Physical Activity in Long Term Musculoskeletal Conditions

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Original Editor - Caroline Hooper

Top Contributors - Wendy Walker, Kim Jackson, Lucinda hampton, Tony Lowe, Michelle Lee, Simisola Ajeyalemi, Vidya Acharya, Tarina van der Stockt, Rucha Gadgil and Lauren Lopez  

Introduction: Long Term Musculoskeletal Conditions.

In 2015, a study on the Global Burden of Disease and the worldwide impact of all diseases and risk factors included back and neck pain, osteoarthritis and other musculoskeletal disorders in the leading ten causes of adult global age-specific years lived with disability. The report stated that Musculoskeletal disorders continue to be a leading cause of disability worldwide” . It advised that “A key component of healthy ageing is to maintain mobility, and a key public health intervention recommended for improving health outcomes for all chronic diseases is physical activity. Painful musculoskeletal disorders increase with age and are a great threat to mobility, compromising health more broadly.34, 35, 36 Even if cures for musculoskeletal disorders are not yet available, the clinical goal of preventing disability is attainable.37, 38

In the UK Each year 20% of the general population sees a GP about a musculoskeletal problem.23 The majority of these consultations are due to back pain and osteoarthritis. The NHS in England spends a further £5 billion per year on treating musculoskeletal conditions. Each year in the UK around 7.5 million working days are lost because of musculoskeletal conditions, second only to mental health problems. ARC 2013

Arthritis Research UK define define Musculoskeletal conditions as “disorders of the bones, joints, muscles and spine, as well as rarer autoimmune conditions such as lupus”. Musculoskeletal conditions interfere with people’s ability to carry out their normal activities. Common symptoms include pain, stiffness and a loss of mobility and dexterity.

ARC report 2013 divides musculoskeletal conditions into 3 main groups
1. the commonest group consists of osteoarthritis and back pain. Risk factors include physical inactivity, obesity and injury.
2. osteoporosis and fragility fractures. ½ women and 1/5 men over the ago of 50 will suffer at least one fragility fracture

3. inflammatory conditions such as rheumatoid arthritis (uncommon)

Long-term Musculoskeletal conditions are associated with pain, disability, general health and mortality. They also impact on mental health. People with persistent pain have a fourfold increase in depression than those without Arnow BA et al. (2006). Comorbid depression, chronic pain, and disability in primary care. Psychosom Med 68(2): 262-268. 
 Studies also show a reciprocal relationship between depression and pain.

ARC MUSCULOSKELETAL HEALTH A public health approach

In August 2013, Arthritis Research UK convened an expert workshop of epidemiologists, public health specialists and others with an interest in helping shape a national agenda for musculoskeletal public health.
Musculoskeletal health means more than the absence of a musculoskeletal condition. Good musculoskeletal health means that the muscles, joints and bones work well together without pain. People with good musculoskeletal health can carry out the activities they want to with ease and without discomfort.
It is possible to have poor musculoskeletal health without having a specific musculoskeletal condition.

At the core of our public health approach to musculoskeletal health is physical activity. Remaining active is one of the best things anyone can do for their musculoskeletal health, to help strengthen muscles, keep bones healthy, reduce pain and prolong the life of joints. Initiatives aimed at increasing physical activity should always explicitly refer to the musculoskeletal health benefits. Those designing and implementing these programmes must ensure that joint or back pain is not seen as a barrier to participation. And those evaluating these activities need to ensure that they are making a difference to people who are living with a musculoskeletal condition.
Musculoskeletal conditions now account for the largest cause of disability in the United Kingdom, following a pattern that has emerged over the last two decades.

Recommendations

Assessment of Population Health

When assessing local and national population health, musculoskeletal health must be included in the assessment. This should describe the needs of people living with musculoskeletal conditions and explore opportunities to promote good musculoskeletal health among the population. 

When developing health promotion messages, the benefits of physical activity to people with musculoskeletal conditions should be emphasised. Common misunderstandings should be challenged, including that nothing can be done if you have arthritis or back pain, that rest is beneficial for painful musculoskeletal conditions, or that physical activity is inherently harmful for people for people living with these conditions. 

All this public health activity must be underpinned by high quality data about musculoskeletal health. The extent and quality of clinical data collected from primary care, community and out-patients health records must be urgently improved. Government agencies across the United Kingdom should work with the musculoskeletal community to agree a consistent question set for use in local and national population surveys to determine the impact of poor musculoskeletal health. 

Musculoskeletal Health and Musculoskeletal Conditions

Musculoskeletal health means more than the absence of a musculoskeletal condition. Good musculoskeletal health means that the muscles, joints and bones work well together without pain. People with good musculoskeletal health can carry out the activities they want to with ease and without discomfort. It is possible to have poor musculoskeletal health without having a specific musculoskeletal condition.

Benefits of Musculoskeletal Health

As well as enabling people to live their lives now, good musculoskeletal health also includes building muscles, joints and bones that will continue to be healthy for many years ahead.

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