By Anthony Ghosh, MD FRCSMR
Back and neck pain are often framed as inevitable features of modern life, an individual inconvenience rather than a collective challenge. Yet new evidence shows that spinal health has become one of the UK’s most significant, yet under-recognised, public-sector issues. Affecting nearly one in five adults, spine-related musculoskeletal (MSK) conditions are now a major driver of NHS demand, workforce inactivity and widening health inequalities. The scale and persistence of this burden demand a coordinated response from government, healthcare systems, employers and local authorities alike.
Musculoskeletal conditions remain among the most prevalent long-term health problems in England, with back and neck pain the leading contributors. Spine-related conditions account for up to 30 per cent of GP consultations, placing sustained pressure on already stretched primary care services. The economic consequences are equally stark. More than 30 million working days are lost each year due to MSK problems. At the same time, work-related MSK disorders alone affect over half a million workers annually, resulting in millions of lost working days.
Crucially, this is not a short-term or self-correcting problem. Since 2019, the number of people economically inactive due to long-term sickness has risen sharply, with back and neck pain consistently cited among the leading causes. Once individuals leave the labour market because of chronic spinal pain, return rates are low without coordinated clinical and occupational support. This creates a cycle of reduced participation, lower productivity and increased welfare dependency.
Spine health underpins almost every aspect of daily life, from mobility and independence to work, caring responsibilities, and social participation. When spinal function declines, people reduce movement to avoid pain. Over time, this leads to muscle deconditioning, greater instability and heightened pain sensitivity, a vicious cycle that drives chronic disability.
For the public sector, the implications are profound. In healthcare, delayed access to physiotherapy and rehabilitation increases chronicity, repeat GP appointments and demand for imaging and pain management services. In employment, spinal pain fuels both absenteeism and presenteeism, with productivity losses often exceeding those caused by sickness absence alone. In social care, loss of mobility and independence among older adults increases reliance on formal and informal care networks.
Viewed through this lens, spinal health is not simply an orthopaedic issue; it is a determinant of national capability and economic resilience.
The rise in spinal disorders reflects significant changes in how people live and work. Sedentary behaviour has emerged as a major, modifiable risk factor. Evidence now shows that spending more than six hours a day sitting increases the risk of developing chronic back pain by around a third. Prolonged sedentary leisure time, particularly television viewing, is causally linked with disc degeneration, sciatica and cervical spine disorders.
Hybrid and home working have increased these risks, as, they have reduced incidental movement, such as commuting and walking between meetings. Many home workspaces lack ergonomic design, and long periods of uninterrupted sitting have become normal. Importantly, research suggests that it is not posture alone that causes harm, but prolonged immobility. Regular movement and posture change are far more protective than striving for a single “correct” sitting position.
For policymakers, this has clear implications. Sedentary behaviour is not merely a lifestyle choice; it is embedded in transport systems, workplace norms and digital design. Treating it as a population-wide prevention issue, on a par with smoking or poor diet, represents a major opportunity to reduce future spinal pain and disability.
The UK’s ageing population adds another layer of urgency. Millions of people are living with osteoporosis, leading to hundreds of thousands of fragility fractures each year. A substantial proportion are vertebral fractures, many of which go undiagnosed and are misattributed to “ordinary” back pain.
These fractures are far from benign. They cause chronic pain, loss of height, spinal deformity and reduced independence, and they significantly increase the risk of further fractures. For employers, fragility fractures among working-age adults already cost tens of millions of pounds annually in sickness absence, a figure set to rise as the workforce ages.
From a public-sector perspective, the universal implementation of Fracture Liaison Services (FLS) and proactive vertebral fracture assessment are among the most cost-effective interventions available. Where FLS models are fully operational, re-fracture rates fall, and long-term care costs are reduced. Yet coverage remains inconsistent across the UK.
Spinal pain does not affect all groups equally. Women consistently report higher rates of chronic back and neck pain than men, reflecting a combination of biological factors, occupational exposure and unpaid caring responsibilities. Socioeconomic deprivation is an even stronger predictor. People living in the most deprived areas are more than twice as likely to report long-term MSK pain as those in the least deprived areas.
These inequalities are reinforced by differences in work conditions, access to early intervention and the built environment. Manual and care-related occupations carry higher physical demands and fewer workplace adjustments, whilst communities with limited green space, public transport infrastructure and affordable exercise facilities provide fewer opportunities for protective movement.
For local authorities and integrated care systems, this underscores the need for place-based strategies that link health improvement with urban planning, transport and employment policy.
The evidence points to a clear conclusion – the UK’s spine-health burden is not inevitable, but it will continue to grow without coordinated action. Three priorities stand out.
First, sedentary behaviour must be included within national prevention frameworks. Clear public messaging, such as encouraging people to stand and move every 30 to 45 minutes, should be reinforced by workplace standards, media campaigns and active travel policies.
Second, community MSK services must be treated as core prevention infrastructure. Early exercise-led intervention reduces chronic pain, and long-term work absence. Scaling up first-contact MSK
practitioners in primary care and shortening waits for physiotherapy would deliver both health and economic benefits.
Third, bone health must be a priority through universal FLS coverage and systematic screening for vertebral fractures. As the population ages, preventing spinal fragility will be central to maintaining independence and controlling future care costs.
Spine health offers a powerful lens through which to view the UK’s broader health and productivity challenges. It sits at the intersection of ageing, work, inequality, mental health and physical inactivity. Improving it does not require high-tech solutions, but consistent, evidence-based policy that makes movement easier, intervention earlier and prevention universal.
For the government and the public sector, the message is clear. Protecting spinal health is not simply about reducing pain; it is about safeguarding the nation’s capacity to work, care and thrive. A healthier spine is the backbone of a healthier, more resilient UK.
A link to the full report can be found here: www.spinemdt.com/conditions-treated/rising-spine-health-burden.php
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