TalkBack, autumn | 2020 (BackCare)

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

AUTUMN n 2020

The dawn of a new ‘golden age for cycling’?

FREE TO MEMBERS

also in this issue: Awareness week Spotlight on back pain in nursing Workplace Making the transition out of lockdown Fundraising Runners line up for the virtual London Marathon

www.backcare.org.uk

2 TALKBACK NEWS

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TALKBACK l AUTUMN 2020

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TALKBACK LEADER 3

A chance to change our travel habits for good?

BORIS Johnson’s £2 billion pledge to prioritise active travel has been one of the few positive news stories to emerge from the Covid crisis.

Lockdown offered us a glimpse of a world with fewer car journeys, less congestion and cleaner air, and inspired the government to set out ambitious plans to double the number of cyclists and walkers by 20251.

Putting cycling and walking at the heart of transport, place-making and health policy is a bold promise – however, the government appears to have recognised this moment as a rare opportunity to deliver a lasting transformative change.

The early signs are good, with fast-track funding and statutory guidance immediately available to local authorities to begin reallocating road space to people walking and cycling. A range of other initiatives will follow, including making bikes available at local surgeries and cycling on prescription for those who are less likely to be active.

In recent months, some parts of Britain have already seen a 70% rise in the number of people on bikes for exercise and socially distanced travel. Many of us have said we’d like to walk and cycle more, and with the right encouragement – and infrastructure – many short car journeys could be made on foot or by bike.

In the short term, persuading people to make cycling and walking part of their commute or daily routine will help keep our towns and cities moving while public transport remains restricted.

Contents

Over the longer term, such a cultural shift would make our communities greener and healthier and, importantly, save the NHS billions by helping prevent and manage a range of chronic conditions from heart disease to MSDs.

Ergonomic risks for nurses POOR moving and handling practice can cause back pain or make existing pain worse, and nurses are among the most vulnerable workers.

Back Pain in Nursing is the focus of this year’s BackCare Awareness Week, taking place 5-9 October. BackCare, through its flagship publication Handling of People (HOP6), aims to prevent significant back injuries in the profession.

This special issue of TalkBack examines some of the ergonomic risks in nursing and shows how back pain and MSDs are part of a wider organisational picture. We also look at how exercise and regular education programmes can help keep back pain at bay.

Richard Sutton Editor

PCNs urged to use physios to tackle MSK backlog 4

Self-management of chronic back pain 6

Low back pain rises with nurse workload 10

LETTERS TO THE EDITOR:

richard.sutton@backcare.org.uk Cover image: prostooleh/Freepik

1) Gear Change: A bold vision for cycling and walking, Dept for Transport

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.

Move to keep aches and pains at bay 16

Under starter’s orders for virtual London marathon 22 TALKBACK l AUTUMN 2020

4 TALKBACK NEWS

Covid-19 sees further increase in electronic prescription service MORE THAN 85% of primary care prescriptions in England are now processed electronically, after a rise in use of the service during the coronavirus pandemic.

Data covering April 2020 shows that 86% of prescriptions dispensed within primary care in England were processed using the Electronic Prescription Service (EPS).

That is an increase of more than 10 percentage points since February, when the usage was 73%. In April 2019, usage was 68%.

EPS saves the NHS time and money by reducing the amount of paper processing required by GPs, pharmacists, non-medical prescribers and the NHS Business Services Authority, and also reduces the need for

face-to-face contact and unnecessary journeys.

In April, use of EPS was expanded into GP Access/virtual hubs, walk-in centres and out of hours settings. This expansion and focus on increasing the use of EPS in urgent care has contributed to the increase in prescriptions processed using this system.

Google searches for back pain help rose sharply during lockdown PRIMARY care networks (PCNs) are being urged to take up funding for first contact physiotherapists to help tackle a backlog of MSK appointments as lockdown eases.

Earlier this year, it was announced there would be 100% funding for first contact physiotherapy (FCP) roles as part of the revised GP contract in England, with the ambition being that the whole NHS England patient population has direct access to them by 2023/24.

The Chartered Society of Physiotherapy (CSP) is now calling on PCNs to act quickly in order to support GPs to get through an expected backlog of MSK cases driven by the inactivity and stress caused by lockdown, services not being available and the reluctance of many people to seek GP appointments during that time.

Larry Koyama, the Society’s head of FCP Implementation said: “FCPs are proven to deliver

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excellent patient care while easing pressures on GPs and reducing onward referrals for tests, scans and secondary care.

“That’s why it is now more crucial than ever for PCNs to take up funding for these roles as Covid-19, months of lockdown and reduced activity levels will have had a serious deconditioning effect on millions of people.

“FCPs can use their expertise to meet this demand, allowing GPs to concentrate on medical cases and the expected increase in appointments sought by people recovering from Covid-19.”

With GP attendances falling significantly during the first months of lockdown, Google searches for back pain help rose sharply during April and May and physiotherapists report increasing numbers of patients presenting with “lockdownrelated” pain, says the CSP. www.csp.org.uk

BackCare runners to compete in virtual London Marathon AFTER months of intensive work and consultation with London’s authorities, organisers confirmed the plans for Virgin Money London Marathon on Sunday 4 October 2020. While elite races will take place on an enclosed looped course in St James’s Park, all other participants will run the 26.2 mile marathon distance from home or anywhere in the world on the course of their choice. l Read about BackCare’s runners on page 22.

image: jcomp/Freepik

Image: rawpixel.com/Freepik

PCNs urged to use first contact physios to tackle MSK backlog

TALKBACK NEWS 5

A NEW campaign, Impossible to Ignore, launched by VersusArthritis, calls on all UK governments to make sure the needs of people with arthritis are addressed as they plan to restart treatment and services.

A survey of more than 6,000 people with arthritis and musculoskeletal conditions found that lockdown, and the impact of the pandemic on the NHS, has had devastating consequences for many managing their conditions.

More than 40% reported that appointments for their arthritis had been cancelled; and for those experiencing chronic pain, the proportion was 44%.

Planned surgery has also been affected, with hundreds of thousands of people with arthritis waiting for joint replacement operations. They are struggling in agony, often without information about when they can expect to be treated.

One third of respondents said they had been advised to self-isolate – and shielders bore the brunt of cancellations with 46% experiencing cancelled appointments, far higher than cancellations experienced by non-shielders.

When asked about their health, care and quality of life during the pandemic, as many

Image: jcomp/Freepik

Cancelled appointments leave many unable to manage their pain

Planned surgery has also been badly affected as 40% have not had access to the care and treatment they needed to manage their pain. Half of respondents reported being unable to manage their pain to do what they wanted around their homes and to undertake basic tasks. A similar number said they are not able to be physically active due to their pain. Inevitably, a large number of arthritis sufferers have been left feeling more lonely or isolated.

