Musculoskeletal Health and Conditions PDF

Introduction to Musculoskeletal Health Community Medicine department Musculoskeletal Health Musculoskeletal health refers to the performance of the locomotor system, comprising intact muscles, bones, joints and adjacent connective tissues. Healthy muscles, joints, and bones wor...

Introduction to Musculoskeletal Health Community Medicine department Musculoskeletal Health Musculoskeletal health refers to the performance of the locomotor system, comprising intact muscles, bones, joints and adjacent connective tissues. Healthy muscles, joints, and bones work together to produce the good MSK health required to carry out daily activities with ease and without discomfort / pain.  Musculoskeletal Health Factors affecting MSK health: 1. Stable and supple joints and spine to support the body and carry out a wide range of movements. 2. Strong muscles to provide the power to move. 3. Sturdy bones to withstand the normal knocks of everyday living without breaking. 4. Healthy nervous system to oversee all this activity, providing coordination and balance. 5. Good mental health to provide energy and motivation to be physically active.  Musculoskeletal Conditions MSK conditions are a group of conditions that affect the bones, joints, muscles and spine, and are a common cause of severe long-term pain and physical disability. The pain and disability caused by these conditions ruin quality of life, robbing people of their independence and impairing their ability to participate in family, social, working life. MSK conditions can affect people across the life course. Prevention, early detection and treatment can enable people to live in good health, remain independent and connected to one’s community.  Musculoskeletal Conditions A recent analysis of Global Burden of Disease (GBD) 2019 data showed that approximately 1.71 billion people globally live with musculoskeletal conditions, including low back pain, neck pain, fractures, other injuries, osteoarthritis, amputation and rheumatoid arthritis. Low back pain is the main contributor to the overall burden of musculoskeletal conditions (570 million prevalent cases worldwide) While the prevalence of musculoskeletal conditions increases with age, younger people are also affected, often during their peak income-earning years  Musculoskeletal Conditions Conditions of Osteoporosis Musculoskeletal and Fragility Pain Fractures Inflammatory Conditions  Conditions of Musculoskeletal Pain 1. Osteoarthritis: a chronic, irreversible, degenerative condition due to breakdown of cartilage in joints, causing the affected bones to rub against each other leading to permanent damage. - Idiopathic osteoarthritis may affect single joint groups (most commonly the knees, hands, feet, hips, and spine) - Generalized osteoarthritis is characterized by involvement of three or more joint groups and typically affecting perimenopausal and postmenopausal women - Risk Factors: aging, physical inactivity, obesity, smoking, Conditions of Musculoskeletal Pain 2. Low Back Pain: a nonspecific condition that refers to perceptions of acute or chronic pain and discomfort in or near the lumbosacral spine that can be caused by inflammatory, degenerative, neoplastic, gynecologic, traumatic, metabolic, etc. - Most episodes of low back pain improve within a few weeks, but recurrences are common. - Low back pain often becomes a chronic problem with intermittent, usually mild, exacerbations. - Risk Factors: aging, obesity, smoking, physical inactivity  Osteoporosis and Fragility Fractures 1. Osteoporosis: A systemic skeletal disease characterized by low bone density and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility - Known as the “silent thief” → bone deterioration can occur over a number of years without presenting any symptoms - Risk Factors: 1. Gender: more common in women 2. Aging 3. Family history of osteoporosis 4. Low calcium intake and low vitamin D 5. Long term use of corticosteroids 6. Physical inactivity and sedentary life 7. Smoking and alcohol consumption  Osteoporosis and Fragility Fractures 2. Fragility Fractures: which result from low energy trauma, such as a fall from standing height or less, are a sign of underlying osteoporosis - Hip fracture is the most serious consequence of osteoporosis and there is a significant risk that a hip fracture might lead to substantial disability and death. - Hip fractures are usually caused by a fall from a standing position, which almost always leads to hospitalization. - Vertebral fractures are clinically silent but can lead to shape deformities → height loss and back pain - Most vertebral fractures are caused by moderate or minimal trauma that is associated with lifting or changing position - Distal forearm fractures generally occur when trying to break a fall with an outstretched hand → Colles’ fracture.  