Quarterly magazine of BackCare, the UK’s National Back Pain Association
SUMMER n 2018
FREE TO MEMBERS
Active habits
Staying healthy and happy when life changes
also in this issue: News NHS under-resourced compared to European neighbours Research Study aims to reduce the impact of childhood arthritis Physical activity Regular dancing lowers the chance of having a fall
www.backcare.org.uk
2 TALKBACK NEWS
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TALKBACK LEADER 3
Falls and fractures: the value of early intervention EARLY identification of progressive conditions such as osteoporosis is vitally important. Failure to choose the appropriate management pathway at an early stage can prove costly for the NHS and potentially “devastating and life changing” for the individual. Vertebral fractures are the most common osteoporotic fracture and are predictive of subsequent hip fractures (more than 55% of patients with hip fracture have evidence of a prior vertebral fracture). And yet, most go undiagnosed and the opportunity to intervene and prevent the hip fracture is missed, according to the National Osteoporosis Society (p20). Among the measures recommended in a new NOS guidance document1, Richard Evans, chief executive at the Society of Radiographers, proposes that clinicians in diagnostic imaging routinely examine all images showing the spine for vertebral fractures. He says: “Vertebral fractures must be reported unambiguously – using the word ‘fracture’ – because clear communication will alert referring clinicians to their clinical significance and ensure that these patients are assessed and treated where appropriate.” The majority of fractures result from a fall and the NOS also offers guidance2 across the “fracture prevention pathway”, where risk assessment and falls prevention interventions have been shown to reduce falls by 24%. Given what we know about the human and
economic cost of falls, preventive strategies should be a priority for the entire community. These provide a focal point for another new publication, on healthy ageing, produced by the Local Government Association3. This document looks at how partnership working between the NHS, councils and the voluntary sector can promote healthier behaviours and help improve balance, strength, muscle power and blood pressure in later life. Ultimately, a more joined-up approach to health and social care pathways will lead to a more responsive service in the face of a growing and ageing population and, importantly, help to ensure patients receive the right care at the right time.
Contents
Care system “unfit for purpose” 5
How back pain impacts on the capacity to work 7
Richard Sutton Editor
Don’t let back pain drive you to distraction! 11
LETTERS TO THE EDITOR:
richard.sutton@backcare.org.uk
1) Clinical Guidance for the Effective Identification of Vertebral Fractures 2) Quality Standards for Osteoporosis and Prevention of Fragility Fractures 3) Adding extra years to life and extra life to those years Cover image: Freepik
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.
Marathon marvels brave the baking sun 12-13
Osteoporosis: why early diagnosis is crucial 20-21 TALKBACK l SUMMER 2018
4 TALKBACK NEWS
NHS under-resourced compared to European neighbours FOLLOWING the Government’s plans to bring forward a new long-term funding settlement for the NHS, the King’s Fund has examined how health spending in the UK compares to other countries and how the NHS measures up in the key areas of provision. In its latest briefing, the health think tank focuses on a small number of key resources – staff, beds, equipment and medicines – using data from the Organisation for Economic Co-operation and Development (OECD). It also updates its analysis of how much the UK spends on healthcare under the new System of Health Accounts 2011 methodology1, which has led to substantial changes in what is classed as “healthcare spending”. Analysis of healthcare Credit: Image: Freepik
How other nations finance their health systems Different countries use very different approaches for financing health systems, though no country relies on a single source of funding for healthcare. Around 80% of healthcare spending in the UK is financed through government expenditure, with the remainder coming from out-of-pocket expenditure, voluntary health insurance or other financing schemes. Australia, Canada and New Zealand use a similar approach for funding healthcare. This contrasts with countries such as Germany and France, which fund health spending largely through compulsory health insurance. Since the 2008 global financial crisis, most countries, regardless of their method for financing healthcare, have had a common aim of containing growth in healthcare expenditure.
spending in 21 countries shows that the UK has fewer doctors and nurses per head of population than almost all the other countries. Only Poland has fewer of both. The UK has fewer magnetic resonance imaging (MRI) and computed tomography (CT) scanners in relation to its population than any of the countries analysed. Although this data should be treated with particular caution, it is clear that the UK lags a long way behind other high-performing health systems in investing in these important technologies.
Generic drugs Of the countries examined, only Denmark and Sweden have fewer hospital beds per head of population than the UK, while the UK also has fewer beds in residential care settings than comparator countries. While lower numbers of hospital beds can be a sign of efficiency, the growing shortage of beds in UK hospitals indicates that bed reductions in the NHS may have gone too far. Although costs are rising, the UK spends less on medicines than most of the other countries. A key reason for this is the success of initiatives to improve the value of expenditure on medicines, such as encouraging the use of generic drugs. Under the OECD’s new definition of health spending, the UK spends 9.7% of gross domestic product (GDP) on healthcare. This is in line with the average among the countries we looked at, but is significantly less than countries such as Germany, France and Sweden, which spend at least 11% of their GDP on healthcare. The picture that emerges from this analysis is that the NHS is underresourced compared to other countries and lags a long way behind other highperforming health systems in many key areas of healthcare resources. 1) www.who.int/health-accounts
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TALKBACK NEWS 5
New survey shows care system is unfit for purpose Credit: Image: Freepik
THE ADULT care system in the UK is “visibly failing” and “unfit for purpose” according to the findings of a recent survey by the Care and Support Alliance (CSA). Almost 4,000 people who identified themselves as having experience of adult social care in England provided a picture of the experiences of the 1.2 million older and disabled people currently unable to get the care they need – a number that’s almost doubled since 2010. The survey found that due to a lack of care: l 1 in 5 felt unsafe moving around their own home l 4 in 10 can’t leave the house l 1 in 4 said they’ve needed hospital treatment and 1 in 8 have been delayed leaving hospital due to not being able to get the care they need l More than a quarter have been unable to
Despite more adults currently needing care, the number of those actually receiving it continues to fall maintain basics like washing, dressing and visiting the toilet l More than 1 in 7 (16%) have had their care packages reduced, even though their needs have increased or stayed the same l More than 1 in 5 have not been able to work. Despite more adults currently needing care, the number of those actually receiving it continues to fall, creating a funding gap
that’s estimated to reach £2.5 billion by 2019/20. “It is especially worrying to have heard stories from people whose care has been cut, even though their needs have either stayed the same or got worse,” said Caroline Abrahams, charity director at Age UK and co-chair of the CSA. “The reality is that care cuts aren’t saving the government money, the NHS is picking up the bill as people are pushed into ill health and crisis because of a lack of basic help.” In light of the survey’s findings, the CSA is calling on people to add their signatures to an open letter to Jeremy Hunt, Secretary of State for Health and Social Care, to highlight the urgent need for action. “The government must provide funding now, as well as focus on future reforms, as essential steps towards getting our care system back on track,” said Caroline Abrahams.
