Musculoskeletal conditions include more than 150 different conditions involving bones, ligaments, connective tissue and joints. They represent the most common chronic conditions in Australia, accounting for 13% of the total disease burden.1,2 Musculoskeletal conditions can result from hereditary, congenital or acquired pathologic processes. They can be caused by infectious, inflammatory or degenerative processes; traumatic or developmental events; or neoplastic, vascular or toxic/metabolic diseases.3 Musculoskeletal symptoms affect all age groups and presentation can vary from acute to chronic and simple to complex.1
Low back pain is the most common musculoskeletal condition globally, followed by fractures, osteoarthritis, other injuries, neck pain, amputations and rheumatoid arthritis.4 Back pain and problems, which include disc disorders, sciatica and other conditions which result from injury or degenerative conditions,1 are a large contributor to illness and disability in Australia, accounting for 4.5% of the total disease burden.2 Osteoarthritis is reported to be experienced by one in 11 Australians and is the most common cause of hip and knee replacement in Australia.5 Aboriginal and Torres Strait Islander peoples have a slightly higher incidence of osteoarthritis.5,6
Risk factors for musculoskeletal conditions include age, being overweight or obese, physical inactivity, occupation (involving manual labour or joint loading) and history of joint trauma and injuries.1,7 Chronic musculoskeletal conditions can have a profound impact on quality of life and can result in the limitation of social, community and occupational activities.8,9 They are highly associated with significant mental health decline and deteriorated functioning.4 Musculoskeletal conditions are also highly comorbid, with the majority of people with a chronic musculoskeletal condition having at least one other chronic condition, for example, cardiovascular disease and mental health conditions.1
The prevalence of musculoskeletal conditions increases with age, from 1% among people aged one to 14 to 72% among people aged 75–84.1 Older people with chronic musculoskeletal conditions are generally less active in comparison with those without musculoskeletal conditions. Musculoskeletal conditions can greatly increase older patients’ risk of functional decline and can result in their reduced ability to manage comorbid conditions. They also increase all-cause mortality in people admitted to hospitals.9-11 Very remote areas also have the highest rate of total disease burden due to musculoskeletal conditions.12
General practitioners (GPs) play a crucial role in the prevention of musculoskeletal conditions, including through obesity management to limit osteoarthritis development and educating patients on injury prevention strategies.13 GPs are also well placed to negotiate a management plan to improve and maintain functioning, delay disease progression and facilitate return to work or activity in patients presenting with musculoskeletal conditions. Some GPs will choose to develop extra skills in the area of sports medicine, but all GPs will manage injuries and other conditions incurred as a result of exercise. This is especially so in rural areas where access to other services may be limited.
For patients with multiple chronic conditions including a musculoskeletal condition, treatment and management can become more complex and require a broader and integrated approach, ranging from interventions like strengthening exercises and stretches, to involvement of other health professionals like physiotherapists, exercise physiologists and rehabilitation physicians. Comorbidities can also make it more difficult for patients to self-manage their conditions. GPs therefore need to facilitate a patient-centred, whole-person care, chronic disease approach. Interdisciplinary teamwork is also an important feature in managing acute and chronic presentations involving musculoskeletal presentations.