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

WINTER n 2016/2017


Modern living: don’t let it grind you down

also in this issue: Workplace Offices must accommodate new work styles Lifestyle & home Sleep needn’t be a painful experience Campaigns Coping with arthritis: why work is so important


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


CAMBRIDGE Contact: Ms Mary Griffiths Telephone: 07787 990214 Email:

READING Contact: Telephone: Email:

Mr David Laird 0118 947 0709

DERBY Contact: Telephone: Email:

Mrs Christine Sissons 01332 763636

SALISBURY Contact: Telephone: Email:

Mrs Barbara White 01722 333925

ESSEX Contact: Telephone: Email:

Mrs Lyndee Oscar 01206 804353

SOUTHAMPTON Contact: Mrs Jo Goudge-Riley Telephone: 02380 464170 Email:

HARROGATE & DISTRICT Contact: Mrs Lin Tippey Telephone: 01423 865946 Email:

SWANSEA (WALES) Contact: Ms Gloria Morgan Telephone: 01792 208290 Email:

HULL & EAST RIDING Contact: Mrs Beryl Kelsey Telephone: 01482 353547 Email:

WEST LONDON Contact: Mrs Teresa Sawicka Telephone: 020 8997 4848 Email:

LOTHIAN (SCOTLAND) Contact: Mrs Jean Houston Telephone: 0131 441 3611 Email:

WEST MIDLANDS Contact: Mrs Thelma Pearson Telephone: 01902 783537

POOLE & BOURNEMOUTH Contact: Mrs Patricia Bowman Telephone: 01202 710308 Email:

WINCHESTER Contact: Ms Gillian Rowe Telephone: 023 8025 2626 Email:


What it is to be human The degree to which robots can communicate and interact has advanced rapidly; indeed, the endearingly humanoid Pepper is said to perceive human emotions and adapt its behaviour to the mood. Scientists are keen to maximise the opportunities the technology has to offer, for example performing tasks such as monitoring patients and supervising medication. As for whether robots can truly provide companionship, the question raises issues of a practical and existential nature. Domestic pets help reduce anxiety and depression and ease loneliness, so might non-living companions be equally beneficial for our health? Initial research suggests that they can; I’m not so sure. Ultimately, what matters is that those most in need of support will be increasingly frail and isolated and more distressingly will have lost their own autonomy; so what could be better than to have a willing assistant who doesn’t judge and is always on hand to help.

Modern life takes its toll on health in middle age 6

Top speakers for the Back Pain Show in May 10

Image: Jake Curtis

HOW do you feel about having a robot helper and companion? It may have been the stuff of fiction not so long ago, but for some of us this will become a reality. More of us are living longer and it is accepted that radical solutions will be needed to relieve pressures in hospitals and care homes – and to promote independent living. Assistive, intelligent robots that are cost-effective, compliant – and on call 24/7 – may offer the answer. In Japan, robots already perform tasks such as lifting patients and serving food. A research team based in the UK is now working on a £2.5m project to develop and evaluate a “culturally aware” robot capable of looking after older people in care environments. Middlesex University and the University of Bedfordshire are collaborating on the international three-year project (funded jointly by the EU and the Japanese Government), which seeks to expand the capabilities of the human-shaped Pepper robot (pictured), which can recognise your face, speak, hear you and move around autonomously, according to its designers Softbank Robotics1. “In order for robots to be more acceptable to older people it is essential that they can be programmed to adapt to diverse backgrounds,” said Irena Papadopoulos, professor of Transcultural Health and Nursing at Middlesex, who will be responsible for ensuring the robots can respond to the culture-specific needs and preferences of elderly clients.


How to avoid slips and falls this winter 14

Richard Sutton Editor LETTERS TO THE EDITOR:

1) Cover image: Katemangostar –

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: Website: Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751. TalkBack is designed by Pages Creative and printed by Severn, Gloucester.

Sitting isn’t the problem – remaining static is 16

Evolution helps explain root causes of joint pain 21 TALKBACK l WINTER 2016/2017


MPs: Government must find consensus on health and social care LEADING MPs have said that a “political consensus” is needed to address the pressing social care challenges facing the country. The chairs of three House of Commons Select Committees are urging the Prime Minister to reach a cross-party agreement on the future of health and social care funding. In a letter to Mrs May published in January, they said that everyone had a part to play in finding a sustainable way of ensuring social care provision in the future. The letter added: “Given the scale of rising demand, this immense challenge will face whichever party is in government over the coming decades.” The committees, led by Sarah Wollaston, Meg Hillier and Clive Betts, want consensus to be reached swiftly so the agreed approach can be reflected in the next round of Government spending. They added: “We also feel that the ongoing separation of health and social care is creating difficulties for individuals and avoidable barriers and inefficiencies. Any

review should cover the two systems.” Responding to the letter, Chris Ham, CEO of The King’s Fund, described the current social care system as “a threadbare safety net that is being stretched ever more thinly.” With the sector facing a £2.4 billion funding gap, the

health think tank estimates that more than 400,000 fewer older people received publicly funded social care in 2014/15 than in 2009/10 – despite growing numbers of older people living with complex care needs. Mr Ham said: “Hard-pressed NHS staff are becoming the shock absorbers as pressures on the health service continue

to grow. These will peak in 2018/19 and 2019/20, when there is almost no planned realterms growth in NHS funding. “A new settlement for health and social care is long overdue. In particular, there needs to be a single, ring-fenced budget for the NHS and social care, paid for through increased public funding.”

