TalkBack, issue 1 | 2016 (BackCare)

■ NEWS ■ EVENTS ■ COMMUNITY ISSUE 1 n 2016

Quarterly magazine of BackCare, the UK’s National Back Pain Association

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FREE TO MEMBERS

Pain in orbit

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On the move

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Astronauts suffer, too

Standing tall

Motion is lotion

Active working

www.backcare.org.uk

2 TALKBACK NEWS

BackCare Events Calendar 2016 London Marathon 24 APRIL

Come and cheer on the BackCare Runners in the London Marathon. If you want to come and say hello to the BackCare Team, we will be at Mile 16.

Rheumatology 2016 conference 26-28 APRIL

Glasgow Exhibition and Conference Centre. Further details can be found at: www.rheumatology.org.uk/events

On your feet Britain 29 APRIL

Take part in our national day when workers across Britain unite together and participate in a variety of fun and simple activities to #SitLess and #MoveMore at work. More information at www.getbritainstanding.org

British Institute of Musculoskeletal Medicine – Spring Symposium 14 MAY

“The Loughborough Connection” at Burleigh Court Hotel, Loughborough Seminars and workshops from world leaders and local experts in musculoskeletal medicine. More information at www.bimm.org.uk/symposia

15th International Philip Zorab Symposium 15-16 JUNE

The leading basic science scoliosis conference in the world, at the Royal College of Surgeons of Edinburgh. World renowned speakers and gala dinner. More information at www.bsrf.co.uk/events

Councils invest in The Carer’s Guide

www.backcare.org/carers TALKBACK l ISSUE 1 2016

TALKBACK WELCOME 3

Welcome Welcome to our first TalkBack of 2016.

As I write this, it feels as if the dark days of winter are finally over and spring is here. The magnolia in my garden is starting to flower and I can hear the birds singing their dawn chorus every morning.

Since our last TalkBack, there have been a number of changes at BackCare. Stuart Blackman, our Chief Executive, and Dr Adam Al Kashi, our Head of Research, have now left. They have worked hard, reviving our website, introducing Active Working and promoting the Carer’s Guide.

Our incredible London Marathon Team are now hard at work, training for the race. We have highlighted some of our runners in this edition, including Andy Earp, who is running an incredible three marathons in one month.

Well done to Mary Burstow for spotting the story on research being done on back pain and space travel. When you consider the forces the body is put under during space flight and while living in zero gravity, it is hardly surprising that more than 60% of astronauts have reported a problem.

We continue our series of practical advice from Yoga for Healthy Lower Backs and the Society for the Teachers of the Alexander Technique on pages 6 and 7 – two of the best evidenced approaches

Contents

for reducing the frequency and severity of back pain. Gavin Bradley writes for us on Get Britain Standing, a campaign to reduce sitting time and encourage more active work in the office. BackCare adopted this approach in June 2015 and has seen a marked improvement in staff wellbeing and productivity.

As always, we welcome contributions from our members – whether you have back pain or treat people with back pain, if you can inform and inspire others, we’d like to hear from you. Just drop me an email at talkback@backcare.org.uk or send us a letter to the usual address.

So I hope you enjoy this issue and I’ll see you in the next!

Dr Brian Hammond Executive Chair of BackCare

We welcome articles from readers, but reserve the right to edit submissions.

Paid advertisements do not necessarily reflect the views of BackCare. Products and services advertised in TalkBack may not be recommended by BackCare. Please make your own judgement about whether a product or service can help you. Where appropriate, consult your doctor. Any complaints about advertisements should be sent to the Executive Chair.

All information in the magazine was believed to be correct at the time of going to press. BackCare cannot be responsible for errors or omissions. No part of this printed publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the copyright holder, BackCare. ©BackCare

On your bike

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Back pain in space

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Active rest

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Top exercise tips

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BackCare 16 Elmtree Road, Teddington, Middlesex TW11 8ST Tel: +44 (0)20 8977 5474 Fax: +44 (0)20 8943 5318 Helpline: +44 (0)845 130 2704 Email: info@backcare.org.uk Website: www.BackCare.org.uk Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751.

TalkBack is designed by Pages Creative www.pagescreative.co.uk and printed

by Severn, Gloucester.

Motion is lotion

12-13

Standing at work

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4 TALKBACK NEWS

Cyclists on the ride in 2015

Expert answers For the first time, the British Society for Rheumatology (BSR) will be holding a oneday event on Tuesday 26 April for patients.

It runs alongside the BSR rheumatology conference at the Scottish Exhibition and Conference Centre, Glasgow and gives you, the patient, an opportunity to hear from world-class experts.

