TalkBack, Issue 1 | 2015 (BackCare)

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

■ NEWS

■ EVENTS ■ COMMUNITY ISSUE 1 n 2015

9

FREE TO MEMBERS

Pain is not damage

16/17

Back, brain or both?

19

Busting the popular myth

Making a stand

Challenging pain beliefs

Tackling prolonged sitting

The Charity for Back and Neck Pain www.backcare.org.uk

2 TALKBACK EVENTS

BackCare Events Calendar 2015 British Association of Spine Surgeons Conference 18 – 20 MARCH

Bath Assembly Rooms. For further information, visit www.cvent.com/d/g4qd6m. For sponsorship opportunities, contact Julie Archer at BASS@archer-yates.co.uk; for membership and other queries, contact Julia Bloomfield at ukssb@boa.ac.uk

International Acupuncture Research Symposium 21 MARCH

“Bridging the Gap between Research and Practice” at King’s College London (Stand campus). Research and education seminars supported by the British Acupuncture Council, Acupuncture Association of Chartered Physiotherapists, Register of Chinese Herbal Medicine and Association of Traditional Chinese Medicine. Visit www.arrcsymposium.org.uk for more information.

British Scoliosis Society – Annual Meeting 21 – 23 APRIL

Sheffield City Hall. Further details will become available at: www.britscoliosissoc.org.uk/events.asp

John Bowlby Memorial Conference 25 – 26 APRIL

“Unlocking Pain – Disrupted Attachment and Chronic Physical Pain” at the Bowlby Centre, London. Psychophysiological perspectives from international leaders in the field. More information at www.thebowlbycentre.org.uk/cpd

British Institute of Musculoskeletal Medicine – Spring Symposium 25 – 26 APRIL

“Time for reflection: evidence informing practice?” at the Hilton Hotel, Nottingham City Centre. Seminars and workshops from world leaders and local experts in musculoskeletal medicine. More information at www.bimm.org.uk/symposia

Stress Illness Recovery Practitioners Association’s Annual Conference 26 APRIL

“Chronic Pain – To Suppress, Manage or Cure?” at the Royal Society of Medicine, London. Leading international speakers in the field of chronic pain recovery. More information at www.curepain2015.com

14th International Phillip Zorab Symposium 11 – 12 JUNE

The leading basic science scoliosis conference in the world, at the Royal College of Surgeons of Edinburgh. World renowned speakers and gala dinner. More information at http://www.bsrf.co.uk/events

NSpine 2015 – Craniocervical to Cervicothoracic Spine 22 – 28 JUNE

“The United Kingdom’s most comprehensive course in Spinal Surgery and associated Specialities”, Nottingham. More information at www.nspine.co.uk

National Back Exchange – Annual Conference 28 – 30 SEPTEMBER

“Tackling Challenges” at the Hinckley Island Hotel, Leicestershire. The must-attend event of moving and handling. Learn, debate, network and reflect in a multidisciplinary environment. More information at www.nationalbackexchange.org

TALKBACK l ISSUE 1 2015

TALKBACK WELCOME 3

Welcome Hello and welcome to the first issue of 2015.

Whether you’re a regular reader or are new to TalkBack, I hope you had a great Christmas and exciting start to the year.

It’s certainly proving to be an exciting new year for the charity, with many developments since the last issue of TalkBack, including the start of our new Chief Executive Stuart Blackman, and launch of the new BackCare website – you can meet Stuart and read all about the website overleaf.

We also now have a dedicated communications person, Mary Burstow, who has been doing a tremendous job with our social media, multiplying the number of people who follow and share BackCare online – you can read her roundup of what’s been trending on page 8.

In the news, we’ll be reporting on a professional member making headlines, a BackCare branch in crisis, and announce the theme of the 2015 BackCare Awareness Week.

As you might recall, we brought you news of the Get Britain Standing campaign in TalkBack last summer. There is growing evidence that sitting for too many hours a day has seriously negative long-term health implications and the biggest culprit appears to be the sedentary office. In January, BackCare attended the first “Active Working Summit”, which is part of a growing movement to rethink the workplace – you can read the full report in this issue (pages 18-19).

We welcome back BackCare professional member Nick Sinfield for the start of a new miniseries focusing on self-management and recovery. We continue our conversation with the

Contents

osteopaths, chiropractors and acupuncturists with a miniQ&A session, with five answers to three common back pain questions. And we also have our usual array of features from leaders in their respective fields, including: osteopath and trigger point therapist, Simeon Neil-Asher; and physiotherapist and researcher, Kieran O’Sullivan.

As always, we do welcome contributions – whether you have back pain or treat people with back pain, if you can inform and inspire others, we’d love to hear from you. Get in touch by email to yourstory@backcare.org.uk or by letter to the usual address.

So I hope you enjoy this issue and I’ll see you in the next!

Back pain conquered

5

Pain is not damage

9

Pools under threat

11

The BIG questions

12

Making a stand

19

Trigger Points

21

Dr Adam Al-Kashi Head of Research & Editor of TalkBack 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 Head of Information and Research.

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 16 Elmtree Road, Teddington, Middlesex TW11 8ST Tel: +44 (0)20 8977 5474 Fax: +44 (0)20 8943 53318 Helpline: +44 (0)845 130 2704 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.

TALKBACK l ISSUE 1 2015

4 TALKBACK NEWS

New Chief Executive outlines his vision for BackCare Stuart Blackman joined the charity just before Christmas 2014. It quickly became clear he was not only full of great ideas, but also all about getting stuck in and getting things done, and looks set to be a key part of BackCare’s bright new future. We’ve asked him to pen a few words about his background and vision…

We are at the cusp of a new phase of development of the charity TALKBACK l ISSUE 1 2015

I am really enjoying working with BackCare as the new Chief Executive. It has been an exciting first few months working with the team.

We are at the cusp of a new phase of development of the charity. Our new website has just gone live and will be the platform to bring new products and services to our key stakeholders – patients along with the clinicians, companies, researchers and educators who support them.

We have used this time to re-envision how we see the charity moving forward.

As the world changes around us, we have new opportunities presenting – for example, the impact we could make into prevention and support in the office environment. Here, fully one-quarter of all days lost to sickness is back pain related (Office of National Statistics).

We have opportunities to partner with other like-minded organisations in helping spread awareness and advice on “health and wellbeing at work”. We are also investigating new research based partnerships and hope to have more to bring you in the next months. The Back Pain Show is another great opportunity we are looking to link with Back Pain Awareness Week later in the year and we are already planning for this.

Our overall aim is, therefore, to seek to understand and meet all our different “stakeholder” needs – the people who we are able to affect and who can help us in our mission. So this is an exciting operational and marketing challenge we face as a small “lean team” at head office.

My own background started with three leading healthcare companies in roles that included extensive clinical trials work in over 100 UK hospitals in the field of musculoskeletal disorders. I was able to build a strong foundation in the commercial disciplines and worked across Europe with experience in China as well.

My career then developed into business development and change management consultancy to organisations from small to large. My passion for the charity sector came out of my experience as chairman for five years of a vocational training startup in Birmingham supporting disaffected students back into productive learning to move them into employability. I realised the huge fulfilment I was feeling working for a “cause led” organisation and decided some 10 years ago to move into the charity sector full time.