‘People at risk of fractures should be offered medicines’ PEOPLE at risk of fractures due to osteoporosis should be considered for medication, according to the National Institute for Health and Care Excellence (NICE). In its draft quality standard on osteoporosis, NICE says those at medium or high risk and diagnosed with osteoporosis should be offered medicines to help strengthen their bones and prevent fractures. Affecting around three million people in the UK, osteoporosis is a progressive


condition in which the bones become weakened, making them fragile and more likely to break. The bones in the wrist, hip and spine are particularly susceptible to fracture in people with osteoporosis. More than one in three women and one in five men will sustain one or more osteoporotic fractures (called fragility fractures, that typically occur from a simple fall from standing height) in their lifetime and in England and Wales this equates to

around 180,000 fractures every year. Professor Gillian Leng, deputy chief executive at NICE said: “Fragility fractures can cause substantial pain and severe disability, often leading to a reduced quality of life and sometimes to a shorter life expectancy. “With direct medical costs from fragility fractures projected to increase to over £2 billion by 2025, they are also very expensive for the NHS.”


New funding available for community places and spaces Community organisations and sports clubs are being invited to apply for funding from the new Community Asset Fund introduced by Sport England. It might be the park you run through, the village hall you visit for a fitness class, or maybe the pitch you play on – just so long as it’s a welcoming, accessible space with the potential to attract a range of people to get active. Sport England sees the quality of the facility as a big factor in how people feel about sport and fitness, and whether they are likely to come back and repeat the activity. It says: “We really want to hear from all kinds of sports clubs, community organisations and social enterprises that have a great idea that’ll get people moving.” The Community Asset Fund is an open, rolling programme and marks a

Image: ASSET

change from the way Sport England has previously organised funding. Applying for funding is going to be easier than ever before. There will be no deadlines, so you

can apply whenever your project or idea is ready and regular decisions will be made as soon as possible on all applications.

Regular health checks play vital role in spotting warning signs REGULAR health checks – which are commissioned by councils as part of their public health duties – are saving lives across the country by identifying early signs of potentially life-threatening conditions, including heart attacks and strokes. Since local authorities took over responsibility for public health in April 2013, more than five million people have had an NHS Health Check. Around 50% of people invited for a check take up the offer. The programme offers eligible people, between the ages of 40 and 74, advice to help delay or prevent conditions such as heart disease, stroke, diabetes, kidney disease and some cancers and dementia. However, the Local Government Association (LGA) – which represents more than 370 councils in England and Wales – is warning that cuts to councils’ public health budgets risks the future success of the programme.

Image: jannoon028/Freepik

Government has reduced councils’ public health grant by £331m from 2016/17 to 2020/21. This follows a £200m

in-year reduction in 2015/16. Izzi Seccombe, chair of the LGA’s Community Wellbeing Board, said: “Reductions in councils’ public health grants of more than £530m will no doubt impact on councils’ ability to continue this good work. “We know that investing in prevention not only improves the health and quality of life of people but also reduces the burden on council services and the NHS.”  A recent review by Queen Mary University of London found that up to 8,400 heart attacks and strokes have been avoided as a result of people taking up the offer to have a health check. The review also revealed an increase in diagnosis of 30% in new cases of diabetes, 50% in new cases of hypertension and 80% in new cases of chronic kidney disease in people who had an NHS Health Check compared to those who had not.



Modern life is taking its toll on health in middle age MODERN life is harming the health of the nation: 77% of men and 63% of women in middle age are overweight or obese. Obesity in adults has shot up 16% in the last 20 years. The diabetes rate among this age group also doubled in this period in England. Obese adults are more than five times more likely to develop Type 2 diabetes than those who are a healthy weight (a body mass index between 18.5 and 25). Ninety per cent of adults with diabetes have Type 2. Public Health England’s (PHE) campaign, One You, is reaching out to people aged 40 to 60 who are overweight or obese, exceed the Chief Medical Officer’s alcohol guidelines or are physically inactive, to provide free support and tools to help them live more healthily. People are being urged to consider their health and the simple steps they can take to improve it, by taking the One You

online quiz. People need to eat better, be more active, stop smoking and consider their drinking. The “How Are You” quiz takes your lifestyle information, gives you a health score and then links to free localised, personalisable information, apps and tools. More than 1.1 million people have taken the quiz so far and, where appropriate, been directed to download apps like Alcohol Checker, Easy Meals and Couch to 5K – a plan to get you off the couch and running 5km in nine weeks. These sit alongside PHE’s other online tools like the Heart Age tool (TalkBack autumn 2016) which gives you your “heart age” based on your age and lifestyle. We would also encourage people to take up their NHS Health Check invitation when they receive it. n Why not give the quiz a try:

It doesn’t have to be like this...

One quarter of adults do ONE QUARTER of adults in England (11.3m) are currently inactive, according to the Active Lives Survey from Sport England. People in the highest socioeconomic groups tend to be more active than those in the lower groups and you’re significantly more likely to be inactive if you’re over 55 years old. Just over half (51%) of disabled people with three


or more impairments are inactive, compared to 21% of people without disabilities. In contrast, 60.7% of adults (or 27 million) do at least 150 minutes of activity a week, meeting the Chief Medical Officer’s guidelines for weekly activity. More men than women are physically active, especially in sporting activities. The survey, which runs 365


What the experts say Professor Sir Muir Gray Clinical Adviser for the One You campaign “The demands of modern day living are taking their toll on the health of the nation, and it’s those in middle age who are suffering the consequences most, as their health reaches worrying new levels. More than 15 million Britons are living with a long-term health condition and busy lives and desk jobs make it difficult to live healthily. But just making a few small changes will have significant benefits to people’s health now and in later life.” Dan Howarth Head of Care at Diabetes UK “We know that people often bury their heads in the sand when it comes to their general health but the consequences of doing nothing can be catastrophic. There are an estimated 11.9 million people at increased risk of developing Type 2 diabetes in the UK because of their lifestyle and more than one million who already have the condition but have not yet been diagnosed. “Type 2 diabetes can lead to serious complications such as amputation, blindness, heart attack, stroke and kidney disease. We know how hard it is to change the habits of a lifetime but we want people to seek the help they need to lose weight, stop smoking and take more exercise.”

