TalkBack, spring | 2020 (BackCare)

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

SPRING n 2020

On the move

FREE TO MEMBERS

Digital interventions to support behaviour change

m INSIDE BackCare runners at the 2020 London Marathon

also in this issue: Research Back pain in most older adults unchanged after five years Workplace Physiotherapy helps tackle long-term sickness absence Physical activity Community walking programme for arthritis sufferers

www.backcare.org.uk

2 TALKBACK NEWS

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TALKBACK NEWS 3

Appreciating the full impact of MSK injuries SOME occupations are far more demanding than people might imagine. Take the case of the musicians in British military bands suffering from long-term musculoskeletal disorders brought about by playing musical instruments and marching at the same time.

Official figures show that of the 348 musicians from military bands who were medically downgraded last April, 137 had to stop playing because of MSK injuries sustained over a period of 10 years1.

Their predicament bears some similarities to the surgeons discussed recently in TalkBack, who experienced chronic pain after standing in awkward positions for hours at a time while carrying out delicate microsurgery. At first glance, neither occupation would seem to implicate injurious behaviour and yet in both cases back pain and MSK-related problems have brought about early retirement.

Evidently, the act of playing instruments while marching carries multiple risks. [And it’s not just a matter of weight or encumbrance as the most hazardous instrument (statistically) turns out to be the piccolo.] Playing in a marching band is described by researchers as a complicated neuro-muscular activity, and one which has been known to cause anything from ankle sprains to spinal issues and osteoarthritis.

The tendency to put up with persistent and recurrent pain so we can keep doing the job we love is all too common. A study from the Netherlands suggests that back pain in the majority (57%) of older adults remains unchanged after five years and that most patients stop seeking the advice of their medical professional in that time2.

Here there is further risk, particularly for those unable to self-manage their pain. Poor MSK health

Contents

can result in lack of mobility, poor manual dexterity and in some cases falls and fractures, as well as isolation and depression, says the Arthritis and Musculoskeletal Alliance. As the “underpinning factor in healthy living”, ARMA wants to make MSK health a priority in any prevention strategy. (p18).

MBE for BackCare trustee

OUR congratulations to physiotherapist and BackCare trustee Ann Thomson who has been made a Member of the British Empire (MBE) for her services to physiotherapy education and disabled people through swimming exercise.

Ann, a member of the Chartered Society of Physiotherapy, qualified in 1960 from the School of Physiotherapy in the Royal Infirmary Edinburgh.

In recent years, she was director of postgraduate physiotherapy at University College London until 2008, moving to Kings College London, where she still teaches the postgraduate master students soft tissue therapy.

Ann’s special interests are musculoskeletal, especially manipulation and soft tissue therapy with therapeutic exercise, and aquatic therapy.

Richard Sutton Editor

43% of adults have at least one long-term condition 9

BackCare runners line up for London Marathon 10

Over-80s provide £23 billion of unpaid care 16

LETTERS TO THE EDITOR:

richard.sutton@backcare.org.uk

Cover image: Nensuria/Freepik

1) Defence Statistics Health/MoD 2) Journal of American Board of Family Medicine

We welcome articles from readers, but reserve the right to edit submissions.

Paid advertisements do not necessarily reflect the views of BackCare. Products and services advertised in TalkBack may not be recommended by BackCare. Please make your own judgement about whether a product or service can help you. Where appropriate, consult your doctor. Any complaints about advertisements should be sent to the Executive Chair.

All information in the magazine was believed to be correct at the time of going to press. BackCare cannot be responsible for errors or omissions. No part of this printed publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the copyright holder, BackCare. ©BackCare

BackCare BackCare, Monkey Puzzle House, 69-71 Windmill Road, Sunbury-on-Thames TW16 7DT Tel: +44 (0)20 8977 5474 Email: info@backcare.org.uk Website: www.BackCare.org.uk Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751.

TalkBack is designed by Pages Creative www.pagescreative.co.uk and printed

by Gemini West, Bristol.

Prevention: an MSK perspective from ARMA 18

Allied Health students to receive £5,000 a year 20 TALKBACK l SPRING 2020

4 TALKBACK NEWS

Paul Chrisp, director of NICE’s Centre for Guidelines, said: “Clinicians may choose to consider these interventions as an option to work alongside traditional healthcare services towards a change in behaviour.”

While highlighting the potential benefit of digital interventions, the new recommendations acknowledge possible complications with their use and urge clinicians to take care that patients do not rely on the apps as a way of avoiding seeing a professional. The guideline also points to the uncertainty of their effectiveness when used alone and recommends them only as supportive tools in addition to regular services.

Digital tools should ‘complement not replace’ existing health and care services

Measuring what really works to minimise hospital stays HOSPITALS can take action to reduce the amount of time older people spend on wards before being allowed home – by more than three days in some areas.

Research on how effective such efforts were in practice, and whether they save money, was undertaken by the University of Exeter and funded by the National Institute for Health Research.

The success of programmes to reduce patient stay varied, depending on the areas of medicine and the type of intervention. The largest reduction was

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in patients who had surgery on a lower limb, in whom programmes that involved components at multiple stages of the care pathway reduced hospital stays by 3.3 days. Interventions focusing on preoperative care reduced stays by 2.2 days in this group.

The most evidence was available for colorectal patients, with 17 studies included in the analysis. In these patients, multiple stage programmes reduced hospital stays by an average of 2.2 days.

Lead author Dr Michael Nunns

said: “Older adults are more prone to complications post-surgery, which can increase the length of stay in hospital. Yet we also know that lengthy hospital stays can increase the likelihood of infections, falls and decline in brain health. We need to do all we can to allow people to leave hospital as soon as they are ready, and part of that is understanding what really works to minimise hospital stays.”

The report synthesised 73 studies inside and outside the UK, in which participants had a mean age of at least 60.

Image: mrsiraphol/Freepik

DIGITAL and mobile interventions could support regular health services in helping people stop smoking and reduce their risk of obesity, says the National Institute for Health and Care Excellence (NICE).

NICE says that digital interventions such as apps, wearable devices and online programmes and websites may help people achieve health goals. This includes helping people to be more physically active, manage their weight, quit smoking, reduce alcohol intake or reduce unsafe sexual behaviour.

The recommendations are in line with the NHS Long Term Plan, though NICE says the digital tools should be offered in addition to existing health and care services, not as a replacement.

Image: Freepik

Digital and mobile interventions to support behaviour change

TALKBACK NEWS 5

IT IS unacceptable to expect patients to wait weeks for a GP appointment, says the Royal College of GPs. It is calling on government to prioritise general practice which has been “running on empty for too long”.

“Patients – and GPs – deserve better,” says Professor Martin Marshall, College chair. “However, the situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years.”

Professor Marshall said workload in general practice has escalated in terms of volume and complexity. However, successive governments have failed to invest sufficiently in the family doctor service in order to keep pace with demand.

