TalkBack, issue 3 | 2015 (BackCare)

■ NEWS

■ EVENTS ■ COMMUNITY ISSUE 3 n 2015

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

4

FREE TO MEMBERS

Back pain in children

16-18

Awareness campaign

What should I do?

22-23

Up-to-date advice

Conquering back pain

Adventuring forth

www.backcare.org.uk

2 TALKBACK EVENTS

BackCare Events Calendar 2015 National Back Exchange – Annual Conference 2015 28 – 30 SEPTEMBER

“Tackling Challenges” at the Hinckley Island Hotel, Leicestershire. The must-attend event of moving and handling. Learn, debate, network and reflect in a multidisciplinary environment. More information at www.nationalbackexchange.org

10th Henry V Crock Lecture – 3D printing and skeletal surgery 30 SEPTEMBER

Professor of Orthopaedic Surgery Justin Cobb presents a lecture on this industrial revolution in healthcare. Poster presentations at 4pm, lecture starts at 6.30pm in the Governors Hall, Guy’s and St Thomas’ Hospital (access from Westminster Bridge Road, south side). Contact annegarley@gmail.com for your free ticket.

BackCare Awareness Week: Back pain in children 5 – 11 OCTOBER

Back pain doesn’t just affect adults. An alarming proportion of school-aged children also suffer from back pain.

This year’s awareness week will focus on back pain in children. More information at www.backcare.org.uk/children

The Society for Back Pain Research, 2016 Annual Meeting 5 – 6 NOVEMBER

Venue: the Anglo-European College of Chiropractic, Bournemouth, UK. Theme: Biological factors in nonspecific back pain; Friday debate: “Non-specific low back pain is a valid concept.” More information at www.sbpr.info

Therapy Expo 25 – 26 NOVEMBER

This year’s newly expanded Therapy Expo featuring 40+ hours of CPD and exhibition will be at the NEC, Birmingham.

Register for just £79 + VAT using the discount code AD3 at www.therapyexpo.co.uk/backcare. You’ll also get free entry to the co-located Occupational Therapy Show.

Councils invest in The Carer’s Guide

www.backcare.org/carers TALKBACK l ISSUE 3 2015

TALKBACK WELCOME 3

Welcome Welcome to TalkBack. I hope you had a great summer, as it certainly seems to have wound down now. For overseas readers, we’re heading into autumn here in the UK which means intermittent showers and colder evenings.

Whether you’re already a member, have picked this up at an event or are reading online, we’ve got a great issue for you. BackCare publishes TalkBack quarterly and now also sends out a free monthly email newsletter which you can sign up for on our website at www.backcare.org.uk/join.

BackCare Awareness Week is upon us. This October 5-11 sees the launch of our “Back Pain in Children” campaign. There will be a radio day to kick off the week as well as the publication of our 2015 campaign pack – in fact, this issue forms part of the pack, so hello to all new readers who’ve received this issue within the “Back Pain in Children” campaign. See page 5 for more details.

Our work continues on the carers front, with a newly updated version of The Carer’s Guide now in circulation and councils nationwide investing in the prevention of back pain in their unpaid carers. We’ve also now formed partnerships with Birmingham Carers Hub and Carers Oxfordshire in a bid to reach out to many more people with our evolving guidance on back pain prevention.

Since our office relaunch in June, we’re pleased to announce that BackCare is now the UK’s first 100% sit-stand charity, equipped to enable all staff to alternate between sitting and standing while they work at their desk – I’m standing as I type this.

We’re also pleased to announce that physiotherapist Nick Sinfield has joined the team as Clinical Advisor to BackCare. This move is part of a new collaboration with Spring Active, where Nick heads up the clinical team. This means that BackCare will now able to offer healthcare for back pain sufferers in the form of a tiered suite of interventions from recovery steps workbook to full residential program. You can read the latest instalment of Nick’s 2015 mini-series on page 9.

Contents

Following on from Individual Members’ feedback which we published in the last issue, the new email newsletter has now been going out monthly since May to a rapidly growing audience. As requested, this issue also features more practical advice – from Yoga for Healthy Lower Backs (page 6) and the Alexander Technique (page 19). We ran a similar survey exercise with our Professional Members in July: many thanks to all who participated. Your feedback will inform how we continue to develop membership for our professional community – read all about it on pages 20-21.

Long-term back pain sufferer and founder of BackStrong Adventures Gillian Fowler returns to tell us about her most recent inspiring adventure – this time kayaking in Croatia – which she has just returned from. You can read her report on pages 22-23.

I’m running out of space here to tell you about the other great features articles in this issue, so I hope you find value in these pages and I’ll see you next time. The next issue will be out in December, but make sure you’re signed up to the monthly newsletter so we can keep you posted in the meantime.

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 Head of Information and Research.

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

Back pain in children

4

The pain-stress loop

9

Exercise and back health 12-13

Standing tall

14-15

Dr Adam Al-Kashi Head of Research & Editor of TalkBack 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.

Back pain, what to do 16-18

Survey results

20-21

TALKBACK l ISSUE 3 2015

4 TALKBACK NEWS

Children suffer back pain, too The theme of this year’s BackCare Awareness Week is back pain in children. Far from being a problem of older people, several studies have shown that back pain also affects children. To investigate further, BackCare ran a UKwide survey of secondary school pupils.

We found that two thirds of UK secondary school pupils have experienced back pain, and one quarter said they have

back pain regularly or every day. There were also some alarming regional variations, most notably with London having more than double the back pain prevalence of other UK regions – more than 40% of secondary school pupils in London said they have back pain regularly or every day.

We also looked at neck pain, shoulder pain and hand/ wrist pain, as well as school

bag burden and the number of hours spent sitting each day.

The full report of our findings has been published in the campaign pack which goes on sale for £12 from BackCare’s online shop to raise money for the charity (order your pack now from www.backcare.org. uk/pack). The campaign pack is also being sent out to the head teachers of all 8,000 secondary schools in the UK to raise awareness and

offer guidance.

In addition to the printed pack, the campaign messages will also go out on the airwaves to an estimated six million listeners through BackCare’s Radio Day on Monday, 5 October. Listen out on your favourite local, regional or national radio station for coverage.

Runners step up to the challenge Many thanks to Kate Sellars, who is engaged in a series of challenge events to raise money for BackCare.

The York-based Pilates instructor and BackCare Professional Member will cover a total of more than 70 miles over seven events this year: the York Brass Monkey half marathon; the Winter Warrior 10K assault course; the Sheffield half marathon; the Leeds half marathon; the Total Warrior 12K assault course; the Wetherby 10K; and the Great North Run half marathon.

So far she’s raised £650. You can help her reach her £1,000 target at www.justgiving.com/ Kate-SellarsGNR2 We’d also like to thank Kevin Deighton who ran the 2015 Vitality British 10K for BackCare.

Kevin, from London, said: “I’d like to raise around £200 for this great charity and hopefully give somebody a better life in doing so. I am running with Great Pride for my friend, who has really been through the wars with his back.”

