TalkBack, spring | 2019 (BackCare)

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

SPRING n 2019

FREE TO MEMBERS

Countdown to London Marathon Runners prepare to hit the streets for BackCare

also in this issue: Med-tech Digital to go maintstream across the NHS Research Co-ordinated push to find cure for osteoporosis Pain management Facet joint injections should be replaced with rehab

www.backcare.org.uk

2 TALKBACK NEWS

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TALKBACK LEADER 3

Get outdoors for healthier, happier lifestyle THE 2019 Virgin Money London Marathon is almost upon us! BackCare’s runners are raring to go and, come 28 April, will be among the 40,000 lining up at Blackheath to begin the epic 26.2mile race through the streets of London.

Our road-pounding fundraisers have come through cold, hard months of training to earn their place in the London Marathon, one of the world’s greatest sporting events – and they can look forward to being cheered on by hundreds of thousands of excited spectators who will be lining the streets of the capital.

Brushing aside the niggling sprains, strains, blisters and bruises that come with the territory, running is a great way to stay healthy – it’s also an excellent opportunity to make new friends, set yourself new challenges and achieve personal goals. The extraordinary growth of 5Ks, 10Ks and half marathons is testament to the sport’s enduring popularity.

A familiar fixture in neighbourhoods across the UK is the free-for-all Parkrun1, which was launched 14 years ago and can now be found in more than 600 locations every Saturday morning.

The swelling ranks of participants of all ages and abilities has persuaded Sport England to invest £3m of Lottery money to create a further 200 Parkrun events over the next three years.

Lottery funds are being targeted at remote rural areas as well as inner cities to encourage people to take advantage of the outdoors to improve their physical and mental wellbeing.

Three projects have recently received £140,000 each towards volunteer development and getting communities more active. The schemes – Cheshire’s “Go Wild, Get Fit”, Kent’s “Down to Earth” initiative and “Flourish in Nature” in the south west – will boost activity while carrying out valuable conservation work.

The role of the built environment, too, in enabling people to be more active in their day-to-day lives, is recognised by the National Institute of Health and Care Excellence2. It is calling on planners to encourage active travel and give priority to pedestrians, joggers and cyclists instead of motor vehicles when new roads are built or upgraded. The personal and economic costs associated with physical inactivity are well documented, and both the individual and the health system will benefit if people can be encouraged “to get out from behind their wheel”. To make this happen, we need more public spaces that are safe, attractive and accessible.

Richard Sutton Editor

Contents

£30m partnership to tackle degenerative conditions 5

e-Referral for healthcare pathway

7

Funding to help bring people closer to nature 8

LETTERS TO THE EDITOR:

richard.sutton@backcare.org.uk 1) http://www.parkrun.org.uk 2) www.nice.org.uk

Cover image: Freepik/www.freepik.com

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

BackCare BackCare, Monkey Puzzle House, 69-71 Windmill Road, Sunbury-on-Thames TW16 7DT Tel: +44 (0)20 8977 5474 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 Gemini West, Bristol.

Self-belief key to recovery from shoulder pain 15

Home share approach offers a lifeline to the isolated 17 TALKBACK l SPRING 2019

4 TALKBACK NEWS

MPs are calling on the Government to broaden the professional diversity of senior NHS staff by removing an “unnecessary” legal restriction excluding allied health professionals (AHPs) from these roles.

Under current legislation, some senior level posts within NHS trust hospitals are not available to a wide group of medical professions, as medical director roles are limited to doctors and only nurses can apply for nursing director roles.

The Health and Social Care (Community Health and Standards) Act 2003 specifies that medical and nursing board directors must have medical or nursing qualifications.

The motion, proposed by Lib Dem MP Norman Lamb and tabled in Parliament by a cross-party group of MPs, stated that these restrictions were “outdated” and that removing restrictions will benefit patients. Mr Lamb said: “If we want more creative thinking, and the voices of physios, OTs, radiographers and many other therapists to be heard in NHS boardrooms, then we need a law change. The current rules are holding us back.”

The Chartered Society of Physiotherapy (CSP) is backing the call to scrap the “ban”. Chief executive Karen Middleton said: “The NHS needs to do everything it can to ensure its boards access the widest talent possible and limiting the executive clinical roles to only two professions is outdated and exclusive, when we should be looking to recruit the very best clinicians to these senior positions.”

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Image: jcomp/Freepik

Time for fresh thinking on NHS leadership roles, say MPs

Home aids grants process ‘outdated and inadequate’ DISABLED Facilities Grants (DFGs) enable major adaptations to a home such as installing a stairlift, building a walk-in shower room, widening doorways, providing ramps and hoists. Such adaptations can have an enormous impact on the quality of life for millions of people with long-term conditions and yet the “outdated and inadequate” grants process is a major stumbling block, according to a new independent review1.

The review, commissioned by the Government and conducted by the University of the West of England, highlights key flaws in the meanstested process, describing it as complex and excessively long. Significantly, it notes that as many as one third of people drop out part-way through the process.

Home adaptations to support people with disabilities to live independently are split into minor (anything under £1,000) and major (over £1,000). If minor, they should be provided free of charge by the local authority after a needs assessment, regardless of how much money a person has, whereas, in order to receive major 1) www.gov.uk/government/publications, (10 December 2018)

adaptations, people have to apply for a DFG. The new review supports conclusions from other research that reveals a system in need of improvement. This includes Versus Arthritis’s Room to Manoeuvre report, published in the summer, which shed light on the problems that many people with arthritis face when trying to get help from the DFG. Some have struggled to access funds in the first place, while those who were successful found managing the process stressful, it said.

“The process of obtaining the DFG was the most frustrating experience I’ve had in a long time,” said one arthritis sufferer, Catherine.

“Information was very hard to come by and even after the grant was approved there was little support from my local authority.”

Versus Arthritis is calling on the Department of Health and Social Care to implement recommendations on the DFG covered in the independent review, particularly those focused on future funding, information and advice for the general public along with the means-test itself.

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Back awareness week targets golfers The charity will be working with practitioners and other partners to promote good back health for all ages and abilities as well as providing media updates, booklets, flyers and posters to shine a light on the subject. To find out how you can get involved, contact BackCare at info@backcare.org.uk.

Image: chevanon/Freepik

Association, BackCare, will look at the key injury factors, from the biomechanics of the game to carrying the golf bag!

Warm-ups, stretches and exercises for the torso, shoulder, hips and hamstrings will be discussed along with forms of treatment to relieve pain and promote healing.

Image: Mario_luengo/Freepik

GOLFERS will be the focus of this year’s BackCare Awareness Week, 7-11 October.

