints healthy.

What are the key tips for healthy bones and joints?

So keeping healthy bones and joints is really important.

The early we start this, the better the impact.

So we know that keeping joints healthy comes about

by keeping the joint strong.

So we need to make sure that the muscles around

that joint are strong, making sure

that we don't excessively load that joint.

So monitoring

and keeping an eye on your weight is really important.

And also giving the joint enough nutrition, calcium,

and vitamin D are really important.

If we go to the strength training, it's important

and we recommend to people

that they're doing strength training at least twice a week

to overload that muscle in order to keep the joint supported

and keep the muscles strong.

With weight. We know that people

who are overweight put more stress

and more load through the joint surfaces.

So if we look for example at running

where we are massively increasing the load

and the research suggests that can be up

to five times our body weight through our lower limbs.

If you've got an extra kilogramme

or three of weight going through that joint,

you can imagine the stresses

and strains that are going to go through that

and the impact that diet might have,

and also diet and nutrition.

So calcium is really important to make sure that

that's in our diet to help lay down good healthy bones.

As we get older, our bone density reduces

and we see that also in post-menopausal women.

The hormonal support in order

to help keep bone density isn't there.

And so we need to make sure that we have enough calcium

to help support that.

Now calcium doesn't help to provide strong bones on its own

and it needs vitamin D and we absorb that from the sun.

So in the summer months in the uk, we're okay.

We might be covered if there's enough skin exposure.

However, in the winter months when we not have

as much skin exposure, it's important

to supplement your diet with vitamin D

to help reduce the risks of changes in bone density.

So to summarise, keep strong,

make sure you're not carrying excess weight.

Keep nutrition to the joints.

And I think the other things to keep in mind of is

not taking too much excessive alcohol and avoid smoking.

Where can I go for useful information about muscles and bones?

I always recommend people look for sources

that are ratified and that are trusted, so go to Bupa.

We know that the literature

that's published on our website has been ratified

by professionals, and it's been reviewed to make sure

that it's in line with good recent evidence-based practise.

Of course, we've got lots of research

and sources through the NHS as well that you could look at.

So look at reputable names that

provide good sound health advice.

When should I seek professional advice and treatment?

So I'd always encourage people

to seek urgent advice if they're finding

that their symptoms are deteriorating quickly.

If you're noticing that you've got any neurological

compromise, what I mean by that is if you're seeing signs

that you're getting any numbness in the body part,

if you notice any pins

and needles, if you find

that you're getting any deteriorating muscle power

or urgent weakness, seek urgent advice.

Any other abnormal systemic symptoms as well.

So if you're starting to develop a temperature, a fever

that might be causing night sweats,

or you're starting to see a significant weight loss,

always go and seek urgent medical advice.

And that may be if you're a Bupa customer,

contacting us at MSK direct access service,

or if you're not seeking advice

and support through your NHS GP

or maybe your self-referral physiotherapy.

How do I access support through Bupa?

If you're a Bupa customer, we can help you

through our MSK direct access,

or you can speak to a physiotherapist

through our digital GP app,

or you can access our Anytime Healthline nurses

who are available 24/7.

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This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.

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The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.

Customers who live on the Isle of Man, or have a Bupa Standard, Bupa Premium or Bupa Your Choice policy, do not have access to Bupa Blua Health, but can access GP24 provided by HealthHero. Some corporate schemes don't include access to Bupa Blua Health or GP24, so please check your scheme documents or give us a call.
Lines are open Monday to Friday 8am to 8pm, Saturday 8am to 4pm. We may record or monitor our calls. Direct Access telephone services are available as long as the symptoms are covered under your policy. If your cover excludes conditions you had before your policy started, we'll ask you to provide evidence from your GP that your symptoms are not pre-existing for a period of up to two years from policy start date (or five years in the case of mental health) before we can refer you to a consultant through the Direct Access service. Always call us first to check your eligibility.
∧∧ We may record or monitor our calls.

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