Knowledge hub aims to improve MSK services A NEW website aimed at healthcare professionals who support people with musculoskeletal (MSK) conditions has been launched. The MSK Knowledge Hub was set up by the Arthritis and Musculoskeletal Alliance and NHS England. It is designed to improve MSK services by channelling valuable information and experience to the right people. The hub incorporates an interactive MSK forum to enable people
to discuss and share views. Clinical topics already on the hub cover back pain, fragility fractures, osteoarthritis and ankylosing spondylitis. It has cross-cutting sections for prevention, selfmanagement and commissioning. To contribute to the hub, it is necessary to register with the site and then click its “add a resource” button. http://mskhub.org.uk
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6 TALKBACK LIFESTYLE
People in the Midlands are developing back or neck pain the earliest THERE ARE significant regional differences in the number of people experiencing back or neck pain across Britain, with rates between regions varying by more than 17%, according to new consumer research from the British Chiropractic Association. The research revealed that people in Northern Ireland are suffering the most, with 57% saying they currently have back or neck pain. Those in the South East appear to have the best back or neck health, with only 40% of people complaining of pain. These figures are in comparison to the national average of 44%, representing a 12% rise in back and neck pain nationally since 2017.
Sedentary lifestyles affecting back health of younger people Those in the Midlands are developing back or neck pain the earliest – with a huge 70% of residents experiencing back or neck pain by the age of 30, compared to just under half (48%) of people in the East of England. Londoners are the most likely to take proactive steps to prevent back or neck pain before it occurs, closely followed by those in the South West. The results also highlighted that Scots are suffering most frequently with a third experiencing back or neck pain daily,
compared to just 17% in London. Lifting and carrying was reported as the top back or neck pain trigger for all regions, followed by sitting still for long periods. Most regions said that back or neck pain was most likely to prevent them sleeping, followed by exercising. British Chiropractic Association President, Catherine Quinn, said: “It’s interesting to note that certain regions are seeing back and neck pain among a much younger age group. Back and neck pain can of course develop at any age and is usually not serious, however this could be a sign that modern and increasingly sedentary lifestyles are impacting on the younger population’s back health.” https://chiropractic-uk.co.uk
Maintaining health and independence in later life
Image: Sport England
Physical activity in older age has multiple benefits, including reduced mortality, improvement of physical and mental capacities and enhanced social outcomes
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OVER the last 10 years, the number of people aged over 65 in England increased by a fifth – that’s nearly 1.7 million extra older people. The biggest increase has been in the over-85s, up by nearly a third. This trend will not only continue in the coming years, it will gather pace. But while the greater longevity is to be welcomed, far too many of those later years are spent in poor health. That is bad for the individual and bad for the state. The longer a person spends in poor health the more care they need, so tackling it is a priority for local government aiming to reduce the impact of long-term conditions, turn the tide and make sure that those in old age are able to maintain their health, wellbeing and independence 1) Adding extra years to life and extra life to those years
for as long as possible. The Local Government Association’s (LGA) new guide1 to healthy ageing discusses ideas for partnership working between local government, the NHS, the voluntary sector and the communities they serve, looking at healthier behaviours, falls prevention, social connectivity and physical activity. “It is never too late to change,” said Izzi Seccombe, chair of the LGA Community Wellbeing Board. “Studies show that even a little activity in our 80s and 90s can improve balance, strength, muscle power and blood pressure. The examples in this report provide plenty of ideas about what can work.” www.local.gov.uk
Image: fanjianhua/Freepik
TALKBACK LIFESTYLE 7
Back pain is the second most common cause of short-term absences
How back pain affects quality of life and capacity to work AN ESTIMATED 9.11 million (16.9%) people in England have back pain, 5.5 million of whom have severe back pain, according to The State of Musculoskeletal Health 2018, a resource for health professionals from Arthritis Research UK. The latest data shows obese people are four times more likely to develop back pain than those with a healthy body weight. The odds of back pain in people with symptoms of depression have been shown to be 50% higher than in those without symptoms of depression. The prevalence of low back pain is approximately 50% higher in daily smokers compared to non-smokers. Furthermore, people aged 45-64 years in the most deprived areas are almost twice as likely to report back pain (17.7%) as
those from the least deprived areas (9.1%). Back pain is a common condition often caused by a simple muscle, tendon or ligament strain and not usually by a serious problem. It can be acute, where the pain starts quickly but then reduces after a few days or weeks, or chronic (severe), where pain might last on and off for several weeks or even months and years.
Minor illnesses Low back pain was the top cause of years lived with disability (YLDs) in the UK in 1990 and 2016. Low back pain patients generally stop seeking medical attention within three months, however 60% to 80% of people still report pain or disability a year later and up to 40% of those who
have taken time off work will have future episodes of work absence. Back pain is the second most common cause of short-term absences after minor illnesses (such as colds, flu and sickness). 68.3% of people return to work one month after an episode of back pain, rising to 85.6% at one to six months and 93.3% at more than six months. People with chronic low back pain have been shown to have a significantly higher frequency of musculoskeletal and neuropathic pain conditions and common sequelae of pain such as depression (13.0% vs 6.1%), anxiety (8.0% vs 3.4%) and sleep disorders (10.0% vs 3.4%), compared to people without low back pain. www.arthritisresearchuk.org
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8 TALKBACK RESEARCH
Study aims to reduce the impact of childhood arthritis Arthritis Research UK has partnered with the Medical Research Council (MRC) to study childhood arthritis and develop tailored treatments for children affected by the condition.