Low back pain is a common golf injury and recurrent episodes can hinder enjoyment of the sport and have a huge impact on other areas of a golfer’s life.

The National Back Pain

£30m international partnership to tackle degenerative conditions MEDICAL researchers in Britain and Japan are to join forces to advance research into treatments for some of the most debilitating degenerative diseases, such as diabetes, heart disease and arthritis.

The new research programme will bring together British and Japanese businesses to develop a new generation of assisted living products and services.

The £30 million partnership will promote new technology and innovation that could transform whole sectors and enable people to live longer, healthier lives in both countries.

This includes a £10m programme led

by the UK’s Medical Research Council and Japan’s Agency for Medical Research and Development that will advance understanding in critical regenerative processes in human health and translate research into tools and technologies to treat patients. This could lead to new therapies for use against many types of cancer and repair damage caused by degenerative conditions such as motor neurone disease, Parkinson’s disease or multiple sclerosis.

British and Japanese businesses will support this by working together to develop a new generation of assisted living

products. Through a joint competition focused on employing Artificial Intelligence (AI) and robotics in assisted living, they can access funding to help create safe, ethical and intelligent home environments.

Additionally, Britain will join Japan in its Well Ageing Society Summit and Global Round Table for Dementia.

Business Secretary Greg Clark said: “This government wants to give older people at least five extra healthy independent years of life by 2035. Japan is the perfect partner with which to build on our strengths in science, medicine and research.”

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6 TALKBACK DIGITAL HEALTH AND MEDTECH

Physios will need to develop their skills in PHYSIOTHERAPY staff will need to develop new skills in using rehabilitative and wearable robotics to support patients in achieving maximum benefit from their prosthesis, says a new report on digital healthcare.

These technologies include prostheses,

exoskeletons and brain-machine interfaces to allow advanced functionality to some patients with physical disability.

The independent Topol Review, produced

by Health Education England, calls on education providers to offer opportunities for healthcare students to learn about

new engineering, computer science and technologies as they emerge.

It calls for new educational resources to equip physiotherapists and other health professionals to exploit technologies.

These include health data provenance, curation, integration and governance.

THE National Institute for Health and Care Excellence (NICE) has developed a medtech innovation briefing on the use of the RT300 Functional Electrical Stimulation (FES) cycle for spinal cord injury rehabilitation.

The RT300 integrated cycling system combines FES with a cycle ergometer, allowing stimulation of muscles in the trunk and arms or legs during a cycling motion as part of rehabilitation or physical activity for people with spinal cord injury.

The intended place in therapy would be alongside standard rehabilitation care for people with spinal cord injuries. This would start in specialist spinal injuries units but can be given in any setting.

The main points from the evidence summarised in this briefing are from six studies (three randomised trials and three observational studies), including a total of 103 patients (43 adults and 60 children) in the US and Canada. Limited evidence shows that using RT300 may be associated with an improvement in quality of life and an increase in muscle volume compared with passive cycling systems or pretreatment baseline. At this stage, the results may not be generalisable to the NHS. www.nice.org.uk

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Image: pressfoto/Freepik

NICE briefing on FES cycle for spinal cord rehab

Helping to meet new goals for health services

Digital to go mainstream across the NHS THE newly published NHS Long Term Plan recognises the extent to which new and improved technology and digital services can enable many of the goals set out for the health services.

A broad spectrum of digital services will support individuals to take a more proactive approach to monitoring their own health and wellbeing. This will enable patients to recognise their individual health risks and symptoms as early as possible and manage their personal

response to these risks. The approach is expected to reduce the demand for health and care services.

NHS Digital’s chief executive Sarah Wilkinson welcomed the focus on digital technology while recognising the difficulty for those under constant pressure to deliver critical services to adopt new technology and digital systems.

She said: “We are completely committed to supporting NHS organisations on all aspects of this journey, from technical

education to integrating new technology into services and care pathways.”

Technology is continually opening up new possibilities for prevention, care and treatment.

The national roll-out of the NHS App has begun and will provide citizens with access to NHS 111 online, their GP record, the ability to book appointments, update data sharing preferences and register for organ donation, all from their computer or smart phone. www.digital.nhs.uk

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computer science, AI and robotics Physio staff should be skilled in the critical appraisal and statistical interpretation of artificial intelligence and robotics technologies too.

Joint learning programmes involving components from computer science, robotics and engineering should be made

available to all healthcare students at undergraduate and postgraduate levels.

For example, physiotherapists working with engineering students in the area of robotics can enrich the learning experience and create the right skills for the future workforce, the report says.

In February, the Chartered Society of Physiotherapy held its first informatics network meeting to explore ways members can achieve the Review’s recommendations. https://topol.hee.nhs.uk www.csp.org.uk

PATIENTS arriving at hospital emergency departments with acute ankle sprains may benefit from a new tool developed by Oxford researchers to aid clinical decisions on treatment.

Ankle sprains are very common and represent up to 5% of all A&E admissions in the UK; between 20% and 30% of those patients are still struggling with pain and mobility issues nine months later.

Researchers at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford, supported by the NIHR, aimed to develop a prognostic model for identifying those people at a higher risk of poor outcome after an acute ankle sprain.

Their study on the SPRAINED (Synthesising a clinical Prognostic Rule for Ankle Injuries in the Emergency Department) prognostic model was published in the open access BMJ Open journal.

Dr David Keene of NDORMS, who led

Image: Freepik

Clinical tool for helping patients with acute ankle sprain Identifying those at a higher risk of poor outcome after an acute ankle sprain

the study, said: “Many patients arrive at A&E in a lot of pain, making these injuries very difficult to assess. Currently, the majority of patients are not referred for follow-up visits to monitor progress or physiotherapy, as clinicians cannot predict who will recover and who would potentially

benefit from further care.

“The new SPRAINED tool will provide clinicians with a risk score, supporting their decision making process when providing advice to people with ankle sprains, and when deciding on ongoing management.” www.nihr.ac.uk

Image: yanalya/Freepik

e-Referral gives patients control over their healthcare pathway THE NHS e-Referral Service has hit 100 million bookings since it was launched in 2005 as the NHS Choose and Book Service.

Currently, the service is booking around 400,000 referrals a week. It allows patients or clinicians to book appointments in hospital or other care settings online and has been shown to reduce the number of people who fail to

attend their appointment.

The latest guidance for GPs includes advice on encouraging patients to look after their own bookings and appointments through the Manage Your Referral website. This means patients will be able to manage their appointments 24/7, allowing them to check, cancel or change their bookings around the clock.

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8 TALKBACK PHYSICAL ACTIVITY

Image: Freepik

New funding to tackle inactivity and Bringing people closer to nature THE GREAT outdoors is being used to boost activity thanks to an investment of more than £430,000 from the Opportunity Fund.

