What Does Success Really Mean in Treating Musculoskeletal Conditions?
After more than three decades in clinical practice, my experience has been that over 90% of the patients we treat for musculoskeletal conditions experience meaningful improvement in pain, function, or both. I am proud of that record, but I also want to be completely transparent about what that number means. It reflects our clinical experience, not the results of a controlled clinical trial, and it should not be interpreted as proof that MSR is 90% effective. No treatment works for everyone, and outcomes will always vary from one person to another.
We did not always achieve results like this. They came from decades of learning, questioning, adapting, and sometimes getting things wrong. We became better at assessment and treatment, placed greater emphasis on exercise and rehabilitation, learned when to bring in other healthcare professionals, and, perhaps most importantly, learned to stop and reassess when someone was not improving.
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What Does Successful Treatment Really Mean?
Success in treating a musculoskeletal condition is about more than simply reducing pain. Pain matters, of course, but ultimately we want to help people move better, function better, and return to the activities that matter in their lives.
Reducing Pain
For many patients, the first sign of progress is experiencing less pain, having painful episodes less frequently, or being able to perform activities with greater comfort. Reducing pain can improve sleep, confidence in movement, and quality of life, but pain reduction is only one part of recovery.
Improving Function
Just as important is what a person is able to do. Can they walk farther, move with greater freedom, return to work, exercise, play a sport, or simply manage everyday activities that had become difficult?
These improvements will look different for every person because successful treatment should be measured against the life that individual wants to return to.
Over the years, this has become increasingly important to how I think about clinical outcomes. Success is not simply a number on a pain scale. It is helping people get back to living their lives.
Why Doesn't Treatment Always Work?
No treatment works for everyone. Even with a thorough assessment, a well-designed treatment plan, and everyone's best efforts, some patients will not improve as expected.
When that happens, I believe one of the worst things we can do as practitioners is simply continue doing more of the same. A lack of progress should cause us to stop, reassess, and ask questions.
Did we get the diagnosis right? Are there contributing factors we have overlooked? Does the treatment or rehabilitation program need to change? Is something making it difficult for the patient to participate fully in their care? Would another healthcare professional bring a different perspective or provide something we cannot?
And sometimes, despite doing everything reasonably well, the outcome is simply not what any of us hoped for. That reality is part of healthcare too.
When a patient isn't getting better, one of the most important questions we can ask is: What are we missing?
Consistency and a Clear Treatment Plan
Successful treatment requires participation from both the patient and the practitioner. When treatment or rehabilitation is recommended over a period of time, consistency can be important. But simply attending more appointments does not guarantee a better outcome.
Patients should understand why a particular treatment frequency is being recommended, what we are trying to accomplish, and when progress will be reassessed. That responsibility belongs to the practitioner.
In my MSK articles, I provide general treatment-frequency recommendations based on factors such as whether a condition is acute, subacute, or chronic. These are guidelines, not formulas. Every patient is different, and treatment frequency should be adjusted according to the individual and their response to care.
Just as importantly, there should be clear points at which we stop and evaluate:
Is pain decreasing?
Is function improving?
Are we moving toward the patient's goals?
Does the treatment plan need to change?
Is continued treatment justified?
A treatment plan should have direction, measurable goals, and regular reassessment. If someone is not progressing as expected, the answer should not automatically be more treatment. It should be to ask why.
Exercise and Rehabilitation
For many musculoskeletal conditions, treatment is only part of the process. Exercise and rehabilitation can play an important role in restoring mobility, strength, coordination, and confidence in movement.
A rehabilitation program should be designed around the individual, their condition, current abilities, and goals. Just as importantly, it needs to be realistic. An exercise program that a patient cannot reasonably incorporate into their life is unlikely to succeed, no matter how good it looks on paper.
The patient has a role to play by participating consistently and communicating when exercises are too difficult, painful, or simply not working. The practitioner has an equally important responsibility: to explain the purpose of the exercises, ensure they are being performed correctly, and adjust the program as the patient progresses.
Rehabilitation should never be a static list of exercises. It should evolve with the patient.
The goal is not simply to complete the exercises. The goal is to restore function and help the patient return to the activities that matter to them.
Knowing When to Refer
Good clinical care also means recognizing when a patient needs something we cannot provide. Referral is not a failure of treatment. Sometimes it is one of the most important decisions we can make.
