Musculoskeletal Conditions

Musculoskeletal (MSK) conditions include anything that affects the bones, muscles, or joints. Broadly, there are three groups of conditions:

• Mechanical – structural problems causing pain or loss of function (e.g. osteoarthritis, lower back pain)
• Osteoporosis – loss of bone density which is typically painless but increases the risk of major fractures
• Inflammatory – inflammation of one or more joints (e.g. rheumatoid arthritis, gout)

MSK services often also include ‘primary pain’ syndromes like fibromyalgia.

Many MSK conditions have common risk factors. Some of these are ‘modifiable’ (e.g. obesity, smoking, physical inactivity, vitamin D and calcium deficiency) and some are ‘non-modifiable’ (e.g. older age, genetic predisposition). In people of working age, occupational factors like manual labour or lack of ergonomic equipment also increase this risk.

MSK conditions are the leading cause of disability worldwide, (Source: World Health Organisation (WHO), 2024) and account for up to 30% of all GP consultations in the UK. (Source: NHS England) They are the leading cause of Years Lived with Disability (YLD) and the one of the largest causes of sickness absence from work. (Source: Office of Health Improvement and Disparities (OHID), 2024) There is a knock-on effect on families (who often provide unpaid care support), and increased reliance on health services. There is also an economic impact with increased sickness absence, risk of long term health-related worklessness, and an increased need for financial support. (Source: Public Health England, 2019) This will likely increase with an aging population, with a longer life expectancy but more years lived in poor health. (Source: DPH Annual Report, 2023)

MSK conditions are a significant contributor to health inequalities, with certain groups of people being more likely to have long term symptoms. (Source: OHID) Many of these differences are avoidable as they are influenced by underlying factors like obesity, occupational risks, and access to appropriate healthcare services. The secondary effects of MSK conditions like loss of earnings due to sickness absence are more likely to affect those who live in deprived areas or already have lower wages. MSK conditions more commonly affect adult women of all ages, who already more likely to be providing unpaid care to family members. (Source: Office for National Statistics (ONS), 2021) They also increase the risk of concurrent mental health conditions like anxiety and depression due to a complex mix of pain and effect on daily function.

While not directly causing symptoms, osteoporosis increases the chance of a fragility fracture – e.g. a hip fracture resulting from a fall from standing height. Hip fractures in particular are a significant cause of disability – only 52% of people will return to living in their own home after 120 days, and 26% will die within 12 months of their fracture. (Source: National Osteoporosis Guideline Group UK, 2025)

The impact of most MSK conditions can be reduced not only by early treatment and intervention, but by addressing modifiable risk factors to prevent the condition from developing in the first place.

National guidance:

• National guidance on care pathways and clinical interventions for specific conditions is provided by:
  • NICE Guidance for many musculoskeletal conditions and chronic primary pain syndromes
  • British Society of Rheumatology for inflammatory conditions
  • British Orthopaedic Association for commissioning guidance on mechanical conditions
  • National Osteoporosis Guideline Group (NOGG) for osteoporosis

• The World Health Organisation (WHO) webinar series in 2024 highlighted the global impact of MSK conditions and summarised the current impact and proposed strategies to address this. (Source: WHO, 2024) WHO also presented a 2019 Global Burden of Disease study series on osteoarthritis, rheumatoid arthritis, lower back pain, neck pain, gout, and other MSK conditions. (Source: The Lancet, 2021)
• NHS England provides resources on implementing best practice solutions for MSK health including a framework for reducing community waiting times. (Source: NHS England) They also recommend that all adults have direct access to First Contact Practitioners for musculoskeletal symptoms without needing a GP referral. (Source: NHS England)
• Arthritis UK collates statistics on the prevalence, risk, and impact of MSK conditions in their 2024 State of Musculoskeletal Health report (Source: Arthritis UK, 2025)
• The Arthritis and Musculoskeletal Alliance (ARMA) is a network of both professional and patient organisations that advises on MSK policies and services. It co-produced the MSK Networks Project with NHS England to develop an online knowledge hub, carried out its own inquiry into MSK health inequalities in 2023, and analysed Integrated Care Board (ICB) MSK policies in 2025.
• The Health Equity Evidence Centre (HEEC) produced a report in March 2025 exploring health and care interventions to support people from disadvantaged backgrounds with MSK conditions. (Source: HECC, 2025)

Local guidance:

• The Lincolnshire Joint Health and Wellbeing strategy identifies preventing two of the key MSK risk factors – by maintaining a healthy weight and increasing physical activity – as priorities.
• The NHS Lincolnshire Joint Forward Plan 2023-28 highlights the need to support people awaiting treatment for MSK conditions and improve physical and mental health for those undergoing operations.
• The Lincolnshire Integrated Care Partnership Strategy advises that interventions focus on preventing MSK conditions by helping people stay fit and active.
• Active Lincolnshire is a charity leading the Let’s Move Lincolnshire strategy to advocate for increased physical activity across the county.