WITH nearly £5m in funding, the CLUSTER childhood arthritis study will follow the ongoing health of 5,000 children aged under 16 who have the condition. The new study will form a consortium, bringing together internationally recognised leaders in the treatment of childhood arthritis from across the UK. Juvenile idiopathic arthritis (JIA) and its associated eye inflammation (uveitis) is an autoimmune condition and can cause long-term disability and poor quality of life, which can continue well into adulthood. If it isn’t diagnosed and treated early, patients may develop irreversible joint damage, experience growth problems and some may lose their ability to remain independent. JIAassociated uveitis can also put children at risk of vision loss and blindness. Currently young people in the UK are given a single drug therapy as first line treatment, but it works only in half of cases. The remaining half must try other treatments, one after
another, to find a therapy which works for them. This trial and error period may lead to a worsening of symptoms and have a knock-on impact on their life – excluding them from playing with friends or attending school regularly. This study will look at differences in genes, immune cells, blood proteins and other features that are seen in patients who respond well to treatments, and those who develop uveitis, a condition that causes eye inflammation and affects around 15% of children with arthritis.
Biomarkers It is hoped the study will allow researchers to tailor personalised treatments and create a biomarkers test for childhood arthritis which would identify potential new treatments and help doctors determine what the right treatment plan is for each patient. It would also identify which children are at risk of developing uveitis and project long-term outcomes for
children with childhood arthritis to better predict their health in future. Lead researcher, Professor Lucy Wedderburn at the UCL GOS Institute of Child Health, said: “Using a stratified medicine approach could be a gamechanger in childhood arthritis and its associated uveitis. A biomarker test could lead to methods for accurately predicting the right treatment for the right duration, halting the worsening of symptoms and leading to shorter time to remission. Nothing like that has been done before in this area of research.” The five-year award will build on a number of previous initiatives and projects supported by Arthritis Research UK, notably: the Adolescent Rheumatology Centre of Excellence, both the Genetics and Epidemiology Centres of Excellence in Manchester, the Childhood Arthritis Prospective Study (CAPS), the Children’s Experimental Arthritis Treatment Centre (EATC) and the clinical trial SYCAMORE.
Thousands suffer severe limitations in movement TWELVE thousand children in the UK have juvenile idiopathic arthritis and this can have a significant impact on their physical, emotional and social wellbeing, according to Dr Natalie Carter, head of research liaison and evaluation at Arthritis Research UK. As well as the pain they experience, more than half of these children may go on to have severe limitations in movement as adults, limiting their ability to carry out everyday tasks. “By working together, we can all make
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a bigger difference for these children living with such a debilitating condition. We are excited to see the results of this project in the future,” she said. Eilean MacDonald, an 18-yearold patient who was diagnosed with childhood arthritis as an 18-month-old baby, is taking part in the study. It took years of trying various medications until she found the right treatment to alleviate her symptoms. She’s now on crutches and requires an ankle replacement this summer. She said: “People don’t believe
children can get arthritis, but we do. I’ve missed school and had to quit activities I loved because of my condition. “This research could mean the next generation of kids with childhood arthritis won’t have to go through what I did. They could have the right therapy handpicked for them, reducing the impact it has on their lives. They could have even one piece of their life that’s more consistent and predictable while living with this disease.” www.arthritisresearchuk.org
Understanding the genes and lifestyle factors behind killer heart condition OVER ÂŁ2m is being spent on the largest study of dilated cardiomyopathy (DCM), a potentially deadly heart condition. DCM stretches and thins the heart muscle so it becomes baggy and unable to pump blood around the body efficiently. It is estimated to affect up to 260,000 people in the UK and is the leading cause of heart transplantation. As many as 650,000 people in the UK risk developing the condition due to a common mutation in the titin protein. This mutation predisposes the heart to developing DCM when it is placed under stress such as pregnancy,
some cancer treatments and possibly other stresses like alcohol abuse. Development of the condition puts people at greater risk of sudden death and can lead to heart failure. Funding the study, the British Heart Foundation explains that DCM is very poorly understood, with most causes unknown and poor outcomes for patients. Research suggests that 15% of patients do not survive beyond five years after diagnosis, and up to half of deaths occur within the first two years of diagnosis. The multi-centre study of more than 2,000 patients with DCM across England
Image: kjpargeter/Freepik
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will investigate the interaction between genes and lifestyle factors to understand more about why people develop the condition and who is at risk of sudden death or heart failure. Six hospital trusts from across England will be recruiting patients for the study. The researchers will use advanced DNA sequencing, biological markers in the blood and cardiac imaging approaches to assess interactions between genes and seek to discover new genetic mutations underlying DCM, as well as assessing for potential environmental interactions. www.bhf.org.uk
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10 TALKBACK RESEARCH
Artificial muscles could aid treatment of muscle diseases ARTIFICIAL muscles grown from human stem cells could offer new ways of treating muscle diseases, according to new research led by University College London (UCL). The study, published in Cell Reports, found that 3D artificial muscles can be generated from both healthy and diseased stem cells of patients with different types of severe muscle disorders called muscular dystrophies. The artificial muscles accurately model severe genetic muscle diseases, which will allow scientists to test different types of therapies on human cells that embody the characteristics of the patients. This
Image: courtesy of UCL
discovery is expected to lead to more personalised treatment options. Dr Francesco Saverio Tedesco from UCL Biosciences, said: “Our work shows that
we can make patient-specific mini-muscles in the lab and those artificial muscles show distinctive features of some forms of severe muscle diseases. Notably, the stem cell technology utilised to produce those muscle allows us to generate a virtually unlimited number of muscles in the lab and to have them combined with other cell types of the same patients which are very difficult to obtain otherwise, such as motor neurons.” The artificial muscles were grown from human cells from patients with different forms of muscular dystrophy, including Duchenne, limb-girdle, and congenital muscular dystrophies. www.ucl.ac.uk
FALLS are a concern for people with muscle wasting conditions because they can cause fractures that reduce mobility. This can lead to even weaker muscles and potentially a permanent loss of ambulation. Some people also develop a fear of falling, which may make them less active and generally less healthy. A new study, published in the scientific journal, Neuromuscular Disorders, has investigated the prevalence of falls and fractures in people with myotonic dystrophy living in the UK, Netherlands and Germany. In total, 573 people completed the survey: 70% reported having a fall in the last year and 17% had falls that resulted in a fracture. The most common reported causes for falling were weakness in the legs and impaired balance. When the researchers compared these results with those of a healthy population, they found that middle-aged people with myotonic dystrophy had a higher risk of falling than healthy people aged over 65. This suggests that people with myotonic dystrophy prematurely age in that they are more at risk of falling earlier in life. It is hoped that the findings will encourage healthcare professionals to record patients’ falls history, provide advice
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Image: Freepik
More work needed on falls prevention in myotonic dystrophy
It is important not to underestimate patients’ risk levels to fall on fall prevention and refer patients to special “falls clinics”, if appropriate. Dr Cecilia Jimenez Moreno, one of the study authors, said: “As a physiotherapist, I am aware that we are increasingly recommending a more active lifestyle for
patients with myotonic dystrophy. However, we must not underestimate these patients’ risk levels to fall and should adjust our advice accordingly to ensure that patients feel safe while moving more.” www.nmd-journal.com
TALKBACK SELF HELP 11
Don’t let back pain drive you to distraction
If you share a car, make sure the seat position suits you each time you get in. The back of the seat should be set slightly backwards, so that it feels natural and your elbows should be at a comfortable and relaxed angle for driving.
