Conservative Treatment

First-line management of chronic LBP and adolescent idiopathic scoliosis, focusing on pain reduction, functional mobility, and preventing curve progression.

Overview

Conservative management serves as the primary intervention for a broad spectrum of orthopaedic conditions, often yielding outcomes comparable to operative care with reduced complication profiles. For Rockwood type III acromioclavicular joint dislocations, nonoperative treatment provides similar long-term outcomes to surgery with fewer complications [1]. In the context of degenerative full-thickness supraspinatus tears, conservative therapy achieves efficacy in 77% of patients [6]. Similarly, most patients with spondylodiscitis are successfully treated by conservative means [5], and nonoperative approaches are preferred for most symptomatic adults with isthmic spondylolisthesis, where success rates reach 60% [4].

Specific timelines and failure criteria guide the transition from conservative to surgical management across various pathologies. For acute calcific periarthritis of the hand, conservative measures provide pain relief and reduced calcification for up to six months, warranting a trial of at least six months before considering surgery [2]. Relative indications for surgical intervention include six months of persisting symptoms in cervical herniated discs [3], failure of conservative measures in thoracic herniated discs [3], and lack of improvement after six weeks in lumbar herniated discs [3]. Surgical treatment for spondylodiscitis is specifically indicated for doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, or unresolved pain [5].

Decision-making also relies on specific failure modes and comparative efficacy data. While operative treatment for humeral shaft fractures reduces the risk of nonunion compared with conservative care, both modalities offer satisfactory results and comparable reintervention rates for indications other than nonunion [19]. In partial distal biceps tendon ruptures, prior conservative management does not detrimentally affect subsequent surgical outcomes, though surgery remains effective for treatment failures [7]. For lateral epicondylitis, combination treatment offers no advantage over physical therapy alone but is superior to brace-only therapy in the short term [12]. Steroid strategies prove more cost-effective than immediate surgery for trigger finger in diabetic patients when release is performed in the clinic after failed conservative treatment [11]. Finally, while operative treatment yields good results for distal patellar tendinosis in athletes when conservative care fails, further studies are necessary to increase the limited evidence on conservative treatments for early knee osteoarthritis [21, 45].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Regular lumbosacral orthosis (LSO) use for three weeks in healthy subjects induces neuromuscular changes including altered trunk stiffness, damping, muscle activation patterns, and spine compression forces [54]. Both conventional and 3D-printed braces limit trunk range of motion compared to the unbraced condition but do not affect gait parameters during timed-up and go tests [82]. Wearable technologies and biofeedback modalities exist to modulate spine motor control, though standardized reporting and further research are needed to establish clinical efficacy [62]. Research efforts for knee osteoarthritis should focus on technologies that 'unload' the joint to address aberrant biomechanics, potentially reversing structural damage or delaying invasive reconstruction [67]. A biomechanical device applied to the feet of patients with knee osteoarthritis significantly reduces pain and improves function [71], yet no braces are currently available with biomechanical evidence that satisfies the requirements of applying correct anatomic joint forces that vary with the knee flexion angle [74].

Spinal Orthosis and Curve Dynamics

In adolescent idiopathic scoliosis, Cobb angle, curve type, flexibility, and correction rate are strong and consistent predictors of curve progression during conservative treatment [65]. Both 3D patient-specific parameters (lordosis, thoracic rotation, rib cage shape, and sagittal profile) and brace design (allowing larger in-brace lordosis and better in-brace Cobb correction) are important predictors of brace effectiveness [79]. Spinal flexibility is strongly correlated with the in-brace Cobb angle or correction rate, with moderate evidence supporting its ability to predict bracing outcomes [80]. Thoracic curves in patients with adolescent idiopathic scoliosis are at greater risk for brace failure than lumbar curves despite similar initial curve magnitudes and average daily brace wear [84]. Corrective forces applied in zone 3 by spinal orthoses do not significantly reduce thoracic kyphosis nor exacerbate the deviation of the scoliotic spine from the sagittal plane [64]. The Lyon brace is highly effective in correcting thoracic curves in adolescent females with thoracic idiopathic scoliosis through biomechanical action on vertebral modeling, particularly when SOSORT guidelines are adopted alongside SRS criteria [68].

Neurophysiology and Pain Mechanisms

Spinal manipulation is associated with two mechanistic pathways: a decrease in mechanical pain sensitivity independent of clinical outcome (neurophysiological) and a decrease reflecting the clinical outcome [83]. Improved sagittal cervical posture alignment outcomes may contribute to the management of cervical myofascial pain syndrome [70]. Orthopaedic surgeons must be aware of the pathophysiology and risks associated with prone positioning in spine surgery to initiate preventive measures and predictable treatment options [63]. Back pain researchers should develop hypotheses and models regarding how risks from different stages of life interact to influence the onset, persistence, and prognosis of back pain throughout the life course [77]. Most individuals with persistent or recurrent low back pain adhere to a traditional biomedical perspective of anatomical or biomechanical causes despite efforts to shift beliefs toward biopsychosocial factors [78].

