Quarterly magazine of BackCare, the UK’s National Back Pain Association
SPRING n 2017
FREE TO MEMBERS
Building exercise into workplace habits
also in this issue: Public Health How creativity positively affects your life Community New resources to help you understand your back pain Events Back Pain Show – the must-see event of 2017
www.backcare.org.uk
2 TALKBACK NEWS
JOIN OUR GROWING NATIONAL NETWORK TODAY 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
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CAMBRIDGE Contact: Ms Mary Griffiths Telephone: 07787 990214 Email: blincomary@gmail.com
READING Contact: Telephone: Email:
Mr David Laird 0118 947 0709 davidlaird@talktalk.net
DERBY Contact: Telephone: Email:
Mrs Christine Sissons 01332 763636 chris.sissons@btinternet.com
SALISBURY Contact: Telephone: Email:
Mrs Barbara White 01722 333925 white.alan@btinternet.com
ESSEX Contact: Telephone: Email:
Mrs Lyndee Oscar 01206 804353 lyndee@kidsbacks4thefuture.co.uk
SOUTHAMPTON Contact: Mrs Jo Goudge-Riley Telephone: 02380 464170 Email: goudgeriley@gmail.com
HARROGATE & DISTRICT Contact: Mrs Lin Tippey Telephone: 01423 865946 Email: keithandlin2@btinternet.com
SWANSEA (WALES) Contact: Ms Gloria Morgan Telephone: 01792 208290 Email: gloriamorgan@talktalk.net
HULL & EAST RIDING Contact: Mrs Beryl Kelsey Telephone: 01482 353547 Email: kelsey59@kelsey59.karoo.co.uk
WEST LONDON Contact: Mrs Teresa Sawicka Telephone: 020 8997 4848 Email: tere_ss@yahoo.co.uk
LOTHIAN (SCOTLAND) Contact: Mrs Jean Houston Telephone: 0131 441 3611 Email: jean.houston@blueyonder.co.uk
WEST MIDLANDS Contact: Mrs Thelma Pearson Telephone: 01902 783537
POOLE & BOURNEMOUTH Contact: Mrs Patricia Bowman Telephone: 01202 710308 Email: patriciabowman@ntlworld.com
WINCHESTER Contact: Ms Gillian Rowe Telephone: 023 8025 2626 Email: gillianmrowe@hotmail.com
TALKBACK LEADER 3
The dream workout? A WELL-KNOWN health club chain has been trialling “Nap-ercise” classes where those too tired for the gym can swap the bike for a soft bed and the chance of some quality midafternoon shut-eye. The idea is aimed primarily at exhausted new parents for whom getting a full 40 winks is considered something of a luxury. In place of the high-octane spinning studio, this alternative space is set at the perfect temperature for snoozing while soothing sounds drift gently through the speaker system. The 45-minute sleep sessions promise to alleviate stress and reinvigorate the mind, body, and even burn the odd calorie. Gyms have a genius for finding ways of charging money for things we can get for free and evidently there is enough unmet demand here for this to become a good earner. The restorative value of good quality sleep is rightly prized; however, it is no substitute for actual physical activity, even if it does take place in a gym. Physical inactivity and sedentary lifestyles are among the most significant health crises today, with the British Heart Foundation1 claiming that a third of us are at risk of fatal heart disease because we do hardly any exercise. The charity estimates that the average man in the UK spends a fifth of their lifetime sitting – the equivalent of 78 days each year. For women, this is around 74 days a year. Along with its cardiovascular benefits,
Contents
regular physical activity can help reduce pain and disability for people with musculoskeletal conditions. This in turn helps individuals maintain their independence and reduces the service burden. Walking is one of the easiest ways to get more active and offers immediate and far reaching benefits. For example, walking for just 30 minutes three times a week has been found to improve the quality of life for individuals with advanced cancer, according to a new study published in the BMJ Open journal2. Any readers who find that walking aggravates their aches and pains might read this issue’s Alexander Technique column which offers tips to help you move with ease and freedom.
How creative activities improve wellbeing 8
Fashion-conscious Brits put style ahead of health 12
Richard Sutton Editor
Industry “ready to engage” in NHS improvements 14
LETTERS TO THE EDITOR:
talkback@backcare.org.uk
1) Physical Inactivity and Sedentary Behaviour Report 2017 2) bmjopen.bmj.com Cover image: Katemangostar/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 Severn, Gloucester.
Simple tips to help you walk with more freedom 22
Twice-a-week Pilates to help treat lower back pain 25 TALKBACK l SPRING 2017
4 TALKBACK NEWS
Who has the more credible plan for tackling the NHS challenges? AFTER Brexit, the NHS is the issue that currently matters most to the public. Mounting evidence of the huge pressures facing health and social care suggest the NHS will be one of the key battlegrounds in the build-up to the general election in June. Chris Ham, chief executive officer at the health think tank, the King’s Fund, has set out five tests for assessing the credibility of the parties’ manifesto commitments. These are:
Ensuring sustainable funding The Department of Health’s budget will rise by around £4.5 billion between 2015/16 and 2020/21 on current spending plans, a long way short of the £10bn increase claimed by the Government. If these plans are left unchanged, patients may be waiting longer for treatment and care.
Improving how care is provided
Working with people and communities
Commit to achieve greater integration of care around the needs of the growing and ageing population. More emphasis must be given to providing care in the community and in people’s own homes, with hospitals and residential care being used only when necessary.
Valuing the contribution of third sector organisations and volunteers in the NHS and social care, and empowering people to play a more active part in their own health and care. It also means supporting families and carers who make a huge contribution.
Giving priority to population health The third test is to translate the rhetoric about prevention into a cross-government commitment to improving population health. This means acting on the wider determinants of people’s health and wellbeing including housing, employment, air quality, diet and nutrition, and opportunities to take exercise and keep fit.
Supporting the NHS and social care workforce Brexit creates a risk that the NHS will lose more EU nationals working in the NHS, thereby adding to the pressures that exist. Chris Ham said: “The true test of the manifestos will be their willingness to confront these issues and engage the public in a grown-up conversation about the balance between public and private responsibilities in a society in which the needs of all are valued and met fairly.”
Real terms decline in social care spending per adult ACROSS England, spending by councils on social care per adult resident fell by 11% in real-terms between 2009-10 and 2015-16. Published figures suggest around six-in-seven councils made at least some cut to their social care spending per adult resident, and one-in-10 made cuts of more than a quarter, according to a new report from the Institute for Fiscal Studies, funded by the Health Foundation.
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Spending fell by most on average in London (18%) and metropolitan districts (16%) covering urban areas like Greater Manchester, Merseyside and Tyneside. More generally, cuts were larger in the north of England than the south. Responding to the IFS research, Caroline Abrahams, Age UK’s charity director said: “This new report lays bare the extent of the care crisis and explains why so many
older people are now missing out on the help they need, often with disastrous consequences for them personally and for other public services, most notably our hospitals. “It also reveals an unacceptable postcode lottery, and there can be little doubt that how much care you receive and, indeed, whether you get it at all varies considerably between different areas of the country.”
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Motability appeals reveal flaws in reassessment system MORE than 50,000 disabled people have lost access to Motability vehicles since changes to disability benefits in 2013. The Government-funded Motability scheme entitles disabled people to lease cars, scooters and electric wheelchairs using part of their benefit. The assessment process changed when personal independence payments (PIPs) were introduced to replace the disability living allowance (DLA). Analysis of official data by Muscular Dystrophy UK shows that the number of people eligible for Motability funding has fallen by half during the reassessment process. In total, 126,300 of the 254,200 people
Image: paymphotography/ Freepik
who were eligible for Motability funding under DLA and were reassessed for PIP by 31 October 2016 have lost access to it. However, statistics from the Ministry of Justice show that 65% of people who contest their PIP award have won
their case on appeal – which illustrates the failures in how cuts have been made. To qualify for the higher level of the mobility component of PIP, which is needed to get a Motability vehicle, a person must be unable to
walk aided or unaided for 20 metres, compared to the previous distance of 50 metres under the DLA assessment. Muscular Dystrophy UK wants the Department of Work and Pensions (DWP) to reverse this controversial change in the rules. The charity is also calling for the DWP to ensure vehicles are not taken away until a final decision has been reached. The appeals process currently takes longer than the time allowed for people to return their cars, during which time some find they have no other option but to purchase a new car locking them into tight financial arrangements before they’re advised their appeal has been successful.