Image: Photoduet/Freepik

Dr Ellie Cannon NHS Doctor and media medic “Lots of us spend our lives working very hard, not sleeping enough and not always having time to exercise, so it can be really difficult to prioritise our health. But it’s vital to find out how you really are, so that you can get the advice and support you need. It’s never too late to improve your health and making small changes now can have a huge impact on your health in the future: it can even help to reverse preventable diseases.”

too little exercise days a year, asks people aged 16 and over across England about the sport and physical activities they take part in. In all, 200,000 people completed the first round of the survey between November 2015 and November 2016. People who are inactive – meaning they do less than 30 minutes of activity a week – stand to benefit the most from starting to

increase their activity levels. That’s why Sport England and the Government is focusing greater expertise and resources in this area. The figures show the enormous role that walking, fitness activities and playing sport have in people’s lives, with many people doing several different things to add up to an active lifestyle.

Source: Active Lives Survey, Sport England



Osteopaths sought as mentors for new community clinic

Research includes the effects of regular pre-emptive treatment on the quality of life of the elderly

ENTHUSIASTIC osteopaths are being sought as mentors – and to be mentored – at the new Centre for Osteopathic Research & Excellence (CORE) in east London, which expects to open in the spring. Duncan Webster and Danny Orchard, directors of CORE, have raised nearly £200,000 to fund the new community clinic in Clapton, which aims to provide a centre for good quality research, support for graduates and access to osteopathic treatment for those who couldn’t otherwise afford it. They are now looking for mentors who feel they could add something to the teaching and research operation, ideally with a specific area that they would like to focus on or specialise in. This will help to direct future projects undertaken by the clinic. Research is planned around the effects of regular pre-emptive treatment on

quality of life of the elderly and on diabetic neuropathy in conjunction with London South Bank University (LSU). As well as LSU, CORE has developed relationships with a range of charities, including The Children’s Society, Independent Age and Dementia UK. The first clinic aims to serve a wide range of community needs, with the ability to host large and small events and meetings as well as a kitchen, café, and multiple offices and treatment rooms, and so is already making links with other local social enterprises and healthcare providers. The intention is that once one clinic has been created, the model can be copied and additional centres will set up around the country. n If you are interested in becoming a mentor or a mentee, please contact Duncan at or Danny at

Diary dates Spine surgeons conference

Scoliosis symposium 15-16 June THE International Phillip Zorab Symposium, the foremost basic science conference for scoliosis, takes place 15-16 June at One Great George Street, London SW1P 3AA. The conference centre is close to the Houses of Parliament, Westminster Abbey, Buckingham Palace and St James’s Park. Organised by the British Scoliosis Research Foundation, the event gives delegates the opportunity to discuss the latest research into the causes and treatment of scoliosis and new ideas for managing the condition. Speakers for 2017 include Robert Dunn, Emma Clark, Mike Gibson, Baron Lonner, Brian Ciruna, Stuart Weinstein and Keyvan Mazda. Although treatment exists, there is currently no cure for scoliosis and in most cases the cause remains unknown. It


15-17 March

is a difficult condition to come to terms with at all ages. For young children it can mean multiple cast fittings and repeat surgery; adolescents may have to wear a brace or have spinal fusion at a time of life when

such a diagnosis can be a major blow to self-confidence; and in mature years pain and immobility can have a significant impact on a person’s quality of life.

THE 2017 British Association of Spine Surgeons (BASS) meeting (main scientific programme) is taking place from 15-17 March at the Lowry Theatre at the heart of the redeveloped Salford Quays, Media City in Greater Manchester. The meeting will take the usual format of three days of scientific content. In addition to the main conference, BASS will be running a Cadaveric Pre Conference session on Tuesday 14 March 2017 at the Manchester Surgical Skills and Simulation Centre (part of Manchester University). The conference dinner this year will take place within the Imperial War Museum.


Healthcare specialist joins BackCare board of trustees LEN GOOBLAR, Head of Sustainable Healthcare at biopharmaceutical company AbbVie UK, will be joining BackCare’s board of trustees in April. Len has been involved in the field of back care for many years and in 2007 launched the original “Fit for Work” initiative which has evolved considerably since then, with the concept now having been rolled out in 31 countries, the creation of a global and European alliance and a programme that has been endorsed by the last 10

Len Gooblar European Presidencies. He has been engaged with the NHS for the last 38 years – at all levels, from medical

students to ministers of state – and has a substantial understanding of its operating framework, key issues and direction of travel as well as the art of engagement and communication within it. Len’s most recent position has been with AbbVie UK during which time he has created both the Sustainable Healthcare and the Government Affairs Department / Functions. “This has given me the opportunity to understand many specific therapy areas of which the whole arena of

musculoskeletal and back problems has been a major focus,” he said. “A key function for me over the years has been to develop programmes that improve standards of care and improve outcomes for patients and this is a goal I will wish to continue with BackCare.” Len has been the recipient of numerous awards, most recently the best European Patient Partnership Award from the European Federation of Pharmaceutical Industries and Associations.

