TalkBack, winter | 2017-18 (BackCare)

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

WINTER n 2017

FREE TO MEMBERS

Relieve stress and improve confidence with yoga also in this issue: Physical activity Exploring the gender gap in active lifestyles Research Sitting without a break carries greater risk Campaigns Patients are waiting too long for vital rehabilitation

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

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

Pain relief through yoga Mira Mehta MPhil (Oxon), Assoc. BAAAP Author of Yoga: the Iyengar Way, How to Use Yoga, Health through Yoga and Yoga Explained

Back pain (simple) and scoliosis – stretching and rotational postures.

Neck pain – postures to relax and strengthen.

Sciatica and prolapsed discs – restful postures that realign and strengthen.

Venue in London WC1 www.yogicpath.com

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TALKBACK LEADER 3

Safeguarding equality of care in a digital age GP consultations by videolink on smartphones are being offered 24/7 via a new, app-based primary care service piloted in London.

GP at Hand1 is offering the standard NHS services including acute and chronic disease management, prescriptions and referrals, to patients living and working in the capital who can sign up by switching their registered practice.

While face-to-face appointments can also be made, if necessary, at one of the group’s five central London surgeries, the virtual service promises to cut waiting times dramatically and offers us a glimpse of how technology could transform doctor-patient relationships in the future.

However, the NHS-backed service also declares that it may not be suitable for patients with complex health problems, raising concerns that the least demanding patients – young, healthier commuters – will be “cherry-picked”, and in so doing drain vital funds away from traditional GP practices that are left to deal with the most ill, ie the elderly and the vulnerable.

Delivering care disproportionately to the “worried well” widens health inequalities and risks undermining the quality and continuity of care to those who need it most, GP leaders have warned2. This represents a critical challenge for the NHS which may have to temper its desire to exploit shiny new consumer technologies if it is to safeguard its core principle of equality of care based on clinical need.

Contents

The health service wants to become more digitally savvy in order to achieve better outcomes but it must continue to treat equality as an obligation, not an obstacle. A new, national structured development programme in change management within the organisation will help in the adoption of systems that improve patient care across the board. The NHS is also busy developing its own health technology champions, recently announcing3 an investment of £6m on specialist IT training and development support for 300 senior clinicians and health managers to help drive digital innovation.

Potential new approaches to osteoporosis 5

More training in CPR can save thousands of lives 7

Richard Sutton Editor

Strengthening activity is key to avoiding falls 8

LETTERS TO THE EDITOR:

richard.sutton@backcare.org.uk

1) www.gpathand.nhs.uk 2) www.rcgp.org.uk; www.bma.org.uk 3) www.england.nhs.uk Cover image: peoplecreations/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.

Working towards a smoke-free generation 16

£10m lottery cash to tackle inactivity 22 TALKBACK l WINTER 2017

4 TALKBACK NEWS

Joint replacement gets patients back to their chosen lifestyle sooner, free from pain and with improved mobility

Image: Sport England

Continuing fears over rationing of hip and knee replacements THE rationing of joint replacement surgery continues to be a concern to members of ARMA (Arthritis and Musculoskeletal Alliance). Funding shortages have seen clinical commissioning groups (CCGs) reducing the number of people who qualify for hip replacements and knee replacements, despite warnings that the NHS may face extra costs from delaying treatment and prolonging pain.

In October, the British Orthopaedic Association posted a strongly worded response addressed to one clinical commissioning group that described hip and knee arthroplasty as ‘procedures of limited clinical value’ and which was asking clinicians to hand out patient information using this term. BOA president Ananda Nanu said that these procedures had in fact been shown repeatedly to be one of the most effective interventions in health care using many different metrics. He stated: “Any clinician who is discussing

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a potential arthroplasty treatment with a patient will talk with them about the benefits, risks and likely outcomes, and will weigh them up with that patient for their situation before arriving at a conclusion based on a shared-decision-making process. Having arrived at a decision that a hip or knee replacement is justified, it is clearly inappropriate that they should be asked to distribute a leaflet referring to it as being of limited value when this is patently not so.”

A record number of joint replacement procedures were performed last year, according to the annual report of the orthopaedic joint replacement register for England, Wales, Northern Ireland and the Isle of Man. Close to 243,000 cases were submitted to the National Joint Registry, an increase of more than 20,000 joint operations than the previous period.

The primary procedures were performed predominately for osteoarthritis or

inflammatory arthritis. The average patient is female, with only ankle replacement procedures showing a male majority.

The risk of having the first-time implant replaced (known as “revision” surgery) within 13 years was low. National Joint Registry medical director Martyn Porter said: “The consistently high number of joint replacement cases submitted per year suggests continuing high levels of patient confidence and clinical performance, in what is a remarkably successful surgical intervention.

“Specifically, in the case of hip replacement, [the] report shows that in the vast majority of patients over the age of 75 at the time of their operation, their hip implant will not need to be replaced again in their remaining lifetime. Similarly, for patients over the age of 75, the data for the most common types of total knee replacement show less than a 3% chance of requiring further surgery at 13 years.”

TALKBACK NEWS 5

Patients to get ‘breakthrough’ treatments faster

Image: kjpargeter/Freepik

Products with the greatest potential could be available up to four years earlier

A NEW fast-track route into the NHS for “breakthrough” medicines and technologies will speed up the time it takes for patients to benefit from groundbreaking products for conditions such as cancer, dementia and diabetes.

From April 2018, the new “accelerated access pathway” will mean products with the greatest potential to change lives could be available up to four years earlier. It will be done by reducing the time it takes to negotiate evaluation and financial approvals before the NHS can purchase the products.

Under the scheme, a number of products each year will receive “breakthrough” designation. This will unlock a package of support allowing firms to accelerate clinical development and gain a fast-track route through the NHS’s approval processes.

Health minister Lord O’Shaughnessy said: “[The] new measures will not only benefit patients by improving how quickly and easily we can get innovative products from the lab to the bedside, but will guarantee future collaboration between the life sciences sector and the NHS post-Brexit – benefiting the British economy and creating jobs.”

Potential new therapeutic approaches to osteoporosis following gene study SCIENTISTS have identified a number of new genetic variants that are implicated in the development of osteoporosis following a major study led by the University of Queensland in Australia and McGill University in Canada.