Soft Tissue and Joint Mechanics

Splinting for trigger finger is considered risk-free, easy to fabricate and perform, and possesses a solid biomechanical rationale [73].

Classification

Rockwood: Classifies acromioclavicular joint dislocations; conservative treatment is a viable alternative to operative treatment for Rockwood type III dislocation, offering fewer complications and similar long-term outcomes [1].

Isthmic Spondylolisthesis: Nonoperative treatment is the preferred approach for most symptomatic adult patients with isthmic spondylolisthesis and is successful in as many as 60% of patients [4].

Adolescent Idiopathic Scoliosis: Conservative treatment approaches are evaluated to determine efficacy, with findings regarding curve morphology and location potentially improving future brace design and patient selection [8, 16].

De Quervain's Disease: Classification based on pre-treatment symptom severity assists in selecting the most efficacious treatment; splintage and NSAIDs are effective for minimal symptoms, while steroid injection is the initial treatment of choice for mild to severe disease [15].

Boutonniere Deformity: Conservative management can achieve one to two grades of range of motion improvement, though deformity can persist even after dedicated conservative management [24].

Patellofemoral Pain Syndrome: A classification system reflects a consensus reached by the European Rehabilitation Panel to help clinicians identify the cause(s) of pain and select the most appropriate non-operative treatment [33].

Low Back Pain: Sub-classification based on specific movement control exercises is superior to general exercise in sub-acute low back pain when both are combined with manual therapy [47]; a study protocol aims to classify patients with chronic low back pain into different clinical subgroups to identify specific target groups who might benefit from specific surgical or conservative interventions [48].

Lumbar Spinal Stenosis: International and multi-professional agreement was achieved for a proposed treatment algorithm developed through expert consensus [56].

Other Considerations: Lateral Epicondylitis: Combination treatment has no additional advantage compared to physical therapy alone but is superior to brace only for the short term [12]. Femoroacetabular Impingement Syndrome: Physiotherapy diagnosis and management from six countries broadly align with contemporary expert recommendations [14]. Carpal Tunnel Syndrome: CTS that does not respond to an initial course of conservative treatment may not improve with additional treatments [9]. Subacromial Impingement Syndrome: There is no evidence from available randomized controlled trials for differences in outcome in pain and shoulder function between conservatively and surgically treated patients [58]. Adolescent Overuse Injuries: Proper evaluation and treatment of overuse injuries and accurate counseling of training types, volume, and progression reduced low back pain problems to 29% of adolescent subjects one year later despite maintained high activity levels [55].

Clinical Presentation

Conservative management serves as the primary approach for a broad spectrum of musculoskeletal pathologies, often yielding outcomes comparable to operative intervention. For Rockwood type III acromioclavicular joint dislocations, conservative treatment provides similar long-term outcomes to surgery with fewer complications [1]. In the context of degenerative full-thickness supraspinatus tears, nonoperative treatment is effective in 77% of patients [6]. Similarly, the majority of patients with low back pain experience symptom resolution without surgical intervention [31], and nonoperative treatment for adult isthmic spondylolisthesis succeeds in up to 60% of cases [4]. Most patients with spondylodiscitis are also successfully managed conservatively [5].

Initial Management Modalities: For acute calcific periarthritis of the hand, conservative treatment may be trialed for at least 6 months, during which patients experience pain relief and reduced calcification [2]. In De Quervain's disease, splintage and NSAIDs are effective for minimal symptoms, while steroid injection remains the initial treatment of choice for mild to severe presentations [15]. For symptomatic lumbar degenerative disk disease, physical therapy and nonsteroidal anti-inflammatory drugs constitute the cornerstones of nonsurgical care [31]. Pharmacological treatment for early osteoarthritis should be integrated with other conservative measures, with patients and physicians maintaining realistic outcome goals [34]. In diabetic patients with trigger finger, steroid strategies are more cost-effective than immediate surgery if release after failed conservative treatment is performed in the clinic [11].

Diagnostic Utility and Imaging: MRI before a trial of conservative management provides negative value in patients with atraumatic shoulder pain, minimal to no strength deficits, and suspected cuff tendinopathy other than full-thickness tears [17]. For carpal tunnel syndrome, moderate and mild cases are initially treated conservatively, whereas severe cases warrant strong surgical recommendation [32]. However, carpal tunnel syndrome unresponsive to an initial course of conservative treatment may not improve with additional interventions [9]. Classification based on pre-treatment symptom severity assists in selecting the most efficacious treatment for De Quervain's disease [15], and physiotherapy diagnosis and management of femoroacetabular impingement syndrome (FAIS) from six countries broadly align with contemporary expert recommendations [14].