Chief Executive of Versus Arthritis

Liam O’Toole said: “The NHS has just about survived Covid-19 so far, but at the expense of services that many relied upon to sustain their quality of life. The government must take urgent steps to ensure people with arthritis are not forgotten or ignored.

“It’s imperative that recovery plans include arthritis treatments, including joint replacement surgery, so this crisis does not accelerate further.”

DO YOU have a chronic (or persistent) pain condition – pain that has persisted for at least three months? You may be interested in taking part in a new study being conducted by Teesside University.

This project aims to study activity pacing, which is an approach to managing chronic pain by adapting one’s planning of activities and activity level. It will investigate the relationship between activity pacing and a set of psychological skills known as “psychological flexibility”, and whether this relationship affects outcome in management of chronic pain. It is

hoped that better understanding of this relationship may shed light on the most effective way to use activity pacing strategies for people with chronic pain conditions.

If you choose to take part, you will be asked to complete a series of questionnaires, which have been collected into an online survey that you can complete at your own pace and convenience. The questionnaires should take no longer than 45 minutes to complete in full.

For more information, email the study co-ordinator Chris MacKellar on V8123711@tees.ac.uk.

Image: kjpargeter/Freepik

Would you like to take part in a research study

Does psychological flexibility moderate the efficacy of activity pacing in chronic pain?

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6 TALKBACK PAIN MANAGEMENT

Self-management and coping strategies for the ESCAPE-pain groups, professionals are required to attend facilitator training. The training is open to healthcare professionals and exercise instructors who meet the prequalification criteria.

Each e-learning session takes approximately 20-30 minutes to complete, with the aim of improving providers’

understanding of what the programme involves and to prepare for the facilitator training.

The research, evidence and endorsements for each programme can be found on the ESCAPE-pain website.

The programme will not cure nor eliminate pain completely.

However, it aims to reduce

pain, improve physical function, self-confidence, sense of being in control of problems, and the depression and frustration that is often felt with chronic pain.

ESCAPE-pain for backs is delivered as two classes a week for six weeks (12 classes in total). Class size is usually about 8-10 people. Each class Image: pressfoto/Freepik

ESCAPE-pain is an evidencebased and cost-effective group rehabilitation programme for people with chronic joint pain – specifically people living with chronic back pain and those with chronic knee and hip pain.

Designed to increase physical function and improve quality of life, the concept integrates education, self-management and coping strategies, with a personalised exercise regimen for each participant.

Two new e-learning resources have been developed by Health Education England’s e-Learning for Healthcare and its partners to help practitioners understand the principles behind the programme and how it may be implemented in their organisation.

Variety of locations The ESCAPE-pain programme can be delivered in a variety of locations including outpatient physiotherapy departments, leisure centres and local community settings by healthcare professionals and exercise instructors.

To deliver to either of

Sessions can be delivered by healthcare professionals and exercise instructors

Antidepressants could be more helpful than COMMONLY used treatments for chronic pain can do more harm than good and should not be used, National Institute for Health and Care Excellence (NICE) has said in recent draft guidance.

Paracetamol, non-steroidal antiinflammatory drugs (these include aspirin and ibuprofen), benzodiazepines or opioids should not be offered for people with a type of chronic pain called chronic primary pain.

This is because, while there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress, there was evidence that they can cause harm, including possible addiction.

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Instead, the draft guideline says that people with this type of pain should be offered supervised group exercise programmes, some types of psychological therapy, and says that some antidepressants can be considered.

Chronic primary pain represents chronic pain as a condition in itself and which can’t be accounted for by another diagnosis, or where it is not the symptom of an underlying condition (this is known as chronic secondary pain). It is characterised by significant emotional distress and functional disability. Examples include chronic widespread pain and chronic

musculoskeletal pain, as well as conditions such as chronic pelvic pain.

The draft guideline also says that antiepileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary pain.

Again, this was because there was little or no evidence that these treatments work but could have possible harmful effects.

The draft guideline emphasises the importance of putting the patient at the centre of their care, and of fostering a collaborative, supportive relationship between patient and healthcare professional.

TALKBACK PAIN MANAGEMENT 7

physiotherapist or an exercise professional will supervise the circuit and tailor exercises to suit your needs.

If you would like to know more about the programme, including access details to the e-learning sessions, please email the team at: hello@ escape-pain.org for more information.

A chance to talk about your experiences with others

Setting yourself a goal YOUR facilitator will explain that it is easier to become more active and do more exercise if you set yourself a goal.

You can start by thinking about something that you really want to do, for example, going to the park with the grandchildren or working in the garden for 30 minutes a day. You can then put together an action plan, explaining: l what you want to achieve (your goal, for example, working in the garden daily) l when you will achieve it (e.g. three months) l how you will achieve it (e.g. completing ESCAPE-pain and continue to exercise twice a week after that) l where you will achieve it (e.g. exercising at home and at the local gym) Your facilitator can help you in setting some short-term goals as stepping-stones to achieve your main goal. https://escape-pain.org/

painkillers for chronic pain It also highlights good communication and its impact on the experience of care for people with chronic pain.

Acupuncture is recommended as an option for some people with chronic primary pain, provided it is delivered within certain, clearly defined parameters.

Nick Kosky, a consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust and chair of the guideline committee said: “Understandably, people with chronic pain expect a clear diagnosis and effective treatment. But its complexity and the fact GPs and specialists alike find chronic pain very challenging to manage, means this is

often not possible. This mismatch between patient expectations and treatment outcomes can affect the relationship between healthcare professionals and patients, a possible consequence of which is the prescribing of ineffective but harmful drugs.

“This guideline, by fostering a clearer understanding of the evidence for the effectiveness of chronic pain treatments, will help improve the confidence of healthcare professionals in their conversations with patients. In doing so it will help them better manage both their own and their patient’s expectations.” www.nice.org.uk

Image: yanalya/Freepik

Image: rawpixel.com/Freepik

usually starts with a brief (1520 minute) group discussion around a specific topic relating to back pain. This gives you the opportunity to share your experiences with other participants and discuss the session topic further.

This is followed by around 4045 minutes of a simple circuittype exercise programme. A

Image: Freepik

chronic back pain

TALKBACK l AUTUMN 2020

8 TALKBACK WORKPLACE

Making the transition out of lockdown – in the office and at home As the coronavirus pandemic starts to ease, businesses and employees face major challenges in transitioning back to life in the office and, increasingly, the “blended working” approach of part-time office/parttime at home.

FOR office-based employees, this may mean no more hotdesking and getting used to working back to back (not face to face). For home workers, it will be vital to avoid awkward makeshift workstations that can lead to severe back and neck pain.

NICHOLA ADAMS, a leading ergonomist and founder of the consultancy Inspired

Ergonomics, has conducted hundreds of assessments remotely during lockdown and has noted how cautious many employers are about the health and welfare of their workforce in the office, especially as a second wave of the virus remains a risk.

