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backcare awareness week: back in the office ■ NEWS

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

ISSUE 3 • 2014

FREE TO MEMBERS

The national back pain survey Best practice in pain management The Alexander Technique at work

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


2 TALKBACK EVENTS

BackCare Events Calendar 2014 Therapy Expo 2014 12 – 13 SEPTEMBER

UK’s dedicated show for Clinic Therapists and Independent Practitioners. Manchester Central. Visit BackCare at Stand 16. www.therapyexpo.co.uk

National Back Exchange Annual Conference and Exhibition 29 SEPTEMBER TO 1 OCTOBER

“Outside the box: Broadening horizons” – this is the “must attend” event of the moving and handling calendar. Hinckley Island Hotel, Leicestershire. www.nationalbackexchange.org

BackCare Awareness Week 2014, “Back in the Office” 6 – 12 OCTOBER

Back pain in office workers will be the theme of our 2014 awareness week. Campaign packs and details of media activities will be released closer to the event.

International Alexander Awareness Week – Stop, Think, Restore and Energise 6 – 12 OCTOBER

Look out for discounted sessions with STAT-registered Alexander Technique teachers in your local area. Visit www.stat.org.uk for more information.

British Scoliosis Society Annual Meeting 9 – 10 OCTOBER

Bristol Royal Marriott Hotel. Visit www.britscoliosissoc.org.uk for more information.

National Arthritis Week 2014 12 – 19 OCTOBER

Awareness week of the Arthritis Research UK charity, highlighting the impact that pain has on the 10 million people living with arthritis in the UK. Visit www.arthritisresearchuk.org for more information.

Association of Sport Rehabilitators and Trainers, Annual Conference 22 – 23 NOVEMBER

Join fellow Graduate Sport Rehabilitators and Allied Health Professionals for the annual “Pain to Performance” conference at the University of Hull. Visit www.basrat.org for more information.

Subscribe to TalkBack magazine for only £22.50 per year If you’ve picked up this magazine at an event and would like to become a subscriber, simply complete and return this form. By becoming a subscriber, you’ll get the latest news, research and educational content delivered to your doorstep quarterly, and you help to support the work of BackCare, the UK’s national back and neck pain charity. Name

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Send to: BackCare Membership, 16 Elmtree Road, Teddington, Middlesex, TW11 8ST Alternatively, you can scan and email this form to membership@backcare.org.uk or phone in your details to 020 8977 5474.

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TALKBACK WELCOME 3

Welcome Welcome to this very special Awareness Week issue of TalkBack. If you’re a new reader who has received this magazine as part of the BackCare Awareness Week pack, we hope you discover great value in these pages. Those interested in becoming subscribers can complete and return the form opposite. The theme of this year’s Awareness Week is “Back in the Office” with the aim of bringing everyone up to date on the scientifically evidenced predictors of back pain in the office setting and in the workplace in general. We take a look at the Get Britain Standing campaign, which highlights the profound detriments that are strongly linked to our culture of excessive sitting, including Q&A with Campaign Director, Gavin Bradley. We also explore the game-changing international precedents where the Alexander Technique has been used in occupational settings to prevent and reduce musculoskeletal disorders, while also promoting health, wellbeing and performance at work. Finally, we bring you a summary report on BackCare’s National Back Pain Survey 2014, which has revealed some powerful insights into the current health status of the general UK population. As per last year, we’ll be doing our Awareness Week radio day at the start of the week (Monday, 6 October), where we’ll be discussing the results of National Back Pain Survey 2014 – so listen out for us on your favourite regional and national stations! In addition to the Awareness Week content, we bring you a focused news round-up with leading edge commentary – we report on the recent paracetamol study which made headlines worldwide, and explore the critique of evidence based medicine from the perspective of an emerging renaissance movement. We also present another clinical case study; this

Contents

Does paracetamol work? 4

time illustrating what best practice in pain management can look like with a real back pain case study from physiotherapist and BackCare professional Nick Sinfield. As always, we welcome contributions from our members – whether you have back pain or treat people with back pain, if you can inform and inspire others, we’d love to hear from you. We’d also love to get feedback on community events during the Awareness Week – did you organise or attend a local event? Let us know by email to yourstory@backcare.org.uk or by letter to the usual address. Finally, we’d like to thank all of those who contributed to BackCare Awareness Week this year, including our headline sponsors, Actipatch, who funded the creation of the campaign pack, and Pfizer who funded the research behind National Back Pain Survey 2014. The fourth and final issue of the year is due out before Christmas. Until then, enjoy this issue and I’ll see you next time.

Evidence of a crisis?

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Map of Medicine

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The sitting problem 12-13 TALKBACK CAMPAIGNS 17

Dr Adam Al-Kashi Head of Research & Editor of TalkBack

Survey demographics Gender

Location Age

65+

Female

Male

45-54 35-44

79

25-34

52

16-24

121 77

Work status Occupational setting

Full-time worker

We welcome articles from readers, but reserve the right to edit submissions. Paid advertisements do not necessarily reflect the views of BackCare. Products and services advertised in TalkBack may not be recommended by BackCare. Please make your own judgement about whether a product or service can help you. Where appropriate, consult your doctor. Any complaints about advertisements should be sent to the Head of Information and Research. All information in the magazine was believed to be correct at the time of going to press. BackCare cannot be responsible for errors or omissions. No part of this printed publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the copyright holder, BackCare. ©BackCare

BackCare 16 Elmtree Road, Teddington, Middlesex TW11 8ST Tel: +44 (0)20 8977 5474 Fax: +44 (0)20 8943 53318 Helpline: +44 (0)845 130 2704 Email: info@backcare.org.uk Website: www.BackCare.org.uk Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751. TalkBack is designed by Pages Creative www.pagescreative.co.uk and printed by Severn, Gloucester.

