**2. Epidemiology of Musculoskeletal Conditions and Injuries**

Musculoskeletal conditions continue to increase in incidence and prevalence, especially as the geriatric population grows, and organizations continue to have unremedied ergonomics issues. Musculoskeletal disorders are highly prevalent, yet frequently mismanaged and costly. Musculoskeletal injuries are also a top cost driver for employers, as no other chronic health condition causes more lost workdays and more healthcare spend than musculoskeletal injuries [10]. Musculoskeletal lower back injury is the leading cause of disability both globally and in the U.S., and the number one reason for missing work [11]. In the U.S. alone, musculoskeletal lower back injuries result in more than 260 million lost workdays each year as well as significant healthcare and disability insurance costs [12]. 1 in 2 adults in the U.S. were diagnosed with musculoskeletal conditions in 2012. Despite the high prevalence of musculoskeletal conditions, 80% of patients do not receive evidencebased care [13]. As detailed below, musculoskeletal pain continues to be frequently

mismanaged with opioid analgesics, and unnecessary surgery is frequently performed when physical therapy and rehabilitation would be more appropriate. Medical costs for imaging, diagnosis and treatment of musculoskeletal injuries and conditions continue to rise [14].

Musculoskeletal joint pain has significant impact on patient function and future health. Joint pain reduces physical activity, increases opioid use, impacts productivity, and leads to obesity [15]. Obesity in turn increases the risk for diabetes, heart disease, depression, and cancer [16].

Yet Musculoskeletal pain is frequently mismanaged with opioid analgesics. Even as warnings of an opioid crisis in the US have increased provider and patient awareness of the dangers of opioid analgesics, opioids remain a commonly prescribed treatment for lower back musculoskeletal pain. The dangers of opioid analgesics are well known and include dependence, dangerous side effects including respiratory depression, fatality from drug overdose, and high incidence of concomitant illicit drug use [17]. Moreover, when used to treat new diagnoses of lower back pain, opioid analgesics result in longer recovery times, increased serious adverse events, and greater healthcare utilization (emergency room visits and hospitalizations) compared to non-opioid analgesics [18].

Likewise, patients frequently receive inappropriate surgery for musculoskeletal conditions. Studies have shown that approximately 66% of surgeries are avoidable [19]. Inappropriate surgery for musculoskeletal conditions comes with significant recovery times, lengthening the treatment period, increasing cost of care, and yielding poorer pain and functional outcomes relative to conservative management and physical therapy [20].

Musculoskeletal issues will continue to rise, especially as the geriatric population grows, ergonomic work situations are not well controlled in factories and warehouses, and medical costs for imaging, diagnosis and treatment continue to rise. Studies predict that by 2030, there will be a 500% increase in total knee replacements [21], and a 200% increase in total hip replacements in 45- to 64-year-olds [22]. Likewise, studies project a 28% increase in spine surgeries by 2024 [23].
