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Physiotherapy
There is evidence supporting the use of manipulation by a physiotherapist for acute and sub-acute musculoskeletal pain1, 35. In more chronic cases, brief, structured courses of exercise that utilise behavioural principles to encourage progressive upgrading, and maintenance of exercises and normal activities are more useful than “hands-on” types of intervention such as manipulation1, 2. Other treatments include Transcutaneous Electrical Nerve Stimulation (TENS) and hydrotherapy. “Passive” modalities (e.g. massage, heat pack, shower, ice pack) are generally discouraged in more chronic cases as they have little supporting evidence of effectiveness, and may reinforce passivity and activity avoidance in these patients1, 2.
Social and occupational functioning
In order to prevent deconditioning, it is important patients are reintroduced to normal activity, encouraged to return to work, and fear avoidance behaviour is addressed1, 2. Generally, people cope better when they have social interaction, social support networks (e.g. family and friends) and purpose in their life. Activity scheduling may assist individuals who are socially isolated1, 5.
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