Treatment & rehabilitation

Musculoskeletal (MSK) practitioners such as chiropractors, osteopaths and physiotherapists commonly encounter a range of conditions that are often multifactorial, with mechanical, postural, and degenerative components playing a role.

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(Click on one of these below to read about the most common conditions seen by MSK practitioners and the best treatment for these as per current research).

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(Click on one of these below to read about the proper settings, indications, contra-indications and prognoses per most common conditions its used for as per peer reviewed research).

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The frequency of care in managing acute, sub-acute, and chronic musculoskeletal conditions varies across chiropractic, physiotherapy, and osteopathy practices. These disciplines share similar goals of reducing pain, restoring function, and improving quality of life. However, the frequency and duration of care often depend on the patient’s condition, response to treatment, and clinical guidelines from evidence-based studies.

1. Acute Phase

The acute phase refers to the initial onset of symptoms, usually lasting up to six weeks. Acute conditions often present with inflammation, muscle spasms, and intense pain.

Chiropractic Care

For acute conditions, chiropractors typically recommend frequent appointments early in the treatment plan. Evidence suggests that during the acute phase, patients may be seen 2–3 times per week for the first two to four weeks to manage symptoms and prevent further injury (Mitchell et al., 2020). As symptoms improve, the frequency of visits is reduced. These initial appointments focus on pain reduction, mobilization, and addressing biomechanical dysfunctions through spinal adjustments and soft tissue therapy.

Physiotherapy

In acute care, physiotherapists often recommend treatment sessions 1–2 times per week for the first two to four weeks. The goal is to reduce pain and inflammation through modalities such as electrotherapy, manual therapy, and exercise rehabilitation. Physiotherapy tends to incorporate home exercise programs early on, allowing patients to reduce dependence on frequent appointments as they progress toward self-management (O’Sullivan & Lin, 2021).

Osteopathy

Osteopaths may see acute patients 1–2 times per week depending on the severity of the condition. Osteopathic treatments typically focus on manual techniques to reduce pain and improve mobility, and treatment frequency decreases as pain subsides (Guillaud et al., 2018). Like chiropractic and physiotherapy care, osteopaths often encourage early patient education and self-management strategies to complement treatment.

2. Sub-Acute Phase

The sub-acute phase occurs when symptoms persist beyond the acute phase but have not yet reached chronicity, usually lasting between 6 and 12 weeks. The emphasis during this phase shifts from symptom control to functional restoration.

Chiropractic Care

During the sub-acute phase, chiropractic treatment frequency decreases to approximately 1–2 times per week for four to six weeks (Mitchell et al., 2020). The goal during this stage is to promote tissue healing, restore joint function, and prevent recurrence of symptoms. Chiropractors may integrate rehabilitation exercises and lifestyle modifications during this phase.

Physiotherapy

Physiotherapy in the sub-acute phase often involves weekly or bi-weekly sessions, with a greater focus on progressive exercise therapy, postural correction, and functional training (O’Sullivan & Lin, 2021). Treatment intervals are extended based on the patient’s progress, typically lasting four to six weeks, depending on the severity and complexity of the condition.

Osteopathy

For sub-acute conditions, osteopaths may reduce treatments to every 1–2 weeks. Osteopathic care at this stage often focuses on more advanced manual techniques and exercises to enhance mobility and strength (Guillaud et al., 2018). The frequency of treatment is generally tapered as the patient’s condition improves.

3. Chronic Phase

Chronic conditions are defined as those lasting more than three months. Chronic pain often involves persistent dysfunctions that require a multidisciplinary approach to manage effectively.

Chiropractic Care

In chronic cases, chiropractic treatment is typically reduced to 1–2 times per month, with a focus on managing long-term symptoms, improving function, and preventing flare-ups (Rubinstein et al., 2019). Long-term management may also include advice on ergonomics, lifestyle changes, and self-care strategies.

Physiotherapy

Chronic musculoskeletal conditions often require a long-term, patient-centered approach. Physiotherapy care may be delivered once every 2–4 weeks depending on the patient’s condition and goals. Treatment is highly individualized, with an emphasis on self-management, strength training, and maintaining mobility. Physiotherapists work with patients to create sustainable home programs and may involve follow-up visits to monitor progress and prevent exacerbations (O’Sullivan & Lin, 2021).

Osteopathy

For chronic patients, osteopathic care typically occurs once every 2–4 weeks or less frequently, depending on the severity of the condition (Guillaud et al., 2018). Treatment during this phase focuses on maintaining mobility, reducing pain, and supporting the body’s self-healing mechanisms. Osteopaths often use a combination of manual therapy, exercise, and patient education to help patients manage their condition long-term.

Conclusion

The frequency of care for patients with acute, sub-acute, and chronic conditions varies based on the practitioner’s discipline and the patient’s individual needs. In the acute phase, patients tend to receive more frequent treatments aimed at pain reduction and inflammation control. As patients transition to the sub-acute and chronic phases, the frequency of care decreases, with a greater emphasis on rehabilitation, functional restoration, and self-management strategies. Chiropractic, physiotherapy, and osteopathic care each offer tailored approaches, but all focus on evidence-based practices to provide effective, patient-centered care.

References

• Guillaud, A., Darbois, N., Monvoisin, R., Pinsault, N. (2018). Reliability of diagnosis and clinical efficacy of osteopathy: A systematic review. PLoS One, 13(7), e0201145. https://doi.org/10.1371/journal.pone.0201145
• Mitchell, M., Haas, M., Goldberg, H., Humphreys, K. (2020). Patient-centered outcomes of chiropractic care for common musculoskeletal conditions: A systematic review. Journal of Manipulative and Physiological Therapeutics, 43(4), 304-317. https://doi.org/10.1016/j.jmpt.2020.01.002
• O’Sullivan, P., Lin, I. (2021). It’s time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 55(4), 191-192. https://doi.org/10.1136/bjsports-2020-102337
• Rubinstein, S. M., de Zoete, A., van Middelkoop, M., Assendelft, W. J. J., & van Tulder, M. W. (2019). Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: Systematic review and meta-analysis of randomized controlled trials. BMJ, 364, l689. https://doi.org/10.1136/bmj.l689