Musculoskeletal disorders are a significant public health problem. Musculoskeletal disorders and diseases are the leading cause of disability in the United States and account for more than one-half of all chronic conditions in people over 50 years of age in developed countries.The economic impact of these conditions is also staggering: In 2004, the sum of the direct expenditures in health care costs and the indirect expenditures in lost wages was estimated as $849 billion or 7.7 percent of the national gross domestic product.1
As you know, one of the most common conditions that bring patients to a chiropractor's office is back pain. Back pain is one of the most common musculoskeletal issues. Moderate back pain has an annual incidence in the adult population of 10-15 percent, with 80 percent of adults experiencing back pain at some point in their life. Of those patients suffering from back pain who seek care, 70 percent will do so from either a primary care medical physician or a chiropractor, making lower back pain the second most common reason for visiting a physician's office.2 Back pain is also the single greatest reason for activity limitation in the under-age-45 population.3
Given the morbidity and economic costs associated with musculoskeletal disorders, specifically back pain, it is imperative that efforts be put forth to appropriately prevent and treat these disorders. The chiropractic profession is well-positioned to contribute to these efforts. However, we alone cannot address this important issue; therefore, it is imperative that chiropractors team with multidisciplinary organizations to work side by side with professionals from other disciplines.
The USBJD: Addressing Musculoskeletal Health Worldwide
One of these organizations – the only one that brings together all specialties concerned with musculoskeletal disorders – is the U.S. Bone and Joint Decade (USBJD). Nine years ago, the USBJD set out to bring the musculoskeletal community together in a unified effort to raise awareness of the burden of musculoskeletal disease. At that time, the American Chiropractic Association had the vision to join with this important organization to bring the voice of the chiropractic profession to the board of directors of the USBJD.
Much has been accomplished in the past nine years and it has become clear that this common effort should be maintained. As the Decade enters its 10th year, the USBJD Board has decided the organization should continue to develop beyond 2011. The global Bone and Joint Decade also has received a mandate to continue this important work worldwide.
To reflect the vibrant organization it has become, the USBJD will be changing its name by the middle of 2011, transitioning to the United States Bone and Joint Initiative (USBJI). With this transition, the ACA will continue to maintain a seat at the table of this important organization. The chiropractic profession has enjoyed a respected place within the board of directors and continues to have representation on important committees, including the nomination committee and the spine committee.
Notable USBJD Achievements
Much progress has been made by both the USBJD and the international BJD. Globally, musculoskeletal conditions have gained public and political priority. These non-communicable diseases are moving up the agenda in national, regional and global organizations, including the United Nations, World Health Organization and National Institutes of Health.1 Some of the most notable achievements of the USBJD in the past decade include the following:
- Publication of The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost, in print and online, and with supporting tools and an executive summary suitable for the public and policy-makers;
- The Young Investigators Initiative, increasing the pipeline of clinician-scientists. To date, the initiative has engaged more than 190 participants, of which 84 have obtained musculoskeletal research funding totaling more than $60 million;
- The Project 100 program, which has increased formalized instruction in musculoskeletal medicine in medical schools, of which less than 50 percent offered such instruction in 2002, improving to 80 percent as of 2009;
- Public education programs such as Fit to a T (bone health and osteoporosis), PB&J (for adolescents) and Experts in Arthritis, with more than 300 sessions for more than 13,000 patients and the public thus far. Straighten Up America has also expanded to an international version and has made a great impact all over the world to raise the awareness of the importance of posture;
- The 2009 Global Network Conference: assembling the worldwide musculoskeletal community; advocating on Capitol Hill to raise awareness, improve access to care, and increase funding for research, prevention, and rehabilitation; providing a forum to present the most important advances in major musculoskeletal conditions and create a roadmap for the future.
Future Direction and Goals
The USBJD/I Board has spent the past several months assessing the direction the ongoing organization should take. The board has decided that it will continue with its most successful programs. The goals for the rest of 2011 and for the new USBJI remain the same: to promote and facilitate collaboration among the public, patients and organizations to improve bone and joint health through education, research and advocacy. The primary areas of focus will be awareness and advocacy, access to high-quality musculoskeletal care, data assessment and dissemination, and interdisciplinary forums and programs.
The Chiropractic Connection
It remains important that the chiropractic profession remain an active participant in this organization. The USBJI presents an important opportunity for the chiropractic profession to be a part of the solution to the public health burden of musculoskeletal disorders. With this in mind, the Chiropractic Health Care section of the American Public Health Association has submitted a policy statement highlighting the importance of musculoskeletal disorders and giving action steps for ways to address this issue.
One of these steps is to utilize the currently available resources of the USBJD/I to help educate the public about important issues such as osteoporosis, adolescent risk factors and posture. We are hoping that by taking a leadership role in this area, we will establish the place for chiropractors to work alongside other professionals to address musculoskeletal disorders through improved preventative and treatment methods.
- Watkins-Castillo S, editor. The Burden of Musculoskeletal Disease in the United States. Copyright 2008, American Academy of Orthopedic Surgeons.
- Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006. Spine, 2009 Sep 1;34(19):2077-84.
- Björklund M, Hamberg J, Heiden M, Barnekow-Bergkvist M. The assessment of symptoms and functional limitations in low back pain patients: validity and reliability of a new questionnaire. Eur Spine J, 2007 Nov;16(11):1799-811.
Click here for previous articles by Rand Baird, DC, MPH, FICA, FICC.
Dr. Paul Dougherty, primary author for this month's "Chiropractic in the APHA" column, chairs the Chiropractic Health Care section of the APHA. Contributing to this article is Toby King, executive director of the U.S. Bone and Joint Decade.