He completed the race in a time of 53m 44s, raising £262.80, and tweeted: “I really enjoyed the British 10K this year and raising money for a great charity!” Well done Kevin.

And remember, we do have guaranteed Gold Bond places for the 2016 Virgin London Marathon but they can get snapped up fast, so visit www.backcare.org.uk/challenge to Kevin Deighton secure your chance to run for Team BackCare next April. after running the 2015 Vitality British TALKBACK l ISSUE 3 2015 10K for BackCare

TALKBACK NEWS 5

Pro member joins as Community champions our Clinical Adviser Chartered physiotherapist and BackCare Professional Member Nick Sinfield has joined the team as Clinical Adviser to BackCare. The move is part of a new collaboration with Spring Active, where he heads up the clinical team.

As a result, BackCare now offers a range of evidencebased back pain management programmes geared according to the Keele STarT Back stratified care approach.

This means that patients with back pain can be objectively assessed for their level of risk and offered a programme to match, from recovery steps workbook, to telecoaching, to full residential programme.

The Take Back Control recovery steps workbook is already available from our online shop (just £13.75 including delivery) and the residential programme can be funded through all major health insurers as well as through a number of workplace schemes.

More than one in 10 of us are now a carer for an unwell, disabled or elderly family member. Carers save the NHS around £100 billion a year but back pain among this group is very high at around 70%.

The Care Act 2014, which came into operation in April 2015, makes prevention an obligation of councils.

To support the adoption of BackCare’s preventative

guidance, we’ve created a new award. The BackCare Community Champion award is given in recognition of councils and carer centres that are providing their unpaid carers with The Carer’s Guide to prevent back pain.

Dundee Carers Centre is the latest to win the award, joining Birmingham Carers Hub, Carers Oxfordshire and Blaenau Gwent Council.

Wide array of events for Awareness Week And finally, we want to give huge thanks to the BackCare Branches (our national network of self-run local support groups) and to the BackCare Professional Members who are putting on events during Awareness Week.

Together they’ll be organising a huge array of events from educational talks to open days to free therapy tasters for their local communities to support the campaign and the wider BackCare message.

TALKBACK l ISSUE 3 2015

6 TALKBACK SELF HELP

Yoga for healthy lower backs The word “yoga” means union between the body, breath, mind and the emotions. Yoga is a system of knowledge about wellbeing that comes from India and is thousands of years old. It is not a religion.

Physical postures or poses are the best-known aspects of yoga. They promote strength, flexibility and good health so that we look and feel better.

Our bodies need to be used regularly; a sedentary lifestyle with its limited range of mostly repetitive movements does not give the stretching, strengthening and relaxing we need.

1 What is yoga?

Regular practice of yoga postures will raise selfawareness and physical and mental health. Yoga aims to enable people to enjoy a comfortable, steady posture with an alert mind. Learning to relax, attend to the breath and mental focus are therefore important aspects of yoga. l Therapeutic yoga can be done to alleviate problems and for prevention. l Yoga is often taught in classes. It can also be learnt one-to-one with a teacher.

Shoulder stretches Stretch arms up high (to wall or ledge) – Urdhva Hastasana How to perform the pose: Ledge variation: Stand 1-2ft away from and facing a high ledge, e.g. the top of a doorframe or the top of a stable piece of furniture that is taller than you. Aim to have your back/trunk straight – not arched or curved. Instructions as in wall variation, but place your fingers on the ledge and use it to give the tractioning effect of gentle hanging, but with your feet firmly on the floor and legs straight, strong and upright.

Hold for 10 seconds and exit the pose on an exhalation.

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

TALKBACK l ISSUE 3 2015

l We recommend you attend regular weekly lessons with a qualified Yoga for Healthy Lower Backs teacher. As yoga is a movement skill, it will take longer to learn from books, DVDs or videos alone. l Once you have learnt how to practise yoga in a class, it is recommended that exercises are done at home. The full benefit of yoga is more likely with regular, disciplined and persistent home practice. l Aim to keep a positive attitude and remind yourself that you want to improve. l Stress and emotional factors

contribute to back problems.

Aim to reduce persistent high levels of stress in your life. l Do not expect improvement in your back pain overnight. But do feel your body accepting and enjoying its new flexibility, strength, relaxation, alignment and postural balance. l Expect to feel better. Yoga can give a sense of wellbeing that will affect not only your back but other parts of your body, your mind, breathing, emotions and your life.

We feel sure you will enjoy learning yoga and continue to learn and practise it.

Wall variation: Stand approximately 1ft away from and facing a wall with your feet hip-distance apart and feet parallel (or slightly turned in). On an exhalation, reach your arms up high to place the palms of your hands flat on the wall; hands shoulder-distance apart with stretched armpits and straight arms. Your legs should be perpendicular to the floor with the weight in your heels and you should feel an upwards elongation to your trunk, especially the front of your body.

Shoulder stretches can help people after sitting or slouching, e.g. in a car or on a sofa n This yoga should be gentle, easy, brief, comfortable and pain-free. Breathe steadily and focus on the relaxing exhalation. You are responsible for your own actions. 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 continues to train 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 Keep a comfortable neck: by taking the outer armpits forwards towards the wall; keep the neck in line with the spine; take the trapezius and shoulder blades down the back; lengthen the neck and head out of the shoulders. l Feel the stretch on the sides of the trunk: armpits, side ribs, side waist. l Take the outer side hips out into the middle of the room. l Mountain Pose legs. l Maintain the natural curve in the lumbar, but realise that this pose can help to lessen the exaggerated curves that can occur in the spine, e.g. lessen the roundedness of the upper back and lessen the inward curve of the lower back by paying attention to it (at the lumbar: there should not be a large back-bending

hollow and the spine should not have disappeared into a deep ravine).

Variations: l Turn toes in a lot to stabilise the spine. l Turn hands out (when using the wall) and/or take them wider for stiff shoulders.

Benefits: l Encourages mobility in the upper back and shoulders and teaches more mobility in those areas and less in the lumbar. l Beneficial space for the discs at the front of the spine. l Traction effect for stiff spinal segments (but more stable than “hanging” from bar/beam).

Related yoga poses: Virabhadrasana I, Adho Mukha Svanasana, Adho Mukha Vrksasana.

We help people with back pain

Take back control with BackCare’s interactive back pain recovery programme.

With its 10 practical back pain recovery steps, the TakeBackControl™ Workbook will help aid your ability to effectively move forward from an episode of back pain. £13.75 l FREE UK mainland delivery The TakeBackControl™ Workbook is now available via the BackCare online shop www.backcare.org.uk/workbook

8 TALKBACK SOCIAL MEDIA

Mary Burstow’s social media round up

Mary Burstow

One of the things I love about working for BackCare, is our members – you are just brilliant!

A few months ago, we sent out an email to our members asking for photos of them in action and what a response we got.

Lots of photos of osteopaths, chiropractors, Alexander Technique teachers and Pilates instructors. It now means I can use these to illustrate our website, as well as any tweets and Facebook entries we do. Please feel free to send in more. I am now looking for photos of people exercising, both gently and strenuously.