Physio-led unit helps reduce hospital readmission rates
image: Freepik
AN innovative NHS-led physiotherapy service designed to reduce readmission to hospital has celebrated a successful first 12 months of work. The short-stay rehab unit based at a Nottingham care home has managed to cut 90-day hospital readmission rates to just 5%, according to the Chartered Society of Physiotherapy’s magazine Frontline. The unit at The Grand Care Centre takes patients who have been medically stabilised in hospital for a period of rehabilitation before going home. It works closely with community and social services to enable people to get home safely with the appropriate support, helping to free up hospital beds. Some 382 patients have been through the pathway throughout the year with an average length of stay of just under 17 days. Of those, 78% went home (14% went back to acute, 5% went to a medical rehab unit, 3% went to long-term placement). Of those who went home, after 90 days, only 5% were readmitted to hospital (76% stayed at home, 5% went into long-term placement, 4% died and 10% were designated “unable to contact”). The team comprises an advanced nurse practitioner, two part-time physios, three part-time occupational therapists, four assistant practitioners, community support workers, social workers and an Age UK representative. www.csp.org.uk
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6 TALKBACK LETTERS & BOOKS
Letters Dear TalkBack, After several accidents to my back, I can sit, walk and stand for a short time only. Sitting is my biggest problem as it is so restrictive. Going to the cinema or theatre is not possible and definitely no coach outings. I do go out with friends for a meal sometimes when I stand up and sit down. I did have a steroid injection, which didn’t work, and attended pain clinics – all to no avail as far as sitting down is concerned. I go to see an osteopath from time-to-time, when my back is very painful. It would be interesting to hear if any of your readers have a similar problem and how they deal with it. Mrs C London (details supplied) Dear Mrs C, Long-standing back pain is now, sadly, very common. Any pain that continues long after an injury is classed as persistent or chronic.
Most tissue damage in the body resolves within three to six months. When pain is still felt after this period it is most likely due to sensitivity of the nervous system rather than structural changes within the body. Learning to manage chronic back pain is complex and involves retraining the brain and nervous system. Evidence has shown that medication can provide some help with reducing the sensitivity of the nervous system, but it is the more active approaches that yield the best long-term results. When starting to increase your activity levels, it may be beneficial to use analgesia to increase your nervous system’s tolerance to exercise and activity. For you to increase your body’s tolerance of sitting, standing and walking in the long term you need to apply a structured, graded exposure programme to each activity. A graded exposure programme works by: 1) Identifying how much of the activity (eg sitting) you can do now
Practical yoga manual for people with scoliosis A PRACTICAL, easy-to-follow yoga manual for people with scoliosis has been written by physical therapist Rachel Krentzman. Scoliosis, Yoga Therapy and the Art of Letting Go, is published by Singing Dragon and is priced £12.99. At the age of 16, Rachel Krentzman was diagnosed with scoliosis. At 32, she suffered a herniated disk and was told she would have to modify her activities for the rest of her life. Instead, Rachel is now a walking testimonial for how yoga can be used therapeutically to heal your back pain.
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An easy and straightforward read, this manual contains step-by-step illustrated instructions for you to address the physical and emotional factors of your scoliosis. The exercises are easy to follow and perform and no technical knowledge or prior experience of yoga is required. Foundational anatomy is carefully explained so that you can understand your body and your scoliosis before applying the exercises. Exemplary case studies will help you on the path to alleviating your back pain without surgery. www.singingdragon.com
2) Breaking down the gap between where you are now and where you need to be into small manageable steps 3) Identifying and learning what external factors exacerbate your pain (eg time of day, type of chair, stressful situations) 4) Regularly doing the activity throughout the day for short stints, building up to longer ones 5) Progressively overcoming the situations involving the activity that you have been avoiding. You may find it beneficial to seek professional support from your GP or Physio to start and progress a graded exposure programme. Although it is not a quick fix, you will reap the rewards in the long term, so stick at it! Denise Kesson BSc (Hons), MSc, Dip.Ortho MCSP, MHCPC, MAACP, MSOMM YourPhysioPlan.com Co-Founder/ Director
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Memoir: a life of adventure across four continents DI LOFTING squeezed the pips out of life and had a ball. She didn’t start out with all of life’s advantages – dyslexia being just one issue she overcame to achieve a successful career and a happy life. She went into nursing to escape and fell in love with her work, which took her to Canada, New Zealand, Australia and Tanzania. Never Say Di is the memoir of Diane Lofting, a pioneering nurse and NHS manager (and keen artist, photographer, golfer, mountain climber and all-round accepter of challenges) who died last year at the age of 76. Di Lofting had a long and distinguished nursing career, bringing her care and professional skills to patients around the world, but particularly in Bath and the west country of the UK. She was a great storyteller who wanted to inspire others to be courageous and “go for it!”. She thought people should recognise their limitations and then ignore them and do the things they longed to do, regardless. For her, this included climbing mountains, skydiving and adventuring far and wide – often alone and on her beloved Vespa called Blossom – and even being recruited as a spy for the drug squad. Di was diagnosed with cancer in the summer of 2016. Her memoir, written in collaboration with ghostwriter Sue Kelso Ryan, was self-published during the second half of 2016 giving Di the opportunity to hold the finished work in her hand – with a glass of champagne in the other. Never Say Di is written in a warm, accessible style and readers are led through her life story, with its rollercoaster of emotions. It is poignant and sad in places but mostly filled with hilarity and boundless optimism. During her illness, Di suffered from intense back pain and benefited from reflexology and acupuncture, provided by Dorothy House Hospice. All proceeds from the sale of the book go to Dorothy House Hospice Care in Bath, whose staff provided wonderful care to Diane Lofting in her final weeks. Price: softcover £9.99 +p&p; e-book £4.29 www.suekelsoryan.co.uk www.dorothyhouse.org.uk
“They came on to the wards at visiting time and you didn’t know who they were because they would be in disguise. Their way of healing their relatives or friends was to lacerate round the wound and they thought the bleeding would heal the patient. But of course they killed them.” Never Say Di – nursing in Tanzania
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8 TALKBACK PUBLIC HEALTH
Image: asierromero/Freepik
Taking part in “creative activities” such as the arts has the most direct influence in improving a person’s wellbeing in later life, new research from Age UK suggests.
How creativity positively affects
Image: jannoon028/Freepik
Image: utanmax/Freepik
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TAKE UP an arts activity, from dancing and playing a musical instrument to photography, singing, or painting and writing, and it can improve your quality of life in your later years. The Wellbeing in Later Life Index, developed by Age UK in conjunction with the University of Southampton, analysed data from 15,000 people aged 60 and over to measure the wellbeing of the UK’s older population. It looked at how people were doing in different aspects of their lives under five key areas – social, personal, health, financial and environmental. Overall, it showed there is no “magic bullet” for positive wellbeing in later life and that, instead, a host of factors under each of the key areas play a part in contributing to a person’s overall sense of wellbeing. Factors that were found to have a bigger influence in improving peoples’ wellbeing than many people might suppose included having an open personality and being willing to try out new things; being physically active; having a good memory and thinking skills; and a good social network and lots of warm relationships. The “positive” impact reported for creative activities may be partly because older people who are fit and well, with an adequate income
and possibly a good education too, are more likely to want to be able to get involved in such pursuits and more likely to be able to do so, than others who lack these advantages. When the attributes of the top 20% of the wellbeing distribution were compared with those in the bottom 20%, some interesting differences emerged. Those in the top 20% scored considerably higher on thinking skills and had more qualifications; were mostly not living alone; were outgoing and engaged, including in cultural activities; had a good friendship network; were physically active; did not have a long-standing illness; were likely to own their home outright; did not have any serious money worries; and were generally satisfied with local public services. On the other hand, those in the bottom 20% scored lower on thinking skills and had fewer qualifications; the majority lived alone; they were mostly not involved in cultural or social activities and they did not have a good social network. Indeed, tragically, one in eight of these older people reported that they had no friends at all. They were also unlikely to be physically active; the great majority had a long-standing limiting illness and two in five had at least three
TALKBACK PUBLIC HEALTH 9
Image: boryanam/Freepik
your wellbeing in later life diagnosed health conditions. Considerably fewer in this group owned their own home outright and one in four was on an income related benefit. Finally, they were likely to be dissatisfied with their local public services – on which, of course, they were likely to be highly reliant because of their needs.
