All men and women are at risk of developing problems with their musculoskeletal system. Symptoms are characterised by pain and loss of physical function that limits the person’s activities and restricts their participation in society. The Bone and Joint Decade aims to empower people to gain priority for their own care.

Musculoskeletal Conditions

Musculoskeletal conditions affect bones and joints and can have a major impact on society due to their frequency, chronicity and resultant disability.

At present 1 in 4 people suffer from longstanding musculoskeletal problems and with an increase in older populations globally this problem is on the rise. These conditions get further exacerbated by harmful lifestyle factors like smoking, overeating, alcohol consumption and lack of exercise.

Musculoskeletal conditions are disorders that include:

• Osteoarthritis
• Rheumatoid Arthritis
• Osteoporosis
• Low Back Pain
• Musculoskeletal trauma and injuries:
• major limb trauma,
• occupational
• sports injuries

OSTEOARTHRITIS is a slowly progressive musculoskeletal disorder that can occur in any joint. Osteoarthritis causes pain, stiffness, immobility and limitation of movement.

Osteoarthritis occurs when the surface of the joint and the protective cartilage covering the bones gets damaged. It becomes too thin to prevent the joints to move freely or smoothly. The joints most commonly affected are hip, knees, wrists and, the joints between vertebrae and fingers.

This may occur as a result of natural wear associated with ageing where the weakened cartilage in the joint fails to withstand the heavy loads placed upon it from excessive body weight or it can follow previous injury.

Sometimes bones adjacent to the damaged joint enlarge and become thick, and often the joint will seem enlarged and swollen due to fluid retention within the joint.

It accounts for more disability among the elderly than any other disease.

RHEUMATOID ARTHRITIS is the most common inflammatory disease of the joints.

Rheumatoid arthritis usually presents with pain, early morning stiffness and symmetrical swelling of the small joints of the hands and feet. Fatigue, weight loss and malaise are also reported along with the above symptoms. It is more common in women than men; and in the ages of 35-45 years.

It affects the lining of the joint, called the synovium (essential for lubrication to make our bones move smoothly within the joint sockets) which becomes inflamed. This inflammation results in the joint becoming tender, swollen and warm, and sometimes reddened.

The disorder causes irreversible deformities with long-term pain and disability.

LOWER BACK PAIN is mainly due to straining the back or is caused by an awkward movement. This usually resolves itself within a short space of time. However, long standing low back pain is due to non-specific causes - that is there is no known underlying reason for it to occur.

It is usually defined as pain localised below the 12^th rib and above the buttocks, with or without leg pain.

There are some specific causes of back pain such as degenerative disc and spine diseases, inflammatory conditions, infections, cancer, referred pain (e.g. from duodenal ulcer); psychogenic pain (originating in the mind rather than the body); trauma (e.g. fractures) and genetic disorders (e.g. severe scoliosis, spina bifida).

OSTEOPOROSIS is a disease where the bone weakens causing an increased risk of fracture, particularly of the spine, wrist, hip, pelvis and upper arm. It is a progressive skeletal disease characterised by low bone mass and deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.

Osteoporosis and associated fractures can result in severe disability and even death.

Are YOU at risk

Some people are at more risk than others in having problems with their musculoskeletal system.

What are the risk factors for specific conditions?

Condition	Risk Factors
Osteoarthritis	Those people over 50 years of age Obesity History of joint injury Intense sporting activities or certain occupations.
Rheumatoid arthritis	History of painful joints
Back pain	Persistence or recurrent back pain
Osteoporosis	Those over 65 years of age Men and women with strong risk factors such as untreated lack of sex hormones, Previous fracture following little trauma, steroid therapy, low body weight, maternal history of hip fracture and excess alcohol or smoking
Major musculoskeletal injuries	Everyone is at risk particularly those participating in traffic, high-risk occupation or leisure activities.
Occupational musculoskeletal injuries	Everyone is at risk, particularly those exposed to repetition, high force, awkward joint posture, direct pressure, vibration, prolonged constrained posture or factors such as psychological stress.
Sports injuries	People who participate in physical activity or sport are at risk, particularly the physically unfit person if they try to do too much, too quickly. Participants in contact sports, where the wrong body type for the sport, the level of expertise and experience differ and the rules of the sport are not observed. In the rehabilitation phase the risk for a new injury is increased.

 

If you are at increased risk, then you have most to gain by following a bone and joint healthy lifestyle. There may be some specific things you will need to do to reduce your risk, so you should discuss this with a health professional.

Can we make healthier bones and joints?

Yes, measures such as being physically active, eating a balanced diet, and avoiding smoking may reduce the development of musculoskeletal conditions such as osteoarthritis, osteoporosis and back pain, and reduce the occurrence of injuries and accidents, and improve the outcome of various musculoskeletal conditions.

