The two main components of non-pharmacological management of regional musculoskeletal disorders are a thorough assessment followed by rehabilitative care.
Assessment includes a careful history, level of daily activities and participation, including occupation, rehabilitative care to date, possible presence of psychosocial problems, sports and hobbies. Special attention must be given to patient's expectations and personal objectives. A systemic enquiry is also important, as regional pain may be due to an underlying medical condition. Clinical examination consists of observation of posture, mobility, and whether there is evidence of wasting, asymmetry, deformity, or muscle imbalances. Palpation of soft tissue and bony structures follows to identify areas of tenderness, lumps, myofascial trigger points, tendon crepitus. Assessment of active and passive movements in all planes follows looking for specific restrictions. Examination is not restricted to the site of pain; as for example upper limb pain syndromes may be referred from the neck. In some patients further medical investigation is necessary when a thorough history, examination, and ultrasonography do not provide sufficient diagnostic information. This may involve blood tests, plain radiography, CT or MRI.
Rehabilitative care is a customized process, which aims to achieve an optimal functional outcome and participation in all aspects of life. Active rehabilitation and a gradual return to normal activities are key points in successful treatment of regional pain syndromes. Progressive exercise is a fundamental part of the treatment of most regional musculoskeletal complaints. The goal is to work towards full, specific, pain free functional activity. In myofascial pain syndromes and non specific arm pain in particular, there is a need for review of postural issues and ergonomics and building aerobic fitness. In addition, providing information to the patient about the nature of the condition, beneficial and negative habits and activities, self help exercises, expected response to treatment and outcome should all be part of the approach to these patients. Psychological interventions may complement rehabilitative care. Cognitive and behavioral methods focus on changing the patient's interpretation and reaction to pain. The main assumption of a behavioral approach is that pain and pain disability are influenced by somatic pathology and also by psychosocial factors (eg, patient's attitudes and beliefs, psychological distress and illness behavior). Consequently, the behavioral treatment of regional musculoskeletal disorders does not primarily focus on removing an underlying organic pathology, but on the reduction of disability through modification of environmental contingencies and cognitive processes.
Disclosure of Interest None declared
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