There is no “magic bullet” for positive wellbeing Even though the index paints a picture of a diverse older population, in which the opportunities to thrive and enjoy later life are not equally shared, it found age itself isn’t a barrier in determining wellbeing in later life: the average age of people in the top 20% and the bottom 20% was very similar, at 70 and 71 years respectively. As the number of people aged 60 and over is expected to pass the 20 million mark by 2030, the index provides a snapshot on how older people are doing now and shines a light on some of the
changes needed to improve the quality of life for our ageing population in the future. Caroline Abrahams, Charity Director at Age UK, said: “The good news from our index is that age need not be a barrier to wellbeing and that there are things we can all do to make life better for individual older people, for our older population as a whole and for ourselves as we age. “Being positive and open, willing to try new things and engaged with what’s going on around us turns out to be incredibly important in sustaining our wellbeing as we get older. Things like playing the piano, singing or dancing all seem to help. “To some extent we can all act on messages like these, but we also need to be realistic and recognise that it is a lot easier to be positive, outgoing and involved if you are in good mental and physical health, financially secure, and well supported by family and friends than if none of these things are in place. “Our index reveals a huge gap between the most and the least favoured older people in our society and shows that we have to do more to help those with the
lowest wellbeing. They are often alone, on a low income, in poor health, and with very few additional resources to fall back on. Good public services can make a huge difference to older people in this position so it is incredibly important that they are sustained. Against this context, the current cuts to social care, the NHS and many local facilities like lunch clubs and day centres are a real worry because it is these least fortunate older people who are most likely to lose out as a result. “More generally, an overall wellbeing score of just over 50% across our entire older population is a cause for concern – we think we should be doing a lot better. Health and finance were the two domains most responsible for holding back this overall score and are both areas where we need to do more. For example, efforts to transform the NHS so it is more responsive to older people with multiple health conditions must be intensified, and policies like the state pension triple lock must stay in place to protect those older people on the lowest incomes.” www.ageuk.org.uk
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10 TALKBACK COMMUNITY
New structure agreed for osteopathic education FOLLOWING a formal signing at the Royal Society of Medicine at the end of January, the Institute of Osteopathy has officially accepted stewardship of the Osteopathic Education Foundation. The charitable trust, renamed as the Osteopathic Foundation, will continue
to use its resources to further the advancement of osteopathy for the benefit of public health. The former Osteopathic Education Foundation was founded in 1947 to financially assist in osteopathic education and research. Since the introduction of its
loan scheme in 2001, the foundation has provided financial assistance to hundreds of students training to become osteopaths, lending close to £700,000. The Institute of Osteopathy represents more than 70% of osteopaths in the UK. www.osteopathy.org
Helping you understand your back pain
The Prudential RideLondon-Surrey 100 takes place on 30 July
Get in gear for capital 100-mile cycle ride BACKCARE has secured places in the Prudential RideLondon-Surrey 100 event and invites cycling enthusiasts to take up these places to raise much needed funds for charity. We would love to hear your story and produce a case study on why you are riding for BackCare and your experience of the whole journey, including your training regime.
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If you are interested, please contact BackCare, emailing info@backcare.org.uk or telephoning 020 8977 5474. Once we have accepted your entry we will send you a copy of the RideLondon magazine and advice on fundraising. The deadline for entries is Friday 26 May so please contact us soon so we can support you on making your online entry.
Show venue for BackCare AGM The BackCare annual general meeting will take place at the Back Pain Show at St Andrew’s Stadium, Birmingham at 3pm on Saturday 20 May. For details about the full event, see page 27.
THE Chartered Society of Physiotherapy is launching new back pain resources this spring, built around the concept of “The 10 things you need to know about your back”. The spine is a strong, stable structure and not easily damaged, so in most instances it is a simple sprain or strain, says the CSP. In these cases – 98%, according to research – people recover reasonably quickly and many do so without treatment. Staying as active as possible and returning to all usual activities gradually is important in aiding recovery. 1 Your back is stronger than you may think 2 You rarely need a scan and it can do more harm than good 3 Avoid bedrest, stay in work and gradually resume normal activities 4 You should not fear bending or lifting 5 Exercise and activity reduce and prevent back pain 6 Painkillers will not speed up your recovery 7 Surgery is rarely needed 8 Get good quality sleep 9 You can have back pain without any damage or injury 10 If it doesn’t clear up, seek help but don’t worry www.csp.org.uk
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BackCare runners go all out at the London Marathon BACKCARE was supported by 28 amazing runners from all parts of the UK in this year’s London Marathon. The Chair, Chief Executive and Trustees positioned themselves at the 16-mile point to cheer the runners on – offering drinks, sugar fixes and moral support – to help energise them to reach the finishing line. BackCare chief executive officer Norma Barry said: “All our runners showed unbelievable commitment to the charity for which we are extremely grateful. They trained diligently and a number have exceeded their fundraising targets. Well done to all of them.” n Finishing times and fundraising results will feature in the next edition of TalkBack.
Claire’s story: one entrant’s compelling reason to run Why BackCare? “My dad has scoliosis and has had the associated pain for years. It is something he was born with and nothing has been done (or could be done, when he was younger) to help him, so I’m keen to help raise money for all back pain sufferers in the hope of better understanding. “My dad has worked all his life and continues to do so part-time now he is 75, as he feels keeping moving is the key to keeping going!”
BackCare runner Michael Tees completes the 26-mile course
Transfer system aims to move patients safely and with ease Top tip Claire staged an 80s night in February to support her marathon bid to raise funds for BackCare, in addition to registering on the Virgin fundraising page.
What gives you encouragement? “I took up running almost two years ago, by going along to the local park run in Great Cornard; I found I enjoyed it and it has grown from there. Last year, I entered a half marathon which was the furthest I had run, so running the London Marathon was going to be a big challenge. “Last summer, I joined our local running club – Sudbury Joggers – and have had lots of support and words of encouragement from them.”
BackCare runner Claire Rooke, from Suffolk
BACKCARE was recently given an exclusive preview of an innovative new patient transfer system that allows patients to be moved in comfort and with dignity in hospital and care environments. The patented Air Cradle can, pneumatically, sit a person up from the supine position or lie a person down from the seated position and slide a patient with ease from surface to surface. The ergonomic design ensures the patient is secure and comfortable at all times, making the unit suitable for situations requiring particularly delicate handling and transfer. The carer does not need to lift the patient and there is no risk of the patient being suspended above the ground. The Air Cradle can be produced in a range of sizes – including for bariatric use – and is available with a toileting aperture option. Robust and light (just 3kg), it is easy to store and to transport, while the accompanying air compressor weighs only 4kg and is quiet to use. The concept was devised by David Edmund Talbot Garman OBE, a British inventor who was awarded a Lifetime Achievement Award by the British Healthcare Trades Association in 2007. It is envisaged that the manufacture and global sale of the Air Cradle patient transfer system will be licensed to a healthcare company or companies capable of exploiting its global potential. n More details from rupert.talbot-garman@live.co.uk
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12 TALKBACK WOMEN’S HEALTH
Skinny jeans, backless shoes and how you carry bags may be contributing to painful back problems, chiropractors have warned.
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TALKBACK WOMEN’S HEALTH 13
Image: Asierromero/Freepik
Fashion-conscious Brits are putting style ahead of their health
NEARLY three quarters (73%) of women have suffered with back pain and their wardrobe could be a cause of the discomfort, new consumer research from the British Chiropractic Association (BCA) has found. Tight clothing that restricts your body from moving freely and fashionable footwear that changes your natural gait can affect your posture and lead to back and neck pain. The study revealed that more than a quarter (28%) of women are aware of the potential risk, yet are not influenced by this in their clothing choices, whereas one third of women were completely unaware that their choice of clothing could have an impact on their health. Commenting on the findings, BCA chiropractor Tim Hutchful said: “Some
Vary what you wear Wearing similar pieces of clothing every day could trigger back pain. Shift the pressure on muscles and joints by varying the styles of clothes that you wear.
Put your best foot forward High heels force you to hold your body in a manner which promotes tension in your spine. If you wear high heels, counteract any potential damage by wearing trainers or shoes with a lower heel from time-to-time and try to choose a wedge or chunkier heel over a stiletto.
of the most popular items of clothing can have a hidden health impact. While overloaded and heavy handbags are a common culprit, some more unexpected items like skinny jeans can also wreak havoc – they restrict free movement in areas such as the hips and knees, affecting the way we hold our bodies. New trends such as asymmetric hemlines, oversized sleeves and hoods and heavy jewellery can also create problems.” The statistics mirror trends seen on the fashion week runways, where mules and heavy jewellery featured prominently. Twenty per cent of women responding in the research said they choose to wear shoes, such as mules, which are without support at the back of the foot, which will increase strain on the legs and lower back.
Get the right support Clothes are important, but what you wear underneath can also affect your posture. Bras need to fit properly so your shoulders don’t take all the strain. When shopping for bras, look for one that has an underband that is neither too tight nor too loose. Ensure the centre-fold fastener sits close to your body and that the straps are not too tight on your shoulders. A fitting at a shop is best.
Try looser clothing Tighter clothes restrict your body from moving freely so looser clothing, such as baggy trousers, maxi skirts, or straight leg jeans, are a good choice.