Over the autumn we are looking to start revising our factsheets, bringing the information up to date.

If you have any blogs or articles you have written that you are particularly proud of, please let us know.

I am especially keen to update our factsheets on choosing the right bag, what shoes are best for your back, how to survive a long car journey and not injure your back, top tips to look after your back while gardening, top tips to look after your back when at your gym, top tips to look after your back while doing DIY, healthy eating for your back and looking after your back in old age.

Are there any I’ve missed?

Having a ball A key theme this summer has been women in sport. It was fantastic to see England’s female football team do so well. Football is becoming increasingly popular among girls – I only have to go down to my local recreation ground on a Saturday morning to see them showing off their ball control skills.

Road rethink needed As a keen advocate of encouraging people to get out of their cars and to walk, cycle or take public transport to work more, I find the work of @LivingStreets and @BrentToderian fascinating.

We need to rethink how we use our roads and not always give priority to the car if we are serious about public health and urban design.

Brent Toderian @BrentToderian Jul 17 I’ll say it again – approving the Reverse #Traffic Pyramid as policy is easy. Implementing it is the important part.

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Campaign taking off On social media, the “This Girl Can” campaign is really taking off. It is aimed at people like me – useless at sport (always the goalie, never wing attack!) – to say just get out there and do it. It’s fun and it will do your body the power of good.

We are @TherealBackCare

TALKBACK FEATURE 9

The pain-stress loop In this four-part miniseries, NICK SINFIELD tackles four of the most commonly held back pain myths that delay or even prevent rehabilitation and recovery. Nick is a chartered physiotherapist, BackCare’s Clinical Advisor and Clinical Director for Spring Active.

Part 3: “My back pain is real – it’s nothing to do with stress” – MYTH! Without even realising, each of us has many stressors in our lives. These may be things that happened in the past or problems that exist in the present. They may involve family, work or financial issues.

Recent clinical research suggests that our ability to cope with these stressors has a direct relationship with the amount of pain we may experience, whereby stress worsens pain and vice versa. These symptoms frequently co-occur; they do not necessarily cause one another, but share a common origin.

When these stressors run at high levels for prolonged periods, the brain responds in many ways and can even influence us physically.

The answer lies in a part of the brain involved in processing our emotional reactions and its connection with the parts of the brain that link to the glandular, endocrine and immune systems.

These glands release hormones

into the bloodstream, which affect the function of every tissue and organ in the body.

This relationship is responsible for processing stress and pain in the form of the normal “fight or flight response”. Importantly, one maladaptive response from this connection can make it easier for us to feel pain.

The long-term stress of back pain can be compared to a black rain cloud hovering over us. This cloud holds the daily threat of pain, fear, worries about work, money, family, and one’s unknown diagnosis or failed treatments. After prolonged periods, this can change our biochemistry. With increased stress, the body produces stress chemicals, such as cortisol. These affect sleep cycles, making it difficult to achieve deep restorative sleep. This has an impact on energy levels, causing fatigue.

You may be too preoccupied by the pain to be aware of exactly how it has affected your behaviour and state of mind.

The disruptive effects of pain on your behaviour and lifestyle may include: a decreased initiative to exercise, irritability, low mood, poor dietary habits, increased tobacco or alcohol intake, and a tendency to spend long periods in a poor postural position. Over time, pain can make people feel depressed,

Key point: if you do not feel able to cope with your back pain, this creates stress. And don’t forget, emotional pain and physical pain ignite similar areas in the brain, which demonstrates the close interrelationship between the mind and the body. affecting relationships, reducing sexual drive and making them feel less attractive.

Brain imaging studies have shown that, in people who suffer persistent back pain, the parts of the brain involved in understanding and perception have been restructured. This is to say, long-term back pain sufferers tend to think, feel and act like a long-term back pain sufferer.

Studies have also investigated the link between personality and

long-term pain; the resulting evidence demonstrates that long-term pain is preceded by the formation of predictable personality structures. For example, people who reported childhood trauma were significantly higher among those who develop persistent pain.

So how we respond to pain can be understood as a consequence of many factors, such as personality, how we handle our feelings and past experiences.

Get BackCare’s 10 Recovery Steps workbook!

BackCare is proud to welcome Nick Sinfield to the team and announce the launch of its new back pain recovery workbook.

Grab your copy for just £13.75 (free delivery to mainland UK) at www.backcare.org.uk/workbook

TALKBACK l ISSUE 3 2015

10 TALKBACK BRANCHES

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 Email: blincomary@gmail.com

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

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

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

ESSEX • first meeting, 9 October Contact: Mrs Lyndee Oscar Telephone: 01206 804353 Email: lyndee@kidsbacks4thefuture.co.uk

SOUTHAMPTON • 32 members Contact: Mrs Irene Bowron Telephone: 01794 340256 Email: irene@macgregors-shadeplants.co.uk

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

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

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

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

LOTHIAN (SCOTLAND) • 66 members Contact: Mrs Jean Houston 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 Contact: Mrs Patricia Bowman Telephone: 01202 710308 Email: patriciabowman@ntlworld.com

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

Hull & East Riding branch We will have a static display at the Central Library for two weeks prior to BackCare Awareness Week. During the awareness week (5-11 October, 2015), we have our Monday walking group, followed by a Branch Open Day on the Tuesday (Centre 88, 10am to 3pm). Then we have a Speaker meeting on Wednesday at Boulevard Village Hall, from 1pm to 3pm; and finally an open session on the Thursday at the hydrotherapy pool from 4.45pm to 5.45pm.

Beryl Kelsey

Harrrogate & District branch Our main activity is hydrotherapy which we have run successfully for more than 14 years now. We also provide regular social get-togethers for our members including a monthly luncheon group.

I’d also like to let you know about a new Qi Gong class starting soon in Harrogate which will focus specifically on the health benefits of Qi Gong – the

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ancient Chinese art of using the mind to naturally develop and circulate the body’s Qi (energy) for improved health, vitality and longevity. Qi Gong teaches breath control and visualisation combined with a variety of simple, slow and safe movements to exercise the body and relax the mind.

The Health Qi Gong class will run every Thursday through the autumn term, starting on Thursday September 24, 11.15am to 12.30pm at the Green Hut, Harlow Hill Community Centre, Harlow Avenue, Harrogate. The class is open to everyone and suitable for all abilities. There is no need to book in advance, just turn up. Price is £6 a session, pay-as-you-go.

Lin Tippey

Essex branch From next month you can visit the BackCare Essex Branch website www.backcare-essex.org for information on locating local health practitioners and updates of events. We welcome any further suggestions to support you and the

website will continually develop.

We look forward to welcoming you at our first meeting during BackCare Awareness Week, 7-9pm on Friday October 9, 2015 (Gaston House, Gaston Street, East Bergholt, Essex, CO7 6SD).

We will have several presentations from local registered health practitioners answering questions within their specialty and offering practical advice and support.

