What Best-Practice Musculoskeletal Care Really Means

Care as a journey, not a series of treatments

Low-value care, unnecessary imaging, and inconsistent treatment remain stubborn problems in how we manage musculoskeletal pain. In 2019, an Australian-led research team asked a deceptively simple question in the British Journal of Sports Medicine: What does best practice care for musculoskeletal pain look like? Reviewing the highest-quality clinical practice guidelines across the most common MSK pain conditions, they distilled a clear, evidence-based answer. What struck me most was not any single recommendation, but how clearly they describe good care as a connected journey rather than a series of isolated treatments. Best practice, it turns out, is less about any one intervention and more about how consistently we guide a patient from that first assessment through to discharge, measuring progress and adjusting along the way. That is the thread I want to pull on here.

When research confirms what clinicians already sense

Clinical Practice Guidelines play a vital role in reducing the burden and cost of low-value healthcare. In an era of rapid advances in musculoskeletal (MSK) treatment and technology, this Australian-led review provides a timely reminder to keep patient-centred care at the heart of clinical decision-making. 

Following a systematic review and critical appraisal, the authors identified 11 key recommendations that are consistently supported across MSK pain conditions, including:

• Deliver patient-centred care through effective communication and shared decision-making.
• Screen for serious pathology and assess psychosocial factors.
• Avoid unnecessary imaging unless it is likely to influence management.
• Undertake appropriate physical examination and monitor patient progress using outcome measures.
• Provide education, encourage physical activity and exercise, and use manual therapy only as an adjunct to evidence-based care.
• Prioritize non-surgical management where appropriate and support return to work and meaningful participation.

Why measuring progress matters most 

One particularly important recommendation is the routine evaluation of patient progress through outcome measures. Looking beyond the range of motion and pain scores allows clinicians to better understand what matters most to patients and whether treatment is meaningfully improving their lives.

The authors also highlight a gap in current MSK guidelines: the limited integration of psychologically informed care. This is where patient-reported outcome measures and psychologically informed clinical practice can intersect, providing a more complete picture of recovery and satisfaction for the patient and a clinician that has provided the highest quality care.

Redefining what best practice means 

Ultimately, Lin et al.’s work reinforces that best practice musculoskeletal care is not defined by the sophistication of technology, the number of scans ordered, or the breadth of interventions available. It is defined by how effectively we understand, support, and partner with the person in front of us. By combining evidence-based practice with psychologically informed care and meaningful outcome measurement, clinicians can move beyond symptom management and focus on the outcomes that matter most: function, confidence, participation, and quality of life.

Reference

Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PPB. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine. 2020;54(2):79-86. doi:10.1136/bjsports-2018-099878