Three projects are each receiving more than £140,000 of Lottery funds to help them provide volunteer programmes.

The Cheshire Wildlife Trust’s “Go Wild, Get Fit” programme will see volunteers given the opportunity to take part in a range of conservation activities, while Kent Wildlife Trust’s “Down to Earth” initiative is focused on women aged 20-45 and aims to create a pool of volunteer leaders.

The final programme, “Flourish in Nature” from EDP Drug and Alcohol Services in the south west, will engage and support people in recovery from substance abuse to become volunteer activity leaders.

Executive director of sport, Phil Smith, said: “When people volunteer in sport and physical activity there’s a dual benefit – volunteers help others in their communities to get active, as well as benefitting themselves.

“Volunteering can do wonders for job and career prospects, mental health and making friends.”

The Opportunity Fund was launched alongside the Potentials Fund – which focuses on youth social action – and aims to encourage people to volunteer and help tackle challenges their communities face. Jointly, they have received £3m in funding.

Projects, of which there are now 37 across both funds, are located in areas ranging from inner cities to remote rural areas with few services.

MORE THAN £16m will be spent on 10 sports over the next two years to help tackle inactivity and develop talented athletes.

British Cycling and Exercise Movement and Dance UK will prioritise recruiting people who regularly dip in and out of exercise; Swim England will look to engage the quarter of the adult population who do fewer than 30 minutes of physical activity a week.

England Netball and Volleyball England, Angling Trust, Baseball Softball UK, the British Equestrian Federation and the England and Wales Cricket Board, will focus their resources on maintaining and

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building their existing base of participants. British Fencing also receives funds for its high performance programme.

“Millions of people love sport and take part regularly and we don’t take their commitment for granted,” said Sport England’s executive director of sport Phil Smith. “Even the most enthusiastic people can sometimes find it hard to maintain the habit, especially when life gets in the way.

“This funding of national governing bodies is to help increase the number of people engaged in sport, through investing in clubs, coaches, facilities, equipment and new ways to play.”

Image: rawpixel.com/Freepik

Governing bodies look to expand their customer base

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Image: jcomp/Freepik

develop sports talent

Guide to help those with dementia take up activity A DEMENTIA-friendly sport and physical activity guide has been produced in conjunction with the Alzheimer’s Society.

The document aims to help the sports sector bring down barriers that prevent people living with dementia from taking part in sport and physical activity.

The aim is to transform the way the sport and physical activity sector thinks, acts and talks about dementia – with every leisure centre, community hall and sports club equipped with the resources to meet the needs of those living with the condition.

Dementia is one of the greatest challenges facing society today and there are more than 850,000 people living with the condition in the UK. Yet many people with dementia say they experience barriers to taking part in activity.

Confidence

Cash will create 200 new parkrun events A £3m investment in parkrun will support the creation of 200 new events across England over the next three years. Sport England wants the free 5km runs to focus on helping more women and people from lower socio-economic groups to get active.

The National Lottery money will help to build on

BY THE NUMBERS l 197 Average number of participants per parkrun l 13.4 Average number of parkruns participated in, per runner

the phenomenal growth parkrun has seen in the 14 years since its creation.

With events taking place in 584 locations around the UK each weekend, parkrun has seen more than 1.8 million people take part to date and the aim is to extend that network.

“We know from our research that cost and a lack of local opportunities are real barriers in stopping people being more active, and what parkrun does brilliantly is offer free, community-based events for all abilities,” said Sport England chief executive Tim Hollingsworth.

The new investment will

enable the modernisation of parkrun’s digital platform for registration, results and event information, in order to allow it to continue to grow, said Parkrun’s chief executive, Nick Pearson.

“Our growth over the past 14 years has been organic and to a large degree dictated by community demand, not need.

“If we are to realise our target of increasing the number of parkrun events by one third in socially deprived areas in England over the next three years, we require a level of investment that will allow us to be proactive rather than organic in our approach.”

These could include difficulty in getting around a sports facility or remembering how to use equipment in a leisure centre. Others say they worry about people’s reactions: for example, staff not understanding their difficulties, or a lack of confidence in finding the right activities.

The practical guide provides tools and guidance so that the sector can help more people affected by dementia enjoy the benefits of staying active in a caring and understanding environment.

Jeremy Hughes, chief executive officer at Alzheimer’s Society, said: “Visiting a gym, sports centre or favourite leisure facility to take part in physical activity can be daunting for people with dementia, loved ones and friends – but with support and adjustments from sport and physical activity providers, they can remain active.” www.sportengland.org

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10 TALKBACK LONDON MARATHON 2019

Countdown to BackCare runners Come 10am on 28 April, BackCare runners will be at their starting positions for the 2019 Virgin Money London Marathon.

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IN THIS, its 39th year, the London Marathon has continued to grow in size and prestige. An extraordinary 414,168 applicants from the UK and overseas registered for a ballot place for 2019 – and close to 55% of the UK applications were from people who had never run a marathon before.

This year’s event is set to pass another major landmark when a total of £1billion in charity funds will have been raised since its outset – cementing the London Marathon’s status as one of the world’s greatest sporting events.

Once they cross the starting line at Blackheath, the 40,000 entrants can expect to be cheered continuously by the hundreds of thousands of spectators lining the 26.2-mile

route. The Marathon course is flat and fast. It heads east through Charlton and Woolwich for three miles, turns west and passes the Cutty Sark in Greenwich after six to seven miles. It crosses the River Thames at Tower Bridge and then loops around the east end of London, past Canary Wharf in Docklands, before heading west again along the Highway and the Embankment to Parliament Square, Birdcage Walk and the final corner in front of Buckingham Palace.

BackCare’s runners – many of whom have beaten the odds through pain, illness and injury to meet this challenge – are raising vital funds for a cause that’s close to their hearts, and TalkBack is proud to celebrate their stories

Robert Moncreiff

Neill Hadden

Jon High

I’ve suffered from chronic back pain all my life and, after an acute vertebra collapse left me crippled in the short term and seriously worried about my future, I’m keen to prove I’m back to full strength by completing my first ever marathon.

Seeing how many people suffer the debilitating effects of chronic back pain I invented the Motionlab Active Commute bag, which is the first backpack in the world to take all the weight off your shoulders, alleviating back and shoulder pain and preventing injuries.

This year I’ll be raising funds for BackCare by running the marathon while carrying a fully loaded Motionlab backpack. I hope to show that we really can find solutions to beat chronic back pain, while also raising funds to help others get back to leading full, happy, pain-free lives.