To be at BackCare is remarkable as it brings me full circle to the medical field I started my career in. I feel greatly supported by the Chairman Brian Hammond and the dedicated board of trustees as I seek to play my part with the team to realise “the potential of the potential” for BackCare and I must thank the staff and volunteers who are working so hard on this venture right now.

TALKBACK NEWS 5

ON YOUR FEET Friday, 24 April is “On Your Feet Britain” day. Offices nationwide will be taking part in the event, which has been organised by the Active Working CIC and the British Heart Foundation.

The aim is to make people aware that prolonged sitting is bad for their health.

“We urge individuals and companies to convert ‘Sitting time’ to ‘Standing time’ while in the office by following some simple changes.” Suggestions include: taking a break from sitting every 30 minutes, standing during phone calls and presentations, and having standing or walking meetings. See pages 18-19 for more about active working and how your workplace can participate.

Fireman’s full recovery after seven years of pain BackCare professional member, Georgie Oldfield made headlines recently (Yorkshire Post, 14 January) with the story of local firefighter, Jimmy Fitt. After seven years of severe back pain and numerous failed treatments including two back operations, Jimmy went on to make a full recovery.

He visited BackCare professional member and chartered physiotherapist, Georgie Oldfield.

After just a couple of months on the chronic pain recovery programme, he was 90 per cent better.

He went on to make a full recovery, which he has maintained for four years.

“I was at desperation point when I met Georgie and was just getting through, living day-to-day and not being able to enjoy my social or family life,” said Jimmy.

“I noticed a real difference in a couple of weeks and as my confidence increased I found I was able to pick up my kids, run and play football again.”

Georgie treats chronic pain on the basis that it is often due to learned nerve pathways, rather than lasting physical damage or abnormality. In 2010, she founded an organisation called SIRPA to teach this approach to other healthcare professionals.

On 26 April, the Royal Society of Medicine hosts the first SIRPA conference, featuring pioneers in pain medicine from the US and UK, as well as BackCare’s own Head of Research and Education Adam Al-Kashi.

See www.curepain2015.com for more information.

TALKBACK l ISSUE 1 2015

6 TALKBACK NEWS

Pushing your way beyond fatigue According to NHS estimates, around 250,000 people in the UK are affected by chronic fatigue syndrome (CFS). The debilitating condition is linked to high rates of several other health problems: around half of CFS patients also suffer from chronic lower back pain.

A recent study has revealed insights which might be important to both conditions. The study involved 641 patients recruited through six CFS centres in the UK, and compared cognitive behavioural therapy (CBT) with two exercise therapies: “graded exercise therapy”, which involved gradually increasing the duration or intensity

exercise sessions over time; and “adaptive pacing therapy”, which involved staying within modest exercise goals (The Lancet Psychiatry, Volume 2, No.2, p141–152, February 2015).

The researchers found that while pacing was ineffective, both CBT and graded exercise significantly reduced disability. The biggest factor in the success of CBT and graded exercise was the reduction of “fear avoidance” beliefs and behaviours – something commonly found in chronic pain patients. By contrast, pacing may reinforce fear avoidance and thereby promote disability.

Marathon approaches We are just weeks away from the Virgin London Marathon.

More than 35,000 runners are expected to participate on Sunday 26 April, making it one of the world’s largest marathons. And the figure, of course, includes the 27 courageous runners of Team BackCare. We have several

returning runners from previous years, including our fastest runner of 2014, Benjamin Guest (3:01:45). Visit www. backcare.org.uk/marathon to find out how you can show your support and help the runners meet their charity pledge of £1,300. Full race report in the next issue!

OBITUARY We were saddened by the news that Dora Grundy, widow of BackCare’s founder, Stanley Grundy, passed away on 19 January 2015, aged 98. Born in Twickenham and living her whole life in the surrounding area, she was a great supporter of Stanley’s work and liked by all who met her.

Dora was a big believer in staying active and remained in good health right up until her death – “a very good tennis player and a tremendous golfer”, recollects her daughter, Susan. Fifty friends and relatives attended her funeral, including BackCare’s chairman, Dr Brian Hammond. Dora leaves three latter generations, including three grandchildren and four great-grandchildren.

TALKBACK l ISSUE 1 2015

CLASS CAMPAIGN Back pain and other musculoskeletal conditions account for a quarter of all UK sickness absence – that’s 31 million lost work days a year, or 1,000 average lifetimes!

Perhaps due to the immense economic cost of back pain in the workplace, we tend to focus on adults – but did you know that one quarter of our schoolchildren are also affected by back pain? And that they aren’t covered by the health and safety laws intended to protect employees?

This year’s BackCare Awareness Week will focus on back pain in schoolchildren, to highlight the scale of the problem and what can be done. Watch this space for further announcements!

WEBSITE REVAMP As reported in the last issue, BackCare won an award from the Big Lottery fund for redevelopment of the BackCare website. This has now happened and a phased launch of the new website began in February with new features coming online over successive weeks. New features include fully online membership signup and an “Ask the Expert” forum.

TALKBACK NEWS 7

TALKBACK l ISSUE 1 2015

8 TALKBACK SOCIAL MEDIA

Mary Burstow’s social media round up

Mary Burstow

BackCare’s campaign to encourage office workers to move around more is getting noticed:

The key to healthy living is to mix sitting and standing throughout the day. What’s your Sitting Calculator score?

Inactivity twice as deadly as obesity “Lack of exercise is twice as deadly as obesity,” The Daily Telegraph...

Our factsheets are always popular:

What is coccydinia and what does it have to do with childbirth? #pregnancy #coccyx http://ow.ly/ i/8peKX http://ow.ly/I0I3Y

TALKBACK l ISSUE 1 2015

your back sitting all day.

“Get America Standing” tweeted: “Sitting is reversing your health. There is NO healthy way of sitting for prolonged hours”.

Chronic pain is discussed less by the professionals and more by sufferers. However, I was struck by one tweet, quoting the late Louis Gifford: “Every pain problem, acute or chronic, has a thinking, reasoning and emotional brain attached to it.” The link between chronic back pain and how the brain works is not often the subject for discussion and needs a wider audience. BackCare will be looking at how we can better promote the discussion on this important subject.

BackCare’s presence on Twitter and Facebook is really starting to take off. It is clear that our Information sheets are popular and regularly get retweeted.

I have noted a number of trends among the tweeting back pain community. The most obvious has to be a real downer on high-heeled shoes and the dreadful damage they do to your posture.

The “Get Britain Standing Campaign”, encouraging office workers to work standing at their desks and move around more is gathering momentum. It is one of those trends I suspect will become steadily more mainstream as awareness grows of the damage you can do to

The link between back pain and mental health is clearly a theme in tweets: What are spondylosis and osteoarthritis and what is the difference? A useful factsheet http:// ow.ly/I0Ehu http://ow.ly/i/8pdYE

A number of tweeters like reminding people of the importance of exercise:

Putting #mentalhealth on an equal footing with physical health should be a key priority for the next govt #timetotalk

Every fitness programme should include some specific core work to improve your posture and prevent lower back pain.

