Written by Unison Risk Advisors
A growing category of complex health conditions is contributing to high-cost claims, alongside established drivers such as cardiovascular disease and cancer.
Musculoskeletal disorders (MSK), conditions that affect muscles, bones, tendons, joints, ligaments, cartilage and spinal disks, have become increasingly common, affecting 127.4 million people in the U.S., research shows.
The prevalence of these disorders has taken a toll on employers. Orthopedics and musculoskeletal conditions were the third leading cost driver in Sun Life’s 2025 annual high-cost claim and injectable drugs trend analysis. Total spending in this category was $1.18 billion for the reporting period.
Musculoskeletal conditions are not only associated with higher healthcare costs but also higher rates of absenteeism and lost productivity, according to the National Library of Medicine. Studies have also demonstrated a strong association between mental health disorders and MSK issues.
As these conditions occur more frequently, organizations should understand their impact on costs and health outcomes. This article will explore the rise in musculoskeletal disorders, as well as strategies employers can use to reduce unnecessary spending in this area.
State of MSK Health
“Wear and tear” injuries account for a substantial portion of claims in the musculoskeletal category. These problems, which include strains, sprains, tears, ruptured disks and degenerative changes, make up almost two-thirds of all MSK-related usage and costs for commercially insured plan members under 65, according to one analysis.
Conditions affecting the back, hip, knee, neck and shoulder are responsible for 80% of usage and costs within the “wear and tear” group. “Wear and tear” injuries are so pervasive that they represent 27% of patient volume across all medical conditions for commercial plans, the analysis says.
Typical working conditions, such as repetitive motions, heavy lifting and sitting for long periods, can also contribute to MSK disorders, according to the National Library of Medicine.
Persistent musculoskeletal pain affects between 40% and 60% of older adults, according to research from the National Library of Medicine. About 75% of people with chronic MSK pain experience it in multiple areas, according to another report. Multisite pain is linked to worse physical function, work ability and mental health.
As the workforce continues to get older, more working people are being affected by these conditions.
Impact of Unnecessary Procedures
The prevalence of MSK disorders in the workplace is not the only factor behind these rising costs. Unnecessary surgeries are also costing the healthcare system millions.
In 2024, the Lown Institute estimated that U.S. hospitals had performed 200,000 unnecessary back surgeries over three years on Medicare beneficiaries, translating to billions in avoidable costs. Another analysis found that 35% of all musculoskeletal surgeries are not evidence-based or necessary and could be prevented.
Unnecessary surgeries are not just a financial burden; they can also negatively affect a patient’s quality of life. For example, a study found that up to 30% of patients who undergo total knee arthroplasty are dissatisfied with the results of the procedure. Plus, surgery comes with its own risks, such as infection or hemorrhage. For some patients, the potential downsides may outweigh the benefits of surgery.
Between the growing prevalence of musculoskeletal conditions and the consequences of unnecessary surgeries, MSK disorders can have a significant impact on employer healthcare costs. One analysis of health claims data found that six percent of people drive 85% of MSK costs.
Organizations can use these considerations to guide their strategies around musculoskeletal health.
Offer high-quality, cost-effective care options, such as advanced primary care. A comprehensive approach to healthcare can help prevent and manage chronic conditions and reduce emergency room visits and hospital stays.
Provide access to digital tools for behavioral health support, chronic condition management and physical therapy. These resources can support members throughout their care journeys and help them avoid unnecessary procedures.
Consider research-based alternatives to surgery. Advanced treatments for common orthopedic surgeries can be cost effective and lessen pain for members. Explore evidence-based treatments before surgery and educate your workforce on the value of such interventions.
Reach out to an Advisor
Our team understands that managing high-cost areas of your health plan requires a tailored approach. We can work to develop a strategy that addresses the specific needs of your employee population.