Runners line up for London Marathon to aid BackCare NO FEWER than 33 runners will be turning out for BackCare in this year’s London Marathon. Come 23 April, they’ll be elbow to elbow with the 40,000 other runners being cheered on by 750,000 noisy spectators lining the 26.2-mile course. The route will take them past some of the city’s most famous landmarks along the River Thames and through central London before finishing in glory in front of Buckingham Palace. The world-renowned sporting event is a key part of BackCare’s programme of activities and presents the charity’s corporate supporters with exciting opportunities for sponsorship, PR and promotion. BackCare offers a comprehensive sponsorship package and companies will also have the chance to directly support the fund-raising efforts of runners from their own regions. n To discuss sponsorship opportunities, contact Norma Barry on 07785 551511.



Flexible thinking can help Changing what you think and do about back pain are at the heart of a 10-point plan put together by physiotherapist David Rogers, who joins an exciting lineup of speakers appearing at the Back Pain Show in the spring.


DAVID ROGERS, who is based at the Royal Orthopaedic Hospital in Birmingham, is co-author of the book Back to Life which offers a new approach to dealing with back pain. “Whether it’s a sudden flare-up which stops us in our tracks or having to deal with persistent pain which prevents us doing the things that make us tick, back pain can often vary from day to day, making it difficult to plan things,” he said. “But the way we help people recover from back pain is changing, thanks to a large body of research which has helped to rewrite the rules on persistent back pain. Understanding these new rules and applying them to your own or others’ back problems will promote recovery and help you get back to doing the things in life you enjoy.” David’s 10 tips for a better back are: 1) Don’t worry if no-one seems to be able to give you a consistent diagnosis Most of the time it is impossible to diagnose a particular structure in your back which is causing your pain. Some common changes found on MRI scans in people with back pain, including slipped discs, worn or degenerative discs or trapped nerves, are just as common in people who have never had back pain. Our current knowledge recognises that once any serious disease has been ruled out, most back pain is caused by a number of different factors which are closely linked to your pain experience.

2) Calm any worries you may have about damage When back pain persists it feels like something is seriously damaged, but it rarely is. Worrying about damage, and how it might influence your future, plays a major role in preventing recovery when back pain persists. So keep any negative thoughts about damage to your back in check and give yourself a reassuring word that it’s safe to get moving. 3) Return to activity gradually It is common for people to become fearful of activity when back pain persists, particularly if it hurts. Returning to activity, initially at low levels, and building up gradually is the best approach, safe in the knowledge that any ongoing back pain isn’t harming you. It might hurt more to begin with, but remember this isn’t causing you any damage. It will feel easier as you repeat the activities over a few days and weeks. 4) Check your thoughts Research tells us that people who think the worst when they experience a flare-up in back pain take longer to recover. So, if when your back goes, you find thoughts going through your head such as “I’ll never get over this” or “how can I ever get back to normal again”, try to reframe them, to focus on recovery. Thoughts such as “I can get over this” or “this will pass” will focus your attention on recovery from a flare-up in back pain.


bring about a flexible body 5) Do some breathing exercises When back pain persists, it is common for muscles to feel tense and tight. You may experience sudden spasms of pain without reason. These frequent episodes are due to your nervous system being oversensitive. Breathing exercises, such as the 7/11 method (breathing in for a count of 7 and out for a count of 11, both through the nose), will calm down the nervous system and the muscles they supply, relaxing tense muscles and preventing sudden spasms of back pain. 6) Exercise regularly The back is designed to move and bend and twist in a variety of ways. Protecting your back from these movements might seem like the logical thing to do at first. But continuing to protect your back from exercise in the medium to longer term will prevent recovery. It doesn’t matter what exercise you do – swimming, cycling, walking the dog, joining a gym class or doing yoga are all excellent types of exercise. 7) Involve your family and friends in your recovery Those close to you want to do the best for you when you are suffering with back pain. Sometimes they can be overprotective and do everything for you. While this is well

intentioned, it can prevent you from trying things out that may promote recovery. Remember, the back likes all types of movement, so tell those close to you that it’s safe to get going and encourage them to help you work towards recovery in function. 8) Manage the stressors in your life Ongoing unresolved distress in your life will wind up your body’s fight and flight system, raising tension in your back muscles which is likely to cause more frequent flare-ups. Some of your daily stressors within your home or work life can be difficult to keep on top of, but if you can find ways to manage these better, you will find that your back will be much less troublesome. 9) Focus on a structured plan to help you sleep better Refreshing sleep is essential for our general health and wellbeing. Avoiding using technology including computers, mobile phones and television; having a bedtime routine leading up to sleep and calming your mind through 7/11 breathing are all simple strategies you can use to make refreshing sleep more likely. While they may not work immediately, persevere with them each evening.

10) Be prepared for some bumps along the road to recovery Applying these new rules will make a difference, but it probably won’t cure your back pain forever. So, having a plan for when things go wrong with your back is really helpful. Keep this close at hand because when flare-ups happen it can feel overwhelming and it’s difficult to believe that recovery can happen.

The Back Pain Show 2017 David Rogers will be speaking at BackCare’s Back Pain Show 2017 at St Andrew’s Stadium, Birmingham, on 19 and 20 May. The free-entry show features therapies, products and services associated with the treatment of back pain as well as a range of professional presentations. Devised for both public and professional audiences, all events are prebookable on the website.



Who else needs chronic Chronic pain is one of the most challenging and difficult conditions people face treating safely and effectively. There is now a new safe pain therapy device that is economical and effective for many individuals suffering with chronic back pain for many years. Pain itself often modifies the way the central nervous system works so that a person actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular – the brain and the spinal cord. It’s well understood that the

extent of tissue injury does not explain the level of pain, and chronic pain can be maintained even after an initial injury has healed. ActiPatch’s neuro stimulation continuously disrupts this signal to allow a good night’s sleep and restores daily activities. The Pain Management publication published a Registry Study of 5,000+ using an ActiPatch 7-Day trial device report a baseline VAS pain score of 8+ of which 2/3 had more than 57% pain relief. This reflects that many individuals respond poorly to drug therapies.