We are planning to structure our meeting like this to enhance the community, which will also give you an opportunity to meet the local health practitioners supporting your health and wellbeing. For further updates visit the website.

Finally, we are very much looking forward to BackCare Awareness week in October, where the focus is pain in our younger generation – our future employees. We will be helping them to keep their backs as fit as possible for the future by visiting as many schools and colleges as possible with our BackWise Station. Our campaign is called “Putting the S back into our spines!”

Lyndee Oscar and Ned Wombwell

On your bike 50 good reasons to exercise

01 Lifts your mood 02 Improves learning abilities 03 Builds self-esteem 04 Keeps your brain fit 05 Keeps your body fit and able 06 Boosts mental health 07 Boosts your immune system 08 Reduces stress 09 Makes you feel happier 10 Has anti-ageing effects 11 Improves skin tone and colour 12 Improves sleeping patterns 13 Helps prevent strokes 14 Improves joint function 15 Improves muscle strength 16 Alleviates anxiety 17 Sharpens memory 18 Helps to control addictions

19 Boosts productivity 20 Boosts creative thinking 21 Improves body image 22 Gives you confidence 23 Helps you keep focused in life 24 Improves eating habits 25 Increases longevity 26 Strengthens your bones 27 Strengthens your heart 28 Improves posture 29 Prevents colds 30 Improves appetite 31 Improves cholesterol levels 32 Lowers risk of (certain) cancers 33 Lowers high blood pressure 34 Lowers risk of diabetes 35 Fights dementia 36 Eases back pain

37 Decreases osteoporosis risk 38 Reduces feelings of depression 39 Prevents muscle loss 40 Increases energy and endurance 41 Increases sports performance 42 Increases pain resistance 43 Improves balance and co-ordination 44 Improves oxygen supply to cells 45 Improves concentration 46 Helps with self-control 47 Lessens fatigue 48 Increases sex drive and satisfaction 49 Makes life more exciting 50 Improves quality of life

12 TALKBACK RESEARCH

Gently does it… how a helping Introduction

I have personal experience of recurrent low back pain (LBP). It was frightening, depressing and exhausting, and ultimately it was physical activity – Tai Chi, dance and Pilates – that aided my recovery.

I am currently (among other things) a GP Referral Fitness Instructor practising in an integral fitness suite within a progressive health centre in Scotland. The medical staff refer patients for exercise to help manage a number of health issues. I have few referrals specifically for LBP, although it is a common co-morbidity. Many participants in my unrelated Pilates classes, however, attend specifically to manage LBP as they believe Pilates will help prevent, or manage, their condition. Indeed, many do report LBP improvement in addition to other fitness benefits as a result.

The science

I recently carried out a research project: “An Exploration of the Management of Low Back Pain Using Physical Activity/Exercise and Stress Reduction Interventions” as part of a BSc degree. I interviewed GPs, fitness professionals and individuals using exercise to manage LBP; it was a small study but it gave me a useful local insight.

I began by looking at the science.

Melzack and Wall’s 1965 paper introducing the “Gate Control” theory of pain modulation started the ball rolling.

This important study began to explain the complex phenomenon of pain perception. This, and more recent work, has changed our understanding of how pain is experienced, as pain was previously thought to be entirely due to physical injury.

It is now known that the amount of pain experienced does not relate to the amount of tissue damage present, as there can be damage without the experience of pain.

The brain interprets sensation differently depending upon previous experiences and current prevailing emotional state. These psychosocial components of emotions, social situations, beliefs and catastrophising thought tendencies all have a role, thus giving rise to the emergence of the bio-psychosocial model in pain science.

Several studies have shown that psychological factors, such as stress, most

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Caroline van der Heiden sets out why the medical profession should collaborate with and work alongside the many nonmedical fitness professionals who are willing and able to offer support, and gently encourage patients on their journey towards the “self” managing life changes that will assist the modulation of their long term/ persistent pain. consistently predict who will develop LBP, and suggest that physical triggers such as lifting are not independently causal (Eriksen 1999, Feyer et al 2000, Christensen & Knardahl 2012).

Research findings

Interestingly, all interviewees who managed their LBP using activity/exercise believed the cause of their pain to be “postural” or “physical damage”. The psychosocial components were largely not considered; a typical comment was: “I don’t think (stress affects back pain) because it is a physical problem, it’s postural”. Even though they didn’t think their LBP to be stress related,

they did think that exercise could reduce stress; commonly suggesting similar exercises for LBP and stress reduction.

The GPs interviewed perceived that any type of activity/exercise could reduce stress, but with individual patient choice and enjoyment being important. Walking was suggested as particularly beneficial; while yoga and Pilates were also recommended to patients. Further, it was thought that these activities helped with stress and LBP.

Stress

While the mechanism behind the proven role of exercise in stress reduction is not fully understood (White 2007), it may be the case that similar mechanisms assist in both pain and stress reduction. Wonders & Dury (2011) carried out a study to investigate an explanation for the premise that exercise could induce hypoalgesia or reduced sensitivity to pain. They found that exercise accumulation time was a factor, and that it appeared to be opioids in the circulation that could be causing an altered perception of pain.

It is well established that exercise helps to decrease the symptoms of depression, and it is possible that its effects on stress may be similar. The mechanisms for this remain unproven but a number of hypotheses have been put forward.

The Thermogenic hypothesis proposes

TALKBACK RESEARCH 13

g hand can go a long way that reduced feelings of anxiety could be due to increasing the temperature in the brain, resulting in feelings of relaxation and reduced muscular tension. The Endorphin hypothesis suggests that a sense of wellbeing is achieved due to the release of β-endorphins into the body after exercise, while the Monoamine hypothesis is that exercise increases neurotransmitters, such as serotonin and dopamine, that affect mood (Craft & Perna 2004).

Why exercise/ movement is essential for back health

Regular weight-bearing body movement is known to be essential for the maintenance of bone mass and muscle tissue, while movement is also necessary for ligament flexibility and strength. It also stimulates the production of synovial fluid which protects and promotes free movement of joint surfaces. Regular changes in posture and body position are vital for articular cartilage and intervertebral disc health, as being avascular these structures rely on movement to create the pressure changes that cause a pumping action, for influx and out-fluxes of nutrition and waste materials.

Lack of movement results in a reduction in synovial fluid volume and fluidity, and this is why fixed body positions and lack of movement can negatively affect back health (Twomey 1992, Hall 1995, Tortora & Derrickson 2011).

Gently does it

Most individuals interviewed said that low-intensity (i.e. not “pulse raising”) exercise was most helpful for LBP and stress management. Other activities they used for stress reduction included sewing, visual and acoustic stimulation, slow breathing, self-awareness and a mindfulness phone app. All agreed that outdoor activity, particularly walking, was helpful.

A helping hand

It may be that people can achieve this gentle start by themselves if they understand the process, but a helping hand would likely be beneficial and enable confident progression towards helpful longer term progression of exercise activities.