She commented: “With many of us facing up to another six months at home, there’s

now a lot of confusion about what people should be doing, especially as there are still so many unknowns ahead.

“Homeworkers are struggling.

One lady in her 20s, who works for a London law firm, was using her ironing board as a laptop desk and a rickety fold-up garden chair to sit on.

The ironing board was too high, giving her severe neck and shoulder problems. The garden chair had a gap at the back, so without support, she got lowerback pain – all compounded by her moving less than she normally would in the office.

“Others use dining tables that are too high, or their beds, slouching and craning their necks. One lady used her sofa arm as a mouse mat. People think they know how to set up a workstation correctly, but they need professional support and advice.”

To help ensure a safe workplace – whether in the office or at home – Nichola Adams offers employers and employees her ten transition tips on how to ease out of lockdown:

FOR EMPLOYERS

Adjust furniture to support a healthy posture

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1 CONSIDER DITCHING ‘HOT-DESKING’ It’s going to be essential when we return to the office to implement a new “singledesk-per-day” regime and to clean work surfaces like desks, chairs, monitors, keyboards and mice, at the end of every individual worker’s shift. So, this does sound a death knell for the widespread cost-saving practice of “hot-desking”.

For longer-term homeworking, use tables and office chairs 2D OWNSIZE TO LOWER CAPACITY Because of the continuing rules on social distancing, companies with, say, 100 staff, will now only have capacity for 20-40 employees in the office at any one time. The need to radically reduce the amount of people in the office has already prompted many companies to rotate staff by day or by the week, to widen the spread between teams.

3G ET BUSY SCREENING AND CLEANING Screens or barriers may be needed around desks. Pods or self-contained units for workers will have partitions on all sides of the desk to stop the virus spreading when we cough and breathe. Workstations should be cleansed after every shift, also chairs, tables, monitors and office break-out furniture as the virus lands on many surfaces. If used, reception sofas should be cleaned after each arriving guest.

TALKBACK WORKPLACE 9

FOR EMPLOYEES

Beware ‘makeshift’ set-ups at home

Positioning equipment incorrectly can cause shoulder and neck strains, headaches and migraines workstation assessments, which they’re legally obliged to if workstations move. Some staff may feel keen to return to the office, others nervous. Talk to individuals about their concerns.

4 INCREASE SUPPORT FOR YOUR WORKFORCE A new Institute for Employment Studies (IES) survey of 500 homeworkers found 75% said their employer had not carried out a health and safety risk assessment of their homeworking arrangements in lockdown.

People are confused, need help, guidance and want to feel safe. I recommend employers host health and wellbeing workshops, support employees’ mental health, and conduct fresh office ergonomic

5 DOUBLE EMPLOYEE ALLOWANCES Musculoskeletal issues like back pain and injuries, and neck and upper-limb problems, cost UK plc nearly seven million working days a year. Part of the problem of homeworking is few people have the right equipment to work comfortably in the long term. In lockdown, some companies are offering homeworkers an allowance (average budget from £150) to buy work furniture. But with rough costs (chair £100-£150), (table £60-£90), (keyboard £40), (mouse £20) adding up to £300, employers should double their allowance. Also, offer advice on what equipment to buy, or consider sending their office equipment home.

Nichola Adams: “Talk to individuals about their concerns”

1 BEWARE ‘MAKESHIFT’ SET-UPS AT HOME The IES survey found, on average, a 50% increase in back pain issues in lockdown.

It’s crucial to seek advice on how to create your homeworking set-up correctly. I’ve seen makeshift workstations using ironing boards, drinks cabinets, coffee tables, bar stools, sofa armrests and old fold-up garden chairs and tables.

Around 5% of people are slouching on beds. You can get away with it short-term but for longer-term homeworking, use tables and office chairs.

Positioning equipment incorrectly can cause shoulder and neck strains, headaches and migraines.

2 THINK TOILET SEAT! Research on germs by UK ergonomics firm BakkerElkhuizen shows there are 45,670 more bacteria on an average computer mouse than there are on the average toilet seat; 20,598 more on a keyboard than on a loo seat.

Returning to your office, take your keyboard and mouse with you so any germs are your own. Leaving work, wipe clean to avoid taking office germs home.

3 SWAP HANDBAGS FOR BACKPACKS Heavy handbags can cause neck and shoulder injuries to

women who haven’t been used to carrying them in lockdown.

Out-of-condition muscles make it especially important to distribute the weight of your belongings evenly using a backpack, preferably with adjustable, padded straps. As many of us may be avoiding public transport, backpacks are also ideal when cycling or walking to work.

4W ATCH YOUR BACK Government guidelines recommend that office workers should no longer be sitting face-to-face at their desks.

Instead, employees social distancing correctly are being encouraged to sit back-toback or side-by-side, and six feet apart. This may mean desks moving position, so a fresh ergonomic workstation assessment is recommended.

5 MAKE A STAND With companies reducing their capacity and allowing fewer employees in the office at any one time, work rooms will be less full. Provided you follow social-distancing guidelines, this new environment allows you to stand up and walk around more often, along the guided route. Take regular screen breaks, stand up and move about to help improve blood circulation, ease muscle tension build-up and prevent injury. Do this at home, too. www.inspiredergonomics.com

If workstations are being rearranged, a fresh ergonomic assessment is recommended

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10 TALKBACK BACK PAIN IN NURSING

Back pain in nursing

Image: freepik

Back Pain in Nursing is the focus of this year’s BackCare Awareness Week, taking place 5-9 October.

BACKCARE is issuing new flyers, A5 booklets, A3 posters and balloons for display, while this Special Awareness edition of TalkBack will cover initiatives from professional partner associations.

BackCare’s campaign will, with the assistance of its flagship publication The Guide to the Handling

of People (HOP6), prevent significant back injuries in the Nursing profession. Many nurses will benefit from training which is provided by our sister organisation, the National Back Exchange. It will be advertised widely throughout the NHS and caring facilities and also through social media.

Must-have training guide for the handling of people HOP6 is the leading and internationally recognised training text for the handling of people. Extensively updated, the 6th edition of this gold standard guide includes four new major sections: ● Legal framework, risk assessment, ergonomics and biomechanics methods and requirements for patient/ person safety and injury prevention ● Key strategies for organisation, training, equipment, work, health and wellbeing essential to safer handling practice ● Practical chapters setting out evidence-based best practice in core manual and

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equipment skills ● Special circumstances, including key pathways and case studies.

HOP6 is widely endorsed by organisations including the Royal College of Nursing, the Chartered Society of Physiotherapy, the College of Occupational Therapists and the Health and Safety Executive.

The mission of HOP6 is to set out a person-centred systems approach, which balances the twin aims of (patient/person) safety, dignity and enablement with the prevention and management of work relevant MSDs in

health and social care workers.

