Prevention is better than cure: SEM in the prevention of musculoskeletal injury

Guest Blog by Dr Sarah Davies

Sport and Exercise Medicine: The UK trainee perspective (A monthly series on the BJSM blog)

“The function of protecting and developing health must rank even above that of restoring it when it is impaired.” Hippocrates

It’s that time of year when the ghosts of Christmas past, present and future are looming, but the present fiscal climate brings little promise to the future legacy of the Olympics that we’re all hoping for, in terms of healthcare benefit.

Musculoskeletal conditions are the most common cause of chronic pain and disability.1 The prevalence of many of these increases with age and many are affected by lifestyle factors, such as obesity and physical inactivity. Increasing numbers of older people and changes in lifestyle means that the problem is set to spiral out of control in the UK.

Last week, my father turned 71. Having swam all his life, in the last 6 months he has swapped the pool for the gym in order to avoid waterlogging his new hearing aids. He has studied the theory of what, when, where and how much he should be doing in the gym (alongside chats to said SEM daughter) but he is missing the physical awareness of specific muscle groups when carrying it out.

Despite his programme at the gym, my father remains posturally challenged in a computer-hunched sort of a way, attacking the rowing machine with all the vigour of a bull in a china shop.  Suffice to say, I’m somewhat alarmed that it may be only be a matter of time before this over-enthusiasm tears his rotator cuff apart at the seams.

In today’s bleak economic landscape, employers cannot afford to treat illness rather than prevent it. If we want to improve both quality and cost-benefit of health care in this country – if we truly believe that SEM can make a difference – we must use the power of prevention.

We know the leading causes of death in our society – Hypertension, smoking, obesity, and physical inactivity – but what about the causes of preventable musculoskeletal injury and the consequent preventable pain and preventable inactivity?

This week, whilst working with the GB B1 football squad on their training camp, I noted that once a person has learned certain postural habits that are associated with being blind, they are very difficult to shake off. In contrast, if these children develop awareness at an early age, they are able to learn better physical awareness and counteract these habits.

The fact is, learning a new physical skill, especially the more ingrained the old behaviour patterns, requires repeated feedback to instil new habits.2

With SEM doctors at the interface of primary care, we are well placed in the community to identify potential musculoskeletal pathology and advise individuals how to prevent this from occurring.

It is in the prevention of illness that SEM can make a difference to the healthcare economy. SEM has the edge in diagnosing and managing musculoskeletal injuries, but SEM clout also lies in assisting the well to stay well.

Wishing you a Happy Christmas and a Healthy New Year.


1. Woolf AD, Akesson K. Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. BMJ 2001;322:1079-80.

2. Nilsen PBourne MVerplanken B. Accounting for the role of habit in behavioural strategies for injury prevention. Int J Inj Contr Saf Promot. 2008 Mar;15(1):33-40.

Related Article

Dvořák, J. Give Hippocrates a jersey: promoting health through football/sport. BJSM 2009;43:317-322 Published Online First: 22 March 2009


Dr Sarah Davies is an ST6 Sport and Exercise Medicine Registrar in the London Deanery, currently on a Rehabilitation and Complex Trauma placement at Headley Court Military Hospital. She also covers disability football for the FA and holds an honorary research fellow post at CXH, where she is looking into causes of pain in patients with hypermobility syndrome.

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