The event aims to be interactive with question-and-answer sessions with physicians and healthcare professionals, supported

by NRAS, NASS and Arthritis Care. You will learn the latest information on medication and new treatments that can improve your quality of life. You can book your place at www. rheumatology.org.uk/ events

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Get in the saddle!

Do you fancy entering the Prudential Ride London Surrey 100 for BackCare?

The race is on Sunday 31 July and we have five allotted places.

This physically challenging bike ride starts at Queen Elizabeth Olympic Park in east London, going through London before crossing the River Thames and heading out into the beautiful Surrey countryside.

Riders explore the Greensand Hills, climbing one of south east England’s highest hills: Leith Hill. After a well-earned descent towards Dorking, it’s on to the next challenge: the world-famous zigzags of Box Hill.

The race heads back into London following the Embankment all the way alongside the Thames, heading past some of London’s famous landmarks as it makes its way across Parliament Square and up Whitehall. The route then swings left at Trafalgar Square, with riders streaming under Admiralty Arch and a spectacular finish on The Mall.

On your feet for a healthier way of life Friday 29 April is “On Your Feet Britain” day, an annual workplace awareness event in partnership with the British Heart Foundation.

Nearly 1,000 companies have already signed up and it is expected that more than 500,000 office workers will be joining in on the day.

The On Your Feet Britain Challenge dares you to take James Brown at his word and convert “sitting time” to “standing time”. Follow some simple changes – it’s easier than you think: l Stand during phone calls l Use the stairs

l Stand and take a break from your computer every 30 minutes l Have standing or walking meetings l Eat your lunch away from your desk l Walk to your colleague’s desk instead of phoning or emailing them l Stand at the back of the room during presentations n For more info visit: www.getbritainstanding.org, www.activeworking.com or contact info@activeworking.com

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NASA conducts space flight research into back pain NASA is conducting research into the risk of intervertebral disc damage from prolonged space flight.

Crew members on the International Space Station are working with the University of California on a series of before and after tests.

The tests will allow doctors to determine how the discs change and whether this correlates to the pain those crew members experience. Lower back pain is 68% more prevalent in space than on Earth.

Crew members have also reported problems when they return to Earth.

Physicians believe this is related to changes in the astronauts’ intervertebral discs – these create a cushion between vertebrae in a person’s spine and changes to their shape and size can affect the spinal column and back.

Applications on space missions Astronauts report back pain during long-duration microgravity missions and experience an increased likelihood of back injuries, such as herniated discs, after return to Earth.

Magnetic resonance imaging, X-rays, bending exercises and strength tests before and after space flight can help identify the suite of changes that can take place in space. Understanding how microgravity changes the structures of a person’s back could help physicians develop exercises or therapies to prevent injury and pain on long-duration space missions, as well as after astronauts return home.

Mission specialists Stephanie Wilson of NASA, Naoko Yamazaki of JAXA, Dorothy Metcalf-Lindenburger of NASA and Expedition 23 flight engineer Tracy Caldwell Dyson work at the robotics workstation on the ISS. Image courtesy of NASA, 2010

Applications to back pain sufferers on Earth People with limited mobility, including patients on bed rest or with spinal cord injuries, experience some of the same spinal changes as those seen in microgravity.

Understanding the origin of spine degeneration in space is expected to aid doctors on Earth to diagnose and treat spine disorders related to inactivity and, conversely, overloading. The study could also have implications for people with curved-spine disorders such as scoliosis, and for children and soldiers who carry heavy backpacks.

Online list of professionals is growing BackCare’s listing of back pain professionals is steadily growing. We now have more than 1,000 Alexander Technique teachers and 100 evidence based Yoga therapists on our online practitioner search.

The partnership is part of a new approach which aims to create the first complete multidisciplinary listing of back pain professionals in the UK. We are in talks with other major professional bodies that register healthcare professionals who treat back pain and will keep you posted.

Principal investigator Alan R Hargens, PhD, University of California San Diego, San Diego, CA, United States www.nasa.gov/mission_pages/station/ research/experiments/856.html

The International Space Station Image courtesy of NASA

Staff benefits In January, BackCare’s Stuart Blackman spoke at the second Active Working Summit on how making BackCare a sit stand charity had resulted in a significant improvement in staff wellbeing and productivity. The event attracted delegates from 10 European countries.

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6 TALKBACK SELF HELP

Yoga for healthy lower backs

Relax: give in and surrender to your innermost calm Savasana Relaxing body and mind, while calming the emotions, is a wonderful yoga technique.

It is essential groundwork for allowing you to feel comfortable more often.

Remember – do not do anything that does not feel 100% comfortable. It is not what you do, but the way that you do it that is important.