The Guide to the Handling of People – 6th Edition (HOP6) is available for £49.95. For bulk order discounts and postage queries please contact orders@ backcaretrading.org.uk or call 020 8977 5474 (Mon-Thu 9am-4pm). www.backcare.org.uk

Better planning can reduce injury in the workplace We know from bitter experience that poor moving and handling practice can cause back pain or make existing pain worse, and nurses can be as vulnerable as any worker.

Many of the potentially injurious tasks will feature in a nurse’s typical working day: lifting heavy or bulky loads; carrying loads awkwardly, possibly one-handed; pushing, pulling or dragging heavy loads; repetitive tasks; bending, crouching or stooping; stretching, twisting and reaching; being in one position for a long time. What’s more, high workloads, tight deadlines, inadequate staffing levels and lack of control of the work can often exacerbate matters.

The HSE has identified measures that can reduce the risk of back pain in your workplace1:

● Identify what activities can cause back pain and decide whether they can be avoided or changed ● Ask your workers for input – they have first-hand knowledge of the work and can suggest changes ● Think about how you can make jobs physically easier, for example, by moving loads on wheels ● Make sure controls, for example lifting aids, are available, used and maintained ● Look for signs of back pain among your workers, such as a reluctance to do a particular task, which may suggest your controls are not working ● Encourage them to report problems early to you or their worker representative so they get the right help.

1 Manual handling at work, HSE

Back pain and MSDs are part of a wider organisational picture EQUIPMENT such as hoists and slide sheets, better training for moving and handling, and a greater understanding of biomechanical principles have assisted in prevention and management of back pain and MSDs to nurses and healthcare employers. However, there are still problem areas that can present a risk to staff, warns the Royal College of Nursing (RCN), which represents more than 450,000 registered nurses midwives, healthcare assistants and nursing students.

Examples include having to provide care and treatment in environments that are unsuitable, such as beds in corridors and storerooms when ED overflows; static and awkward postures are also an issue, including doing dressings in home environments, operating theatres and clinics; while, for community staff, even using portable electronic equipment such as laptops in the car presents a risk.

A Healthy Workplace toolkit is available from the RCN website to help implement safe

Image: freepik

Image: kjpargeter/Freepik

TALKBACK BACK PAIN IN NURSING 11

Key factors include working patterns and shifts working environments with high quality employment practices and reduce sickness absence.

Employers can health check their organisation against key indicators to achieve essential goals, including job design, health and safety, work-life balance, dignity at work, and

learning and development. The toolkit challenges employers to consider important factors such as working patterns and shifts, monitoring sickness absence for hot spots and trends, and having policies in place on stress and/or mental wellbeing. www.rcn.org.uk

Intensive care nurses more likely to suffer MSD problems INTENSIVE care unit nurses are widely believed to have more ergonomic risks than nurses working in other units in hospital, though studies on the prevalence of symptoms, as well as associated factors, are relatively scarce.

A study1 of more than 1500 nurses working in the intensive care units of public, private and university hospitals in Turkey, found the highest prevalence for the musculoskeletal symptoms of the nurses was in the legs, lower back and back.

Most of the nurses taking part in the study had encountered musculoskeletal pain or discomfort related to the previous month. The risky body movements that were frequently performed by the nurses during a shift were “turning the patient” and “bending down”.

Data were obtained by a tailored data collection form, a workplace observation form

and a Rapid Upper Limb Assessment tool to delineate ergonomic risks. The final Rapid Upper Limb Assessment score for the patient turning movement was found to be higher than for the bending down movement.

Musculoskeletal symptoms were mainly associated with organisational factors, such as type of hospital, type of shift work and frequency of changes in work schedule, rather than with personal factors.

The study, which was published by the International Council of Nurses, proposed that health policy makers should develop and support occupational health teams, and “ergonomic risk prevention programs” should be implemented throughout the units. www.icn.ch 1 P redisposing factors for musculoskeletal symptoms in intensive care unit nurses; D Sezgin, MN Esin, 2014

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12 TALKBACK BACK PAIN IN NURSING

Low back pain increases in parallel with nurse workload Nurses are among the professionals with the highest incidence rates of work-related low back problems. Every year, thousands of nurses worldwide work with less efficiency, receive medical reports and/or retire early.

This study of hospital units in Turkey highlights the key influencing factors impacting the frequency and severity of low back pain in nurses THOSE working in intensive care units experience low back pain more frequently due to reasons such as providing patient care by bending forward for long durations, over-forcing/ overloading some body parts while repositioning patients, and sparing more time for patient care.

In addition, the workload in intensive care units, and frequent repetition of body movements and functions such as reaching up-forward, holding, claspinghugging, lifting and turning, prepare the ground for the emergence of this problem.

A 2014 study1 of intensive care units in the province of Gaziantep, Turkey, examines the frequency and severity of low back pain and influencing factors in nurses working especially in intensive care units and considers the options for reducing the incidence of back pain in the profession.

Some 84.2% of the nurses experienced low back pain and 66.7% of the nurses evaluated this pain as “moderately severe”.

More than half (53.1%) of the

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nurses experienced low back pain for up to three years and almost 40% had pain attacks once a week. It was determined that 37.5% of the nurses who experienced low back pain did not make any attempts to relieve the pain, 49% experienced an increase in low back pain, 71.9% did not see a doctor, and 79.2% did not receive any treatment for their low back pain.

The study found the vast majority of nurses in the sample (97.9%) remained standing for a long time; those who performed interventions that require bending forward numbered 95.8%; who lifted patients (68.8%); who changed sheets while the patient was in the bed (65.6%); who repositioned patients (83.3%) and who did not use any aiding equipment during interventions (60.4%).

Surprisingly, a high proportion (86.5%) of the nurses sampled in this study did not receive education on low back pain.

Most of the nurses worked in standing position for long durations, performed interventions that required bending forward, lifted and repositioned patients, and these nurses had higher average low back pain scores. Moreover, it was observed that the nurses who did not use any aiding equipment during interventions yet believed in the benefit of using it constituted the majority.

This result may be explained by the lack of sufficient education given to nurses about the risks that may cause low back pain and the lack of sufficient time during interventions for using aiding equipment.

Education

It was reported that low back pain increased in parallel with the increase in working hours and this result was associated with sparing less time for resting. As other research2 has observed, orthopaedic

Nurses, who play such an important role in protecting, maintaining and improving individuals’ health, should attach greater importance to protecting their own health, says the report.

Working conditions

and ICU departments have heavy workloads that are likely to cause low back pain, and therefore the risks posed by these clinics should be evaluated. In this study, it was noted that nurses who worked in internal diseases and pediatric intensive care units had higher low back pain average scores.

This may be due to the fact that interventions that are more likely to cause low back pain are applied more in patients hospitalised in these units since these patients need different nursing cares, and that these clinics provide service under different conditions.

