Long Term Musculoskeletal Conditions

Original Editor - Wendy Walker

Top Contributors - Wendy Walker, Kim Jackson, Lucinda hampton, Rucha Gadgil, George Prudden, Wanda van Niekerk and Lauren Lopez

Introduction

Musculoskeletal conditions can be extremely painful and debilitating.  Their incidence and resulting impact on health and well-being increase with age.   Common symptoms include pain, stiffness and a loss of mobility and dexterity. Long-term Musculoskeletal conditions are associated with pain, disability, poor general health and mortality. They also impact on mental health

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.  When discussing disease-specific issues 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”

Arthritis Research UK published a Public Health Report on Musculoskeletal Health in 2013. It stated that 20% of the general population sees a GP about a musculoskeletal problem, and that 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, and each year in the UK around 7.5 million working days are lost because of musculoskeletal conditions, second only to mental health problems. The report emphasized that at the core of a public health approach to musculoskeletal health is physical activity at all stages of life  (Arthritis Research UK 2013)  . A plethora of evidence and numerous reports are reflected in the WHO Global Recommendations for Physical Activity and Health, which supports this for virtually all aspects of health and well-being  (WHO 2010).  

Constituents of Musculoskeletal Health

Several factors combine to produce musculoskeletal health.

The Arthritis and Rheumatism Council state that “the joints and spine need to be both stable and supple to support the body and carry out a wide range of movements".

• Muscles need to be strong enough to provide the power to move.
• Bones need to be sturdy enough to withstand the normal knocks of everyday living without breaking.
• A healthy nervous system is needed to oversee all this activity, providing co-ordination and balance.
• Good mental health is required to provide energy and motivation to be physically active.

What’s more, all this should happen "without pain, stiffness or fatigue”

Key Musculoskeletal Conditions

The Arthritis and Rheumatism Council divide musculoskeletal conditions into three main groups: osteoarthritis and back pain, osteoporosis and fragility fractures, and inflammatory conditions.

Osteoarthritis and Back Pain

Many people develop joint and soft tissues disorders ranging from minor injuries to long-term conditions. Two long-term conditions that are well documented include osteoarthritis and back pain.  Key risk factors for this group include obesity, physical inactivity and injury(ARC 2013). Evidence-based guidelines such as the UK NICE Guidelines promote conservative management with advice, medication and activity / exercise (NICE 2014, 2016).  Rarely, surgery may be indicated.

Osteoporosis and Fragility Fractures

Osteoporosis is described by the World Health Organization (WHO) as a “progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture” (Kanis et al 1994).  Worldwide, 1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men aged over 50 (IOF 2015 ).  Falls are identified as a risk factor and reported to be a “growing public health issue” (NOGG 2017).  They are more likely in those with poor musculoskeletal health, with weak muscles, stiff joints and reduced co-ordination(ARC 2013).  Evidence-based Guidelines such as the 2017 National Osteoporosis Guideline Group (NOGG) “Clinical Guideline for the prevention and treatment of Osteoporosis” advocate lifestyle measures to improve bone health, which include increasing the level of physical activity. Regular tailored weight bearing exercise help increase bone mass density, and muscle strengthening with balance exercise interventions may reduce falls by improving confidence and co-ordination, and maintaining bone mass.(NOGG 2017).  The International Osteoporosis Foundation also advocate exercise from the time of adolescence as important(IOF 2015 ).

Inflammatory Conditions

Arthritis Research UK describe “The Inflammatory Arrthritis Pathway” .(NOGG 2017).  It classifies inflammatory arthritis or autoimmune diseases as a group of conditions including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis (ARC2017).   The immune system attacks and destroys the joints and sometimes the internal organs. These relatively uncommon conditions affect less than one per cent of the population (ARC 2013 ).    Evidence based guidelines such as the UK NICE Clinical Guideline for Rheumatoid Arthritis advocate specialist multidisciplinary input including pharmacological management. It also states that  “people with RA should have access to specialist physiotherapy, with periodic review to improve general fitness and encourage regular exercise, and learn exercises for enhancing joint flexibility, muscle strength and managing other functional impairments” (NICE 2015).