It emerged from my study that referral directly from GPs to exercise specialists does not routinely take place. Most GPs referred patients for physiotherapy, or recommend physical activity to their patients, as all agreed that exercise was useful for LBP. The exercise specialists received very few referrals from GPs and none of the LBP individuals interviewed had been directly referred to exercise professionals. Only one exercise specialist had regular referrals from a physiotherapy department (due to a joint initiative).

I think people do want to (and try to) comply with their GP’s advice, but find it is not easy on their own and need a helping hand. It appears likely that they may give up, as it could seem impossible to make such changes, which may result in them feeling bad about themselves.

It would appear the medical profession doesn’t routinely have meaningful links with

the fitness profession at a local level (though this may differ nationally). I believe the expertise is there, but not well accessed. To address this, one of my research recommendations was: “To improve exercise referral pathways by local medical/fitness professional collaboration”.

Finding a helping hand

Clinicians/individuals looking for a fitness professional should select someone who is appropriately qualified. Ideally, they should seek a “Registered Exercise Professional” (REPs member) with at least a Level 3 qualification and preferably a Level 4 “Exercise for the management of low back pain” qualification. Some registered Pilates and yoga instructors are also qualified to instruct LBP clients. To find registered instructors in your area, contact the Register of Exercise Professionals (link below).

REFERENCES: 1 Christensen JO, Knardahl S. Work and back pain: a prospective study of psychological, social and mechanical predictors of back pain severity. Eur J Pain. 2012 Jul;16(6):921-33. doi: 10.1002/j.15322149.2011.00091.x. Epub 2011 Dec 21.

2 Craft L, Perna F. The Benefits of Exercise for the Clinically Depressed. Prim Care Companion J Clin Psychiatry. 2004 6(3): 104–111.

3 Eriksen W et al. Smoking, heavy physical work and low back pain: a four-year prospective study. Occup Med (Lond). 1999 Apr;49(3):155-60.

4 Feyer AM et al. The role of physical and psychological factors in occupational low back pain: a prospective cohort study. Occup Environ Med. 2000 Feb;57(2):116-20.

5 Hall S. Basic Biomechanics, 1995, 2nd edn. St Louis: Mosby: 259-260 6 Melzack R, Wall P. Pain mechanisms: a new theory. Science. 1965, 19; 150(699):971–979.

7 Tortora G, Derrickson B. Principles of Anatomy & Physiology. 2011, 13 edn, vol 1. Hoboken: John Wiley & Sons,Inc : 234,295,305 8 Twomey L. A rationale for the treatment of back pain and joint pain by manual therapy. Physical Therapy, 1992, 72.12: 885-892.

9 White D. (2007) Step 5, Controlling your body. Glasgow. Stresscontrol Ltd 10 Wonders K. Dury D. Exercise Intensity as a Determinant of Exercise Induced Hypoalgesia. Journal of Exercise Physiology. 2011, 14 (4):134-144 LINKS: Register of Exercise Professionals’ links: www.exerciseregister.org/ www.exerciseregister.org/members/members-directory-listing

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14 TALKBACK INSIGHT

Humans: a very unusual great ape “We often say the reason people get lower back pain is because we became bipeds and being a biped is a stupid way to use your back,” says Harvard evolutionary biologist Daniel Lieberman, taking careful aim at some of his fellow scientists who maintain that humans never really adapted to being upright. “But actually that doesn’t make any sense, because if back pain is so difficult, such a challenge, natural selection surely would have acted to lessen the prevalence and severity of back pain.”

There’s no doubt about it: we are an unusual type of great ape. Not only are we furless but we can stand in a fully upright stance with fully extended ankle, knee and hip joints in such a way that our thigh bones are aligned with the bones of our lower legs to form flexible, continuous vertical columns. Intriguingly, as anatomists have discovered, this allows a well-coordinated person with an extended S-shaped spine to stand for hours, their body weight transmitted through their feet to the centre of the Earth, using only seven percent more energy than while lying on the ground. By contrast, our closest living relatives, furry bonobos and chimpanzees, with their slightly C-shaped spines, can stand on their hind legs without using their forelimbs for support, but only for relatively short periods because of the high energy costs used in counteracting the pull of gravity on their unstable, semi-flexed bodies.

Compared with other apes, we are unusual in another respect – we are capable of walking upright for miles, and, if need be, to run for miles. The exact details of how our ancient ancestors managed to stand upright and then used that capability to travel on the surface of the planet, as well as standing on tiptoe, bending down, and twisting their heads,

…we have lost the ability to move freely and easily as most of us did as young children TALKBACK l ISSUE 3 2015

Seán Carey has some ideas why our bodies were made for walking, running, stretching, twisting, bending – anything but sitting still…

shoulders and waists, in order to obtain food and manipulate other objects, is still the subject of much debate among paleoanthropologists and evolutionary biologists.

One thing we do know for sure is that when we are standing fully upright, swaying slightly, there is more weight in front of the spine than behind it and so a bipedal human anywhere in the world – London commuter, Siberian nomad or east African hunter-gatherer – has a tendency to fall forwards. That’s why evolution has provided a neat mechanism through which the muscles in the neck, back and legs (the so-called extensor or anti-gravity musculature) keep us erect with the minimum amount of effort.

But uprightness in humans, which also lends itself to biomechanically efficient

locomotion, has a downside. The big problem for most of us who live in the so-called advanced economies is that we never, ever manage to come up to our full height; instead we droop or collapse, and in so doing create stiffness throughout the body. Furthermore, that mal-coordination affects kinaesthesia – the ability to sense oneself in position and movement. The result is that we have lost the ability to move freely and easily as most of us did as young children, and as people who maintain a traditional foraging lifestyle still do. Back to Daniel Lieberman: “If you start asking people who work with huntergatherers, most people say yes, actually come to think of it, I don’t really recall anybody saying that they had back pain.

I’ve never seen anybody have back pain in the hunter-gatherer context.”

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equipped for standing tall I suggest that the main reason for the difference between us and hunter-gatherers is that they squat whereas we spend a lot of time in collapsed sitting on chairs (and sometimes collapsed standing), our spines forced into an unnatural, very pronounced C-shape. Alas, trying to sit up (or stand up) “straight” is not the answer; so-called good posture, as we understand it in the West, creates strain in the body, which is why we can’t maintain it for very long and eventually return to C-shaped slumping.

FM Alexander, the originator of the Alexander Technique, had a nice term for this everyday compression or misuse of the musculoskeletal system – he called it “shortening the stature”. Put simply, this means that the distance between the crown of your head and soles of your feet is, to a greater or lesser extent, less than it could be. Is there a way out of the maze of habitual mal-coordination that we have made for ourselves? I think there is.

Whenever possible, it’s a good idea for us to reduce the degree of habitual shortening of the stature, and perhaps even on occasion exchange it for lengthening of the stature.

Generating and then maintaining lengthening of the stature in daily life is a skill that takes time and practice, of course.

But you can make a start by performing Alexander-style lying down – the “semisupine” position. This involves lying on a firm surface, such as a carpeted floor, with your head supported by a pile of books, your knees bent towards the ceiling and your feet flat on the floor, comfortably near your pelvis about shoulder-width apart.