In addition, it was also found that working conditions and satisfaction with the place of employment affected low back pain; nurses who worked in shifts had higher low back pain average scores; and nurses who were partially satisfied with their place of employment experienced more low back pain.

Working with fewer personnel during shifts, having to perform patient transfers on one’s own

physical load, and necessary protocols should be established to control compliance to these rules by close monitoring.

In addition, it is considered vital that attention is paid to complying with body mechanics during all kinds of nursing interventions in patient care, and the differences between clinics in terms of the risk factors for low back pain are taken into consideration.

1 F requency and Severity of Low Back Pain in Nurses Working in Intensive Care Units and Influential Factors; Ozlem Ovayolu, Nimet Ovayolu, Mehtap Genc, Nilgun ColAraz Pak J Med Sci, 2014 Jan-Feb 2 V ieira ER, Kumar S, Coury HJ, Narayan Y. Low back problems and possible improvements in nursing jobs. J Adv Nurs. 2006

The vast majority of nurses said they remained standing for a long time Image: Freepik

without help, lack of sleep, and decrease in the quality of sleep may be associated with low back pain. Moreover, it is thought that the employees feel better and experience less anxiety as their satisfaction with the institution of employment increase, and that these factors have a positive effect on low back health.

Nurses who evaluated their health condition as “very good” experienced less low back pain problems and had lower low back pain average scores. This result may indicate that nurses who define their health status as “very good” feel much better, as observed in the satisfaction with the institution of employment, and this situation increases their performance and therefore decreases their low back pain related problems.

In line with its findings, the study highlights the value of regular education programmes to control risk factors that may cause low back pain.

Nurses should be provided with guidance on using aiding equipment that would reduce

Image: jcomp/freepik

Wavebreakmedia_micro/Freepik

TALKBACK BACK PAIN IN NURSING 13

FIVE ESSENTIALS FOR NURSES ON THE GO ● Wear comfortable and supportive shoes ● Maintain good body posture ● Lift wisely and with caution ● Eat a healthy diet and stay hydrated ● Have a positive outlook at work

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14 TALKBACK BACK PAIN IN NURSING

Image: jcomp/Freepik

Bariatric patient handling in theatre and on the ward THE obese population in the UK continues to grow and this group is over-represented in their use of health and social care services. The manual handling of these patients presents a specific challenge partly due to individual factors but also in terms of policies, space, equipment and vehicles for safe care, treatment and transportation.

A 2007 HSE report RR5731 explored the risk factors associated with the bariatric patient pathway through the health and social care systems – which up until that time had not been investigated systematically – and it was estimated that 40%-70% of Trusts did not have a bariatric policy. Education and training in this specialised area have steadily improved as has the design of appropriate equipment and accessible environments, though efficient management processes and communication remain critical in order to ensure the safety, dignity and comfort of the patient and the health and safety of staff.

In the theatre

Clinical issues associated with treatment and care include stretching to treat and holding the weight of limbs

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The RR573 report explores risks within the patient journey across health, social care and domestic settings. The pathway through theatres identified concerns associated with the equipment, furniture and management. For example, due to the other ceiling mounted equipment in an operating theatre it was not always possible to have a ceiling mounted hoist/track so sliding boards were used for lateral horizontal transfers. On the table, there were difficulties

in positioning the patient due to unpredictable movements of the excess flesh changing the weight distribution on the table. Supporting limbs in limb holders was the preferred option but where patients did not fit then staff might have to stretch across the patient and/ or hold the flesh/limb. Slide sheets were not left in situ due to pressure concerns adding to the difficulty of repositioning during the operation.

On the ward When it came to care on the ward, factors again included the equipment (design, width, safe working load) and spatial constraints. It was identified that equipment could be used to stand (using the electric bed), turn (using a hoist) and reposition (by leaving the sliding sheets in situ) the patient to reduce the risks.

An overhead track or monkey pole could help to increase the patient’s independence.

Clinical issues associated with treatment and care included stretching to treat and holding the weight of limbs (internal examination and blood pressure observations). Tissue viability was a concern, with specialist mattresses, leg dressings and the problem with the limbs being too heavy for the leg cradle. Respiratory treatment needed specialist equipment, and chest physiotherapy was difficult to deliver due to problems with positioning the patient for access to different areas of the chest, and the physical effort involved.

1 R isk assessment and process planning for bariatric patient handling pathways

www.hse.gov.uk

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Anxiety and depression exacerbate chronic pain that overweight and poor physical fitness are important contributors to back pain.

Anxiety and depression have long been recognized as conditions that exacerbate chronic pain. There is increasing evidence to suggest that inflammation is an important process underlying chronic pain.

We need large scale studies to explore these relationships which have so far not been funded.

Over the last 25 years, there have been many improvements in lifting and handling techniques and practices.

BackCare publishes a regularly updated

evidence-based training guide to lifting and handling, currently the edition is HOP6, with a new HOP7 on the way, which has specific advice for nurses and their training.

There are many aids for lifting and handling patients. They range from simple devices to facilitating sliding patients during transfers, to sophisticated devices for recovering fallen patients, such as the HoverJack Device (https://hovermatt. com/products/evacuation-ems-hoverjackdevice/). These have transformed nursing practice.

Fortunately, most people, including nurses, have back pain that can be controlled with simple measures available in primary care, including basic analgesics, fitness, weight control and manual therapy.

We still have more work to do to develop effective and evidence-based therapies for chronic back pain.

Jeremy Fairbank MD FRCS, Emeritus Professor of Spine Surgery, University of Oxford 1 L eighton D, Reilly T. Epidemiological aspects of back pain: the incidence and prevalence of back pain in nurses compared to the general population. Occupational Medicine,1995;45(5):263–7.

Image: Freepik

NURSES have long been seen as vulnerable to developing back pain. In fact, in 1995 the prevalence in nurses of back pain was 14.7% compared with 11.5% in age-matched controls, according to the study Epidemiological aspects of back pain1. An obvious cause for this difference would be due to the demands of lifting and handling, as was felt by the participants.

The study also shows that back pain is common even if you are not a nurse.

University of Oxford research has shown that in some people with early onset chronic back pain, especially those younger than 50, there are links with earlier than average disc degeneration in the lower lumbar spine that are more prevalent than asymptomatic age matched controls. In others there are no identifiable pathological changes on MRI scans. Most of these degenerative changes occur at the lower two mobile levels of the lumbar spine. This study, submitted for publication, was confined to female subjects, though there is no reason to believe that males are more or less afflicted than females.

So what are the factors that contribute to this common complaint? We know

Image: Freepik

Assessing the key reasons for chronic back pain

Choose an exercise you enjoy to manage your back pain EXERCISE is commonly advised as one of the best ways to help prevent and manage most back pain. The type of exercise you do does not matter as long as you do something and remain active.