I hurt my back six years ago and experienced a whole new world of pain which prevented me from working for six weeks and from sitting on the sofa for nearly a year. This experience changed my perspective on life and I decided to go sailing around the world for a year. No problems with my back!

On my return, I adapted again to an urban lifestyle (including lots of sitting) and consequently had another episode of significant back pain. Since recovering from this, I have taken up running and set myself the challenge of running the marathon.

Much like my decision to go sailing, this was taken from a slightly naive perspective and I am now beginning to realise what an undertaking it is.

Training is going well however and I am delighted that I can help to support this charity and raise awareness of back issues at the same time.

I started running 18 months ago because I was overweight, unfit and unhappy about it. My progress, like my running, was slow, but over time I could tell that something changed in me.

I started enjoying it!

I realised that running is a great privilege, I’ve learned so much about myself and joined a community of people who are challenging themselves to be their best. That’s where my marathon journey began – I wanted to see whether I could do it, to push myself to be as good as I could be doing something I loved, and to show my children that you can achieve your dreams, but you have to work at it.

Running has unlocked major improvements in my health, not least of which is significantly reduced back pain, and so when the chance came to run the London Marathon for BackCare, I couldn’t turn it down!

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Santa Claus closing in on the finishing line in 2017

Mo Davies

Aron Burghart

Myra Taylor

Luke Oscar

My lovely brother Brian and husband Richard passed away suddenly last year which made me realise how precious life is.

Brian had done many charity events for BackCare which inspired me to apply for the Marathon – it had always been an ambition of mine. I wanted to ensure I had a connection with the charity I raised money for.

Training began in January and I’ve been building up the miles.

I’m also working with a PT in the hope of getting stronger, plus running 4-5 times a week. It’s been my toughest challenge but it has inspired me to raise as much money as possible – and to finish!

Many years ago, I suffered a back injury. Once I got back to full health, I strongly believed that maintaining fitness keeps my back strong and the aches and pains away. So as long as I’m able to keep this ageing body running then I will.

I’m nowhere near a fitness junkie though, just an ordinary working bloke that likes a pint and a good meal. Running keeps me going and able to chase the grandkids around.

Having a target to aim for like the Virgin Money London Marathon gives me incentive to get out there on chilly dark Sunday mornings for a long run.

I started running in 2013 after a dare and never stopped!

Satisfied initially with the shorter distances, I was adamant that I would never do a marathon. But as someone who loves challenges, marathons were inevitable.

Thanks to BackCare, the London Marathon will be my seventh! I’m currently chasing the 6-star medal for the Abbott World Marathon Majors. I love travelling around the world, doing this series and helping charities like BackCare; its mission is important to me because I’ve been managing back pain since 2009. With proper care, anything is possible!

Taking care of my back has been key all my life, with my mother and grandmother being osteopaths. This inspiration was the driving force behind becoming a director for Kids Backs for the Future, a community interest company helping prevent back pain and injury in young people.

It is a great opportunity to run the Virgin Money London Marathon 2019. Thank you BackCare for providing support and research to help reduce the impact of back and neck pain for the many who suffer. Good luck to my co-runners! Together we will make a difference! continued on p12 >

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Image: Courtesy of Virgin Money London Marathon

pounding the streets of London

12 TALKBACK LONDON MARATHON 2019

Lyndi Wiltshire

Abigail Grand

Laura Purssell

Alice Pike

Everyone who has ever known me understands the importance that exercise and sport has played in my life. In 2014, while on a relaxing run I suffered a bulging disc which turned my world upside down. I went from ‘super fit’ to virtually immobile overnight.

Having to cope with the inactivity and the loss of my type of relaxation was unbelievably stressful. I can truly understand how distressing having a back injury can be on a person and their wellbeing. I was lucky; I went through months of rehabilitation and support from specialist practitioners and have now made a full recovery.

I have decided to run the London Marathon in 2019 to support the work of BackCare, which supports people in the same situation. I know the money raised can help me, in helping others achieve the same recovery, and assist BackCare to give others the opportunity for good health and wellbeing following such an injury.

I gave birth to my son in 2017, following an emergency C-section. Unfortunately, I picked up sepsis and was in hospital for 10 days. Over the years, I’ve enjoyed athletics, horse-riding, hockey and now running. Since my early 30s, I started to suffer with bad lower back pain. For seven years, I suffered with sciatica but with regular physio and exercise I have beaten both and I’m now pain free – at the age of 41!

I have always dreamt of running the London Marathon.

As a child, I talked about running it; this stemmed from my uncle running it 10 times.

Sadly, he passed away in 2018.

My Mum ran it three times. In October, I found out I had a BackCare charity place and I feel so lucky to have it. Wish me luck and I hope to make you, my uncle and mum proud!

I decided to run the London Marathon this year and didn’t think twice about running on behalf of BackCare.

As a chiropractor, I see people suffering with musculoskeletal conditions every day and I have seen the impact it can have on their day-to-day lives.

Whether that’s not being able to exercise, go to work, or to spend that special time with their grandchildren.

It is also a huge personal goal for me to do something like this, as prior to training I had never even run 5km before!

Even though this is a huge feat, I don’t take for granted that I am able to train for something like this where others may not be as able. So, anything I can do to further help people with their musculoskeletal issues I will give it my 100%!

I’ve suffered from back pain from the age of 17. Over the years I have learnt to live with the condition and have found exercise is one of the best therapies.

Therefore, I have chosen to run the marathon and hope the funds I raise will be able to help others in similar situations.

Who else is raising funds for BackCare?

Images: Courtesy of Virgin Money London Marathon

Ian Jackson Paul Jones Paul Logan Robert Martin Jon Murgatroyd El Ogilvie Vicki Bailey Samantha Gabb Adrian Gasser Simon Wright Corrie Thompson Abi Webb Melanie Whittall Matt Russell Paul Richardson Arrun Saunders

Last year’s London Marathon coincided with a spring heatwave... but still attracted good numbers in fancy dress

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TALKBACK LONDON MARATHON 2019 13

£1.5m in grants for regional projects The London Marathon Charitable Trust has announced new grants totalling £1,569,580 for projects in London and Surrey, taking the total amount of money awarded by the trust to more than £78m. The largest grant in the latest round of funding has been awarded to the London Borough of Croydon with £500,000 towards the development of the Purley Way Playing Fields Parklife Community Facilities. This project will develop the existing playground, building new community football facilities and a games area for new activities aimed at children, young people with disabilities, women and girls. www.virginmoneylondonmarathon.com www.backcare.org.uk

Course records l Course record men (2016) Eliud Kipchoge, KEN, 2:03:05 l Course record women (2003) Paula Radcliffe, GBR, 2:15:25 (mixed race) l Wheelchair record men (2009) Kurt Fearnley, AUS, 1:28:57 l Wheelchair record women (2017) Manuela Schar, SUI, 1:39:57

Top effort!