Overall, the research triples the number of genes known to be implicated in the loss of bone mineral density, and could underpin future efforts to develop screening programmes to identify individuals who would benefit most from preventive measures.

The study was published in the medical

Sir Andrew Witty, former CEO of GlaxoSmithKline, will lead the Accelerated Access Collaborative, to highlight which products should be granted access to the pathway. The collaborative will draw on advice from patients, clinicians and industry. In return, life sciences firms will be expected to deliver additional value for the taxpayer, with a new Strategic Commercial Unit being created within NHS England to negotiate cost-effective deals.

The government is also providing an £86m package to help innovators of all sizes gain access to the NHS market, to get their products to patients. The package includes: l support for small and medium-sized enterprises to help them build a stronger evidence base for their products, with £35m over four years for digital products, and £6m for medtech, diagnostics and pharmaceutical products l £6m to support clinicians to use new treatments and technologies in everyday practice l £39m to encourage grassroots adoption and uptake of new medical technologies – driven by 15 Academic Health Science Networks.

The research triples the number of genes known to be implicated in the loss of bone mineral density Image: kjpargeter/Freepik

journal Nature Genetics and reported by Arthritis Research UK. It analysed data from more than 140,000 individuals from the UK Biobank, with bone mineral density assessments taken from ultrasounds of the heel.

Assessing this information allowed the team to identify 153 new gene variants associated with the loss of bone mineral density, which often result in fractures. Of 8,540 participants who reported previous fractures from falls, associations were made with 12 of the new gene regions.

Of particular note was the discovery of

a strongly implicated gene called GPC6, which had not previously been linked to osteoporosis, as well as the fact that the new gene variants account for 12% of the heritability of the disease.

Professor David Evans, a researcher at Queensland’s Diamantina Institute, said: “What makes this gene particularly interesting is that it encodes a protein that is present on the surface of cells, making it a potential candidate for a drug target. Our studies show that removing it in animal models resulted in an increase in bone thickness.”

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6 TALKBACK COMMUNITY

LETTERS Dear TalkBack, Alexander Technique for Parkinson’s disease in NICE update (again) ADULTS with motor symptoms of Parkinson’s Disease can benefit from referral to Alexander Technique teachers for assessment and tuition according to the guidelines from the National Institute for Health and Care Excellence (NICE).

The document (NG71) published in July updates a 2006 version and says that learning and applying the Alexander Technique is beneficial in this condition.

This follows a pilot study and randomised control trial published in the peer-reviewed journal Clinical Rehabilitation1 as well as the more recent paper called Lighten Up: Scientific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease2.

Crucially, Alexander Technique teachers can provide information about the most efficient way to perform physiotherapy exercises when offering advice to people with the condition, especially those experiencing balance or motor problems.

The updated guideline was received positively by the Society of Teachers of the Alexander Technique (STAT). The Society welcomes a more accurate description of the Alexander Technique as a discipline in its own right rather than a subset of physiotherapy. Physiotherapy exercises and advice enhanced by improved general functioning and proactive selective inhibition targeted at the neck muscles (a proximal constraint which facilitates learning and regulates global control3 will provide better results than either physiotherapy or Alexander Technique tuition alone.

Dr Miriam Wohl Leicester

Dr Wohl is a former GP who has been teaching the Alexander Technique for 27 years and currently works part-time as a GP expert witness in Leicestershire and Lincolnshire.

Retention of skills learnt in Alexander Technique lessons: 28 people with idiopathic Parkinson’s disease. C Stallibrass, C Frank, K Wentworth. Journal of Bodywork and Movement Therapies (2005) 9 150-157.

Randomized controlled trial of the Alexander Technique for idiopathic Parkinson’s Disease. Clinical Rehabilitation 2002; 16: 705-718 Stallibrass C, Sissons P, Chalmers 2 Neurorehabilitation and Neural Repair 2015 Feb 9. Pii: 1545968315570323.

[Epub ahead of print] Choen RG, Gurfinkel VS, Kwak E, Warden AC, Horak FB 3 http://ieeexplore.ieee.org/ document/7792725 1

Want to take part in London’s Big Half 2018?

THE CAPITAL’S new annual mass participation race over the classic half marathon distance takes place on Sunday 4 March 2018, starting at Tower Bridge and finishing by The Cutty Sark in Greenwich.

General entries have now sold out, but you can still register for one of BackCare’s guaranteed charity places.

The Big Half programme is being billed as a street party of epic proportions, and includes the Big Festival in Greenwich with a huge

range of food, music, entertainment and fun activities for the whole family to enjoy.

To run for BackCare, the registration fee is £30, with a fundraising target of £300.

Call Anusha on: 020 8977 5474 or email anusha.vamadeva@backcare.org.uk

Tracking regional waiting times WITH the NHS under constant pressure to meet targets for A&E waiting times, cancer treatment and planned surgery, the BBC provides a tracker that allows you to check any NHS Trust to see how it is doing on meeting the targets. Using this

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tracker, Luton & Dunstable is the best performing trust for A&E, Barnsley for cancer care and Mid Cheshire Hospitals for planned ops and care. www.bbc.co.uk/news/health-41483322

Image: topntp26/Freepik

TALKBACK COMMUNITY 7

Image: jannoon028/Freepik

PUBLIC Health England commissioned York Health Economics Consortium to develop an economic tool to compare the return on investment (ROI) of interventions for the prevention of musculoskeletal conditions. The tool focuses on high volume MSK conditions in working age adults (osteoarthritis hip and knee, back pain and neck pain) and compares the cost effectiveness of a selected number of interventions.

The aim of the project was to develop

Comparing the ROI of MSK interventions an easy-to-use, interactive tool for use by various stakeholders including NHS Clinical Commissioning Groups, Local Authorities and Sustainability & Transformation Partnerships, to assess the potential return on investment for investing in programmes aimed to prevent and treat individuals with MSK conditions.

The results screen in the tool shows the net cost of the interventions, any gains in quality adjusted life years (QALYs) and days of work saved. The ROI values show

the estimated value generated for every £1 spent on the intervention. When taking a healthcare financial perspective, four of the seven interventions selected to be included in the tool produce a positive return on investment when compared with usual care. These are STarT Back (Stratified Risk Assessment and Care) for back pain; “PhysioDirect - Early telephone assessment and advice”; Self-referral to physiotherapy for all MSK conditions; ESCAPE-pain for knee pain.