Inflammatory Conditions 1. Rheumatoid Arthritis: an inflammatory, autoimmune condition, where immune system attacks and destroys the joints and sometimes internal organs. - The clinical symptoms include stiffness, pain, and swelling of multiple joints, most commonly the small joints of the hands and wrists. - Risk Factors: 1. Gender: more in women 2. Age: can occur at any age but most commonly in middle age 3. Family history of RA 4. Smoking 5. Obesity - Disability is a major concern among persons with persistent rheumatoid arthritis  The Interaction between Mental Health and MSK Health The connection between mental health and musculoskeletal health is complex and reciprocal. Living with a painful condition such as osteoarthritis can lead to depression and anxiety, while psychological distress and depression worsen pain → vicious cycle Worsening pain and low mood can lead to social withdrawal and progressive reduction in quality of life Mental health conditions can increase the likelihood of developing some MSK conditions: - Depression is an independent risk factor for developing back pain - Poor mental health, life stress, and childhood trauma are major risk factors for developing fibromyalgia (severe, and persistent widespread pain)  The Public Health Impact of MSK Conditions Musculoskeletal disorders are painful, limiting, and debilitating, adversely affecting the daily lives and productivity of millions of people. Musculoskeletal conditions are also the biggest contributor to years lived with disability (YLDs) worldwide with approximately 149 million YLDs, accounting for 17% of all YLDs worldwide. 1. Associated healthcare costs: A medical condition rarely exists alone. Over 50% of people living with a musculoskeletal condition have at least one comorbidity → increase the direct cost of management and healthcare services 2. Employer cost: Musculoskeletal conditions place a large economic burden on employers, as they account for 31% of absenteeism. Employees with a musculoskeletal condition miss an average of 4.3X more workdays than people without. 3. Access to care: Increased average appointment wait time and referral. Additionally, older people, people living in rural areas, and people whose jobs make it challenging to miss work have an even harder time accessing the right care at the right time for their musculoskeletal conditions. Musculoskeletal Conditions  Risk Factors Age: as people age, the body's ability to repair and maintain musculoskeletal tissues decreases, which can increase the risk of injury and chronic conditions Genetics: some people may be genetically predisposed to certain musculoskeletal conditions, such as osteoporosis or arthritis Lifestyle factors: poor diet, lack of exercise, smoking, and excessive alcohol consumption can all contribute to poor musculoskeletal health. Obesity: excess weight can put pressure on joints and increase the risk of osteoarthritis, as well as other musculoskeletal problems Poor Posture: poor posture can put undue stress on the muscles and joints, leading to pain and discomfort  Risk Factors Occupational Hazards: jobs that require repetitive movements, heavy lifting, or prolonged periods of sitting or standing can increase the risk of musculoskeletal injuries and conditions. Injury: trauma, such as fractures, dislocations, and sprains, can damage musculoskeletal tissues and increase the risk of chronic conditions. Nutritional Deficiencies: lack of proper nutrition, including calcium and vitamin D Medical Conditions: certain medical conditions, such as diabetes, autoimmune disorders, and hormonal imbalances, can affect musculoskeletal health. Medications: Some medications, such as glucocorticoids and anticonvulsants, can weaken bones and increase the risk of fractures.  MSK Disorders in Childhood & Adolescence  Maternal Health Effect on MSK Health of The Child Many of the foundations for lifelong musculoskeletal health are laid down before birth. The growth of muscles, bones and joints in the womb is an important determinant of MSK health in later life. Maternal nutrition during pregnancy can also play a role in the development of the child's MSK system. Adequate intake of nutrients such as calcium, vitamin D, and protein is essential for the development of strong bones and muscles in the growing fetus. Maternal lifestyle factors such as smoking, alcohol consumption, and stress can also impact the child's MSK health. Smoking during pregnancy has been linked to a higher risk of hip dysplasia and scoliosis in infants. Women who engage in regular exercise during pregnancy tend to have infants with stronger bones and muscles compared to those who are sedentary. However, excessive exercise or strenuous physical activity during pregnancy can increase the risk of premature birth or low birth weight, which can also impact the MSK health of the child.  MSK Conditions in Childhood & Adolescence Childhood and adolescence are important for MSK health in 3 ways: 1. Children and young people may themselves be affected by arthritis and MSK conditions 2. Adult MSK health depends on the normal, healthy growth and development of bones, muscles and joints in childhood 3. Lifestyle habits upon which good MSK health depends are often laid down in early life  Excess weight puts extra strain on the joints, which can lead to wear and tear over time. Obesity & Obesity can affect bone health, as it can interfere with the body's ability to Pain absorb calcium and other important nutrients. This can increase the risk of fractures and osteoporosis later in life. Conditions of persistent or recurrent musculoskeletal pain (e.g., low back pain) are relatively common among young people. Obese adolescents are more likely to experience persistent or recurrent joint pain, including knee pain. Childhood obesity may have impact on persistent pain later in life by placing strain on vulnerable joints. Bone Development & Osteoarthritis MSK problems in adults can sometimes be caused by differences in the shape of bones and joints that develop early in life. Hip dysplasia is an important cause of childhood disability, leading to delays in children starting to walk. The size and shape of bones that develop throughout childhood and adolescence determine the biomechanics (the way joints handle and transmits forces) of a joint → influence the risk of developing painful osteoarthritis later in life.  