Indications for Surgical Escalation: Specific timelines and failure patterns dictate the transition to surgery. Six months of persisting symptoms is a relative indication for surgery in cervical herniated discs [3], while failure of conservative measures is a relative indication for thoracic herniated discs [3]. For lumbar herniated discs, failure to improve after six weeks is a relative indication for surgery [3]. In spondylodiscitis, surgical treatment is indicated for doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain [5]. For partial distal biceps tendon ruptures, surgery remains an effective option for treatment failures, with prior conservative management having no detrimental effects on subsequent surgical outcomes [7]. Early detection combined with early brace treatment is critical for a good final result in adolescent idiopathic scoliosis [35], while early diagnosis of cauda equina syndrome is often challenging due to subtle initial signs and symptoms [36].

Investigations

MRI: MRI is indicated for evaluating osteochondritis dissecans lesions [57], though all other AAOS Clinical Practice Guideline recommendations for this condition are either inconclusive or require consensus grading [57]. In patients with atraumatic shoulder pain, minimal to no strength deficits, and suspected cuff tendinopathy (excluding full-thickness tears), MRI prior to a trial of conservative management provides negative value at both individual and population levels [17]. For spontaneous osteonecrosis of the medial compartment of the knee, the MRI appearance of the necrotic lesion does not alter with either conservative or operative treatment [60]. MRI findings also assist in identifying stable, nondisplaced ligament Lisfranc injuries suitable for nonoperative management [59].

Plain radiography: Clinical and radiological results achieved with the Lucerne cast for extra-articular fractures of the proximal phalanges are comparable to established treatments [46]. Radiographic severity in knee osteoarthritis may be similar between patients receiving conservative treatment and those undergoing total knee replacement, despite the latter group exhibiting significantly worse baseline clinical outcomes, particularly in WOMAC scores [50].

Laboratory: Radiological and laboratory evaluation methods may allow for objective monitoring of symptomatic bone marrow lesions of the knee, though these methods appear to capture different dimensions than patient-reported pain [49].

Other Considerations: Conservative treatment for Rockwood type III acromioclavicular joint dislocation provides fewer complications and similar long-term outcomes compared to operative treatment [1], although surgical treatment using a hook plate achieved better results regarding Constant score and radiologic outcomes [52]. Conservative management for acute calcific periarthritis of the hand provides pain relief and reduced calcification for up to 6 months, and should be attempted for at least 6 months before considering surgery [2]. For cervical herniated discs, six months of persisting symptoms is a relative indication for surgery [3]; failure of conservative measures is a relative indication for thoracic herniated discs [3]; and failure to improve after six weeks is a relative indication for lumbar herniated discs [3]. Nonoperative treatment is the preferred approach for most symptomatic adults with isthmic spondylolisthesis and is successful in as many as 60% of patients [4]. Most patients with spondylodiscitis are successfully treated by conservative means, with surgical indications reserved for doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, or unresolved pain [5]. Carpal tunnel syndrome that does not respond to an initial course of conservative treatment may not improve with additional treatments [9]. Active nonoperative treatment with casting and bracing for acutely injured posterior cruciate ligament yielded satisfactory functional and MRI results in the majority of patients at intermediate-term follow-up [20]. Nonoperative treatment for Boutonniere deformity can achieve one to two grades of range of motion improvement, though deformity can persist even after dedicated conservative management [24]. Among patients with MRI-verified meniscal lesions, 58% could be treated conservatively with good results [43]. Stable, nondisplaced ligament Lisfranc injuries without significant MRI findings can be treated nonoperatively, allowing most athletes to safely return to sport within 6–10 weeks with minimal complications [59]. One-third of patients with advanced radiographic thumb carpometacarpal arthritis underwent surgery within 5 years of initial corticosteroid injection [61].

