A novel approach to pain relief pre-therapeutic exercise.

Musculoskeletal problems are often multifactorial and consequently can be challenging to treat. This paper examines management of chronic musculoskeletal conditions in the light of Panjabi's stabilisation subsystems and Dye's concept of homeostasis and critical symptom threshold. In many circumstances treatment can aggravate symptoms. Tape may be used to unload painful structures to minimise the aggravation of the symptoms so treatment can be directed at improving the patient's 'envelope of function'. This involves specific muscle training of the dynamically unstable segment/s and increasing the mobility of the less flexible surrounding soft tissues. Three case studies of chronic low back and leg pain, patellofemoral pain and shoulder impingement secondary to multidirectional instability, are presented as examples of multifactorial musculoskeletal problems requiring unloading, stabilisation and control.