The benefits of a bone and joint healthy lifestyle will be felt within a few years.These measures must be undertaken throughout life to see the greatest benefits, which will be most apparent in the later years.

Be active now to stay active tomorrow!

What is a Bone and Joint healthy lifesyle?

Many factors contribute to the deterioration of our musculoskeletal system. This system consists of our bones and the connective tissues surroundings bones such as joints, ligaments, and tendons. Our musculoskeletal system is continuously being tested by various factors such as stress, improper diet, and exercise.

A healthy musculoskeletal system is important for everyone - the young, the elderly, sports enthusiasts, people constantly on their feet, and people using repetitious movements such as computer keyboarding. Failure to maintain a healthy musculoskeletal system and joints can lead to a reduction in overall health and wellbeing.

Keep active

Physical activity is important for musculoskeletal health. It helps build and maintain healthy bones, muscles and joints. A brisk walk everyday enhances bone mineral density and muscle strength. Remember it is essential to maintain a moderately active lifestyle rather than over exert and damage oneself.

The type of exercise carried out is important, as only weight bearing exercise such as walking and weight training will have direct benefits on the bones. Exercises such as walking, running, tennis, weight training and aerobics are the best forms of exercise to help reduce bone loss associated with ageing and directly benefit the bone.

Although non-weight bearing exercise, such as swimming and cycling, do not directly benefit bones, many people enjoy the activities and they can still form an important part of the exercise programme. They provide the combination of developing muscle strength and aerobic exercise and help to improve balance and agility, so reducing the risk of a fall.

Yoga and Pilates are also good ways to improve balance as well as providing a relaxing form of exercise. If taught correctly, they can help to reduce the risk of falls, and also of fractures, by improving balance and coordination.

It is recommended to remain as physically active as possible and guidelines suggest that we need 30 minutes of physical activity per day to stay healthy.

Set a careful exercise programme not an intense one!

It is of prime importance to understand that it is the regularity of physical activity rather than the intensity that will deliver benefit. Sharp bouts of loading and more intense or prolonged exercise do not reap more benefits.

Intense exercise in the extreme can have an adverse effect, resulting in a decrease in bone density and damage due to accidents.

The uses of physical protectors and supports as a physical means of protection are invaluable to help you feel more secure whilst exercising.

As we get older, we do become more prone to aches, pains and injuries, and over flexing and stressing the body through an intense level of exercise should be avoided to prevent the occurrence of any further injuries.

Always remember you should never be in pain whilst exercising, although some discomfort that disappears after exercising is normal. If you experience pain or other worrying events when you are exercising, you should seek expert advice.

Maintain An Ideal Weight

An ideal body weight is important for healthy bones and muscle. Weight control is important to people who have problems with their musculoskeletal system because extra weight puts extra pressure on some joints and can lead to aggravated pain and discomfort.

IMPERIAL MEASUREMENT		METRIC MEASUREMENT
HEIGHT without shoes in ft. and ins.	BMI 20-25 in st. lbs.	HEIGHT without shoes in metres	BMI 20-25 in kg
4 ft 10 ins	6.12 - 8.8	1.47m	43.2 - 54.0
4 ft 11 ins	7.1 - 8.12	1.50m	45.0 - 56.2
5 ft 0 in	7.4 - 9.2	1.52m	46.2 - 57.8
5 ft 1 in	7.8 - 9.6	1.55m	48.0 - 60.0
5 ft 2 ins	7.11 - 9.11	1.57m	49.4 - 61.6
5 ft 3 ins	8.1 - 10.1	1.60m	51.2 - 64.0
5 ft 4 ins	8.5 - 10.6	1.63m	53.2 - 66.4
5 ft 5 ins	8.8 - 10.10	1.65m	54.4 - 68.0
5 ft 6 ins	8.12 - 11.1	1.68m	56.4 - 70.6
5 ft 7 ins	9.2 - 11.6	1.70m	57.8 - 72.2
5 ft 8 ins	9.6 - 11.10	1.73m	59.8 - 74.8
5 ft 9 ins	9.9 - 12.1	1.75m	61.2 - 76.6
5 ft 10 ins	9.13 - 12.6	1.78m	63.4 - 79.2
5 ft 11 ins	10.3 - 12.11	1.80m	64.8 - 81.0
6 ft 0 in	10.7 - 13.2	1.83m	67.0 - 83.8
6 ft 1 in	10.12 - 13.7	1.85m	68.4 - 85.6
6 ft 2 ins	11.2 - 13.13	1.88m	70.6 - 88.4

 

Ideal body weight can be assessed using a measurement known as the Body Mass Index (BMI). This can be determined if you know your weight and your height. BMI measures a person’s weight relative to his or her height. A healthy BMI is between 20 and 25. Check your Body Mass Index next time you visit the doctor.