Steering without strain Once you have adjusted your seat, your hands should fall naturally on the steering wheel, with a slight bend in the arms. If the wheel is too high and far away, tension will build up in your shoulders and upper back. If it is too low and close to you, the wheel may brush your legs, which will reduce your ability to turn it freely, putting strain on the wrists and the muscles of the upper back.
seat – tensing and relaxing) as well as shoulder shrugs and circles. Allow plenty of time for journeys to avoid stress. www.chiropractic-uk.co.uk
Your reactions must be quick, so you should not need to move your head a lot. The mirror positions should allow you to see all around the car with the movement of your eyes with minimal head movement. Set your mirror positions before you drive off.
Sensible footwear Avoid wearing high heels, or very thick-soled shoes, as you will have to overextend the ankle in order to put pressure on the pedals. As well as making it much harder to perform an emergency stop, this position will raise your thigh from the seat (reducing support to your leg) and create tension (and possibly cramp) in the calf. This, in turn, will impair the blood flow on a long journey.
Relax and take breaks A relaxed driving position reduces stress on the spine, allowing your seat to take your weight. Take regular breaks, at least every two hours. If you are stuck in traffic, exercise in your seat. Try buttock clenches, side bends, seat braces (pushing your hands into the steering wheel and your back into the
If the wheel is too high and far away, tension will build up in your shoulders and upper back
Image: jcomp/Freepik
Adjustments for comfort
Mirrors and visibility
Image: Welcomia/Freepik
THE sunny weather has arrived and we can expect plenty of opportunities to load up the car and head out for some fun weekend breaks. Unfortunately, others may have the same idea! This can often mean uncomfortable delays in queues which can be torture for those with back pain. The British Chiropractic Association has issued a series of car travel tips to help keep pain to a minimum during your journey.
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12 TALKBACK LONDON MARATHON 2018
Marathon mar
Stilts walker Michelle Frost crosses the line
No shortage of fancy dress entrants
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Image: Virgin Money London Marathon
Image: Virgin Money London Marathon
Paul Jones
third triple London men’s champion and cement his status as king of the roads. He was followed two minutes later by Sir Mo Farah who sealed his 10th British record to take third and a cherished spot on the celebrated London podium. Thousands of sun-bathed British fans were on hand to cheer the following throngs of participants, among them BackCare’s heroes, braving temperatures of up to 24°C. Image: Virgin Money London Marathon
BACKCARE runners played their part in an historic London Marathon in April, crossing the finish line along with more than 40,000 fellow runners on the hottest race day on record to pick up their hard-earned medals. Her Majesty the Queen pushed the event’s famous red button from the grounds at Windsor Castle, which was relayed to the runners waiting at Blackheath to run the 26.2 miles to The Mall, in front of Buckingham Palace. Just over two hours later, it was the majestic Eliud Kipchoge who strode under the finish line first (2:04:17) to become only the
A runner proposes to his girlfriend at the finish line
Images: Virgin Money London Marathon
Runners crossing Tower Bridge
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rvels brave the baking sun WHO ELSE WAS RUNNING? Barnaby Hopson, fastest marathon dressed as an insect 3:14:24 Michael Odell and Guy Dunscombe, fastest marathon in a two-person costume (horse and jockey) 3:25:17 Five of the nine Gloucestershire runners who raised funds for BackCare this year
Louise Andrews and Neil Sheward, fastest marathon three-legged (mixed) 3:59:56 Colin Haylock, fastest marathon wearing ski boots 5:52:16
BACKCARE WINNERS!