ACTIPATCH LONG-TERM USE: ● 2/3 (including opioid users) reported moderate to complete elimination of pain medications ● 2/3 reported improved sleep ● 3/4 increased physical activity ● 4/5 experienced a substantial improvement in overall quality of life.


pain relief? This data demonstrates that ActiPatch has a higher response rate and is much more effective than common chronic pain drugs and other therapies for chronic back pain. ActiPatch is drug-free, and unlike medications, there are no adverse effects. It is safe for people with diabetes, the elderly, and those with heart and lung disease. ActiPatch can be used safely 24 hours a day for extended pain relief. ActiPatch long-lasting pain relief has been proven to help people get a good night’s rest. It’s the new pain reliever that lets you be your best! ActiPatch is now available at Lloyds Pharmacy, Boots, Superdrug and Gordons Chemist stores and costs only £24.99 for 720 hours of treatment.

ABOUT THE AUTHOR Ian Rawe is the Director of Clinical Research at BioElectronics Corporation, the manufacturer of ActiPatch® Therapy.



How to avoid slips and falls this winter

With the temperatures hitting some icy lows, the British Chiropractic Association’s Tim Hutchful offers some practical advice for staying on your feet this winter.


ICY ROADS and pavements mean potentially hazardous conditions underfoot and a rise in injuries caused by slips and falls. It is quite natural, therefore, for us to be wary when walking outdoors and adopting our “ice walk”; the problem is that an unnatural walking posture could cause as many problems as the icy conditions themselves.


It is a good idea to have two pairs of shoes, one for walking in the ice and snow, the other for indoors or while driving. Waterproof or other, lined shoes are preferable, as are thermal socks, as these will help keep your feet warm. Cold, numb feet are less able to sense and adapt to changing conditions. Footwear should have a large, solid, raised tread on the sole to maximise your grip on the ice. Shoes with support features are important – walking shoes with firm ankle support are ideal as they help prevent you “going over” on your ankle and help you feel more stable in slippery conditions. If shoes have laces, they should be tied firmly to give a close fit without limiting the circulation.

WHAT TO AVOID Wellingtons can be practical, but they often don’t give enough support and can be difficult to take off. Also, avoid walking outside in leather or other, smooth-soled shoes.


Clothing should be warm and allow you to move freely. Anything that impedes you from walking normally could make you more prone to falling over or lead to you walking in an unnatural way.

Be prepared

There are things you can do to prepare yourself for better balance. Standing on one leg, as an exercise, is a great way to help improve your balance. When you are out and about, keep your hands out of your pockets (use gloves) so that you can use your arms for better balance. Watch out for parts of the pavement that may have been in shadow or under trees, where there is more likely to be black ice, but make sure you pay attention to what is ahead too!

If you fall, do it gracefully!

If you do fall, try to curl up and “roll” with the fall and stay relaxed, this will minimise any jarring to your body. While it may be an automatic reaction, try to avoid putting your hands out to save you – this may cause wrist injuries.

Keep your wits

Try to avoid alcohol. Not only will you be more prone to feeling the adverse effects of the cold (because alcohol causes loss of body heat) but it may also cause you to take risks that you wouldn’t normally and, of course, make you more unsteady on your feet. Keep topped up with warm drinks to keep your temperature up.


Can weather conditions increase joint pain?

Image: Picjumbo

Don’t forget the usual precautions l A woollen hat will significantly reduce heat loss. l Keep a mixture of salt and sand handy to put on steps or paths in icy weather. l Consider fitting a grab rail if you have steps at your front or back door. l Keep your mobile phone handy in case of emergencies.

PEOPLE have long claimed that the weather affects the pain experienced from conditions such as arthritis and there is plenty of anecdotal evidence of people predicting changes in the weather based on sensation in their joints. Research led by the University of Manchester is using new technology to put this ancient wisdom to the test. Researchers are using a smartphone app to collect data and investigate the connection between chronic pain and the weather. The “Cloudy with a Chance of Pain” research project involves more than 9,000 participants. They were asked to record their symptoms each day using the uMotif app on their smartphone. This information is then matched to weather reports from their area, as identified by their smartphone’s location data. Early results indicate that these ageold beliefs have merit, according to the team. Analysis of 100 participants in three regions – Norwich, Leeds and London – found that increased hours of sunlight between February and April led to a reduction in the reports of severe pain. However, pain levels were shown to increase during a particularly rainy June, despite the hours of daylight and relative warmth during that month. The project, a collaboration supported

by Arthritis Research UK, uMotif, the Office for Creative Research in New York and the Health eResearch Centre, and led by the University of Manchester, concluded its data gathering in January. It is hoped the results of the research will help people experiencing chronic pain to better predict and manage their symptoms, including the possibility of a “pain forecast” to help people plan ahead.

Tingling sensation a sign of poor circulation RAYNAUD’S phenomenon is a common condition that makes your fingers and toes change colour and become very painful in cold weather. Fingers can go white, then blue, then red, and throb and tingle. It’s a sign of poor circulation in the small blood vessels of the hands and feet. In severe cases, medication can help, but most people live with their symptoms.

Smoking and drinking caffeine can worsen symptoms. Raynaud’s phenomenon is a common condition. It affects up to 20% of the adult population worldwide. There may be as many as 10 million people with the condition in the UK. Raynaud’s is slightly more common in women than men.



