MSK education & REALISTIC OPTIMISM (4/02/26)

Education is a powerful tool for MSK problems, but maybe not in the way that most people think about interventions.

Education doesn’t magically reduce pain, as much as we might like it too. Instead, it probably makes having pain easier to deal with by (hopefully) reducing anxiety, worry and rushing to get any treatment under the sun. 

One of the key bits of information people seem to require is, “how long will this take to get better”, which of course can be challenging to fulfil. 

 I often talk about the need to be accurate with the information we give people, one of the reasons for being ‘evidence based’, but sometimes this information is not always optimistic. 

 A worry I have seen from clinicians is sometimes that when accuracy is not optimistic or the best-case scenario this might not be what patients want to hear, but being overly optimistic might also lead to disappointment and the blow to confidence and expectations that can bring. 

 So, in my opinion we need REALISTIC OPTIMISM based on the best data and research we have currently. So we can still be optimistic, but also hopefully without being inaccurate and the issues that might bring. 

 We know that expectations of outcome are a strong prognostic factor for many MSK conditions, and this should be based in what is currently known to set realistic timeframes. 

 Overly optimistic education could also lead to poor medical decisions such as unnecessary scans, investigations and treatments that are not very well evidenced, as recovery might be seen as failing, when in fact it is still in a realistic timeframe. 

 Often things do take a little longer than people expect or would like. Of course, there is a range of outcomes dependent on the prognostic factors present and presenting that potential range is important. I often suggest that if we do things that are positive for recovery then the probability is it will be shorter rather than longer timeframe, and a key part of realistic optimism. 

 Sciatica is often discussed as having a natural history of around 4-6 weeks, like non-specific back pain. BUT…..the data tells a bit of a different story, with recovery looking a lot more like 8-12 weeks and then not always fully recovered. This could lead to operations or injections that are not always successful or required. I have regularly encountered people with multiple rounds of both! 

 Tennis elbow, or lateral elbow tendinopathy, seems to have a pretty long recovery with a clinical course somewhere between 6 to 18 months. I can see why that would perturb some folk, but if someone thinks it’s going to go in a couple of weeks then they will be sorely disappointed.  This could lead to a CS injection to speed things up, that is known to actually create worse outcomes! 

 Non-specific low back pain often makes ineffective treatments look good as episodic recovery can be quite swift, regardless of treatment type. But of course, it often returns with vengeance leading to more treatment that is seen as effective but maybe nothing more than coinciding with the natural history. 

 So think REALISTIC OPTIMISM!