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).