“One consequence is that we now have a worrying shortage of GPs,” he said. “We hope that the new government will take

this seriously and that it will deliver quickly on its general election manifesto pledge of 6,000 additional GPs and many more thousands of the wider general practice team.”

More than one million patients are seen in general practice every day. Professor Marshall added: “There are limits beyond which GPs can no longer guarantee safe care to patients and the potential for error or misdiagnosis increases. There is also the risk that long waiting times for a GP appointment will deter some patients from seeing a GP at all, which could mean they seek help at a much later stage when the problem is much more serious.”

There are more GPs in training than ever before, but it takes a long time to qualify and the Royal College of GPs wants action to retain existing GPs and ensure they are supported to remain in the profession.

Image: Freepik

Family doctor service unable to keep pace with demand

Workload has escalated in terms of volume and complexity

Widening the range of support services offered by general practice THE Royal College of GPs has published an introductory guide on multidisciplinary working to support practices to develop their clinical teams and create a way of working better able to meet their population needs for both urgent and routine primary care.

The Multidisciplinary Team (MDT) toolkit is intended for primary care professionals who are thinking about introducing new clinicians into their team. It supports GPs in clinical supervisor roles by providing information on example roles and related topics such as managing demand and capacity, determining a skill mix, workforce design and teamworking. While this guide has been applied to an English context, many of its principles and ideas can be applied across the UK. Expanding practice teams creates opportunities to embed new skills into primary care, says Dr Stephanie Coughlin,

RCGP clinical lead for innovation.

“It widens the range of services offered by general practice and works towards resolving some of the challenges currently faced in primary care.

“We know that general practice is facing unprecedented change with considerable GP workforce shortages. This has been impacted by several factors including reduced numbers of doctors choosing general practice, problems with retention of newly qualified GPs and the early retirement of middle-aged GPs. This, coupled with an ageing population and the shift of care from secondary care into primary care, has led to an increase in primary care workload.”

Determining a skill mix, workforce design and teamworking

Image: Freepik

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Image: Freepik

6 TALKBACK PHYSICAL ACTIVITY

Sustainable sports programmes will be set up in schools

RESEARCHERS at the University of Aberdeen are exploring if a successful community walking programme from the United States, “Walk with Ease”, designed specifically for people with arthritis, could be exported to the UK. The research, funded by Versus Arthritis, aims to address the fears many people have about exercise because they believe it may cause further damage to their joints.

Lead researcher Dr Kathryn Martin’s personal motivation for bringing Walk with Ease to the UK was inspired by childhood experiences of family members who lived with arthritis and witnessing the challenges they faced with work and simple day-to-day activities.

She said: “As an undergraduate, I had the opportunity to be a summer research student at the Multipurpose Arthritis and Musculoskeletal Diseases Centre at Brigham and Women’s Hospital. It was here that I developed an interest in issues related to arthritis and joint pain. As I continued my studies, I became increasingly aware of the impact of arthritis and other musculoskeletal conditions on the individual and society.

“I worked on evaluating the Arthritis

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Image: Freepik

Community-based walking programme

Participants have increased confidence and motivation at the end of the programme Foundation’s programme in the US, when I was a PhD student, and noticed the tremendous impact the six-week programme had on people’s health and wellbeing.

“When I moved to Aberdeen, I joined the local online walking forum to understand what walking activities were available to

people with arthritis in the city. I soon became aware that there wasn’t anything specific for this group of people.

“With my knowledge of the US programme and understanding the challenges that people with arthritis face when it comes to exercise, I was keen to introduce the programme to the residents of

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CHILDREN from some of the poorest areas in England will have the chance to get physically active by trying a wider range of sports that may not have traditionally been accessible in their area.

Sport England has awarded £500,000 of National Lottery funding to UK charity Sport Inspired to help more than 9,000 children, young people and families live happier, healthier lives through sport.

The charity, set up in 2008, delivers programmes in places where children have the fewest opportunities, bringing together different parts of the community to create longer-term change. Following one-day sports festivals – events that give young people the opportunity to try a range of activities – regular and sustainable sports programmes are set up in schools.

Mike Diaper, Sport England’s executive director of children and young people,

said: “The project will focus on the communities most in need, working with schools, sport clubs and community partners to provide more opportunities for local young people to access sport or physical activity.

“The focus will be on celebrating the joy of taking part. Our research shows that enjoyment above competence is the main driver in children getting and staying active.”

To deepen the impact, Sport Inspired will launch a pioneering programme encouraging families to get active together and embed healthy habits across multiple generations. There are 4.1m children growing up in lower socio-economic groups in the UK and research has shown that these children are less likely to be physically active than those from more affluent groups. www.sportinspired.org

for arthritis sufferers Aberdeen. I applied for a grant with Versus Arthritis and the rest is history!”

Trials In introducing Walk with Ease in the UK, 97 individuals took part in the walking programme. Fifty-two people undertook the instructor-led, group-based programme and the remaining 45 used the guidebook to carry out the programme in a self-directed manner.

Dr Martin and the team found the participants reported being moderately better in their physical health and emotional wellbeing at the end of the six weeks. The qualitative findings reinforced the survey results and showed that individuals had increased confidence and motivation at the end of the programme, as they knew how to exercise properly. Their mindset about exercise had changed and now they could think about being more active. For example, rather than driving to the shops, they chose to walk.

An accompanying guidebook provided support for participants, with material that helped them to focus on their goals and what they wanted to achieve.

Dr Martin believes there is wider scope

for implementation in the UK. “I would like to take the programme into remote and rural areas and see it being used by NHS Trusts or health boards. Our programme has shown that people enjoy the social aspect of walking and I think it needs to be with a group of people who understand what it’s like to live with arthritis, and who understand that someone may need to walk slower on certain days.

“There is so much possibility with this programme in terms of the positive impact it can have on people’s lives and I want to see people with arthritis being able to live their life to the fullest.” www.pathsforall.org.uk www.abdn.ac.uk

Image: jcomp/Freepik

More sporting options on way for the poorest children

Participants have increased confidence and motivation at the end of the programme

Plugging the ethnicity gap in sport and physical activity

PEOPLE from black and minority ethnic backgrounds are far less likely to be physically active.

The deep-rooted inequalities that mean people from black, Asian and minority ethnic (BAME) backgrounds are far less likely to be physically active have been laid bare in a new report from Sport England1.

Presently, 62% of adults in England currently meet the Chief Medical Officer’s guidelines of 150 minutes of physical activity a week. However, just 56% of black people and 55.1% of Asian people (excluding Chinese) reach this figure.

Sport England board member Chris Grant said: “When it suits us, we’re happy to talk about the leadership role that sport can play, its capacity to inspire a nation or to transform lives. No other aspect of national life has so many column inches and broadcast hours devoted to it.