In BackCare, we say that suffering from a back pain doesn’t just hurt, it can be torture.

Learn to do stretching and exercises when you wake up. It boosts circulation and digestion, and eases back pain.

Mental health problems can affect anyone and no one should feel ashamed to talk about it. Today is Time to Talk.

We are @TheRealBackCare

TALKBACK FEATURE 9

Take back control In this new four-part miniseries, NICK SINFIELD tackles four of the most commonly held back pain myths that delay or even prevent rehabilitation and recovery. Nick is a chartered physiotherapist, BackCare Professional Member and Clinical Director for Spring Active.

Part 1: “Pain means the damage is still there or getting worse” – MYTH! When the body is injured, pain signals allow an amazing repair process to take place to heal the structure. This repair process takes a maximum of 3-6 months and usually, as the tissues heal, the pain gets less and then disappears. However, sometimes pain can continue to be felt in these areas even though the tissues have healed. This type of pain is known as chronic, long-term or persistent pain.

Although it is often difficult to find the cause of persistent pain, we know that it is due to how the brain processes information from the body and environment.

Every part of your body has nerves in and around it. The nerves in your lower back connect to the spinal cord, so that messages can be sent from your tissues to the brain. The nerves will tell your brain if any part of your body is under threat. The brain interprets these messages and initiates any action needed to keep you safe and well.

All this happens very fast and automatically without you being aware of it!

In some people the warning signals do not settle down even though the tissues have healed and the pain continues. We are not sure why this happens, but we know that these signals can be increased by a variety of things.

Do any of these statements fit your own situation? l Not getting an acceptable diagnosis for the cause of your pain. l Fear of movement and exercise. l Anxiety about the impact on your income and family. l Doubts or concerns following X-ray or MRI results.

l Negative experiences with healthcare professionals.

When you have had pain for a while the nerves around your back can become over-sensitive. This means that it will take much less general activity to set off messages that indicate a threat is present.

The brain gets these messages and interprets them as meaning that damage is occurring even though it isn’t and the result – pain! You naturally think that something serious is causing your pain!

Are your nerves over-sensitive?

Do any of these statements fit your own situation?

l Pressure on your skin or around the painful area is very sensitive. l You are generally doing a lot less activities than before the pain. l When doctors test you, all movements are painful. l Cold temperatures set off your pain easily. l Just thinking about certain movements or tasks sets off your pain. l Stressful situations make your pain worse.

Your mind can play tricks on you! In one study, people were shown red rods contacting the skin. Red is associated with heat and danger, and these rods produced more pain than blue coloured rods which are associated with cold, nondamaging sensations, even though in the experiment both coloured rods were the same temperature!

The parts of the brain that process pain also connect with the parts that relate to your beliefs and understanding about your pain, other sensations, everyday stresses, worries about the future, treatments and more. For example, if you believe that a certain activity will increase your back pain, just having that belief may activate your pain map.

But it is not all bad news! Once you know that nerves can become over-sensitive and that a lot of pain is due to this, you can learn how to turn down the sensitivity and make the pain easier.

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10 TALKBACK BRANCHES

BACKCARE BRANCHES 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 info@backcare.org.uk

CAMBRIDGE • 56 members Contact: Ms Mary Griffiths Email: blincomary@gmail.com

READING • 24 members Contact: Mr David Laird Telephone: 0118 947 0709 Email: davidlaird@talktalk.net

DERBY • 61 members Contact: Mrs Christine Sissons Telephone: 01332 763636 Email: chris.sissons@btinternet.com

SALISBURY • 122 members Contact: Mrs Barbara White Telephone: 01722 333925 Email: white.alan@btinternet.com

ESSEX • opens in June 2015 Contact: Mrs Lyndee Oscar Telephone: 01206 804353 Email: lyndee@kidsbacks4thefuture.co.uk

SOUTHAMPTON • 32 members Contact: Mrs Irene Bowron Telephone: 01794 340256 Email: irene@macgregors-shadeplants.co.uk

HARROGATE & DISTRICT • 32 members Contact: Mrs Lin Tippey Telephone: 01423 865946 Email: keithandlin2@btinternet.com

SWANSEA (WALES) • 56 members Contact: Ms Gloria Morgan Telephone: 01792 208290 Email: gloriamorgan@talktalk.net

HULL & EAST RIDING • 90 members Contact: Mrs Beryl Kelsey Telephone: 01482 353547 Email: kelsey59@kelsey59.karoo.co.uk

WEST LONDON • 15 members Contact: Mrs Teresa Sawicka Telephone: 020 8997 4848 Email: tere_ss@yahoo.co.uk

LOTHIAN (SCOTLAND) • 66 members Contact: Mrs Jean Houston Telephone: 0131 441 3611 Email: jean.houston@blueyonder.co.uk

WEST MIDLANDS • 11 members Contact: Mrs Thelma Pearson Telephone: 01902 783537

POOLE & BOURNEMOUTH • 5 members Contact: Mrs Patricia Bowman Telephone: 01202 710308 Email: patriciabowman@ntlworld.com

WINCHESTER • 39 members Contact: Ms Gillian Rowe Telephone: 023 8025 2626 Email: gillianmrowe@hotmail.com

Essex branch to open in June 2015 I am Lyndee Oscar MSc BSc (Hons) DO. I have been a registered osteopath for the last 22 years and have worked as an NHS occupational therapist within the orthopaedic and surgical sector as well as within the private sector. I have also taught complementary therapy to further education students in Colchester and manual handling training within the corporate, health and social care sectors.

I currently design and deliver back care workshops for children in primary schools as a response to the escalating trend of treating the younger generation in my clinic. I am the founder of Kids Backs 4 the Future, where our mission is to empower children to develop their awareness, their knowledge and their skills for a healthy approach to back care for the rest of their lives.

We help children become and stay back wise in schools, helping them to recognise that back pain can be preventable and how to take action now! We believe back care education should be in the school curriculum as

TALKBACK l ISSUE 1 2015

recent research highlights more children than ever are suffering from back and neck pain. Sadly, modern technology has become a health risk enforcing poor postural habits and reduced activity in the younger generation and is, therefore, more of a health burden than a tool these days.

Children are not given any training in back care until they are adults in the workforce. Children with back pain are more likely to develop back pain in adulthood. This can limit their work productivity and career choice.

Our “Backcare Awareness Specialised Induction for Children” project (BASIC) promotes preventative practice, equipping and empowering primary school children to change their lifestyle now, adopting preventative practice. The BASIC project supports the “Every Child Matters” government initiative and the PHSE curriculum.

At the new BackCare Branch – covering Colchester and surrounding areas of Essex – our aim is to identify and

provide access to a network of health professionals who will positively support activities. These will include interesting talks, self-help groups, health walks and events for sufferers of back and neck pain. We also aim to promote the essence of a preventative healthy back care culture within a positive environment as an extension of, and in accordance with, BackCare.

We look forward to helping and supporting you in Essex. Come and see us at the upcoming East of England Health and Well being show (Colchester, 13 June).