More training in CPR can save thousands of lives AN estimated one in five adults in the UK witness someone collapse who needs immediate CPR, yet the majority of people do not act, according to new research funded by the British Heart Foundation (BHF).

Image: creativeart/Freepik

The findings were released on Restart a Heart Day – an awareness day staged in October, which saw more than 150,000 young people across the UK trained in CPR in the largest event of its kind.

Researchers at the University of Warwick carried out a survey of 2,000 people across the country to find out how likely people are to witness a life-threatening cardiac arrest. They also found that people were nearly three times more likely to perform CPR if they had received training.

Survival rates for out-of-hospital cardiac arrest in the UK are still worryingly low with less than one in ten people surviving. The BHF estimates that 10,000 people die every year in the UK as rates of bystander CPR are as low as 39% in some parts of the country. This is significantly worse than other places such as the Netherlands (66%), Seattle (69%), Victoria, Australia (69%) and Norway (73%).

Simon Gillespie, chief executive at the BHF, commented: “CPR is the difference

between life and death for thousands of people every year in the UK who suffer a cardiac arrest. Every second counts, and it simply isn’t enough to hope that someone who knows CPR is present. We need everyone to learn this life-saving skill to give them the confidence to step in and give CPR when someone collapses after a cardiac arrest.” www.bhf.org.uk

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8 TALKBACK PREVENTION

Simple bodyweight exercises can be a good place to start Image: Sport England

Strengthening activity is key to avoiding falls TOO many people are letting muscle waste as they age, according to physiotherapists.

A survey for the Chartered Society of Physiotherapy (CSP) found 24% of people aged 65 and over do no strengthening activities at all each week, potentially putting themselves at risk of falls and other serious ill health.

The national activity guidelines recommend doing two strengthening sessions a week – in addition to the better-known call to be active for 150 minutes. For people up to the age of 64, the guidelines say these sessions can include exercising with weights or lifting and carrying heavy loads such as groceries. For those 65 and over, they can

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also include activities that involve stepping and jumping, like dancing, or chair aerobics.

The poll also raised concerns that those approaching retirement are not doing enough to protect their long-term health, with the survey showing 34% of people aged 55-64 missed the target completely.

Muscle mass Across both age ranges, 19% said they didn’t know how to do strengthening activities while a further 18% said they just didn’t want to. Some 35% of respondents said a health condition prevented them from strengthening.

Studies show that strengthening activities can help prevent falls and other ill health as we age – and reverse the process whereby

we lose up to 8% of our muscle mass each decade from the age of 30. Falls cause an estimated 95% of all hip fractures and cost the NHS more than £1bn a year.

Prof Karen Middleton, chief executive officer of the CSP, said: “We must move past the idea that becoming weaker and frailer is inevitable as we get older.

Research shows getting stronger brings a host of health benefits so it is incredibly important that people don’t overlook strengthening when being active.

“It doesn’t mean immediately hitting the gym to lift weights – to start, it can be digging in the garden or simple bodyweight exercises like standing up out of a chair 10 times.” www.csp.org.uk

TALKBACK PREVENTION 9

Identifying those at risk of inherited high cholesterol

Medical records should be systematically checked Image: jannoon028/Freepik

PRIMARY care medical records should be systematically checked to find people who may be at risk of familial hypercholesterolaemia (FH), an inherited form of high cholesterol, the National Institute for Health and Care Excellence (NICE) has recommended in updated guidance.

FH is caused by a genetic defect (or mutation) which affects the body’s ability to break down cholesterol, causing high levels to accumulate in the blood from birth.

At the moment only 15% of the estimated 260,000 people in the UK with FH have been diagnosed, including just 600 of the 56,000 children thought to have the condition. In men, FH can lead to a one in two chance of having a heart attack or stroke, before they are 50. In women, the risk is nearly one in three by the time they are 60. Siblings and children of people with FH have a 50% risk of inheriting the condition.

The guideline recommends that primary care records are examined to identify people who have a total cholesterol level greater than 7.5 mmol/l if they are under

30 years old, or 9.0 mmol/l if they are aged 30 or over. These thresholds will identify people at risk of FH. The updated guidance recognises that DNA testing is now considered to be the gold standard for identifying affected relatives (cascade testing) and no longer recommends using lipoprotein cholesterol (LDL-C) measurement because some people with an identified mutation and diagnosis of FH may not have an LDL-C concentration above the diagnostic threshold.

Professor Mark Baker, director of the centre for guidelines at NICE, said: “Familial hypercholesterolaemia is a serious, often undiagnosed but relatively common condition which, if treated early, ideally in childhood, will not affect normal life expectancy for the majority of people with it. However, without treatment people with FH have a high chance of developing cardiovascular disease earlier than most people.

Starting on the right treatment, usually with a high-intensity statin, as soon as possible is important, but only a fraction of people with the condition know they have it.” www.bhf.org.uk

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10 TALKBACK SELF HELP

How yoga can alleviate back

Sitting awkwardly, craning the neck for long periods and lifting heavy weights are well known causes of back pain TALKBACK l WINTER 2017

YOGA practice means the practice of yoga postures (asanas). Although superficially similar to physical exercises, they differ from these as they are not mere repetitive movements – they involve a systematic, structured and intelligent way of moving the whole musculoskeletal system. They also affect the psyche in that they develop confidence and physical and mental stability.

Yoga postures can be divided into groups according to type, such as standing, sitting, twisting, inverted and back-bending postures. With a varied practice, these build a sound and healthy physique based on the harmonious alignment of the whole physical structure – bones, muscles and organic body. In ordinary life, the limbs are limited in the range of movement required of them. While they function more or less adequately with a fair degree of misalignment, severe misalignment is incapacitating.

The harmonising movements of yoga postures involve a number of actions: l Extension: muscles are stretched so that joints can be straightened or flexed to their optimum degree. Using muscles strengthens them and improves their functionality. l Rotation: where rotational movements are required, bones are deliberately turned with their muscles. This can only be done if the muscles are also extended. l Creation of space: this is between bone and bone, as between the spinal vertebrae, or above and below a joint.