“But there’s an elevated level of discomfort when talking about race and culture in sport and we need to get beyond this if we are genuinely going to do something about the ethnicity gap.” www.sportengland.org 1) Sport for all – why ethnicity and culture matters in sport and physical activity

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8 TALKBACK PUBLIC HEALTH

Good blood supply to fat could explain ‘fat but fit’ paradox THE “fat but fit” paradox – where some people who are overweight have a seemingly healthy metabolism – may be explained by a good blood supply to their fat cells, according to research funded by the British Heart Foundation.

The research suggests encouraging the growth of new blood vessels in fat could offer some protection against heart attacks and strokes.

Scientists from the University of Leeds studied a receptor – known as IGF1-R – that plays a role in the growth of new blood vessels. The team showed that the removal of this receptor in cells lining the inside of blood vessels of mice fed a high-fat diet encouraged the growth of new blood vessels into fat.

This was followed by beneficial changes to the fat, which may offer protection against heart and circulatory diseases in the long term.

According to the researchers, poor blood supply to fat can switch it into an “unhealthy” state. Under these conditions, the fat cells release inflammatory signals that can promote the development

of diabetes, high blood cholesterol and high blood pressure, which can all lead to furring of our arteries – the underlying cause of most heart attacks and strokes.

The researchers believe that blood vessels in fat release bioactive chemicals which encourage the fat cells to “brown”. Brown fat burns calories to generate heat, helps to control blood sugar, blood pressure and cholesterol levels, and protects against the furring of arteries.

The researchers now hope to use these insights to help develop drugs which can hijack this process and protect the heart and circulation.

BHF associate medical director Professor Metin Avkiran also shared his thoughts: “All of the cells in our bodies need a good blood supply to stay healthy – and that includes fat cells. If our diets are high in fat, we may risk storing up fat more quickly than our bodies can build new blood vessels.

“Fat is an essential part of our diet, but too much of it can cause a wide range of health issues. This research may explain why some people who are overweight are more at risk of heart and circulatory disease than others. It’ll take a lot more research before we have a new drug to keep these fat cells healthy. For most people, with or without obesity, the best medicine will be a healthy diet and active lifestyle.” www.bhf.org.uk

Image: jcomp/Freepik

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‘Nearly half of all adults’ have at least one long-standing condition THE prevalence of long-standing conditions among adults and children in England is reported in the recently released Health Survey for England. The study surveyed just over 10,000 adults and children in 2018 to bring together data on conditions such as diabetes and hypertension, adult and child weight, smoking, drinking and physical activity.

It compares the prevalence rates of different types of conditions and how these vary across different demographic and socio-economic groups and by overall health status.

Forty-three per cent of adults aged 16 and over had at least one long-standing condition. The most common types were conditions of the musculoskeletal system (17%); of the heart and circulatory system (11%); mental, behavioural and

neurodevelopmental conditions (9%); diabetes and other endocrine and metabolic conditions (8%); and conditions of the respiratory system (8%).

Most conditions increased in prevalence with age. For example, musculoskeletal conditions affected 5% of those aged 16 to 24, but this increased to 40% of those aged 85 and over. Mental, behavioural and neurodevelopmental conditions did not follow this pattern; prevalence decreased with age, from 12% of those aged 16 to 24 to 2% of those aged 85 and over.

In adults aged under 45, the most common type of long-standing conditions were mental, behavioural and neurodevelopmental conditions, followed by musculoskeletal and respiratory conditions. In adults aged

45 and over, musculoskeletal conditions were most common, followed by heart and circulatory conditions, then diabetes and other endocrine and metabolic conditions.

Adults with long-standing conditions assessed their health less positively; had worse health status; were more likely to have mental ill-health; and had higher prescribed medicine usage than those without such conditions.

Long-standing conditions were less prevalent among children than adults, varying with age from 7% of infants aged up to one year old to 20% of children aged 10 to 15. Across age groups, respiratory diseases (5%) were most common, followed by mental, behavioural and neurodevelopmental conditions (4%). https://digital.nhs.uk

One third of premature deaths linked to social inequality poverty and inequality have a major effect on people’s health and life expectancy. Our study shows how this translates into actual numbers of deaths.

If everyone in England had the same mortality rate as people living in the best-off areas, there would have been 877,000 fewer premature deaths between 2003 and 2018. That’s one death every 10 minutes.

Fewer deaths “When we look at the figures across the life-course, we show that there could have been 22,000 fewer deaths in children aged under 10 if everyone had the same life chances as the best-off. We hope our study

brings home the reality of differences in life expectancy in this country.”

Northern towns and cities had the highest number of premature deaths associated with social inequality. In Manchester, Blackpool and Liverpool, there was more than double the number of premature deaths than in the best-off parts of the country.

Cambridgeshire, Dorset and Hampshire had the lowest number of premature deaths.

The researchers hope that the study can help inform allocation of public health resources as it breaks down the data by disease category and geographical area. www.ucl.ac.uk

Image: mrsiraphol/Freepik

NEARLY 900,000 deaths in England could have been avoided in a more equal society, according to a UCL study of 2.5 million premature deaths over the last 16 years.

The study, published in The Lancet Public Health, found that one in three deaths before the age of 75 are attributable to socio-economic and regional health inequalities.

Heart disease, lung cancer and lung diseases such as chronic bronchitis were the biggest problems, causing almost 400,000 excess deaths between them.

Lead author, Research Fellow Dan Lewer (UCL Epidemiology & Health Care) said: “We have known for a long time that

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10 TALKBACK MARATHON

BackCare runners line up for FROM the legendary hand-inhand finish of joint winners Dick Beardsley and Inge Simonsen in the very first London Marathon to countless world records; from one million finishers to £1 billion raised for charity; from crazy costumes to the incredible and inspiring examples of spirit and courage, the 40th Race – the name of this year’s Virgin Money London Marathon campaign – will celebrate them all.

BackCare’s runners taking on the 26.2-mile challenge will be cheered on by the 750,000 spectators expected to line the streets. As ever, they can expect to be running alongside other charity fundraisers, plus many familiar faces from television and sport. Many of the participants in this, the 40th London Marathon, have their own personal goals and inspirational stories. These include: l The Ever Presents, a group of 10 men who have run every London Marathon since 1981,

alongside Louise Blizzard, who will be running her 26th London Marathon since first taking part in 1994. l In the men’s elite race, the two fastest marathon runners of all time, world record holder Eliud Kipchoge (KEN) and Kenenisa Bekele (ETH) go head-to-head while women’s world record holder and defending champion Brigid Kosgei (KEN) leads the greatest female marathon field ever assembled, as she takes

on 2018 champion Vivian Cheruiyot (KEN) and world champion Ruth Chepngetich (KEN). l In the wheelchair races, defending champions Manuela Schar (SUI) and Daniel Romanchuk (USA) will look to continue their dominance while British athletes will be looking to secure a place at the Tokyo Olympic Games as the 2020 Marathon is the official British Athletics qualifying race.