Lyndee Oscar

TALKBACK BRANCHES 11

Lothian branch at risk of losing hydrotherapy pools BackCare was recently contacted

by Lothian branch secretary, Jean Houston, with news that their three local hydrotherapy pools were facing potentially imminent closure. Hydrotherapy is a key activity for Lothian branch members – indeed for many BackCare branch members – and a campaign is now under way to protect the pools.

Jean explained how the Lothian branch provides unique access to longterm hydrotherapy: “Currently, NHS patients can only receive six weeks of hydrotherapy. If they wish more, they have to return to their GP for a new referral and then wait for a reassessment, which may mean months before they can have more treatment. There is no provision for ongoing hydrotherapy. This is where we come in.

“For an annual branch membership of £10 and a monthly fee of £20 our members can have weekly sessions of hydrotherapy throughout the year with a lifeguard and physiotherapist present.

“It is always difficult to promote preventative work, even though it allows

many people increased independence, the ability to return to work and greatly reduced dependence on painkillers and all their side effects.

“This should be included in the assessment of cost effectiveness, improving quality of life and reducing bed blocking, but I think it rarely is.”

One of the pools at risk of closure

…fellow BackCare members voice their concerns Ann – I am extremely sorry to hear of the imminent closure of the hydrotherapy pools. I can appreciate how devastating this news must be.

When I became a member in 1996, I was severely disabled with back pain. I did not have access to a hydrotherapy pool, and instead used our local swimming pool twice or three times a week. This truly was a life saver for me. Being able to move freely in the water has not only physical benefits, but was also extremely good for my mental health. It is cruel to deprive back pain sufferers this important therapy.

Elizabeth – I used the hydrotherapy pool at the Astley Ainslie, Edinburgh for about 15 years. I have back and shoulder problems and was working full

time when I started. The pain was helped a great deal and I could not have worked if I had not had the pool to attend.

My husband used it for a few years, too, as he is still working and has back problems. My sister recommended it to me around 2003. She used it for years before she had a hip replacement. It helped her continue until she could have her operation. This is an invaluable service as ordinary pools are too cold; this is not just for older people, young people attended too.

Tony – We would think it a catastrophe if the local hydrotherapy pools were to be closed. I have now been attending weekly classes for almost 20 years and these have assisted me greatly:

first, in helping cure severe back spasms that I used to have in my 40s; and second, regular attendance keeps my body, and my back in particular, in good condition. If for any reason I have to miss more than about three weeks of classes then I stiffen up considerably and it is a great relief when I can restart.

The NHS authority in Lothian should consider very carefully before closing any hydrotherapy pools because this will undoubtedly increase the burden on other parts of the physiotherapy service and most other treatments are not nearly as effective as hydrotherapy.

Chris – 2013 was a horrendous year for me with excruciating back pain. The

three months before I finally met an orthopaedic consultant I was housebound and could only slide up and down stairs.

The consultant diagnosed, from my MRI scan, that an operation was the way forward, so two months later I had a back decompression L1, L2, L3, L4 and some disc work.

As part of my recovery, a friend told me of the Reading BackCare branch’s weekly hydrotherapy. It has been a wonderful way of getting back to health and I am now walking well. It has been a major contribution to getting my life back and, if they will have me, I intend to keep going.

There should be more such locations around the country, not less. By the way, I am nearly 76 and thoroughly enjoying my life again!

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12 TALKBACK PARTNERS

Experts answer those BIG questions Following on the last issue, here we pose three common back pain questions to representatives from each of our five supporting clinical member organisations.

Tim Hutchful

Question 1: Back pain is the world’s leading cause of human disability and affects around half the population in a given month. Why are we so prone to back pain?

Tim Hutchful, British Chiropractic Association. Back pain is not just one condition, it can be caused by over-activity – sprains and strains of joints, muscles, ligaments and tendons – as well as under-activity – where our bodies become de-conditioned or we hold ourselves in poor postures. Humans are bipedal and, therefore, we do not load weight evenly on our bodies; this can lead to mechanical problems. If we walked on four legs, our weight would be distributed more evenly and we’d suffer from fewer back problems! Sitting a lot is a danger flag, too, as sitting badly can put twice the load on to our spines and the effect of this is cumulative over time.

Robin Lansman, Institute of Osteopathy. Osteopaths are seeing that more sedentary lifestyles are leading to poorly-conditioned muscles and when activities are performed (such as shopping or gardening) the body is less able to meet the demands placed upon it, resulting in stresses, strains and injury. An osteopath will be able to give personalised advice on how to help your muscles support your body and keep you moving while protecting your back.

Neil Osborne, Anglo-European College of Chiropractic.

A lack of knowledge about how to look after your back and a decline in fitness levels among the general population are the biggest contributors. There is usually something in a person’s activity in daily living which is causing a repetitive problem. Then they do something that is relatively trivial that sets it off. You often

TALKBACK l ISSUE 1 2015

Robin Lansman

Neil Osborne

BAcC brand with a top right corner crop mark On your artwork please ensure you align our brand with your top right corner crop mark

Catherine Tiphanie

Ian Stones

hear people recount stories that they have done something simple like put their back out as they have bent over to pick up a pencil. In this kind of situation, it was always going to happen. It was just a question of when.

Catherine Tiphanie, British Medical Acupuncture Society.

The human body is designed for movement. Our musculoskeletal system is a complex interaction of strong supporting structures (including bones and the spine); joints between these bones

TALKBACK PARTNERS 13

(stabilised by ligaments); and muscles and other soft tissues (including tendons and fascia) which allow us to move through our daily activities. Musculoskeletal health begins in childhood, with the development of these structures, and is best maintained by investing in a suitable level of physical activity throughout our lives.

Unfortunately, lifestyle changes have made many of the present population less active, more obese, with a musculoskeletal system weakened from decreased use.

Ian Stones, British Acupuncture Council. Chronic back pain is nothing new. Classic acupuncture texts, dating back thousands of years, describe different types of back pain and how to treat it.

From an acupuncturist’s perspective, back pain isn’t isolated to the spine and supporting muscles and there can be many factors which cause the pain. Acupuncture works on the principle of stimulating the body’s energy known as Qi, which should circulate freely around the body. If our Qi becomes blocked or deficient, then we suffer pain and other symptoms and back pain is often a result of a blockage or shortage of energy in the channels that flow through the back. Acupuncture is an effective treatment for stubborn back pain because it works on the whole body and addresses all the factors that cause it.

Question 2: Most back pain goes away by itself, but for more than two million people in the UK each year it develops into chronic/persistent pain. Why do some people not recover?

Tim (BCA). Often people confuse being symptom free with being problem free. I believe that a lot of back pain is not

curable, just like diabetes or high blood pressure and, as with these conditions, if back pain is managed well, then the impact on someone’s life is minimised. The key is not only to manage symptoms but to also understand that there is an underlying condition as well. It’s important that when people seek treatment that they address the situation(s)/habit that caused the problem(s) in the first place, undertake exercises prescribed to address any muscle weakness/tightness related to the problem, make recommended lifestyle changes and follow all the advice for the need for maintenance care.