Part-time worker Retired

70 87

Home

Not working

37

Service

Homemaker

Office

Full-time student

Manual

not tell us whether low SOC preceded back pain or vice versa in our survey participants. Nonetheless, the evidence from published studies shows that low SOC predicts several forms of musculoskeletal pain. Furthermore, it may be useful to think of physical symptoms and low SOC as the products of “co-emergent” processes – in other words, physical health and sense of coherence appear to go hand-in-hand. Our survey featured 490 people with back pain (169 of whom were “bothered a lot” by back pain) and 513 without back pain. The SOC scores among those with and without pain were significantly different. In particular, those bothered a lot by back pain were three times more likely to have low SOC score (lower quartile), while those without back pain were twice as likely to score highly (upper quartile). Here are some specific SOC statistics:

Current physical symptoms The clinical evidence supports the idea that back pain is one of the most common forms of somatisation – this is the technical name for this very common process through which psychological stress causes physical symptoms. Put simply, the body functions differently in the context of stress. Without pre-existing psychological factors, the usual physical triggers such as posture and lifting are largely unrelated back pain. Tension headaches are the most familiar example of somatisation, but somatisation can include many other common symptoms, including chest pain, stomach pain, shortness of breath, and insomnia. In a sense, somatisation is ‘normal’ in modern societies where more than 90% of people will experience tension headache and more than 80% will experience back pain at some point in their lives. When someone has multiple concurrent stress-induced symptoms, they may be classified as having a ‘somatisation disorder’, meaning that they have a general tendency to process stress as physical symptoms. In light of this, our survey included a 15-symptom checklist (PHQ-15) which is used within the NHS and clinical research to help detect somatisation disorders. Here are a couple of specific statistics from the survey data:

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Back pain survey

72% of people who said “My life is never a source of deep pleasure and satisfaction”, had back pain. 77% of people who said “My daily activities regularly or very often have little meaning”, had back pain. 85% of people who said “I regularly or very often have feelings inside that I’d rather not feel”, had back pain.

101 128 148

16-17

66% of people who said they were, “bothered a lot by back pain” met the criteria for a moderate or severe somatisation disorder (compared to 6% without back pain). 94% of people who met the criteria for having a moderate or severe somatisation disorder had back pain.

The full report

The full report on the National Back Pain Survey 2014 is available as a booklet (“National Back Pain Survey: Back Pain and the Workplace”) which forms part of the BackCare Awareness Week campaign pack (and which you will also be able to purchase separately or download for free). References 1

2

3

4

5

Christensen, JO & Knardahl, S. Work and back pain: a prospective study of psychological, social and mechanical predictors of back pain severity. Eur. J. Pain Lond. Engl. 16, 921–933 (2012). Armon, G, Melamed, S, Shirom, A & Shapira, I. Elevated burnout predicts the onset of musculoskeletal pain among apparently healthy employees. J. Occup. Health Psychol. 15, 399–408 (2010). Larsen, K & Leboeuf-Yde, C. Coping and back problems: a prospective observational study of Danish military recruits. J. Manipulative Physiol. Ther. 29, 619–625 (2006). Viikari-Juntura, E. et al. A life-long prospective study on the role of psychosocial factors in neck-shoulder and low-back pain. Spine 16, 1056–1061 (1991). Badura-Brzoza, K., Matysiakiewicz, J., Piegza, M., Rycerski, W. & Hese, R. T. Sense of coherence in patients after limb amputation and in patients after spine surgery. Int. J. Psychiatry Clin. Pract. 12, 41–47 (2008).

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Prevention is better…

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4 TALKBACK NEWS

Does paracetamol work? A study questioning the “universal endorsement of paracetamol” for acute lower back pain was published in The Lancet journal (July 24, 2014). The study attracted a flurry of media attention, with headlines such as: “Paracetamol for low back pain ‘no better than placebo’” (BBC); “Paracetamol does not help lower back pain, study finds” (The Guardian); and “Paracetamol ‘has no effect on back pain’: Research casts doubt on most popular GP remedy” (Daily Mail). The study involved 1,652 back pain sufferers in Sydney, Australia who were randomised into three groups, taking either: paracetamol three times a day (4g a day); paracetamol as needed (4g a day maximum); or placebo tablets as needed (for four weeks). The study found that “neither regular nor as needed paracetamol improved recovery time or pain intensity, disability, function, global change in symptoms, sleep, or quality of life at any stage during a three-month follow up.” This present study is an example of evidence based medicine (EBM) in action – a large doubleblind, randomised, controlled trial attempting

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to challenge the widespread endorsement of paracetamol that has thus far been based on tradition, anecdote and theory, and it makes for arguably damning evidence against our most consumed pain medication. However, the study did not measure one critical factor which may have explained the discrepancy between its own conclusions and the convictions of so many individuals who will continue to choose paracetamol because they feel it works for them. That factor is expectation. We know from prior research that positive expectation creates a positive physiological response (placebo effect) and can double the intrinsic effect of a painkiller. We also know that negative expectation creates a negative response (nocebo effect) and can completely abolish the intrinsic effect of a drug. Thus we know that conventional diagnostic categories (such as “acute low back pain”) are not sufficient to explain individual treatment responses. Until we start to measure individual factors such as patient expectation within research, the full story will forever elude us.


TALKBACK ADVERTORIAL 5

Give your back a treat with “Goldfish Exercise” The FlexxiCore Passive Exerciser

Continuous Passive Motion (CPM) equipment has been used clinically to prevent joint stiffness1 and provide stimulus to joint regeneration processes2. CPM has been used to treat low back pain with clinically significant results3. By creating a sideways oscillating motion through the spine, the flow of synovial fluid between the discs can be encouraged, helping to reduce inflammation and ease pain, as well as improving range of motion.