Similarly, 10% of women are sporting heavy jewellery, such as statement necklaces, which increase pressure on the neck and can compromise posture. Tim added: “While we are certainly not saying stop wearing your favourite clothes altogether, like most things in life moderation is best and there are easy ways you can reduce the impact on your posture and overall health. For example, try to limit the number of times you wear skinny jeans or high heels each week to give your body a break, or use a backpack on days when you have a lot to carry around.” ■ There’s no need to suffer for the sake of fashion. The BCA has come up with these tips (below) for staying stylish and back pain free.
Watch out for overloaded bags Heavy handbags are a particularly common cause of back pain in women. Pay attention to the bag you carry around and regularly check for and empty your bag of unnecessary items. Backpacks are the best design for your posture as they distribute weight evenly across both shoulders, so it’s great that these are back in style. Avoid bags that must be carried in the crook of your arm, as the weight of these held away from your body pulls one shoulder lower than the other, twisting your neck and spine. If your bag has one strap, alternate the shoulder you carry it on or, if it has a long strap, wear it across the body.
Image: Javi_indy/Freepik
TOP FIVE CLOTHING CULPRITS 1 Skinny jeans 2 Oversized bags and those worn on one side of the body 3 Coats with large fluffy hoods 4 High-heeled shoes 5 Backless shoes, eg mules www.chiropractic-uk.co.uk
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14 TALKBACK BRIEFING
MSK community “ready to engage” The Next Steps on the NHS Five Year Forward View document1 was published at the end of March, setting out the NHS’s main service improvement priorities over the next two years, and how its key goals of better health, better care and better value are to be implemented. While there is relatively little which explicitly references Musculoskeletal (MSK) services, the Arthritis and Musculoskeletal Alliance (ARMA) has issued a briefing paper2 to help its members understand where the document has relevance for the MSK community. Here, TalkBack looks at some of the key issues it raises.
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A&E While most MSK services are not accessed through A&E, nonetheless MSK conditions have an impact on one of the key deliverables in terms of delayed transfers of care. Even where the reason for admission was not MSK, one of the common reasons for people needing social care support to leave hospital is lack of mobility due to MSK conditions.
Primary care There is a focus on expanding multidisciplinary primary care, including increasing the numbers of clinical pharmacists, mental health therapists, physician associates and general practice nursing. However, there is no specific mention of some of the other professions which could assist in reducing pressure on GPs, such as allied health professionals. Given the evidence of the value of physiotherapists in GP practices and selfreferral to physiotherapists it is perhaps surprising that this is not an area of workforce that is identified for expansion.
Contract reform Next Steps also makes reference to changing the Quality and Outcomes Framework (QOF). The GP contract links a proportion of practice income to these quality indicators. If the QOF is to be replaced, the MSK community will want to ensure relevant MSK conditions are included in whatever replaces it.
Integrating care locally The NHS Five Year Forward View stated that “out-of-hospital care needs to become a much larger part of what the NHS does. And services need to be integrated around the patient”. Sustainability and Transformation Partnerships (STPs) are seen as the way to do this. The MSK community will need to be able to engage with this. The aim is for STPs to make a transition to population-based integrated health systems. The way STPs will work will vary according to the needs of their local area. “Place based health and care systems should be defined and assessed primarily
by how they practically tackle their shared local health, quality and efficiency challenges.” The network approach to MSK services seems ideally placed to work in this way. The ARMA/NHS England regional MSK events were organised in STP footprint areas for this reason.
Prevention The NHS is working with employers to help people with a health condition to stay in work. MSK is not specifically referenced which is surprising since we know that the Department for Work and Pensions and the Department of Health recognise its importance in this area.
Reduce avoidable demand for elective care Over the last 15 years, the number of hip replacements has doubled and knee replacements have tripled. In the last 10 years, the waiting time has fallen from just under half of patients waiting more than 18 weeks to one in 10. While these improvements look good, they may not reflect more recent changes. Indeed, the recent report from the Kings Fund, Understanding NHS Financial Pressures3, indicated numbers of hip replacements might have fallen in the last year. There is also reference to Getting it Right First Time4 as a means to tackle variations in clinical productivity. This is an area of concern, says ARMA. “We know that some clinical commissioning groups (CCGs) are rationing hip and knee operations in a way that does not comply with NICE guidelines. Reference to procedures of questionable clinical value gives the example of some spinal surgery and we need to ensure this isn’t wrongly applied to procedures of strong clinical value.” There is welcome reference to redesigning patient pathways to allow speedier access to physiotherapy for musculoskeletal patients with back pain.
Strengthening our workforce The predictions are that by 2020 the NHS will be looking after more patients than today. Therefore, the plan is to improve
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in NHS service improvements Funding and efficiency Several measures are proposed to increase efficiency. In terms of MSK, the most significant is “reduce avoidable demand and meet demand more appropriately”. A specific example of Ashford CCG shows a 30% reduction in acute MSK demand and a 7% reduction in MSK spend through introduction of a triage service.
productivity and grow the workforce. Priority areas for workforce growth are listed as nursing, mental health, urgent and primary care. As noted under primary care above, the focus seems to be on nursing and doctors rather than the allied health professionals that we know could improve productivity in MSK services. Delivering the multidisciplinary, integrated working, and effective MSK secondary prevention, is likely to need additional allied health professionals.
Technology and innovation By this summer, GPs will be able to seek advice and guidance electronically from a hospital specialist without the patient needing an outpatient appointment – a development that is likely to benefit patients with some MSK conditions.
Sue Brown, chief executive officer of ARMA, said: “Musculoskeletal conditions represent a significant percentage of the work of the NHS and £4.76 billion of NHS spending each year. The effective delivery of the Five Year Forward View must include these patients and the professionals who treat them. The NHS will find the musculoskeletal community is ready to engage with the challenge of making the changes needed to deliver the vision. We have plenty to offer to support in primary and secondary care.” Sue Brown Responding
to the NHS report, Norma Barry, chief executive officer of BackCare said: “My initial reaction was one of disappointment in that the UK Government appears not to be giving due consideration to what can be done to reduce the costs to the NHS and social care providers of MSK conditions; relieve the pressures on GPs through the use of health professionals; the need to increase the workforce in respect of physiotherapists, chiropractors and others – despite this being included in Higher Education England’s annual work force plan.”
1) www.england.nhs.uk 2) www.arma.uk.net 3) www.kingsfund.org.uk 4) www.rnoh.nhs.uk
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16 TALKBACK ADVERTORIAL
Who else needs chronic Chronic pain is one of the most challenging and difficult conditions people face treating safely and effectively. There is now a new safe pain therapy device that is economical and effective for many individuals suffering with chronic back pain for many years. Pain itself often modifies the way the central nervous system works so that a person actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular – the brain and the spinal cord. It’s well understood that the
extent of tissue injury does not explain the level of pain, and chronic pain can be maintained even after an initial injury has healed. ActiPatch’s neuro stimulation continuously disrupts this signal to allow a good night’s sleep and restores daily activities. The Pain Management publication published a Registry Study of 5,000+ using an ActiPatch 7-Day trial device report a baseline VAS pain score of 8+ of which 2/3 had more than 57% pain relief. This reflects that many individuals respond poorly to drug therapies.
ACTIPATCH LONG-TERM USE: ● 2/3 (including opioid users) reported moderate to complete elimination of pain medications ● 2/3 reported improved sleep ● 3/4 increased physical activity ● 4/5 experienced a substantial improvement in overall quality of life.
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pain relief? This data demonstrates that ActiPatch has a higher response rate and is much more effective than common chronic pain drugs and other therapies for chronic back pain. ActiPatch is drug-free, and unlike medications, there are no adverse effects. It is safe for people with diabetes, the elderly, and those with heart and lung disease. ActiPatch can be used safely 24 hours a day for extended pain relief. ActiPatch long-lasting pain relief has been proven to help people get a good night’s rest. It’s the new pain reliever that lets you be your best! ActiPatch is now available at Lloyds Pharmacy, Boots, Superdrug and Gordons Chemist stores and costs only £24.99 for 720 hours of treatment.
ABOUT THE AUTHOR Ian Rawe is the Director of Clinical Research at BioElectronics Corporation, the manufacturer of ActiPatch® Therapy.