Robin (iO). Osteopaths find that getting prompt treatment and advice can help to prevent episodes of back pain from becoming more frequent and severe over time. An osteopath will take the time to assess your health and use their expertise to provide a detailed understanding of your pain, suggesting the most appropriate course of action for your needs. This may include hands-on treatment and advice on lifestyle changes or exercises that aim to resolve underlying causes of pain and prevent recurrence, rather than just treating your symptoms.

Neil (AECC). There can be various reasons. For example, if a person has serious underlying pathology such as cancer, this can cause chronic pain (though this is only responsible for a very small proportion of back pain sufferers). Additionally, if a person is repeatedly straining themselves inadvertently, this will hinder recovery (and exacerbate any historical complaints). Thirdly, there may be an intrinsic mechanical fault, which simply will not recover until it is identified and treated. continued on p14

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14 TALKBACK PARTNERS

from p13 Catherine (BMAS). There are three broad groups of musculoskeletal conditions which can affect people and may develop into chronic/persistent pain: 1) Conditions of musculoskeletal pain are the most common – e.g. osteoarthritis and back pain. Causes include injury, physical inactivity or obesity.

2) Osteoporosis – weakening of the bones with age.

3) Inflammatory conditions – e.g. rheumatoid arthritis. Rarer, and affecting fewer than 1% of the population.

Each of these groups requires a different approach to treatment.

The most common conditions of musculoskeletal pain may require some physical therapy to treat underlying injury – before the individual can return to strengthening their body with physical activity.

Ian (BAcC). Persistent back pain is a sign something is preventing your Qi from moving as it should. Sometimes the cause is obvious, like an injury which will cause short-term pain, but if this isn’t treated quickly it can develop into a chronic condition.

Acupuncturists will always look at the whole body and will connect other, seemingly unrelated, symptoms which give us an overall picture of your health. Chronic persistent back pain is often a sign of a weakness in the body’s energy which requires longer term treatment along with appropriate lifestyle advice to mitigate the effects of the weakness.

Question 3: There are many treatments and products available, but the more effective solutions often require more effort than quick fixes. How can people become more proactive?

Tim (BCA). If someone sees a practitioner to address their back pain, it is important to follow the course of treatment and follow any exercises/lifestyle adjustments that are recommended.

Following advice and taking proactive measures can help someone to take control of their condition and play an active role in prevention. Taking a look at all aspects of lifestyle is also a great way to identify risk areas. Do you have a desk job? Do you spend hours a day driving? Is your mattress saggy and unsupportive? Do you spend hours slouched on the sofa? Addressing risk areas will reduce the chance of developing a problem. Regular exercise is important too. Essentially, keep the engine in good order!

Robin (iO). As the causes of back pain are so varied, getting a

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detailed diagnosis and personalised advice is vital. Self-awareness and understanding how your body works is key. An osteopath, having examined you, will be able to help you identify what triggers your pain and educate you about what you can do to improve and maintain your own health. You could speed the process by selfreferring to an osteopath, who is a primary healthcare practitioner and expert in musculoskeletal health. Get a recommendation from a friend who has already benefited from osteopathy or use the Find an Osteopath section of www.osteopathy.org.

Neil (AECC). Movement is the key, little and often. No-one has perfect posture 24/7 and, even if they did, they would still suffer; no posture is ideal to be sustained, we are designed to move.

Without setting aside an hour a day to exercise, building in small changes in position throughout the day can help prevent back pain. Jobs consisting of prolonged static positions, e.g. desk workers, are most at risk. Changing habits can be tricky, so find a cue that works for you, e.g. every time you receive an email, then use it to prompt you to change position or stretch.

Catherine (BMAS). It is useful to have back pain assessed by a healthcare professional specialising in musculoskeletal health.

This helps an individual to understand the cause of their pain, treat any underlying injury, and – importantly – to make lifestyle choices to improve their musculoskeletal health. Choices may include increasing physical activity levels and maintaining a healthy weight. We need stability from our bones, joints and spine, strength from our muscles and co-ordination and balance from our nervous system. Treatment can help get you back-on-track, but appropriate daily exercise provides the long-term stability, strength and co-ordination for everyone wanting a healthy musculoskeletal system.

Ian (BAcC). Again, we come back to persistent pain being a sign that your Qi, or energy, is blocked or deficient in some way.

That doesn’t just affect your body, but every aspect of your life.

Acupuncture works on every level and often includes lifestyle changes which are appropriate to that individual based on their constitution. So, as well as pain relief, most people experience lots of other changes, too. For example, after a few acupuncture sessions, as well as less pain, better sleep and more energy, people often report feeling less anxious, more positive and motivated. So it becomes easier to do the other things such as exercise that help your body recover from the effects of long-term back pain.

Acknowledgements

Many thanks to the following for contributing their time and knowledge: Tim Hutchful, DC. Secretary BCA Council, Chair BCA Marketing & PR Committee Robin Lansman, DO. Vice President – Institute of Osteopathy, Principle of Body Back-Up Osteopathy and senior tutor – British School of Osteopathy.

Neil Osborne BSc, DC, PhD – Director of Clinic at the AngloEuropean College of Chiropractic Catherine Tiphanie – Osteopath, Acupuncturist and Homoeopathic Practitioner; Vice President of British Medical Acupuncture Society Ian Stones MBAcC – Acupuncturist, and member of the British Acupuncture Council

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16 TALKBACK FEATURE

Body-mind interactions in low back pain Mary O’Keeffe and Dr Kieran O’Sullivan Department of Clinical Therapies, University of Limerick, Ireland

Invited contributors Mary and Kieran have a keen interest in challenging widely-held low back pain beliefs.

In this feature, they tackle one of the most common – that low back pain is either physical or psychological, but cannot be both. Drawing on parallels from other health conditions, they illustrate why back pain management remains too focused on the physical anatomy of the back.

Mary O’Keeffe

Kieran O’Sullivan

…the things we see on MRI scans are a lot like finding some grey hair on your head or some wrinkles on your face TALKBACK l ISSUE 1 2015

Low back pain (LBP) is exceptionally common.

In fact, not to experience LBP at some point of your life would be abnormal. Many healthcare professionals have been trained to view the high incidence of LBP as either a terrible sign of the way we live in modern society (e.g. prolonged sitting) and/or the inherent fragility of our spine.

Instead, LBP is like becoming tired or sad, which is perfectly natural to experience at some point in our lives. Usually, it only lasts a short period and people recover and go on to live a full and healthy life.

Unfortunately, a small proportion of people experience LBP that either never goes away or returns so frequently that it has a big impact on their quality of life. In these cases, like among people with clinical depression or chronic fatigue, there is a need to step back and consider why this person has not recovered, as opposed to why most of us develop LBP at some point in our lives. Therefore, we are not convinced that we should be trying to “prevent” LBP in terms of aiming to get to a point where almost nobody in society gets LBP. Almost all of us will experience LBP at some point in our lives – as Nortin Hadler has said,2 LBP is one of the common “predicaments” of life which most of us will face. The more important question is how to ensure when someone gets LBP that it only lasts a very short period and doesn’t affect a person’s life long term. Key to this is the body-mind relationship in people with LBP, which LBP management has usually not addressed.

