In this post we discuss why the future of musculoskeletal health care must include resistance training to both improve results and reduce costs.
In 1903 Thomas Edison wrote;
“The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.”
Edison was certainly a visionary. Nearly 120 years after this profound statement I wonder what he’d think of health care today?
Let’s take a look at musculoskeletal health care in particular.
Musculoskeletal (MSK) medicine.
MSK medicine focuses on bone, joint and muscle health.
The NHS reports that over 20 million people in the U.K. have a MSK condition and they account for up to 30% of GP appointments.
Whilst this might be anything from a fracture to a pulled muscle, many of these complaints are ongoing in nature.
Unsurprisingly the most common chronic issue is back pain.
Back pain costs the NHS £1 billion per year and the U.K economy a further £1 billion in lost productivity.
Whilst the financial costs are enormous, fortunately most cases of back pain aren’t life threatening.
In fact just 1% of cases in people over the age of 55 are a sign of something ominous. The majority of episodes, whilst debilitating, will go away on their own.
So you might wonder, why does a complaint of this nature cost so much to treat?
And why is that cost rising in most developed countries?
There are three main reasons.
Advances in medical imaging have made it possible to see inside the human body better than ever before.
Whilst you might assume this is a good thing, in most circumstances people who are sent for scans have worse outcomes.
This is due to delays in appropriate treatment and the inappropriate referrals that occur as a result of imaging.
Typically scans record normal signs of wear and tear that in most cases don’t have to change for you to feel better. This is why the interpretation and explanation of what’s seen on a scan is so crucial. Unfortunately this often done poorly.
This study found only 16.7% of scans were appropriately interpreted by GPs, with 65.4% of patients being referred on for ineffective care as a result of over diagnosis.
It follows that if you over investigate something you are more likely to overtreat it.
Imaging often shows disc bulges or degeneration which is a normal part of the ageing process.
67% of people over the age of 50 in this study had multiple abnormalities at various discs, but crucially none had never complained of back pain.
Once an abnormality is identified there’s a greater chance of a procedure taking place if the individual is complaining of pain. Whether that procedure is entirely necessary is open to debate.
What is certain is that most back pain cases are best left alone. A desire to do something for people with chronic issues can lead to both an inappropriate prescription of strong pain medication and invasive procedures that may have poor outcomes.
In some cases this leaves patients in a worse situation than if no action had been taken at all.
An ageing population.
The population of the U.K. is ageing. According to the 2021 Census results 18.6% of the total population are aged 65 or over, up from 16.4% in 2011.
The Office for National Statistics estimates there will be a further 8.6 million people in this category by 2071. That’s an increase equivalent to the population of London.
This will place an enormous burden on our health care system. Not just MSK medicine but also orthopaedic departments.
In 2017 there were 91,698 hip replacements and 102,177 knee replacement surgeries in England, Wales and Northern Ireland according to the National Joint Registry.
By 2035 it’s predicted the NHS may be required to perform as many as 439,097 hip replacements and over 1.2 million knee replacements for the U.K as a whole.
In short we are living longer, but require invasive surgery just to keep moving.
We’re not maintaining our bodies for our life expectancy and the gap between minimal levels of function and death is getting wider.
Muscular system maintenance.
Likewise ageing produces predictable changes in the muscular system that can be successfully ameliorated with resistance training.
Preventing the loss of muscle that occurs with age also reduces the risk of type 2 diabetes, cardiovascular disease and maintains function as we age.
None of this information is new. There’s plenty of research to demonstrate the effects resistance training can have on MSK health.
Here’s the critical point though, how many GPs recommend resistance training to their patients?
I regularly encounter individuals who’ve been through the health care system looking for solutions to MSK issues, many of whom are over 50.
Rarely has a medical professional suggested regular resistance training as a solution.
This should be as standard as a dentist suggesting you clean your teeth regularly.
I wonder what Mr Edison would make of all this.
We’re spending billions of pounds on high cost solutions that are at best providing low value results.
At worst they’re creating further issues for the people they’re supposed to be helping.
Meanwhile less costly alternatives that could prevent many conditions and provide more effective solutions, aren’t considered.
Edison was right, education on appropriate exercise, diet and sleep was the future 120 years ago. It should be a reality now.