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Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?
  1. Jeremy Lewis1,2,
  2. Peter O’Sullivan3,4
  1. 1 School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
  2. 2 Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
  3. 3 Health Sciences Division, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  4. 4 Bodylogic Physiotherapy, Perth, Western Australia, Australia
  1. Correspondence to Professor Jeremy Lewis, School of Health and Social Work, University of Hertfordshire, Hertfordshire AL10 9AB, UK; jeremy.lewis{at}LondonShoulderClinic.com

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The current approach to musculoskeletal pain is failing

The majority of persistent non-traumatic musculoskeletal pain disorders do not have a pathoanatomical diagnosis that adequately explains the individual’s pain experience and disability. We contend this has resulted in two concerning developments in the management of people with such disorders. First, 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. In this context, this information may result in the individual believing that their body is damaged, fragile and in need of protection, resulting in a cascade of movement and activity avoidance behaviours and seeking interventions to correct the structural deficits.1 This trend has led to exponential increases in elective surgery rates and associated costs, while the efficacy of repairing (eg, rotator cuff and medical meniscal tears), reshaping (eg, subacromial decompression) or replacing (eg, lumbar intervertebral discs) the structures considered to be at fault has been substantially challenged.2–10Second, it is arguable that musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected (such as trigger points, sacral torsions), and they have developed and perpetuated treatment paradigms (such as ‘correcting’ upper body posture and muscle imbalances) that do not conform to current …

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