Goldfish Exercise

Independently of this, the Japanese have been practising what they affectionately call “Goldfish Exercise” for more than 80 years. First devised as part of the Nishi Shiki healthcare system, it was adopted as an exercise form in martial arts like Aikido, and in therapies such as Shiatsu. Around 1990, the Japanese invented an ingenious passive exercise machine which gently swings your feet, generating an elegant oscillating motion through the spine. The FlexxiCore® Passive Exerciser was introduced in Britain as an adaptation of this Japanese exerciser, combining the calming and energising effects of Goldfish Exercise with the therapeutic back care benefits of CPM – at a fraction of the cost of sophisticated CPM equipment. The user simply lies down, puts their feet up on a cushioned cradle and lets the FlexxiCore’s robust motor do the work.

The FlexxiCore in use

Adaptable to people of all ages and fitness levels

The body’s natural response to the swinging of the feet is a pleasant goldfish– like motion from the hips up, releasing tension in back, neck and shoulders, deepening respiration, and boosting circulation. The beauty of the FlexxiCore is that its precisely adjustable controls and broad speed range allow people of all ages and fitness levels to enjoy an invigorating workout at a speed that can be as relaxing or stimulating as they wish.

Research validates the FlexxiCore’s benefits

Research has shown that much back pain can be attributed to an inability to relax, physically or mentally4. A regular rocking motion is also known to help synchronize brain waves and calm the nervous system5. Other research has shown how cartilage

Endnotes 1 2 3 4

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O’Driscoll SA, Nicholas J, Giori NJ. Continuous passive motion (CPM): Theory and principles of clinical application. Journal of Rehabilitation Research & Development. Mar-Apr; 37(2), 179-88 (2000). Salter R. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res, May; 242: 12-25 (1989). Acosta-Rua AJ, Scuderi GJ, Levine SM, et al. Treatment of subacute low back pain with a novel device for continuous passive motion of the spine. Am J Ther Mar-Apr;15(2), 176-9 (2008). Lundberg U. Stress responses in low-status jobs and their relationship to health risks: musculoskeletal disorders (1999). Ann N Y Acad Sci 896:162-72.; also Lundberg U. Psychological stress and musculoskeletal disorders: psychobiological mechanisms. Lack of rest and recovery greater problem than workload. Lakartidningen 100(21):1892-5. 297 (2003). Bayer L, Constantinescu I, Perrig S, Vienne J, Vidal PP, Mühlethaler M, Schwartz S. Rocking synchronizes brain waves during a short nap. Curr Biol. Jun 21(12):R461-2 (2011). Viidik, A. Functional properties of collagenous tissue. Review of Connective Tissue Research 6:144–149 (1970). McDonald, H. Clinical Relief with Use of FlexxiCore Exerciser. Positive Health 141 – November 2007. Tisserand, M. Supervised Use of the FlexxiCore Passive Exerciser in a Clinic Context. Positive Health 177 – December 2010.

production in degenerative joints can be stimulated by relatively small degrees of motion, allowing for better gliding of the joint surfaces without pain or restriction6. The FlexxiCore thus works in several ways to maintain back health. Popular among those with common back problems, such as gardeners and golf players, it works wonders for many with stiffness and general fatigue. It’s also popular among practitioners who use it with clients – either pre- or posttreatment – and as a great stress buster for themselves and family.

Case studies from practitioner trials

Case studies from practitioner trials with more than 200 healthcare professionals have confirmed the FlexxiCore’s benefits with a broad range of health conditions7. For example, one practitioner’s client had back problems after removal of a benign tumour. Given a pessimistic prognosis and with a list of debilitating symptoms, including constipation from prescribed painkillers, she was keen to try the FlexxiCore. After just 11 sessions, she reported relief of tension in the back, neck and shoulders, increased mobility, and better posture8. To find out more and watch a video, visit FlexxiCore.com, or call 08456 120129 Email: info@EnergyForHealth.co.uk

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6 TALKBACK NEWS

Evidence based medicine in crisis?

I

n 1992, the Evidence Based Medicine Working Group announced a “new paradigm” for teaching and practising medicine. Proponents declared that evidence from high-quality, randomised, controlled trials would replace tradition, anecdote and theory. However, more than two decades on, leading voices are calling for a renaissance. Professor Trish Greenhalgh and colleagues who comprise the new Evidence Based Medicine Renaissance Group campaign recently published an essay in the British Medical Journal highlighting the emerging crisis within the EBM movement.

The elements of crisis

Any movement which seeks to challenge unfounded assumptions must surely be applauded. The achievements of the EBM movement include setting standards in research quality (such as GRADE) and building the national and international infrastructures (such as NICE) to collate evidence and develop guidelines. However, Greenhalgh and colleagues cite several problems that have arisen. The exploitation of EBM Vested interests have adapted to the standards set by EBM. There are concerns that drug and medical device industries are employing tactics to manipulate results in their commercial favour. These include: defining new diagnoses and pre-disease risk states to fit their products; using surrogate outcome measures to establish efficacy; overpowering trials with so many participants they ensure small differences will be statistically significant; and setting inclusion criteria to select those most likely to respond. The compound effect of subtle biases in evidence was perhaps best revealed by an analysis of three drug trials funded by their respective manufacturers which showed: (Trial #1) Drug A outperforms rival Drug B; (Trial #2) Drug B outperforms rival Drug C; and (Trial #3) Drug C outperforms rival Drug A.

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Information overload There is now an unmanageable volume of guidelines. This was well illustrated by an audit of a medical department during a 24-hour period which included 18 patients, 44 diagnoses and 3,679 pages of national guidelines relevant to their immediate care.

Individualised care for the patient The priority must be “What is the best course of action for this patient, in these circumstances, at this point in their illness or condition?” (rather than “How can we ensure that everyone with this diagnosis takes this drug?”).