How is low back pain typically treated?

Healthcare – and society in general – has spent decades thinking that once we find an accurate diagnosis of a local tissue that is causing LBP, treatment of that specific local tissue will eliminate the pain. Unfortunately, what this has led to is more scans, more rehabilitation, more medications and more surgery.1 There is no denying that the approaches we have taken to manage LBP in recent decades have had little benefit.1 This is not because LBP has become more prevalent – rather we have more unhelpful methods of frightening people in recent years, e.g. through using high-tech imaging such as MRI scans inappropriately.

In fact, it is likely that it is the interpretation of such tests which is the biggest problem. For example, it is very rare for an MRI of someone’s back not to show something such as disc degeneration.6 We used to think these things were always important, but it now looks like the things we see on MRI scans are a lot like finding some grey hair on your head or some wrinkles on your face. In other words, they may not be cosmetically appealing, but they are themselves not dangerous and just signify a combination of genetics and ageing.

The pain is still there – and the pain is “real” – which makes the situation frustrating for patients.

However, it is critical that we dispel inaccurate notions of serious back degeneration in most people with LBP. Society has overwhelmingly accepted the idea

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that LBP and injury are very closely connected.

Furthermore, there’s an assumption that if a person’s stress levels or mood are involved then that person’s pain is psychological or “all in their head”. However, even if LBP commonly starts with injury,5 its persistence is not related to the degree of injury or damage.4 Consequently, treating LBP solely as an injury is misguided and has not led to impressive clinical outcomes.4 If we compare LBP management to other healthcare areas, it has not given the taxpayer the same value for money. For example, the risk of being disabled by cardiovascular disease or breast cancer has decreased, but the risk of being disabled by LBP has increased.1 We are not saying that typical treatments have nothing to offer, but we are concerned they tend to look at “fixing” one aspect of a person with LBP (e.g. their facet joint, or a tender point in their muscle, or a disc, or their posture) and not considering the entire person. Even psychologically informed treatments such as CBT are not immune to such criticisms – tending to be almost exclusively psychological, such that their effectiveness is similar to physical treatments.3,7 With patients, we obviously need to examine their back, but we also need to look at the whole person – their sleep, their stress, their fears, and what they think is wrong with their back.

How is low back pain similar to other health conditions?

It is well accepted that high blood pressure can be linked to physical factors (e.g cholesterol or diabetes) as well as psychological factors like stress. There is no suggestion that patients with high blood pressure should be divided into “real” and “imaginary” cases depending on whether stress is involved. I think sensible management would address acute symptoms and then focus on each person’s own contributing factors – be that obesity, stress or whatever.

Cold sores provide another useful comparison.

They have a “real” biological trigger (a virus).

However, the virus typically only becomes symptomatic when a person is “run down”, e.g. stressed, sleep deprived, poor diet, lack of exercise. Once overall health improves, the cold sore resolves, despite the virus remaining. We see the virus being a lot like a sensitive tissue in the back (e.g. muscle, disc, ligament). When overall health is good, the back is much less symptomatic. Cold sores are typically managed through (i) short-term local treatment and (ii) enhancing the person’s overall health in the medium term.

Unfortunately, LBP is not as visible as a cold sore – patients can feel reluctant to accept

something like stress is part of their pain and fear being judged by others. Consequently, treatment then focuses almost exclusively on the back and not the big picture of their overall health. This possibly increases risk of recurrent pain as an accurate understanding is critical to long-term self-management.

We have personally both had cold sores in the past. We have similarly both had LBP, headaches and other various aches and pains at points in our lives. We see managing such infrequent episodes of pain as being very similar to the management of intermittent cold sores – get some symptomatic relief if needed in the short term and work on boosting our overall health in the medium term.

…even if LBP commonly starts with injury, its persistence is not related to the degree of injury or damage

l Mary O’Keeffe is a PhD student at the University of Limerick. Her PhD research is examining whether tailoring multidimensional rehabilitation to the individual chronic LBP patient enhances effectiveness, and is worth the additional time (and costs!) involved. Her supervisors are Dr Kieran O’Sullivan and Dr Norelee Kennedy from UL and Prof Peter O’Sullivan from Curtin University, Perth. l Dr Kieran O’Sullivan is a lecturer at the University of Limerick and has been awarded specialist status by the Irish Society of Chartered Physiotherapists. He is also a researcher with over fifty peer-reviewed publications, whose work has attracted €1 million in funding, including a multi-centre randomised controlled trial of LBP treatment.

Further resources:

www.pained.com – public health information on chronic pain www.ulresearchimpact.com/category/health – ‘Building Resilience’ initiative REFERENCES: 1 2 3

4 5

6

7

Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating Chronic Back Pain: Time to Back Off? J Am Board Fam Pract. 22:62-68, 2009 Hadler NM. Stabbed in the back: Confronting back pain in an overtreated society, Univ of North Carolina Press, 2009.

Machado LA, Azevedo DC, Capanema MB, Neto TN, Cerceau DM. Client-Centered Therapy vs Exercise Therapy for Chronic Low Back Pain: A Pilot Randomized Controlled Trial in Brazil. Pain Med. 8:251258, 2007 O’Sullivan P. It’s time for change with the management of non-specific chronic low back pain. BJSM. 46:224-227, 2012 Steffens D, Ferreira ML, Latimer J, Ferreira PH, Koes BW, Blyth F, Li Q, Maher CG. What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care Res. 2014 Steffens D, Hancock M, Maher C, Williams C, Jensen TS, Latimer J. Does magnetic resonance imaging predict future low back pain? A systematic review. Eur J Pain. 18:755-765, 2014 Turner JA, Clancy S, McQuade KJ, Cardenas DD. Effectiveness of behavioral therapy for chronic low back pain: a component analysis.

J Consult Clin Psychol. 58:573-579, 1990.

When overall health is good, the back is much less symptomatic TALKBACK l ISSUE 1 2015

18 TALKBACK SUPPORT

ACTIVE WORKING SUMMIT – REPORT January 2015 saw the first Active Working Summit. Experts in sedentary science and stakeholders from an array of patient and medical organisations, including BackCare, turned out for the oneday event to participate in presentations and discussions.

This landmark event was part of a now escalating movement set to target the prolonged sitting and sedentary office environment.

The case for change The summit saw the launch of an expert statement – “The Sedentary Office: a growing case for change towards better health and productivity” – jointly commissioned by Public Health England and Active Working CIC (who launched the Get Britain Standing campaign in 2014). The statement, supported by more than 70 academic references and endorsed by the Chief Medical Officer for England, makes five core recommendations for deskbased occupations (abridged): l Build up to two hours of standing and light activity per full working day, then progress to four hours. l Regularly alternate between sitting and standing; sit-stand adjustable desk stations are highly recommended. l While sitting is worse, prolonged static standing carries similar risks. l Individuals new to standing-based work can expect some musculoskeletal sensations and some fatigue as part of the positive adaptive process. l Along with other health promotion goals (improved nutrition, reducing alcohol, smoking and stress), companies should also help staff to reduce sitting.

