Rehabilitation principles for chronic musculoskeletal injuries

Dr Saul Geffen (University of Queensland) has reviewed rehabilitation principles for treating chronic musculoskeletal injuries. He describes some injuries to be benign and self-limiting, requiring little more than routine medical care and advice; while others become chronic and present complex therapeutic challenges.In the review, Geffen proposes that a patient's evaluation for rehabilitation after musculoskeletal injury should involve identification, grading and assessment of the injury and its impact on the patient's normal activities. He identifies optimal management, especially for patients with associated co-morbidities, as being the simultaneous addressing of the physical condition, the underlying psychological processes and the social environment of the patient. Geffen recommends a multidisciplinary patient management team to achieve this management approach, comprising of the patient, doctor and physical therapist, with other health professionals recruited as required.He describes the key component of the plan to be active mobilisation utilising strengthening, flexibility and endurance exercise programs, with passive physical treatments (heat, ice, and manual therapy), as well as drug therapy and psychological interventions to be used as adjunctive therapy.Geffen advocates a progressive, staged return to activity after the achievement of full range of movement, adequate strength and control, with a simulated environmental testing and effective team communication facilitating the process. The decision to return to full activity should be made by the whole treatment team, including the patient, he adds.ReferenceGeffen, S. et al 2003, 'Rehabilitation principles for treating chronic musculoskeletal injuries', The Medical Journal of Australia, vol. 178(5), pp. 238-242....