Open Forum: Musculoskeletal Rehabilitation - Facilitated by Kieran Doyle

The open forum focused on collaborative clinical reasoning for complex musculoskeletal presentations, emphasising differential diagnosis, clinical prioritisation, and staged rehabilitation. The first case explored a multi-factorial presentation involving hip and lumbar symptoms, highlighting the importance of distinguishing neural involvement from somatic referral and differentiating intra‑articular versus extra‑articular hip pathology. Discussion centred on ruling out significant radiculopathy, using movement-based assessment and neurological screening to guide priority, and avoiding over‑treating multiple impairments simultaneously. Management principles included education around symptom‑provoking positions, graded exposure to load, and a phased rehabilitation approach progressing from isometric loading to functional strengthening and improved tolerance to compression and daily activities. The second case examined persistent low back pain in a younger adult with a history of spinal stress injury and prolonged morning stiffness. Clinical discussion focused on screening for inflammatory features, considering systemic contributors, and balancing local motor control strategies with restoration of general activity levels. Across both cases, the forum reinforced the value of structured assessment, load management, patient education, and aligning intervention strategies with irritability, functional goals, and real‑world context rather than pursuing impairment-based treatment alone.

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