As ardent followers each year of this amazing spectacle, here’s our five favourites from the 34 Guinness records that were broken in 2018: l Rob Pope, Fastest marathon in film character costume (Forrest Gump) 2:36:28 l Barnaby Hopson, Fastest marathon dressed as an insect 3:14:24 l Louise Andrews & Neil Sheward, Fastest marathon three-legged (mixed) 3:59:56 l David Smith, Fastest marathon dressed in motorcycle leathers 4:00:11 l Michelle Frost, Fastest marathon on stilts 6:37:38.

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14 TALKBACK PAIN MANAGEMENT

REPLACING short-term pain relief injections with long-term physical and psychological rehabilitation programmes could help tens of thousands more patients cope with debilitating back pain, according to a new Getting It Right First Time (GIRFT) report on spinal surgery.

The latest GIRFT national report found that, despite NICE guidance, a significant number of patients are still receiving facet joint injections (injections of local anaesthetic and/ or steroids to block pain), which have limited clinical value. On average, between 2015 and 2018, almost 6% of patients with back pain received three or more facet joint injections in a year, at a cost to the NHS of £10.5m.

Reinvesting this money in longerterm physical and psychological rehabilitation programmes – close to patients’ homes – is one of the key recommendations in the GIRFT report. This is in line with the National Low Back and Radicular Pathway, endorsed by NICE. A series of 22 recommendations bring opportunities to improve the patient experience through earlier discharge from hospital, reducing cancelled operations and ensuring

trusts are equipped to deliver the best care in the most timely manner.

It is estimated the recommendations could deliver cost efficiencies of up to £27m.

Among the other key recommendations in the report are: l Referral without delay to 24hour MRI scanning in all hospitals for patients with suspected cauda equina syndrome (a spinal emergency which can lead to limb paralysis and permanent loss of bowel and bladder function if not treated quickly). l All major trauma centres to have the ability 24/7 to stabilise and decompress the spine in patients with fractured and dislocated spines. l Suggested changes to the referral pathway of paediatric spinal deformity patients to enable children to be treated close to home where appropriate, but at a centre with the shortest waiting time. l Better recording of implants, their use and patient outcomes.

The report’s author, Mike Hutton, a consultant spine surgeon at the Royal Devon & Exeter Hospital, visited 127 spinal units across England in his review. https://gettingitrightfirsttime.co.uk

Image: kjpargeter/Freepik

Spinal surgery report calls for rehab to replace short-term fix

Mobilisation and exercise can help reduce A COMBINATION of joint mobilisation and exercise can significantly decrease pain for people with knee osteoarthritis according to a new study from the Prince of Wales Hospital, Hong Kong.

The mobilisation is relatively simple.

Patients were instructed to lie on their side, with the knee supported and

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slightly flexed. This allowed the patella, or kneecap, to glide vertically from side to side. This mobilisation was performed over a course of three sessions once every two months.

Patients were also instructed to perform certain exercises twice a day in order to encourage the muscle to keep firing. After 24 weeks, the patients scored their pain

levels by using the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain score to self-assess their pain.

The patients that had undergone the mobilisation and exercise scored significantly lower on the WOMAC scale than a control group of patients who hadn’t undergone the treatment, indicating

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PEOPLE are more likely to recover from shoulder pain if they have the confidence to carry on doing most things, despite their pain – according to new research from the University of East Anglia and University of Hertfordshire.

Researchers studied more than 1,000 people undergoing physiotherapy for shoulder pain. They found that those who expected physiotherapy would help them were likely to recover more than those who expected minimal or no benefit.

Meanwhile, people suffering more pain, who were confident in their ability to still do most things despite their pain, were likely to recover better with physiotherapy than those suffering less pain, but who weren’t confident.

The team investigated the strength of a patient’s belief or confidence in their own ability to complete tasks and reach a desired outcome despite being in pain – known as “pain self-efficacy”.

Most patients significantly improved during their course of physiotherapy. The most important predictor of outcome was the person’s pain and disability at the first appointment – higher (or lower) levels were associated with higher (or lower) levels six months later.

But the most interesting finding was that pain self-efficacy could change this outcome.

Lead researcher Dr Rachel Chester, from UEA’s School of Health Sciences, said: “We looked at people who started off with a high

Image: Freepik

Self-belief is “key to recovery” from shoulder pain

level of pain and disability and found that the more they believed in their own ability to do things and reach a desired recovery outcome, the less likely they were to be in pain and have limited function after six months.

“What really surprised us was that these people were more likely to have a better outcome than people who reported a low level of baseline pain and disability but had low pain self-efficacy.

“In addition, on average, people who expected to recover because of physiotherapy did better than those

who expected minimal or no benefit. We recommend that physiotherapists help patients understand and manage their pain and to select treatments and exercises which help them build confidence in their shoulder and optimise their activity levels.”

Self-Efficacy and Risk of Persistent Shoulder Pain: Results of a Classification and Regression Tree (CaRT) Analysis is published in the British Journal of Sports Medicine. The research was funded by the National Institute for Health Research (NIHR). www.uea.ac.uk

that they were experiencing much less pain.

More studies will need to be done to show the full potential of this type of treatment and how long the effects on pain may last for, said Dr Devi Rani Sagar, research liaison manager at Versus Arthritis.

“Testing new treatment approaches is essential if we are going to improve the

Image: Freepik

knee osteoarthritis pain quality of life for millions of people with arthritis.

“However, we also need to focus on prevention and early intervention. We need arthritis, including knee osteoarthritis, to be taken seriously and recognised as a priority.” www.versusarthritis.org www.womac.org

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16 TALKBACK HOME CARE

Image: rawpixel.com/Freepik

Squeeze on home care finance is leading some providers to withdraw from the market.

Uncertain future for public funded home care THE FUTURE of home care remains uncertain, with some major providers withdrawing from the market, quality “far from uniform” and with the constant struggle to recruit and retain staff.

These conclusions are drawn from a new report by The Kings Fund. Between 2016 and 2018, the health think tank carried out three pieces of research exploring: the factors driving commissioning adult social care; the mechanisms of purchasing and delivery of home care; alternatives to traditional models of delivering care at home.

Home care (or domiciliary care) is in the front line of social care delivery in England, with around 257,000 older people and more than 76,000 younger people using publicly funded home care in 2015 and others paying for their own home care. Home care is largely about personal care – help with washing, dressing and eating – but the term also covers re-ablement services for those leaving hospital and broader support, for example to help someone with learning disabilities live independently.