Treatment

Non-Operative

Conservative management serves as a viable alternative to operative treatment for Rockwood type III acromioclavicular joint dislocation, offering fewer complications with similar long-term outcomes [1]. For acute calcific periarthritis of the hand, conservative treatment provides pain relief and reduced calcification for up to 6 months, warranting a trial of at least 6 months before considering surgical options [2]. In cervical herniated discs, persisting symptoms for six months constitute a relative indication for surgery, whereas failure of conservative measures is the relative indication for thoracic herniated discs [3]. For lumbar herniated discs, failure to improve after six weeks is a relative indication for surgery [3]. Nonoperative treatment is the preferred approach for most symptomatic adults with isthmic spondylolisthesis and succeeds in as many as 60% of patients [4]. Conservative treatment was effective in 77% of patients with a degenerative full-thickness supraspinatus tear [6]. A comprehensive conservative program positively and lastingly affects pain and disability scores in non-radicular peripheral neuropathic pain [10]. For trigger finger in diabetic patients, steroid strategies are more cost-effective if release after failed conservative treatment is performed in the clinic [11]. Combination treatment for lateral epicondylitis is superior to brace only for the short term, though it offers no additional advantage compared to physical therapy [12]. Hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects for femoroacetabular impingement syndrome [13]. If nonoperative modalities fail for trigger digits, open release and percutaneous release are both safe and relatively simple options [18]. Active nonoperative treatment with casting and bracing yielded satisfactory functional and MRI results in the majority of patients with acutely injured posterior cruciate ligament at intermediate-term follow-up [20]. Conservative management is equally effective to a new suture anchor technique for acute mallet finger deformity, with no statistically different therapeutic effectiveness [29]. Ultrasound may be used as a conservative non-pharmaceutical and non-invasive treatment option for knee osteoarthritis [37]. Compared with normal saline, none of the conservative therapies show statistically significant improvements in pain relief or functional recovery across all follow-up periods for partial-thickness rotator cuff tears [38]. Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release for posttraumatic proximal interphalangeal joint contracture [39]. Non-operative management was more effective in level I patients with gluteal muscle contracture than in level II and III patients [40]. Non-surgical treatment for thumb base osteoarthritis provides clinically worthwhile improvements in pain and function, with a recommended stepwise approach starting with self-management, followed by splints and injections if symptoms persist [42]. Nonoperative treatment provided symptomatic relief in most patients with degenerative posterior root tear of the medial meniscus [41]. The most compelling indication for the use of spinal orthoses remains the management of traumatic spine injury [44]. Further studies are necessary to increase the limited medical evidence on conservative treatments for early knee osteoarthritis [21].

Operative

Indications: Surgery is indicated for Rockwood type III acromioclavicular joint dislocation when conservative treatment fails, though it remains a viable alternative [1]. Relative indications for surgery include six months of persisting symptoms in cervical herniated discs [3], failure of conservative measures in thoracic herniated discs [3], and failure to improve after six weeks in lumbar herniated discs [3]. Surgery is considered for acute calcific periarthritis of the hand if conservative treatment fails after 6 months [2]. Hip arthroscopy is indicated for femoroacetabular impingement syndrome given its statistical superiority over conservative treatment [13]. Open surgical release for posttraumatic proximal interphalangeal joint contracture should be done in selected patients after nonoperative modalities fail [39]. Surgery is an option for trigger digits if nonoperative modalities fail [18]. Operative treatment for humeral shaft fractures is indicated to reduce the risk of nonunion compared with conservative treatment [19].

Surgical Approach / Technique: For partial distal biceps tendon ruptures, surgery remains an effective option for treatment failures with no detrimental effects from prior conservative management [7]. Open release and percutaneous release are both safe and relatively simple treatment options for trigger digits if nonoperative modalities fail [18]. A new suture anchor technique is an operative option for acute mallet finger deformity, showing therapeutic effectiveness not statistically different from conservative treatment [29]. Operative treatment for humeral shaft fractures reduces the risk of nonunion compared with conservative treatment [19].

Implant Selection: Evidence does not specify implant selection criteria for the conditions listed in this evidence base.

Alignment / Balancing Strategy: Evidence does not specify alignment or balancing strategies for the conditions listed in this evidence base.

Pain Management: Evidence does not specify pain management regimens for the conditions listed in this evidence base.

Adjuncts: Evidence does not specify adjuncts such as tourniquet, tranexamic acid, drains, navigation, or robotics for the conditions listed in this evidence base.

Setting of Care: Evidence does not specify outpatient versus inpatient settings for the conditions listed in this evidence base.

Revision: Evidence does not cover revision-procedure principles for the conditions listed in this evidence base.

Other Considerations: Operative treatment for humeral shaft fractures has comparable reintervention rates to conservative treatment for indications other than nonunion [19]. Satisfactory results can be achieved with both conservative and operative management for humeral shaft fractures [19]. Non-operative management was more effective in level I patients with gluteal muscle contracture than in level II and III patients [40].

Complications

Other Considerations: Conservative management of Rockwood type III acromioclavicular joint dislocations is associated with fewer complications compared to operative treatment [1]. In contrast, conservative treatment of distal radius fractures is associated with an increase in upper limb disability after 1 year of follow-up [23]. For posterior shoulder instability, 46% of patients initially managed nonoperatively converted to surgery between 1 and 10 years after initial diagnosis [25]. Regarding Perthes' disease, 19% of nonoperatively treated hips underwent total hip arthroplasty after a mean follow-up of 48 years [27]. In cases of rotator cuff tears treated conservatively, about 90% of patients had no or only slight pain at 13 years after diagnosis, and about 70% had no disturbance in activities of daily life at 13 years after diagnosis [28]. The original study on long-term outcomes of conservatively treated rotator cuff tears was suggested to have divided participants into asymptomatic and symptomatic groups to better evaluate operative rates in the symptomatic group [66]. Prior conservative management does not have detrimental effects on outcomes for patients requiring surgery due to treatment failure of partial distal biceps tendon ruptures [7].