You are responsible for your own actions. This yoga should be gentle, easy, brief, comfortable and pain-free.

This article is mainly taken from a Lotus Publishing book, Yoga for Healthy Lower Backs, written by Alison Trewhela & Anna Semlyen. The book was written as a manual used in The University of York Department of Health Sciences randomised controlled trial funded

by Arthritis Research UK to accompany a successful 12-week specialised, gentle yoga

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Photo:© www.STAT.org.uk

How to perform the pose: Sit on the floor with knees bent and hands behind you.

Gently lie back down on to the floor, placing a book or folded blanket under your head and neck. Close your eyes. With your hands on the abdomen to observe that the pelvis and abdomen do not get disturbed, straighten your legs, with a pillow under your knees. You may benefit from having legs bent, possibly up on a chair.

Close your eyes and stay for 5-20 minutes, observing some of the following to keep the mind steady and focused.

programme. It was shown to be cost-effective for the NHS and the workplace (70% reduction in workplace absenteeism).

The Yoga for Healthy Lower Backs Institute trains experienced yoga teachers in individualised back care and how to deliver this best practice, evidence-based course that teaches long-term self-management skills. More information: yogaforbacks.co.uk

Observations: l Allow the legs to relax from feet to hips l Have a feeling of spreading as muscles relax l Allow the bones to sink l Relax the arms from fingertips to shoulders l Relax the sides of the trunk from side hips to armpits l Sink the navel on exhalations l Relax the front ribs l Relax the shoulders, allowing them to sink into the floor l Relax the upper and middle back l Relax the back of the waist, lower back and pelvis l Relax the neck l Relax the back of the head and the top of the head l Relax the forehead l Soften the eyelids l Soften the cheeks l Soften the lips l Relax the jaw l Sink the eyes into their sockets and turn them down towards the centre of the chest l Breathe softly, smoothly and steadily l Keep the mind in check by clearing it with your steady exhalations l Note and enjoy the comfort, joy and positivity of this moment and allow that to spread l Do not stay, if uncomfortable.

To exit pose: Take some steady, deep breaths to re-energise. Slowly bend one leg at a time to place feet on the floor. On an exhalation and without twisting, gently roll completely on to your right side and rest for a few breaths.

When you feel ready to come up, do not use your back muscles, but facing towards the floor, use your arms to bring you up to a sitting position on an exhalation.

Slowly, and perhaps using a piece of furniture for support, come up off the floor, without rushing, making the effort on the exhalation. Inhale once upright and breathe normally.

Benefits: l Relieves pain l Relaxes the physical body l Brings stability/equilibrium to the emotions l Increases mental clarity and productivity l Enhances energy levels l Reduces stress l Relieves anxiety l Allows homeostasis of the body l Creates positive mood l WONDER POSE – one of the best tools you will ever have!

So practice to improve.

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Learning the Alexander Technique has been shown by randomised controlled clinical trial to have long-term benefits for people with chronic and recurrent back pain. Researcher and teacher of the Alexander Technique, Lesley Glover shows that while learning it involves one-to-one lessons, there are many tips we can take away and explore by ourselves.

There’s more to rest than lying about on the floor Making rest active

In the last issue I introduced the idea of lying down as active rest. This time I want to say more about what it is that makes rest active.

To recap, the idea is to lie on the floor with your knees bent and your head on books to keep your head, neck and back in alignment. I suggested you begin by “arriving” on the floor then pausing for a moment and allowing yourself to take in where you are and to acknowledge that for the next few minutes you can stay here and just be present. Following this, I suggested noticing the support from the floor and inviting yourself to release into that support.

The next step on from here is to notice parts of your body in turn and to invite ease and release in those parts. This is a gentle invitation to yourself, not a trying to release or making an effort to let go.

Start by inviting your neck to be free; often we hold a lot of tension in our necks but lying in this position with a supported head, your neck can release and do nothing. Next, bring your attention to one arm and have the thought that there can be space and ease in your shoulder joint, in your elbow and in your wrist joint, then invite your fingers to lengthen. Repeat this with the other arm. Then, again, invite your neck to be free. You do not need to do anything, just notice and invite. Have your eyes open and be aware of the room around you as you do this. If you notice that you are holding your breath then blow gently for a breath or two.

Next, move onto your legs, one leg at a time, invite space and ease in your hip joints, your knee joints and ankle joints,

Photo:© www.STAT.org.uk

invite lengthening in your feet. Once more, invite your neck to be free. If you find your mind wandering at any point in the process (which it almost certainly will) then gently bring your attention back to yourself and to your awareness of the room around you and carry on where you left off.