Physical Activity & Bone Strength Over 90% of adult bone mass is accumulated during childhood and adolescence. Bone strength is one of the most important factors in determining whether a minor injury, such as a fall from a standing height, will lead to a fragility fracture. Regular exercise is important for maintaining musculoskeletal health. Young people who take part in sport have greater bone density in adult life. High impact activities (e.g. jumping and running) increase bone density much more than moderated and low-impact activities (e.g. jogging and walking) Young people become progressively less physically active throughout adolescence. Sex differences emerge early → by 4 yrs old girls are less physically active than boys.  Nutrition & Bone Strength Adequate nutrition and maintaining a healthy bodyweight are important for bone strength. Poor early childhood growth is associated with a doubling risk of adult hip fracture. Adolescent eating disorders and excessive dieting lead to increased risk of fragility fracture in later, particularly with low levels of physical activity. Calcium and vitamin D are both required to produce normal, healthy bone. Major deficiencies in these leads to bone abnormalities such as rickets.  MSK Disorders in Adults  MSK Injuries For many people, adult life is the first time they will develop a MSK condition, creating important opportunities for people to make lifestyle changes to improve their musculoskeletal health. Injuries to joints, bones, and muscle are an important cause of MSK conditions in adult life. These injuries include major traumas such as broken bones, injuries during intense physical exertion, or the common sprains, strains and falls that can happen in everyday life. In short term, injuries impair MSK health due to the pain and lost physical function while body tissue heal. They also may cause long-term pain and disability due incomplete healing and damage to the surrounding tissues. Pain following an injury and the fear of further injury can lead people to reduce their physical activity, causing loss of muscle strength leading to further joint instability and damage.  Workplace Injuries There is a complex relationship between work and musculoskeletal health. Certain types of work and workplace conditions may have a negative impact on MSK health, failing to create a healthy environment and increasing the risk of MSK conditions. Regardless of the cause, MSK conditions can reduce people’s ability to work → working days lost. The psychological and financial impact of lost work on health compounds the ill health due the condition itself. Work-related pain disorders such as back pain are more strongly associated with perceived workplace stress, high job demands and low job satisfaction than they are with the physical characteristics of and particular job. Modifying physical environments and work practices reduces incidence of acute injury. Early intervention to identify problems and the underlying occupational exposure can prevent chronic pain, disability and work loss.  Obesity & MSK Conditions Obesity increases the risk of osteoarthritis, and other MSK conditions such as back pain, gout and rheumatoid arthritis. Obesity directly damages weight bearing joints such as knee and hips because of abnormally high loads they have to carry. Obese people are more than twice as likely to develop osteoarthritis of the knee than those of normal body weight. Weight loss at every stage of life reduces the risk of developing osteoarthritis. For people with osteoarthritis, losing weight improves symptoms and may slow progression. A combination of dietary restriction and exercise is the best strategy to improve osteoarthritis symptoms.  Obesity & MSK Conditions Obese people are twice as likely to develop gout and tend to develop it at a younger age. The risk of developing back pain increases with rising BMI. The morbid obese are four times more likely to develop back pain. MSK Disorders in Adults and Elderly MSK Conditions In Elderly Much mass and bone strength gradually decline with age. This is thought to be due to a combination of systematic inflammatory and hormonal changes associated with the ageing process along with lifestyle factors such as physical inactivity, obesity and smoking. After menopause, women lose bone twice as quickly as men. Weaker muscles and fragile bones are major threats to MSK health of older people. Weaker leg muscles make it more difficult to remain physically active, destabilize joints leading to injury, damage and pain, and increase the likelihood of falls. Fear of falling can reduce older people’s confidence, leading to loss of independence and social isolation. Poor MSK health is a major contributor to frailty and multimorbidity. MSK Conditions In Elderly Exercise builds muscle bulk and strengthens bones at every stage of life. Although it is markedly attenuated in older age, it is possible to overcome this effect of ageing with additional and regular exercise. Everyday activities such as taking the stairs can have a positive impact on muscle strength and bone health. Physical activity among older people increase flexibility and mobility and improving balance → lowers the risk of falls and fractures