The Case for Prevention
Musculoskeletal (MSK) conditions remain one of the leading causes of pain, disability, and reduced quality of life across all ages. Over 20 million people in the UK (almost a third of the population) live with one or more MSK conditions, these include neck pain and back pain, the two largest causes of disability worldwide. Beyond physical symptoms, MSK issues can negatively affect mental health, that may contribute to anxiety, depression, and social isolation. The impact is not only on the individual, but also influences family life, workplace functioning, communities and the broader economy. MSK disorders account for approximately £5 billion in NHS expenditure each year and contribute to an estimated 28.2 million lost workdays annually.
As the demand on healthcare services increases and workplace pressures rise, the conversation around MSK prevention has never been more important. Prevention requires a partnership that includes individuals, workplaces, wider communities and healthcare systems to create environments where people can move and thrive healthfully.
The Patient Perspective: Movement, Self-Care, and the Seven Pillars of Lifestyle Medicine
For most people, the single most powerful action to protect MSK health is regular and varied movement. Our bodies adapt positively to appropriate loading, proprioceptive challenges and mobility. Movement supports joint health, muscle function, bone density, stress regulation, neurology and mood. It also reduces the likelihood of persistent pain by keeping the body confidently active.
In addition to movement, the Seven Pillars of Lifestyle Medicine offer a holistic framework that aligns closely with MSK health:
The Seven Pillars of Lifestyle Medicine
- Physical activity – regular movement, cardiovascular activity, mobility/flexibility training, strength training, and reduced sedentary time
- Nutrition – balanced eating that supports tissue health, energy, and recovery focussing on wholefoods and hydration
- Restorative sleep – essential for tissue repair, cognitive function, and pain regulation
- Stress management – reducing mental load that can amplify pain and tension
- Avoiding harmful substances – minimising exposure to factors that undermine recovery and inflammation control
- Positive social connection – support networks that reduce isolation, improve resilience and adherence to healthy habits
- A sense of purpose or meaning – motivation and psychological wellbeing that sustain long term health behaviours, personal values and goals, feeling connected to something bigger
These pillars provide practical tools for real-world MSK prevention. Some examples may include:
- Sleep disturbances can increase pain sensitivity and fatigue.
- Stress heightens muscle tension and increases the likelihood of persistent pain.
- Nutrition influences inflammation, tissue quality, and energy levels.
- Social support affects whether people maintain exercise routines, stay active or avoid activity due to varying factors.
The strong links between lifestyle and physical comfort can often come as a surprise to patients. Integrating these pillars into everyday life can help individuals build confidence, reduce symptoms, recover more quickly, and prevent recurrent issues.
Modern lifestyles, including busy schedules, caring and financial responsibilities, and uncertainty about what is safe, can make attitude and behaviour change somewhat challenging. Therefore, healthcare professionals, such as chiropractors, play a vital role in offering appropriate support such as, reassurance, clear explanations, and personalised strategies. Research suggests that individuals often find strategies overwhelming and unachievable. The aim is to empower individuals, thus helping them with small but consistent changes, that can have a significant cumulative impact on their MSK health.
The System Perspective: Creating Environments That Support Healthy Choices
From a systems perspective, there are three important environments: communities, workplace and healthcare that can either restrict or facilitate an individual’s ability to achieve MSK wellbeing and long-term prevention. Therefore, system level considerations are crucial in enabling people to live in closer alignment with the Seven Pillars of Lifestyle Medicine by transforming individual responsibility into achievable opportunity.
Integrated healthcare systems that empower self-management
Contemporary MSK care is increasingly supportive of preventive approaches that are enabling and co-creating, moving away from dependency-oriented models. Health systems can promote self-management and resilience by:
- Providing timely access to evidence based MSK guidance.
- Delivering consistent clinical messages that build confidence in movement and recovery.
- Integrating services so that people receive coherent, coordinated care.
- Signposting to high quality self-care resources.
- Promoting lifestyle approaches alongside clinical interventions.
- Encouraging active recovery rather than over-reliance on passive treatments.
- Running public awareness campaigns on MSK conditions (such as back care), physical activity and early help-seeking.
- Prioritising physical activity within health policy, including investment in community exercise programmes, exercise referral schemes and collaboration with schools, workplaces and local authorities.
Healthcare systems that align with lifestyle medicine principles can support patients to develop long-term coping strategies and manage existing symptoms that can reduce the likelihood of recurrence.
“People often underestimate how profoundly lifestyle influences their MSK health. The Seven Pillars of Lifestyle Medicine give individuals practical tools to take control of their wellbeing, but they can’t be expected to do it alone. The evidence is clear, if we want to reduce the burden of MSK conditions on patients and health systems, we must embed prevention into every level of public policy, just as ARMA has called for. That means integrating physical activity, workplace health, community design, and early intervention into the everyday fabric of people’s lives."
– Adrian Bradley CEO Arthritis and Musculoskeletal Alliance
The role of chiropractic
A skilled, multi-disciplinary workforce is fundamental to delivering integrated musculoskeletal (MSK) healthcare that empowers prevention and self-management.
Given that MSK conditions account for a significant 30% of all GP appointments, placing immense pressure on the NHS, integrating chiropractic more closely within health and community services is a logical and much needed step.
Alongside GPs, physiotherapists, and other medical professionals, chiropractors can act as accessible front-line practitioners, helping to alleviate pressures on primary care facilities while providing patients with greater choice and more direct routes to the treatments they need. This early intervention is crucial, as chiropractors can utilise early identification of functional changes (such as restricted movement or muscle imbalances) to intervene before issues progress into dysfunction, pain, or disability.