When you have finished, roll to the side and get up slowly. When you are standing, pause for a moment and notice your surroundings and what, if any, changes you

may have experienced. It can take time for things to change and it can be hard to release long-held tension, so don’t be put off if it is difficult or if things don’t seem to be different straightaway.

Adding this awareness of your body and inviting release changes lying down from a passive activity to an active one. Thinking rather than doing can change things significantly.

Lesley Glover www.lesley-glover.co.uk

Approach to improve health and wellbeing The Alexander Technique is a self-management approach which offers people of any age or ability a way to improve their health and wellbeing. It can be applied in all situations in everyday life and can lead to better balance, co-ordination and freedom of movement. It can increase confidence, self-awareness and provide greater control over your actions. It is widely used to reduce pain as well as to improve performance in sport, music and drama, public speaking and interview technique. Find out more at www.alexandertechnique.co.uk

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8 TALKBACK SOCIAL MEDIA

Mary Burstow’s social media round up This time, I thought it would be good to take you on a whirlwind tour of some of my favourite Twitter sites.

Some are health related, others not.

Mary Burstow

I am really pleased about what our local secondary school, Turing House School, is doing to promote good health Turing House School @turinghouse February 26 Super assembly today from Mr St. John-Smith on body awareness. @TherealBackCare

I am a big fan of the work of Roy Lilley and the Academy of Fab NHS Stuff. It is always good to hear what NHS Trusts are doing and to spread the word.

AcademyOfFabNHSStuff @FabNHSStuff March 15 Care Navigation #vanguards365 http://wp.me/p5H5EW-1pS ensuring pts get the right care when they need it @RoyLilley

Does eating chocolate really make you smarter? I saw the headline in more than one national paper. NHS Choices debunked this story.

NHS Choices @NHSChoices March 9 Catch the headlines that chocolate makes you smarter? #BehindTheHeadlines takes another look http://ow.ly/Zgnfa

It is good to see more organisations joining the Active Working movement StepJockey @StepJockey March 6 The links between sitting, exercise and cancer, a great paper from @NCIEpi – http://ow.ly/Z4XCw

And finally a lesson in mindfulness from a pug Cute Pics Of Pugs @CutePicsOfPugs March 11 Sometimes, the best lessons come from our beloved critters.

We are @TherealBackCare TALKBACK l ISSUE 1 2016

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Top 10 tips to stick to your exercise plan NICK SINFIELD is a chartered physiotherapist, BackCare’s Clinical Advisor and Clinical Director for Spring Active.

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Really commit to the belief that your body needs movement to be healthy. Don’t let fear hold you back. Give your mind a rest and get your body moving.

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Make the active choice. In general, when you’re faced with the choice of moving more or moving less, move more. For example, if you approach an escalator alongside a staircase, choose the stairs. Change the mindset from trying to expend as little energy as possible and adopt a “pro-active attitude” that eagerly looks for opportunities to move. Park in the farthest spot or walk to the store, arrange a walking meeting, stand up and stretch when on the phone.

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Understand the importance of resilience and having a can-do attitude.

If you believe in yourself and in your ability to achieve your goals, you are more likely to succeed.

Don’t give your back an excuse to grumble so avoid sitting for prolonged periods. Whenever you must sit for an extended length of time, take regular breaks, stretch, and walk around.

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Doing something is better than doing nothing. Many people think that unless they have at least 30 minutes to exercise, it’s not worth it. This isn’t true!

Whether it’s five minutes of cycling, three minutes of stretching, two minutes of walking, or even 30 seconds of stretching and a few deep breaths, moving around will benefit your mood and your health.

As you begin the exercises, aim to connect to your body mentally. When you stretch a muscle, concentrate on the sensation this creates within that muscle.

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Schedule exercise into your weekly routine. Make a commitment and stick to it.

To help, enlist an exercise buddy, whether human or canine. Why not try a local exercise class? People who exercise with a partner are more likely to stick with their programme.

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While it’s important to keep moving, it’s equally crucial to strike a healthy balance between exercise and rest, especially when you’re just beginning. How much is too much varies widely, depending on your health status and fitness level. Generally speaking, a modest amount of movement daily is better than knocking yourself out with a big bout of exercise once a week. Ease into it gradually and when starting to exercise, it may make your back sore – it is important to be aware of this. But this is similar to moving and exercising after an ankle sprain.

Be patient. We all get frustrated at not progressing faster at one time or another. Give your body the chance over the long term to reach your goals.

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Be realistic.

You may not achieve a 100% painfree life. But you will achieve substantially less pain during your daily activities if you stick to your exercise programme.