The choice of exercise is yours because if you enjoy what you are doing, you will be more likely to continue and see the benefits. Walking and

running have remained popular during lockdown despite the disappointment of many cancelled events this year.

Other people find that swimming helps their back pain, the water environment taking the strain off joints and muscles while engaging the major muscle groups. Yoga is also great for strengthening core and back

muscles and increasing flexibility.

Similarly, Pilates strengthens muscles and the spinal column and promotes good posture.

Now that gyms are reopening (cautiously), a wide variety of structured exercise programmes can provide cardiovascular workouts and all over body conditioning which includes the back and core muscles.

There are also some exercises you can do on your own at home without specialist equipment that can help to strengthen your back and prevent and ease back pain.

These can be found in information sheets on the BackCare website. https://backcare.org.uk/ get-involved/

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16 TALKBACK RESOURCES

Move more to keep the aches If you are working from home, moving regularly throughout the day will help you avoid the aches and pains – and stress – associated with being sedentary. The Chartered Society of Physiotherapy (CSP) offers some exercises you can build into your working day. tingling in your arms. Hold the stretch for 20 seconds and repeat three times.

Leg stretch Stand in front of your desk and place your left hand on it for balance. Standing on your left leg, raise your right heel towards your right buttock. Grab your right foot with your right hand. You should feel a stretch along the front of your thigh. Hold the stretch for 20 seconds, repeat three times and then switch legs.

Sit stretch Perch on the edge of your seat and stretch your right leg out in front of you. Rest your heel on the floor with your foot pointing up.

Lean forward slightly from your hips and look straight ahead. You should feel a gentle stretch but no pain along the back of your right leg. Hold the stretch for 20 seconds, repeat three times and then swap legs.

Chest stretch Sit forward from the back of your chair.

With your thumbs pointing towards the ceiling, open your arms out to the side until you feel a stretch in the front of your chest.

Ensure your shoulders are back and down.

Aim to switch on the muscles between your shoulder blades by gently drawing them together. You should not feel pain or Image: wavebreakmedia_micro/Freepik

Wall press Stand with your feet hip-width apart. Stretch out your arms and rest your palms against

Try going up and down the stairs every 30 minutes

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Long periods of sitting can lead to pain and the wall at shoulder-height and slightly wider than shoulder-width apart. Take a couple of tiny steps back, engage your stomach muscles and slowly bend your arms at the elbows. Keep your back and neck straight and look at the wall in front of you. Lower yourself until you are a couple of inches from the wall, then push yourself back up to your starting position. Make sure you lead with your chest so your arms are doing the work.

Do not allow your back to arch. Aim for three sets of 10 press-ups.

Is there a ‘perfect’ posture?

There is no perfect posture, the key is to keep moving. Your best posture is your next posture! You may experience aches and pains as the body is not used to being in a particular position for prolonged periods of time. Take regular breaks for movement, try setting an alarm to remind you to get up and move.

You will also find breaks beneficial for your mental health. If you need to make a phone call, try and get away from your desk. Stand up and walk around the room. www.csp.org.uk

Image: yanalya/Freepik

EXPERT physiotherapists at the CSP advise home workers to break up prolonged periods of sitting with short bursts of activity to improve mental health and circulation.

This can be small amounts of light walking, moving around the house, cleaning, gardening or going up and down the stairs every 30 minutes.

“Increasing your daily activity and doing some more structured exercise such as a brisk walk outside, yoga or weight training can reduce symptoms of stress, anxiety and depression.”

The CSP suggests a range of simple exercises you can build into your working day:

TALKBACK RESOURCES 17

and pains at bay

increase stress

Image: yanalya/Freepik

Image: javi_indy/Freepik

New public health hub for AHPs PHYSIOTHERAPY staff can now access an online hub that provides guidance and key documents about the role of allied health professionals (AHPs) in public health.

The UK AHP Public Health Hub contains toolkits, strategies, case studies, evidence and evaluation reports, blogs and comprehensive information

about the contributions AHPs make to public health.

The free online resource was developed by the Royal Society for Public Health (RSPH) in collaboration with the Chartered Society of Physiotherapy (CSP) and other AHP professional bodies. www.rsph.org.uk

Easily and instantly record all physical pain events PAIN and discomfort associated with many differing types of musculoskeletal problems can now be self-recorded at the time of the event, in the context and sequence in which they occur using the new Grasp device (pictured above) and software.

The soft, easily compressible device, which is the size of a small pebble, allows the user to easily and instantly record all physical pain events.

When it is squeezed, Grasp records, with a date and time stamp, the strength, frequency, and duration of the squeeze enabling the user to easily and instantly record all physical pain events.

During a light pain attack the user can squeeze gently for as long as the event lasts, if the attack becomes worse, the user can modulate the squeeze to reflect their own perception of the severity of the attack.

Pain experience data is presented as a series of graphs which can show either a single event or trends over time.

By using the Grasp pain recording platform to reproduce in the pain management space, pain care providers can rapidly and easily scale operations to deal with any Covid-19 related service pressures and provide an overview of the effect of any policy changes or new interventions.

Would you like to take part in a pilot study?

Having recently entered the British market, Grasp Health UK will undertake a limited number of pilot studies of around 20 patients per pilot. It will provide the Grasp devices and software free of charge for the duration of the pilot including all training, support and any updates. Further information can be found on the website. https://grasp.global

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18 TALKBACK PHYSICAL ACTIVITY

Government wants to inspire a Image: Freepik

THE government has detailed how it will spend £2 billion on increasing the numbers of people walking and cycling for travel.

The plans will involve transforming infrastructure through building thousands of miles of protected cycle routes in towns and cities and improving the National Cycle Network.

To encourage people to take up cycling, cycle training will be made available for every child and adult who wants it, accessible through schools, local authorities or direct from cycle training schemes.

Hangars So that more people can make cycling part of their commute or daily routine, more cycle racks will be installed at transport hubs, town and city centres and public buildings, and funding will go towards new bike hangars and on-street storage for people who don’t have space to keep a bike at home.

The investment will also see bikes made available through the NHS, with GPs prescribing cycling to people in poor health and making bikes available at local surgeries, including e-bikes.

Make cycling part of your commute or daily routine

Virtual help with activity planning and motivation AS a quarter of adults living with a long-term health condition report being afraid to leave the house with coronavirus (Covid-19) restrictions eased, Sport England’s We Are Undefeatable campaign returns with a new advert.

The campaign seeks to encourage people with long-term health conditions to keep active as a means of maintaining good health and wellbeing and, in some cases, managing symptoms. A quarter of those with long-term health conditions say they won’t return to communal sport and leisure centres until there’s a vaccine.

The new advert shows the ups and downs of managing a condition and getting active in these unusual times – a library of customisable mini-workouts, called 5in5, and My Daily Undefeatable, a virtual assistant tool in Facebook Messenger that helps with activity planning and motivation.