Automation and rule-based care Template-based computerised decision support systems designed to juggle the evidence during consultation can end up overlooking the reality of the individual patient. Clinicians who rely on such automated systems may be preventing the development of their own clinical judgement. Systems designed to standardise care may unwittingly promote one size that fits no one and undo advances in patient-centred care.

Judgement not rules The Group cites five levels of learning which begin with the novice who learns basic rules and applies them mechanically with no attention to context, move up through stages of increasing sensitivity to context, and end in a style of judgement that is “characterised by rapid, intuitive reasoning”.

Poor fit for multimorbidity Medical trials typically seek to recruit large groups of patients who are as close to identical as possible to ensure a more significant effect – those with other medical conditions are excluded. In reality, patients more commonly have multiple ailments, and with an aging population and the rise in long-term conditions the multimorbid patient is becoming the norm. Even with trials accommodating patients with multiple diagnoses, multimorbidity affects each person differently, defying efforts to apply objective scores and guidelines. The evidence based manageability of one condition may cause or worsen another – most commonly seen in the multi-drug regimens prescribed to older patients.

Returning to ‘real’ EBM

The EBM Renaissance Group defines several ideals within their campaign for a return to “real” EBM, which include, but are not confined to, the following:

Alignment with the therapeutic alliance Real EBM builds on a strong interpersonal relationship between patient and clinician. Objective evidence must be metered within the social, ethical and technical context of the patient. As serious illness is lived, evidence based guidelines may become irrelevant, absurd or even harmful (most obviously in terminal illness). Evidence must be useable Evidence users include clinicians but also patients who vary in their statistical literacy and may have limited time and inclination for small print. While systematic reviews may be methodologically robust, they may also be expensive, lengthy and ultimately unusable. Non-expert summaries and similar should be offered.

Editor’s comments

What we have here is a worthy attempt to adaptively manage the trajectory of the EBM movement. If the renaissance campaign is proactively adopted on a similar scale to the original movement, we can expect no less of a leap forward. But, as Greenhalgh points out, EBM has thus far made the problems of bias and corruption more subtle and harder to detect. And as long as evidence remains based on objective probability, as long as medicine remains a commercial product, and as long as research groups compete for the same limited funding, these problems continue to adapt with us.


TALKBACK NEWS 7

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8 TALKBACK FEATURE

Best practice in pain management The Map of Medicine produces clinical guidance that is evidence-based, practice-informed and mindful of national policy (www.mapofmedicine.com) – “Created by medical professionals for medical professionals, we use the latest clinical evidence to provide you with guidance that is accurate, locally relevant, and endorsed by the world’s leading medical bodies.” At the end of 2012, the British Pain Society (BPS) produced five new pathways of care via the Map of Medicine, which included one on back pain. As part of the implementation process, the BPS has produced a summary guide of each pathway which will be distributed to GPs in the UK via GP Magazine. BackCare was invited to participate, and BackCare Professional Member Nick Sinfield has contributed a back pain management case study for the guide. Nick is a Chartered Physiotherapist and Clinical Director of Spring Active which specialises in back pain programmes. His case study appears here with Editor’s commentary…

EDITOR’S COMMENTS Most episodes of back pain resolve spontaneously, although we may use pain medication to make recovery more comfortable. However, in around 20 per cent of cases, the pain persists long term and simple symptomatic relief becomes an inadequate strategy. The body has the natural potential to be robust and resilient, but stress primes the nervous system to respond differently. The tendency towards anxiety, rumination and catastrophising (negative cyclic “what if” thinking), and fear avoidance or kinesophobic behaviours are indeed none other than the classic predictors of long-term pain and disability. Although most back pain spontaneously resolves, around 20 per cent of cases do not. The most consistently evidenced predictors of long-term pain and disability are psychological factors. The STarT Back Screening Tool detects those patients at high risk and informs appropriate treatment. This stratified approach has been shown to significantly reduce pain, disability, depression and time off work in high risk cases. CONTINUED ON PAGE 9

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THE CASE OF MRS E Mrs E was a 36-year-old graphic designer. She experienced a sudden stab of pain in her lower back when leaning into her newborn daughter’s cot. Her GP prescribed painkillers, but things got progressively worse over the next few months. Sometimes, the pain was so bad she could hardly walk and had to use her daughter’s buddy as a walking frame. As the pain became chronic, she became very anxious about her recovery. She would anticipate pain in every move, bracing herself every time she went to pick up her daughter. Her anxiety about her back made her pain worse, while the fear about carrying her daughter compounded her anxiety because she worried she wasn’t the mother she wanted to be. Following her deterioration, the GP asked her to complete the STarT Back Screening Tool, where she was shown to be a high-risk candidate for developing persistent pain. She was subsequently referred to Nick Sinfield, a physiotherapist specialising in psychologically informed physiotherapy, who provided a comprehensive biopsychosocial assessment and management plan to enhance her physical and functional status. CONTINUED ON PAGE 9


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This therapeutic process is based on using a standardised model where Mrs E received a psychological and physical low back pain treatment programme. Each programme is individualised to provide the necessary self-management skills for long-term recovery while continuously setting functional patient goals. The therapeutic focus covers low intensity cognitive behavioural therapy (CBT) for back pain, relaxation and breathing, postural education and exercise programmes consisting of strengthening, stretching and general functional exercises. She was provided with a Back Pain Personal Health Plan workbook consisting of all the educational materials supplied in the programme. Assessments were performed before and after the programme. The patient’s pain and functional disability levels were evaluated using the numerical pain rating scale (NPRS) and patient specific functional scale (PSFS). Following the programme, Mrs E achieved significant functional gains, with an improvement in the average score of the PSFS from 8.0 to 3.3 and the NPRS from 9 to 4.