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10 TALKBACK ADVERTORIAL

Who else needs chronic Chronic pain is one of the most challenging and difficult conditions people face treating safely and effectively. There is now a new safe pain therapy device that is economical and effective for many individuals suffering with chronic back pain for many years.

Pain itself often modifies the way the central nervous system works so that a person actually becomes more sensitive and gets more pain with less provocation.

That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular – the brain and the spinal cord. It’s well understood that the

extent of tissue injury does not explain the level of pain, and chronic pain can be maintained even after an initial injury has healed. ActiPatch’s neuro stimulation continuously disrupts this signal to allow a good night’s sleep and restores daily activities.

The Pain Management publication published a Registry Study of 5,000+ using an ActiPatch 7-Day trial device report a baseline VAS pain score of 8+ of which 2/3 had more than 57% pain relief. This reflects that many individuals respond poorly to drug therapies.

ACTIPATCH LONG-TERM USE: ● 2/3 (including opioid users) reported moderate to complete elimination of pain medications ● 2/3 reported improved sleep ● 3/4 increased physical activity ● 4/5 experienced a substantial improvement in overall quality of life.

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pain relief?

This data demonstrates that ActiPatch has a higher response rate and is much more effective than common chronic pain drugs and other therapies for chronic back pain.

ActiPatch is drug-free, and unlike medications, there are no adverse effects.

It is safe for people with diabetes, the elderly, and those with heart and lung disease.

ActiPatch can be used safely 24 hours a day for extended pain relief.

ActiPatch long-lasting pain relief has been proven to help people get a good night’s rest. It’s the new pain reliever that lets you be your best!

ActiPatch is now available at Lloyds Pharmacy, Boots, Superdrug and Gordons Chemist stores and costs only £24.99 for 720 hours of treatment.

ABOUT THE AUTHOR Ian Rawe is the Director of Clinical Research at BioElectronics Corporation, the manufacturer of ActiPatch® Therapy.

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12 TALKBACK FEATURE

Motion is lotion: the importance P

Mary O’Keeffe

Kieran O’Sullivan

eople are advised from many different quarters about the huge benefits of physical activity for several aspects of physical and mental health. For example, it is now clear that low fitness levels are worse for your health than smoking, diabetes and obesity combined!

However, many people who experience pain are naturally reluctant to take part in exercise, because it can be painful (at least initially). Also, many people with pain fear it may cause them more problems. This is not the case! There is strong scientific evidence that prolonged rest and avoidance of activity for people with persistent pain actually leads to such people becoming even more disabled.

Not only is regular exercise important for a person’s general health, it also helps reduce pain and disability once a person starts gently, progresses the amount they are doing sensibly and sticks with it in the long term.

Which type of exercise?

All types of exercise are beneficial, with no single type clearly being the best at reducing pain or

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improving function. Studies have shown no difference between walking, cycling or pilates for chronic low back pain. Across a wide range of painful conditions, walking, stretching, cycling, jogging, running, yoga and many more formats all seem to be safe and equally effective for pain reduction. The three top tips we have highlighted will increase the likelihood of you sticking to exercise in the long term and reaping the benefits.

How to get started:

When you are in pain, starting exercise can be very hard. Underused muscles get sore more quickly than healthy muscles. Feeling stiff and sore after exercise does not indicate harm or damage to your body – it simply reflects your body not being used to the activity.

You can start by doing some gentle light activity and then increase your levels when you feel confident to do so. A health professional (e.g. a physiotherapist, personal trainer or strength and conditioning coach) can help you form an exercise plan, which will involve increasing your

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of exercise for pain and health activity levels gradually and when you are happy to do so. Regular exercise has the following benefits for pain as well as general health: l Reduces muscle tension and nervous system sensitivity, by activating our own body’s natural painkillers (e.g. endorphins) in the body. l Improves memory and concentration (e.g. reduces the rate of thinking and memory decline in Alzheimer’s disease). l Improves mood by releasing endorphins, and by giving you a sense of self-mastery, control and achievement. l Strengthens your immune system. l Helps with weight control when supplemented with a healthy diet. l Reduces the risk and progression of heart disease, blood pressure, cholesterol, chest and lung problems, type 2 diabetes, and neurological conditions. l Increases muscle strength (e.g. can reduce falls in the elderly). l Can reduce the need for surgery (e.g. as effective as surgery for low back pain, hip and knee osteoarthritis and shoulder pain conditions).

l Improves sleep quality. l Reduces fatigue, tiredness and increases energy levels. l Can prevent and reduce stress and anxiety.

Research shows that pain can be driven by multiple related factors, such as lack of exercise, sleep, mood, stress and reduced immunity.

Improving these factors by increasing your levels of exercise could significantly help your pain.