In normal life joints become compressed, causing pain and stiffness. Once space is created, mobility is increased.

These various actions increase the mobility of the limbs and joints and encourage the healthy circulation of blood to affected areas, with obvious beneficial effects. By redressing imbalances between overworked and underused muscles, they relieve stress.

Let us now turn to some common conditions affecting the back. These vary considerably according to the location, nature and cause of the pain, and whether the pain is due to structural or organic problems. In the latter case, the condition is likely to be complex and needs careful and expert handling.

Structural problems fairly obviously lend themselves to correction by yoga postures.

They can be divided into two broad types. The first encompasses congenital problems or those caused by growing too quickly, such as abnormal curvatures of the spine (scoliosis, kyphosis, lordosis). Under the second

come problems created by continued bad posture or repeated movements involving strain. Sitting awkwardly, craning the neck for long periods and lifting heavy weights are well known causes of back pain. Habitually carrying heavy bags in one hand or on one shoulder, particularly in childhood, develops a one-sidedness that can lead to back pain later.

If a person suffers generalised backache in the sacral, lumbar or dorsal areas, a series of standing poses and seated twists are extremely effective in giving relief (Trikonasana, Parsvakonasana, Virabhadrasana 1, Virabhadrasana 2, Ardha Chandrasana, Parivrtta Trikonasana, Bharavajasana (on a chair), Marichyasana (standing)). Individuals are likely to find different postures particularly beneficial.

Other helpful postures are Supta Padangusthasana and Utthita Padangusthasana.

Image: tirachard/Freepik

Many people find their back pain alleviated or cured through the practice of yoga. Leading yoga expert, author and trainer Mira Mehta explains some processes of yoga and considers yoga practice in relation to a number of painful back conditions.

Yoga is a systematic, structured and intelligent way of moving the whole musculoskeletal system

TALKBACK SELF HELP 11

 pain Repetition of these postures brings increasing relief.

Repeated practice strengthens the back, often to such an extent that the problem does not recur.

For lower back conditions such as herniated discs and sciatica it is essential to realign the back and create space before beginning the strengthening process.

An important principle, wherever there is pain, is to stretch away from that pain. A great deal of pain is due to compression.

Compression An important principle, wherever there is pain, is to stretch away from that pain. A great deal of pain is due to compression. Thus, by systematically extending and moving the arms and shoulders in various ways, lightness and relief is felt in the back. Examples of such movements are Parvatasana, Gomukhasana, Garudasana and Namaste. When the chest expands as a result of these stretches breathing improves, bringing an immediate sense of feeling better.

Another important point is to perform movements with an exhalation. Usually when pain is felt there is a tendency to hold the breath. This makes a person tense. We relax, and relax the affected area, on an outward breath.

A special yoga boon to backache sufferers is found in inverted postures. Here the pressure of gravity is reversed and the spine can lengthen in an upside-down position.

If there is pain these postures can be done with support, as for example Ardha-Halasana.

The principles outlined above also apply in arthritic conditions

such as ankylosing spondylitis and cervical spondylosis, and in back pain due to trauma or injury. Here, of course, great care must be taken and each individual’s programme specifically arranged according to their capability and need. Sensitive observation and handling are required of the therapist, who must take careful account of the feedback given by the patient.

A great feature of yoga is that it promotes self-reliance.

Although the practices need a teacher’s guidance initially (and continually for many people) they can be practised independently once the student gains confidence. This gives a tremendous psychological boost. Instead of relying on medicine or another person to remove pain, you learn to alleviate it yourself. www.yogicpath.com

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12 TALKBACK PHYSICAL ACTIVITY

There are still more men than women getting active – though that gap has been closing

A project to help carers – and the people they care for – experience the joy of walking, is being funded

by Sport England.

Stepping Out with Carers co-organiser Sue Mott explains how the scheme came together.

Group walking scheme IT WAS a curious thing. The organisers of the White Cliffs Walking Festival in Kent were baffled that, for the third year, their walk for disabled people had produced no takers.

The venue: scenic. The weather: fine. The volunteers: ready to go. The customers: none!

It was a great disappointment, and maybe the walk should be withdrawn forever, they concluded. Clearly, there was no demand.

This seemed odd, though. Why would people, no matter what their disability, not enjoy a stroll – or a wheel – in the great outdoors?

Then a chance encounter with someone from a carers’ support organisation

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identified not one, but a series of obstacles preventing participation.

Disabled people and those who cared for them would love the exercise and sociability that walking entails, but they felt defeated from the outset. Health issues and financial problems were chief among the obstacles.

In addition, there was a sense of isolation, loss of confidence and a lack of connection with the outside world – depression, loneliness and a sense that they inhabited a “kind of prison”. It was hard to spring open the door and take that first step.

That’s when Stepping Out with Carers was born.

In March this year, a walk – in fact two walks – were offered in Folkestone. An easy one along the top of The Leas with glorious views over the English Channel, and a more challenging route down a zigzag path to the seashore (and hopefully up again).

It was made known that this was an event specifically catering to the disabled and their carers. Carers’ support organisations spread the news among their clients.

Transport could be provided for those who had neither the finances nor the vehicles to get to the start line. And a snack lunch would round off the activity.

TALKBACK PHYSICAL ACTIVITY 13

Unpicking the gender gap in active lifestyles THE Active Lives Adult Survey, published

by Sport England, lifts the lid on the reasons people do or don’t get active.

The findings help to identify the reasons behind the gender gap, unpicking the differences between how men and women engage with sport and physical activity, looking at factors like ethnicity, pregnancy and retirement.

More men choose to take part in gym sessions and are more likely to do activities like rugby, cycling and running, while women are more likely to choose a fitness class, swimming or walking for leisure. Walking becomes even more

important to women who are pregnant or have young children.

On average, men do one more session of physical activity a week and their sessions last about 11 minutes longer. This is because the activities women choose to do tend to last for shorter periods of time.

Talking to women and girls about activity has shed light on what influences their choices. For example, adverts for quick workouts and other short-term challenges are very visible on social media channels. Although some women are sceptical about the benefits, quick workouts are appealing to women looking

for ways to fit activity into their life. For many mums, short bursts of activity can be more manageable where the day can often feel disjointed or unfixed.

