This systematic review synthesizes evidence on non-pharmacological interventions for managing acute, non-traumatic musculoskeletal pain (<6 weeks) and summarizes findings across efficacy, safety, acceptability, and cost-related considerations. A structured literature search was conducted on 15 June 2025 across four databases (PubMed/MEDLINE, the Cochrane Library, Embase, and Scopus) for publications from 1 January 2021 to 15 June 2025, supplemented by targeted website screening, outreach to relevant organisations, and backward citation searching. Study selection followed PRISMA 2020 with deduplication, title/abstract screening, and full-text assessment; 18 studies meeting the acute <6 weeks criterion was included in the final evidence base and narratively synthesized. Across the included evidence, advice to remain active and graded mobilization were consistently represented as core components of care, while selected modalities (e.g., superficial heat and transcutaneous electrical nerve stimulation) demonstrated short-term symptom relief in some settings. Evidence for cryotherapy was inconsistent and generally of low certainty in acute sprain populations, and findings for manual therapy and complementary approaches were heterogeneous and often condition-specific. Psychoeducational approaches were associated with improvements in pain-related cognitions (e.g., catastrophizing) in limited pilot evidence. Overall, the literature supports a pragmatic multimodal approach that prioritizes early activity and function, complemented by short-acting physical/neuromodulatory modalities and brief psychoeducation when appropriate; however, heterogeneity of populations, intervention parameters, and outcomes limits definitive comparative conclusions, and longer-term trials of predefined combinations are needed. The article will be helpful to clinicians, physiotherapists, pain specialists, and researchers developing integrated models of non-pharmacological rehabilitation.

acute musculoskeletal pain, non-pharmacological treatment, physiotherapy, transcutaneous electrical nerve stimulation, manual therapy, psychoeducation, neuromodulation, pain chronification

Baumann, L., Bello, C., Georg, F. M., Urman, R. D., Luedi, M. M., & Andereggen, L. (2023). Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors. Current Pain and Headache Reports, 27, 437–444. https://doi.org/10.1007/s11916-023-01127-0

Burke, C. A., Fillipo, R., George, S. Z., Kapos, F. P., Kosinski, A. S., Ford, E., Danyluk, S. T., Kingsbury, C. A., Seebeck, K., Lewis, C. E., Plez, C., Brown, M. C., & Goode, A. P. (2024). Transition from Acute to Chronic Low Back Pain in a Community-Based Cohort. Journal of Pain, 26, 104704. https://doi.org/10.1016/j.jpain.2024.104704

Carrière, J., Coutu, M.-F., Darnall, B., Léonard, G., Royer, M.-P., Li, M. Y., Bordeleau, M., & Durand, M.-J. (2025). Changes in Pain Catastrophizing and Related Outcomes Following a Single-Session Empowered Relief Intervention Delivered by Physical Therapists in Workers with Low Back Pain: A Pilot Study. Journal of Pain Research, 18, 4845–4857. https://doi.org/10.2147/jpr.s527830

Fink, W., & Raffa, R. (2025). A Pluripotent Progression of the Gate Control System Theory of Pain – Modeling Ascending & Descending Pain Pathways as a Lotka-Volterra Coupled Control & Feedback Loop. Journal of Pain Research, 18, 4373–4385. https://doi.org/10.2147/jpr.s525449

González-Iglesias, M., Martínez-Benito, A., López-Vidal, J. A., Melis-Romeu, A., Gómez-Rabadán, D. J., Reina-Varona, Á., Di-Bonaventura, S., La Touche, R., & Fierro-Marrero, J. (2025). Understanding Exercise-Induced Hypoalgesia: An Umbrella Review of Scientific Evidence and Qualitative Content Analysis. Medicina, 61(3), 401. https://doi.org/10.3390/medicina61030401

Guan, S.-Y., Zheng, J.-X., Feng, X.-Y., Zhang, S.-X., Xu, S.-Z., Wang, P., Cai, H.-Y., & Pan, H.-F. (2025). The impact of population ageing on musculoskeletal disorders in 204 countries and territories, 1990-2021: global burden and healthcare costs. Annals of the Rheumatic Diseases. https://doi.org/10.1016/j.ard.2025.08.002