In short, exercise is medicine! No drug or tablet delivers the same amount of benefits as exercise.

All types of exercise are good and are equally beneficial for reducing pain. Always remember to pick an exercise you enjoy, that is easy to afford and is easy to get to.

TOP TIPS: MOTION IS LOTION MOVE TO IMPROVE EXERCISE MADE FUN, GETS DONE Mary O’Keeffe and Dr Kieran O’Sullivan, University of Limerick, Ireland

Always remember to pick an exercise you enjoy

n For more information: Visit the website www.pain-ed.com on how you can help your pain.

Youtube “Let’s make our day harder by Mike Evans” and “23 and a half hours: What is the single best thing we can do for our health”.

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14 TALKBACK FEATURE

Got hip dysfunction?

Many individuals will experience hip problems related to prolonged sitting, inactivity, or injury. These situations will lead to and perpetuate non-optimal use of the hips, which contributes to chronic tightness, discomfort and the loss of optimal performance.

Many of these individuals will go through rehabilitation or training protocols aimed at restoring hip range of motion, strength and functional performance. While there are many great exercises to improve hip function, there are some strategies that will actually perpetuate or directly contribute to hip dysfunction. This article, the first of two, will briefly discuss how non-optimal posture and movement habits contribute to hip dysfunction. Along with the second article in the next edition of TalkBack, it will highlight the Foundational A, B, Cs and ways the Pilates instructor can incorporate these three simple principles to improve their client’s hip function.

Part 1:

T

he hip (femoroacetabular) joint is part of a larger anatomical complex that includes the pelvis and lumbar spine.

Alignment and control of the pelvis and lumbar spine are therefore critical to optimal function of the hip joint. To support optimal function of the hip muscles, the pelvis and lumbar spine need to be aligned and controlled in a neutral position. Neutral alignment is a slight anterior pelvic tilt where the ASISs (anterior superior iliac spines) are held slightly in front of the PS (pubic symphysis). This alignment in turn promotes neutral alignment of the lumbar lordosis and position of the femoral heads within the acetabulum.

Holding the pelvis in a posterior pelvic tilt and the lumbar spine in flexion is a common finding in individuals who sit for a living or find themselves in a prolonged seated position for the majority of their day (main image, p15). Essentially, these individuals have reversed the neutral pelvis and lumbar spine alignment. This position lengthens the psoas and lumbar erectors – two muscles which are key to maintaining optimal pelvic, spine and hip function

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By Dr Evan Osar – and shortens the abdominals and the hamstrings. This chronic postural position and resultant muscle imbalances make it nearly impossible for these individuals to achieve a neutral pelvic alignment during life and hence when they exercise. An inability to control neutral pelvic alignment contributes to non-optimal control of the hips and hence is directly responsible for chronic hip dysfunction.

Many exercises such as Hundreds can perpetuate this non-optimal posture when attention isn’t placed upon re-establishing neutral alignment and control of the deeper core and hip muscles like the psoas, diaphragm, transversus abdominus, pelvic floor and deeper glute fibers. Additionally, postural and exercise cues to “pull the abs up and in” or “flatten the spine” upon the mat or Reformer during supine exercises can perpetuate this posture and the aforementioned muscle imbalances.

Similarly, postural cues to over-activate the abdominals and glutes – “squeeze the

abs in”, “flatten your spine” and “tuck your tailbone under” – will pull the pelvis further into a posterior pelvic tilt and flatten the lumbar lordosis. Over time, this posture creates stress upon the lumbar spine and irritates the soft tissues of the lumbar spine leading to disc issues. This postural alignment will disrupt optimal control of the hip leading to tightness, impingement, and often labral tears. These individuals will frequently complain of chronic low back and hip tightness and the need to continually use the foam roller or stretch for relief.

The Pilates instructor can be instrumental in helping these individuals develop more optimal hip function and reduce chronic tightness and discomfort. The Integrative Movement System™ is one of the simplest yet most effective methods for restoring optimal posture and movement and hence hip function. The three essential principles of the Integrative Movement System™, alignment, breathing and control can be easily integrated into the Pilates method and will be discussed below.

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Start with the A, B, Cs Alignment

Benefits: Re-establish alignment and control of neutral pelvic and lumbar spine posture and reduce stress upon the hips created by postural compensations.

To improve hip strength and length, the individual must learn how to align and control neutral position of the pelvis and lumbar spine.

Neutral alignment will help position the femoral heads properly within the acetabulum and make it easier for the individual to access the appropriate muscles during their training and subsequently during activities of life.