Some sports and the environments where they take place can feel intimidating for women. For those who have not been active for a while, memories of unpleasant past experiences of sport can be strong.

In response, Sport England’s insightled “This Girl Can” campaign has opened many women’s eyes to the range of activities out there and challenged those who deliver sport to make the experience more attractive and welcoming.

proves a crowd pleaser Everyone involved, not just those with a disability, reports physical, mental and emotional benefits from the very simple fact of getting together. Rambler volunteers would chat, guide and wait with those who needed to go at a slower pace. All kinds of disabilities, from dementia to Parkinson’s disease, cancer to learning disabilities, could be welcomed when the practical barriers were removed.

Thirty-six people attended. And that was just the beginning.

There have been eight monthly walks this year and the attendance figures have steadily grown, culminating in a beautiful

walk along the sea path at Deal during the White Cliffs Walking Festival, when more than 50 people turned up for the fun and a challenging three-mile route.

New walks for 2018 Joy Stickells, a carer for her husband Tony, has chronic arthritis and is managing a diagnosis of multiple sclerosis herself. She said: “We could not have wished for a better way of spending our wedding anniversary.

We were surrounded by friends – new ones many of them.”

The plan is to offer a further set of walks in 2018 across a string of new venues

from seashore to stately home, from rolling Kent countryside to the iconic White Cliffs themselves – and to spread the idea to other areas.

It turned out there was a demand. Just not the right kind of supply. Now, friendships have been made, offshoot activities organised and new people regularly welcomed. A walk is the simplest thing in the world. Free, healthy, heartbeat-raising and a release into an outside world that for many, stuck at home, seems unattainable. www.whitecliffswalkingfestival.org.uk www.ramblers.org.uk www.sportengland.org

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14 TALKBACK PAIN MANAGEMENT

Dispelling the myths about back pain Research has uncovered peculiar ideas about back pain and how to cure it

BIZARRE measures such as drinking your own urine and spraying on WD40 are among the unusual “cures” back pain sufferers have tried in order to alleviate their condition, members of the British Chiropractic Association (BCA) have reported.

A series of weird and wonderful anecdotes have been revealed as part of a campaign by the BCA to debunk myths about the causes and cures for back pain.

Consumer research carried out on behalf of the organisation also revealed that 50% of people believe you should always rest a bad back – increasing to 64% in 16- to 24-yearolds – whereas moderate activity is usually the best idea. Additionally, more than 40% believe back or neck pain is simply part of the ageing process when in fact lifestyle factors such as inactivity are more often to blame than old age.

Rishi Loatey, BCA chiropractor, commented: “I see patients every week who share their strange stories about how they’ve tried to cure their back pain or why they think they’re suffering in the first place and, while some of these may seem amusing, there is a really serious message here.

“If people don’t know enough about what causes back pain or how best to treat it they could not only delay their recovery but potentially aggravate their problem.”

The BCA wants to bust some of the common myths and misconceptions around back and neck pain. It has created a programme of three-minute exercises, Straighten Up UK, which help improve posture and prevent back pain by promoting balance, strength and flexibility in the spine.

Image: asierromero/Freepik

If people don’t know enough about what causes back pain or how best to treat it they could not only delay their recovery but potentially aggravate their problem

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TALKBACK PAIN MANAGEMENT 15

COMMON MYTHS AND MISCONCEPTIONS You should always rest a bad back: Moderate exercise is essential to build and maintain strength and flexibility in the spine, improving posture and protecting you from any further pain. While total rest may seem like a good way to recover, often continuing moderate physical activity will help in the long run.

Back or neck pain is simply part of the ageing process: While ageing can have an impact on your back health, back or neck pain can occur at any age.

Maintaining good health into later years and being aware of how to preserve one of our body’s most important assets, the back, is important in allowing us to maintain activity levels.

Back or neck pain is not common: Back and neck pain is very common,

and statistics have shown that 80% of people will experience back pain at some point in their lives.

The spine can be injured easily: The spine is actually one of the strongest parts of your body and is designed to be strong.

Like any other part of your body though, taking good care of it is essential to allow it to do its job effectively for as long as possible.

A slipped disc means a disc has slipped out of your spine: The discs are circular pads of connective tissue – cartilage – in between each vertebra in your back. These discs have an inner gel-like substance and a tough outer case. They help maintain your back’s flexibility and wide range of movement. A slipped disc means that one of the discs

of cartilage in the spine is damaged and possibly extruding, irritating or pressing on the nerves. It can also be known as a prolapsed or herniated disc.

Painkillers can cure back pain: Most back pain is “mechanical” in nature so, even though painkillers can be helpful, some sort of mechanical, hands-on treatment involving movement/exercise is more likely to help manage the problem and reduce recurrence.

Actually true!

Staying hydrated can help prevent back pain: Dehydration can exacerbate back or neck problems so it’s important to drink plenty of water. www.chiropractic-uk.co.uk

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Image: jcomp/Freepik

16 TALKBACK CAMPAIGNS

Seeing that your wishes are respected after death

Hundreds missing out on organ transplants each year MORE than three families a week say no to organ donation because they didn’t know what their relative wanted, according to new figures released by NHS Blood and Transplant.

Last year more than 450 people in the UK died while on the active transplant waiting list. There are currently more than 6,000 people waiting for a transplant.

A contributing factor to these deaths is that families don’t know the wishes of their loved ones when they die. NHS Blood and Transplant’s annual audit of potential donors in 2016/17 shows 177 families said no to donation because “they were not sure whether the patient would have agreed”.

Those refusals could have led to around 460 life-saving or life-transforming transplants,

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according to the figures.

There are more than half a million people in the UK living with heart failure, a debilitating condition where the heart is unable to pump blood around the body effectively. In its severest form, heart failure has a worse survival rate than many cancers. Today, the only cure for heart failure is a heart transplant.

Dr Mike Knapton, associate medical director at the BHF, said: “It takes two minutes to sign up to the Organ Donor Register, and even less time to have a conversation with your loved one about your wishes.

