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J Athl Train. 2007 Jul-Sep; 42(3): 325–326.
PMCID: PMC1978467

“These Old Bones”—A Growing Public Health Problem

Jennifer M Hootman, PhD, ATC, FACSM

The Bone and Joint Decade (2000–2010) was designated by the United Nations and the World Health Organization to focus attention on the growing worldwide burden of musculoskeletal disease. October 12–20, 2007, is National Action Week for the US Bone and Joint Decade ( and the perfect avenue for increasing the awareness of the public health problem of musculoskeletal disease.

Musculoskeletal conditions make up some of the most common acute and chronic conditions affecting both children and adults and are the leading causes of physical disability and work-related disability in the United States. 1, 2 The numbers affected are alarming for US adults 2–6:

  • Arthritis: 46 million
  • Low back pain: 34 million
  • Neck pain: 9 million
  • Osteoporosis: 10 million
  • Unintentional injury: 15 million emergency department visits
  • Musculoskeletal disorders: 30% of lost work days

The economic costs of these musculoskeletal conditions are staggering, an estimated $240 billion annually, equivalent to approximately 3% of the gross domestic product, equal to a moderate economic recession. 7 Not only is the current burden of musculoskeletal conditions high, but the burden will only increase over the next decades. For example, by 2030, an estimated 67 million US adults will have arthritis, 25 million of whom will have associated activity limitations. 8 Factors that will contribute to this increasing burden and consequences of musculoskeletal conditions include the ongoing “obesity epidemic,” aging of the population, and other social issues (eg, having to work longer before retirement). 9, 10

The Bone and Joint Decade has 4 major aims:

  • To raise awareness of the growing problem of musculoskeletal conditions in society
  • To promote prevention of musculoskeletal conditions through educational campaigns and to empower patients to take a proactive role in preventing and self-managing their disease
  • To advance research on prevention, diagnosis, and treatment of musculoskeletal conditions
  • To improve diagnosis and treatment of musculoskeletal conditions

To achieve these aims, it is important to consider the basic tenets of good general health, which are also critically important for maintaining and enhancing musculoskeletal health:

  1. Maintain a healthy body weight
  2. Engage in regular physical activity
  3. Don't smoke
  4. Protect yourself from injury
  5. See your health care provider regularly

Maintaining a healthy body weight results in less stress on the joints and muscles and reduces the risk of developing musculoskeletal disease. Regular, moderate-intensity physical activity is necessary for normal bone and joint health, and a well-rounded regimen includes aerobic, flexibility, and muscle-strengthening activities. Endorsement of a no-smoking lifestyle not only reduces the risk of many life-threatening diseases (eg, cancer, cardiovascular disease) but may also be linked to lower rates of musculoskeletal conditions such as low back pain and traumatic injury. Engaging in known injury-reducing behaviors (eg, wearing seatbelts) as well as protecting joints from sports and occupational injuries can reduce the risk of musculoskeletal disease. Lastly, it is important to see a health care provider for regular preventive health checkups as well as for consultation at the first signs and symptoms of deteriorating musculoskeletal health. Early identification and appropriate treatment of musculoskeletal conditions can delay disability and premature loss of functional independence.

A multisystems approach may provide the best opportunity to slow the growth of these conditions and to address the needs of future patients with disabling musculoskeletal conditions. The educational system needs to implement curricular programs addressing healthy eating (for weight maintenance) and physical activity promotion across the lifespan. The health care system requires more providers trained in the diagnosis and treatment of the most common musculoskeletal conditions, as well as referral systems for low-cost, accessible, community-based weight loss and exercise programs for the general public. In addition, improving reimbursement for allied health care services and self-management education and other nonpharmacologic interventions may save long-term costs. The public health system should focus on disseminating evidence-based, community-level programs and policy interventions to facilitate healthy behaviors that can affect musculoskeletal health. Lastly, individuals must take a proactive role in their general and musculoskeletal health by following the 5 basic tenets of good health listed previously.

The athletic training community plays a major role in helping achieve the aims of the Bone and Joint Decade. Not only do we provide specialty health care to patients with musculoskeletal conditions but we are also responsible for patient education, injury prevention counseling, and raising community awareness. In addition, the athletic training research community is a major contributor to the scientific knowledge base on prevention, diagnosis, and treatment of musculoskeletal conditions. I encourage all certified athletic trainers to actively participate in promoting National Action Week in their communities. The NATA Web site ( has useful aids, including a media guide, fact sheets, and other resources that can help athletic trainers develop a plan to increase awareness of musculoskeletal conditions in their communities.


Editor's Note: Jennifer M. Hootman, PhD, ATC, FACSM, is an epidemiologist in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. She is also a JAT Section Editor.


  • Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults: United States 1999. MMWR Morb Mort Weekly Rep. 2001;50:120–125.
  • Bureau of Labor Statistics, Nonfatal occupational injuries and illnesses requiring days away from work, 2005. Available at: Accessed June 11, 2007 .
  • Centers for Disease Control and Prevention. State prevalence of self reported doctor-diagnosed arthritis and arthritis-attributable activity limitation—50 states. MMWR Morb Mort Weekly Rep. 2006;55:484–489.
  • Strine TW, Hootman JM. Low back and neck pain: psychological distress, health risk behaviors, and co-morbidities. Arthritis Care Res. 2007;57:656–665.
  • National Osteoporosis Foundation. Disease Facts. Available at: Accessed June 5, 2007 .
  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online] Available at: Accessed June 5, 2007 .
  • Yelin E. Cost of musculoskeletal diseases: impact of work disability and functional decline. J Rheumatol Suppl. December 2003;68:8–11. [PubMed]
  • Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54:226–229. [PubMed]
  • Wang Y, Beydoun MA. The obesity epidemic in the United States: gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28. [PubMed]
  • Dieppe P. The relationships of musculoskeletal disease to age, pain, poverty and behaviour. Rheumatology. 2006;45:249–249.

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association