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Where is the care in healthcare? How health systems are feeding their own negative spiral of cost and disability
  1. Jørgen Jevne
  1. Correspondence to Jørgen Jevne, Private practice, Hønefoss Kiropraktikk og Rehabilitering, Torvgata 2, Hønefoss 3513, Norway; Jorgen{at}

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Musculoskeletal (MSK) pain is a global problem: low back pain, neck pain and osteoarthritis are leading causes for disability worldwide. Exercise therapy has historically been a dark horse in MSK treatment, with pain-medication, injection and surgery representing the elixir of medical management. However, given the questionable evidence for these procedures that are not without risk, one could argue that exercise prescribed within a biopsychosocial framework may be considered a panacea for many diseases including MSK pain.1 ,2 Unfortunately, a major problem with exercise therapy is compliance with long-term strategies demanding time and effort,3 thus potentially paving the way for more invasive alternatives. The reimbursements seen in many modern health systems are largely based on history and tradition, and this dysfunctional funding might actually play an important role in the negative spiral surrounding MSK management. Surprisingly, this is frequently a overlooked factor in the current literature.

How health systems are ‘priming’ patients for expensive and risky treatments

The global burden of MSK disease is a …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.