Other Considerations: Conservative treatment for acute calcific periarthritis of the hand can result in pain relief and reduced calcification for up to 6 months [2]. For lumbar spinal-canal stenosis, conservative management with land-based exercise is recommended prior to surgical intervention due to the condition's slowly progressive nature and potential surgical complications [69]. Manipulation for intervertebral lumbar-disc syndrome has shown sufficiently gratifying results based on twenty years' experience in over 600 patients [76]. Improvement in medial epicondylitis primarily reflects the natural history of the disorder and the therapeutic effects of physical therapy and non-steroidal anti-inflammatory medications rather than steroid injections alone [72]. Enrolment of low back pain patients in clinical studies is likely to provoke responses that reflect nonspecific effects of seeking and receiving care, independent of study design [75].

Other Considerations: Surgical intervention for herniated discs is indicated for thoracic levels following failure of conservative measures [3]. Surgical intervention for herniated discs is indicated for lumbar levels when symptoms fail to improve after six weeks [3]. Surgical treatment for spondylodiscitis is indicated for patients with progressive neurological deficits, progressive spinal deformity, unresolved pain, or those who fail to respond to conservative treatment [5]. Surgery for carpal tunnel syndrome appears more effective than local corticosteroid injections in long-term follow-up [22]. Hip arthroscopy is statistically superior to conservative treatment for femoroacetabular impingement syndrome in both long-term and short-term effects [13]. It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression [26].

Recovery

Light activity (weeks): Return to desk work and driving is not explicitly quantified in the provided evidence; however, nonoperative management of ulnar collateral ligament injuries in throwing athletes allows a return to competition at an average of 24.5 weeks [87]. For Rockwood Type V acromioclavicular dislocations, the average time to return to duty was not improved with acute versus delayed surgical intervention, though specific timelines for conservative care are not detailed [81].

Full activity (months): Conservative treatment for acute calcific periarthritis of the hand resulted in pain relief and reduced calcification for up to 6 months [2]. Six months of persisting symptoms is a relative indication for surgery in cervical herniated discs, while failure to improve after six weeks is a relative indication for surgery in lumbar herniated discs [3]. A follow-up timeline with time points 4 and 10.5 months after onset is suggested when deciding whether to perform surgery for symptomatic lumbar disc herniation [86]. Conservative treatment of distal radius fractures produced an increase in upper limb disability after 1 year of follow-up [23].

Complete recovery / outcome plateau (months): In cases of rotator cuff tears treated conservatively, about 90% of patients had no or only slight pain at 13 years after diagnosis, and about 70% had no disturbance in activities of daily life at 13 years [28]. Conservative treatment for Rockwood type III acromioclavicular joint dislocation provides similar long-term outcomes to operative treatment with fewer complications [1]. After a mean follow-up of 48 years, 19% of nonoperatively treated hips in Perthes' disease had undergone total hip arthroplasty [27]. Long-term cumulative treatment outcomes for ataluren were presented over a median period of 6.3 years [85].

Rehabilitation protocol: Conservative treatment for acute calcific periarthritis of the hand could be tried for at least 6 months before considering surgical options [2]. Failure of conservative measures is a relative indication for surgery in thoracic herniated discs [3]. Conservative treatment was effective in 77% of patients with degenerative full-thickness supraspinatus tears [6]. A comprehensive conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular peripheral neuropathic pain [10]. Hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects for femoroacetabular impingement syndrome [13]. In long-term follow-up, surgery is more effective than local corticosteroid injections for primary carpal tunnel syndrome [22]. It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression [26].

Functional milestones: 46% of patients initially managed nonoperatively for posterior shoulder instability converted to surgery between 1 and 10 years after initial diagnosis [25]. Nonoperative treatment allowed 42% of throwing athletes with ulnar collateral ligament injuries to return to their previous level of competition [87]. Conservative treatment was successful in a majority of patients with Rockwood Type V acromioclavicular dislocations [81]. Patients with severe intermittent claudication should be carefully followed up because they are significant candidates for deterioration despite the success of conservative treatment for lumbar spinal canal stenosis [89].

Other Considerations: High-quality trials and long-term follow-up are recommended to evaluate disability, quality of life, and pain outcomes for transcutaneous vagus nerve stimulation in chronic low back pain [51]. The authors hypothesize that tailored neck-shoulder pain treatment will have better short, intermediate, and long-term effects on pain and function than non-tailored treatment or treatment-as-usual [53]. Early diagnosis and aggressive treatment are required to obtain a satisfactory outcome for life- and limb-threatening infections following the use of an external fixator [88].

