14 minute read
a call for evidence
New strategy on women’s health – a call for evidence
A NEW women’s health strategy is examining ways to tackle health inequalities. The government is welcoming written submissions from individuals and organisations who have expertise in the area.
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Despite living longer than men, women spend a greater proportion of their lives in ill health and disability. Secretary of State for Health and Social Care Matt Hancock said the “male by default” problem of the past must be put right. “It can lead to poorer advice and diagnosis and, as a result, worse outcomes. Symptoms can often differ between men and women, and studies show some conditions, like coronary blockages, are more likely to be misdiagnosed among women than men.”
The spotlight on women’s health has been welcomed by healthcare professionals. Rachel Newton, head of policy at the Chartered Society of Physiotherapy, said: “Women tend to have poorer access to rehabilitation services to prevent deterioration or help manage a whole range of long-term health conditions.”
A key area where action is needed is in pelvic rehabilitation. The NHS Long Term Plan is committed to multidisciplinary maternity teams that include physiotherapists who can advise women after childbirth on strengthening pelvic floor muscles, through exercise.
Rachel Newton added: “This level of support needs to be available to women of all ages with pelvic health issues and women should be referred for pelvic rehabilitation before surgical options are considered.”
The deadline to submit evidence for the Women’s Health Strategy is 31 May.
Rehab should be first option for pelvic floor disorders
Image: katemangostar/freepik
Advice function set up to improve efficiency of NHS e-Referral Service
NHS Digital has improved the NHS e-Referral Service (e-RS), to make referring smoother and easier.
Provider clinicians can now turn an advice conversation directly into a referral, making it easier and quicker for busy clinicians to use the e-RS.
Further changes will also allow the advice and guidance function to be integrated into provider systems so that conversations can be directly embedded into the patient’s medical record and clinicians do not have to switch between systems to seek advice from each other.
Martin O’Keeffe, senior clinical lead from NHS Digital, said: “By making it easier for primary and secondary care clinicians to talk to each other, we know that GPs can get the advice they need at their fingertips while hospital consultants can have greater confidence that a referral is appropriate before a patient is referred to them.”
Consultants and other provider clinicians will only be able to convert the advice and guidance conversation into a referral with the agreement of the referrer, where both agree it is in the best interests of the patient to do so.
Image: pressfoto/freepik
Virtual marathon aims to smash record
LACE UP your running shoes and take part in something iconic. While 50,000 people will be running the Virgin Money London Marathon 2021 in London, another 50,000 people will have the opportunity to run the same marathon virtually over the course of 24 hours. From midnight on 2 October until 23:59:59 on 3 October you will be able to take part in one of the World’s greatest marathons, from wherever you are on the planet – and attempt to smash a Guinness World Record for the most runners participating in a remote event.
This year we have 15 virtual, Virgin Money London Marathon places available and we hope our supporters will run for BackCare (or maybe you know a friend or relative who can).
All virtual runners will receive their running numbers before the event as well as their coveted official finisher medal – and if the Guinness World Record is broken you can also claim your Official World Record certificate.
Registration is £50 (+vat) and all we ask is that you raise as much money as you can to help us to help people living with back pain.
“Herniated disc” is not a phrase we tend to learn about in biology classes at school. Patients usually come across it for the first time from a therapist or doctor, just after they have found themselves with excruciating pain in their neck, back or legs, wondering what on earth they have done to themselves. STEPHEN HAYNES reports.
OUR spines are like a stack of cotton reels, with sponge-like cushions between them surrounded by soft tissues. The cotton reels are the bones and the cushions are the discs. When the centre or nucleus of a disc pushes out and even passes through the wall of the disc, this is what we refer to as a herniated disc.
The good news is that the majority of herniated discs can be treated without surgery using manual therapy and exercise or with IDD Therapy disc treatment. It is only a small percentage of cases which go on to have surgery. This article helps to explain what causes a herniated disc and how the non-surgical treatments aim to resolve this debilitating condition.
Healthy discs before herniation
between the bones of our spines. In the spinal column, each bone (vertebra) is a solid structure. In order to bend our spines and cushion the vertebrae which are stacked on top of each other, the discs act as shock absorbers sandwiched between the vertebrae.
The discs are very strong, slightly spongy and provide cushioning. They consist of an outer wall made of collagen and the centre of the disc is made of a toothpaste like substance, called the nucleus pulposus. At birth, the nucleus is made of 80% water and this percentage reduces as we age.