This Morning’s resident NHS GP Dr Zoe Williams has also been enlisted to help people living with a health condition to adjust to life, mentally and physically, as lockdown restrictions ease.

The doctor will also oversee the virtual

Air quality Launching the scheme, Prime Minister Boris Johnson said: “From helping people get fit and healthy and lowering their risk of illness, to improving air quality and cutting congestion, cycling and walking have a huge role to play in tackling some of the biggest health and environmental challenges that we face.”

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Image: Pressfoto/Freepik

40% of volunteers are apprehensive about returning

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Image: Freepixel/Freepik

cycling and walking revolution Maintain routines and build new skills online

coming together of a walking football team and a dance group to get active online under the guidance of two coaches. The team members, made up of people living with long-term health conditions, will meet with their coaches online to learn a routine and build new skills.

Walking football England’s walking football manager Stuart Langworthy will be coaching the team, with sessions provided for a range of abilities and fitness levels.

He said: “Whether you are already part of a team but don’t feel comfortable about returning just yet, or you simply want to find a new way to get active with a group of like-minded people, these sessions will be a great way to have fun and keep moving in your own space.”

“We hope that the sessions will not only

help people stay active and motivated, but also ensure that people don’t feel alone with their condition and can help forge connections with other people who may be feeling the same way.

“We will aim to use the social media to build a good team spirit as well as providing activities suitable for each member.”

The ‘5in5’ concept is a customisable mini-workout to help people living with health conditions explore what may work for them. Users can choose five individual exercises from the library, which you do for one minute at a time. The library will include four categories to choose from depending how you feel – warming up, stress-busting, mood-boosting, and exercises with accessories.

A virtual assistant tool, hosted on Facebook messenger, will check-in with

people to see how they’re feeling, physically and emotionally, as well as how they’re keeping active. Users can answer questions about what motivates them to keep moving, and then schedule reminders to check-in on a daily or weekly basis.

Dance The dance squad will be led by independent dance teacher Katie Mason – a specialist in dance classes for people with restricted mobility, health conditions and/or limited space at home – with the football and dance programmes running for an initial period of 10 weeks, ahead of an intended broadening to more teams and disciplines.

Each team’s progress, along with helpful tips and advice, will also be shared on the We Are Undefeatable social media channels so people can try it for themselves at home. https://weareundefeatable.co.uk

Training to help sports volunteers return with confidence A £250,000 investment is being made to help the sport and physical activity sector reopen.

The ReActivate training initiative has been created by Sport England and the Chartered Institute for the Management of Sport and Physical Activity (CIMSPA).

“The sport and physical activity workforce and volunteers are going to play a vital role in keeping the nation fit and healthy as we emerge from this crisis,” said CIMSPA chief executive officer Tara Dillon.

“With our recent Return to Work survey indicating that 40% have some degree of apprehension about returning, it is vital we give them the support they need to return with confidence and create a safe environment for the public.”

ReActivate will take the form of a free, online training platform. It will be delivered by a consortium of partners, each with extensive experience in online training and the physical activity sector and led by Future Active Workforce CIC.

Its content will cover topics such as risk management, social distancing, cleaning and use of equipment and coronavirusspecific procedures, as well as health and wellness support for all staff still on furlough.

Upon course completion, participants will receive a CIMSPA “Covid-Safe” training certificate. ReActivate will be free to use for 12 months, for anyone working or volunteering in the sport and physical activity sector in England. www.sportengland.org

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20 TALKBACK COVID UPDATE

Are you or a loved one recovering RECOVERY from coronavirus, much like its symptoms, differs from person to person.

Someone on the path to recovery may worry they’re not getting better as quickly as they’d like and question whether the way they’re feeling is normal.

Regardless of whether someone was admitted to hospital or stayed at home during their illness, the body goes through a lot and it can take time before people start to feel like themselves again.

Some will find they have been left with symptoms that are slow to get better.

Others have reported recurring symptoms.

Some of the more common symptoms that people have been left with are: feeling tired a lot of the time, often with a lack of energy; weak muscles and stiff joints, which can make balance and walking difficult; feeling breathless, especially when active; a lingering, troublesome cough; loss of weight and muscle mass leading to a general weakness; losing interest in food and feeling

Image: Freepik

Lack of energy, weak muscles and stiff joints are common symptoms. Although it’s important to rest, small periods of physical activity will help rebuild strength and fitness

THE risks faced by healthcare workers treating patients with viruses which can be transmitted through the air are highlighted by new research1 published by the Institution of Occupational Safety and Health (IOSH).

Researchers from University Hospitals of Leicester NHS Trust in the UK and Turku University of Applied Sciences in Finland examined these risks and how different forms of ventilation can protect those treating patients. Under different ventilation, distance and PPE settings, laboratory experiments were carried out using a breathing thermal manikin as the patient and computer simulation to assess contaminated and supply airflow.

It found that if the healthcare worker is leaning over a patient lying on a bed in an isolation room – for example, to check blood pressure, pulse rate of temperature – the air the patient breathes out flows directly towards them. In a room with mixing ventilation, this means their exposure level rises by up to six times, significantly increasing their chance of infection.

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Image: wavebreakmedia_micro/Freepik

Better environmental control can protect staff from viruses

Well-positioned room ventilation design will reduce risk

Downward ventilation One form of ventilation, called local downward ventilation, can reduce this exposure to one third of the exposure found with a general mixing ventilation, researchers found.

However, consideration has to be given into how this is designed and where it is placed to

minimise discomfort for patients, for example from draughts such a system creates.

The report adds that the position of the exhaust plays a role in healthcare worker protection, in addition to supply air distribution. In this study, the most effective exhaust positions were in the wall behind the patient bed or in the lighting panel above and behind the patient.

Dr Julian Tang, Consultant Virologist at the University Hospitals of Leicester NHS Trust, said: “We have to try to improve the amount of clean air in the environment compared to the amount of contaminated air.

“Obviously it’s difficult to modify existing isolation rooms to these new findings and some existing facilities will be easier to modify than others, but if you know what the optimal ventilation design and strategy is, you can work towards it.” www.iosh.com 1 Reducing aerosol infection risk in hospital patient care

TALKBACK COVID UPDATE 21

from coronavirus? unmotivated to eat; difficulty chewing and swallowing; finding it hard to get off to sleep and stay asleep; finding it hard to think clearly and feeling forgetful at times.

As coronavirus is still relatively new, people will be unsure of what they can do to help speed up their recovery.

Age UK has drawn up a list of things people can be doing to help get back to their normal selves.

Nutrition Eating and drinking regularly throughout the day is important to help keep strength up and aid recovery. Being well nourished and hydrated will help the body fight the illness.

If someone’s appetite is small they should try to eat six small snacks throughout the day. Eating something is better than nothing so have anything which takes your fancy – you might have a milky coffee or hot chocolate, a small piece of cake, small

It’s important to stay hydrated so try to have eight drinks throughout the day

finger foods and small pieces of ripe fruit to freshen your mouth.