Lincolnshire’s particular mix of geographic and social factors affects its burden of MSK disease. It is estimated that 22.4% of people in Lincolnshire have at least one long term MSK condition, compared to a national average of 17.9%. (Source: Department of Health and Social Care, (DHSC)) This disparity is fuelled by a number of inequalities which both increase the risk of MSK problems and create barriers to accessing timely and effective healthcare for those with these conditions. These inequalities include differences in exposure to risk factors that worsen MSK disease, practical barriers to support, and indirect influences like type of (particularly skilled manual trades like agriculture and construction). (Source: Health and Safety Executive, 2025)

Lincolnshire has significant variation in deprivation – some rural and coastal regions are among the most deprived in the country, with more affluent communities containing ‘hidden’ pockets of deprivation. This contributes to the MSK burden of disease in a number of ways – these communities are more likely to be exposed to risk factors like smoking or physical inactivity and are more likely to have comorbid conditions. MSK problems are also more likely to have an impact on ability to work due to precarious or seasonal employment roles with limited opportunity for flexibility or modified duties. (Source: DPH Annual Report, 2022)

Lincolnshire has higher rates of both smoking and obesity than the national average. Smoking increases the risk of osteoporosis and fractures; in Lincolnshire, 14.5% of people currently smoke compared to 12.4% across England. Higher weight puts strain on joints which worsens mechanical pain and increases the chance of negative outcomes from surgery; 67.9% of adults are overweight or obese in Lincolnshire compared to 64.5% across England. This contributes to higher rates of disease and worse outcomes from treatment. (Source: DHSC)

Lincolnshire has an aging population. The over-65 population is projected to increase by 41% by 2043. (Source: DPH Annual Report, 2023) The rise in MSK conditions in this group will particularly impact coastal and rural regions which already experience problems with workforce recruitment and retention. Both this and the physical distance to healthcare services increase barriers to accessible healthcare. (Source: ARMA, 2024)

Medication for MSK pain management can also pose risks to health – in 2022, Lincolnshire was identified by NHS England as being an outlier in prescriptions of high dose opioids for non-cancer pain, with almost double the national average. (Source: Lincolnshire PACE)

Lincolnshire is seeing significant growth in both agricultural and manufacturing sectors. This is good for increasing availability of jobs, but both these types of occupations can be associated with MSK conditions through manual labour and lack of flexibility in job roles. (Source: Greater Lincolnshire Local Enterprise Partnership)

Lincolnshire does have a lower proportion of ethnic minority groups than the national average, but these groups are disproportionately likely to be affected by MSK conditions. (Source: ONS, 2021) In particular, Pakistani women and Black Caribbean people of any gender are most likely to report long term MSK problems. (Source: OHID)

These factors all affect the landscape of Lincolnshire’s MSK disease burden and contribute to the health inequalities seen across the region, with some communities at far higher risk of ill health due to avoidable differences in risk factor exposure and healthcare access.

MSK conditions have been prioritised by the NHS Lincolnshire Joint Forward Plan 2023-28, particularly in supporting people waiting for treatment. There have been several pilots of novel strategies for this including a ‘Grantham Aches and Pains Hub‘ event. This brought together a variety of professionals including primary and secondary care, physiotherapy, pain management, local charities and other agencies in a community setting to provide a ‘one stop shop’ for patients on an MSK treatment waiting list to get information and support with their conditions.

The hip and knee service pathway has been updated after patient and public engagement and is being piloted in some areas of Lincolnshire. This brings together community, hospital, and social care services as part of the ICB’s ‘Care Closer to Home‘ programme.

Lincolnshire Community Health Services trust maintains the Lincs Physio website which has advice about self-care for joint and back problems as well as signposting to healthcare services. Lincs Physio is also providing First Contact Physiotherapy services to a number of GP practices across Lincolnshire to assess and manage patients with MSK conditions.