Michelle Frost, fastest marathon on stilts 6:37:38
Highest individual total raised for BackCare (at the time of going to press): Miles Grinter from Wokingham – £2,992 Fastest BackCare runner: Aijuan Zhang from Beijing, China – 3:50:59 Antony Greensweig
It was hot! Runners feel the heat in the 2018 London Marathon
Andrea Daly
Taking on fluids
Images: Virgin Money London Marathon
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Image: Virgin Money London Marathon
Kevin Gani
14 TALKBACK PHYSICAL ACTIVITY
THE OpenActive Accelerator, an initiative run by Sport England and the Open Data Institute (ODI), has selected 10 startups that will spend the next six months developing new services – including apps and websites – to help people discover events and clubs in their local area. Currently, much of the information about what, where and when activities take place is hidden away on old-fashioned websites, social media groups, PDFs or printed flyers. The new services will use OpenActive data, published by sport and activity providers in the same standard format, to bring opportunities to users’ fingertips. When travel operators unlocked their data several years ago, it transformed the experience for holidaymakers, and OpenActive aims to do the same for the
Image: Vectorpocket/Freepik
New apps and websites to promote local clubs
sport and activity sector to help more people get active. More than a quarter of the population in England are inactive, which means they do less than 30 minutes of moderate intensity activity each week, and this can take a big toll on their health and quality of life. Jeni Tennison, CEO of the ODI, said the technology would make it much easier for
users to find what they are looking for and discover opportunities they may otherwise have missed. “People struggle to find time to take part in activities or are not able to find an activity which suits their abilities. The OpenActive Accelerator brings some of the most creative minds in data and technology together with rich datasets to create services that can help encourage more people to get more active.” Sport England’s Allison Savich said she hoped the programme would be especially helpful to those who had traditionally been less likely to engage in physical activity. “We will share behavioural insights with the startups and support them to use the data that fits people’s lifestyles. We believe this will reduce one of the main barriers for people trying to get active.” www.openactive.io/accelerator
Image: Freepik
You should be dancing, yeah! All that jive lowers the chances of having a fall
Falls are a threat to older people’s self-confidence and independence
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ONE in 10 of the over-65s in the UK are regularly dancing and attending dance classes, according to Age UK’s Wellbeing in Later Life Index. Dancing is a highly sociable activity and the opportunity to meet new friends is a major attraction of getting involved. By participating in dance classes, older people are also doing a lot to reduce their risks of falling, since research has found that just an hour of dancing a week lowers the chances of having a fall. Falls and fractures among the over-65s account for more than four million hospital bed days each year in England alone and are a serious
threat to older people’s selfconfidence and independence. Age UK is therefore urging older people to take up activities such as dance to improve their health. Dancing and other forms of physical activity also help to keep the brain as well as the body in good working order as we age. In addition to the physical benefits, The Wellbeing Index found that participating in “creative activities” of all kinds, including dancing, was the single most effective thing any older person could do to improve their sense of wellbeing. www.ageuk.org.uk/ comedancing
TALKBACK PHYSICAL ACTIVITY 15
When your life changes, your activity habits can change, too Projects win funds to help people stay active dropping out when they go through a major life change. Helping these people become and stay active is a key part of its overall strategy, Towards an Active Nation. Director of Sport Phil Smith, said: “We know that when life changes, activity habits can change, too. Leaving school or college, starting a family, retiring from work, or becoming ill – all are big challenges for even the most committed to sport and fitness. “Thanks to money raised by National Lottery players, these 18 organisations will explore how to help people keep their activity habits or find new ones.
Sport England will support this work and share what works – and what doesn’t – more widely among the sport and health sector.” Carers are also recognised for the sacrifices they make to their health and wellbeing. The London Borough of Lambeth receives £182,000 to support new carers, by offering activities, complimentary therapy, wellbeing support, volunteering and training. £105,000 is awarded to Cotman Housing Association in Norwich, whose scheme supports carers of people with dementia who will be helped to become active again. Image: Sport England
A PROGRAMME for previously active people who have been diagnosed with a disability is among 18 community initiatives to benefit from the latest round of National Lottery funding. The scheme, run by Leonard Cheshire Disability in London, will receive £365,000 to help make it easier for people to stay active following a major change in their life. The Neuro Therapy Centre, which runs a community scheme in West Cheshire, has received £137,000 to help people who have a long-term neurological condition such as MS, Motor Neurone Disease or Parkinson’s, that is now starting to affect their activity levels. The awarding body, Sport England, recognises that even people with the strongest exercise habits are at risk of
Reducing the risk of depression and diabetes LATEST figures from Sport England’s Active Lives Adult Survey show 27.7 million people – 61.8% of the population aged 16 and over in England – are active. That means they meet the Chief Medical Officer’s guidelines and do at least 150 minutes of moderate intensity activity each week – gaining health benefits including a reduced risk of dementia, depression, diabetes, and improved mental wellbeing. At the other end of the scale, 11.5m people (25.7%) are inactive, meaning they do less than 30 minutes of physical activity a week. The results, which are based on a sample of almost 200,000 survey respondents, show that activity levels in England are stable.
Walking Walking remains the most popular activity, with 18.6m people walking for leisure. There are 14.5m people who walk for travel – an increase of 423,000. For Sport England, the figures show the huge importance of investing to tackle inactivity and the inequalities between different groups in society www.sportengland.org
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16 TALKBACK PAIN MANAGEMENT
How back exercise can bring relief NICE guidelines now include the Alexander Technique for Parkinson’s disease. This is important because musculoskeletal issues such as back pain are a major issue for people living with Parkinson’s, says Alexander Technique teacher Dai Richards.
SOME of the classic postural shapes that are used by the medical fraternity to diagnose Parkinson’s – head bent forward, mask-like facial expression, rigidity, stooped posture, shuffling gate… are not dissimilar to a young person bent over their mobile phone (whose poor habits may one day see them as an adult in pain and in front of a therapist). However, that’s where the similarity ends and the young person can snap out of it and run for the bus. Parkinson’s is a complex syndrome and every person is different, though there are some common threads. Very commonly, the disease interferes with a person’s balance and motor functions. Their proprioception becomes poor and thinking becomes muddled. Energy levels become unpredictable and bodies stiffen. Poor postural habits such as allowing the head to bend forward become ingrained and magnified; drooping posture follows.