This might seem like a difficult conversation, but it could save lives of people in desperate need of a heart transplant, and ensure your wishes are respected after death.” www.bhf.org.uk

Working hard towards CLOSE TO 40,000 healthcare professionals have been trained to offer quit smoking advice as part of a drive to make the NHS smoke-free by 2019.

In support of the Government tobacco control plan (see separate panel), Public Health England is urging all NHS frontline staff to take advantage of free online training to help them give “very brief advice on smoking” (VBA). The evidence shows that giving VBA to patients makes them 68% more likely to quit if they’re offered stop smoking medication. So far, 39,447 healthcare professionals have been trained to deliver effective stop smoking advice.

The 30-minute online course, provided by the National Centre for Smoking Cessation and Training, is based around short film clips providing examples of how very brief

advice can be delivered to patients; including key facts, figures and messages.

The burden to the NHS in England from smoking is £2.6 billion. Last year more than half a million people ended up in hospital due to a smoking attributable condition. The savings to the NHS for each patient referred to stop smoking services and prescribed nicotine replacement therapy is estimated at £13 each year for four years.

NHS England is investing almost £600m in commissioning for quality and innovation schemes, including one which focuses on identifying and supporting people who smoke or who drink alcohol at higher risk levels. Under the scheme, additional funding is being made available to hospitals that help their patients to quit smoking.

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Around 55% of delayed discharges from hospital are down to problems arranging ongoing NHS services

a smoke-free generation Breakdown: Cost of smoking Total smoking-related burden to the NHS is estimated at £2.6 billion: GP visits – £794m; practice nurse visits – £111.7m; prescriptions – £144.8m; outpatient visits – £696.6m; hospital admissions – £851.6m Incidence Smoking prevalence figures: In 2016, 15.5% of adults in England aged 18+ smoke, down from 19.9% in 2010; In 2000, 26.8% of adults aged 16+ were smokers.

Prevalence since 2010 has fallen most in younger age groups.

Government targets The aim of the tobacco control plan is to achieve these objectives by the end of 2022: ● Reduce the number of 15-year-olds who regularly smoke from 8% to 3% or less ● Reduce smoking among adults in England from 15.5% to 12% or less ● Reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population ● Reduce the prevalence of smoking in pregnancy from 10.5% to 6% or less.

WHILE medical advances and the skill of NHS staff are keeping far more people alive than in the past following potentially fatal injuries and illness, too often patients leaving hospital are unable to access high-quality rehabilitation services to continue their recovery and regain their independence.

Waiting too long for vital rehabilitation – or missing out entirely – can reverse recoveries and cause lasting damage to a person’s quality of life, says the Chartered Society of Physiotherapy (CSP).

The Stroke Association reported that 45% of stroke survivors feel abandoned when they leave hospital. Meanwhile, just 50% of people with hip fractures were found to have any rehabilitation after leaving hospital, with most waiting more than four weeks.

The gap in provision ultimately brings greater pressures for the NHS, with significantly higher numbers of A&E admissions.

The CSP and other organisations, including Arthritis Research UK and the Stroke Association, have called on the Health Select Committee to launch an inquiry into provision of community-based rehabilitation services, looking at how they can be improved and expanded to meet the increasing demand of our ageing population.

Access to community rehabilitation services also helps people get out of hospital once they are well enough to return home – some 55% of delayed discharges are down to problems arranging ongoing NHS services.

Prof Karen Middleton, CEO of the CSP, said: “Too many people are left facing a distressing future dependent on health and social care when access to high-quality rehab could have made an enormous difference to their life.

“It is a hidden scandal because it takes place in people’s homes, away from the public glare which so often falls on hospital pressures. But it’s one that as a nation we must address to stop the system wasting so many lives for entirely avoidable reasons.” www.csp.org.uk

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image: mrsiraphol/ Freepik

Patients waiting too long for vital rehabilitation

18 TALKBACK RESEARCH

Employers need more awareness about rheumatoid arthritis RHEUMATOID arthritis patients are frequently not being provided with the level of support they require from their employers, according to a new report.

A survey carried out by the University of Manchester and the National Rheumatoid Arthritis Society has indicated that many patients feel their bosses are not sufficiently aware of their condition, with many having to change jobs as a consequence of their condition.

The survey questioned more than 1,500 people in the UK and found that 39% of patients feel that their employer lacks awareness of rheumatoid arthritis, up from 29.5% in a survey carried out in 2007.

Moreover, 41.5% said they have had to change jobs since the onset of the illness, while 15% have been forced to stop

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working altogether. Having to take time off when feeling unwell or experiencing a flare-up was cited as the biggest barrier that those living with the condition face, with 37% ranking this as a serious or very serious problem.

Progress

The survey revealed some signs of progress, with 97% of people with rheumatoid arthritis feeling they are being more open about their condition at work, while 63% of people with the condition are in employment today, compared to 55% 10 years ago.

However, only half of those working were offered adjustments such as flexible working, reduced hours or special equipment in their last job, while more than half would feel unable to continue if their

job became more physically or emotionally demanding, showing this progress is precarious.

Dr Devi Sagar, research liaison manager at Arthritis Research UK, said: “Rheumatoid arthritis is a painful and continually fluctuating condition which affects more than 400,000 people in the UK. The unpredictable nature of the condition not only makes workplace tasks like typing and writing difficult, but can also make planning ahead troublesome.

“It is great that more people feel confident about discussing their condition and are in employment, and our hope is this will increase as more employers become more aware of rheumatoid arthritis.” www.arthritisresearchuk.org

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Image: mindandi/Freepik

Sitting without a break carries greater risk, US study shows

Earlier age of arthritis onset for obese people THE rising prevalence of obesity is leading to an increase in the frequency of rheumatoid arthritis cases.

This is according to a new study from the University of Toronto and Krembil Research Institute in Canada, which has indicated that weight problems are cancelling out the positive impact of other lifestyle factors when it comes to rheumatoid arthritis risk.

The study analysed data from 8,817 people taking part in the Canadian National Population Health Survey between 1994 and 2011. Four generational cohorts were analysed: those born from 1935 to 1944, older baby boomers born 1945 to 1954, younger baby boomers born 1955 to 1964, and Generation X children born 1965 to 1974.