The ICB has recently completed a public consultation on community pain management services and patients can be referred to a community pain clinic.

Lincolnshire Pain Star is a strategy to reduce opioid prescribing across Lincolnshire with support for patients and education for professionals.

There have been recent research projects in Lincolnshire regarding the use of digital technologies such as wearable devices (Source: Helicon Health, 2023). The Technology Enabled Prevention and Care Pilot has been using technology for the prevention of falls and other negative health outcomes, and a service model has been established to help scale up the use of these technologies.

There are patient-led support groups for those living with fibromyalgia.

Lincolnshire has a specific Falls Management Exercise Programme (FaME) to improve strength and balance and reduce falls in at-risk groups. The programme is offered in different locations across the region to improve access. Lincolnshire’s frailty pathway includes specific resources to educate professionals about combating loss of muscle strength.  Lincolnshire also has a targeted Falls Response Unit provided by LIVES, a Lincolnshire charity working in partnership with Lincolnshire County Council. This service provides urgent assessment, support, and interventions for people who have had a fall.

Inflammatory MSK conditions are generally managed within specialist rheumatology teams, and United Lincolnshire Teaching Hospitals trust has a dedicated Rheumatology Advice Line for patients to directly access support with their conditions. They also provide outreach clinics in Boston, Grantham, Spalding, and Skegness hospitals to improve access.

The ICB has held several public consultations on MSK services. The hip and knee pathway consultation has been concluded and has informed the development of the new clinical pathway which includes expanded access to First Contact Practitioners for assessment of MSK conditions. The 2025 public consultations on musculoskeletal physiotherapy services and community pain management have been completed and will be used to further develop these services.

The Personalisation team at the ICB have also been surveying staff working in the MSK pathways to inform the development of new training resources as part of the service redesign. (Source: Its all about People)

Healthwatch Lincolnshire surveyed those living with fibromyalgia as part of their research on neurological conditions. This showed some gaps in services, with many patients feeling that there was a lack of understanding of fibromyalgia among professionals, and that they had been left to self-manage their condition. Several areas for improvement were identified including improving healthcare staff education, establishing specialist clinics or hubs, and using a more holistic approach including access to pain management specialists and mental health support.

There has been a very positive response from those service users who have taken part in specific interventions. Those who took part in FaME have reported its benefits on their mobility and quality of life. (Source: Public Health Intervention Responsive Studies Teams, (PHIRST) 2024) However, some participants found it difficult to engage in the programme partly due to accessibility of venues, especially for those in rural areas. The Grantham Aches and Pains Hub event also had positive feedback, both from patients who enjoyed the more informal setting and from staff members who enjoyed novel ways of working and connecting with colleagues from different areas. (Source: ROC Research Consultancy, 2024)

There is a gap in the provision of care for those with fibromyalgia, as patients have noted a perceived lack in understanding by staff in general healthcare settings, and a specific lack of specialist holistic care. There is the opportunity for improved staff education and to provide more targeted specialist care after diagnosis. (Source: Healthwatch Lincolnshire, 2025)

The Falls Management Exercise programme has a waiting list of several months, with demand far exceeding capacity.

First Contact Practitioners have been implemented in a number of GP practices across Lincolnshire, but there are still areas that do not have access to this. (Source: NHS Lincolnshire Community Health Services)

There remains significant inequity in MSK healthcare, with more deprived communities having greater exposure to risk factors for ill health along with higher barriers to healthcare access. An increase in digital services such as virtual clinics may help to alleviate some of this (especially in rural areas with poor transport links), but there is also a risk of digital exclusion for those unable to afford access to the relevant technology or for people who do not have technical skills. Any digital solutions therefore need to consider how people in need can receive help with equipment and services requiring internet access.

• The ICB is evaluating MSK physiotherapy pathways and community pain services with the results of the recent public consultations, and this will inform service development in the next few years.
• Expand the reach of First Contact Practitioners (FCPs) to meet the target of all patients having access to FCP assessments for MSK symptoms without requiring a GP referral.
• Review the scope of the Falls Management Exercise Programme to meet the demand for service provision.
• Continue to explore the use of digital technologies in the prevention and management of MSK conditions, with a focus on reducing health inequalities by expanding access to care for those in deprived areas who are most at risk.