Pre-Conservative Optimisation In Musculoskeletal Physiotherapy: A Narrative Review Of Biomechanical, Psychological, And Systemic Readiness

Background: Musculoskeletal (MSK) conditions are a leading cause of global disability, with conservative management as the primary intervention. However, standard physiotherapy protocols often overlook baseline readiness, leading to poor adherence, high dropout rates, and suboptimal outcomes. While prehabilitation is established in surgical contexts, \\\"pre-conservative optimisation "preparing patients prior to conservative care remains underexplored. Methods: This narrative review synthesised literature from PubMed, Embase, and CINAHL (January 2014–August 2026) using search terms related to musculoskeletal disorders, conservative management, patient readiness, and optimisation. Studies were thematically analysed to identify key factors influencing rehabilitation success prior to routine care. Results: Three critical dimensions of pre-conservative readiness were identified: 1) Biomechanical Readiness, establishing baseline load tolerance to prevent \\\"boom-bust\\\" cycles; 2) Psychological Readiness, leveraging Pain Neuroscience Education (PNE) and shared decision-making to reduce catastrophising and build self-efficacy; and 3) Systemic Readiness, optimising nutritional status for tissue healing and pain modulation. Integrating these dimensions creates a stable foundation for progressive therapeutic loading. Conclusion: Pre-conservative optimisation represents a vital paradigm shift in orthopaedic physiotherapy. Prioritising baseline readiness before standard protocols can enhance adherence, minimise symptom flares, and improve long-term outcomes. Future research should develop standardised assessment tools and evaluate the cost-effectiveness of this model.