Results published in the medical journal Arthritis Care & Research showed that more recent cohorts experienced a successively greater prevalence of arthritis, with any positive impact from increasing education and income counterbalanced by higher body mass index (BMI). The evidence also pointed to an earlier age of arthritis onset for obese individuals compared to those of normal weight.

Devi Sagar, research liaison manager at Arthritis Research UK, said: “Obesity is bad for the joints and can increase the chances of conditions like arthritis. As people live longer, it is important to maintain healthy diets and lifestyles, which promote musculoskeletal health.” www.arthritisresearchuk.org

IT ISN’T just the amount of time spent sitting, but also the way in which sitting time is accumulated during the day that can affect risk of early death, according to a new study from Columbia University Medical Center.

The study, published online in Annals of Internal Medicine, found that adults who sit for one to two hours at a time without moving have a higher mortality rate than adults who accrue the same amount of sedentary time in shorter bouts.

“We tend to think of sedentary behaviour as just the sheer volume of how much we sit around each day,” said Keith Diaz, associate research scientist in the Department of Medicine at Columbia University Medical Center and lead investigator of the study. “But previous studies have suggested that sedentary patterns— whether an individual accrues sedentary time through several short stretches or fewer long stretches of time—may have an impact on health.”

The researchers used hipmounted activity monitors to measure inactivity during waking time over a period of

seven days in almost 8,000 adults over the age of 45.

On average, sedentary behaviour accounted for 77% of the participants’ waking hours, equivalent to more than 12 hours a day.

Over a follow-up period of four years, 340 of the participants died. Mortality risk was calculated for those with various amounts of total sedentary time and various sedentary patterns.

Those with the greatest amount of sedentary time—more than 13 hours a day—and who frequently had sedentary bouts of at least 60 to 90 consecutive minutes, had a nearly twofold increase in death risk compared with those who had the least total sedentary time and the shortest sedentary bouts.

The researchers also found that participants who kept most of their sitting bouts to less than 30 minutes had the lowest risk of death.

“So if you have a job or lifestyle where you have to sit for long periods of time, we suggest taking a movement break every half hour. This one behaviour change could reduce your risk of death,” Dr Diaz said. www.cumc.columbia.edu

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20 TALKBACK PUBLIC HEALTH

Image: suksao/Freepik

Obesity in children on the rise

Image: topntp26/ Freepik

“There is no single solution to reverse what’s been decades in the making”

NEW figures from the National Child Measurement Programme overseen by Public Health England (PHE) show obesity rise for the second year in a row in reception year children in 2016 to 2017.

The data show the number of obese children in reception year has risen to 9.6% in the 2016 to 2017 school year, up from 9.3% in 2015 to 2016. For year 6 children, it has remained stable at 20%.

The findings also reveal a stubborn gap between the richest and poorest. In the most deprived areas, 12.7% of children in reception year are obese, compared to 5.8% in the least deprived. Obesity in year 6 is 26.3% in the most

Sustained actions needed to tackle poor diets and excess calorie intakes

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deprived areas, compared to 11.4% in the least deprived.

The report underlines the importance of PHE’s work to tackle childhood obesity. This includes working with the food industry to reduce sugar and calories in the foods children eat the most.

Dr Alison Tedstone, chief nutritionist at PHE, said: “There is no single solution to reverse what’s been decades in the making. We need sustained actions to tackle poor diets and excess calorie intakes. We’re working with industry to make food healthier, we’ve produced guidance for councils on planning healthier towns and we’ve delivered campaigns encouraging people to choose healthier food and lead healthier lives.”

In addition to PHE’s work to reduce sugar and calories in food, the Soft Drinks Industry Levy has become law and will take effect from April 2018. Leading retailers and manufacturers have announced they will lower the amount of sugar in their products as a result of these programmes.

The Change4Life campaign is also helping millions of families to make healthier choices through meal swap suggestions and the Be Food Smart app, helping parents to identify the sugar, salt and fat in food. It also supports schools to help them embed healthier habits into everyday school life.

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What you can do to help avoid the ‘post-antibiotic apocalypse’ IT IS estimated that at least 5,000 deaths are caused every year in England because antibiotics no longer work for some infections.

As the chief medical officer and experts around the world warn of a “post-antibiotic apocalypse” and “the end of modern medicine”, Public Health England (PHE) has launched a major new campaign to help “Keep Antibiotics Working”.

The campaign warns people that taking antibiotics when they are not needed puts them at risk of a more severe or longer infection, and urges people to take their doctor’s advice on antibiotics.

PHE’s ESPAUR report1 reveals that as antibiotic resistance grows, the options for treatment decrease. Worryingly, four in 10 patients with an E.coli bloodstream infection in England cannot be treated with the most commonly used antibiotic in hospitals.

Antibiotics are essential to treat serious bacterial infections such as meningitis, pneumonia and sepsis, but they are frequently being used to treat illnesses such as coughs, earache and sore throats that can get better by themselves.

Taking antibiotics encourages harmful bacteria that live inside you to become resistant. That means that antibiotics may not work when you really need them. It is estimated that at least 5,000 deaths are caused every year in England because antibiotics no longer work for some infections and this figure is set to rise, with experts predicting that in just over 30 years

Image: creativeart/Freepik

Taking antibiotics when they are not needed puts you at risk of a more severe or longer infection

antibiotic resistance will kill more people than cancer and diabetes combined.

The “Keep Antibiotics Working” campaign urges the public to always trust their doctor, nurse or pharmacist’s advice as to when they need antibiotics and if they are prescribed, take antibiotics as directed and never save them for later use or share them with others. The campaign also provides effective self-care advice to help individuals and their families feel better if they are not prescribed antibiotics.

Professor Paul Cosford, medical director at Public Health England, said: “Antibiotic resistance is not a distant threat, but is one of the most dangerous global crises facing the modern world today. Taking antibiotics when you don’t need them puts you and your family at risk of developing infections

which in turn cannot be easily treated with antibiotics.

“Without urgent action from all of us, common infections, minor injuries and routine operations will become much riskier.

“PHE’s ‘Keep Antibiotics Working’ campaign helps to explain the risks of antibiotic resistance to the public. It is important for people to understand that if they are feeling under the weather and see their GP or a nurse, antibiotics may not be prescribed if they are not effective for their condition, but they should expect to have a full discussion about how to manage their symptoms.” http://antibioticguardian.com English surveillance programme for antimicrobial utilisation and resistance report.

