{"id":11962,"date":"2026-09-21T06:00:36","date_gmt":"2026-09-21T05:00:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11962"},"modified":"2026-09-03T16:40:02","modified_gmt":"2026-09-03T15:40:02","slug":"musculoskeletal-barriers-to-rehabilitation-a-role-for-sport-and-exercise-medicine","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2026\/09\/21\/musculoskeletal-barriers-to-rehabilitation-a-role-for-sport-and-exercise-medicine\/","title":{"rendered":"Musculoskeletal barriers to rehabilitation: a role for Sport and Exercise Medicine"},"content":{"rendered":"<p><strong>Why Sport and Exercise Medicine may be valuable where functional rehabilitation, not performance, is the priority<\/strong><\/p>\n<p><b>Keywords: <\/b><span style=\"font-weight: 400\">Sport and Exercise Medicine; Rehabilitation; Musculoskeletal health<\/span><\/p>\n<p><b>Introduction<\/b><\/p>\n<p><span style=\"font-weight: 400\">Sport and Exercise Medicine (SEM) is still often associated with athletes, pitch-side care and return to sport. Yet some of the clearest opportunities for SEM to improve outcomes may sit far from traditional sporting environments. In inpatient rehabilitation, musculoskeletal problems frequently limit recovery, but can be under-recognised or difficult to address quickly within existing care models. This blog explores how SEM may naturally fit into this space.<\/span><\/p>\n<p><b>Musculoskeletal problems quietly limit rehabilitation<\/b><\/p>\n<p><span style=\"font-weight: 400\">Rehabilitation patients commonly present following neurological injury, surgery, frailty syndromes, falls, deconditioning or prolonged immobility. Alongside the primary diagnosis, there is often a significant burden of musculoskeletal pathology.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Common examples include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hemiplegic shoulder pain\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Osteoarthritis flares\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Acute crystal arthropathy, including gout and calcium pyrophosphate deposition disease\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Post-operative joint effusions\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Occult or missed fractures after falls\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Joint stiffness following prolonged admission or immobility\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">These issues matter. Pain, swelling and restricted movement reduce engagement with therapy, delay functional gains and can prolong length of stay. A swollen knee, painful shoulder or undiagnosed fracture may be the difference between progressing with transfers, gait retraining and discharge planning &#8211; or losing rehabilitation momentum.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Crystal arthropathy is a particularly relevant example in frail, multimorbid patients, especially around acute illness, admission, renal dysfunction or medication changes. Timely diagnosis and targeted treatment may avoid unnecessary transfers, reduce reliance on systemic therapies where these carry risk and allow rehabilitation to continue.<\/span><\/p>\n<p><b>Why SEM aligns with rehabilitation<\/b><\/p>\n<p><span style=\"font-weight: 400\">SEM is well suited to rehabilitation because the specialty combines broad medical training, MSK diagnostic expertise, use of diagnostic ultrasound, image-guided intervention skills and a functional, movement-focused mindset.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In practice, this means SEM clinicians can support proportionate decision-making at the bedside: is this pain safe to move through? Is there an effusion to aspirate? Is imaging needed? Would a targeted injection improve therapy participation? Does this presentation need escalation to orthopaedics, rheumatology or acute medicine?<\/span><\/p>\n<p><span style=\"font-weight: 400\">The role is not to replace rehabilitation medicine, geriatrics, neurology, orthopaedics, rheumatology, physiotherapy or occupational therapy. It is to add an embedded MSK-functional skillset within the multidisciplinary team.<\/span><\/p>\n<p><b>SEM as a flow-enabling specialty<\/b><\/p>\n<p><span style=\"font-weight: 400\">When SEM input is available within rehabilitation teams, its value may extend beyond individual diagnoses. Timely MSK assessment, bedside ultrasound and targeted intervention can restore engagement with therapy, reduce avoidable transfers or acute referrals, support safer post-falls assessment, clarify weight-bearing and exercise progression and contribute to discharge planning.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In a local 3-month service report in 2025 from St Pancras Rehabilitation Unit, embedded SEM input delivered 18 ultrasound-guided injections, 4 joint aspirations and 11 diagnostic MSK ultrasound assessments. At least 31 external referrals or acute trust reviews were estimated to have been avoided over this period. While these figures require more formal evaluation, they suggest that timely MSK input may have meaningful impact on patient flow, therapy participation and system burden.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In this context, SEM is not simply a referral endpoint. It can act as a flow-enabling specialty, aligned with wider healthcare priorities around rehabilitation, community care, reduced acute burden and functional recovery.<\/span><\/p>\n<p><b>Impact beyond patients: the MDT and workforce<\/b><\/p>\n<p><span style=\"font-weight: 400\">The benefits are not limited to individual patient encounters. Rehabilitation units often include clinicians with variable MSK confidence, including resident doctors rotating through services where MSK presentations are common but formal MSK training may be limited.