Professor John Buckley (pictured), lead author of the expert statement, said: “What may be most shocking is that irrespective of your level of physical activity, prolonged sedentary working leads to a significant increase in the risk of heart disease, diabetes, obesity, certain cancers, depression and muscle and joint problems.”

Moving forward We caught up with some of the researchers in the coffee break to gain more insight…

Dr Stacy Clemes (pictured) is a senior lecturer in Human Biology at Loughborough University.

Her research focuses on the measurement of sedentary behaviour and physical activity in children and adults.

TalkBack: Comfort and convenience was always sold as one of the technology era’s benefits, but now we’re hearing that we’ve become dangerously comfortable.

You specialise in measuring sedentary behaviour and promoting ways to reduce it among adults and children – what do you see as the way forward in our workplaces and school classrooms?

Dr Clemes: In the workplace I see adjustable sit-stand desks as good tools to help people reduce their sitting time; most adults spend many hours sitting while at work. Sit-stand desks offer people the

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choice between sitting and standing and enable people to regularly alternate their postures, which will likely have health benefits.

In workplaces where sit-stand desks are not an option, due to costs, for example, there are other ways in which people can reduce their sitting time. Examples include: standing up to talk on the phone; walking to speak to colleagues rather than emailing; removing waste bins and recycling bins from offices and encouraging people to use pooled facilities.

In classrooms, we have found that the use of sit-stand desks was effective at reducing children’s sitting time at school.

These desks were observed to have positive effects on children’s behaviour also. Whether schools are able to invest in sit-stand desks or not, I think a great way to reduce children’s sitting time in schools will be for teachers to incorporate more movement during their classes through active breaks and active learning.

Dr Michael Loosemore is a consultant in Sport and Exercise Medicine (SEM) at the English Institute of Sport. He is also working to promote exercise as a preventative intervention and treatment in many medical conditions.

TalkBack: You gave a powerful presentation about the need for a solution accessible to all and empathetic to the reality of most people’s daily life, that it’s not all about tracking devices and fitness regimens suited only to the already healthy. Can you sum up how you see sustainable populationwide change happening?

Dr Loosemore: Population-wide change can only be effected if an intervention can affect all members of the population.

Current solutions to lack of fitness and inactivity are centred around quick-fixes, often driven by soundbites and political expediency. Conversely, rejection of these measures by the majority comes from a combination of impracticalities such as lack of time, money and willing, alongside emotional issues such as embarrassment, poor self-esteem and irrelevance.

TALKBACK SUPPORT 19

Innovating culture This was an important and interesting event, not least because it points to how we do such fundamental things as inhabit workplaces.

In the run up to the event, there was debate in the BackCare office, about how the organisers would manage a sitdown event about the dangers of sitting. They rose to the challenge, with an innovation of conference culture – we received different coloured ID lanyards on the way in, and were invited by colour to stand for the duration of particular presentations (pictured).

Any sustainable solution must adhere to a series of simple principles, the most important of which is to recognise an intervention must focus on behaviour change not fitness regimes. Therefore, any activity must be simple to achieve, easy to learn, part of one’s normal routine, continuous, rewarding and better when shared.

Let us not start with gyms or jogging.

Instead, we should concentrate on the small movements of standing up more often, moving more during your daily life and use your legs rather than transport and the cumulative benefits they offer over time.

If co-ordinated into a structured programme of motivation, communication, evaluation and support, we will begin to reshape minds not bodies – the only way to ensure long-term wellbeing for one and all.

Dr Tom Yates is a senior lecturer in physical activity, sedentary behaviour and health at the University of Leicester.

A core theme running through his work has been the physiological and epidemiological impact of substituting sitting time for standing.

TalkBack: You said that reducing sitting requires a “whole system approach” to impact education, policy, industry and other key areas. I think it is widely understood that we need to be exercising more, but reducing sitting is a different message that is yet to sink in – is this

just newer evidence or is there confusion around the relationship between exercising and sedentary behaviour?

Dr Yates: I think there is still a significant amount of debate and some vested interests blocking meaningful incorporation of sitting time as a target for intervention. Some of this debate is healthy and appropriate, as the science is still in its infancy.

It is likely that recommendations may need to be far more nuanced than they are for physical activity as health benefits may only apply to specific sections of the population. Consequently, there is a perception that developing recommendations to limit sedentary behaviour would make the current physical activity guidelines more confusing to the average person. However, these blocks are not insurmountable and I suspect we will be in a very different position in 15 years time.

Conversely, I think the focus on sedentary behaviour, through the provision of items such as sit-stand desks, has a far better chance of making an impact in an occupational setting. It is something employers can do for their workforce that does not require time away from the desk (as opposed to purposeful exercise) and is likely to have a direct impact on employee health (i.e. through musculoskeletal health). Therefore, I think the prospects of “sedentary science” making a difference in an occupational context are much more positive.

GET ON UP! The next event on the active working calendar is a national awareness day called “On your feet Britain” on Friday, April 24.

We urge individuals and companies across Britain to convert “sitting time” to “standing time” while in the office by following some simple changes. Suggestions include: taking a break from sitting every 30 minutes, standing during phone calls and presentations, and having standing or walking meetings.

See their website – https:// getbritainstanding.org/onyourfeetbritain/ – for support and resources to help your workplace participate.

SIGN UP EARLY Early bird delegates, booking before the end of March 2015, get a 30% discount on next year’s Active Working Summit (London, 28 January 2016).

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20 TALKBACK BRANCHES

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TALKBACK SELF HELP 21

Chronic back pain and “trigger points”

by Simeon Niel-Asher Muscular (myogenic) back pain and dysfunction can arise from many factors, such as trauma, chronic postures, sports injuries, systemic disease and even depression. Muscular pain is a key part of our protective and defense mechanism. Pain is a valuable alarm bell to tell us something is wrong.

According to Dr Bob Gerwin – head of pain medicine at John Hopkins University School of Medicine – up to 95% of mechanical musculoskeletal back pain may be trigger point related, especially in chronic back pain.

Trigger points have been implicated in a range of conditions and they can often mimic others: conditions ranging from fibromyalgia, bursitis, headache, dizziness, earache and even toothache.

A true story

John, according to his mother, was a “very, very sick little boy”; he nearly died of scarlet fever just before his third birthday. By the age of five he had developed whooping cough and chicken pox and he was left with shaky health.

In his teens, even though he played lots of sports and tried to stay healthy, John developed digestive problems; at 14 he weighed 95 pounds. He was (eventually) diagnosed with colitis and celiac disease.

John also suffered from back pain. His father was so concerned that he sent John, now aged 17, to the Mayo clinic in Rochester, Minnesota, where he was eventually diagnosed with Addison’s disease of the adrenal glands. In the course of time, John developed chronic back pain.

His back problems started after a spinal accident during military service, as a result of which John underwent major back surgery.

This was only partially successful, so he was treated with drugs and a back brace, but his pain got worse; according to his brother, it was a “constant source of difficulty”.

As time went on, he could not touch his toes or do up his shoelaces. Sometimes he had to use crutches and he was on

constant medication. This medicine helped him temporarily, but also left him with unwanted side effects, such as depression, osteoporosis, chronic constant muscular pain and muscle spasms.