1

Digital products in trials to tackle obesity and Type 2 diabetes MORE than 5,000 people are expected to benefit from a pilot project which will see five companies and eight areas of the country test a range of apps, gadgets, wristbands and other innovative digital products in the battle against obesity and Type 2 diabetes.

Users will be able to access health coaches and online support groups as well as set and monitor goals electronically.

Some patients will also receive wearable technology to

help them monitor activity levels and receive motivational messages and prompts, which is being made available on the NHS for the first time.

This online method of receiving support has the potential to have a similar impact to face-to-face interventions – helping bring down high blood sugar levels and in turn prevent or delay the onset of Type 2 diabetes. www.england.nhs.uk

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22 TALKBACK INNOVATIONS IN HEALTH

£10m lottery cash to tackle inactivity in the over-55s SPORT ENGLAND is investing up to £10m of National Lottery money into 20 projects across England to reduce the number of inactive older adults.

The projects will use sport and activity to help tackle problems such as poor mental health, dementia, loneliness caused by bereavement, and addiction.

Thirty-six per cent of people aged 55 and over are currently inactive compared to 26% of the population as a whole. There are big differences in perceptions, experiences, motivations and capabilities among this age group, which is why Sport England is funding a broad range of projects aiming to tackle inactivity with the audience’s wants and needs in mind.

Recipients of the Active Ageing fund range from community football schemes and local nature partnerships to a digital exercise regime and a rehabilitation programme for people with arthritic pain (see below).

Image: Sport England

Self-help programme to ease knee and hip pain ESCAPE-pain is the Health Innovation Network’s rehabilitation programme for older people with chronic knee or hip conditions. The six-week programme teaches people about their condition, shows them what they can do to help themselves and guides them through an exercise programme that enables them to do more.

Coleen, 84, is a retired nurse who has suffered knee pain for many years. The pain made normal daily activities, like walking to the shops and taking a bath, extremely difficult. About a year ago, her pain increased so much she was unable to climb stairs.

Enough was enough. She went to her GP, who referred her to an orthopaedic surgeon for a knee replacement. Coleen

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was reluctant to have surgery and was referred to a physiotherapy programme called ESCAPE-pain at her local hospital.

After completing the programme, Coleen noticed big improvements in her walking. She is able to climb stairs again, feels more confident and says she is “much better in myself because I can do things again”.

The programme taught Coleen how to manage her condition – and she’s determined to continue to do the exercises she learnt through ESCAPEpain. “I don’t think I need knee surgery,” she added. “The pain is much less and it doesn’t bother me. I know how to cope now.”

Physically active older people have

higher levels of mobility and a lower of risk of disease than those who are inactive. Ill health often means the loss of independence and is linked to social isolation and depression.

“People are living longer but not necessarily in the best of health,” said Mike Diaper, Sport England executive director. “We’re excited to be supporting these 20 partners with National Lottery funding to help get older adults get active.

“We’ll be sharing learnings so successful approaches can be scaledup or replicated across the country, so we can help more adults lead happier and healthier lives.” www.escape-pain.org www.sportengland.org

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Sports therapist develops cushion to provide relief from sciatica IAN Garside was struck with a severe attack of sciatica during a long car journey. On reaching his destination he was unable to get out of the car and three weeks of agonising and debilitating pain put Ian’s life on hold.

A qualified remedial and sports massage therapist, Ian recognised the symptoms, having experienced them 15 years previously and treated many patients. Knowing all the best practices still could not prevent the impact these painful symptoms had on his daily life.

In the acute phase Ian recalled: “At its worst, sitting was a no-no. I had to stand to eat, there was no driving and there were many sleepless nights. It’s not just the pain, it’s the havoc it can wreak on your quality of life.”

It was during this episode of acute sciatica that the idea for the sciatic pain relief cushion was born and in the unlikely of places. Ian explains how he came up with the sciatic pain relief cushion: “After two to three weeks I was desperately searching the internet for some sort of relief cushion so that I could sit down. I had noticed however that when seated on the toilet the pain was not as bad as sitting on a chair, even with a cushion. This got the grey matter working, and I designed and made myself a cushion in a certain shape, and found it eased my pain. I believe it is because it offloads the sciatic nerve while sitting, reducing the nerve stimulation. Whatever the mechanism, I could finally sit down for a meal and even sit as a passenger in a car for short rides.”

Feedback Once the acute phase of the sciatica had passed, Ian was able to return to his massage work. He was treating a couple of patients suffering with sciatica and was able to lend them his cushion to help ease their pain as they recover. It was a good opportunity to receive feedback from other people experiencing sciatic pain.

One of the first patients to try the cushion was Karen Lee. She said: “I have used both cushions, the smaller one in my car for a couple of weeks and the larger one at home for two to three months now and have found that they do aid in my pain relief, mainly in the sitting position. We have a relatively flat cushioned

“It’s not just the pain, it’s the havoc it can wreak on your quality of life” sofa at home and I have found that the larger cushion has helped me to sit more comfortably for longer periods of time. My driving seat is more of a bucket style seat and the smaller cushion is better in my car, as this is where I have the most pain, when sitting for long driving journeys.”

On the journey to get the product to market, patient feedback has been key in development.

The product has detailed feedback from more than 50 people who have low backrelated leg pain, which has helped shape the design of the cushion. Ian has also conducted pressure mapping with the cushion to see if the offloading mechanism for the sciatic nerve can be seen.

Two years on, the cushion is now available and the company is embarking on projects with Innovate UK support to further improve the product. www.sciaticrelief.co.uk

Ian Garside

Pressure map shows offloading • • • • •

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The first image is of the individual sat on an office chair with no cushion The red areas show the areas of highest pressure These are in the area of the sciatic nerve The highest pressure shown is 256mm Hg The second image is with The Sciatic Pain Relief Cushion on the same chair, with the same individual, facing the same way There is an overall reduction in interface pressure The area of the sciatic nerve is shown as similar pressure to the rest of the seated tissue There is an area showing pressure which is the pressure mat being supported on the cushion The peak pressure is now 63mm Hg (less than 25% of that without the cushion)

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24 TALKBACK NEWS

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Charity No. 256751