Chiropractic offers significant value across the continuum of care, promoting prevention and long-term resilience through patient education - routinely coaching on important aspects, such as strength, flexibility, posture, movement behaviours, and the 7 Pillars of Lifestyle Medicine. This approach helps individuals make sustainable changes that protect their MSK health. Furthermore, chiropractors contribute meaningfully to secondary and tertiary prevention by supporting early access to evidence-informed MSK care, which helps reduce the recurrence and overall burden of MSK conditions. By minimising time away from work and reducing dependency on medication, chiropractic care can prevent the escalation of minor problems into chronic conditions, ultimately reducing wider system-level pressures and empowering people to remain active and independent.
Despite the fact that chiropractic care is recognised internationally - including within the World Health Organisation’s guidance for lower back pain treatment and as an integral MSK response in countries like the US, Canada, and Denmark - chiropractors in the UK are not included in the Allied Health Profession (AHP) status list, unlike physiotherapy and osteopathy. This exclusion prevents NHS patients from being referred, despite research indicating it could improve patient outcomes and speed of care. Addressing this not only benefits patients but also the national economy: a recent research conducted by the York Health Economics Consortium (YHEC) found that utilising the current additional capacity in the chiropractic sector could see an extra 114,424 people per year, leading to an estimated £400 million per year in productivity gain as people are able to return to work quicker.
Communities that support movement and connection
Neighbourhood design and community infrastructure play an essential role in movement and social connection. Walkable areas, safe cycling routes, accessible green spaces and integrated active travel options promote regular physical activity as part of daily life. Community programmes, social groups and local health initiatives can strengthen social ties, which are an important yet often neglected determinant of long-term adherence to health promoting behaviours.
Public health messaging that builds confidence in movement, addresses unhelpful beliefs about posture or pain, and presents physical activity as normal and safe can reduce fear-based avoidance and support early engagement.
Workplaces designed for wellbeing
Workplaces are a key setting for musculoskeletal (MSK) health, with more than a quarter of workforce sickness absences being related to MSK conditions. Thoughtful workplace design is therefore fundamental in supporting good MSK health by:
- Providing ergonomic and workstation assessments and setup.
- Encouraging varied postures, regular movement breaks, provide movement-friendly policies such as walking meetings and brief stretch breaks, and flexible working arrangements.
- Offering practical workshops on back care, safe lifting and manual handling, posture and movement, and early recognition of MSK symptoms.
- Reducing chronic workplace stressors and making wellbeing resources easily accessible.
- Supporting adequate rest and a sustainable work life balance.
- Providing early access to health and wellbeing services, including mental health support and MSK advice, so that minor symptoms are addressed before they escalate.
These measures are associated with benefits for employees but also for employers, through reductions in sickness absence and gains in productivity. Sickness absences in the workforce have been estimated to be responsible for more than £100 billion of lost productivity in the UK every year and effective MSK health management and prevention could mean a value of productivity gain of an estimated £400 million per year, as people are able to stay at work or return to work quicker.
In summary
Preventing MSK problems requires a collaboration between informed individuals, proactive healthcare professionals, and supportive systems. The Seven Pillars of Lifestyle Medicine provides a practical framework for helping people move more, live well, build resilience and thrive. Chiropractors contribute uniquely to this effort by identifying early functional changes, providing evidence-informed care, and empowering people with education, confidence, and personalised guidance. Their role spans primary, secondary, and tertiary prevention, helping individuals stay active, avoid escalation of symptoms, navigate recovery safely and prevent reoccurrence.
Lasting change also depends on the environments in which people live and work. Communities, workplaces, and healthcare services must be designed to support healthy choices, enable movement, reduce stressors, and provide timely access to MSK expertise. When individuals, clinicians, and systems work together, MSK health becomes a shared goal rather than something people manage alone. The result is healthier communities, reduced healthcare burden, improved productivity, and a more active, thriving population.
References:
- Office for National Statistics (2025) Musculoskeletal health profile: statistical commentary, April 2025. London: ONS. Available at: https://www.gov.uk/government/statistics/musculoskeletal-health-profile-april-2025-update
- Department of Health and Social Care (n.d.) Musculoskeletal health:applying All Our Health. London: DHSC. Available at: https://www.gov.uk/government/publications/musculoskeletal-health-applying-all-our-health
- Public Health England. Musculoskeletal Health: A 5-year strategic framework for prevention across the life course [Internet]. PHE publications gateway, 2019.
- Public Health England (2019) Guidance. Health Matters: Health and Work. Available at https://www.gov.uk/government/publications/health-matters-health-and-work/health-matters-health-and-work
- Cvetanovska, N., Petkovska-Lazova, B., Milenkovska, S., Zafirova-Ivanovska, B., & Angelov, V. (2023). Patients’ perspectives of factors influencing active self-management in neck/chronic low back pain: A qualitative study. Patient Education and Counseling, 106(7), 107808 - https://doi.org/10.1016/j.pec.2023.107808
- NHS England - https://www.england.nhs.uk/elective-care/best-practice-solutions/musculoskeletal/#:~:text=Musculoskeletal%20(MSK)%20conditions%20account%20for,million%20people%20in%20the%20UK
- The Impact of Chiropractors on Workplace Productivity in NHS MSK Pathways - https://chiropractic-uk.co.uk/sites/default/files/2025-03/Chiropractors%20in%20NHS%20MSK%20pathways%20-%20Technical%20Report%20FINAL%20120225.pdf
- ARMA Policy Position “Prevention and MSK health” - https://arma.uk.net/prevention-and-msk-health/