Therapeutic exercise for prevention, treatment and rehabilitation of musculoskeletal pain and function.

Musculoskeletal pain and impaired function present the most common chronic health disorders. They are a huge burden on society affecting the economy as well as having serious consequences for quality of life at the individual level. Musculoskeletal disorders are one of the largest work related problems. They interfere with both activities of daily living and work ability, and constitute large expense in relation to sickness absence and productivity. Musculoskeletal pain and impaired function are, in the main, non-specific and fluctuating but, if left untreated, may develop into chronic conditions. In the health care system, impaired musculoskeletal health should be subject to screening for risk factors, prevention oriented interventions, ongoing monitoring and comprehensive care models as occurs with other chronic lifestyle diseases. Therapeutic exercise should be a safe first choice of early prevention of recurrence and treatment. This is a preferred position to the attitude, that nothing can be done until the pain or function is reaching a level where an implant and reconstructive surgery procedure is justified. In the past few decades, physical exercise, from a public health perspective, has been shown to be beneficial for prevention, treatment and rehabilitation of a number of lifestyle diseases, such as obesity, cardiovascular diseases, metabolic syndrome and diabetes. In contrast, the role of therapeutic exercise as an efficient way to prevent and treat musculoskeletal disorders has, until recently, attractedmuch less attention. Nevertheless, using therapeutic exercise to preservemusculoskeletal healthmay potentially have a double effect. Apart from the direct beneficial effect on pain and function, preserved musculoskeletal health is crucial for the ability of individuals of all ages to perform the levels of physical activity needed to maintain cardiovascular health, and prevent life style diseases by pursuing the recommended physical activity level. With increasing age, musculoskeletal disorders such as arthritis, frequently co-occur with other adverse health conditions. Therefore the adverse health effects of musculoskeletal disorders and contributions to health costs, are amplified if they hamper an ability to maintain physical activity levels. Therapeutic exercise can play a role in musculoskeletal health in at least three different ways, 1) as prevention of occurrence/recurrence of new episodes of musculoskeletal disorders 2) as recovery to return an injured patient to a fully functioning, pain-free state or 3) as treatment to maintain current function and prevent further deterioration or impairment. Therapeutic exercise refers to a wide