Your hands can be placed by your sides or on your abdomen. Lying down in this way uses gravity to good effect and by

…so-called good posture, as we understand it in the West, creates strain in the body, which is why we can’t maintain it for very long eliminating or at least reducing the fear of falling helps to decompress your spine.

Whichever way you decide to get on to the floor, you may observe that even the thought of what you are about to do (“I’m going to put my head on the books on the floor”) tends to result in changes in your body. Typically, we shorten the stature by going into a mini-crouch even before getting involved in any significant flexing of the leg joints. So it makes sense to take your time and think how you can keep your head poised on the top of your neck and keep your spine lengthening as you move towards the floor. Alexander used a full-length mirror to see what his body was doing. Alternatively, you can use a

n Seán Carey PhD is a member of the Society of Teachers of the Alexander Technique (STAT).

He teaches in London and St Albans. He is also honorary senior research fellow in the School of Social Sciences, University of Manchester. Seán is the author of an exciting new book, Alexander Technique in Everyday Activity: Improve how you sit, stand, walk, work and run.

smartphone to record your movement and then see if you can detect any tendency to pull your head down on to your neck and round your back as you start to move from upright.

You will need enough books so that, viewed from the side, your forehead is slightly higher than your chin, but not so few that your head is falling back or not so many that your chin is pushing down on to your throat. Once again, someone with a smartphone can record what happens so that you can work out the right amount of support. It’s important to keep your eyes open while you are lying on floor, in part because of the important role that visual sense plays in maintaining balance. You can lay in semi-supine for up to 20 minutes.

And if you want to, or there is a need, you can perform it more than once a day.

Finally, you need to pay attention to how you get back to upright in order to maintain any musculoskeletal expansion you have achieved while lying down. So take your time and then with your eyes leading slowly turn your head to the left or right, turn your knees in the same direction, go on to all fours, get up on to the knees, sit on your haunches, and then stand up. You’re now ready to re-engage with the world.

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16 TALKBACK INSIGHT

I have back pain… what Mary O’Keeffe and Dr Kieran O’Sullivan, Department of Clinical Therapies, University of Limerick, Ireland

We have a particular interest in challenging common, yet unhelpful beliefs which exist about low back pain (LBP) and delivering evidenced-based messages on how to manage it. In a previous issue of TalkBack (Issue 1, 2015), we discussed how the body and mind are interconnected in back pain, similar to many other health conditions. For this issue, we will explore some options for a person who is in pain, based on some common questions posed by patients.

What should I do when I initially hurt my back, or if the pain is severe?

There is strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery

The evidence shows it is best to start simple. From a medication perspective, while the effectiveness of non-prescription painkillers (e.g. paracetamol) is limited, they are as effective as stronger medications (e.g. nonsteroidal anti-inflammatory drugs, opioids) which have more side effects.1 From an activity perspective, in the first few days after the initial injury, avoiding aggravating activities may help to relieve pain, similar to pain in any other part of the body, such as a sprained ankle.

However, there is strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery. It is best to remain active as relaxed movement will help the pain settle quicker. In fact, your back gets stronger with movement.2 In contrast, prolonged bed rest is unhelpful and is associated with higher levels of pain, greater disability, poorer recovery and longer absence from work. In fact, it appears that the longer a person stays in bed because of back pain, the worse the pain becomes.3 Identifying what triggered the back pain episode can be helpful,4 for example, were you doing something particularly unusual or were you more tired or stressed than usual as these make the body vulnerable to the onset of pain.

Should I get a scan to better understand my pain?

Both healthcare professionals and members of

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the public often consider getting a scan “just in case” there is something serious involved in their pain.

We used to think that if we got a good enough picture of the spine with scans that it would be a big help in solving back pain. However, we now know that this is most often not the case. All the evidence suggests scans only show something truly important in a tiny minority (<5%) of people with back pain.5 Unfortunately, when people have scans for back pain, the scans often show up things that are poorly linked with pain. In fact, studies have shown that even people who don’t have back pain have things like bulging discs (52% of people), degenerated or black discs (90%), herniated discs (28%) and “arthritic” changes (38%) visible on their scans. Remember, these people do NOT have pain!

Unfortunately, people with back pain are often told that these things indicate their back is damaged and this can lead to further fear, distress and avoidance of activity. The fact is that many of these things reported on scans are more like baldness – an indication of ageing and genetics that do not have to be painful. A brief consultation with a healthcare professional (e.g.

GP, chartered physiotherapist) would usually be able to identify if a scan was really needed based on a person’s symptoms and medical history.

Will I need surgery?

Only a tiny proportion of people with back pain require surgery. Most people with back pain can manage it by staying active, developing a better understanding about what pain means,

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should I do? and identifying the various factors that are involved in their pain.

This should help them continue their usual daily tasks, without having to resort to surgery. On average, the results for spinal surgery are no better in the medium and long term than non-surgical treatment.6

Should I avoid activities that hurt, like bending and lifting?

It is common, especially during the first few days of back pain, for your movement and activity to be significantly altered. This is similar to limping after spraining your ankle and generally resolves as the pain settles.

While initially hard, getting back to doing valued activities which are painful or feared is important. Many people after an episode of back pain can begin to move differently due to a fear of pain or a belief that the activity is dangerous. Such altered movement can be unhealthy in the long term and can actually increase the strain on your back.

People with back pain often believe that activities such as lifting, bending and twisting are dangerous and

should be avoided. However, contrary to common belief, the research to date has not supported a consistent association between any of these factors and back pain.

Of course, a person can strain their back if they lift something awkwardly or lift something that is much heavier than they would usually lift. Similarly, if a person has back pain, these activities might be more sore than usual. This, however, does not mean that the activity is dangerous or should be avoided.

While a lifting or bending incident could initially give a person back pain, bending and lifting is normal and should actually be practiced to help strengthen the back, similar to returning to running and sport after spraining an ankle.

actually reduces pain and discomfort. It relaxes muscle tension, helps mood and strengthens the immune system once started gradually and progressed over time.

All types of exercise are good, with no major differences in effectiveness between them.7 Exercising in a group and exercising on your own can both be of benefit. Therefore, you should pick a form of exercise that you enjoy, that is affordable and convenient.

Walking, using the stairs, cycling, jogging, running and stretching are all good and help relax tension in your body. When you are in pain, starting exercise can be very hard. Under-used muscles feel more pain than healthy muscles. Therefore, if feeling sore after exercise, this does not indicate harm or damage to the body.

Should I exercise?

What other factors are worth addressing to help my pain?

