Lyme disease, transmitted via the bite of a tick, can often present as a musculoskeletal issue with joint and muscle pain, nerve pain, fatigue, weakness, pins and needles and numbness. It can also have many overlapping clinical symptoms with inflammatory arthritis, connective tissue disease, fibromyalgia and chronic fatigue syndrome. These later stage symptoms of Lyme disease can occur weeks, months or years after the initial infection, when the disease has become systemic and more complex. Physiotherapists have a key role to play in recognising these signs and symptoms within their patients. This session will discuss when to suspect Lyme disease, the relevant clinical questions to ask and what to do next. A case study will illustrate this learning.  Learning outcomes: At the end of the session participants will: - Understand how Lyme disease is transmitted to humans - Recognise the multi-systemic signs and symptoms of Lyme disease - Understand the challenges in differentiating Lyme disease from other MSK conditions and masqueraders. -  Recognise  the key role that physiotherapists can play in identifying this complex disease.-  Know how to access and use up-to-date guidelines on the diagnosis and treatment of Lyme disease - Have an awareness of the recognised scientific uncertainties and the need for further research.