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18 TALKBACK PHYSICAL ACTIVITY
Improving quality of life for advanced cancer sufferers WALKING for just 30 minutes three times a week could improve the quality of life for those with advanced cancer, a study published in the BMJ Open journal has found. Researchers from the University of Surrey collaborated with those from the Florence Nightingale Faculty of Nursing & Midwifery at King’s College London to explore the impact of walking on the quality of life and symptom severity of patients with advanced cancer. Despite growing evidence of significant health benefits of exercise to cancer patients, physical activity commonly declines considerably during treatment and remains low afterwards. Initiatives in place to promote physical activity for those suffering with cancer are normally supervised and require travel to specialist facilities, placing an additional burden on patients. During the study, 42 cancer patients were split into two groups. Group one received coaching from an initiative by Macmillan Cancer Support which
“A great boost to my morale” included a short motivational interview, the recommendation to walk for at least 30 minutes on alternate days and attend a volunteer-led group walk weekly. Group two were encouraged to maintain their current level of activity. Researchers found that those in group one reported an improvement in physical, emotional and psychological wellbeing having completed the programme. Many participants noted that walking provided an improved positive attitude towards their illness and spoke of the social benefits of participating in group walks. One of the participants said: “The impact has been immense! It gave me the motivation to not only increase walking activity from minutes to three to four hours a week, but also to reduce weight by
altering diet, reducing sweets/sugars. Great boost to morale. No longer dwell on being terminal – I’m just getting on with making life as enjoyable as possible, greatly helped by friends made on regular ‘walks for life’.” Professor Emma Ream, co-author of the paper and Professor of Supportive Cancer Care and Director of Research in the School of Health Sciences at the University of Surrey, said: “The importance of exercise in preventing cancer recurrence and managing other chronic illnesses is becoming clear. Findings from this important study show that exercise is valued by, suitable for, and beneficial to people with advanced cancer. “Rather than shying away from exercise, people with advanced disease should be encouraged to be more active and incorporate exercise into their daily lives where possible.” The study was funded by Dimbleby Cancer Care. www.surrey.ac.uk
Image: Freepik
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Physical activity helps tackle pain of arthritis For millions of people in the UK, the pain and disability caused by musculoskeletal conditions, including osteoarthritis and back pain, can limit independence and the ability to participate across many aspects of family, social and working life.
NEARLY three-quarters of people with osteoarthritis report some form of constant pain, which in itself reduces quality of life. Furthermore, people with musculoskeletal conditions are less likely to be employed, and more likely to retire early, than those in good health. However, physical activity can help tackle the pain of arthritis. Supporting regular physical activity for people with musculoskeletal conditions reduces pain and disability, improves mental health and wellbeing, and helps with other long-term conditions such as heart disease or diabetes. Health and care systems gain as people maintain their independence, reducing the burden on services. Improving musculoskeletal health should improve workplace participation, reducing individual hardship and delivering wider economic benefits. Local authority physical activity provision is a core element of a comprehensive approach to support people with musculoskeletal conditions. However, the needs of people with these conditions are often overlooked in local health priorities, with osteoarthritis absent from 64% of local authority Joint Strategic Needs Assessments (JSNAs). There is, therefore, an opportunity for commissioners to develop plans to enable and support physical activity for people with arthritis and musculoskeletal conditions. A new report, jointly produced by Arthritis Research UK, the Department of Health, Public Health England and NHS England, reviews the benefits of physical activity both for people with musculoskeletal conditions and wider society,
Report provides realistic solutions for local activity provision and provides a framework that supports a tiered approach to intervention. The report, Providing physical activity interventions for people with musculoskeletal conditions, provides realistic solutions for local physical activity provision and includes a focused checklist to empower local decision-makers to map, and identify gaps in, current levels of physical activity provision, and take action. Much can be done to improve the quality of life for people with musculoskeletal conditions. “For many people with joint or back pain, becoming physically active isn’t straightforward, said Dr Liam O’Toole, chief executive officer at Arthritis Research UK. “They often are unaware that physical activity can benefit their symptoms. Health and fitness professionals can lack the knowledge and skills to promote physical activity or provide reassurance and tailored advice. “However, a ‘one size fits all’ approach isn’t appropriate for people with differing levels of mobility and activity. Depending on an individual’s needs, physical activity can involve a spectrum of approaches prescribed by a health professional. The report aims to ensure these approaches are at the heart of commissioners’ plans.” www.arthritisresearchuk.org
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20 TALKBACK WORKPLACE
Inactivity takes its toll on MORE than 20 million UK adults are classified as physically inactive according to a report by the British Heart Foundation (BHF). The charity warns that inactivity increases the risk of heart disease and costs the NHS as much as £1.2bn each year. The Physical Inactivity and Sedentary Behaviour Report addresses one of the most significant national health crises threatening people’s cardiovascular health today. Findings from the new study suggest that levels of adult inactivity are significantly higher than Sport England’s latest Active Lives Survey (TalkBack winter) which places the number at 11.3 million, roughly a quarter of the adult population. The BHF report shows the regions in
England where people are most physically inactive, with the North West coming out worst as almost half of the adult population – 2.7 million adults – are insufficiently active. Evidence is growing that also shows a sedentary lifestyle, regardless of how physically active you are, is associated with poor health. BHF estimates show that the average man in the UK spends a fifth of their lifetime sitting – the equivalent of 78 days each year. For women this is around 74 days a year. More than five million deaths worldwide are attributed to physical inactivity. In the UK alone it causes one in 10 premature deaths from coronary heart disease, and one in six deaths overall. Evidence shows keeping physically
active can reduce the risk of heart and circulatory disease by as much as 35% and risk of early death by as much as 30%. Dr Mike Knapton, our Associate Medical Director, said: “Physical inactivity is one of the most significant global health crises of the moment. Levels of physical inactivity and sedentary behaviour in the UK remain stubbornly high, and combined these two risk factors present a substantial threat to our cardiovascular health and risk of early death.”
Building exercise into workplace habits IN THE US, the incidence of heart disease is similarly discouraging. Here, the challenge for health professionals is immense, with some sources suggesting as many as 80% of American adults do not get the recommended amount of exercise. More bosses would like to see exercise become part of the working day as the benefits aren’t limited to health, with noticeable improvements seen in both staff morale and productivity. At the 700-strong social media company HootSuite, employees are encouraged to exercise before, during and after working hours. Writing on medium.com1, ceo Ryan Holmes explained how a healthy, exercise culture has been vital in the growth and development of his organisation – not least on a personal level in helping him overcome his problems with back injuries. In the early years, it began with encouraging employees to bike to work, and over time the company has installed a gym and yoga room, showers and changing rooms. Yoga classes, he says, are packed before work, at lunch and after work, while the gym stages bootcamps and cross-training classes. In addition,
groups set out from the office for lunchtime runs and evening hikes. “We have a hockey team and a road biking team and even a Quidditch team that does battle on broomsticks in the park,” said Holmes. Ultimately, having the right workplace culture is far more important than creating dedicated facilities, he added: “Even on a ruthlessly practical level, allowing and encouraging employees to exercise at work makes good sense. I see employees return from workouts refreshed and better focused on their jobs.” 1) First published, Mar 2015 www.bhf.org.uk
A Quidditch team battles on broomsticks in the park
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Tips for employers l hold a pedometer challenge l set up regular running groups l offer a scheme for staff to buy bicycles and equipment l develop a flexible working policy.
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heart health BHF case study:
YMCA in Cornwall
Sporting challenge… THE Workplace Challenge, funded by Sport England, is designed to get staff active in workplaces. The programme ranges from fun and friendly inter-workplace sports competitions and tournaments to the Business Games where teams compete in multi-sport events. Employees are able to keep an online physical activity log and compete with other workplaces for prizes. In partnership with the British Heart Foundation, the Workplace Challenge co-ordinates a series of training sessions to support a Workplace Challenge Champion, providing them with practical ideas to take back to the workplace and improve the health of their colleagues. www.workplacechallenge.org.uk
THE YMCA in Cornwall is an independent charity helping the communities, families and young people. Stress-related sickness absence was a big issue for the organisation. It decided to take action and prioritise the health and wellbeing of their employees by setting up a workplace health programme. For its efforts, it achieved the Healthy Workplace Gold award for two years running. Louise Mallas, who co-ordinated the programme, said: “We have halved our overall absence figure but not at the expense of ‘presenteeism’. Most importantly, we now have no absence due to stress.” Louise was keen to provide a variety of initiatives for employees to take advantage of. As well as more conventional health and wellbeing initiatives, Louise also organised a successful team building day which incorporated both physical activity and team building opportunities. “We asked staff what they wanted from the programme. As a result of this consultation, we organised a team building day helping out at a local community farm. The day involved digging, painting hen sheds, moving tyres, holding down ground sheets, building poly tunnels and much more. It was a lot of physical hard work which was loads of fun and great for team building. “There is now more cross team working as doing things out of work has helped build better relationships.”
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22 TALKBACK SELF HELP
Six steps that can put you on the right path to walking happiness Walking is acknowledged as one of the easiest ways to get more active, lose weight and become healthier. However, for many people walking may aggravate aches and pains, or they simply cannot understand why it is supposed to be so easy and enjoyable. Korina Biggs discusses how the Alexander Technique can help your walking. AS WITH all forms of movement, it is not the moving per se that automatically brings benefits but the way in which we move and the attention that we are paying to ourselves in the process. You may make some discoveries about your habits when walking by considering the following (think of these as gentle explorations rather than as actions that you have to try hard and do):
suggesting to your head that it lightens up and can easily and freely balance on top of the spine. If you need to look down then let your eyes drop first and then allow a gentle nod from this area without shortening your neck column. When going up hills, try thinking of the crown of your head leading the way.