The biopsychosocial patient centred pain management programme is multidisciplinary by nature. Here, we see the combination of interventions that address negative thinking habits, emotional stress, as well as physical fitness and functioning. The patient is ultimately guided to take responsibility for their own management.

The patient centred healthcare professional welcomes the patient into a collaborative process whereby their own goals become part of the clinical outcomes. For example, the PSFS assessment asks the patient to nominate specific personally important activities that have been limited by their pain.

At the time of discharge she was less anxious, more positive about her future recovery, no longer taking painkillers, returned to swimming, started Pilates classes and performs back stretches every day. One year after the last session, she was contacted again to check on her progress. She reported a continued improvement and was expecting her second child.

Yellow Flags have been effectively disarmed and the patient is no longer taking pain medication. New healthy practices are adopted as part of self-management and recovery. Best practice in pain management emphasises empowerment and enablement with a return to normal functioning and even growth towards new levels of functioning.

Mrs E is convinced psychological factors played an important part of her ongoing pain – this therapeutic approach provided the reassurance and education for her to become more active. These findings demonstrate the benefit of patient pathways which provide a biopsychosocial approach, patient centred management plan and self-management educational materials for improving the functional recovery of patients suffering from low back pain.

Best practice in pain management fosters the patient’s own insight into the relationship between their pain and their psychology. The known predictors of poor outcome, the Yellow Flags, are largely psychological barriers to recovery.

Editor’s discussion An overwhelming burden of clinical evidence supports the transition from the biomedical model to the biopsychosocial model in pain medicine. Back pain has a multifactorial aetiology, meaning its presence and future is fed and governed by multiple influences, irrespective of specific cause or trigger. While a biomedical approach may solely endorse passive drug

therapy, the pain management paradigm hinges on addressing the multiple evidenced factors as part of an individualised collaboration with the engaged patient. When this is applied with best practice, the clinical outcome is beyond the reach of the biomedical model, perhaps especially in such cases where there is a high risk of persistence and non-recovery.

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10 TALKBACK FEATURE

The Alexander Technique and Health by Korina Biggs BScEcon MA MSTAT What does being in good health mean to you? Is it simply an absence of physical illness or does it include psychological aspects or successful ways of being and relating in the world? A new client came to me recently for Alexander Technique lessons because she had been in hospital and in the next bed was a woman in the last days of her life. She was struck by how calm and poised the woman was, despite the invasive procedures and the patronising attitude of some of the staff. The dying woman said she was applying the Alexander Technique. She was obviously not healthy in the narrow sense of the word, but something about her state of being was healthy and inspirational. A health visitor colleague of mine connects the Alexander Technique with a healthcare concept called salutogenesis. It comes from the Latin salus meaning health and the Greek genesis meaning origin. It rejects the traditional separation of health and illness, instead describing a health continuum, and focuses on people’s resources and capacity to create health rather than on disease1. Internal resources include ways of being and acting – and this is where the Alexander Technique comes in. Through the Alexander Technique we can develop the skills to recognise and change habitual responses to all stimuli – whether that be simply gravity, a stressful situation or the experience of pain. We can learn to be able to choose either to carry on with the same response, not respond at all or to respond differently. As Dr Wilfred Barlow, an Alexander teacher and medical advisor, put it: “Health involves many things at many levels but full health is impossible unless we maintain a balanced equilibrium in the face of forces which tend to disturb us.”2 My client Tara says: “I’d always say that I had a bad back – it was painful and it felt like the bones were locked up my lower back, but then, after taking

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about six months of Alexander lessons, I noticed I’d stopped saying that I had a bad back. I know how to move and use myself better and I do have more confidence to do things. If I’m trying to walk somewhere really quickly I think ‘light and swift’ and instead of everything being heavier (because I’m trying to be quicker and pounding the pavement) it’s actually much lighter. I experience health differently as I have a lot more freedom in my body. I’m less constrained. The Alexander lessons always put me in a better space – emotionally as well as physically.” Cathy, who has osteoporosis, says: “I’m very conscious that your mind affects the way you use your body. I stand hunched much less now and it’s had an effect on my confidence, particularly when I look at elderly ladies with dowager’s humps. It gives me an incredible boost to think that I have reduced the hump, and that I have the possibility of avoiding it being as severe. Learning the Alexander Technique is an absolute lifeline for me, a pathway has opened up in which I feel empowered to tackle an illness. The quality of pain is vastly different – some of that is a result of the surgery and some of it is this awareness of moving upwards and being in my body and not just busy outside it. I do

feel that I’m seeing myself and the ways in which I inhabit the world in a different way.” To sum up I shall quote Alexander Technique teacher Miranda Tufnell who writes: “To look at our lives differently, to find the possibility of change, requires first that we loosen the reflex of habitual responses – the shapes, postures and judgments which order our lives. In the Norse, ‘haelen hal’ health means ‘wholeness’, a call to move more fully into life. Our health is the art of living, an awakening to a more fluid and creative part of ourselves that in turn expands and changes the quality of our lives.”3 You can find a qualified teacher near you by contacting the Society of Teachers of the Alexander Technique (STAT), www.stat.org.uk; tel: 0207 482 5135.

References 1 Salutogenesis was a term coined by medical sociologist Aaron Antonovsky who wrote Health, Stress and Coping San Francisco: Jossey-Bass Publishers (1979) and Unraveling The Mystery of Health – How People Manage Stress and Stay Well, San Francisco: JosseyBass Publishers (1987). 2 Barlow W (1984), The Alexander Principle. London: Arrow Books, p47. 3 Tufnell M (2000), Beneath Our Words in P. Greenland (ed.) What Dancers Do that Other Health Workers Don’t…, Leeds: JABADO, p12.