With Parkinson’s, activity of any kind can be challenging We all grow into the shape our unconscious habits pull us into, without us even noticing. With Parkinson’s, the pulls become firmer and
are harder to let go. When that leads to pain, the normal recommendations such as those given out by the NHS may be very sensible but are
Arthritis study reveals fewer swollen joints but no A NEW study has shed light on how outcomes for people diagnosed with arthritis in the early 2000s compared with those diagnosed 10 years earlier. The study, published in the Annals of the Rheumatic Diseases, examines how disease activity, disability and mortality have changed over time for people with early inflammatory arthritis. Using data from the Norfolk Arthritis Register1, the researchers compared outcomes for 1,022 people recruited
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between 1990 and 1994, to outcomes for another 631 people recruited from 2000 to 2004. The team looked at factors such as swollen and tender joints and disability levels among the two groups. They also compared 10-year mortality levels and the risk of cardiovascular mortality. The study showed that disease activity (measured by the number of swollen joints) was 17% lower for the more recently recruited patients. However, pain (ie, number of tender joints) and disability
appeared to be much the same for both groups. No significant difference in mortality rate was found beyond what has been seen in the general population. The study was led by Dr James Gwinnutt and Dr Suzanne Verstappen at the Arthritis Research UK Centre for Epidemiology. Dr Verstappen said: “The findings shown in this study could be due to both better medical care and an increased awareness across the public of the need for healthy living. What is interesting is
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to Parkinson’s sufferers
out of reach for many people living with Parkinson’s. Top of the list of NHS recommendations is “stay active” – for many with
Parkinson’s, activity of any kind is challenging and often in ways which seem bizarre. Some people can be stopped in their tracks by having to cross a threshold – even if it is into their own kitchen. Next on the list is “back exercises and stretches”. The impact of Parkinson’s on co-ordination can be such the that, even with assistance, stretching can be very tricky. The disease muddles the mind. Someone can intellectually know what they want to happen, but transferring it into action gets clumsy and confused. Third is painkillers (nonsteroidal anti-inflammatory drug (NSAID) tablets, such as ibuprofen). Medication becomes a preoccupation for people living with Parkinson’s. It dominates their lives and they function according to how successfully they manage their drugs. Adding anything into the mix is a very worrisome and risky decision. So, seeking relief is not trivial.
The Alexander Technique has an established history as being effective for the management and relief of back pain. However, with Parkinson’s the benefits are probably more profound than for the general public. This is because it helps to address the more basic balance and motor functions which then facilitate freedom of movement, walking, sitting and standing. The lessons are an education rather than a treatment. This means that the effects can last into the long term, providing people with the tools they need to live more active and enjoyable lives with reduced back pain and a greater sense of relaxation and wellbeing. The Alexander Technique has many applications outside of pain relief. The freedom, ease and efficiency of movement it develops is appreciated by actors, musicians, sports people and, not least, the average person in the street wanting to get more out of life. www.stophurting.co.uk
improvement in pain that this reduction in disease activity has not translated into improvements in disability for patients in the new millennium compared to 10 years previously.” NOAR is led by Professor Alex MacGregor from the University of East Anglia. www.arthritisresearchuk.org
Image: Freepik
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Alexander Technique earns NICE guideline Studies indicate that the Alexander Technique (AT) can help people living with Parkinson’s disease (PD) in daily activities. A randomised controlled trial found that 24 AT lessons reduced PD disability and depression, and benefits were retained at six months, indicating potential for long-term retention. Participants reported “subjective improvements in balance, posture and walking, as well as increased coping ability and reduced stress.” (Stallibrass et al 2002, 2005). A study of an AT-based intervention reported improved postural alignment, reduced postural sway, improved torso mobility, and smoother movement during step initiation, likely indicating better movement efficiency (Cohen RG 2015). AT shows promise as a long-term selfmanagement approach to reduce PD motor symptoms and maintain an active life. As a result, NICE guidelines contain the following statement in the section called “Non-pharmacological management of motor and non-motor symptoms”: “1.7.4 Consider the Alexander Technique for people with Parkinson’s disease who are experiencing balance or motor function problems.” www.nice.org.uk/ guidance/ng71 www.alexandertechnique. co.uk
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18 TALKBACK COMMUNITY
Funding for physiotherapists in NI GP practices FIRST contact practitioner funding forms part of the Department of Health’s £100m Health and Social Care Transformation Fund for Northern Ireland. Some £5m is being provided for the rollout of multidisciplinary teams in GP practices. The establishment of practice-based physiotherapist roles is a major win for patients who will benefit from faster access to the specialist advice and assessment they need, said Tom Sullivan, policy and public affairs manager for the Chartered Society of Physiotherapy in Northern Ireland. “Having these
physiotherapists available as a first point of contact for patients will ease pressures on GPs, who are facing ever-growing demand. “Furthermore, these roles are shown to save money by reducing the number of patients sent for unnecessary diagnostic tests such as x-rays and scans, or being referred on to secondary care. This is what transforming services is all about – ensuring that patients in need are able to access the right care at the right time in the right location.” www.csp.org.uk
Image: javi_indy/Freepik
The move will reduce the number of patients sent for unnecessary diagnostic tests
Transforming pelvic health treatment in Wales NEW pelvic health care pathways will ensure that women in Wales will receive physiotherapy or other treatments before surgery is considered. The provision of £1m towards the new pathways was in response to a Welsh government-commissioned report on the use of vaginal synthetic mesh tape and sheets for stress urinary incontinence and pelvic organ prolapse. Physiotherapy and specialist services for continence should be prioritised for incontinence and prolapse, with surgery as a last resort, the report says. It wants this approach to be part of a new “pelvic health and wellbeing pathway”. This initial care pathway will include access to multidisciplinary teams of clinicians offering continence care, physiotherapy, pain management and, where appropriate, psychology skills. Patients need better information to make sure they can make fully informed decisions about treatment options, the document recommends. In addition, GPs must have direct access to specialist advice so they can provide better support for patients. The team which produced the report was chaired by Simon Emery, a consultant in obstetrics and gynaecology at Singleton Hospital, Swansea, and included two
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Image: katemangostar/Freepik
More education and training needed in women’s pelvic health physiotherapists – Gillian McCabe, a specialist in pelvic health with a private practice, and Carol Broad, clinical lead physiotherapist for women’s health at University Hospital Wales. Ms McCabe said: “What emerged during our discussions was that often GPs do not consider physiotherapy as an appropriate treatment for this patient group and make referrals for surgery before physiotherapy has been pursued. “There is work to do in standardising
