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Introduction

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The good physician treats the disease; the great physician treats the patient who has the disease.

William Osler

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Treatment begins when the patient first presents with symptoms. But the boundary between the end of treatment and the start of rehabilitation is blurry. In many conditions that are managed conservatively (e.g. hamstring muscle strain, tendinopathy), the exercises that are started for “treatment” also contribute to the rehabilitation process. If one were required to make a distinction, it might be that the treatment techniques are often used in acute to subacute presentations, and rehabilitation commences when clinical presentation stabilizes, which can be anywhere from subacute to chronic.

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This book discusses therapies that apply to both “treatment” and “rehabilitation” in just one of the relevant chapters. For example, manual therapy is covered in this chapter, even though it can be an important part of ongoing rehabilitation. On the other hand, exercise prescription (resistance exercises, proprioceptive training, flexibility training, and activities that combine these elements), an essential “treatment” of musculoskeletal conditions, is covered in Chapter 15.

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Evidence for treatment effectiveness is continually changing

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This chapter provides the essential background for treatments that are referred to in Part B, “Regional problems.” Here specific treatments are defined and described, the levels of evidence for their effectiveness are reported, and a clinical perspective is provided for their use in musculoskeletal medicine.

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There has been a remarkable explosion of evidence to support treatments in sport and exercise medicine in the past decade (see box). In 2010 alone, new sports medicine treatment evidence was published in the New England Journal of Medicine,1 Journal of the American Medical Association (JAMA),2 BMJ, and the Lancet.3

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Just a small sample of high-quality research published during a small window of time (2010). This provides an increasingly stronger foundation for treatment in sports and exercise medicine.

Frobell RB, Roos EM, Roos HP et al. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 2010; 363: 331–42.

Emery CA, Kang J, Shrier I et al. Risk of injury associated with body checking among youth ice hockey players. JAMA 2010;303:2265–72.

de Vos RJ, Weir A, van Schie HT et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 2010;303:144–9.

Coombes K, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010;376(9754):1751–67.

Cooper R, Kuh D, Hardy R; Mortality Review Group; FALCon and HALCyon Study Teams. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 2010 Sep 9;341:c4467. doi: 10.1136/bmj.c4467.

Bleakley CM, O’Connor SR, Tully MA et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ 2010;340:c1964. doi: 10.1136/bmj.c1964.

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Nevertheless, we remind the ...

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