00:01
So we’re going to talk about
why do we think about musculoskeletal
disorders so much.
We know they’re a common problem.
00:08
We know everybody gets some
kind of muscle pain,
some kind of muscle tension,
but it’s more than that.
First of all, musculoskeletal disorders
are any pain or disability
that comes from the bone and joint,
and it affects your ability to function.
When people feel pain, they
don’t work as well,
they don’t think as well,
they don’t rest as well,
and it affects all levels of functioning.
00:32
It’s called the burden of musculoskeletal
disease
when we look at the dollar
amount, the loss of work,
and how much damage it does to individuals.
We’re going to focus on the big disorders
and those where the attention
is drawn to it
because most of us think, yeah, we get
muscle pain when we work out,
when we play, and when we
do different things,
but it’s more than that.
We have to worry about the parts
of the body that are affected,
where we’re going to get these problems,
how we’re going to get these problems,
and why we deal with it.
01:05
A lot of musculoskeletal disorders
are joint deterioration.
01:09
They’re wear and tear in the bones.
01:11
They’re destruction of the bones.
01:13
They’re inappropriate use
that causes tearing
or non-healing or swelling of
the muscles in the body,
and cause the bones not to function well.
01:25
So the parts of the body that are affected
are the joints, the muscles, and the bones.
01:29
Arthritis is one of the most common.
01:32
You can have rheumatoid arthritis
which is autoimmune or you
can have osteoarthritis—
more wear and tear.
We also see a lot of spine disorders
that are just the way the body is built.
01:44
It’s not going to function
at peak maximal intensity all the time.
You’re going to get neck pain.
You’re going to get back pain.
01:52
You’re going to have arm pain
when you lift too much
r lift in the wrong way, when
you stress or strain.
01:58
We also know that humans tend to have
a lot of differences in their anatomy,
a lot of differences in their vertebra,
and some of them lead to spinal deformity,
spina bifada, or scoliosis,
and that becomes a very, very expensive form
of musculoskeletal disease.
02:18
With aging, women, particularly,
are going to get osteoporosis
but both men and women
have a hormonal depletion of bone
which causes an increased risk of fracture,
a decreased ability to function as we want,
and causes disability.
02:34
And we always have to think about cancer
and issues of the connective tissue.
02:39
So the whole body really is at risk
and it is something that we do see.
So how do we deal with this?
Well we define how much of a problem it is.
02:51
It’s all ages,
but we do know that the most
expensive problems,
the hardest problems to deal with
are musculoskeletal problems
that start in childhood
either with juvenile rheumatoid arthritis
or deformities are big ones.
03:05
We also know that working-age
adults tend to miss a lot of work
from overuse, misuse,
or functioning that’s just not appropriate,
and then older adults with fractures
and other musculoskeletal conditions.
03:20
Just to put some numbers on this,
over the age of 18,
126 million Americans have reported
musculoskeletal pain
that stopped them from being
able to function normally.
03:32
We also know that in a year,
1 out of 3 people are affected by
back pain or neck pain,
and lastly, 18 million people were going
to have some chronic issues
where they can’t perform their
activities of daily living
because of musculoskeletal disorders.
03:49
And this leads to people not being
able to live independently,
needing help, and just it’s a tremendous
burden of disease.
So musculoskeletal disorders
not only stop functioning,
but they make people feel bad. They make
people unable to do what they want to do,
and it affects their other areas
of health as well.
04:09
We do know that the burden of the disease
is figured in the number of
dollars spent on it,
the number of days lost to work,
and the number of people.
04:17
So if it's 290 million lost work days
due to back and neck pain,
people think about it and
they try to figure out
what can they do to make it less?
Well, you start by making
work more ergonomic
with desks that rise and lower,
chairs that are more comfortable that
have support for your low back,
and early detection—knowing when people
can continue to work and when
they have to stop and stretch.
04:44
We do know that there are refractory
periods that after you
get full motion you may
get 20 to 30 minutes.
04:50
We do know that stretching
gives you 2 to 3 hours
of increased proprioceptive sense
and ease of functioning,
after which you’ll lose the benefit.
04:59
Our muscles and bones are
not set up to act forever
and to act without support.
So we’re talking about $213 billion
spent every year in direct
and indirect costs
and $796 billion dollars to treat
musculoskeletal disorders.
05:18
That’s why it gets our attention.
05:20
In contrast, the entire GME
system is $9 billion
so it’s almost 100 times the amount of money
spent on musculoskeletal disorders
as we spend on training residents
to become full fledge physicians.
We can predict how much it’s going to be.
05:38
We know where the cost is going to be.
05:40
We know where the breakdown is going to be,
but just because we can describe
musculoskeletal disorders,
doesn’t mean we can successfully treat them.
And also, when dealing with humans, it doesn’t
mean that humans are going to listen.
05:52
If you tell people that
if you crack your joint, don’t crack
it again for 20 minutes,
some people may listen, most won’t.
06:00
So getting people to listen to their bodies
s something that we have to work on more.