The art of active sitting Adults of working age in England spend an average of 9.5 hours a day sitting down, according to the British Heart Foundation – increasing the risk of diabetes and cardiovascular diseases, as well as creating tension in our backs that can lead to long-term back pain issues. Jenkin Au looks at how office design can help prevent back pain. TALKBACK l WINTER 2016/2017

THE EVOLUTION of technology, and the subsequent introduction of smartphones, tablets and laptops into everyday lives, as well as different workstyles, have not only revolutionised the way we work, but also placed a greater strain on our bodies. We are sitting at our desks all day long, having to adopt new and not always ergonomically correct sitting positions, as we toggle between different electronic devices. However, traditional seating has not been designed for this kind of activity, causing unnecessary strain on our backs to accommodate our use of new devices. Indeed, a global posture study by workplace furniture specialist Steelcase, which observed more than 2,000 employees, discovered that new technologies and behaviours have led to nine postures that are not adequately addressed by current seating solutions. Modern offices now need to consider how they can introduce new designs and furniture to better accommodate more ergonomic work styles, while promoting creativity and employee wellbeing. Rather than focusing on sitting as something to be avoided, we should take a balanced view of the issue: that a healthy day should consist of a mixture of sitting, standing and walking. Sitting is often the easiest solution for getting work done, and it is a necessary part of most people’s everyday routine. However, staying in one position throughout the day

Sitting isn’t the problem – remaining static is should be avoided, as it can lead to a range of health problems. One of the most effective solutions is choosing ergonomically sound seating that allows for “active sitting”, where people are free to move around, changing positions naturally and often. Active sitting not only reduces fatigue from standing and walking, it also allows you to shift some of your upper body weight from your legs and feet. By moving around, the tension created in our backs and necks is eased, and we can avoid slouching; a posture that is all too easy to return to. Workplace seating and furniture therefore needs to be designed for variation and intuitive adaptability, so that people can choose from a much wider range of positions than chairs have traditionally allowed. The time we do spend sitting down should be the highest quality possible. While desk work is hard to avoid, there is no reason for this to be a static part: seating and furniture design can support employee health and encourage movement throughout the day, as long as variety, versatility and adaptability are integrated at every level. ■ Jenkin Au is EMEA product manager at Steelcase.


Exploring the ergonomic implications of working with new technologies

Inside the office of tomorrow

The workplace: an ecosystem of spaces THE KEY is to design the workplace as an ecosystem of interconnected spaces that support the physical, cognitive and emotional needs of employees, and give them choice and control over where and how they work. There needs to be a variety of spaces that encourage people to sit, stand and move throughout the day, while supporting different types of work and the use of multiple technologies. Addressing these issues, Steelcase has devised a range of office chairs and desk systems to counteract the ill effects of prolonged sitting, adapting to the ways people work today. Ology Bench is simple, efficient and adaptable to support new, more flexible work styles. It allows workers to customise their work environment based on their preferences, provides sufficient legroom and offers space-division for privacy, lighting, power and work tools.

Gesture with Headrest is an office chair that supports a greater range of technologies, postures and user sizes. It adjusts to nine new postures to accommodate our daily interactions with technology. Brody WorkLounge features patented LiveLumbar technology—bringing thoughtful ergonomic design to the lounge posture. The adjustable work surface holds technology at eye level, reducing neck and shoulder strain.

While technology boosts productivity, it can cause pain that disrupts our work, our ability to concentrate and our creativity. To understand the body at work, Steelcase observed more than 2,000 people in a wide range of postures. It discovered that new technologies combined with new behaviours led to nine postures which, it believes, are not adequately addressed by current seating solutions.

INCREASING flexibility and digitalisation has seen businesses adapt to new ways of working. The design challenge for the furniture industry is to develop attractive new environments that stimulate creativity, co-operation and communication while promoting healthy working practices. The Living Tomorrow innovation hub established in Brussels by Bene Group presents the coming trends in working environments and their effects on office design. Bringing together leading businesses and the public in an open dialogue, its research activities are focused on technical innovations that can have a positive impact on people’s productivity and their quality of life and, importantly, test these in a realistic setting. The complex, which incorporates a range of spaces themed around modern living, attracts more than 150,000 visitors a year and hosts more than 300 events.



Managing low back pain A NEW guideline by the National Institute for Health and Care Excellence (NICE) on managing low back pain encourages people to continue with normal activities as far as possible. It adds that massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone. Paracetamol on its own is no longer the first option for managing low back pain. Instead,

Exercise in all its forms – whether stretching, strengthening, aerobics or yoga – is an important first step in managing low back pain and sciatica, according to an updated guideline from the National Institute for Health and Care Excellence.


the guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable. Combined physical and psychological treatments (talking therapies) are recommended for people who have not seen an improvement in their pain on previous treatments or who

have significant psychological and social barriers to recovery. The updated guideline has been expanded to include sciatica, a painful condition typically caused by irritation or compression of the nerves which run from the lower back, through the legs and down to the feet. Professor Mark Baker, clinical practice director for NICE, said: “Millions of people are affected every year by these often debilitating and distressing conditions. For most, their

symptoms improve in days or weeks. However, for some, the pain can be distressing and persist for a long time. “Regrettably, there is a lack of convincing evidence of effectiveness for some widely used treatments. For example, acupuncture is no longer recommended for managing low back pain with or without sciatica.” Low back pain causes more disability than any other condition, affecting one in 10


and sciatica people and becoming more common with age. In the UK, it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in women. The total cost of low back pain to the UK economy is reckoned to be more than £12 billion a year. Sciatica is a relatively common condition, with estimates suggesting that as many as 40% of people will experience it at some point in their lives. Professor Baker added:

“It is possible to reduce the impact that low back pain and sciatica can have on people’s lives. The guideline continues to recommend a stepped care approach and means people whose pain or function are not improving despite initial treatment should have access to a choice of further therapies. “Our aim is to give clarity and set out the most clinical and cost effective ways to treat low back pain and sciatica based on the best available evidence.”

