5.6.1. Introduction

Musculoskeletal problems are most often characterised by pain and physical disability. These symptoms can sometimes be ascribed to specific musculoskeletal conditions but often the exact cause is unclear and are described by the region that is symptomatic, such as low back pain.

Musculoskeletal problems and conditions include: (1) joint conditions e.g. rheumatoid arthritis, osteoarthritis; (2) bone conditions e.g. osteoporosis and associated fragility fractures; (3) spinal disorders e.g. low back pain; (4) regional and widespread pain disorders; (5) musculoskeletal injuries e.g. high energy limb fractures, strains and sprains often related to occupation or sports; and (6) genetic, congenital and developmental disorders. Problems and conditions not related to injuries or traumas are sometimes called rheumatic diseases and those predominantly affecting joints are collectively called arthritis. The pathophysiology of these problems and conditions is varied and not fully understood. Some have clear pathophysiological mechanisms whereas others have more complex biopsychosocial mechanisms. This chapter will consider musculoskeletal problems as a whole, as well as the specific conditions of osteoarthritis, rheumatoid arthritis, osteoporosis and back pain.

Musculoskeletal problems and conditions are common and their impact is pervasive (Eurobarometer Special Report No 272e, 2007). They are a major burden on health and social care, are one of the most expensive disease categories (Jacobson and Lindgren, 1996) and the most common cause of health problems limiting work and leading to early retirement or long-term sick leave (Swedish Yearbook of Health and Medical Care, 2001).

The burden of musculoskeletal conditions is predicted to increase dramatically with the ageing of the population as many of these conditions are more prevalent or have a greater impact in older age, in particular osteoporosis and osteoarthritis. Changes in lifestyle factors such as obesity and lack of physical activity will also increase the burden. This great and increasing impact of musculoskeletal conditions is now recognized by the United Nations, the World Health Organisation, World Bank and governments throughout Europe, through support of the Bone and Joint Decade 2000-2010 initiative (Woolf, 2000). Musculoskeletal conditions are highlighted as one of the major non-communicable diseases in Europe in the WHO European Strategy (WHO European Strategy for NCD 2006).