Heading up
We hold our arms and shoulders in so many habitual ways for functional as well as emotional and psychological reasons. Walking is a wonderful time to release much of that tension. Try allowing your shoulders to float out to each side so as to widen both the front and the back of you. You could allow your arms to swing naturally as a result of the rotational movement that occurs through your body. Your hands and fingers could be relaxed without them being restricted by being in pockets or having to hold anything. If you
Pictures: Mariona Cabassa
Many people look down when they are walking, maybe because they are worried about tripping, are wrapped up in their thoughts, or texting. Usually, the looking down brings the neck down with it – with subsequent strain on the muscles and a compression of the spine. Or they may be looking out, but pushing their chins forward and squashing the back of their necks. Try paying attention to the top joint of your spine which is between your ears and allowing that area to be a little freer. Try
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The weight of the world on your shoulders
need to carry a bag, try a rucksack over both shoulders that is close fitting or a bag with the strap going across you so that the weight is distributed.
Walking on air Rather than thinking of walking as controlled falling (which can lead to a heavy tread), think of it as forward propulsion. Let your hip joint be free, and allow the knee to release forward so the leg swings like a pendulum while propelled by the other leg. Simply thinking of lightening up and extending your awareness to the space all around can help you expand and breathe more freely.
A spring in your step In this relaxed swing forward of the leg, explore keeping your feet more underneath you. If we stride out, we often stiffen in the foot and ankle in anticipation and that can interfere with the extraordinary architecture that enables springy arch
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Korina Briggs leading a Walk with Ease course and, below on previous page, demonstrating correct posture
support as well as the ability to adapt to changing surfaces. Wear shoes that enable your feet to be at their full natural shape and flexibility. Where the ground is free of hazards, try walking barefoot to stimulate the arch muscles and wake up your sensory awareness of your feet.
I’m late, I’m late for a very important date! So often our thoughts are on getting where we are going, especially when we are rushing, and the habits of undue tension become exacerbated which can interfere with our balance, our breathing and using our energy effectively. When you can, practice being attentive to yourself and the environment. You can play with imagining that the world is flowing towards you rather than you towards it (for example, pick something ahead of you and imagine as you walk that you are on a travelator).
It also helps to relax the eyes and allow in periphery vision, and also to let the eyes move freely to what draws them. This may sound obvious, but we have habits around the way we focus on the world which can create further tension in the body. Furthermore, when we are in a hurry we often pull forward in our chests and compress our backs. When you have the opportunity, explore walking backwards while thinking of your back becoming more long and broad. As you then turn to walk forwards see if you can keep this sense of your back. Try doing this when you are going up hills, as well as keeping a sense of the world and the ground flowing towards and past you. This can help with the struggle, both physically and mentally, that we can have with walking up hills.
Go green Finally, it can be of benefit to walk on a treadmill but, in order to maximise our
physical and mental wellbeing, it is worth seeking out natural environments that give us pleasure. According to Jules Pretty, member of the Green Exercise research team at Essex University, there is “increasing evidence to show that exposure to nature and green space positively affects health and well-being.”1 1) www.julespretty.com/research/nature-and-health/
Korina Biggs is an Alexander Technique teacher who runs Walk with Ease courses. The Alexander Technique is a taught self-care 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, freedom of movement and confidence. www.korinabiggs.co.uk www.alexandertechnique.co.uk
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24 TALKBACK RESEARCH
New insights into CMT disease RESEARCHERS at the University College London (UCL) Institute of Neurology have discovered developmental problems in a mouse model of Charcot Marie Tooth disease (CMT) type 2D. The findings may provide a better understanding of what is going wrong in the peripheral nerves of people with CMT2D. This is caused by mutations in the GARS gene, which leads to the production of a faulty GARS protein. Although the GARS protein is found in all cells of the body, only the nervous system is affected by CMT2D. The new research suggests that CMT2D, and perhaps CMT more generally, may be caused by a combination of developmental problems and degeneration of the nervous system. If this is shown to be the case in CMT patients, this discovery may have important implications for the timing of treatments. It suggests that patients should be treated before the appearance of clinical symptoms, such as during childhood or adolescence. This study was published in US scientific journal, Proceedings of the National Academy of Sciences.
Image: ya nalya/Freepik
What is CMT?
CMT is a genetic condition affecting the peripheral nerves, which connect the brain and spinal cord to the rest of the body. This includes the motor neurons, which carry messages from the brain and spinal cord to our muscles, telling them to contract, and the sensory neurons, which convert specific external stimuli, such as touch and pain, into signals that are transmitted back to the brain. CMT causes the motor and sensory neurons to become damaged and eventually die. This leads to muscle weakness and numbness in some parts of the body. www.pnas.org
Physiotherapy can improve outcomes for stroke and Parkinson’s A WIDER application of professional skills such as physiotherapy can improve outcomes for patients with neurological diseases. Professor Jane Burridge, Head of the Neurorehabilitation Research Group and newly elected President of the Association of Chartered Physiotherapists in Neurology (ACPIN), says that neurological physiotherapists are more effective than ever before and that clear evidence was now emerging for new and established treatments. ACPIN members specialise in complex conditions such as stroke, Parkinson’s, multiple sclerosis, spinal injury and motor neurone disease. Speaking at the association’s annual conference, Professor Burridge said discoveries in neuroscience
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enable us to understand much more about neurological diseases, their progression and patient recovery, while new technologies are providing powerful tools for therapy and assessment across the field of rehabilitation. Accordingly, ACPIN stands ready to work ever more closely with government, health commissioners, patient organisations and medical colleagues to ensure improved outcomes and economic benefits are more widely and speedily available, said Professor Burridge. However, she stressed that leaders need “a seat at the table” where budgets, strategies and healthcare pathways are debated and decided upon, across a wide range of neurological conditions. www.acpin.net
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PILATES could offer a cost-effective alternative to traditional manual therapy interventions for non-specific lower back pain. Helen Llewellyn, a senior lecturer in Sports & Exercise Therapy in the School of Clinical and Applied Science at Leeds Beckett University, conducted the six-week study in which participants took part in an hour of supervised Pilates exercise twice a week. Each session included a ten-minute warm-up concentrating on movements of the trunk musculature. Participants were then taught various Pilates movements and techniques including spine stretch, spine twist and single leg stretch. Speaking about findings of the research, Helen said: “Non-specific lower back pain affects one third of the UK population. By carrying out this research, I am looking at whether a lower cost alternative to traditional therapy should be considered. Whether by simply taking part in one hour’s
Image: pressfoto/Freepik
Twice-a-week Pilates ‘can help treat lower back pain’
Pilates exercise, twice a week, can help those who suffer from lower back pain. “Pilates focuses on the principles of centring, postural alignment, co-ordination, concentration, breathing, precision and movement sequencing. Recently, Pilates-
based exercises have been increasingly incorporated into physiotherapy rehabilitation programmes and exercise has been reported as an effective strategy for the management of lower back pain.” www.leedsbeckett.ac.uk
Drugs target for DVT treatment RESEARCHERS have found a new target for drugs to prevent dangerous blood clots in the legs, thanks to funding from the British Heart Foundation. The research found that mice with a defective receptor called CLEC-2 were protected from deep vein thrombosis. The current treatments for deep vein thrombosis (DVT), which affects around 60,000 people in the UK every year, include anti-clotting drugs such as heparin and warfarin. These drugs are relatively effective but put patients at increased risk of dangerous bleeding. This is because as well as targeting the blood clot, they also affect haemostasis, the body’s natural response to blood vessel injury and bleeding. Imbalanced haemostasis can be dangerous, so patients have to be monitored carefully and hospitalised following bleeding injury. In the study, the researchers, led by Professor Alex Brill at the University of Birmingham, “knocked out”, or “turned off” the gene for a receptor on the surface of platelets called CLEC-2. The “knock out mice”, which didn’t have CLEC-2, were protected from DVT. The team also found that in the veins, CLEC-2 binds to a protein called podoplanin. They showed that using drugs to block podoplanin can also suppress DVT. Now research is needed to find out if the same processes take place in humans, which could lead to clinical trials to prevent DVT and save lives.
Image: whatwolf/Freepik
What is DVT?
DVT is a blood clot that develops within a deep vein in the body, usually in the leg, and causes swelling, aching and difficulty walking. It can be caused by prolonged periods of immobility, such as after surgery or during a long flight. If the clot becomes dislodged it can travel to the lungs and block a blood vessel – this is known as a pulmonary embolism (PE). Twenty-five per cent of PEs cause sudden death.