Key Evidence

• [L1] Conservative treatment provides a viable alternative with fewer complications and similar long-term outcomes. (10.1186/s12891-024-08100-x)
• [L4] Those who continued conservative treatment showed pain relief and reduced calcification for up to 6 months, suggesting conservative treatment could be tried for at least 6 months before considering surgical options. (10.1186/s13018-018-0997-5)
• [L5] Relative indications vary by level: six months of persisting symptoms for cervical, failure of conservative measures for thoracic, and failure to improve after six weeks for lumbar. (10.1302/2058-5241.6.210020)
• [L4] Nonoperative treatment is the preferred approach in most symptomatic patients and is successful in as many as 60%. (10.5435/00124635-199607000-00004)
• [L5] Most patients with spondylodiscitis are successfully treated by conservative means; however, surgical treatment is indicated for doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain. (10.1302/2058-5241.2.160062)
• [L2] Conservative treatment was effective in 77% of patients with a degenerative supraspinatus tear. (10.1302/0301-620x.107b12.bjj-2025-0742.r2)
• [L3] Surgery remains an effective option for treatment failures with no detrimental effects from prior conservative management. (10.1016/j.jse.2025.04.017)
• [L1] This trial will evaluate which of the tested conservative treatment approaches is the most effective for patients with adolescent idiopathic scoliosis. (10.1186/1471-2474-14-261)
• [L2] CTS that does not respond to an initial course of conservative treatment may not improve with additional treatments. (10.1016/j.jhsa.2014.04.034)
• [L3] A comprehensive, conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular PNP. (10.1016/j.jht.2014.02.003)
• [Letter] Steroid strategies are more cost effective if release after failed conservative treatment is performed in the clinic. (10.1016/j.jhsa.2017.03.037)
• [L1] Combination treatment has no additional advantage compared to physical therapy but is superior to brace only for the short term. (10.1177/0095399703258714)
• [L1] In our meta-analysis, hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects. (10.1186/s13018-022-03187-1)
• [L4] Findings of physiotherapy diagnosis and management of FAIS from six countries broadly align with contemporary expert recommendations. (10.1186/s12891-025-08708-7)
• [L4] Classification of patients based on pre-treatment symptom severity assists in selecting the most efficacious treatment; splintage and NSAIDs are effective for minimal symptoms, while steroid injection is the initial treatment of choice for mild to severe disease. (10.1054/jhsb.2001.0568)
• [L3] These findings may improve future brace design and patient selection for conservative treatment. (10.1302/0301-620x.103b2.bjj-2020-1113.r2)
• [L4] The use of MRI before a trial of conservative management in patients with atraumatic shoulder pain, minimal to no strength deficits on physical examination, and suspected cuff tendinopathy other than full-thickness tears provides negative value in the management of these patients, at both the individual and population level. (10.1016/j.jse.2019.04.003)
• [L5] If nonoperative modalities fail, open release and percutaneous release are both safe and relatively simple treatment options. (10.5435/00124635-200107000-00004)
• [L1] Satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). (10.1016/j.jse.2020.01.072)
• [L4] Active nonoperative treatment with casting and bracing yielded satisfactory functional and MRI results in the majority of patients at intermediate-term follow-up. (10.1016/j.arthro.2011.06.030)
• [L4] Further studies are necessary to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA. (10.1007/s00167-011-1713-8)
• [L1] In long-term follow-up, surgery seems more effective than local corticosteroid injections in primary CTS. (10.1177/1558944720944263)
• [L3] Conservative treatment of distal radius fractures produced an increase in upper limb disability after 1 year of follow-up. (10.1177/1558944717708025)
• [L3] One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management. (10.1016/j.jht.2025.02.013)
• [L3] Long-term follow-up demonstrates that 46% of patients initially managed nonoperatively converted to surgery between 1 and 10 years after initial diagnosis. (10.1016/j.arthro.2019.01.056)
• [L4] It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression. (10.2106/00004623-199604000-00009)
• [L3] After a mean follow-up of 48 years, 19% of nonoperatively treated hips had undergone total hip arthroplasty. (10.1302/0301-620x.107b6.bjj-2024-1310.r1)
• [L2] In cases of rotator cuff tears treated conservatively, at 13 years after diagnosis, about 90% of patients had no or only slight pain and about 70% had no disturbance in activities of daily life. (10.1016/j.jse.2011.10.012)
• [L1] The therapeutic effectiveness of the suture anchor technique was not statistically different from conservative treatment. (10.1016/j.jht.2017.07.006)
• [L2] The majority of patients suffering from cubital tunnel syndrome with mild or moderate symptoms benefit from conservative treatment. (10.1177/1753193408098480)
• [L5] In most patients with low back pain, symptoms resolve without surgical intervention; physical therapy and nonsteroidal anti-inflammatory drugs are the cornerstones of nonsurgical treatment. (10.5435/00124635-200902000-00006)
• [L3] Surgery is strongly recommended for severe CTS, while moderate and mild cases are initially treated conservatively. (10.1177/1753193408087119)