Join us on the day!

The BackCare team will be stationed at the mile 16 marker from 10:30 on race day and would welcome any members and supporters to join us in cheering the runners on.

Any help or support you can give to our runners will be gratefully received. https://issuu.com/ backcare/docs/runners_profile_page_booklet Every little helps!

Image: courtesy of Virgin Money London Marathon

On Sunday 26 April, the world’s greatest marathon celebrates another landmark moment in its extraordinary history – the 40th race.

Runners in the 2018 London Marathon

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Image: courtesy of Virgin Money London Marathon

the 40th London Marathon

ADAM FROST, 34, Duston, Northampton Adam lives in Northampton with his partner Abby and two small girls. “Running the London Marathon has been a dream of mine and I’m delighted to be raising money for BackCare. My mum has suffered with back issues for many years and it means a lot to me to be able to help the charity support other people like her, to cope better with daily life.”

Runners in the 2018 London Marathon

ADRIAN LEIGH, 42, Measham, Swadlincote “I count myself as one of the lucky ones with back issues because I am able to run. My L3-L4 and L4-L5 discs are herniated and press on my spinal cord causing sporadic sciatica in my legs, lower back and abdominal area pain. I have followed all the advice from doctors and believe that what works for some does not work for others. The BackCare website has resources that have made me realise I’m not doing anything wrong and that it is acceptable to run with back issues – one of the key messages is to keep moving.”

AMANDA WATERS, 49, Wokingham “I am not your typical runner, the other side

of 40, slightly chubby and often mistake gym for gin! I had debilitating back pain during my first pregnancy which I thought would go once I had the baby. It didn’t, it stayed with me for more than 10 years. I tried many different treatments with some giving short-term relief. I ended up having spinal fusion surgery in 2012. The recovery sparked my interest in other treatment modalities and a six-year journey to retrain as a chiropractor.

I am now a fully-fledged chiropractor and living life to the full. I consider myself lucky as I no longer have any back pain. However, I see people every day who are in pain and hear how it is affecting their everyday life. I can only help a finite number of people each week; by raising funds for BackCare I can help many more people every day.”

ANDY FORTUNE, 40, St. Helier, Jersey “As a 6ft 2ins 40-year-old, I have experienced regular lower back pain for

a number of years, never thinking I would be able to run a marathon. As I got into running more and more, I found the training and conditioning actually improved my back strength, reducing pain. London 2020 will be my seventh marathon since 2017; when I saw the place available for BackCare it felt like a cause I could really support.”

ANDY GARRATT, 52, Tunbridge Wells “I started running four years ago at my local park run to help improve my asthma. I gradually started to run a little bit further until I found myself last year running 10k to get fit for a skiing holiday. After running a half marathon last year, my wife, a chiropractor, told me BackCare were looking for people to run the London Marathon for them, so I thought this would be a great opportunity continued on p12

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12 TALKBACK MARATHON

from p11 to take on another running challenge and at the same time raise money for a charity that aims to prevent back pain.”

HAMEDAH SHKOKANI, 32, Borehamwood “When I was 15 I was diagnosed with scoliosis (curvature of the spine) and at 16 I had major surgery to correct it. Now I live a normal life and exercise is a big part of that.

Scoliosis can often cause back pain and so running for BackCare makes it very rewarding.”

JANE MORGAN, 48, Quedgeley, Gloucester “This will be my first marathon. I started running about nine years ago, I thought it would be a case of trying the couch to 5k and getting bored of it by week three, but I managed to stick it out and have now completed a few half marathons, 10ks and numerous 5ks. I am a run leader/coach and love nothing more than seeing others achieve their goals. Having completed Prudential Ride London in 2019, I am looking forward to completing the London Classics in 2020.

My husband has scoliosis and kyphosis of the spine and this causes considerable pain at times for him. Understanding back pain and ways of easing it will be very important to his future.“

KATE LANCEFIELD, 39, Hawkinge, Folkestone

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“I have suffered with back pain for about 12 years. Running has helped so much, keeping me active and helping manage the pain. I am excited about running the London Marathon this year and looking forward to fundraising for this amazing charity.”

KURT OGDEN, 51,Yarm “I am an American expat living in the north-east of England. My wife has suffered from back pain for several years and ultimately had surgery. We found it challenging to collect trustworthy information and navigate competent care. I’m proud to be associated with BackCare and its mission to provide guidance and advice to others who have been similarly affected.”

MARTIN WILLIAMS, 62, Stockport “Twenty years ago I suffered a back injury and some great people got me up and running again, literally! It’s time for me to give something back. I have run 50 or so long races over the last 20 years and could not have done all that running and getting on with my life without the help of others.”

MATT RUSSELL, 31, Wakefield “I am proud to be running the 2020 London Marathon for BackCare and for my dad, who has suffered chronic back pain since a car accident nearly 30 years ago. My dad has battled through so much over the years and since I signed up to do the marathon in September, he has been diagnosed with lymphoma and is now undergoing treatment.

If hitting (hopefully smashing) my target can assist other people suffering with back pain, then I’d be incredibly grateful to anyone who can donate.”

NICOLA BRAMMER, 45, Burston, Stafford “Running the London Marathon is a dream come true for so many reasons. It has always been something that I felt was beyond my reach. Fortunately, I have positive people in my life who have encouraged me to dare to try, and try I will! I am running for BackCare because two years ago my back pain was so bad I couldn’t walk let alone run. Improved back health has helped me to love life and running instead of dreading sitting or standing.”

PAUL ROBERTS, 56, Amersham “Like many people, I’ve had issues with my back over the years. However, last year I injured it which laid me up for weeks.

Since then I’ve had to make a few lifestyle changes and work on my fitness. I’m not a life-long runner, I started with the couch to 5k in 2011 and have been ramping up the miles over the last few years; this will be my first full marathon. When I was looking for a charity place, BackCare stood out as one I could relate to.”

RICHARD POTTER, 38, Tiverton “I am choosing to run for BackCare as I have suffered with degenerative disc disorder for the past 15-16 years and simply wouldn’t be able to function day to day without regular exercise – especially

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running which I have been doing for the best part of 10 years and has made a huge difference not only to the back pain but also my general mental health.”

SARAH MILLINGTON, 39, Worfield, Bridgnorth “After suffering with back problems since I was 18, then a replacement disc in 2017 and spinal fusion in 2018, I decided to prove my consultant wrong that I couldn’t run. I completed VMLM in 2019 and in 2020 want to raise money to ensure other people don’t have to resort to surgery to be able to run.”