To find relative neutral position of the pelvis, have the individual lie in the

supine position and place one hand on their ASIS and the other on their PS. They will perform three to five repetitions of anterior and posterior pelvic tilts until their pelvis rests in a position where the ASISs are slightly higher or anterior to their PS. In this position there should be a gentle lordotic curve in their lumbar spine. Some individuals may need to release gripping from their hip rotators, lumbar erectors, abdominals or superficial hip flexors to better achieve this position. Once this position is established, the individual must learn how to breathe three-dimensionally to help maintain control of this position.

References

Osar E, and Bussard M. 2016. Functional Anatomy of the Pilates Core. Lotus Publishing. Chinchester, UK. Osar E. 2012. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Lotus Publishing. Chinchester, UK.

Next time: Breathing and Control

Dr Evan Osar

About the Author Dr Evan Osar is an internationally-recognised lecturer, author and expert on assessment, corrective exercise and integrative movement.

Dr Osar and his wife Jenice Mattek created the Institute for Integrative Health and Fitness Education™, which provides advanced-level live education and free online resources incorporating assessment, corrective exercise and functional exercise. Dr Osar has authored one of the most

highly acclaimed industry resources on corrective exercise – Corrective Exercise Solutions – and recently co-authored Functional Anatomy of the Pilates Core. He has developed the industry’s most advanced training certifications – Integrative Corrective Exercise Instructor™ and Integrative Movement Specialist™. For more information including free educational resources visit www.IIHFE.com

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16 TALKBACK FUNDRAISING

Team BackCare The Virgin London Marathon is almost here. More than 40,000 runners are expected to participate on Sunday 24 April, making it one of the world’s largest marathons. And the figure, of course, includes the 45 courageous runners of Team BackCare.

You can follow Team BackCare’s training on their Facebook page: BackCare London Marathon Runners.

Meanwhile, meet some of our fundraisers...

ANDY EARP BackCare runner Andy (pictured left) must be super human. He will be running three marathons in two weeks (15 days) for the charity, taking on Manchester on 10 April, Brighton on 17 April and London on 24 April.

Andy said: “As many of you probably know, I’m no stranger to the marathon distance, so just asking people to part with their hard-earned money to run a single marathon just didn’t seem fair… so I’ll try and run three in two weeks.

“I’m sure many of us have suffered with back pain at some point or other in our lives and can sympathise with how crippling the pain can be. BackCare aims to fund scientific research into the causes, prevention and management of back pain.”

Please support Andy on his JustGiving page: Andy Earp

ADAM PIERSON Adam organised a charity football match. In spite of rain, he raised a magnificent £1,250.

TREVOR CORDING

HANNAH EPPS Hannah is a pilates teacher and a busy mum of two girls. She is running while coping with her own back pain – so does lots of stretches and leg work with a pilates reformer on rest days.

Trevor is keeping a blog (www. trevorcording.com) of his running for the Marathon.

It makes for inspirational reading, really bringing home just how hard our marathon runners have to train.

Visit www.backcare.org.uk/marathon to find out how you can show your support and help our London Marathon runners meet their charity pledge of £1,200. Full race report in the next issue!

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TALKBACK BRANCHES 17

BACKCARE BRANCHES The BackCare branches are a network of local support groups up and down the country. They are run by local members who organise educational, social and fundraising events. You can find your local branch in the listing, right.

If you’d like to start a branch in your area, please contact branches@backcare. org.uk

CAMBRIDGE • 56 members Contact: Ms Mary Griffiths Telephone: 07787 990214 Email: blincomary@gmail.com

READING • 24 members Contact: Mr David Laird Telephone: 0118 947 0709 Email: davidlaird@talktalk.net

DERBY • 61 members Mrs Christine Sissons Contact: Telephone: 01332 763636 Email: chris.sissons@btinternet.com

SALISBURY • 122 members Mrs Barbara White Contact: Telephone: 01722 333925 Email: white.alan@btinternet.com

ESSEX • Contact: Telephone: Email:

SOUTHAMPTON • 32 members Contact: Mrs Jo Goudge-Riley Telephone: 02380 464170 Email: goudgeriley@gmail.com

Mrs Lyndee Oscar 01206 804353 lyndee@kidsbacks4thefuture.co.uk

HARROGATE & DISTRICT • 32 members Mrs Lin Tippey Contact: 01423 865946 Telephone: Email: keithandlin2@btinternet.com

SWANSEA (WALES) • 56 members Ms Gloria Morgan Contact: Telephone: 01792 208290 Email: gloriamorgan@talktalk.net

HULL & EAST RIDING • 90 members Mrs Beryl Kelsey Contact: Telephone: 01482 353547 Email: kelsey59@kelsey59.karoo.co.uk

