Musculoskeletal (MSK) injuries are so common that they have become almost invisible in discussions about healthcare spending. Yet for self-insured employers and other plan sponsors, MSK conditions consistently rank among the top cost drivers, often representing 20–30% of total health plan spend. What makes this especially troubling is that the majority of these expenses stem from injuries and conditions that are low acuity and, in many cases, would resolve on their own with appropriate early guidance.
In orthopedics, roughly 80% of the issues we see are not catastrophic fractures or complex surgical cases. They are twisted ankles, sore backs, minor knee injuries, and overuse strains. These are everyday occurrences. The problem is not their frequency; it is the pathway patients take immediately after the injury. That pathway frequently determines both cost and outcome.
I often refer to this critical moment as the “white space” of MSK care – the period right after an injury occurs, when a person asks two simple questions: What’s wrong? and What should I do? If individuals lack timely access to knowledgeable clinical advice, they are left to triage themselves. Understandably, many default to the emergency room or urgent care because it feels safe and definitive. Unfortunately, this decision can set off a chain of unnecessary interventions.
Consider the common ankle sprain. Data analyses, including work we’ve done with large employee populations, show millions of dollars spent annually on ankle injuries that are largely self-limiting. If a person can walk on the ankle and there is no significant bone tenderness, the likelihood of a clinically meaningful fracture is low. In many of these cases, rest, ice, compression, and elevation, along with a brace, are sufficient. Yet without early guidance, patients often spend hours in an ER, undergo imaging they may not need, and incur substantial direct and indirect costs, including time away from work.
Back pain offers another instructive example. When someone with acute lower back pain goes straight to the emergency room, the probability of advanced imaging increases. MRI scans in adults over 40 frequently reveal incidental findings – bulging discs or minor degenerative changes – that may not correlate with symptoms. Once these findings are documented, referrals and procedures can follow, sometimes culminating in surgeries that evidence suggests are unnecessary. A low-acuity condition has now escalated into a high-cost, high-risk scenario.
Primary care physicians ideally serve as the quarterbacks of patient care, but access challenges and time constraints often limit their ability to provide immediate consultation. Years ago, informal “curbside consults” between primary care doctors and specialists were commonplace. Those spontaneous professional interactions have largely disappeared, leaving patients with fewer easy avenues for rapid, informed advice.
The solution is not to discourage appropriate emergency care or specialist involvement. Rather, it is to ensure that individuals have access to expert triage at the moment of injury – triage before the triage. When patients receive prompt, credible guidance, they are more likely to follow a high-value pathway that improves outcomes while reducing unnecessary spending. Just as importantly, they feel supported and reassured rather than anxious and alone.
This is precisely the gap that Upswing Health is looking to address. By providing rapid access to athletic trainers – often within minutes – and orthopedic specialists within 24 hours, they help members navigate that critical white space with confidence. Instead of defaulting to the emergency room, individuals receive informed direction at the right time, leading to better clinical decisions, higher satisfaction, and more responsible stewardship of healthcare dollars.
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