When a disc is healthy and hydrated it is bouncy like a well-inflated bicycle tyre, this is called hydrostatic pressure. The most important thing we can do to look after our discs is to move, have good posture and to drink plenty of water.
Image: freepik
Movement, posture and hydration
The reason movement and good posture are so important is because discs help to support the pressure of our body. If we don’t move, the constant pressure pushes the nucleus of the disc against the outer wall and, over time, weakens it.
The discs absorb water from their surroundings and if they are under constant pressure (compression) they cannot do so. Without water the discs lose some of their hydrostatic pressure and shock-absorbing properties. Additionally, the walls of the disc can dry out and weaken, making them less able to keep the nucleus inside.
We talk about posture with our patients. Sitting and slouching squashes the life out of our discs. This is because if we slouch we put a lot of pressure on the discs at the base of the spine.
The majority of herniated discs can be treated without surgery using manual therapy and exercise or with IDD Therapy disc treatment.
Pressure can also be exerted on the body when the surrounding muscles are weak, meaning there is less support for the discs, and they are squashed even more. The muscles in our back and our “core” muscles provide essential support to keep the spine supported and strong, which takes excess pressure off the discs.
We are recommended to drink two litres of water a day. Our discs are made of collagen, the same material as in our skin. We moisturise our skin to keep it from drying it out. Water in the body is essential for the collagen in our discs and without enough water, the disc walls will dry out and weaken.
When a disc herniates
At any given time, we may have discs bulging out of shape. When the nucleus of a disc pushes out and even passes through the walls of the disc, this is called a herniated disc or disc herniation. Pain can strike immediately.
The spinal column houses the spinal cord and, at each level of the spine, nerves branch off from the spinal cord. The discs separate the vertebrae and allow space between them for these nerves to travel to the different parts of our body.
If the disc herniates, the nucleus can press against one of the nerves and this pressure can cause pain. Additionally, the material of the nucleus causes a chemical irritation to the nerve and pain. When there is an injury to the disc, the body has a natural inflammatory response to heal an injury. Inflammation is a good thing, but, if pain persists, the inflammation can be a source of pain in itself. This is why we often take anti-inflammatories to dampen down the inflammation.
For discs in the neck, this can lead to shooting pains in the arms. In the lower back, it can cause pain in the buttocks or legs as pressure is put on the sciatic nerve, “sciatica”. The lower back has five discs and, depending on which disc has herniated, the pain is felt in different parts of the leg or buttocks as different nerves control different parts of our lower limbs.
The body guards itself when the disc herniates. To stop further injury, the body goes into spasm. This is where the muscles contract rigidly to stop any further movement which may risk damage, and this causes intense pain in itself.
The herniation can be caused by an injury such as falling or a collision, where the impact pushes the nucleus violently against the disc wall causing it to rupture (herniated). Or more commonly, where
How to treat a herniated disc
< from p7 a disc wall has been weakened over time, a twisting movement, poor bending posture, or improper lifting can force the nucleus against the disc wall which is unable to contain it. Herniation results.
How to treat a herniated disc
The good news is that the body will repair itself, provided the conditions are right and the injury is not too severe. However, if the pain persists, the spinal segment is not moving and over time it can become stiff and immobile and prevent the healing mechanism from working normally.
Manual therapy and exercise
Manual therapists work with patients in a number of ways. When someone presents with a herniated disc, we look at the overall function of the body. We can use stretching techniques to ease the muscle spasm and then we use our hands to move the joints, to mobilise them. This mobilisation is important to free the movement and allow the body’s natural healing mechanisms to operate.
A herniated disc is not purely about the spine. As an osteopath, I look at the hips and the whole body. If one part of the body is not moving properly, this can mean that certain movements and thus additional forces pass through the back, eg if the hips are not moving, a twisting motion which would normally be a combination of hip and lower back movement can pass primarily through the back. That puts excessive forces on the discs, and they can herniate. So we look at those imbalances and work on them. Once we get movement back in the spine and start to address structural imbalances, simple exercises to strengthen the muscles will help to support the spine and ease pressure on the disc.
Life after a herniated disc
Image: kjpargeter/freepik
If the disc herniates, the nucleus can press against one of the nerves and this pressure can cause pain
IDD Therapy disc treatment
Disc herniation usually occurs at a specific level. The two discs at the base of the spine, called L5/S1 and L4/L5 are the most common to suffer herniation. The spinal segments are extremely strong and if they become stiff over a long period of time, it can be difficult to take pressure off the disc and get the segment moving again.