Janet and John

When John was in his late 30s, a friend introduced him to the “controversial but brilliant” MD Dr Janet Travell, who was pioneering a new type of treatment called myofascial trigger point therapy. She treated him regularly and recommended him heel lifts and a rocking chair covered in carved knobs and balls for him to lean against to ease his pain.

After only a few weeks John started getting better: for the first time in his life he was able to manage and reduce his pain.

In fact, her treatments were so “profoundly successful” that she helped John to achieve and sustain his wonderful career — a career that changed the world!

John finally found the relief from his pain that had eluded the most eminent of doctors; his problems were mechanical — his muscles had developed trigger points. Dr Travell’s treatment was “natural”, mechanical and simple: she had found a

way to release hidden pain-codes locked within his muscular system. John publicly acknowledged Dr Travell’s work and soon after he became President of the United States, he appointed Janet as his personal physician, the first woman and one of the few civilians to hold that post.

Dr Travell continued to develop her theories and the science behind trigger points until her death in 1997 at the age of 95. Over time, her legacy has been extensively researched, expanded and validated.

Trigger points 101

The term trigger point was coined in 1942

by Dr Janet Travell to describe painful lumps or nodules felt within tight (taut) bands of muscle. Trigger points all seem to have the following characteristics: l pain, often exquisite, is present at a discrete point l a nodule is embedded within a taut band in the muscle (mostly in the thicker central portion) l pressure (more than five seconds) reproduces the pain symptoms, with radiations in a specific and reproducible distribution (map) continued on p22

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22 TALKBACK SELF HELP

manage and control your pain on your own, at home, and without a therapist.

Self-help massage techniques are easy to learn and master. There is also a range of “trigger point tools” designed to help you.

The most common trigger points for back pain are in the Lumbar erector Spinae, Psoas and Quadratus lumborum muscles.

Here’s the best technique to try at home, follow with some stretching. For more information see The concise book of trigger points or visit www.facebook.com/ triggerpointcentral

Quadratus Lumborum Superficial

Deep

Inhibition Compression Technique from p21 l pain cannot be explained by findings from a neurological examination.

One of the most important features of trigger points is that they may be embedded in the muscles remotely from where the pain is felt. It is partly for this reason that so many therapies fail to help. More often than not, therapists tend to focus on the symptomatic area.

Understanding trigger points and their maps will help guide you toward finding the source of your pain. See Quadratus Lumborum diagrams (above).

Trigger points tend to manifest in muscles that both protect and move the spinal structures. One explanation for these trigger points is that the body “shuts down” in a holding pattern around chronic and acute injuries. If untreated, this situation can cause further mechanical issues.

Evidence base

Studies over the past decade have imaged trigger points, shown that their activation results in CNS activation through fMRI scanning, demonstrated electrophysiological activity at the trigger point, and have shown biochemical changes in the trigger point zone. Further studies have shown that manipulation of the trigger point modulates muscle function and induces local and referred pain.

What is trigger point therapy?

Trigger point therapy covers a range of techniques aimed at deactivating these painful knots. Many approaches are practical and “hands-on”; they can be performed at home with a partner or

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on your own with trigger point “tools.”

Combined with some simple lifestyle changes, trigger point therapy can yield dramatic, immediate and sustainable results. The goals of this therapy are simple: l to identify the correct trigger point(s) l to pinpoint how or why they manifested l to use appropriate techniques to deactivate the point(s) l to develop strategies to prevent them returning.

Chronic pain – what can you do?

Simply understanding what trigger points are and how they may be related to your pain is therapeutic. Reproducing your pain in the therapeutic context validates that you are not “crazy” and gives you a powerful self-help tool.

I believe that it is essential to empower patients to get better on their own, and that “knowledge is power”. Studying the muscles that are often involved in low back pain and understanding the process of treatment will help you understand,

This technique involves locating the heart of the trigger/tender point. When this is compressed it may well trigger a specific referred pain map (preferably reproducing your symptoms). This technique involves applying direct, gentle and sustained pressure to the point:

PROCEDURE 1) Identify the tender/trigger point you wish to work on.

2) Place the host muscle in a comfortable position, where it is relaxed and can undergo full stretch.

3) Apply gentle, gradually increasing pressure to the tender point until you feel resistance. This should be experienced as discomfort and not as pain.

4) Apply sustained pressure until you feel the tender point yield and soften. This can take from a few seconds to several minutes.

5) Steps 3–4 can be repeated, gradually increasing the pressure on the tender/ trigger point until it has fully yielded.

6) To achieve a better result, you can try to change the direction of pressure during these repetitions.

Self-help tools for manipulating trigger points

a)

e)

b)

c)

f)

d)

g)

h)

a) backnobbler, b) ball, c) foam roller, d) four, e) knobble, f) one, g) theracane, h) tola

TALKBACK ADVERTISING AND SUBSCRIPTIONS 23

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Content Regular content includes: l News and commentary l Educational features l Research reports l Clinical case studies l Member contributions l Support group updates

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Issue 1 – published in March (copy deadline 15 February) Issue 2 – published in June (copy deadline 15 May) Issue 3* – published in September copy deadline 15 August) Issue 4 – published in December (copy deadline 15 November) *This is a special bumper edition in line with the theme of the annual BackCare Awareness Week campaign, with larger circulation and special opportunities for collaboration and sponsorship.

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TALKBACK l ISSUE 1 2015

24 TALKBACK NEWS Why Back Pain?

There is a disease spreading across the UK, claiming 7,000 new victims every day. It increases your risk of fatal heart attack and terminal cancer. It causes structural changes to the brain and increases your risk of suicide. It’s also resistant to conventional NHS treatments.

Sounds like a horror movie, right? Actually, we’re talking about highly disabling chronic back pain, which now affects around 1-in-20 people and millions more every year.

Because back pain is so common, most people have no idea how serious it can be.

Yes, most back pain is not serious and goes away by itself just like headaches and the common cold. But for hundreds of millions of people worldwide, the pain becomes chronic and never goes away. For many it is torture, all day, every day, forever.

Not only can back pain destroy lives, but it also costs huge amounts of money in NHS treatments, disability benefits and sickness absence – more than £50 million a day. In fact, the amount of money the UK spends on back pain in just one year would solve the entire water crisis in Africa where 4,000 children die each day from contaminated water. Makes you think, doesn’t it?

Why BackCare?

BackCare is the UK’s national back pain charity. Our mission is to turn the tide on back pain through our research, education and outreach initiatives. We are a unique charity and no one else is doing the same work.

Just by reading and sharing this magazine, you are helping to support our work – thank you.

Why Not Donate?

Back pain is a major global health problem. By donating to BackCare you are helping a very worthy cause. We are very grateful for all donations and people can donate their time, effort or money in many different ways – whether that’s volunteering your skills, organising a fundraiser, running the marathon or simply popping a cheque in the post.

Why not get in touch to find out how you can get involved?

Call us today on 0208 8977 5475 or email yourstory@backcare.org.uk

TALKBACK l ISSUE 1 2015

www.

The Charity for Back and Neck Pain

.org.uk