Dr Robin Chatterjee
Rehabilitating a musculoskeletal (MSK) problem is a complex issue; an individualised programme involving several stages, and several healthcare professionals is needed.
Historically the term ‘rehabilitation’ originates from the Latin ‘Re’, which means ‘again’ and ‘habitare’, which means ‘make fit’.
What does musculoskeletal rehabilitation have an effect on?
Musculoskeletal (MSK) rehabilitation is the process by which clinicians are able to help individuals who have muscle, bone, joint, tendon or ligament problems return to their previous levels of physical fitness, improve symptoms, increase self-worth, reduce pain and optimise functional ability and independence.
This may also involve improving the quality of their psychological, emotional or social life as these factors often have a symbiotic relationship with the state of one’s physical health.
MSK disorders that may benefit from rehabilitation can be broadly categorised into rheumatological problems (such as arthritis), non-surgical MSK issues (such as back, knee or hip problems that cannot be operated on), MSK pain of unknown cause, post-operative orthopaedic patients, sporting injuries and amputees.
What must be considered for MSK rehabilitation?
Rehabilitating an MSK problem is a complex issue; an individualised programme involving several healthcare professionals is needed. Patients are initially assessed for their baseline levels of physical activity, mental health, and wellbeing and also their degree of motivation to make lifestyle changes. Modifiable personal lifestyle factors, which can affect the ability to be active, are also addressed in addition to prescription of exercise. These are sleep, nutrition (including hydration levels), posture and emotional and mental well being.
The multi-disciplinary rehabilitation team
A co-ordinated, integrated multi-disciplinary approach is required to give the patient the best chance to return to their previous physical state. Members of this team can comprise of some or all of the following: sport & exercise medicine doctor, rehabilitation doctor, orthopaedic surgeon, physiotherapist, occupational therapist, exercise physiologist, nutritionist, dietician, podiatrist, psychologist, psychiatrist, prosthetist.
What physical therapy is involved?
This part of the rehabilitation process is mainly led by physiotherapists. It follows many of the same principles of training. Training deals with strengthening normal tissues. Rehabilitation involves strengthening injured tissue.
Physical rehabilitation can be divided into early, intermediate and late stage where the aims of rehab are to protect the injured area and manage pain in the early stage, address strength and proprioception in the intermediate phase and improve agility, coordination and endurance in the late stage.
Physical therapy can sometimes include the fitting of casts, braces, orthotics (splints) or prosthetics (artificial limbs).
Exercise prescription is designed to act as an adjunct to the standard pharmacological management that the patient is already receiving. The overarching aim is to reduce some medications, if possible, and use a holistic approach to improve overall morbidity. The objective is to integrate purposeful movement into the daily schedule of the individual.
The importance of nutrition, sleep, mental and emotional well being
Many people have MSK pain of unknown cause where all tests, investigations and scans are normal. These are often the trickiest patients to rehabilitate. In these cases, the individual has to be assessed holistically. A patient-centred approach is taken where the whole patient and not just a single body part is assessed. Changes to diet, the ergonomics of their workplace, footwear, stress, or other such factors may instigate a significant change in a person’s physical self, consequently alleviating their MSK pain.
To summarise, MSK rehabilitation is more than just addressing the affected body part. It is treating the whole individual and is a complex process that involves many specialist clinicians working together in a structured and integrated manner.