Many people with pain are afraid of exercise and avoid it as they think it may cause them more problems. However, this is not true! We now know that regular exercise helps to keep you and your body fit and healthy and

Poor sleep, stress and low mood negatively influence back pain. In the same way that these factors are linked to other health conditions like cold sores, irritable bowel syndrome and tiredness, they have a very large effect on back pain through increasing the sensitivity of our nervous system, reducing our immunity and continued on p18

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18 TALKBACK INSIGHT

from p17 increasing muscle tension. As a result, improving our stress, mood and sleep levels by addressing the causes, doing things we enjoy, and engaging in relaxation and exercise can be really beneficial in helping back pain.8 So REMEMBER: l The back is a strong, robust structure which is designed to move to keep it healthy. l Serious or permanent damage is rare. l Finding things on scans such as disc bulges and degenerative discs are common in people with and without back pain, with NO DIFFERENCES between the scans of people with and without pain! It is therefore important not to be distracted, or distressed, by them. l X-rays and MRIs are rarely needed, since pain is driven by lots of factors and it is very rarely something that shows up on a scan. l The best treatment is an approach that involves keeping active, thinking positively about your back and adopting a healthy lifestyle, by enhancing exercise, sleep, stress management and relaxation.

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ABOUT THE AUTHORS: Mary O’Keeffe is a PhD student at the University of Limerick (UL), Ireland. The broad area of her research is the role of multidimensional rehabilitation in chronic low back pain. Her PhD research is examining whether tailoring this rehabilitation to the individual patient presentation enhances effectiveness, and is worth the additional time (and costs!) involved. Her supervisors are Dr Kieran O’Sullivan and Dr Norelee Kennedy from UL and Professor Peter O’Sullivan from Curtin University, Perth.

Dr Kieran O’Sullivan is a Chartered Physiotherapist who lectures at the University of Limerick (UL) in Ireland. He completed his PhD on low back pain (LBP). He is currently co-ordinating several research projects including a multi-centre randomised controlled trial (RCT) on treatment of LBP. He has been awarded “specialist” physiotherapist status by the national Physiotherapy Society (ISCP). He has published more than fifty peer-reviewed articles, as well as one book and three book chapters. He has obtained funding of more than €950,000 for his research. His research group disseminates public health information regarding chronic pain using their online platform www.pain-ed.com.

The impact of his research has also been recognised by UL http://ulresearchimpact. com/category/health.

REFERENCES: 1 2 3 4 5 6 7 8

Evans M. Best Advice for People Taking Opioid Medication. 2013. www.youtube.com/watch?v=7Na2m7lx-hU&list=PLdu SqEwSaqmLRL84vq52KyNzcjhaRwy_c&index=15.

O’Sullivan P, Lin I. Acute low back pain: Beyond drug therapies. Pain Management Today 2014; 1(1).

Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. Bmj 2003; 327(7410): 323.

Steffens D, Ferreira ML, Latimer J, et al. What triggers an episode of acute low back pain? A case-crossover study.

Arthritis Care Res 2014.

Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal 2010; 19(12): 2075-94.

Brox JI, Sørensen R, Friis A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003; 28(17): 1913-21.

Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical rehabilitation 2015.

O’Sullivan K. The role of a healthy lifestyle in chronic pain. 2015. http://www.pain-ed.com/blog/2015/08/13/the-role-of-ahealthy-lifestyle-in-chronic-pain/.

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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. Starting a new series, researcher and teacher of the Alexander Technique, Lesley Glover shows us that while learning the Alexander Technique involves one-to-one lessons, there are many practical tips that we can take away and explore by ourselves.

Stop and take stock: do less so you can do more The magic of stop

There are lots of ways in which the Alexander Technique can help people and I thought it might be useful to share some tips and ideas for improving wellbeing and making life easier. That is what the Alexander Technique is all about, reducing unnecessary tension and finding more ease, balance and confidence in life.

Over the next few months I’m going to suggest some ideas to try: these will give a flavour of the elements of the Alexander Technique.

I thought I’d start by suggesting something very simple and straightforward.

Lots of people have things they do that they find cause them some discomfort, pain or stress. It might be working at the computer, lifting something, entering a stressful situation or even just getting up out of a chair. If there is something like that for you, here is a small experiment to try.

Instead of just doing the activity as you normally would: 1 Stop just before you do the activity or action.

2 Allow yourself to notice something in the room or in the surroundings around you.

Notice the colour, the texture, the size, the shape or any other detail about it.

3 Now do the action or the activity.

4 Ask yourself what, if anything, is different?

You might be about to stand up, open the door to your house after a day at work, start getting tea. Whatever it is, stop for a moment or two and notice something, then carry on with what you were doing.

Save energy and effort

We all go through life using more effort than we need to do things. A key part of the Alexander Technique is to learn to notice unhelpful habits and create an opportunity to do things differently. These habits can be small or large, and of any kind, but often what is unhelpful is that we do more than is needed or use more effort than is needed. By noticing and changing these habits we can save lots of energy and effort.

As well as leading to feeling less tired and better overall, this can also free us up to do more. The way habits are changed in the Alexander Technique is by identifying the habit and then using thoughts rather than actions to change things.

Here’s something to try. Next time you are doing an everyday task, for example chopping vegetables, using a computer mouse, writing with a pen, or brushing your teeth: 1 Stop and notice how much effort you are using to do the activity. You might be really gripping the knife, squeezing the mouse, strangling the pen etc.

2 Once you have noticed, ask yourself: “What if I did less holding or gripping or squeezing?” You don’t need to answer the question or actively do anything, just ask yourself “What if I did less?”

3 See if anything changes.

If you noticed a helpful change, choose one activity and for the next few days apply these steps to that activity.

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.stat.org.uk

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20 TALKBACK MEMBERS

Professional membership In July, we invited our Professional Members – our practitioner and trainer audience who treat or work with back pain sufferers – to participate in an online feedback survey. We asked what challenges you face in your profession, why you joined BackCare, and how you rate the professional membership so far. Thank you to all members to took part; we really appreciate you taking the time. As promised, here are the results.

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What are the biggest challenges you face?

When we asked, “what is the biggest challenge you face in your profession?” we got many different answers, but there were common themes. Here’s what your responses revealed…

About the NHS l People want treatment on the NHS, but it’s difficult to become an NHS provider. l It’s hard to keep track of all the different back pain treatments available in each NHS trust. l It’s a challenge to provide a low-cost service to patients who cannot really afford private care. l It’s hard to get the NHS to accept non-surgical approaches.

Getting recognition l We are not recognised by doctors despite clinical evidence. l The media misrepresents our profession to the public. l The public do not know who we are or what we do. l The public don’t understand the difference between fitness classes and qualified teachers.

Helping patients l It’s difficult to treat patients with long-term conditions such as chronic pain, fibromyalgia, chronic fatigue and complex regional pain syndrome. l Getting people to change their behaviours to avoid future health problems. l It’s hard to convince people to invest in their health and go private.

Within the profession l It’s hard to combat poor practice and misinformation within the profession. l It’s hard to deal with resistance to change because they’ve “always done it this way”. l Attending enough CPD events to meet requirements of professional registration.

Why did you join BackCare?

Our survey showed that healthcare practitioners and trainers join as BackCare Professional Members for a number of reasons, but there were also a number of recurring themes…

Education l I’m interested in back pain and like the articles in TalkBack. l I want to keep updated on the latest news, research and practical guidance. l I want to ensure that what I teach matches what other professionals are saying. l The resources are useful for both me and my patients.