Local authorities have a duty to “shape” this market and ensure there are enough

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quality services to meet demand. Yet lack of available home care is a significant reason for delayed discharge from hospital, says The Kings Fund.

Facing a £16 billion reduction in government grant funding since 2010, councils have attempted to control expenditure on adult social care, including by reducing the rate they pay providers for commissioned home care. Though there are signs that this squeeze is coming to an end, rates paid still differ significantly from one part of the country to another.

Low status More than a third of local authorities report that providers have handed back home care contracts, and some of the largest providers have withdrawn from the publicly funded home care market.

Securing an adequate workforce is one of the greatest challenges facing home care, fuelled by the low status of care work, which in turn is related to poor pay and job security. Competition for staff is intense, even within the health and care sector, with employment in the NHS and care homes being more attractive to some workers.

Many commissioners reported that they were frustrated by commissioning on a “time and task” basis, prioritising procedures and the amount of time spent on delivering care rather than considering the longer-term outcomes of the care provided. A key problem was the requirement to collect and monitor outcomes data, which some commissioners doubted providers had the infrastructure to implement.

Alternative approaches to home care provision include Shared Lives, in which individuals are supported in a paid carer’s home, and others such as local area coordination, which aim to harness a person’s own resources and those of their family and community to support them more effectively. While these models reported strong outcomes, there were doubts about the extent to which they were fully scaleable or could fully replace traditional home care services.

Other approaches using assistive technology and telehealth to improve or replace existing services have not yet had time to be properly evaluated. www.kingsfund.org.uk

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HOMESHARE, the initiative that matches lonely older householders with younger people in need of affordable accommodation, is gaining recognition as an effective approach to helping people with low-level support needs.

Actually, it does a lot more than that. By supporting older people in their homes for longer, it reduces the strain on A&E and social care services, while helping those in need of affordable housing and making better use of housing stock.

The premise is simple. The homesharer obtains a cheap place to live in return for companionship and a spot of help around the house. This does not involve any personal care, but may include shopping, gardening or help with the computer. The householder has the reassurance of having someone in the house, especially at night, while the new housemate has the comfort of being part of a home.

Monthly fee The programme co-ordinator – usually a charity – ensures each Homeshare match is individually suited and carefully agreed, and the sharer and householder pay a monthly fee to cover administrative and support costs. This can vary from scheme to scheme; for example, with Homeshare Oxford, a recent pilot scheme managed by Age UK Oxfordshire, the sharer pays a monthly fee of £200 (in place of rent) and the householder pays £100 a month.

Everybody wins with Homeshare, that’s the theory

Image: bearfotos/Freepik

Home share approach offers a lifeline to the isolated

A Homeshare match takes into account personal interests and any support requirements of individuals at any rate. Even for public authorities, the idea addresses a range of important policy objectives. Despite this, they have been slow to adopt it and it has fallen to charities like Shared Lives Plus, Age UK and Foyer Federation to take the lead, backed by £2 million initial funding from Lloyds Bank Foundation and the Big Lottery Fund for England and Wales.

This vital support has enabled the development of eight new schemes and a national network, Homeshare UK.

With safeguarding a natural concern for householders and their family members, the expertise and oversight

by Homeshare co-ordinators is key. Potential candidates are screened and matched sensitively, the contract is negotiated carefully to suit both parties, provides support and monitors outcomes.

Currently, more than two thirds (69%) of householders and 81% of homesharers are female, though the proportion of male participants

Company works its magic “I value the company the most, because I was on my own, had no one to talk to and you get bored when you’re on your own. Now that I’ve got Lauren (homesharer), I’ve got someone to talk to.”

Householder, PossAbilities “Dad seems much happier. He enjoys the company and he and Greg have become close. As an only child, the responsibility is all on me. It feels like a weight has been lifted off my shoulders.”

Son of householder, Homeshare UK

is steadily growing. Sharers are often students, though not exclusively. As part of the “contract”, they commit to 10 hours of help a week around the home and contribute an agreed amount towards household costs, although it is clear that successful matches enjoy spending time together over a meal or a cup of tea.

Reportedly, six Homeshare schemes in the UK are now financially sustainable. The aim is to build on the numbers of compatible participants as word begins to spread through communities. Positive feedback is helping and, where matches have been made, evaluations show how the lives of both parties are enriched, with improved mental health, intergenerational learning and sharing of skills. https://homeshareuk.org www.ageuk.org.uk/oxfordshire

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Image: yanalya/Freepik

18 TALKBACK WORKPLACE

Organisations can implement a healthier workplace culture

Employers could do more to prevent work-related back pain ONE THIRD of Britons have taken at least one day off work due to back or neck pain in the past year, resulting in 12 days off work on average, new consumer research reveals.

The research, from the British Chiropractic Association (BCA), also found that 40% of workers who spend most of their time at work sitting don’t feel they are able to take regular breaks, with only 6% reporting they are actively encouraged to. This is in spite of almost half (45%) of people who have experienced back or neck pain identifying sitting for long periods of time as a trigger for their condition and getting up from your desk being one of simplest and most effective ways to combat the pain.

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The BCA study also found that only a minority of employers are proactively offering support to workers. Less than a quarter (23%) of respondents had been offered advice by their employer on how to sit at their desk to prevent work-related back pain, and only a fifth had been offered a desk assessment, ergonomic chairs or laptop stands.

Catherine Quinn, chiropractor and BCA President said: “No-one should feel chained to their desk all day at the expense of their health and it is an organisation’s responsibility to empower staff to look after themselves in the office.

With so many workers missing work due to the condition, it is truly in employers’ interests to offer proactive help and advice to protect the health of their employees.”

Tips for employers l Workstations: consider bringing in an external organisation to undertake desk assessments for staff. They can offer personalised advice on the best way to set up workstations to prevent back or neck pain l Technology: a number of accessories are available to promote healthier working, from adjustable screen stands, to standing desks or active seating which encourages the use of your core muscles when sitting l Healthy breaks: implement a company culture which empowers workers to take breaks from their desk and stay active, for example by organising lunchtime walks or offering gym incentives to personnel. https://chiropractic-uk.co.uk

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Building a hard evidence base on the impact of sedentary work

Heart disease The relationship between sedentary work and occupational health is not a new issue and has been the subject of epidemiological research for more than 60 years. In the early 1950s, researchers (Morris et al) demonstrated that there was a higher mortality rate and risk of first clinical episodes of coronary heart disease (CHD) and earlier onset of CHD for bus drivers than there was for the conductors. This they linked to the sedentary nature of driving. Similarly, the relationship between sedentary work and back pain has been contested for many years (Kelsey, 1975; Riihimaki, 1991). Much of the research in more recent years has been focused on the wider public health issues relating to a sedentary lifestyle, such as obesity, with sedentary work generally seen as a subset of this lifestyle.