ZOE HUGHES, 34, Pockington, York “I’ve chosen to run for BackCare as I am one of the many people who has to do literally that ... ‘care’ for my ‘back’. Having been run over by a taxi 13 years ago and spending more than a year living on Fentanyl and Oramorph, I now live on running as it keeps my back supple and pain-free.”

running, has really eased my physical pain and improved my mental wellbeing.

I consider it an essential part of my daily routine and really feel proud to call myself a runner. My mother has also suffered with back pain all her life. I can’t wait to take part in the London Marathon for BackCare and experience this race with all my friends to support me.”

VIDA SPILLER, 42, Aylesbury “I am very excited about this challenge and helping people with back and neck problems. I still struggle with pain so I know what people are going through.”

TAPANTOSH CHAKRABARTY, 70, Calgary, Canada “Having started running a full marathon at the age of 50 in 2000 to improve my physical and mental health, I’ve so far run 40-plus marathons – at least one in each of the seven continents, including Antarctica, and two Comrades Ultramarathons in the valley of a thousand hills in South Africa, raising for and donating close to C$50,000 to various charities and charitable causes. In the 2020 London Marathon, I hope to finish all six world marathon majors in the shortest

WHO ELSE IS TAKING PART? MICHELLE CARR “As a teenager, I would do everything I could to avoid the cross country run at school and led my teacher to despair as I walked round the 1500 metre track taking twice as long as the other pupils! I suffered a lot of pain at that time. I got into running around five years ago and quickly became hooked. Exercise, in particular

BACKCARE offers its thanks to its other runners taking part in the 2020 Virgin Money London Marathon, including Andrea Goodman, Carl Bailey, Richard Wilson, Daphne Anuden, Jonathan Crocker, Jo Dent, Liz McGoldrick, Patrick Murphy, Malcolm Pritchard, and Amanda Smith.

possible time, starting from 2019 Berlin, to receive my second Abbott Six-Star Medal in as many years, the first being in 2019 Tokyo. For this milestone, I am thrilled to be part of the 2020 Team BackCare.

A healthy and painless back is crucial in having a long marathon running life, as it is in having a long, productive and peaceful life. In particular, I will need one to finish the London Marathon, only six days after the 2020 Boston Marathon. By being part of Team BackCare, I hope to improve the health of my own back and that of others, the latter by raising back-health awareness through social media.”

ROSEMARY COPSEY “I’m raising money for back pain in recognition of all healthcare workers, nurses and carers working hard in our hospitals, nursing homes and communities, including my sister who is now sadly a wheelchair user following an accident. I’m a healthcare worker myself and suffer from back pain. There are many people out there who have damaged their backs working in the health sector or looking after loved ones.

Each and every penny will help. Let’s do it lovely people. Let’s raise and beat the target!”

JOSEPHINE SHULZ “Last summer, I herniated a disc in my back and experienced indescribable pain.

I have had two babies without pain control and surgery on a few occasions, but nothing compared to this. The pain was unrelenting and accompanied by numbness in my foot. I am a nurse so back pain is something that is rife in my profession and I can be pretty unsympathetic, until it happened to me!

My GP was kind but there was huge fear that I would become addicted to pain killers so that it was difficult to control the pain. I am fortunate that the NHS responded with quick appointments for MRI and access to specialists in neurosurgery and physiotherapy. I am now left with residual numbness in my foot but I feel fortunate that I am now fit enough to contemplate running a marathon. The work undertaken by BackCare is essential to provide education and support to back pain sufferers.”

more on p14/15

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14 TALKBACK MARATHON

Virgin Money London Marathon challenge to improve your running THERE are many ways to strengthen and prepare your body for the physical challenge of distance running. Here are just four exercises to be getting on with:

Bridge WHY: To strengthen the glutes, lower back and improve pelvic stability.

HOW: Lie on the floor with knees bent and feet flat. Curl the spine off the floor to form a straight line from knees to shoulders. Hold for five seconds, then return the spine to the floor, curling your back down bit by bit so the buttocks hit the floor last. Repeat 10 times. Progress to five 10-second holds. Once you can do this comfortably, lift each foot alternately off the floor (just a few centimetres) in a slow “marching” action for 20 steps. Keep your pelvis level (placing your hands on your hip bones can help). Repeat three times.

Resisted squat WHY: To improve knee, hip and ankle

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alignment and strengthen the hips, quads and hamstrings.

HOW: Stand with your feet hip-width apart and a resistance band secured above the knees with some tension in the band pulling your knees together. Have your arms extended in front at chest height.

Take your bottom backwards and, bending the knees, squat until your thighs are at or near, parallel, pushing out against the resistance band to prevent your knees rolling in. Don’t overarch the back and try to keep the torso upright. Pause in the lowered position, then stand and repeat.

Aim for eight to 12 repetitions.

Plank WHY: To promote good running posture by strengthening the core stabilisers and lower back with the body fully extended.

HOW: Lie face down on the floor.

Engage the core and, supporting yourself on your forearms and feet, raise your body up to form a straight line from the nape of the neck to the heels. Hold, but don’t

forget to breathe. Progress by extending the length of the hold, building up towards one minute.

Single-leg dip WHY: To strengthen the muscles that stabilise the pelvis and support the knee joint, preventing the knees from rolling in when you’re running.

HOW: Stand tall with your feet below your hip bones and hands extended in front of you. Lift one foot in front of the body and then “sit down” by flexing the hip and knee of the supporting leg. Lead with the bottom, not the knee. Keep the hip bones level and torso upright, and make sure the bending knee travels in line with the middle toe and does not roll inwards or outwards. Lower as far as you can, pause and straighten. Aim for eight to 12 repetitions then change to other side. www.virginmoneylondonmarathon.com www.runningforscience.org https://bmjopensem.bmj.com www.backcare.org.uk

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Marathon running may reduce knee damage in middle-aged adults RUNNING a marathon may actually improve damage in the knees of middle-aged adults, according to a new study.

As part of research led by Dr Alister Hart of University College London and the Royal National Orthopaedic Hospital, and conducted in part by London Marathon Medical Director Professor Sanjay Sharma, 82 healthy adults underwent MRI scans on both knees six months before and two weeks after their first marathon.

Cartilage MRI scans before training and running the London Marathon showed signs of damage to key structures in the knees of the majority of the 82 participants in the study.

But after the marathon, the 71 participants who completed the training and the event itself saw a reduction in the damage sustained to a number of essential components of the knee, including cartilage.

However, there was also evidence of some wear and tear to other parts of the knee which are put under stress during running.

How to keep your joints functioning well IF you’ve ever had pain in your knees or hips after running, you’ll know how miserable it can be. Whether it lasts a few hours or a few days, it impacts your daily life and might even make you think twice about that next run.

