There are two things behind this idea. One that everyone should be treated with the same presence, time, listening, care and attention to detail as an athlete is in today’s culture of rehab. Two that care should be dictated toward getting the patient back to moving better and finding or encouraging a movement practice they love. Just like when we are doing a “return to play” strategy with an injured athlete.
So you may be thinking, “What should I look for in my musculoskeletal care? There are so many options, it’s hard to sift through the weeds.” Funny you should ask. The British Journal of Sports Medicine came out with a systematic review study last year of the 11 consistent recommendations for musculoskeletal pain from high-quality clinical practice guidelines. These guidelines were formed based on research identifying the overuse of imaging, surgery, and opioids and lack of use of quality education to manage musculoskeletal conditions. Here is a breakdown of the 11 recommendations.
Individualized care and patient included in decision making– Care plan should be individualized to the patient’s condition and goals. The conversation about the best route of care should include the patient’s thoughts and concerns.
Clinicians should question and examine for red flags– Musculoskeletal pain can become manifest from several different things. Patients need to be questioned and screened for more serious underlying conditions and promptly referred out to the right physician that can help treat it. This is why the right classification for the pain and condition is so important. We need to know what the actual problem is before we can select the intervention to treat it.
Psychosocial Factors Need to Be Addressed– As we see depression and anxiety rates continue to increase this becomes more and more important to screen. Emotions being held in the body can manifest as musculoskeletal pain and typical interventions done in medical, physical therapy, or chiropractic offices will have little to no effect or won’t fully solve the problem until all underlying issues are addressed. We can have multiple pain mechanisms going on at one time and until all of them are addressed, full pain-free symptoms may not be accomplished.
Imaging like X-rays and MRIs should only be used if major injury or damage is suspected, zero to little results seen with a conservative treatment plan, or imaging will change the course of the current treatment plan– Imaging can useful, but a lot of times it is not needed to dictate care. It can even hinder care as the patient gets in their head that they are damaged from seeing image results. Most results are normal and just like wrinkles under the skin and normal part of the aging process. We’ve posted about it before but image findings do not always correlate to pain. Many people are walking around with disc bulges for example and have zero symptoms. Here at ICT Muscle & Joint, we educate on treating the function and not structural findings.
Musculoskeletal assessment should be hands-on and include neurological, mobility, and strength tests– This is simple: if you don’t assess, then you are guessing. This goes for any doctor looking at musculoskeletal complaints. If they don’t assess your range of motion, strength, or neurological sufficiency then find a new doctor. We love using things like Selective Functional Movement Assessment (SFMA) or Functional Movement Screen (FMS) to assess how the body is moving fully.
Treatment plan advancement should be assessed, including the utilization of approved result measures– Results need to be measured with care. This is usually done with outcome measure quizzes throughout care and asked through doctor conversation questions. If results are not meeting expectations laid out by both the doctor and patient, then it’s back to the drawing board to figure out what could be changed to get better results. This could mean a referral to another provider if necessary that can better treat the condition at hand.
Patient education is key and should be used to help the patient understand their condition and all management options– The doctors here believe that patient education is the number one thing in treatment. Empowering and educating patients on how resilient their body is and how to use movement to treat aches and pain themselves can do more for them than any soft tissue work in getting them back to the things they love doing and performing better.
Patient goals and treatment should include management with physical activity and/or exercise–We want to get patients moving the injured area in some way as fast possible to expedite the healing process and get on track with the “return to play” with whatever activity goal they want to get back to.
Manual therapy like IASTM, dry needling, cupping, ART, chiropractic adjustment can be used but only in alliance with other treatment approaches like education and exercise– Manual therapy and chiropractic techniques can be very useful, but should be used as a way to get the patient moving better or in less pain so that the exercises we are doing are easier to accomplish. Dependence on manual therapy for care should be avoided.
After ruling out contraindications and red flags, a trial of care with evidence-informed conservative treatment should be offered before surgery– After ruling out serious pathology, a trial of conservative care with chiropractic work or physical therapy should be used before going under the knife for surgery.
Encourage and lay out plan for return or continuation of work and sport– After the initial visit a “return to play” strategy to work or sport should be laid out based on the patient’s condition of goals. We love using the clinic/gym hybrid model get people rehabbing and exercising within their appointments. At our west Wichtia location we use the gym space to even more reinforce the idea with group fitness and exercise technique classes.
Reference: Lin I, Wiles L, Waller R, et al
What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review
British Journal of Sports Medicine 2020;54:79-86.