Hartard, M., Hartard, C., Scharla, S. H., Scharla, S. A., & Saad, H. B. (2025). Influence of heat therapy and/or vibration on nonspecific back pain: A prospective, open, randomized, controlled, parallel-group clinical study. La Tunisienne Médicale, 103(6). https://www.researchgate.net/publication/392285267_Influence_of_heat_therapy_andor_vibration_on_nonspecific_back_pain_A_prospective_open_randomized_controlled_parallel-group_clinical_study

Hopkins, S., Yang, V., & Liew, D. F. (2025). Choosing a nonsteroidal anti-inflammatory drug for pain. Australian Prescriber, 48(4), 139–144. https://doi.org/10.18773/austprescr.2025.032

Huo, L., Liu, G., Deng, B., Xu, L., Mo, Y., Jiang, S., Tao, J., Bai, H., Wang, L., Yang, X., Yang, J., & Mu, X. (2023). Effect of use of NSAIDs or steroids during the acute phase of pain on the incidence of chronic pain: a systematic review and meta-analysis of randomised trials. Inflammopharmacology, 32(2), 1039–1058. https://doi.org/10.1007/s10787-023-01405-8

IJzelenberg, W., Oosterhuis, T., Hayden, J. A., Koes, B. W., van Tulder, M. W., Rubinstein, S. M., & de Zoete, A. (2024). Exercise therapy for treatment of acute non-specific low back pain: a Cochrane systematic review and meta-analysis of randomised controlled trials. Archives of Physical Medicine and Rehabilitation, 105(8), 1571–1584. https://doi.org/10.1016/j.apmr.2024.02.732

Johnson, M. I., Paley, C. A., Jones, G., Mulvey, M. R., & Wittkopf, P. G. (2022). Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open, 12(2), e051073. https://doi.org/10.1136/bmjopen-2021-051073

Lin, H., Wang, X., Feng, Y., Liu, X., Liu, L., Zhu, K., Shen, J., Zhang, P., Yu, J., & Yang, T. (2024). Acupuncture Versus Oral Medications for Acute/Subacute Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. Current Pain and Headache Reports, 28, 489–500. https://doi.org/10.1007/s11916-023-01201-7

Liu, M., Rong, J., An, X., Li, Y., Min, Y., Yuan, G., Yang, Y., & Li, M. (2025). Global, regional, and national burden of musculoskeletal disorders, 1990–2021: an analysis of the global burden of disease study 2021 and forecast to 2035. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1562701

Miranda, J. P., Silva, W. T., Silva, H. J., & Mascarenhas, R. O. (2021). Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function, and recurrence in acute ankle sprain: A systematic review of randomized controlled trials. Physical Therapy in Sport, 49, 243–249. https://doi.org/10.1016/j.ptsp.2021.03.011

Rizzo, R. R., Cashin, A. G., Wand, B. M., Ferraro, M. C., Sharma, S., Lee, H., O’Hagan, E., Maher, C. G., Furlan, A. D., van Tulder, M. W., & McAuley, J. H. (2025). Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews, 2025(3). https://doi.org/10.1002/14651858.cd014691.pub2

Serrano-García, B., Martínez-Cepa, C. B., Forriol, F., Angulo-Díaz-Parreño, S., Mesa-Jiménez, J. A., & Zuil-Escobar, J. C. (2024). Effects of Manual Therapy and Strengthening Exercise on Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Applied Sciences, 15(1), 215–215. https://doi.org/10.3390/app15010215

Trybulski, R., Kużdżał, A., Stanula, A., Muracki, J., Kawczyński, A., Kuczmik, W., & Wang, H.-K. (2024). Acute effects of cold, heat, and contrast pressure therapy on forearm muscles regeneration in combat sports athletes: a randomized clinical trial. Scientific Reports, 14, 22410. https://doi.org/10.1038/s41598-024-72412-0

Zhu, B., Ba, H., Kong, L., Fu, Y., Ren, J., Zhu, Q., & Fang, M. (2024). The effects of manual therapy on pain and the safety of patients with knee osteoarthritis: a systematic review and meta-analysis. Systematic Reviews, 13(1), 91. https://doi.org/10.1186/s13643-024-02467-7