13/12/2025
𝗧𝗵𝗲 𝗚𝗼𝗹𝗱 𝗦𝘁𝗮𝗻𝗱𝗮𝗿𝗱 𝗼𝗳 𝗠𝘂𝘀𝗰𝘂𝗹𝗼𝘀𝗸𝗲𝗹𝗲𝘁𝗮𝗹 𝗖𝗮𝗿𝗲: 𝗘𝗹𝗲𝘃𝗲𝗻 𝗖𝗼𝗻𝘀𝗶𝘀𝘁𝗲𝗻𝘁 𝗥𝘂𝗹𝗲𝘀 𝗳𝗼𝗿 𝗕𝗲𝘀𝘁 𝗣𝗿𝗮𝗰𝘁𝗶𝗰𝗲
▪️ 🌍 Musculoskeletal (MSK) pain—encompassing conditions like back, neck, shoulder, and knee pain—is the leading cause of disability globally, yet the quality of healthcare provided for these conditions is often suboptimal.
A systematic review by Lin et al. highlights a significant gap between evidence and practice, characterized by the overuse of radiological imaging, surgery, and opioids, alongside a failure to provide patients with essential education and advice.
▪️ 📘 To address this, researchers analyzed 44 clinical practice guidelines (CPGs) for spinal, hip, knee, and shoulder pain, identifying only 11 that met high-quality standards.
From these high-quality guidelines, they distilled 11 consistent recommendations that constitute best practice care for MSK pain, regardless of the specific body part affected.
◼️ 𝗖𝗼𝗿𝗲 𝗣𝗿𝗶𝗻𝗰𝗶𝗽𝗹𝗲𝘀 𝗼𝗳 𝗔𝘀𝘀𝗲𝘀𝘀𝗺𝗲𝗻𝘁
▪️ 🔎 Screen for "Red Flags":
Clinicians should first screen to exclude serious pathologies, such as fractures, malignancy, infection, or severe neurological deficits.
▪️ 🧠 Assess Psychosocial Factors:
It is essential to assess factors such as depression, anxiety, fear of movement, and recovery expectations, as these are critical prognostic indicators.
▪️ 🏃♂️ Conduct a Physical Examination:
A physical exam including mobility, strength, and neurological screening is recommended to assist in diagnosis and classification.
▪️ 🖨️ Discourage Routine Imaging:
Radiological imaging (X-rays, MRIs) should not be used routinely. It is discouraged unless serious pathology is suspected, there has been an unsatisfactory response to conservative care, or the results are likely to change management strategies.
◼️ 𝗖𝗼𝗿𝗲 𝗣𝗿𝗶𝗻𝗰𝗶𝗽𝗹𝗲𝘀 𝗼𝗳 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁
▪️ Patient-Centred Care:
Care must respond to the individual context of the patient, utilizing effective communication and shared decision-making.
▪️ Education and Information:
All patients should receive education about their condition to encourage self-management and provide reassurance regarding prognosis.
▪️ Physical Activity and Exercise:
This is a cornerstone of management; guidelines consistently recommend physical activity, aerobic exercise, or specific strengthening exercises depending on the condition.
▪️ Manual Therapy as an Adjunct:
Manual therapy (hands-on treatment) should only be applied in conjunction with other evidence-based treatments, such as exercise and education, rather than as a standalone therapy.
▪️ Non-Surgical Care First:
Unless there is a specific "red flag" indication, patients should be offered evidence-informed non-surgical care prior to any consideration of surgery.
▪️ Facilitate Return to Work:
Clinicians should actively facilitate the continuation or resumption of work, as staying active is generally beneficial.
▪️ Monitor Progress:
Patient progress should be evaluated using validated outcome measures to ensure the chosen management strategy is working.
◼️ 𝗪𝗵𝗮𝘁 𝘁𝗼 𝗔𝘃𝗼𝗶𝗱: 𝗖𝗼𝗻𝗱𝗶𝘁𝗶𝗼𝗻-𝗦𝗽𝗲𝗰𝗶𝗳𝗶𝗰 "𝗗𝗼𝗻’𝘁𝘀"
▪️ Osteoarthritis (OA):
Arthroscopic lavage and debridement (clean-out surgery) should not be performed for knee OA unless there is a specific rationale like mechanical locking. Additionally, glucosamine and chondroitin are not recommended for disease modification.
▪️ Low Back Pain (LBP):
Paracetamol should not be offered as a single medication, and opioids should not be offered for chronic low back pain. Furthermore, spinal injections and disc replacement are generally discouraged.
◼️ 𝗧𝗵𝗲 𝗕𝗶𝗴 𝗣𝗶𝗰𝘁𝘂𝗿𝗲
▪️ 🌍 This review suggests that MSK pain conditions in different body areas share significant similarities regarding mechanisms and management.
▪️ ⚖️ By adhering to these 11 recommendations, clinicians can reduce the waste of healthcare resources—such as unnecessary imaging and surgeries—and improve patient outcomes.
▪️ 🔄 The findings serve as a "common ground" for high-quality care, signaling a shift away from passive, medicalized fixes toward active, educational, and holistic patient management.
◼️ Analogy
▪️ Treating musculoskeletal pain is like navigating a ship through a storm.
▪️ 𝗕𝗮𝗱 𝗽𝗿𝗮𝗰𝘁𝗶𝗰𝗲 is like immediately firing distress flares (opioids) or abandoning the ship for a lifeboat (surgery) at the first sign of rough waves, without checking the hull or the weather report.
▪️ 🧭 Best practice, as described in this review, is like a skilled captain steadying the wheel. They first check for major structural breaches (𝘀𝗰𝗿𝗲𝗲𝗻 𝗳𝗼𝗿 𝗿𝗲𝗱 𝗳𝗹𝗮𝗴𝘀), check the crew’s morale (assess psychosocial factors), and rely on their charts rather than staring blindly into the fog (discourage routine imaging). Most importantly, they keep the ship moving forward (encourage physical activity) and make small course corrections (manual therapy as adjunct) rather than letting the storm paralyze the vessel.
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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️
Link to Article 👇