• [L5] The authors introduce a classification system reflecting a consensus reached by the European Rehabilitation Panel to help clinicians identify the cause(s) of patellofemoral pain and select the most appropriate non-operative treatment. (10.1007/s00167-004-0577-6)
• [L4] Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. (10.1007/s00167-016-4089-y)
• [L3] Early detection in combination with early brace treatment is as important for a good final result in the population as are good treatment methods. (10.2106/00004623-198163030-00002)
• [L5] Early diagnosis is often challenging because the initial signs and symptoms frequently are subtle. (10.5435/00124635-200808000-00006)
• [L1] The clinical findings suggest that ultrasound may be used as a conservative non-pharmaceutical and non-invasive treatment option for patients with knee osteoarthritis. (10.1186/s13018-018-0965-0)
• [L1] Compared with normal saline, none of the conservative therapies show statistically significant improvements in pain relief or functional recovery across all follow-up periods. (10.1002/arj.70022)
• [L5] Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release, which should be done in selected patients. (10.1016/j.jhsa.2013.03.014)
• [L4] Non-operative management was more effective in level I patients than in level II and III patients. (10.1186/1471-2474-10-34)
• [L4] This study demonstrated that non-operative treatment provided symptomatic relief in most patients with the degenerative posterior root tear of the medial meniscus. (10.1007/s00167-009-0891-0)
• [L1] Non-surgical treatment provides clinically worthwhile improvements in pain and function, with a stepwise approach recommended starting with self-management, followed by splints and injections if symptoms persist. (10.1177/17531934241313206)
• [L2] Among a consecutive group of patients with MRI-verified meniscal lesions, 58% could be treated conservatively with good results. (10.1007/s00167-013-2494-z)
• [L5] The most compelling indication for their use remains the management of traumatic spine injury. (10.5435/00124635-201011000-00003)
• [L4] Operative treatment seems to give good results in most cases of distal patellar tendinosis in athletes when conservative treatment has failed. (10.1007/s00167-006-0135-5)
• [L2] The clinical and radiological results achieved with the Lucerne cast are comparable to those of established treatment. (10.1016/j.jhsa.2012.02.017)
• [L1] Sub-classification based specific movement control exercises are superior to general exercise in sub-acute low back pain when both are combined with manual therapy. (10.1186/s12891-016-0986-y)
• [L3] It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. (10.1186/1471-2474-9-81)
• [L3] Radiological and laboratory evaluation methods may allow for objective treatment monitoring but appear to capture different dimensions than patient-reported pain. (10.1007/s00167-019-05598-w)
• [L3] Patients undergoing TKR exhibited significantly worse baseline clinical outcomes, particularly in WOMAC scores, despite having similar radiographic severity to those receiving conservative treatment, suggesting that functional and symptomatic measures may be more valuable than radiographic findings in determining surgical intervention. (10.1186/s13018-025-05552-2)
• [L1] Therefore, high-quality trials and long-term follow-up are recommended to evaluate disability, quality of life, and pain outcomes. (10.1186/s12891-024-07569-w)
• [L3] Surgical treatment by use of a hook plate achieved better results than conservative therapy, particularly regarding Constant score and radiologic outcomes. (10.1016/j.jse.2007.07.017)
• [L2] The authors hypothesize that tailored treatment will have better short, intermediate, and long-term effects on pain and function than non-tailored treatment or treatment-as-usual. (10.1186/1471-2474-13-75)
• [L4] The study documented neuromuscular changes in healthy subjects during a 3-week period while they regularly wore a LSO, specifically measuring trunk stiffness, damping, muscle activation patterns, and spine compression forces. (10.1186/1471-2474-11-154)
• [L3] A proper evaluation and treatment of overuse injuries and accurate counseling of training types, volume, and progression reduced the low back pain problems to 29% of subjects 1 year later in spite of a maintained high activity level. (10.1007/s00167-003-0389-0)
• [L4] International and multi-professional agreement was achieved for a proposed LSS treatment algorithm developed through expert consensus. (10.1186/s12891-022-05485-5)
• [L5] The guideline suggests using MRI to evaluate the lesion, but all other recommendations are either inconclusive or required consensus grading. (10.5435/00124635-201105000-00008)
• [L1] According to the best-evidence synthesis, there is no evidence from the available RCTs for differences in outcome in pain and shoulder function between conservatively and surgically treated patients with SIS. (10.1016/j.jse.2009.01.010)
• [L5] Stable, nondisplaced ligament injuries without significant MRI findings can be treated nonoperatively, with most athletes safely returning to sport within 6–10 weeks and minimal complications. (10.1002/ksa.70244)
• [L3] The MRI appearance of the necrotic lesion does not alter with either treatment mode. (10.1007/s001670050191)
• [L4] Of patients who presented with advanced radiographic arthritis, one-third underwent surgery within 5 years of initial injection. (10.1016/j.jhsa.2020.03.025)