TALKBACK ADVERTORIAL 11

Spring Active – the back pain specialists Back pain is a common disorder affecting around one-third of the UK adult population each year – and nearly everyone is affected by it at some point in their lives. It is estimated that the cost of back pain in the UK is around £12.3 billion per year. Current evidence suggests a multidisciplinary, biopsychosocial approach is the most effective treatment for those suffering with long-term back pain. However, the NHS Spinal Task Force has stated that the lack of multidisciplinary treatment available for back pain sufferers “represents the single most serious gap in the provision of services at present”.

Who are Spring Active? Here at Spring Active, we are passionate about helping people suffering with long-term back pain. Our heritage stems from the world-famous Defence Medical Rehabilitation Centre at Headley Court, and our clinical experts have a wealth of experience after helping hundreds of people improve their lives. So, whether it’s helpful advice and

information, a phone call, or a more structured locally delivered or residential programme that you are seeking, we believe that Spring Active has the answer to managing your recovery.

Our services

Depending upon your level of pain or disability, Spring Active is able to direct you to the most effective treatment within our back pain services and products. This can range from our self-management workbooks and telephone support, to our outpatient physiotherapy led Essentials Programme, through to our residential psychology led Premier Programme, all of which is underpinned by a multidisciplinary evidence based approach. Developed by renowned physiotherapist and Spring Active Clinical Director Nick Sinfield, our back pain learning tools include easy to use booklets, simple exercise routines and cognitive behavioural self-management workbooks, which provide positive, unique support for back pain sufferers.

How can we help you?

Every person’s pain is unique. This is why we have developed a structured, yet individualised, range of services. We will discuss with you the potential causes of your pain and, importantly, how to move forward with your recovery. Spring Active Programmes include all components recommended by NICE guidelines for back pain, and are consistent with the recommendations set out in other national and international guidelines for the management of low back pain lasting longer than three months. Our programmes and learning tools combine physical and psychological training to put you back in control of your life. For more information: www.spring-active.com Spring Active Limited, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ Tel: 0844 324 8697 Email: info@spring-active.com

TALKBACK l ISSUE 3 2014


12 TALKBACK EDUCATION

Pay close attention to your ‘Sitting Calculator’ Take a stand: workplace health matters The chances are you’re reading this at work, sitting at your desk, staring at your PC screen, laptop or tablet. If so, you could be falling foul of what the medical professionals are dubbing the major public health problem of the beginning of the 21st century: “Sedentary Lifestyles and the Sitting Problem”.

Unhealthy desk

Prolonged sitting in the workplace can contribute to major health issues and, regardless of how physically active you are, the risks are not necessarily reduced. The traditional office environment – a place where many of us can spend up to 10 hours sitting at our desks – may well be the single biggest contributing factor to an early grave. The latest evidence, presented by www.getbritainstanding.org, makes for pretty scary reading: Heart: Prolonged sitting has been linked to high blood pressure and elevated cholesterol and people who sit more than eight hours per day are more than twice as likely to have cardiovascular disease than those sitting less than four hours. Irrespective of how physically active a person is. Cancer: A 2014 study assessing 70,000 cancer cases among four million individuals revealed that for every two hours of sitting (above four hours) the risks of bowel, womb and lung cancer grow between eight and 10 per cent. A 2011 study found that

The traditional office environment – a place where many of us can spend up to 10 hours sitting at our desks – may well be the single biggest contributing factor to an early grave TALKBACK l ISSUE 3 2014

prolonged sitting could be responsible for as many as 49,000 cases of breast cancer and 43,000 (1,800 cases) could also be related to excessive sitting. Obesity: After 90 minutes of sitting, your metabolism shuts down and the body’s cells become less responsive to insulin and muscles release lower levels of the enzyme which burn cholesterol (lipoprotein lipase). Diabetes: Cells in idle muscles don’t respond as readily to insulin, so the pancreas produces more and more which can lead to other diseases. Muscle degeneration: When you stand, you use your abdominal muscles to keep you upright. However, excessive sitting leads to tight back muscles and soft abdominals which lead to bad posture which can exaggerate the spine’s natural arch (a condition called hyper lordosis or swayback). This is just the start. High blood pressure, back and neck pain, depression and even dementia have all been linked to physical inactivity and excessive sitting. Dr Mike Loosemore from University College Hospital, London believes active individuals reduce their risk of heart disease by 40 per cent against their inactive counterparts. High blood pressure can be lessened by almost 50 per cent and the risk of recurrent breast cancer by almost 50 per cent, while the likelihood of colon cancer goes down by more than 60 per cent.

So, what defines an “active individual”?

The UK government’s recommendation is that adults in the UK complete 30 minutes of moderate activity five days a week to help achieve the above gains. But, as Dr Loosemore notes, “when adults were monitored, barely seven per cent of men and four per cent of women were carrying out enough activity to fulfil them.” Gavin Bradley, Campaign Director at Get Britain Standing, goes even further than this: “Multiple research shows that increased exercise for an hour or so per day can’t undo the negative effects of sitting for eight hours, any more than

running a mile can’t erase the damage caused by a smoking habit.” So, if bolting on an hour of exercise when we get home from work isn’t going to help, what’s the solution to prevent ourselves heading to an early grave? Gavin Bradley is very clear on what needs to be done: “The primary focus has to be reducing our sitting time – especially at work. It all starts with assessing your Sitting Calculator – just as you assess your daily calories, weekly exercise and alcohol consumption. Like five a day, you should be sitting no more than four to five hours a day. “The sit-stand desk, which enables your workstation to go up and down, is the optimal solution. By mixing up your time at the desk between sitting and standing, you make huge leaps forward to improving your wellness in the workplace, while increasing productivity too.” While Britain languishes with one of the highest rates of obesity in the world, it should come as no surprise that our Scandinavian cousins lead the way when it comes to tackling the problem of physical inactivity. Bradley continues: “Throughout Scandinavia, more than 80 per cent of


TALKBACK EDUCATION 13

Q&A with Gavin Bradley, Campaign Director, Get Britain Standing

Sit-stand desks can improve wellness in the workplace and increase productivity. Churchill wrote all his speeches standing office workers have sit-stand desks. In the UK, the figure is less than one per cent.” While Britain may have been slow on the uptake, both manufacturers and end-user businesses are starting to heed the message. Up until recently, sit-stand desks were only available from specialist ergonomic equipment dealers. They would often be specified by a DSE (Display Screen Equipment) assessor or a doctor, on a reactive basis, to individuals who already had chronic backache or neck pains. Even if an employer was enough of a visionary to roll out sit-stand desks for every user to prevent illnesses from developing before they surface, the cost was too prohibitive. The recent statistics are frightening and serve as a wake-up call to employers and employees alike. Gavin Bradley concludes: “Too much sitting at work is bad for us, so it’s time to take a stand.”

