The way we treat non-traumatic MSK pain is failing

A brand new paper by Jeremy Lewis and Peter O'Sullivan, a couple of research based physiotherapists, has really lit the fire under this issue.

Their editorial has just been published in the British Journal of Sports Medicine, and may be read in full here.

Entitled: Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?

A couple of points really jumped out at me.

First, they propose that there are two concerning developments in the management of people who suffer persistent non-traumatic musculoskeletal pain disorders.

They contend that structural changes observed on imaging that are highly prevalent in pain free populations, such as rotator cuff tears, intervertebral disc degeneration, labral tears and cartilage changes, are ascribed to individuals as a diagnosis for their condition.

I can also think of a number in relation to the lower limb, for example tibial stress reaction in runners, plantar plate tears and neuroma to mention a few.

Diagnosis based on what might be normal images can lead to a cascade of very negative events for the patient, based on the belief that the pathology identified by imaging MUST be responsible for the pain they are now suffering. In addition, this may amplify anxiety related to the notion that their body is damaged, fragile and in need of protection.

This in turn can result in a cascade of movement and activity avoidance behaviours and seeking interventions to correct the structural deficits

Ultimately this may lead to the search for a "quick fix", most often surgery, that, based on what might conceivably be completely normal imaging studies for that patient and their age, is destined to failure.

Now none of this is good, but it is the second proposition by the authors that should really worry us.

Simon Bartold
Director of Bartold Clinical