1. From your perspective, what defines the “hidden” nature of the MSK–mental health crisis among young people, and why has it remained under-recognised within healthcare systems?
What makes this crisis “hidden” is that it often sits between what patients feel and what healthcare systems are designed to identify. Young people may present with back, neck or joint pain, but the mental health impact that can accompany persistent MSK problems, such as anxiety or social withdrawal, is far less visible. Pain is usually easy to recognise. The psychological burden behind it is much harder to spot, both for the individual and for the system.
Greater self-management may also be exacerbating the problem. While giving people more control over their health is positive, it can mean underlying mental health challenges are less likely to be picked up through traditional clinical contact. Someone may recognise that their back hurts, but not immediately see that their sleep, stress or mood are being affected in clinically significant ways.
The MSK–mental health crisis has remained under-recognised because healthcare systems still tend to treat MSK and mental health separately, despite clear data showing that depression is 4 times more common among people in persistent pain compared with those without pain. That creates a blind spot, especially for younger adults, whose mental well-being may be shaping their recovery even if they do not seek help for it directly.
2. What does the latest evidence reveal about the bidirectional relationship between long-term MSK conditions and mental health disorders such as anxiety and depression, particularly in younger populations?
Studies consistently show that the relationship between long-term MSK pain and mental health is bidirectional. Persistent MSK pain can increase the risk of later anxiety and depression, while existing mental health difficulties can also increase the likelihood of ongoing pain. In younger people, the relationship appears to be stronger in the direction of pain leading to later mental health problems. A 2024 population-based study found that children and young people presenting with pain had around a threefold higher risk of subsequently developing a mental health condition.
In practical terms, that is not surprising. Persistent MSK pain can disrupt sleep, reduce activity and undermine confidence, all of which can contribute to low mood. For young people already navigating adolescence, education, relationships and social pressure, that impact can be especially acute.
My concern is that this does not end in youth. Research shows that multisite MSK pain in adolescence is associated with greater later use of mental healthcare services and a higher risk of mental health disorders in young adulthood.
So the key takeaway is that long-term MSK conditions and mental health disorders should not be treated as separate issues. They are closely intertwined, especially in younger people, which is why prevention, early intervention and effective rehabilitation are so important.
3. Why do you think younger adults with MSK conditions are disproportionately affected by poor mental health outcomes compared to older cohorts?
One factor may be greater awareness of mental health conditions. Younger adults are often more likely to recognise and articulate poor mental health, so part of what we may be seeing is better visibility and education.
However, younger adults may also be less likely to have established coping strategies or to expect physical limitations as part of daily life. For a younger person, pain can feel more isolating and more out of step with where they believe they should be in life. MSK problems can be especially disruptive earlier in life, and persistent pain at that stage can undermine confidence in a very immediate way.
My view is that it is probably a combination. Younger adults may be more open about mental health difficulties, but they may also experience a sharper sense of disruption when long-term MSK conditions affect everyday life.
4. To what extent do socioeconomic factors and health inequalities amplify the overlap between MSK disorders and mental health challenges?
Socioeconomic factors impact literally every health condition. In MSK and mental health, they don't just impact who is more likely to develop long-term problems, but also who is least likely to get timely support. The prevalence of chronic pain is 36% in the most deprived areas of the UK, compared with 19% in the least deprived areas. Deprivation affects almost every stage of the care pathway, from prevention and early identification, through to access, recovery and long-term outcomes.
Access is also a major part of the health inequality issue. In rural or underserved areas, it can simply be harder to get the right care at the right time, whether that is physiotherapy, pain support or mental health services, due to difficulties in travelling and the low number of services in these areas. The overlap between MSK and mental health challenges is often greatest where more of these barriers intersect.
5. Where are current clinical pathways fundamentally failing patients with co-existing MSK and mental health conditions?
In many cases, it is far easier for someone to present with an MSK complaint than to describe anxiety. There is often less stigma attached to saying “my back hurts” than saying “I’m struggling mentally”. That means the physical symptom becomes the entry point into care, and the wider picture is not always explored. If the care pathway then focuses only on the physical issue in isolation, a big part of the patient’s experience can be missed.
However, we know that the things that help many MSK patients recover, such as moving more and practising exercises grounded in self-awareness, often also have a positive impact on mental wellbeing. In other words, the treatment approaches are often overlapping, even if the services delivering them are not.
7. What role do early intervention and prevention play in addressing both MSK conditions and associated mental health issues?