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Embedded SEM input can provide immediate educational value by supporting:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Confidence in MSK examination and red flag recognition\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Better assessment of pain and injuries after falls\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Practical understanding of aspiration and injection procedures\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improved shared decision-making with therapists\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Early exposure to SEM as a career pathway\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">This matters because the educational gain persists after the individual SEM consultation. Improving baseline MSK confidence across resident doctors and the wider MDT can strengthen rehabilitation services more broadly.<\/span><\/p>\n<p><b>What this means for SEM<\/b><\/p>\n<p><span style=\"font-weight: 400\">Rehabilitation challenges the narrow view of SEM as a specialty focused only on athletes or outpatient MSK clinics. At its core, SEM is about restoring movement, reducing pain and enabling participation.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As healthcare systems face ageing populations, multimorbidity and increasing emphasis on recovery and function, SEM\u2019s relevance in rehabilitation is likely to grow. The question is not whether SEM adds value here, but whether service design should evolve to make that value available where it is needed most.<\/span><\/p>\n<p><b>Conclusion: what should the reader take away?<\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">MSK pathology is a major, under-recognised barrier to rehabilitation.\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li><span style=\"font-weight: 400\">SEM\u2019s integrated skillset aligns closely with rehabilitation needs.\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li><span style=\"font-weight: 400\">Embedded SEM input may improve patient flow, MDT confidence, resident doctor education and system efficiency.<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11963\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/How-SEM-unlocks-rehabilitation-216x300.png\" alt=\"\" width=\"582\" height=\"808\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/How-SEM-unlocks-rehabilitation-216x300.png 216w, https:\/\/blogs.bmj.com\/bjsm\/files\/2026\/09\/How-SEM-unlocks-rehabilitation.png 369w\" sizes=\"auto, (max-width: 582px) 100vw, 582px\" \/><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 1: Infographic summary highlighting the advantages of SEM in rehabilitation<\/span><\/i><\/p>\n<p><b>Authors<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400\">Dr Raj Amarnani, U<\/span><span style=\"font-weight: 400\">niversity College London Hospitals NHS Foundation Trust\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr Nicola Fitzgerald, C<\/span><span style=\"font-weight: 400\">entral and North West London NHS Foundation Trust\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr Frances Baawuah, C<\/span><span style=\"font-weight: 400\">entral and North West London NHS Foundation Trust\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr Arvind Chandratheva, C<\/span><span style=\"font-weight: 400\">entral and North West London NHS Foundation Trust\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr Sophie Edwards, C<\/span><span style=\"font-weight: 400\">entral and North West London NHS Foundation Trust\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr Will Goodison, C<\/span><span style=\"font-weight: 400\">entral and North West London NHS Foundation Trust\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Carole Walters, C<\/span><span style=\"font-weight: 400\">entral and North West London NHS Foundation Trust\u00a0<\/span><\/p>\n<p><b>Competing Interests<\/b><\/p>\n<p><span style=\"font-weight: 400\">Nil\u00a0<\/span><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Why Sport and Exercise Medicine may be valuable where functional rehabilitation, not performance, is the priority Keywords: Sport and Exercise Medicine; Rehabilitation; Musculoskeletal health Introduction Sport and Exercise Medicine (SEM) is still often associated with athletes, pitch-side care and return to sport. Yet some of the clearest opportunities for SEM to improve outcomes may sit [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2026\/09\/21\/musculoskeletal-barriers-to-rehabilitation-a-role-for-sport-and-exercise-medicine\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":11964,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[16068,16306,8191,1858],"class_list":["post-11962","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-featured","tag-msk","tag-rehabilitation","tag-sports-and-exercise-medicine"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Musculoskeletal barriers to rehabilitation: a role for Sport and Exercise Medicine - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=11962\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Musculoskeletal barriers to rehabilitation: a role for Sport and Exercise Medicine - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Why Sport and Exercise Medicine may be valuable where functional rehabilitation, not performance, is the priority Keywords: Sport and Exercise Medicine; Rehabilitation; Musculoskeletal health Introduction Sport and Exercise Medicine (SEM) is still often associated with athletes, pitch-side care and return to sport. 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