A patient's recovery may involve factors that extend beyond the musculoskeletal system or beyond a practitioner's scope of practice. Severe or persistent pain may require medical assessment or medication. Significant sleep problems can interfere with recovery and may require further evaluation. Psychological distress, neurological symptoms, or other health concerns may also require the involvement of another healthcare professional.
The responsibility is shared. Patients need to follow through with important referrals, but practitioners must recognize when additional expertise is needed and make those referrals promptly. We also need to be willing to collaborate with other healthcare professionals rather than assuming that one practitioner or one approach has all the answers.
Sometimes helping a patient means treating them. Sometimes it means recognizing when someone else can help them more.
A Shared Responsibility
Successful treatment is rarely the result of one person simply doing the right thing. It is a partnership between the patient and practitioner, with each having an important role to play.
The practitioner is responsible for listening carefully, developing a thoughtful treatment and rehabilitation plan, explaining the reasoning behind it, and regularly reassessing whether it is working. The patient brings something equally important: their goals, feedback, questions, concerns, and active participation in the process.
When progress is occurring, we build on it. When it isn't, we need to be willing to change direction, reconsider our assumptions, modify the treatment or rehabilitation plan, or involve another healthcare professional.
Ultimately, good clinical care is not about following a predetermined plan. It is about continually responding to the person in front of us and asking: Are we helping them move toward what matters in their life?
More Than 30 Years of Learning
Have we always achieved the results we see today? Absolutely not.
Over more than three decades in clinical practice, my approach has continued to evolve. The way I assess and treat patients has changed, exercise and rehabilitation have become increasingly important, and my understanding of biomechanics, fascia, the nervous system, and musculoskeletal conditions continues to develop as the research advances.
I have always considered myself a student. Over the years, I have attended and taught many courses, written close to 200 articles, and been involved in publishing 10 books. Much of that work has required returning to ideas I once accepted and asking whether they still hold up.
Sometimes they do. Sometimes they don't.
That is one of the humbling realities of working in healthcare for a long time. We make decisions based on the best knowledge available to us, but knowledge changes. Research challenges assumptions, clinical experience raises new questions, and occasionally something we once accepted needs to be modified or abandoned.
That is not a failure of the process. It is how the process should work.
I hope I am still questioning some of what I believe today ten years from now. There will always be more to learn, and ultimately that is how we continue to become better at helping the people who place their trust in us.
References
World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization. ISBN: 978-92-4-008178-9.
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021(9), CD009790. https://doi.org/10.1002/14651858.CD009790.pub2
World Health Organization. (2023). Package of interventions for rehabilitation: Module 2: Musculoskeletal conditions. World Health Organization. ISBN: 978-92-4-007110-0.
Naylor, J., Killingback, C., & Green, A. (2023). What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies. Disability and Rehabilitation, 45(6), 950–961. https://doi.org/10.1080/09638288.2022.2055165
World Health Organization. (2023). Therapeutic patient education: An introductory guide. World Health Organization.
Disclaimer:
The information provided on this website, including articles, videos, exercises, and other educational materials, is intended for general educational purposes and should not be considered a substitute for individualized assessment, diagnosis, or treatment by a qualified healthcare professional.
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Musculoskeletal conditions vary considerably from person to person. An exercise, treatment, or technique that is appropriate for one person may not be appropriate for another. If you have pain, neurological symptoms, an injury, or concerns about your health, consult an appropriately qualified healthcare professional.
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Dr. Brian Abelson, DC | Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work explores musculoskeletal conditions, human movement, and the biomechanics of sport, with an emphasis on translating complex science into practical information for healthcare professionals and the public.
He is the developer of Motion Specific Release (MSR), an integrated approach that draws upon manual and fascial techniques, joint mobilization and manipulation, acupuncture, neurodynamic techniques, and exercise-based rehabilitation.
Brian has written close to 200 articles and has been involved in publishing 10 books. His clinical and educational work reflects an evidence-informed, multidisciplinary approach and a commitment to continually reassessing ideas as both research and clinical understanding evolve.
Dr. Abelson is the Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
If success is measured against the activities each FNF patient wants to return to, how is that progress tracked when those goals are very different from one person to another?