It’s important to stay hydrated so try to have eight drinks throughout the day.

Physical activity Although it’s important to rest, small periods of physical activity will help to rebuild strength and fitness.

Start off with small things, such as going to make a drink, or getting in and out of a chair a couple of times. Doing a little bit each day is important, as is listening to your body and making sure not to overdo things.

Taking time to rest between each task is

good, and if someone experiences fatigue one day, they should have a rest and try again the next.

Don’t be disheartened Feelings of frustration are natural if someone feels unable to do the things they could before, or about the length of time they’ve been unwell, but try not to be disheartened.

Even if recovery isn’t as quick as expected, it’s important to stay positive and motivated.

Comparing recovery to someone else’s isn’t helpful, as the process will be different for everyone. It is often helpful to take some time to think about what is important and set achievable goals to help get there.

Discussing experiences It can help to share experiences with friends and family or maybe a self-help group, where others have experienced similar feelings. This can be a good way to help process and come to terms with it.

Relaxation techniques and mindfulness can help manage difficult and unhelpful thoughts and emotions. If more help is needed, speaking to a GP is good idea.

GPs understand how upsetting having coronavirus can be and how poorly it makes people feel. www.ageuk.org.uk

Image: Freepik

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Image: ArthurHidden/Freepik

22 TALKBACK LONDON VIRTUAL MARATHON 2020 THOUGH only the elite races for men, women and wheelchair athletes will take place in London’s St James’s Park, everyone with a place in the event has the chance to run the 26.2-mile marathon distance from home or anywhere in the world on the course of their choice.

All finishers will receive the coveted finisher medal and New Balance finisher T-shirt.

In addition, all runners and charities will also be able to defer their place to a future London Marathon – in 2021, 2022 or 2023.

Any runner that was accepted to run in the 2020 event can take part in the Virtual 40th Event on 4 October and still have their place deferred.

Under starter’s orders for the VIRTUAL Marathon This year’s Virgin Money London Marathon will be a virtual event for BackCare runners and thousands of other entrants who are determined to achieve their personal goals after so many gruelling months of training.

(PLEASE NOTE: Our list of runners is correct at time of going to press. Updates will be available online.)

Participants can run the 26 miles on their choice of course 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, who is 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 to raise money for a charity that aims to prevent back pain.” https://uk.virginmoneygiving. com/AndyGarratt

Andy Garratt

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Jane Morgan

JANE MORGAN, 48, Quedgeley, Gloucester “I started running approximately 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. 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.” https://uk.virginmoneygiving. com/JaneMorgan27

Nicola Brammer NICOLA BRAMMER, 45, Burston, Stafford “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.

So many of us suffer from the misery of back pain at some point in our lives.” https://uk.virginmoneygiving. com/NicolaBrammer 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

Paul Roberts and work on my fitness and stretching. 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 years. This will be my first full marathon.” https://uk.virginmoneygiving. com/PaulRoberts109 RICHARD POTTER, 38, Tiverton “I have suffered with degenerative disc disorder for the past 15-16 years and simply

Richard Potter

TALKBACK LONDON VIRTUAL MARATHON 2020 23 wouldn’t be able to function day to day without regular exercise – especially running which I have been doing for the best part of 10 years and has made a huge difference to the back pain and my general mental health.” https://uk.virginmoneygiving. com/richard.potter1

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.” https://uk.virginmoneygiving. com/AmandaJWaters

“I’ve chosen to run for BackCare this year 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 over a year living on Fentanyl and Oramorph, I now live on running as it keeps my back supple and pain-free.” https://uk.virginmoneygiving. com/ZoeHughes11

Vida Spiller Sarah Millington SARAH MILLINGTON, 39, Worfield, Bridgnorth “After suffering 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 VLM 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.” https://uk.virginmoneygiving. com/Sarah4uk

VIDA SPILLER, 42, Aylesbury “I still struggle with pain, my husband goes through it daily and my mum had terrible problems with her back. As a child seeing her in such pain and ending up in hospitals so often made me feel sad and helpless.

I want to raise money to help people with such horrible pain.” https://uk.virginmoneygiving. com/VidaSpiller1

Hamedah Shkokani 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 this. Now I live a normal life and exercise is a big part of that. Scoliosis can often cause back pain and so running for a charity which is relatable makes it even more rewarding.” https://uk.virginmoneygiving. com/HamedahShkokani

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 health care 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.” https://uk.virginmoneygiving. com/RosemaryCopsey JONATHAN CROCKER “Time to get running and jump from ‘unable to walk’ to ‘four hours of running’ in just under five months.” https://uk.virginmoneygiving. com/crockerrun2020 JODIE GROVER “It seems bad backs run in the family with both mum and I suffering. I am running this time as a tribute to my mum.

She had real problems with her back that caused her a lot of discomfort but it never really stopped her.” https://uk.virginmoneygiving. com/JodieGrover1

Michelle Carr

Amanda Waters 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 that I thought would go once I had the baby. It didn’t, it stayed with me for over 10 years. I tried many treatments with some giving short-term relief. I ended up having spinal fusion surgery in 2012. The recovery sparked my interest in other treatments 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 back pain. However, I see

MICHELLE CARR “I got into running around five years ago and quickly became hooked. Exercise, in particular running, has really eased my physical pain and improved my mental wellbeing. I consider it an essential part of my daily routine and feel proud to call myself a runner. My mother has also suffered back pain all her life.” https://uk.virginmoneygiving. com/MichelleCarr7

Mary Hockenhull Kate Lancefield KATE LANCEFIELD, 39, Hawkinge, Folkestone “I have suffered with back pain for about 12 years. I have found running has helped so much, keeping me active and helping manage the pain. I am excited about running the Virtual London Marathon and looking forward to fundraising for this amazing charity.” https://uk.virginmoneygiving. com/KateLancefield

MARY HOCKENHULL “I’ve suffered for a number of years now – on and off – with a variety of unwelcome back and shoulder issues. Despite this, I am very lucky that none of these issues/injuries has stopped me from running for any significant length of time, and so I wanted to raise money for a charity close to my heart that helps raise awareness.” https://uk.virginmoneygiving. com/MaryHockenhull

Zoe Hughes ZOE HUGHES, 34, Pockington, York

ROSEMARY COPSEY “I’m raising money for back pain in recognition of all health care workers, nurses and

www.virginmoneylondon marathon.com www.backcare.org.uk

TALKBACK l AUTUMN 2020

24 TALKBACK NEWS

For further information and free posters, email info@backcare.org.uk

BackCare, Monkey Puzzle House, 69-71 Windmill Road, Sunbury-on-Thames TW16 7DT. +44 (0)208 977 5474 Registered Charity No: 256751

TALKBACK l SPRING 2020