WEST LONDON • 15 members Mrs Teresa Sawicka Contact: 020 8997 4848 Telephone: Email: tere_ss@yahoo.co.uk

LOTHIAN (SCOTLAND) • 66 members Mrs Jean Houston Contact: Telephone: 0131 441 3611 Email: jean.houston@blueyonder.co.uk

WEST MIDLANDS • 11 members Contact: Mrs Thelma Pearson Telephone: 01902 783537

POOLE & BOURNEMOUTH • 5 members Mrs Patricia Bowman Contact: Telephone: 01202 710308 Email: patriciabowman@ntlworld.com

WINCHESTER • 39 members Ms Gillian Rowe Contact: Telephone: 023 8025 2626 Email: gillianmrowe@hotmail.com

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18 TALKBACK INSIGHT

Why you should stand up for Sit-stand desks can be found in offices all over Scandinavia.

Health campaigners are hoping they become ubiquitous in the UK, too.

W

hile visiting a charity in Gothenburg, Sweden, in 2013, Gavin Bradley was curious to understand why all the staff had access to sit-stand workstations – and what’s more, they thought nothing of it.

Puzzled by this, Gavin decided to investigate why sit-stand desks at work are commonplace across Sweden (and indeed Scandinavia) and to delve into the fragmented but compelling scientific evidence on the health risks associated with prolonged sedentary behaviour.

He quickly decided that other countries needed simple (but stern) communication from the fast-emerging area of sedentary science.

“In short, we have dropped the ball and need to become more aware of just how dangerous and widespread the health risks of prolonged sitting can be – irrespective of the levels of physical activity.”

Hence the Get Britain Standing campaign was born and the Active Working community

interest company was set up. Its first goal was to draw attention to the significant increases in health risks caused by sitting (i.e. heart disease, diabetes and cancer) and compelling benefits of converting sitting time to standing time while at work (wellbeing, productivity and positive attitude).

A recent study by a panel of experts and commissioned by Active Working CIC, with the help of Public Health England, attracted global media attention. The recommendations, based from an analysis of more than 60 existing studies on sedentary behaviour and health outcomes, were published by the British Journal of Sports Medicine and strongly suggest that office workers make an effort to stay out of their seats for at least two hours every workday, and eventually plan to spend at least four hours on their feet in some capacity.

Gavin Bradley, Founder of Active Working and Campaign Director of the Get Britain Standing

Sit-stand desks in use at Active Working

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TALKBACK INSIGHT 19

yourself in the workplace

Sit-stand desks in use at Get Britain Standing campaign, which has now gone international, said: “Multiple researches show that prolonged and excessive sitting at work is impacting the health, wellbeing and productivity of employees.

“We’ve known more or less for 50 years that sitting has an impact on health. What’s more, physical activity exercise for an hour or so a day can’t undo the negative effects of sitting for eight

Get Britain Standing is a dynamic campaign run by Active Working C.I.C to educate the public and employers on the health risks (heart disease, type 2 diabetes, mental health and cancer) and multiple benefits of reducing sitting time at the office.

Prolonged sitting is no longer seen as a risk factor in just backache and MSD. The campaign is growing rapidly. It is now running in the USA, Canada, Australia and there are plans to expand in Europe.

hours, any more than running a mile can’t erase the damage caused by a smoking habit. It’s a matter of seeing standing as your default position as opposed to sitting as your default position.”

Gavin is very clear on what needs to be done: “The primary focus has to be reducing our sitting time – especially at work. Office workers spend on average 10 hours a day sitting and 70% of sitting time is in the office. So it all starts with assessing your sitting calculator – just as you assess your daily calories, weekly exercise and alcohol consumption, we now need to assess and reduce, where possible, our sitting time.

“The benefits are huge and business is now learning more about the amazing benefits of something that is relatively simple.”

Active Working is now helping a growing number of companies plan their journey in this direction. Unfortunately, behaviour change is not as simple as just putting in a new sit-stand desk: each member of staff should be educated and trained and strong leadership is essential to promote the change in every office.

Its vision is that, within 20 years, more than 80% of the workforce will swap two to fours hours of sitting time with standing at their desk each day.

Prolonged and excessive sitting at work is impacting the health, wellbeing and productivity of employees

n For more information visit: www.getbritainstanding.org www.activeworking.com or contact: info@activeworking.com or call: +20 7060 1920

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20 TALKBACK NEWS

participate!

Calling all BackCare members!

Would you like to: l become an advisor on research steering committees l give independent feedback on clinical trial protocols l participate in the development of new medical devices l take part in research questionnaires and surveys?

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If you suffer from back pain and would like to get involved with research, please visit www.backcare.org.uk/research