Does aggressive rehabilitation offer the best outcomes?

Musculoskeletal injuries, such as lower back and neck pain, can emanate from the skin, fascia, bursa, muscle, ligaments, tendons and bones. The origin of this pain is often multifactorial, and can include acute injury, repetitive strain and overuse, work and posture related musculoskeletal disorders.

Management of musculoskeletal injuries typically involves manual therapy, non-steroidal anti-inflammatory drugs and biomechanical corrections. Historically, manual therapists have applied techniques up to the threshold of pain, and not past it. Reasoning behind this was to avoid causing further tissue damage, but does this approach still apply?

Research trials evaluated the effectiveness of treatment strategies for tendon overuse injuries, myofascial trigger points and specific sports injuries. It was concluded that manual therapists should not fear, but respect the pain that their patient experiences through dynamic therapeutic interventions. The pain that will result from aggressive techniques should by no means be excessive, and should not lead to protective muscle spasm, swelling or persistent pain. It is a fine balance that the manual therapist should be able to apply to each and every patient, to offer the very best outcome according to patient expectations.