Professional status l I wanted to be part of a national charity and help patients find me. l I want to show my commitment to helping people with pain. l To build my respectability and professional status. l To help promote my practice and my profession.

Support l I joined because of all the help and support received from BackCare. l It seems logical to support a back pain charity.

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survey results How do you rate your membership experience so far?

We finally asked Professional Members to rate the various elements of their membership by value and usefulness. TalkBack magazine was most highly valued with two thirds of members giving a score of at least 7/10, and one third giving it top score. The Professional Member website listing, logo and certificate trailed in joint second place, with around half of surveyed members giving scores of 7 or higher.

Many thanks again to all who participated. We’ll be in touch again soon via email to follow up on your suggestions and to explore new ways of strengthening and supporting BackCare’s professional community for the benefit of the healthcare professionals and the patients they serve.

Your comments and suggestions In addition to these insights, we received an array of great comments and suggestions.

Many of you asked for more contact with local fellow members and there was significant interest in the idea of participating in a private Professional Member peer support forum. We also had several calls for BackCare CPD events aimed at health and social care professionals, both in terms of attending such events and presenting at them.

Several people suggested running television commercials to raise awareness and highlight the work we do. Television is rather expensive per viewer reached, so we generally opt for radio, e.g. our annual awareness week radio day (5 October, 2015) which is very economical, typically reaching more than 10% of the UK population at a rate of around 30 listeners per penny invested.

There was also considerable interest in contributing to BackCare’s educational and outreach activities such as writing online factsheets, answering patient questions online, and setting up local patient support groups.

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22 TALKBACK SELF HELP

Chronic pain doesn’t have to

‘‘

I am a great believer in everyone trying new things, pushing limits that bit further, building confidence and being open-minded to discovering new passion.

As such, all BackStrong Adventures’ trips are carefully chosen so they can be adapted and give lifetime memories for those taking part through achieving amazing, personal feats.

Setting off to take part in BackStrong Adventures’ Sea Kayak in Croatia trip was exciting – though I have to admit, I had butterflies in my stomach as I knew this was out of my comfort zone! But kayaking in Croatia intrigued me. As someone who had never kayaked before, has major spinal injuries and is weak in the upper body, I wanted to see what this trip had to offer and how I could adapt it so I could thoroughly enjoy it.

Without a doubt, I love travelling. But as always, travelling proves difficult and painful as I face obstacles, such as standing in security queues (triggers back pain), sitting on uncomfortable seats in the departures

Gillian Fowler knows only too well about suffering a trauma with life-changing effects, having broken her back in 2008 in a horse-riding accident and enduring years of surgery. She lives with chronic pain, but believes everyone can achieve so much, regardless of what life throws at you – you just need to adjust to your new “normal” and adapt how things are done. lounge, and carrying around my rucksack with my back support for the aeroplane and tablets at hand should they be required. Lifting luggage for check-in and off the carousel at the arrivals hall is always awkward and painful, so too moving my luggage to where I can offload it altogether!

Thankfully, for this trip, I was travelling with one of my good friends.

The Meet & Greet at Dubrovnik Airport proved easy and stress free and we were soon on our way in an air-conditioned SUV to the Old Town of Dubrovnik to pick up two others, before going to the harbour where a speedboat awaited us. The normal transportation to the island of Lopud – our base for the week – is the ferry, but we were lucky to enjoy this speedy, fun journey – it kick-started our adventure perfectly.

On reaching Lopud, we were greeted at the marina by our guide for the week – Stefano – who kindly showed us key attractions, HF House where we would breakfast each day, and took us to our guest house. Our accommodation was very basic but perfectly adequate. After unpacking, it was time to walk along the harbour to get my bearings and enjoy the warmth!

Every meal included in the package is with your group for the week, as well as your guide, who will go over details for the day, the plans for the next day, and answer questions. We were to enjoy the week with two other adults – Sam and her brother Dan – and our small group proved exceptionally good fun. The other group we

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mean a life without adventure

Kayaking guide Stefano Canciani with, from back left, Dan Vasey, Sam Alexander-Vasey, Gillian Fowler and Lisa Sisson saw at breakfast consisted of three families with children of varying ages, and it was good to see the organisation that went into the group dynamics.

The itinerary issued is very flexible because it is based on weather. It is reassuring to see that safety is paramount to the guides. Ironically, as there was barely a cloud in the sky after day one, and light winds, we thought every day was the perfect day, but Stefano was diligent, checking wind directions and forecasts.

The first day in the kayak was a test for my back as I did not know how I would manage in that particular sitting position

and without cushioning. However, the seats were comfortable and over the week I moved the back position numerous times so that my back wouldn’t have spasms or pain additional to the normal. I also quickly realised I had to use my arms more because I struggle with torso rotation.

You couldn’t help but be immersed in the stunning scenery around you, you are seeing places you’d never see except by boat or kayak – secret caves you can only swim into (you had to jump out the kayak), ruins, attractions, “pirate” caves you kayak into to explore, and of course exploring each island you visited. Breathtaking is an understatement.

On the day we all headed for sunset kayaking, there was quite a swell and a couple of us felt a bit nauseous. That passed as soon as we rounded the headland, where the sea was completely calm. Watching the sun go down from our kayaks out in the sea, surrounded by silence, seemed to place us in a different dimension – something I will never forget.

On other days the water was so calm the sea looked like rippling silk.

Without doubt, kayaking each day (apart from the one day off) is very tiring and every night you head to bed after dinner as you have another busy day ahead. Kayaking distances varied from about 8km in a day to 20km, with the latter proving exhausting for me and my back. However, in a kayak you can take your time, rest when needed, enjoy siting back and taking in the scenery, and slowly make your way back to the island.

Highlights for me included the sunset kayak, swimming in Blue Cave and enjoying the very warm sea, kayaking each day and managing to adapt seat and posture to manage back issues, discovering just how beautiful all the

islands off Croatia are, visiting Trsteno Arboretum and Neptune’s Fountain, having lunch at a 500-year-old farm on Šipan Island, discovering the beauty of Koločep, exploring the Old Town of Dubrovnik, and thoroughly enjoying bonding with our small group and leaving our trip all as good friends.

Whether a group of friends, family of all ages or a solo traveller, our Kayak in Croatia trip offers the most amazing experience and fantastic memories. You will not be disappointed – if anything, you’ll be planning a return trip!

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n To find out more about this adventure, or other trips, go to www.backstrongadventures.com or email info@backstrongadventures.com

BackStrong Adventures specialises in challenges for those with an adventurous spirit and especially welcomes enquiries from those who have experienced trauma, injuries, loss, depression, disability, disease and any other life-changing ailment.

Its founder, Gillian Fowler, has climbed a number of mountains in the UK in preparation for various overseas climbs. This summer, as well as the week’s kayaking in Croatia, she has been abseiling and ran her first 10k since sustaining her injuries.

TALKBACK l ISSUE 3 2015

24 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?

TALKBACK l ISSUE 3 2015

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