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26 TALKBACK RESEARCH
Designers key to healthy places A COLLABORATIVE national research survey is under way to better understand the barriers that stop built environment professionals from creating healthier places through their work. Some of the country’s most pressing health challenges, such as obesity, mental health issues, physical inactivity and the needs of an ageing population, are influenced by our physical environment. With mounting pressure on health and social care services across the UK, preventable diseases such as heart disease and type 2 diabetes continue to account for a large proportion of hospital admissions and care costs. Diabetes UK, for example, reports that around 700 people a day are diagnosed with diabetes. Launched as part of the new research project Creating Healthy Places undertaken by Design Council and Social Change UK, the large-scale survey will explore the role of professionals such as architects, urban designers, highways engineers and town planners in addressing health challenges in the UK. Its objective is to discover what hinders them in creating places that could help people of all ages and backgrounds lead healthy, active lives, eat well and enjoy their social lives. Clare Devine, Design Council’s executive director for Architecture, Built Environment and Design, believes creating healthier places in which to live and work is an important part of reducing the burden of
Tackling preventable disease by shaping the built environment
Image: teksomolika/Freepik
preventable diseases on individuals, public services and the wider economy. Devine explained: “There are many good examples of how designers are shaping places that help us all to live healthier and happier lives. However, despite the growing evidence of the vital role placemaking can play in improving health, we are not seeing healthy environments being created at the scale required. “We instigated this research as now it is time to tackle these issues through the way we shape our buildings, streets, parks and neighbourhoods.”
Healthy life expectancy Disparities in health have led to nearly 17year differences in “healthy life expectancy” – time living in good health – between different groups of people across the UK, with those living in the most deprived areas living fewer years overall and more years in poor health. The findings of the research will inform future work to help tackle public health issues such as this through development and regeneration. The results will be publicly available in June 2017. www.designcouncil.org.uk
Practical ways to improve indoor areas TYPICALLY, we spend around 90% of our lives in and around buildings and so these can have a major impact on our physical and mental health. Health issues impacted by our buildings may include eyestrain, cardiovascular and coronary problems, bronchial complaints including asthma and allergies, dermatological complaints, along with musculoskeletal problems and a range of psychological impacts such as fatigue, stress, anxiety and depression. Assessment methods for buildings, such as BREEAM, consider environmental and physiological factors covering key health and
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wellbeing impactors that need to be addressed. These include: l Light, thermal comfort, overheating, noise and pollution l Quality of life issues including views, landscape, connections to nature (biophilic design) l The use of materials that do not contain or omit toxins and other chemicals injurious to health l Spaces and facilities that allow behaviours and activities that have health benefits l Greater adaptability to accommodate an ageing population. www.breeam.com
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What’s happening at the Back Pain Show?
For the first time, The Back Pain Show comes to Birmingham on the 19 and 20 May at St Andrew’s Stadium – home of Birmingham City Football Club. This popular show, which has been successfully held for many years in London, promises to be bigger and better than ever.
VISITORS to the two-day show can register – free of charge – at www. thebackpainshow.co.uk where you can also find out all about the event, see who is exhibiting and book free talks, presentations and workshops with some of the country’s top back pain specialists. The show, organised on behalf of BackCare, is a must for all those who suffer from back pain and for the professionals who treat them. Some of the highlights of the show include free osteoporosis screening by the BackCare professionals. One in two women and one in five men in the UK will suffer a fracture after the age of 50 and there are three million people in the UK alone suffering from osteoporosis. The scan itself takes approximately two minutes and is a simple and painless procedure that uses a very low dose of radiation. The cost of this service is usually £100, but in order to raise osteoporosis awareness and give people the opportunity to know whether they are
at risk, we are offering a FREE scan at the show in exchange for a donation to the national charity Backcare. There will also be free taster sessions introducing you to the art of Pilates and yoga, and a series of workshops with David Rogers, a chartered physiotherapist with more than 20 years’ experience of helping people with back pain to recover function and regain their quality of life. David is based at the Royal Orthopaedic Hospital in Birmingham, where his work is focused on applying a biopsychosocial approach to recovery, using cognitive behavioural principles aimed at maximising recovery. He is co-author of the book Back to Life which offers a whole new way of dealing with back pain. David will be running four different workshops each day as well as delivering a presentation – Shedding new light on back pain treatment. Exhibitors will include specialist bed and mattress suppliers, footwear, exercise equipment, therapists, masseurs, medical products, and a range of organisations specialising in arthritis, scoliosis and sciatic pain. Salonpas, sponsor of the show guide and show bag, will also be exhibiting. Its pain-relieving gel patch is designed for aches and pain relief especially for the shoulder and upper and lower back. Visitors to the show will also be able to get a range of special show prices on a variety of goods and services. l The show is open from 9.00am to 5.00pm each day. St Andrew’s Stadium is easily accessible from the city centre and New Street Station and is regularly serviced by local buses numbers 58, 60, 97 and 97A. There is also free, limited parking at the Stadium – postcode for sat nav B9 4RL.
PROGRAMME OF EVENTS PAGES 28-31 TALKBACK l SPRING 2017
28 TALKBACK EVENTS
Things to see and do The Healthy Back Bag Company It’s all about the shape! A stylish one-strap alternative to a rucksack, designed by a chiropractor and a doctor to reduce strain on neck, shoulders and back. www.thehealthybackbag.co.uk Tel +44 (0) 20 7812 9800 ARMA – The Arthritis and Musculoskeletal Alliance ARMA is the umbrella body for the musculoskeletal community. Our member organisations represent patients and professionals. http://arma.uk.net Tel: +44 (0) 203 856 1978 BackCare The national charity, BackCare, aims to support its members in reducing significantly the impact of back and neck pain through advice and guidance, and the funding of research. www.backcare.org.uk Tel +44 (0) 208 977 5474 Back in Action Back pain? Neck pain? Back in Action can help today. As tested, adopted and used widely by RAF/NATO. www.backinaction.co.uk Tel: +44 (0) 1628 477177
Bad Back Company An exhibition of products designed to help with the relief of back pain, joint pain, posture pain and arthritis. www.thebadbackcompany.co.uk Tel: +44 (0) 845 606 3335 Bakpro A new product designed for anyone suffering with back, neck or pelvic pain. Particularly for anyone who sits at a desk or laptop all day and it is also good for children and sporty gym types. https://bakpro.com Bowen Association Learn how the Bowen Technique works, training information, find a therapist near you and home use products for back pain. www.bowen-technique.co.uk Tel: +44 (0) 1205 319100 Feet and Spine www.feetandspine.com Tel: +44 (0) 161 488 4491 N:rem Mattress Designed specifically for Back Pain sufferers, the N:rem Sleep System is a mattress that is customisable to your exact needs. www.nremsleepsystem.com Tel: Freefone 0333 003 3352 Joya Shoes Joya shoes support the natural movement process and encourage active walking. The shoes promote healthy posture, which can also reduce and prevent back and joint pain. http://joyashoes.co.uk Tel. +44 (0)7809 207473 gwf human-health ltd Designed to help maintain freedom of movement, aid supple joints and support the natural anti-inflammatory actions of the human metabolism. www.elavina.com Tel: +44 (0)1225 708482 Hypervibe UK The Hypervibe range offers a fast, impact-
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free, effective – and surprisingly enjoyable! – way of treating back pain. www.hypervibe.com/uk Tel: 0808 164 0680 Human Office The Human Office, national supplier of seating solutions for back pain and all musculoskeletal problems. www.humanoffice.com Tel: +44 (0) 191 493 0333 The Sciatic Pain Relief Cushion The Sciatic Pain Relief Cushion will be available with an early bird offer for the first buyers. info@sciaticrelief.co.uk Massage Training Institute Provider of high-quality holistic massage training and practitioners since 1988. www.massagetraining.co.uk Real Health Providing functional restoration and pain management programmes including the just launched MyRealHealth – an online version to help people self-manage their pain. www.realhealth.org.uk Tel: +44 (0) 2476 996883 Medi Direct Exhibiting natural pain relief products, from Paingone, the TENS pen; Fisiocrem natural pain relief rub; Scaitix, a wrap for Sciatic pain; and Paingone Freeze Gel, soothing cooling relief gel. www.medi-direct.co.uk Tel: 44 (0)115 9778372 Medserve www.medserveltd.com Tel: +44 (0) 1275 218161 Ortho Medical Disk Dr back support belt and back decompression device recommended for back treatment, lower back pain relief, herniated disc, sciatica, spinal decompression. www.orthomedical.co.uk Tel: 0800 002 9757