Virgin Money London Marathon suggests a few things you can do as a runner to prevent and reduce joint pain: 1. Always warm up. We tend to think of the warm-up as being focused on muscles and that a few minutes of gentle activity helps prevent injury to those soft tissues. But warming up the muscles will also benefit our joints, by making sure they are properly supported and mobile before the strenuous activity begins.

2. Lose weight. The less weight your knees and hips need to carry, the less likely they are to become painful. Aim to be at a healthy weight for your height by eating sensibly and exercising regularly.

3. Try an anti-inflammatory diet. Many people find that joint pain is improved by reducing their consumption of things that are thought to exacerbate inflammation: sugar, refined carbs, alcohol and processed meats. Antiinflammatory foods include fish like salmon, tuna and sardines; antioxidant-rich fruits like

berries; vegetables like spinach and kale; and mono-unsaturated fat sources like almonds, avocados and olive oil.

4. Vary your workouts. You may find that alternating your running with lower impact exercise like swimming or cycling will reduce joint pain. Cycling is thought to help particularly with strengthening runners’ knees.

5. Have your gait analysed. Gait analysis will tell you what your joints are doing when you run – and whether the way you move is causing you pain. Different shoes or orthotics may improve your gait and reduce the strain on your joints.

6. Stretch. When your muscles are tight, you decrease the range of motion within your joints, leading to additional pain. If you can loosen your muscles post-workout, you’ll have happier joints. Yoga is often helpful for runners in stretching tense muscles and improving joint mobility.

7. Support medical research. VMLM’s Knee Study and Hip Study have already challenged the assumptions around running and our joints – but there is always much more to learn.

Studies like these rely on both funding and volunteers to explore and test new theories.

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16 TALKBACK COMMUNITY

Free app helps people manage AN app has been developed to help people with rheumatoid arthritis (RA) to take an active role in managing their health.

My Arthritis is an app developed by Ampersand Health drawing on the expertise of patients and clinicians from King’s College Hospital. It helps people manage their arthritis day-to-day, bringing together a personal health record, daily tracking and easy-to-access help and support from the National Rheumatoid Arthritis Society.

Hospitals that sign up can use the app to manage their patients remotely, improving care quality and reducing unnecessary hospital visits.

Inflammatory auto-immune conditions – including rheumatoid arthritis, Crohn’s disease and ulcerative colitis – are characterised by periods of relapse and remission and impact people of any age, including the young. In addition to the physical symptoms of pain, fatigue, swollen joints, anxiety, depression and other factors impact emotional wellbeing and can severely affect quality of life.

At times of relapse, when help with flare management is needed, rapid access to specialist advice can lead to better outcomes (and reduce hospital admission costs). Many people with RA experience anxiety and depression as this disease impacts on quality of life in a major way.

People need access to tools and resources

There is a growing body of evidence that self-management works for patients with rheumatoid arthritis which can help them manage their disease better. People who are able to self-manage better reduce the burden and cost to the healthcare system.

Nader Alaghband, founder of Ampersand Health, said: “We know that the patient’s journey is often long and lonely and a model of care based on infrequent outpatient appointments (which rarely coincide with a clinical need) can be significantly improved through better communication and increased patient engagement.

“There is a growing body of evidence that self-management works for patients with rheumatoid arthritis”, said James Galloway, consultant rheumatologist at King’s College Hospital. “Equally, the burden that long-term conditions such as RA place on the NHS is unsustainable and the time is right to develop and advocate for new, digitally enabled models of

The My Arthritis app facilitates daily tracking care that could drive savings and quality improvement.”

The app – which is free – is currently being used by many people living with RA and several hospitals are either using or about to start using the platform to manage their patients remotely when appropriate. https://www.nras.org.uk http://ampersandhealth.co.uk

ONE in three people over 80 are unpaid carers for sick or disabled relatives, according to Age UK. It is estimated that they save our economy an incredible £23 billion a year through the unpaid care they give loved ones.

Responding to the figures, Helen Walker, chief executive of Carers UK, said: “Most people over 80 have health problems and can do less than they once could, so the fact they are providing £23 billion’s worth of unpaid care for others is a sure signal that our social care system is failing.

“Older carers are far more likely to be caring for someone with multiple

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needs, dealing with complex conditions like dementia and physical disabilities.

Yet often they care alone, unable to take a break or step out the door for long, leaving their own needs at the wayside.

“Older carers who have contributed – and continue to contribute – so much to our society deserve far better.

“This crisis in social care needs to be taken seriously by all politicians.

We urge the Prime Minister and his Government to acknowledge our country’s carers by taking firm steps towards delivering an enduring social care solution.”

Image: rawpixel/Freepik

Over-80s provide £23 billion of unpaid care

Older carers are often unable to take a break or step out the door for long

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their arthritis

FATIGUE can be one of the most difficult symptoms to cope with for people with rheumatoid arthritis. A new study has found that group cognitive behavioural courses may help.

The study, funded by the National Institute for Health Research, compared six weekly group sessions plus a booster session with a single brief one-to-one meeting. Both groups also received an educational booklet. It took place in seven UK hospitals and was codelivered by pairs of trained rheumatology nurses and occupational therapists.

Image: Dragana_Gordic/Freepik

Satisfaction Image: katemangostar/Freepik

and easy-to-access help

Courses may reduce fatigue from rheumatoid arthritis

Cold homes can exacerbate existing health conditions

The group sessions caused a small reduction in the impact of fatigue which was still evident after two years. The course was well received by participants, with more than 80% expressing satisfaction with it and saying they would recommend it to others.

Those members of the rheumatology team delivering the courses also found the additional training they had received beneficial in other areas of their practice. It was felt the intervention could be more widely implemented to reduce the emotional and practical problems associated with fatigue.

Fatigue is a significant problem for more than 50% of people with rheumatoid arthritis and can be an enduring presence in their lives. www.nihr.ac.uk

More help needed for people living in cold homes AROUND three million people in England live in homes that are too cold. The health effects are enormous – people can end up visiting their GP more, being admitted to hospital, becoming depressed, or even dying because they are just not warm enough at home.

Health Education England e-Learning for Healthcare has worked with Public Health England to develop the Helping People

Living in Cold Homes e-learning programme for health and care professionals.

The new resource supports health and social care professionals to put National Institute for Health and Care Excellence guidance into practice.

Aimed at health and care staff who undertake home visits, the resource provides information on local services that can assist people living in cold homes,

such as installing insulation, improving heating systems or helping reduce energy bills.

It also helps people spot the signs of a cold home – including less obvious ones.

With this information, staff can have a conversation with people whose health may be affected by being too cold at home, and signpost them to the relevant local services. www.e-lfh.org.uk

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18 TALKBACK PREVENTION

The high profile given to musculoskeletal health in last summer’s government Green Paper – Advancing our health: prevention in the 2020s – was roundly welcomed by the Arthritis and Musculoskeletal Alliance (ARMA)

Prevention in the 2020s: a

MSK health should be a priority in any prevention strategy MORE than 18 million people live with a musculoskeletal condition in the UK, outnumbering those with diabetes, heart disease and COPD combined.