Getting people to understand what they do,
what kind of lifting, how they can lift,
and how much they can lift is something
that we need to get through to people.
06:15
The other thing is when we don’t understand
how the body can heal itself,
we take over. Joint replacements
cost $66 billion
in one year,
and that’s the average number,
and it’s increasing every year
as our population ages.
We’re trying other forms of therapy.
We’re trying viscosupplementation.
06:36
We’re trying bracing.
06:37
We’re trying other forms of
support for the muscles,
but people don’t want to wait the 2 to 3
years for a bone to reform, to heal.
They want more immediate action
even if it means 4 to 6 weeks
of physical therapy to get there.
06:52
And whenever you have multiple
answers to one question,
it mean no one answer is ideal,
no one answer is best,
and matching the treatment to
the person is very important.
07:04
We know that in hospitalized patients,
we do tend to take over.
07:06
We do tend to give them physical
therapy for large muscles,
ccupational therapy for small muscle
groups and fine motor movement,
and we do try and train them
so that they are able
to continue to take care of themselves
with the goal, of course, being discharge.
07:19
A patient’s goal is not discharge, a
patient’s goal is full functioning.
07:23
So some of the costs
get figured into the divergent goals
that the individuals have
and the healthcare system
which looks it a floor
of how can we get this person
home functioning,
caring for themselves with
minimal discomfort.
We do know that we can prevent
musculoskeletal disorders with proper use.
07:43
We do know that if somebody goes into,
what’s called non-neutral mechanics,
and pinches a bone in one spot,
two things form bone—
Wolff’s Law, the area of greatest pressure
causes bone deposition and
the piezoelectric forces
that come from muscle that
stimulate bone formation.
08:01
So by working within those rules
and strengthening the areas that
need to be strengthened,
protecting the core muscle mass
that support the body skeleton,
is going to be very, very important.
But it’s also very hard and it
takes continued exercise
which we have a tough time
getting patients to do.
08:20
So gaining motility and function
is our guideline.
08:23
Full motility, full function is our goal,
and once we get there, patients
will be happier.
08:31
But again, multiple answers
to a single question—
we don’t have one best answer—
we need to keep searching,
and research is needed.
We need to find the right questions,
we need to agree on the questions
with our patients—
will often have different questions
than we have
and different goals than we have.
As a doc, I can tell you someone came
into my office and said,
“I did break my leg, but I still plan on
running the marathon next week.
08:56
What can you do to help me?”
Well, you broke your leg—you shouldn’t,
but if they’re going to use crutches
that person may still try and run the
marathon or hobble the marathon.
09:06
So you need to screen who’s going
to get overuse injuries,
who’s going to get tears, who’s going
to get sprains and strains,
and how do we deal with this?
And we do know that there’s an unequal
distribution of resources,
there is a preponderance of the emergency
room when the pain gets bad,
and less early intervention
which would really help prevent
permanent damage
and help with healing.
09:32
Under 35 years of age, most sprains
will heal in 2 weeks.
09:36
Over 35, you add a week
a year up until 6 weeks,
and after 55 years of age, it takes
a lot longer to heal
nd there is some evaluation afterwards
to make sure that the healing is occurring.
We’re also learning about external
stimulates for bone growth
which may have some place and other
ways of addressing a problem
that is still trying to be fully understood.
09:59
We’re always asking for more research
dollars, more research involvement
because the questions are clear.
People want to function
and they want to function
easily and comfortably.
10:09
So getting the government interested,
getting funding agencies interested,
is a key principle in what
we’re dealing with.
10:15
Getting us to understand the
questions, the healing time,
and where and when we
have to intervene is key.
10:23
And how do we get people the proper
level of care at the proper time?
How do we get them to a doctor
when they first start getting
microfractures
or stress fractures?
When do they start getting overuse injuries?
When do they start getting
laxity of ligaments
and start issues?
So those are things that we have to address
and are working actively to address.
We also need to understand
that acute pain, subacute, and chronic pain
are very different conditions
and they have a very different
natural history.
10:56
ntervening early and understanding if
a disease is going to heal on its own
and what the patient needs is observation
is very different than a pediatric issue
that’s caused by a deformity
that is going to worsen over time
and some kind of supporting mechanism,
supporting structures,
ancillary devices may be needed
to help it from causing other problems
and causing what we call, compensatory
problems,
because we know if you have a problem
in the right upper back
eventually it’s going to move
to the left lower back
as you twist to support it, and then
it’s going to hit the pelvis,
and it just is a continual decline
that gets more expensive, more painful,
and more difficult to treat.
11:36
So finding the key points
to intervene is critical.
11:41
We also need to coordinate better
between physicians, physical therapists,
occupational therapists, and a system
that helps monitor what’s going on
and helps keep people active and healthy.
11:53
At some point, we’ll even get to exercise
and lifestyle specialists
who are critical to maintaining
a healthy lifestyle
and a healthy musculoskeletal functioning.
12:02
But again, we’re not there yet, but
now that we have a system
where knowledge is integrated
and we know what’s going on,
it’s going to happen more rapidly
and we’ll be able to use that to our benefit.