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Bone and Joint week:

MSK equality and mental health

The relationship between mental and musculoskeletal (MSK) health outcomes is often under-appreciated. People with MSK conditions not only face physical challenges, such as fatigue, pain, and disability, but also experience negative impacts on mental health, such as social isolation, and increased risk for depression, and anxiety. People who have persistent pain are four times more likely to experience anxiety or a depressive disorder than those without[1]. Depression and mental distress can be risk factors for developing chronic pain and affect an individual’s ability to manage their MSK condition[2].

“Poor MSK health contributes to and exacerbates health inequalities. MSK is fundamental to our ability to work, socialise, move, eat a good diet – in fact, all the things that enable us to stay healthy;” Sue Brown, ARMA[3].

ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain using Exercise) is an evidence-based and cost-effective group rehabilitation programme for people suffering from chronic joint pain. MSK conditions, like joint pain, can affect individuals’ mobility, confidence, and overall quality of life. The ESCAPE-pain programme helps people understand their condition and provides a safe space for participants to foster new relationships, sharing their experiences and reducing feelings of isolation whilst getting back to the physical activities they enjoy.

Supported by Orthopaedic Research UK (ORUK), ESCAPE-pain aims to contribute towards a healthy ageing society, enhancing ORUK’s education and research offering through the ESCAPE-pain facilitator training. Addressing MSK health inequalities and their relationship with mental wellbeing requires multiple approaches. Individuals need positive messaging to be confident taking steps to look after their MSK health within their own community.

Organisations such as ORUK and ESCAPE-pain need to equip health and fitness professionals and researchers with the tools to manage MSK conditions. Developing more community based MSK hubs is an important long-term approach to MSK health. Successful pilots of transforming leisure centres into MSK health hubs play a key role in supporting the health and social care systems by reducing the burden on the NHS by treating people with bone and joint conditions.

Painkillers and surgical intervention are often provided as treatments for long-term bone and joint conditions. However, for those on waiting lists for orthopaedic procedures such as hip replacements, the mental health challenges are exacerbated by the stress of waiting for appointments and isolation caused by reduced mobility[4],[5]. ESCAPE-pain and ORUK want to emphasise how exercise is a safe and effective self-management strategy that helps individuals feel empowered to manage their pain.

Robust evaluation and independent review of the ESCAPE-pain programme has shown it to improve the psychosocial consequences of pain, reduce depression and alleviate fears that exercise may exacerbate joint pain and damage.

Throughout 2024, ESCAPE-pain want to continue spreading the programme into more localities, focusing our efforts on more deprived areas that may not offer access to free self-management programmes. If you’re interested in the programme and would like to see how it could help people suffering from bone and joint conditions in your area, please visit our website, and check out our facilitator training course, or contact us directly at

[1] Lepine, J. and Briley, M. (2004). The epidemiology of pain in depression. Human Psychopharmacology, 19(S1), pp. S3-S7.

[2] Versus Arthritis (2021). Unseen, Unequal and Unfair: Chronic Pain in England

[3] Sue Brown, ARMA

[4] Versus Arthritis (2021). We are calling for more support for those waiting for joint replacement surgery.

[5] Lepine, J. and Briley, M. (2004). The epidemiology of pain in depression. Human Psychopharmacology, 19(S1), pp. S3-S7.