Musculoskeletal health is a fundamental building block of health. Poor MSK health results in pain, lack of mobility, poor manual dexterity and, in some cases, falls and fractures. It can lead to isolation, loneliness, loss of employment, depression and anxiety.

“Maintaining independence and a healthy lifestyle depends on good MSK health and appropriate support with any existing MSK conditions,” says ARMA. “As the underpinning factor in healthy living, MSK health should be a priority in any prevention strategy.”

The Alliance provided a consensus view of MSK patient and professional groups in response to the questions

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posed in the Green Paper.

TalkBack looks at some of the key issues.

Which health and social care policies should be reviewed to improve the health of people living in poorer communities, or excluded groups?

“The incidence of both musculoskeletal conditions and chronic pain is higher in poorer communities. Prevention measures therefore need to be targeted to these communities, delivered in a way which recognises the barriers people may face to accessing them, (eg high numbers of people with low levels of literacy in English, people in jobs which allow little flexibility to access services, high levels of anxiety and depression which affect motivation).

“Local authorities in these areas require sufficient

funding for adequate social care support as people are less likely to be able to afford to fund their own support, and sufficient funding for public health to address the barriers outlined above. Health information and support provided by third sector organisations is essential in addressing the barriers faced by these particular groups of people. Local authorities need to support such groups and signpost patients to them.

“Adequate pain and mental health services are essential, including community based and peer support, IAPT, and access to integrated secondary pain services for those with high levels of need.

This will reduce the need for more intensive support.

People’s social situation and the psychological impact of this will be a major factor in their experience of pain and

treatments that don’t recognise this are unlikely to be effective.

Services therefore need to take an integrated biopsychosocial approach.”

Do you have any ideas for how the NHS Health Checks programme could be improved?

“We would like to see discussion of musculoskeletal health and of physical activity (based on the new Chief Medical Officer’s guidelines) in the checks. Delivering the check in mid-life is an ideal time to encourage behaviour changes which will lead to a healthier later life.

“Being physically active improves musculoskeletal health, for instance, and smoking cessation support can drastically reduce the onset of inflammatory conditions such as rheumatoid arthritis.

Asking about early signs

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musculoskeletal health perspective

Poor MSK health results in pain and lack of mobility of musculoskeletal pain could ensure that people understand that much of this is preventable, and the benefits of early diagnosis for disease progression. This would encourage people to make changes which will benefit them throughout their adult lives potentially ensuring they are able to stay working for longer, and active into older age.

“Musculoskeletal health is a building block of physical and mental health. The ability to move is important for daily activity. The manual dexterity to prepare food is critical to maintaining a healthy diet and avoiding the development of malnutrition, which in turn increases risk of falls and frailty.

“The depression and anxiety associated with chronic pain make healthy lifestyles more difficult to maintain. Therefore, anything which can be done to keep people active and able to

High levels of anxiety and depression affect motivation

Musculoskeletal health is a building block of physical and mental health move pain free will also assist in reducing conditions such as heart disease, stroke and diabetes. Early conversations, with staff skilled in motivational interviewing will help to ensure people take action early, and enable referral to appropriate treatment, services or support.”

Have you got examples or ideas that would help people to do more strength and balance exercises?

“Falls prevention is an important area and requires interventions on several levels. Firstly, encouraging people to remain active and not reduce their activity levels as they grow older.

This will include signposting

to community activities and for those with existing MSK conditions, patient organisations who support activity in their members. Signposting people with any long-term condition to appropriate support and information on safe exercising in relation to their condition should be key in every health consultation.

“Secondly, sufficient falls prevention programmes should be commissioned for those identified as at risk of falling.

These should be in line with Strength and balance quality markers: supporting improvement, published July 2019, produced by Public Health England and the National Falls Prevention Co-ordination Group).

“The impact of falls is greatest when they result in a fracture. One of the most effective ways to prevent fractures is a Fracture Liaison Service (FLS) which aims to reduce the risk of subsequent fragility fractures by systematically identifying, assessing, treating and referring to appropriate services all eligible patients aged 50 and over who have suffered a fragility fracture. Per 300,000 population, an effective FLS will prevent around 250 fragility fractures over five years, with total expected local savings to the NHS and social care estimated at £2.1 million over five years for a service cost of around £640,000, a net benefit of £1.46 million.

“The most recent estimate is that 95 FLS are commissioned meaning that over half of CCGs do not commission one.” www.arma.uk.net

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Update for manual handling at work HSE has updated its INDG143 Manual Handling at Work guide for employers. The document explains the problem with manual handling and includes simple risk filters for lifting and lowering, pushing and pulling and carrying operations to distinguish between low and highrisk tasks. The guide also provides practical advice on making a risk assessment and suggests ways of controlling the risks. www.hse.gov.uk

Knowledge hub Public Health England’s Musculoskeletal Health programme aims to help maintain and improve the musculoskeletal health of the population in England, supporting people to live with good lifelong MSK health and freedom from pain and disability, which includes strategies for prevention.

It has established a Knowledge Hub (KHub) for those interested in musculoskeletal health.

Professionals are welcome to join the group to share knowledge and keep up to date with the latest news, events and resources. https://khub.net/sign-up

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20 TALKBACK WORKPLACE

Walking and cycling to work linked with fewer heart attacks AN active commute to work is linked to a lower rate of heart attacks, according to a new study part-funded by the British Heart Foundation (BHF).

In areas in England where walking or cycling to work were more common in 2011, the rates of heart attacks were lower for both men and women across the following two years.

Researchers at the University of Leeds noted that this difference in heart attack rates could be partly explained by differences in risk factors for heart disease such as lack

of exercise, having obesity, smoking and diabetes. However, for two groups – women who walked to work and men who cycled to work – the protective link remained when the researchers adjusted for these risk factors.

“Finding time to exercise can be tricky given our increasingly busy and often sedentary lives. But exercising doesn’t have to involve a pricey gym membership or hours spent on a treadmill,” said BHF associate medical director Professor Metin Avkiran.

“Upgrading your commute by swapping the gas pedal for a bike pedal is a great way to get your heart pumping on a daily basis. If that’s not an option, parking a few streets away or getting off the bus a few stops early can help pave the way to a longer, healthier life,” he added.

The number of people getting to work walking or cycling varied greatly across the UK, with as few as 5% of people walking or cycling to work in some local authorities, compared to as many as 41.6% in other areas. www.bhf.org.uk

Allied health students to receive MANY of those training for the allied health professions are among the nursing students on courses from September 2020 who will receive a payment of at least £5,000 a year which they will not need to pay back.