Sources Gavin Bradley, Get Britain Standing. www.getbritainstanding.org. See website for research source links. BBC News Health, 20 June 2014: article “Exercise guidelines hard to meet” by Dr Mike Loosemore.

When and how did the Get Britain Standing campaign get started? While doing some work for a charity in Gothenburg, Sweden in 2013, I noticed all the staff had access to sit-stand work stations – and, what’s more, thought nothing of it. Puzzled by this, I decided to investigate the background to why Sweden (and indeed Scandinavia) is all sit-standing at work and I soon realised that there was some stark scientific research which has failed to be clearly presented to the general public and was often very confusing. Then I read that a British study published in 1953, by scientists who examined two groups of workers (London bus drivers and bus conductors), concluded that the bus drivers were nearly twice as likely to die of heart disease as the conductors. Since media coverage of heart disease, obesity, diabetes, muscle degeneration and cancer did not point the finger firmly enough at “sitting time”, I decided to start a campaign which was launched in April 2014. What are the objectives of the campaign? For now, the chief objective is to grow awareness and education of the dangers of sedentary working (i.e. sitting more than four hours). Regular minor movement while at work is essential for us to keep our bodies healthy, prevent illness and relieve stress. The key obstacles for us are inertia and ignorance of the multiple and serious risks linked to prolonged sitting. Contrary to common belief, NO chair is good for your health. Our vision is that within 20 years more than 80 per cent of the workforce – four in five staff – will spend more of their day working at a sit-stand desk (just like Scandinavia today).

With whom is Get Britain Standing collaborating? We are still very new, but we have already agreed to run an event with the British Heart Foundation to raise awareness of the prolonged sitting problem in the workplace. We are also planning to collaborate with Bowel Cancer UK and, of course, BackCare who are all natural partners for our message. In time, we will be extending our list of partners, but we need to be careful that the messages are kept very simple. Isn’t standing all day bad too? Indeed it is. We certainly do not want people to be doing excessive standing either. Like everything in life, we need moderation. Our strong advice is for people to reduce their sitting time down to four to five hours each day and much of sitting time can be replaced by standing. Get Britain Standing has a unique sitting calculator which enables you to calculate whether your daily routine is exposing you to higher risk of ill health. Visit www.getbritainstanding.org

Get Britain Standing .org

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14 TALKBACK ADVERTORIAL

At last, back pain relief By Ian Rawe, PhD 8.5

The dire need for real pain relief

Up to 80% of the population in the UK will experience back pain at some stage in their life. During any one year, up to half of the adult population (15%-49%) will have back pain and the prevalence of chronic back pain is 23%. In only 15% of patients can a cause be identified. The general aims of treatment are to improve pain and to optimize physical, psychological and social functions. Physical therapies may improve pain and functional status but the vast majority of chronic back pain sufferers resort to drug treatment. Drugs are limited in effectiveness and have serious risks of adverse effects, especially with consistent, long-term use. There is a great need for new effective drug free therapies to help people self-manage their back pain and improve their quality of life.

Life changing

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4.3

New development in pain relief

ActiPatch® is an innovative technology in the form of a small, light wearable microelectronic medical device. The device emits a pulsatile electromagnetic field that penetrates the body without sensation or heat to induce an electric field in the affected tissue or joint. This novel mechanism reduces inflammation, improves blood flow and reduces pain. A validated 2014 consumer survey highlights ActiPatch’s benefit in chronic muscle and joint pain. In the consumer survey, with a pain score of 10 being the worst pain and 0 being no pain, the 500 chronic pain sufferers report an average baseline chronic pain level of 8.5, clearly indicating little or no relief from current methods of pain management. Of these, 213 reported chronic back pain. After just a one-week ActiPatch trial, 75% reported an average pain

reduction of 4.3 points or 50% in their pain levels; most reported an improvement in the first three days. ActiPatch has a higher response rate and is much more effective than the common chronic back pain drug therapies. ActiPatch is drug free, and unlike medications, there are no adverse effects and it is safe for the elderly, diabetics and those with heart and lung disease. ActiPatch can be used safely 24 hours a day. About the author Ian Rawe is the Director of Clinical Research at BioElectronics Corporation, the manufacturer of ActiPatch® Therapy. Contact details email: actipatch@bielcorp.com phone: +001-301-874-4890 website: www.actipatch.com


Thirsty? Thirst is a poor test for dehydration

Even mild dehydration puts stress on the body

You may need to drink more than you’re used to

Dehydration increases pain, anxiety and fatigue

Aim for ďŹ ve clear urinations per day Use a bottle to build positive habits easily

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16 TALKBACK CAMPAIGNS

National back pain survey 2014 The 2014 BackCare Awareness Week (BCAW) is upon us; in fact, a copy of this TalkBack is included in the BCAW campaign pack. The theme this year is ‘Back in the Office’ with the aim of getting everyone up-to-date on back pain in office workers. We also present the results of our National Back Pain Survey 2014 which combines insights from a wide spread of the research into a current health and back pain snapshot of the UK. Who participated in the survey?