Researchers (Ng & Popkin) estimated in 2012 that sedentary behaviours have increased by 43% in the USA and 47%

Image: Freepik

THE Workplace Health Expert Committee, which provides independent expert opinion to the Health & Safety Executive, recently published two reports on sedentary work and health.

Attempts to reduce exposure to sedentary work in the workplace have been shown to have small but demonstrable impacts on behaviour, but only when the interventions are appropriately designed, the committee found. Currently, while physical activity in leisure time is generally seen to be beneficial for health, some physically active occupations have been associated with poorer health and this needs to be clarified to prevent confusion for both employers and employees.

While there is little contemporary evidence that occupational sitting is associated with an increase in musculoskeletal symptoms, such problems are reported in young workers/ adolescents and the committee believes this should be a focus of attention, especially as this demographic will form the future workforce.

There is a need for more reliable measurement of the relationship between sedentary work and back pain in the UK since the 1960s. Shifts in the nature and design of work are used to explain these changes. However, self-reported postural behaviours and the use of job titles as a substitute for measurement of workplace activities, are recognised as having poor validity and reliability. As a result, most studies are subject to significant potential for exposure measurement and classification errors that may reduce the strength of associations, the committee reports. However, recent advances in technology mean that simple, ambulatory recording devices that recognise many different physical behaviours may rapidly change our ability to record exposures in sedentary work.

Such studies will inform our knowledge of potential risk and make it easier to establish the benefits of any workplace intervention strategies.

Would attempting to reduce exposure to sedentary postures in the workplace make a difference? Chau et al (2010) reviewed the literature regarding workplace studies to reduce sedentary work. They found few, high-quality studies and no evidence of significant, effective interventions. A small study by Pronk et al (2012) considered the benefits of a sit-stand device for a range of workers with sedentary jobs. They reported a reduction in sitting of 66 minutes a day (representing a reduction of 224%) along with reduced upper back and neck pain and improved mood states (Grove & Prapavessis, 1992). The study results are of interest and the committee concluded they should be the subject of further research where problems such as random allocation to the intervention groups and improved exposure assessment might be overcome. www.hse.gov.uk

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20 TALKBACK COMMUNITY

Prioritise pedestrians, cyclists and public image: katemangostar/Freepik

Physical inactivity is responsible for one in six deaths and is believed to cost the UK £7.4 billion each year, including £900m to the NHS.

People can feel less safe when they walk or cycle compared with when they drive

Award winning inventor of patient lifting and DAVID Edmund Talbot Garman, the inventor of the world’s first portable powered bath lift, among other products, died peacefully at his home in mid-Wales on 4 January, aged 96.

In 2007, aged 85, Mr Garman was awarded the British Healthcare Trades Association Lifetime Service Award for his contribution and dedication to the rehabilitation industry.

In the Queen’s New Year’s Honours 2015,

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he was awarded an OBE for services to healthcare in appreciation of his invention of the bath lift and other patient lifting and handling equipment now used internationally in private dwellings, day centres, hospitals and care homes, as well as by ambulance services.

He designed and manufactured his products through Mangar International, a company he founded with his wife,

Francesca, and which he sold in 2014, when he was well into his 90s.

As a carer for a number of his elderly relatives, he became aware of the difficulties in bathing experienced by older people, which inspired the portable powered bath lift for which he won the HTV Design Award in 1981. He successfully visualised and commercialised this product, which would result in a safe and dignified

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PEDESTRIANS, cyclists and those who use public transport should be given priority when new roads are built or upgraded, the National Institute of Health and Care Excellence (NICE) has said.

In light of the personal and economic costs associated with physical inactivity, NICE wants planners to develop policies and initiatives to ensure safe, convenient, inclusive access for non-motorists.

The aim is to get people to be more active in their dayto-day lives by encouraging active travel that is accessible for everyone, including older people and people with limited mobility. Measures should include tactile paving and even surfaces for those with limited mobility, and non-reflective, anti-glare paving surfaces for people with visual impairments.

“Getting people to be more physically active by increasing the amount they walk or cycle has the potential to benefit both the individual and the health system,” says Professor Gillian Leng, deputy chief executive and director of health and social care at NICE. “As a society, we are facing a looming Type 2 diabetes crisis, which is in part caused by people not exercising enough. We need more people

to change their lifestyle and to take more exercise.”

People can feel less safe when they walk or cycle compared with when they drive. “We’ve got to change this,” says Professor Leng. “Asking planners to prioritise pedestrians, cyclists and those who use public transport when roads are built or upgraded can ensure they are safe, attractive and designed to encourage people to get out from behind their wheel.”

Congested roads Joe Irvin, CEO of Living Streets, the UK charity for everyday walking, said: “For decades our towns and cities have been built to prioritise motor vehicles; resulting in unhealthy air, congested roads and a decline in people walking everyday journeys.

“It’s time that towns and cities were built for everyone – first and foremost for those on foot.

Placing key services like schools, GP surgeries and bus stops within walking distance is vital.

More people getting out and walking everyday journeys, such as to work or school, will make us a healthier country.”

The NICE proposal is made in a draft quality standard for encouraging physical activity, currently out to consultation. www.nice.org.uk

Image: javi_indy/Freepik

transport, says NICE

Demand for physiotherapy staff is still exceeding supply, says the Chartered Society of Physiotherapy

Student intake set to boost physio workforce THE physio workforce is set for a boost as student numbers have soared by 41% over the past four years, according to the Chartered Society of Physiotherapy (CSP).

Analysis by the CSP reveals a dramatic growth in the number of places for physiotherapy students in England. It was also found that around 90% of recent graduates moved into roles in the profession within six months of completing their studies.

Meanwhile, the new physiotherapy degree apprenticeship is ready for delivery, at both BSc and MSc levels, which is also expected to widen access to the profession.

Rachel Newton, the CSP’s head of policy, said she would now like to see a guaranteed five-year NHS contract for all new physio graduates. “This would attract further people into the profession and help to address the need for more physiotherapy staff.”

Demand for physiotherapy staff is still exceeding supply, according to the CSP. Ms Newton also called for training opportunities to be available to provide a pipeline of physiotherapists who can take up band 7 and 8A first contact practitioner roles. www.csp.org.uk

handling equipment dies aged 96 bathing experience for older and disabled people. His later inventions all assist elderly or disabled people and include different types of emergency lifting cushion, such as “the Elk” and “the Camel”, which continue to be used by paramedics and nurses.