IDD Therapy is a mechanical tool which allows us to decompress and mobilise targeted spinal segments.
Patients are connected to the Accu SPINA machine with ergonomic harnesses. Then, using computer controlled pulling forces, IDD Therapy directs a pulling force to a targeted level to gently open the space between two vertebrae and to relieve pressure on the disc and nerves. At the same time, the system gently oscillates the forces, meaning the soft tissues are both stretched and mobilised.
The combination of decompression and mobilisations helps to take pressure off the disc and restore mobility. The treatment forces applied are progressively increased as the body adapts.
IDD Therapy is combined with manual therapy and exercise and patients have a course of treatments over a six-week period, the aim being to relieve pain and create a platform for long-term healing.
IDD Therapy is suitable for most patients with an unresolved herniated disc. The exceptions being if people are pregnant, have metal implants in their spine or they have severe osteoporosis. If a patient has severe weakness in their legs or the herniated disc is causing incontinence, then we would refer them immediately to a consultant.
If weakness and a lack of movement contributed to the disc herniation, certain lifestyle changes will make a big impact on preventing a recurrence of the problem. Gentle activity like walking helps, or specific exercise classes to stay flexible and strong, such as Pilates may benefit. Of course, we want people to be more aware of their posture and hydration.
Most people fully recover from a herniated disc. The goal of registered practitioners is to help people out of pain and onto a path of long-term wellbeing.
l Stephen Haynes is an Osteopath and IDD Therapy provider, and Clinical Director of Active Therapy Clinic in Cirencester, Gloucestershire.
Surgery is a last resort
Surgery is a last resort to treat a herniated disc. When the pain is so severe and unresolved, or if the nerve pain is causing weakness in the leg, then surgery can be carried out to remove the part of the disc pushing on the nerve.
Surgery can relieve leg pain. However, it is not given routinely because there are risks and it does not address the underlying causes of the compression, immobility in the spine and weakness. Hence it is so important to have full rehab when a patient undergoes surgery for a herniated disc.
http://iddtherapy.co.uk/
Redefining integrated MSK delivery and crossboundary working
Growth in NHS activity
NHS activity has grown every year since records began (at an average of 3.3% a year). Over the last nine years (between 2009/10 and 2018/19), the number of attendances in A&E increased by 4.3 million; the number of GP appointments have risen from 222 million in 1995 to 308 million in 2018/19; and outpatient attendances have increased by almost 36 million since 2009/10. www.gov.uk/government/ publications http://arma.uk.net
New national NHS programme to drive life-long MSK battle
A new programme from NHS England, which aims to deliver evidence-informed, personalised, high-quality integrated healthcare, is expected to increase the resource to support MSK service delivery. The initiative, part of the Pathways for Better Health Programme, covers the breadth of MSK including orthopaedics, rheumatology and pain. The programme has 10 workstreams, each led by a relevant clinical specialist: diagnostics; orthopaedics; rheumatology; primary and community MSK provision; spinal services; falls, fragility fractures and osteoporosis; data, validation and coding; communications and developing MSK networks; supporting those with long-term MSK conditions; outpatients.
The primary and community workstream is expected to be vital to the success of the programme overall. The other workstreams all depend on effective support in primary and community services, and having all the pieces of work in one programme will enable co-ordination and help break down some of the boundaries in the NHS.
There’s help on the way for MSK sufferers, spanning primary, secondary and community services.
as the NHS starts thinking about new structures in response to the NHS White Paper, Integration and Innovation: Working together to improve health and social care for all, published in February. This sets out proposals for changes in legislation with the aim of enabling integration within the NHS in England and between the NHS, local government and other health system partners.
Every part of England will be covered by a statutory integrated care system (ICS). These will be made up of an ICS NHS body and a separate ICS Health and Care Partnership, bringing together the NHS, local government and partners. The ICS NHS body will be responsible for the day-to-day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs.
Do you live with chronic pain?
Newcastle University is looking into connections between adult relationship styles, thoughts about pain and the impact on everyday life. If you are over 18 and live with chronic pain (lasting three months or more), please consider taking part in this research project. Claire Borthwick, primary researcher. Email: C.Borthwick2@newcastle.ac.uk http://nclpsych.eu.qualtrics.com/jfe/ form/SV_cwpHJuAcAbifzpA