The government funding will be given to all new and continuing degree-level nursing, midwifery and many allied health students from September 2020. It is expected to benefit more than 35,000 students every year.

Students will receive at least £5,000 a year, with up to £3,000 further funding available for eligible students, including for: l specialist disciplines that struggle to recruit, including mental health l an additional childcare allowance, on top of the £1,000 already on offer l areas of the country which have seen a decrease in people accepted on some nursing, midwifery and allied

health courses over the past year.

The funding will not have to be repaid by recipients. Students will also be able to continue to access funding for tuition and maintenance loans from the Student Loans Company.

The measures will be part of the upcoming NHS People Plan, which will set out work to reduce vacancies across the NHS and secure the staff needed for the future.

With physio students in England set to benefit from new funding, Kate Middleton, chief executive officer of the Chartered Society of Physiotherapy, said: “NHS physio vacancy rates in England are around 8% and demand is rising. Expanding the numbers in training is therefore vital to patient care. Better funding is great news, but we have to have a guarantee that it will not be funded by cutting physio training numbers.” www.csp.org.uk

New funding is on the

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Physiotherapy-led graded activity should be considered as an intervention

Physiotherapy can help tackle long-term sickness absence

Exercising doesn’t have to involve a pricey gym membership

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a £5,000 payment a year

way for physio students in England

ORGANISATIONS should be making the health and wellbeing of their staff a core priority and using interventions like physiotherapy to help people return to work.

New guidance on workplace health published by the National Institute for Health and Care Excellence (NICE) says physiotherapy can help tackle long-term sickness absence.

It emphasises that all employers should have measures in place to ensure a “smooth and sustainable” return to work for people who are returning after a long period of absence. And for those who have been absent with musculoskeletal conditions, it advises that a programme of physiotherapyled graded activity should be considered as a suitable intervention.

The aim of the NICE guidance is to help people return to work after long-term sickness absence, reduce recurring sickness absence, and help prevent people moving from short-term to long-term sickness absence.

Helen Harte, professional adviser for the Chartered Society of Physiotherapy, welcomed the guidance. She said: “We recognise how important it is to support people to safely transition back into work after illness or injury, and physiotherapy has a key role to play.

“Physiotherapists are expertly placed to offer advice and support for employees and employers on work health.” www.nice.org.uk

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22 TALKBACK RESEARCH

Back pain in most older adults AS MANY as 57% of older adults said their back pain had not improved in the five years after initially presenting to their general practitioner, a new international study shows.

The survey, which took place in the Netherlands and was published in the Journal of American Board of Family Medicine, included 675 patients aged 55 and older. At the five-year follow-up, 392 responded. The survey showed that most patients stopped seeking the advice of their medical professional during that five-year span.

“While it is known that spine pain can be difficult to treat, it is surprising that more than half of patients had pain five years later,” said Ron Riesenburger, director of the USbased Spine Center at Tufts Medical Center.

Obidiugwu Duru, professor of medicine at UCLA’s David Geffen School of Medicine, suggested that some patients may simply give up and accept their pain, rather than seek alternative treatment.

“Back pain is a lot like knee arthritis in that it is always lurking in the background,” he said. “As our patients get older, they are more likely to have other degenerative conditions that take longer to heal and aggravate these conditions.

Our patients may even throw their hands up and say it is not worth trying any other treatments.”

According to Professor Duru, clinicians need to encourage more healthy living among their patients: “that way patients don’t have to live in constant pain”.

Quality of life The findings showed that at the five-year follow-up, 43% reported themselves as (almost) completely recovered. The average clinical outcomes over the five-year course show that main improvements in pain, disability, and physical quality of life occur in the first three months of follow-up. After these three months, the average levels of pain and disability remain practically constant over time. In other words, most patients experience persistent or recurrent back pain.

Medical consumption, mainly pain medication, remains substantial, with approximately one-third of the cohort (range 25% to 39%) using at least one type of medicine for their back pain.

However, over time, patients report less contact with healthcare professionals.

This implies most patients do not consult their GP or other medical healthcare professionals after the first year, despite having persistent (or recurrent) back pain. They are “out of sight”, but their problem may not be solved. Either they have accepted their disability and pain level and learned strategies on how to cope with their back pain, or patients refrain from a visit because they assume it will not help them further in alleviating the pain. It remains unknown whether patients seek help from other healthcare workers or find alternative ways to relieve their pain. www.jabfm.org

New theory links motor neurone disease to SCIENTISTS have developed a new theory on the underlying cause of motor neurone disease, which could lead to more accurate diagnosis for patients and new treatments.

A team at the University of Exeter has found evidence that the condition is caused by an imbalance in cholesterol and other fat levels in the compartments of the body’s cells, triggered by a number of different gene mutations.

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There are many different forms of motor neurone disease, which together affect around one in 2,500 people in the UK. Due to their complex nature, motor neurone conditions may be difficult to diagnose and currently no treatments are available to stop progression.

The degenerative condition can vary hugely in terms of specific symptoms, age of onset and rate of progression, even between members of the same

family. If confirmed, the new theory could lead scientists to use blood samples to predict the course and severity of motor neurone disease in an individual, and to monitor the effect of potential new drugs to treat these disorders.

Spinal cord The finding particularly relates to the large group of motor neurone conditions called the “spastic paraplegias”, due

to malfunction in how motor neurons in the upper part of the spinal cord communicate with muscle fibres. This leads to symptoms including muscle stiffness, weakness and wasting.

Professor Andrew Crosby of the University of Exeter Medical School is lead author of the paper1 outlining the theory, published in Brain: a Journal of Neurology. He said: “For years, we have known that a large

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is unchanged after five years

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Learning strategies on how to cope with your back pain

number of genes are involved in motor neurone disease, but so far it hasn’t been clear if there’s a common underlying pathway that connects them. Our group’s previous research has identified 13 genes which, if altered, may cause the condition, and some of these discoveries have proven crucial as the genes we identified are directly involved in the cholesterol processing pathway. That led to a eureka moment, that cholesterol and

other fat processing pathways in cells are, in fact, the common link.”

The medical school’s Dr Emma Baple said: “Currently, there are no treatments available that can reverse or prevent progression of this group of disorders. Patients who are at high risk of motor neurone disease really want to know how their disease might progress and the age at which symptoms may develop, but

that’s very difficult to predict.

This paper should guide further research in this area, and we’re confident it could lead to more effective diagnostic tools and treatment strategies for a group of diseases that have a huge impact on people’s lives.”

The research is supported by a range of partners including the Medical Research Council. https://medicine.exeter.ac.uk 1) Lipid metabolic pathways converge in motor neuron degenerative diseases

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cholesterol imbalance in cells

A large number of genes are involved in motor neurone disease

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24 TALKBACK NEWS

To help solve back pain and poor posture at your desk try out a Back App chair for free Go to www.relaxbackuk.com or call 01727 757221

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