education and training for women’s pelvic health physiotherapy across Wales. We need to make sure that new graduates or less experienced physiotherapists are not undertaking this specialist treatment. They need to be educated first.” The report highlights a lack of data about the treatment for pelvic problems. It calls for improvements to data capture about interventions, complications and access to specialist support. www.csp.org.uk
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Back pain sufferers harmed, not helped, by ‘inappropriate’ treatments INCREASING numbers of people are suffering from low back pain worldwide – an issue being made worse by the prevalence of inappropriate treatment methods, according to recent scientific papers published by The Lancet. It is most common and burdensome in working populations, with many older people finding that their back pain prevents them from taking part in daily activities. Although most cases of low back pain are short-lasting, recurrences are common, with the costs associated with back pain-related healthcare and work disability shown to be enormous. Part of the reason for this was highlighted by The Lancet, which revealed significant discrepancies in the types of treatment given to these patients. In many cases, sufferers receive emergency care for their pain and are encouraged to rest and stop work, contrary to medical recommendations; they are also commonly referred for scans or surgery, or prescribed painkillers such as opioids,
which are discouraged for treating low back pain. Professor Nadine Foster, professor of musculoskeletal health in primary care at the Arthritis Research UK Primary Care Centre at Keele University, was the leader of this second review. She said: “In many countries, painkillers that have limited positive effect are routinely prescribed for low back pain, with very little emphasis on interventions that are evidencebased, such as exercises. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practices entail.” Healthcare providers are reminded that simple physical and psychological therapies that keep people active are usually best. Patients should be empowered to self-manage their conditions and avoid unnecessarily aggressive treatment where possible, supported by a medical system that understands what works in the management of low back pain and what doesn’t. www.arthritisresearchuk.org
Image: jannoon028/Freepik
MSD ‘risk reduction through design’ award THIS AWARD, sponsored by the Health and Safety Executive (HSE) and the Chartered Institute of Ergonomics and Human Factors (CIEHF), is intended to inspire businesses to consider how ergonomics–based design changes can reduce the risks of work-related musculoskeletal disorders. Among the commendable features, is the inclusion of persuasive evidence of productivity
benefits as well as other indicators such as patient care, reductions in costs, incidents and numbers of MSD cases. The winner for 2017 was Freyssinet UK and commended nominations in a range of sectors were announced at the MSD Summit in March. If you wish to make an entry for the 2018 award, submit your nominations by 31 January 2019 to msdpp@hse.gov.uk. www.hse.gov.uk
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20 TALKBACK PREVENTION
Osteoporosis: why early identification is crucial EARLY identification and management of osteoporosis following a low-trauma fracture presents a real opportunity to reduce the risk of a second fracture, according to Richard Evans, CEO at the Society of Radiographers. “Vertebral fractures are the most common osteoporotic fracture and are the most predictive of subsequent hip fractures. The cost to the patient and the NHS of further fractures can be avoided if we design systems that are alert to a patient’s first vertebral fracture,” he said. “Reporting clinicians often have the first opportunity to diagnose a patient’s vertebral fracture, which, until then, may have been asymptomatic and clinically unsuspected. Clinicians in diagnostic imaging need to routinely examine all images showing the spine for vertebral fractures. Vertebral fractures must be
reported unambiguously – using the word ‘fracture’ – because clear communication will alert referring clinicians to their clinical significance and ensure that these patients are assessed and treated where appropriate. Effective identification of patients with vertebral fractures via a vertebral fracture pathway is achievable in every locality if we seize this opportunity.” Vertebral fractures are the most common osteoporotic fracture. Prevalence studies suggest that 12% of women aged 50-79 have vertebral fractures, the majority of which will be osteoporotic in origin – increasing to 20% in women over 80 years of age. More than 55% of patients with hip fracture have evidence of a prior vertebral fracture. However, as the majority are undiagnosed, the opportunity to intervene and prevent the hip fracture is missed, says
A life turned upside CONTRIBUTING to the foreword of the Society’s guidance document, osteoporosis sufferer Christine Sharp explains how earlier diagnosis could have spared her a great deal of pain and suffering. “I found out I had osteoporosis a few years ago, after I slipped on some ice, but the first fracture was not picked up, probably because of a lack of awareness on the part of the health professionals I saw at the time,” she said. “Instead of starting a treatment for osteoporosis, I was sent away from my
Image: kjpargeter/Freepik
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Identifying vertebral fractures systematically has proven challenging for clinicians and currently more than two-thirds are undiagnosed. New guidance1 from the National Osteoporosis Society seeks to address this and highlights the significant role of reporting clinicians in diagnostic imaging.
the National Osteoporosis Society. A recent study of patients with hip fracture who also had evidence of vertebral fracture on prior imaging found that only 46% of the vertebral fractures had been reported by a radiologist at the time the image was taken, and even fewer had been acted on by the referring clinician. A Fracture Liaison Service (FLS) prevents secondary fractures by identifying patients with a fragility fracture using dedicated case-finding. It provides assessment for osteoporosis and where appropriate, treatment and follow-up. FLS designed to the national clinical standards offer the best model for effective secondary fracture prevention. The standards specifically require FLS to identify systematically all patients over 50 with a newly reported vertebral fracture. However, in the first two annual reports
from the national FLS-Database, the Royal College of Physicians reported low rates of vertebral fractures identified by FLS, with the lack of a patient pathway being the most frequently cited barrier to their identification. Research shows that osteoporotic older people with vertebral fracture have worse physical-health-related quality of life than osteoporotic older people without vertebral fracture, even after accounting for age differences. Left untreated, vertebral fractures often progress to involve multiple levels in the thoracic and lumbar spine, leading to disabling pain, increased kyphosis (curved spine), and loss of independence and confidence. Increases in thoracic kyphosis and height loss contribute to problems such as swallowing and breathing difficulties, and incontinence.
1) Clinical Guidance for the Effective Identification of Vertebral Fractures
down by the onset of osteoporosis local hospital with painkillers. As a result of this, I suffered more fractures in my spine – which were devastating and life changing. “My life has not been the same since. I went from being someone who ran my own hair salon and walked over 30 miles a week to someone who had to stop work and all physical activities due to the horrendous pain. It was a struggle just to get through each day and I couldn’t plan anything in advance. “As if this wasn’t bad enough, I also had
to cope with a change in body shape. I have lost four inches in height and gone down two dress sizes. Losing height means that your digestion and breathing are affected due to your organs being squashed into less space. You look in the mirror and hardly recognise yourself and feel ashamed of how you look. “Your self-esteem takes a dive and you try to cover up your embarrassment by wearing loose-fitting clothes to hide your body. The impact is not only physical but also psychological.”