Early intervention and prevention are critical because they stop MSK problems from becoming longer-term, more disruptive conditions that affect every part of a person’s life. Once pain starts to interfere with sleep, mobility, work or social activity, the risk of a wider psychological impact increases significantly.
That is why timing is so important. If people get support early, before pain becomes persistent or behaviour changes become entrenched, there is a much better chance of preventing both physical deterioration and the mental health effects that can follow. Early intervention can help people stay active and avoid the cycle of inactivity, poorer sleep and increasing distress that so often makes recovery (both mental and physical) that much harder.
8. In your view, how can digital health solutions reshape the management of MSK conditions while also addressing psychological comorbidities?
Digital health solutions can play a really important role by lowering the barrier to entry for people seeking help in the first place, making digital MSK care a valuable front door for both treating pain and addressing some of the factors that also contribute to poorer mental well-being. If someone can access support earlier, more easily and in a way that fits around daily life, there is a better chance of preventing the knock-on effects of persistent pain.
The real opportunity of digital pathways is that they can be designed around the whole patient experience, rather than around traditional service siloes. In practice, that means combining triage, education, exercise, symptom tracking and behaviour change support in a way that reflects how closely MSK and mental wellbeing are linked.
9. What are the limitations of existing digital MSK care models when it comes to integrating mental health support?
One of the main limitations is that many digital MSK models still focus too narrowly on simply “move more”, rather than on what recovery actually means to the person using the service.
While they may be good at prescribing exercises or tracking symptoms, many digital models are less effective at understanding what matters most to the individual patient, and especially where physical and mental health issues may intersect.
That matters because mental health support is rarely just about identifying anxiety or depression in a formal sense. It is also about recognising the psychological impact of not being able to do the things that make life feel normal or meaningful. If a digital pathway is too generic or too focused on movement in isolation, it can miss that wider context.
So the limitation is not necessarily that digital MSK care cannot support mental well-being. It is that many current models are not yet sufficiently person-centred. To do this well, digital care needs to go beyond asking how someone is moving and ask what lifestyle they are trying to return to, what barriers are holding them back, and how support can help rebuild both function and confidence.
12. How can clinicians be better equipped or trained to recognise and manage the psychological dimensions of MSK disorders?
Clinicians need to start from the assumption that the physical and psychological dimensions of MSK conditions are not mutually exclusive, and in many cases, they exist alongside one another from the outset. That mindset shift is important because it moves mental wellbeing from being seen as an optional extra to being part of good MSK care.
In practice, that means training clinicians to look beyond pain location and movement alone, and to feel confident exploring issues such as fear, low mood, sleep disruption, loss of confidence and reduced participation in daily life. Physiotherapists do not need to become mental health specialists, but they do need to be comfortable recognising when psychological factors may be influencing recovery and be able to respond appropriately.
Ultimately, better training is about helping clinicians treat the whole person. If we assume from the start that physical and mental health are interconnected, care becomes more effective.
13. What measurable outcomes or KPIs should healthcare systems prioritise to evaluate success in tackling this dual burden of MSK and mental health?
Success should not be judged only by whether a service delivered an assessment or prescribed an exercise programme, but by whether it helped someone get back to what matters in their life.
That is why the most useful KPIs need to be patient-centric. For one person, success may mean returning to work. For another, it may be sleeping through the night. Systems need room for that variation, because what matters to one patient will not necessarily be the same for another.
Ultimately, the right KPI framework recognises both clinical improvement and personal progress. If we are serious about addressing the dual burden of MSK and mental health, we need to measure success in terms of whether care is helping people live better, not just move better.
14. Looking ahead, what systemic shifts—whether technological, clinical, or cultural—are essential to ensure that young people with MSK conditions no longer fall through the cracks?
Young people with MSK conditions often fall through the cracks because their needs do not fit neatly into traditional service boundaries.
Technology has an important role to play, particularly tools such as AI, which could enable more personalised and responsive care. But this should not mean automation without oversight. It must be grounded in clinical expertise and keep the human firmly in the loop.
Culturally, we need to move beyond the idea that young people are either too healthy to need support or resilient enough to manage alone.
If we want to stop them falling through the cracks, the system has to become more joined up and more responsive to how these conditions are actually experienced.
Footnotes:
- https://www.gov.uk/government/publications/musculoskeletal-health-applying-all-our-health/musculoskeletal-health-applying-all-our-health
- https://www.sciencedirect.com/science/article/pii/S1526590024006187
- https://bmjopen.bmj.com/content/7/2/e012035
- https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2024/chronic-pain