Exercise options

Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.

Manual therapies

Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.

Psychological therapy

Consider psychological therapies using a cognitive behavioural approach for managing low back pain with or without sciatica but only as part of a treatment package including exercise, with or without manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage).

Not recommended

Acupuncture, ultrasound, PENS (percutaneous electrical nerve simulation), TENS (transcutaneous electrical nerve simulation), interferential therapy.

What the BAC had to say…

THE British Acupuncture Council believes the guideline to be mistaken on acupuncture, stressing that acupuncture is based on the eastern tradition of medicine and healing and so does not fit easily into the western methods employed to “measure” treatments. It said: “Clinical decision-making has always been between the patient and the clinician made at the point of care. There is a threeway blend of expertise and opinion between published information, the clinician and the patient. In traditional acupuncture based upon the eastern system of medicine, this decision-making considers the whole person and provides a holistic approach to what might be the presenting symptom of low back pain. Thus a guideline based upon a single intervention approach is of less validity.”

Image: Photoduet/Freepik

£7m to fund innovative treatments for arthritis A NEW partnership has been formed between the Universities of Oxford and Birmingham to speed up the development of novel treatments for arthritis, supported by a £7m investment from the Kennedy Trust for Rheumatology Research. The Arthritis Therapy Acceleration Programme (A-TAP) will develop and test therapies based on the underlying causes of inflammatory disease, rather than simply treating the clinical symptoms. The alliance between the two universities will develop a network of consultants, nurses and clinical researchers in clinical units along the M40 corridor between the two sites.

University Hospitals Coventry and Warwickshire will also be involved. Professor Fiona Powrie, Director of the Kennedy Institute of Rheumatology in Oxford, said: “Lots of new molecular targets have been identified recently for a range of immune mediated inflammatory diseases like arthritis, yet there remains a time lag between identification of drugs, the choice of which disease to use them in, and their adoption into clinical practice. By identifying the underlying causes of disease we will be able to bridge current knowledge gaps and match therapy to underlying disease pathology.” n For more news about arthritis, turn to page 22



Sleep need not be a painful experience THOSE hitting middle age are most likely to be blighted by back or neck pain aggravated by sleeping than any other age group, according to new research from the British Chiropractic Association (BCA). The research into this age group (45-54) found that nearly two-fifths (39%) who have suffered from back or neck pain identify sleeping/mattress as the trigger for those aches, and more than half (58%) admit pain keeps them from sleeping. With a huge 87% of people in this group saying they wake up with back or neck pain – approximately one in eight (13%) every day – the BCA is now urging people to pay attention to their sleeping habits. Commenting on the findings, BCA chiropractor Rishi Loatey said: “As we age, our bodies start to see the cumulative effect of years of poor posture, which can in turn lead to back pain. For many, this pain is triggered by sleep.


“To help stop sleep from becoming a painful experience, I recommend sleeping on your side, so your neck isn’t twisted all night. In this position, your spine should be parallel to the mattress and should not sag (bed too soft) or bow (bed too hard). Before bending or doing anything sudden or strenuous in the morning, make sure your body – and your back – has woken up. Devoting time to exercise in the daytime is also an important step to build muscle tone and promote good posture.”

What you can do

l Update your mattress: chiropractors recommend buying a new mattress at least every 10 years. Mattresses lose their support over time, so if you can feel the springs through your mattress, or it is no longer level, your mattress is no longer providing the support you need. Those looking for a new mattress can choose the one that’s right for them with Sealy’s

bed selector app: l Buy the right mattress: ensure your mattress is supportive for you. If you share a bed with your partner, it’s a good idea to look for two single mattresses which can be joined together, to ensure you both get the support you need. l Start your day right: getting up out of bed too quickly in the morning could lead to injury. When you first wake up, try doing some gentle stretches and avoid doing anything too strenuous or making any sudden movements. l Get moving: activities such as yoga, which can improve posture, are recommended for people in the 45-54 age group. Other exercise which helps build your abdominal muscles could also help to protect your back. When exercising, warming up and warming down is essential to ensure your joints and muscles don’t get a shock.


Are we evolving to be taller and faster or weaker?

Image: Photoduet/Freepik

Modern design approach to age-old problems CONTEMPORARY design continually strives to solve age-old customer comfort issues and, in healthcare settings, can assist in the recovery process. Two new recliners introduced by Pineapple Contracts are suited for oncology, maternity and neonatal wards, as well as facilities for elderly and less mobile users. Esto, an easy-to-move

Esto chair

lightweight recliner featuring an antibacterial lacquer finish, is designed for areas where space is at a premium. Nonmarking castors and brakes are available, with fabrics that are MRSA resistant. The Esto chair has good posture support and an attractive wave design to the sides and arms which helps to soften an environment. The Vida recliner features a full lie-flat position for relaxation and rest, as well as optional riser-assist movement to aid standing for those less mobile and reduce staff injuries from lifting users. The wing-back design gives optimum comfort and support.