When he wasn’t inventing, Mr Garman was a passionate conservationist and naturalist and served for decades as the vice-president of the Radnorshire Wildlife Trust. He invested

heavily in the preservation of flora and fauna in mid-Wales, where he planted one of the largest broadleaved woodlands of more than 10,000 trees near Llandrindod Wells.

David Garman married Francesca Jackson in 1972 and they moved to Radnorshire in Powys, where they lived happily together for almost 50 years. He is survived by Francesca and their four sons, Rupert, Jocelyn, Benedict and Dominic and eight grandchildren.

David Edmund Talbot Garman, right, and in younger years, left

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22 TALKBACK EDUCATION AND RESEARCH

Co-ordinated push to find cure Millions of people in the UK today could have broken bones in their spine which are not being recognised, according to the Royal Osteoporosis Society.

PEOPLE incorrectly think getting shorter is just a natural part of growing old or “just one of those things”, says the charity’s chief executive, Claire Severgnini. “If one of your parents lost height as they got older, then it could be a sign of osteoporosis, which means you’ve got a greater chance of getting it as well.

“And that back pain you’ve complained about could actually be the result of broken bones, especially if you’re over 50.

“The nation is simply shrinking and it is no longer acceptable to think of it as just one of those things that happens as you get older.

That’s why we’ve announced we want to find a cure for osteoporosis and encourage everybody to start to look after their bones, no matter how old they are.

“Imagine losing five inches in height due to the bones in your spine breaking. Now think how that will affect your breathing and eating. It’s surprising, but most people actually know

Most people actually know somebody with osteoporosis without realising it somebody with osteoporosis without realising it.”

Osteoporosis causes bones to lose their strength and break more easily. It is estimated half of all women and one in five men are affected. Osteoporosis itself doesn’t cause pain, the pain felt comes from the broken bones.

The Royal Osteoporosis Society has launched the Osteoporosis and Bone Research Academy which brings together leading researchers, clinicians and academics to advance scientific knowledge of the disease and help drive the development of new medications and treatments.

The Society will set out an osteoporosis research roadmap charting the route to a cure and giving hope to

We want to find a cure for osteoporosis

future generations. Emeritus Professor of Bone Medicine at the University of Cambridge School of Clinical Medicine Juliet Compston, Chair of the new Osteoporosis and Bone Research Academy, said: “That could mean using genomics and other new sciences to improve our knowledge of the causes of osteoporosis and how to prevent it, or regenerative medicine, prevention medicine, big data and engineering. And, importantly, fostering strong collaborations between the osteoporosis and bone health community to strengthen the drug development pipeline.”

More than three million people, aged over 50, are estimated to have a spinal fracture in the UK (broken bones in the spine) of which up to 2.2 million are undiagnosed. n Royal Osteoporosis Society specialist nurse helpline on 0808 800 0035

Image: kjpargeter/Freepik

Go-ahead for rheumatoid arthritis A CLINICAL trial to investigate a preventative therapy for rheumatoid arthritis is about to get under way, having successfully completed patient recruitment.

The randomised, double blind, placebo controlled clinical trial aims to determine whether rheumatoid arthritis (RA) can be prevented if therapy is given to individuals at high risk of developing the disease. A patient is defined as high-risk if there is a presence of autoantibodies in the blood, together with joint symptoms (pain but not joint swelling).

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The study, supported by the NIHR Joint Translational Research Collaboration, had a target of recruiting 206 patients from hospitals across the UK and Netherlands.

Professor Andrew Cope, Chief Investigator on the study and Professor of Rheumatology at Kings College and Guys and St Thomas NHS Foundation Trust, said: “This is a really tough study to recruit to because we don’t have access to existing cohorts of patients in the same way that we do for trials of established disease.

“These at risk subjects are referred by

Image: Dr Kenneth Poole/ University of Cambridge

for crippling disease This is a 3D print of the CT spine scans of a 74-year-old woman taken five months apart. She had osteoporosis within all her vertebrae but nobody had picked it up, so all the vertebrae collapsed.

Sheila’s story Sheila Knight, 79, from Gravesend, Kent, has broken four bones in her spine and lost five inches in height: “I was in so much pain, it was agony. I feel as if my spine is crumbling. It alters my life completely. Because of the disease my bones have squashed down.

I don’t like to make a fuss and I carry on as much as I can. My husband has been too frightened to hug me in case he breaks another bone… so that’s very sad.

If we find a cure for osteoporosis, then my granddaughters won’t have to suffer as I’ve suffered.”

Sheila’s story is viewable at youtube.com/osteoporosissociety

What you can do You can improve your bone health by maintaining a good body weight, not smoking or drinking too much alcohol and taking regular exercise, but there are risk factors you can’t change such as your genes, age, gender and ethnic background. It is important that, up to the age of 30, you build your bone bank and start thinking about bone health. www.theros.org.uk

prevention trials for those considered “at risk” their GPs to early arthritis clinics cross the UK and the Netherlands. We then have to determine whether they fit the “at risk” phenotype.

“It’s tough on these at risk subjects too, because they are not only having to come to terms with being at risk of a chronic disabling disease, but then have to consider the risks associated with taking a preventative therapy – in this case weekly injections of a biological therapy for 12 months.”

The drug, called abatacept, is already

licensed for use in patients with established rheumatoid arthritis. The study is investigating the feasibility, acceptability and effectiveness of a 12-month course of therapy with abatacept. The results from this trial will provide valuable insight into the “at risk” state and whether this intervention is effective.

The study has benefited greatly from the support of many patients, patient focus groups and the National Rheumatoid Arthritis Society.

The researchers will also investigate

immune and inflammatory responses before, during and after therapy with abatacept in order to understand better the immune system at the very earliest detectable stages of the disease.

Professor Cope said: “We chose abatacept because we know it has beneficial effects in patients with established rheumatoid arthritis, it has a good safety profile and because of its beneficial effects on reducing harmful immune responses.” www.kcl.ac.uk www.nras.org.uk

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Image: Courtesy of the Royal Osteoporosis Society

TALKBACK EDUCATION AND RESEARCH 23

24 TALKBACK NEWS

BackCare Awareness Week 7-11 October 2019

BACK PAIN IN GOLF Golfers are the focus of this year’s BackCare Awareness Week, 7-11 October. Low back pain is a common golf injury and recurrent episodes can hinder your enjoyment of the sport and have a huge impact on your life in general.

This year, BackCare will be shining a light on the subject and promoting good back health for everyone involved in the sport.

KEY TOPICS

l Injury factors l Warm-ups and stretches l Treating the pain l Rehab and exercise l Supports and accessories

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Charity No. 256751

Image: chevanon/Freepik

WE WANT TO HEAR FROM YOU! Tell us how you’d like to get involved.

Contact info@backcare.org.uk