Designing an effective fracture prevention pathway
Assessment and action plan templates OSTEOPOROSIS is a long-term condition that causes bones to become fragile and break easily, often after a bump or fall (such breaks are known as “fragility fractures”). More than three million people in the UK are estimated to have osteoporosis and there are an estimated 500,000 new fragility fractures each year. Quality standards2 to support health professionals in providing care to treat osteoporosis and reduce fracture risk are available from the National Osteoporosis Society. The standards provide information to help people engage effectively with available services and ensure they receive care to meet their needs. Most fractures result from a fall. One third of people aged over 65 fall at least once a year and 255,000 falls result in an emergency admission – 80% of those with a non-hip fracture are not offered strength and balance exercises. Yet risk assessment and falls prevention interventions reduce falls by 24%, says the National Osteoporosis Society. Individual services can download the following templates to evaluate their pathways: l Self-assessment template and audit tools l Action plan template l Patient and carer experience measures. www.nos.org.uk 2) Quality Standards for Osteoporosis and Prevention of Fragility Fractures
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22 TALKBACK PRODUCTS AND INNOVATION
Helping patients to realign their pelvis and spine The physical effects of a bad back are obvious, but what is often overlooked is the significant social and emotional impact that the pain can have on those who experience it.
BACK PAIN can cause you to take time off work, disrupt your sleep, lead to cancelled social engagements and spoil family time. So, it’s unsurprising that people who suffer longterm or recurring symptoms can increasingly feel its nonphysical effects, too. They can experience anxiety, depression, irritability and helplessness, as well as a growing fear of physical deterioration. Chris Aldred, a physiotherapist based in Harrogate, treats people who have suffered for decades and whose back pain has had a significant impact on their lives. “They are desperate to start living their life again,” he said. Chris became convinced that the key to combating the psychosocial effects of back pain is not only to provide relief from the pain, but to empower sufferers to manage it themselves. He developed a device that would help his patients to relieve their back pain by themselves, should it start niggling again between sessions at his clinic. The first thing he would do to a patient, as the basis of further treatment, was to put them
The Pelvipro, which seeks to correct misalignment between pelvis and spine
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Physio, Chris Aldred “back in alignment” – in other words, make sure their pelvis was straight and not being pulled to one side or the other, and that the patterns of movement around the lumbopelvic-femoral region were correct. Often, this “realignment” process gave them some immediate form of pain relief. He saw the opportunity for a device that would help to do just this and which his patients could turn to whenever the need presented itself. He invented Pelvipro, a simple-touse, portable device that works by correcting a misalignment of the spine and pelvis, which in turn strengthens muscles and heals damaged tissue. Most importantly, the device can reduce the psychosocial effects of back pain by helping sufferers feel “in control” of their pain. Chris said: “I knew from my clinical experience that realignment had a positive effect and that patients would therefore find it helpful to be able to control their pain on their own, whether at home, at work or on holiday. “But what I didn’t expect from our trials was how marked the psychological benefits would be from patients feeling they could create this positive effect themselves and that they were finally in control of their pain.”
When muscles stop working properly LIGAMENTS and muscles contain lots of tiny nerve endings. If forces of movement are misdirected when travelling from your spine to your pelvis through to your hip, and vice versa, injury to these ligaments and muscles can happen and the nerve endings transmit the sensation of pain to your brain.
Injury When pain occurs or your body is held in a certain posture, muscles can stop working properly and they weaken. This can lead to further injury because they are not supporting the body in the way that they used to. Pelvipro works to redirect the forces acting between your lumbar spine, pelvis and hips, to ensure the correct structures are doing the correct job. Switch off pain and you’ll switch on your stabilising muscles. www.pelvipro.com
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Stretch your vertebrae while the sling takes the strain BACKSTATION is specifically designed to mobilise the core muscles of the spine in an upright position. The freestanding unit allows the user to stretch the vertebrae and relieve the stress and tension in an upright stance, as opposed to lying on the floor or hanging upside down. The sling takes the weight of your torso while you just bend your knee. Inventor David Hawkes said: “I slipped a disc many years ago and was left with a spinal problem that would flare up at any time which would leave me incapacitated. The only solution was to find a way to exercise my back and strengthen my
muscles at the same time. “You do only one exercise and that is to bend your knees – you do not swing on the frame and you do not leave the ground, and with the Backstation you can repeat the process as many times as you like. This is your pain management system and will leave you in control to set your own routine as and when you need it.” Five reps of five seconds each can provide relief, with the decompression helping to ease the pain, says David Hawkes. The unit has the footprint of a dining room chair and can take the weight of 20 st (130 kilos). http://the-backstation.co.uk
Design aims to reduce the stresses placed on feet A WOMEN’S footwear brand has designed a footbed that mirrors the anatomical shape to help improve health and wellbeing. Biomechanical Footbed Technology from Strive Footwear uses the principle of comfort “as nature intended” – rather than artificially through excessive cushioning. When you wear footwear with a flat foot bed, pressure is focused on to the heel and ball of foot, which are two of the most common foot complaints. Whereas when
you wear footwear with a contoured footbed, the pressure is dispersed evenly over a larger surface area, says Strive. The concept helps to prevent excessive arch collapse, both in the mid-foot and forefoot. It also helps improve posture and reduce stresses placed upon your body and feet – a contributing factor to many common aches and pains. www.strivefootwear.com
Did you know? One in three people suffer with heel pain at some point in their lives. Cases of ball of foot pain increase during the summer due to wearing flat and unsupportive flip flops.
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24 TALKBACK NEWS
participate! Four great reasons to join BackCare l We bring you the latest advice and research l We have extensive links with major service providers l We offer a balanced view on the different therapies l We listen to our members and invite collaboration BackCare has a number of local branches and regional representatives who can help you with your back pain. Call us today on: (0)208 977 5474 TALKBACK l SUMMER 2018