• [L1] The review identifies a range of wearable technologies and biofeedback modalities used to modulate spine motor control, highlighting the need for standardized reporting and further research to establish clinical efficacy. (10.1186/s12891-024-07867-3)
• [L5] Orthopaedic surgeons should be aware of pathophysiology and related risks associated with spine surgery in the prone position, and initiate preventive measures and predictable treatment options. (10.5435/00124635-200703000-00005)
• [L4] Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of the scoliotic spine from the sagittal plane. (10.1186/s12891-024-08014-8)
• [L2] Strong and consistent evidence supports Cobb angle, curve type, flexibility, and correction rate as predictors of curve progression. (10.1302/0301-620x.104b4.bjj-2021-1677.r1)
• [Letter] The authors suggest that the original study should have divided participants into asymptomatic and symptomatic groups to better evaluate the use of the word 'treatment' and to clarify the operative rate in the symptomatic group. (10.1016/j.jse.2012.10.027)
• [L5] The authors propose that research and development efforts should focus on addressing aberrant biomechanics through technologies that 'unload' the joint, as this may reverse structural damage, delay the need for invasive joint reconstruction, or obviate the need entirely. (10.1007/s00167-011-1403-6)
• [L4] The Lyon brace, through its biomechanical action on vertebral modeling, is highly effective in correcting thoracic curves, particularly when the SOSORT guidelines were adopted in addition to the SRS criteria. (10.1186/s12891-015-0782-0)
• [L1] However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention. (10.1186/1471-2474-13-30)
• [L2] The authors speculate that improved sagittal cervical posture alignment outcomes contributed to these findings. (10.1186/s12891-018-2317-y)
• [L2] The biomechanical device and treatment methodology is effective in significantly reducing pain and improving function in knee OA patients. (10.1186/1471-2474-11-179)
• [L1] The improvement observed primarily reflects the natural history of the disorder and the therapeutic effects of physical therapy and non-steroidal anti-inflammatory medications. (10.2106/00004623-199711000-00006)
• [L4] However, the intervention is risk-free, easy to fabricate and perform, and has a solid biomechanical rationale. (10.1016/j.jht.2008.07.002)
• [L4] No braces are currently available with biomechanical evidence that satisfies the requirements of applying correct anatomic joint forces that vary with the knee flexion angle. (10.1007/s00167-012-2048-9)
• [L1] In addition to a shared 'natural history', enrolment of LBP patients in clinical studies is likely to provoke responses that reflect the nonspecific effects of seeking and receiving care, independent of the study design. (10.1186/1471-2474-15-68)
• [L4] Based on twenty years' experience in over 600 patients, manipulation for intervertebral lumbar-disc syndrome has shown sufficiently gratifying results to continue with the procedure. (10.2106/00004623-195537050-00003)
• [L5] Back pain researchers could usefully develop hypotheses and models of how risks from different stages of life might interact and influence the onset, persistence and prognosis of back pain throughout the life course. (10.1186/1471-2474-11-23)
• [L4] Despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with LBP adhere to the traditional biomedical perspective of anatomical/biomechanical causes. (10.1186/s12891-017-1831-7)
• [L3] Both 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS. (10.1186/s12891-019-2754-2)
• [L1] Spinal flexibility was strongly correlated with the in-brace Cobb angle or correction rate, and moderate evidence supported that spinal flexibility could predict bracing outcomes. (10.1186/s13018-023-04430-z)
• [L4] Conservative treatment was successful in a majority of patients with Type V AC dislocations, and the average time to return to duty was not improved with acute versus delayed surgical intervention. (10.1177/2325967115s00017)
• [L4] Both brace types limited trunk range of motion compared to the unbraced condition but did not affect gait parameters during TUG tests. (10.1186/s12891-025-08311-w)
• [L2] Results suggest two different mechanistic pathways associated with the spinal manipulation target: a decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and a decrease as a reflection of the clinical outcome. (10.1186/s12891-020-03873-3)
• [L3] Thoracic curves are at greater risk for brace failure than lumbar curves despite similar initial curve magnitudes and average amount of daily brace wear. (10.2106/jbjs.16.01050)
• [L4] This is the first study to present long-term cumulative treatment outcomes over a median period of 6.3 years on ataluren treatment. (10.1186/s12891-021-04700-z)
• [L1] The authors suggest a follow-up timeline with time points 4 and 10.5 months after onset when deciding whether to perform surgery. (10.1186/s12891-020-03548-z)
• [L4] Nonoperative treatment allowed 42% of athletes to return to their previous level of competition at an average of 24.5 weeks after diagnosis. (10.1177/03635465010290010601)
• [L4] Early diagnosis and aggressive treatment are required in order to obtain a satisfactory outcome. (10.1302/0301-620x.97b9.35626)
• [L3] Patients with severe intermittent claudication should be carefully followed up because they are significant candidates for deterioration despite the success of conservative treatment. (10.1186/s13018-018-0947-2)

See Also

• Pain Management
• Surgical Complications

References

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