It is essential to keep to an ideal body weight!

 

Being over-weight or obese is associated with the development and progression of osteoarthritis of the knee.

A modest weight loss of 4-7kgs is likely to relieve symptoms and delay disease progression of knee osteoarthritis.

Pain in rheumatoid arthritis can be reduced by weight reduction. Severe obesity may play a part in aggravating a simple low back problem, and contribute to a long-lasting or recurring condition.

On the other hand too low a BMI may lead to osteoporosis and prolonged disability after a fracture.

Eat a Balanced Diet

An important part of the prevention of musculoskeletal disorders can be achieved by eating a well-balanced diet. Along with exercise, a balanced diet can help to manage body weight and keep you healthy.

A balanced diet contains the correct proportions of carbohydrate, protein, fat, vitamins, minerals and fibre and meets the recommended daily allowance for calcium (at least 800mg per day) and fish oils.

A balanced diet is important at all ages, especially during the phases of growth and development and also in the elderly to maintain strength and agility.

Diet is important in both the prevention and progression of musculoskeletal conditions.

Higher levels of calcium intake are associated with healthier bones; in particular higher dietary intake in childhood has been associated with healthier bones in adult life.

Older people in general have low calcium intake and the frail elderly are often deficient in vitamin D. In this population calcium and vitamin D supplementation may prevent fracture. Good general nutrition is also important in recovery from hip fractures.

Don’t Smoke/ Quit Smoking

Although most people believe that cigarette smoking damages the lungs and heart, they may not be aware that smoking is also detrimental to bones, muscles and joints.

Avoidance of smoking may reduce the frequency of rheumatoid arthritis, osteoporosis and back pain.

Cigarette smoking reduces blood supply to bones, impedes bone metabolism, and decreases calcium absorption. As a result, bone formed when nicotine is in your system has inferior biomechanical properties. Smoking weakens bones and delays fracture healing.

The avoidance of smoking may reduce the frequency of rheumatoid arthritis, osteoporosis and back pain. It is unknown if giving up smoking will reduce the risk of musculoskeletal disease however, tobacco smoking is harmful not only to the individual smoker but, because of passive smoking, to others also.

Smoking is known to be associated with a wide range of diseases, which include heart disease, lung, bladder and kidney, pancreas, oral cavity, pharynx, larynx, oesophagus, uterus and cervical cancers, peptic ulcers, low birth weight babies, sudden infant death (SIDS) and lower fertility. Smoking represents the largest single determinant of avoidable deaths.

Reduce Alcohol Intake

It is important to have a balanced use of alcohol and avoidance of alcohol abuse. Excess alcohol is estimated at more than 60 gm/day.

Heavy drinking is associated with accidents on the road, in the workplace and with falls, osteoporosis and fractures.

Prevent accident and injuries

Being careful and creating safer surroundings can prevent accidents.

This will also reduce musculoskeletal trauma and its consequences, including osteoarthritis, specific back pain due to injury and fractures as a result of underlying osteoporosis and long term disability.

By preventing or highlighting accident prone incidents one can reduce the:

• risk of premature death
• risk of developing complications, such as infection, and blood clots in the heart or brain
• number of sick days and early retirements

Avoid overuse of bones and joints

Abnormal or overuse of the musculoskeletal system needs to be avoided. This includes reducing workplace exposure and correct training for occupational activities (e.g. repetitive tasks, lifting) and sports activities. Overuse of the musculoskeletal system, including poor posture and position, can often contribute to osteoarthritis and back pain as well as musculoskeletal injuries related to sports and occupational activities.

The long-term consequences of structural or functional abnormalities of the musculoskeletal system, such as hip problems and osteoarthritis of the knee and hip, back pain, and foot deformities may be prevented by not overdoing physical activity.

The other health benefit of avoiding abnormal or overuse of the musculoskeletal system will be reduced number of sick days and early retirements.

What if I already have musculoskeletal problems?

If you have started to develop a musculoskeletal problem, or have had a problem for some time, that is causing pain and limitation of activities, then you should seek professional advice so that you can receive appropriate treatment. This may help you to manage and take responsibility for your own condition. This should enable you to be more active and independent.

The management of a musculoskeletal problem may involve:

• explanation about the cause and how to self-manage it
• lifestyle advice
• drug therapies to relieve the symptoms or control the disease process
• surgery to correct the problem
• rehabilitation to improve function and to make it easier for you to do what you want to do

There are now effective treatments for musculoskeletal conditions to help control pain, prevent progression of the disease and to reduce the disability that these problems can cause.

The health of your musculoskeletal system is in your hands!