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Relaxback Relaxback UK will help you sit well, move well and ultimately feel well while at work in your office. http://relaxbackuk.com Tel: +44 (0) 1727 757221 Rocktape RockTape makes products that help people move better – with kinesiology tape, comprehensive rehab and mobility equipment, cutting-edge education and fitness support products. www.rocktape.co.uk Tel: +44 (0) 1206 615 464 Salonpas Proud Sponsor of The Back Pain Show The Salonpas Pain Relief Patch is designed to provide up to 12 hours of antiinflammatory pain relief from backache, muscle and joint pains. The patch will not leave greasy marks on clothing, skin or hands. In the UK, Salonpas is available in Boots and other good chemists nationwide. www.salonpas.co.uk Tel: 0800 0853462
Sit-Stand Sit-Stand.Com is a supplier of office wellness and productivity solutions including sit-stand desks, desk risers, active seating and accessories. https://sit-stand.com Tel: 0333 22 00 375 Smarter Posture The Smarter Posture mat helps to correct back pain from bad posture – simple correctional solution for people with posture defects arising from bad sitting habits. www.smarterposture.com
Sole Mates Back, foot, knee or hip pain? Plantar Fasciitis? Poor circulation? Try Sole Mates insoles for immediate pain relief. https://sole-mates.eu Tel: +44 (0) 151 345 6061 Status Seating Status Seating specialises in posture dynamic seating solutions and manufactures ergonomic office chairs. www.statusseating.com Tel: +44 (0) 1494 768870
Society of Teachers of the Alexander Technique Providing information on the Alexander Technique and also taster sessions. http://alexandertechnique.co.uk Tel: +44 (0)20 8885 6524
Sandstone Yoga & Pilates Sandstone Yoga & Pilates offer studios, courses, training, retreats and a franchise model. http://sandstoneyoga.co.uk Tel: +44 (0) 1922 277684 Scoliosis Association Scoliosis can cause the spine to curve to the side. SAUK provides support for people with scoliosis. Affiliated with BSRF, it helps advance the treatment of scoliosis through research and collaboration. www.sauk.org.uk Tel: +44 (0) 20 8964 1166 Shiatsu Society The Society will be talking to people about shiatsu and the health benefits it can bring and giving treatments on a futon. www.shiatsusociety.org Tel: +44 (0) 1788 547900
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A line-up of top industry speakers Presentations can be booked by going to www.thebackpainshow.co.uk and going to the speakers’ section where you will find detail on each of the talks. We recommend that you pre-book to guarantee your place. All presentations will last approximately 45 minutes unless otherwise indicated. FRIDAY 19 MAY These presentations are open to all visitors to the show 10.00 Dave Rogers – Shedding new light on back pain treatment David Rogers will review current clinical guidelines for low back pain, describing what treatments are recommended to help restore function and quality of life, including the biopsychosocial approach to back pain. 11.00 Daniel Lawrence – Applying RockTape Taping with RockTape is a tried and tested method of reducing back pain and improving movement and function. This demonstration will show you how to apply tape for common back pain in a simple and easy to follow way. 11.00 Dr Miriam Wohl – Why is the Alexander Technique now in the NICE Guidelines? The Alexander Technique is now in the NICE Guidelines for showing long-term benefit for people suffering from chronic back pain. Dr Wohl will describe the evidence, take questions and give a demonstration. 11.30 Dave Rogers and Grahame Brown – workshop – Why pain persists Understanding why back pain persists and why daily activity becomes more difficult. Introducing how the nervous system can contribute to persistent back pain and understanding why both physical and psychological factors are important for helping recovery.
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12.00 Ernie Boxall – A demonstration of the benefits of shiatsu When used in an office environment, this therapy allows the busy business owner or employee to experience a short period of total relaxation before returning to work with a much clearer mind and a body free from tension. In the clinic, it allows the client to experience a longer period of recovery from joint pain, tension and chronic conditions. 12.00 Sarah Cohen – What is holistic massage? A wide variety of techniques that can be adapted to an individual client rather than applying a set routine to treat all. These include Swedish massage, energy work, joint mobilisation, passive stretches and deep tissue massage. 12.30 Dave Rogers and Grahame Brown – workshop – Managing activity Why goal setting is essential to promote recovery and understanding how activity management can help you get back to life. Guidance will be given on formulating your own recovery plan. 13.00 Dr Nick Hacking – Why doctors cannot treat pain, but sometimes we can Many different factors influence the chronic pain experience, including: genetic predisposition, childhood experience, psychological state, neuroplasticity. Nick Hacking shall try to explain what chronic pain is, how some treatments do work well for some patients and why many do not. 13.00 Michelle Nicklin – The role played by yoga and Pilates in managing back pain
Michelle Nicklin – the founder of Sandstone Yoga & Pilates – will offer simple techniques for managing pain and list her dos and don’ts, including simple tips for maintaining a pain-free life. 14.00 Esther Williamson – Back skills training Dr Williamson is part of the team carrying out a programme of research into the use of cognitive behavioural approaches for managing persistent back pain. Studies have shown that a structured group programme delivered by a health professional (mostly by physiotherapists) can help patients to be more active and have less back pain. 14.30 Dave Rogers and Grahame Brown – workshop – Exercise and relaxation Understanding why exercise and relaxation are important to assist recovery and how to choose exercise and relaxation strategies to help you. The session will also look at different exercise approaches. 15.00 Nickatie Dimarco – The Bowen Technique Nickatie Dimarco is a Bowen therapist, instructor and equine muscle release therapist. She uses the Bowen Technique to support patients with musculoskeletal issues and neuropathic pain; she also treats carers who frequently suffer from back pain and anxiety. 15.30 Dave Rogers and Grahame Brown – workshop – Difficult days Recognising triggers that can contribute to flare-ups in back pain and formulating an emergency flare-up plan to help you minimise their impact.
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s These presentations are aimed at healthcare professionals
SATURDAY 20 MAY
11.00 Dr Miriam Wohl – Why is the Alexander Technique now in the NICE Guidelines?
These presentations are open to all visitors to the show
12.00 Ernie Boxall – A demonstration of the benefits of shiatsu 12.00 Esther Williamson – Back skills training 13.00 Dr Nick Hacking – Why doctors cannot treat pain, but sometimes we can 14.00 Gavin Bradley – Get Britain standing Gavin Bradley, MD of Active Working, will look at why people sit on average 8.9 hours each day and whether “sitting really is killing us”. You will learn about the top 10 risks and the cost to workplace productivity. 15.00 Nickatie Dimarco – The Bowen Technique 15.00 ARMA – Integrated approaches to back pain The session will look at the importance of integrated approaches to back pain in relation to inflammatory back pain and osteoporosis. Sue Brown, CEO of the Arthritis and Musculoskeletal Alliance (ARMA), will outline the importance of clinical networks in delivering integrated, person-centred services. Debbie Cooke, CEO of the National Ankylosing Spondylitis Society (NASS), will discuss managing inflammatory back pain, including the importance of exercise. Dr Gavin Clunie, Addenbrooke’s Hospital, and Hilary Arden, National Osteoporosis Society, will discuss vertebral fractures and the importance of fracture liaison services in prevention.
10.00 Dave Rogers – Shedding new light on back pain treatment 10.00 Jeremy Fairbank – MRI or not MRI? Professor Fairbank, a consultant orthopaedic surgeon at the Oxford University Hospitals, says the problem with MRI scans is that it is possible to find something wrong with everyone. The scan is very sensitive to degenerative changes that happen to everyone from teenage years onwards. 11.00 Daniel Lawrence – Applying RockTape 11.00 Michelle Nicklin – The role played by yoga and Pilates in managing back pain 11.00 Simon Love – Body biomechanics This session will examine the basic principles of how to reduce body forces associated with activities of daily living, static postural tasks as well as reducing forces in sitting, standing, pushing, holding, supporting or carrying any load.
14.30 Dave Rogers and Grahame Brown – workshop – Exercise and relaxation 15.30 Dave Rogers and Grahame Brown – workshop – Difficult days These presentations are aimed at healthcare professionals 10.00 Jeremy Fairbank – MRI or not MRI? 10.00 Gerry Andrews – Holistic massage: positive touch Gerry Andrews is a Massage Training Institute-trained holistic massage therapist who has also benefited from holistic massage as an active sportsman, which has given him an appreciation of the need to cope with stress and the troubles life can throw at us. 11.00 Simon Love – Body biomechanics 12.00 Gavin Bradley – Get Britain standing 14.00 Nickatie Dimarco – The Bowen Technique www.thebackpainshow.co.uk
11.30 Dave Rogers and Grahame Brown – workshop, Why pain persists 12.30 Dave Rogers and Grahame Brown – workshop – Managing activity 14.00 Nickatie Dimarco – The Bowen Technique
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