Long Term Musculoskeletal Conditions

Original Editor - Caroline Hooper

Top Contributors - Wendy Walker, Wanda van Niekerk and George Prudden

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”[1][2]

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[3]. 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[4].  

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”[3]

Key Musculoskeletal Conditions

The Arthritis and Rheumatism Council divide musculoskeletal conditions into three main groups:

  1. Osteoarthritis and back pain
  2. Osteoporosis and fragility fractures
  3. Inflammatory conditions

Osteoarthritis and Back Pain

Back-pain.png

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[3]. 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”[5].  Worldwide, 1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men aged over 50[6]. Falls are identified as a risk factor and reported to be a “growing public health issue”[7].  They are more likely in those with poor musculoskeletal health, with weak muscles, stiff joints and reduced co-ordination(ARC 2013)[3].  Evidence-based Guidelines such as the 2017 National Osteoporosis Guideline Group[7]. “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[7].  The International Osteoporosis Foundation also advocate exercise from the time of adolescence as important(IOF 2015 )[6].

Inflammatory Conditions

Arthritis Research UK describe “The Inflammatory Arthritis Pathway”[3].  It classifies inflammatory arthritis or autoimmune diseases as a group of conditions including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.   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[3].    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”[8].

Wider Health Impact of Musculoskeletal Conditions

Musculoskeletal conditions cause pain and disability, and also affect physical and mental health. Studies indicate that patients with osteoarthritis showed a high frequency of co-morbities such as hypertension[9], depression, metabolic syndrome and its components in isolation[10], though cause and effect  or general effects of age of these co-mordities were not evaluated.  

Hip fractures cause the most morbidity with reported mortality rates up to 20-24% in the first year after a hip fracture and greater risk of dying may persist for at least 5 years afterwards. Loss of function and independence among survivors is profound, with 40% unable to walk independently[11].  

Many of the rarer inflammatory musculoskeletal conditions such as rheumatoid arthritis are associated with multiple co-morbidities and may substantially shorten the life-span  of those affected[12]

Depression is four times commoner for those people in persistent pain than in those without such pain. Two-thirds of people with osteoarthritis report symptoms of depression when their pain is at its worst. One in six people with rheumatoid arthritis has major depression[3].

  1. GBD 2015 Disease and Injury Incidence and Prevalance Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
  2. Hiwale D. 2017 Influence of Physical Activity on Musculoskeletal System. Heath Guidance for Better Health. [1]
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Arthritis Research UK: Policy and Public Health document.
  4. World Health Organisation 2010. Global recommendations on physical activity for health. ISBN 9789241599979
  5. Kanis JA, Melton 3rd LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9: 1137–41.
  6. 6.0 6.1 International Osteoporosis Foundation (IOF) 2015 Facts and Statistics. [2]
  7. 7.0 7.1 7.2 NOGG 2017: Clinical guideline for the prevention and treatment of osteoporosis
  8. NICE. Low back pain and sciatica in over 16s: assessment and management NICE guideline [NG59] Published date: November 2016
  9. Breedveld F C. 2004. Osteoarthritis—the impact of a serious disease. Rheumatology 2004;43(Suppl. 1):i4–i8
  10. Leite et al  2011 Comorbidities in patients with osteoarthritis: frequency and impact on pain and physical function. Rev. Bras. Reumatol. vol.51 no.2 São Paulo Mar./Apr. 2011
  11. International Osteoporosis Foundation (IOF) 2015 Facts and Statistics. [3]
  12. Dougados M, Soubrier M, Antunez A, et al 2014. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Annals of the Rheumatic Diseases 2014;73:62-68