EVOLUTION HELPS EXPLAIN THE ROOT CAUSES OF JOINT PAIN SCIENTISTS at the University of Oxford have been looking to evolution to help explain the root causes of modern joint conditions, such as shoulder, hip and knee pain. By examining CT scans of bones from humans, primates and early hominids dating back millions of years, researchers are gaining new insights into the morphological trends associated with common orthopaedic complaints, how we ended up with such problems and how they might continue to develop in the future. The research, conducted at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, has involved producing interactive 3D computer models to plot changes in the shapes of species throughout the human lineage. Extrapolation of these trends has allowed 3D printing of possible future skeletal shapes as humans evolve.

Planning tools

Samples used in the study were from shoulders, hips and knees and has enabled the researchers to make mathematical comparisons that could be used as planning tools for orthopaedic surgery. Dr Paul Monk, who has been leading the project, said: “Throughout our lineage we have been adapting the shape of our joints, which leads to a range of new challenges for orthopaedic surgeons. Recently, there has been an increase in common problems such as anterior knee pain and shoulder pain when reaching overhead, which led us to look at how joints originally came to look and function the way they do. “These models will enable us to identify the root causes of many modern joint conditions as well as anticipate future problems that are likely to appear based on lifestyle and genetic changes. Current trends reveal that the modern shapes of joint replacements won’t work in the future, meaning that we will need to rethink our approach for many common surgeries. “We also wanted to see what we’re all going to look like in the future and to answer questions such as ‘are we evolving to be taller and faster or weaker’, and ‘might we be evolving to need hip replacements earlier in the future?’”



Coping with arthritis: why work As many as one in five people are worried they won’t be fit enough to continue working in 2017, according to a survey conducted by Arthritis Research UK to launch its Work Matters to Me campaign.

DISABILITY AND EMPLOYMENT About 48% of disabled people are employed compared with 78% of non-disabled people.


ARTHRITIS affects around 10 million people in the UK and the opportunity to work can play a crucial part in providing independence, a sense of control and improve quality of life. However, only 60% of people living with musculoskeletal conditions are actually in work. Arthritis Research UK wants the Government to better support people living with such long-term conditions, to help them find – and stay in – suitable work. The survey of more than 2,000 people also showed that one third (33%) of those with a long-term condition felt their colleagues don’t

understand the impact of their condition, and 39% don’t feel confident discussing their workplace health with their employer. More than one in seven (15%) wouldn’t disclose a long-term health condition such as arthritis or recurrent joint pain to their employer. Arthritis can cause extreme pain, stiffness and functional limits that can make everyday tasks such as sitting, standing, commuting and typing very difficult. Symptoms can fluctuate, which can make planning ahead difficult. Despite this, many people with arthritis want to work but don’t have access to the necessary support to do so.


matters Adaptations

Arthritis Research UK has been urging people with arthritis to speak out and share their experience of work in response to the recent green paper consultation on work, health and disability. The Work Matters to Me campaign asks for specific changes from Government to support people with arthritis, including helping people with arthritis to remain in work. This means more funding and better promotion of the “Access to Work” scheme for employees and employers, to get help with the costs of work adaptations to enable people with arthritis to maintain workplace health, and assist with the cost of fares to work if someone can’t use public transport. It also wants the Government to support people with arthritis when they are trying to find work. This can involve tailoring the Government’s new “Personal Support Package” specifically for people with arthritis including ensuring work coaches and disability employment advisors receive training on working with people with arthritis. Tracey Loftis, head of policy and public affairs at Arthritis Research UK, said: “Arthritis and musculoskeletal conditions such as back pain are the number one cause of pain, disability and workplace sickness absence in the UK, so this issue needs urgent attention from the Government. Our ageing population and growing levels of obesity and physical inactivity mean growing numbers of us will be trying to work with the pain and unpredictability of arthritis.” Professor Dame Carol Black, expert advisor to the Government on health and work, said: “Careful attention to the right type of work can contribute not only to a successful and rewarding working life but also to good health and wellbeing generally. We must enable roles which are meaningful, fulfilling, flexible and adapted both to their skills and their capabilities.”

Amanda’s story

“I felt I had to hide my condition” AMANDA Histed, 42, was diagnosed with rheumatoid arthritis and osteoarthritis in her early 30s. She explained the impact her conditions have had on her career as a credit controller: “When I was first diagnosed with arthritis, I felt I had to hide my condition from my employer and colleagues. My hands were incredibly painful and were constantly red and swollen. I didn’t feel like people would understand, so I would wear long sleeves and hide my hands under my desk so no one could see how bad they were. “I’ve since changed jobs and luckily my current employer is very

understanding. My role is still deskbased, but they’ve supported me by adapting my workstation. I also get up and move around throughout the day so that my joints don’t stiffen up. “For me, staying in work is incredibly important as not being able to work would feel like my condition has won. I know I’m fortunate to have such an understanding employer, but there are thousands of people living with arthritis who don’t receive the same level of support. That’s why it’s really important that the Government consider our needs, so that we can remain in control of our careers.”

The impact on mental health More than a third (36%) of people with arthritis wouldn’t disclose a mental health condition such as depression to their employer. However, many people with arthritis may be at greater risk of developing mental health issues such

as depression than those without the condition. A previous study showed that 68% of those with osteoarthritis reported depression when their pain is at its worst. More than a quarter of 35-54 year olds with a long-term health condition

reported missing out on career development opportunities due to their poor health. Among the public generally, 82% strongly agree that work is important to their mental wellbeing.




TalkBack issue 1 | 2017 (BackCare)  

TalkBack is the quarterly magazine of BackCare, serving those with a personal or professional interest in back pain with news, views and edu...

TalkBack issue 1 | 2017 (BackCare)  

TalkBack is the quarterly magazine of BackCare, serving those with a personal or professional interest in back pain with news, views and edu...