BackCare’s 2014 National Back Pain Survey took place in April 2014 and involved 1,003 UK residents. Participants spanned the range of ages, locations and occupational categories – see demographics panel.

How prevalent is back pain?

In total, 49% of all participants were bothered by back pain in the last four weeks – this matches existing statistics to re-affirm that back pain affects around half of us at any given time. This figure was largely independent of age, gender, residential location, work status and type of workplace. One notable exception was that being a full-time (FT) student appears to be a protective factor among those aged 16-24, halving the back pain prevalence within that same age group (i.e. among those aged 16-24, 27% of FT students had back pain, compared to 49% of those who were not FT students). The take away message is that back pain prevalence was largely independent of demographics.

What else did we ask, and why?

In addition to basic demographic questions, the survey participants were asked several multi-part questions that covered three broad themes: stress and tension at work; coping and purpose in life; and current physical symptoms. Let’s briefly discuss why we chose these themes and how we explored them. Stress and tension at work Work constitutes a major part of life and can have a major impact on health, for better or worse. As you can imagine, health and wellbeing at work is a large and very

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active area of research. Overwhelming evidence tells us that psychological factors most consistently predict who will develop back pain – stress simply causes the body to behave more symptomatically. To date, several studies have served to tease out the workplace-specific psychological factors at play. l In 2012, a study which tracked 2,808 workers from 28 organisations in Norway for two years found that lack of decision control and lack of leadership quality were the most consistent predictors of who would develop back pain1. l In 2010, a study which tracked 1,704 workers in Israel for three years found that burnout doubled the risk of developing a musculoskeletal disorder, such as back pain2. This evidence was incorporated into our survey. Decision control and leadership quality were assessed with the same 12 questions used in the Norway study (QPSNordic). Burnout was assessed using the 19-question, Copenhagen Burnout Inventory (CBI). Our survey was a snapshot (crosssectional) and did not involve tracking people over time (“longitudinal”), so while the studies mentioned above clearly show that psychological factors precede back pain, our survey data can only show differences between people with and without back pain at one time-point. Nonetheless, our data is up to date, UK-based, and in agreement with the published longitudinal studies. Participants who reported being “bothered a lot” by back pain in the last four weeks were 2-3 times as likely to also report: never having influence over important decisions for their work; and having a boss who never treats workers fairly and equally. They were also 2-3 times as likely to report regularly or very often feeling: frustrated;

emotionally exhausted; and tired of working with clients as a result of their work. Here are some specific statistics from the QPSNordic and CBI questions: 74% of people who said “My boss is regularly or very often a source of stress for me”, had back pain. 76% of people who said “I can rarely or never set my own pace of work”, had back pain. 81% of people who said “I regularly or very often find it frustrating to work with clients”, had back pain. Coping and purpose Our ability to cope and our sense of purpose have a significant impact on our health. Perhaps one of the most compelling combined measures of coping and purpose is the ‘Sense of Coherence’ (SOC) assessment. This measures three distinct components, detailed below, and low SOC has been found to predict back pain3, neck and shoulder pain4, and back pain surgery outcome5. l Comprehensibility: The belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future. l Manageability: The belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control. l Meaningfulness: The belief that things in life are interesting and a source of satisfaction, that things are worthwhile and that there is good reason or purpose to care about what happens. Again, our survey data is a representative snapshot of the UK population and does


TALKBACK CAMPAIGNS 17

Survey demographics Gender

Location Age

65+

Female

Male

45-54 35-44

79

25-34

52

16-24

121 77

Work status Full-time worker Part-time worker Retired Not working Homemaker Full-time student

not tell us whether low SOC preceded back pain or vice versa in our survey participants. Nonetheless, the evidence from published studies shows that low SOC predicts several forms of musculoskeletal pain. Furthermore, it may be useful to think of physical symptoms and low SOC as the products of “co-emergent” processes – in other words, physical health and sense of coherence appear to go hand-in-hand. Our survey featured 490 people with back pain (169 of whom were “bothered a lot” by back pain) and 513 without back pain. The SOC scores among those with and without pain were significantly different. In particular, those bothered a lot by back pain were three times more likely to have low SOC score (lower quartile), while those without back pain were twice as likely to score highly (upper quartile). Here are some specific SOC statistics: 72% of people who said “My life is never a source of deep pleasure and satisfaction”, had back pain. 77% of people who said “My daily activities regularly or very often have little meaning”, had back pain. 85% of people who said “I regularly or very often have feelings inside that I’d rather not feel”, had back pain.

Occupational setting

70 87

Home

37

Service Office Manual

Current physical symptoms The clinical evidence supports the idea that back pain is one of the most common forms of somatisation – this is the technical name for this very common process through which psychological stress causes physical symptoms. Put simply, the body functions differently in the context of stress. Without pre-existing psychological factors, the usual physical triggers such as posture and lifting are largely unrelated back pain. Tension headaches are the most familiar example of somatisation, but somatisation can include many other common symptoms, including chest pain, stomach pain, shortness of breath, and insomnia. In a sense, somatisation is ‘normal’ in modern societies where more than 90% of people will experience tension headache and more than 80% will experience back pain at some point in their lives. When someone has multiple concurrent stress-induced symptoms, they may be classified as having a ‘somatisation disorder’, meaning that they have a general tendency to process stress as physical symptoms. In light of this, our survey included a 15-symptom checklist (PHQ-15) which is used within the NHS and clinical research to help detect somatisation disorders. Here are a couple of specific statistics from the survey data:

103

101 128 148

66% of people who said they were, “bothered a lot by back pain” met the criteria for a moderate or severe somatisation disorder (compared to 6% without back pain). 94% of people who met the criteria for having a moderate or severe somatisation disorder had back pain.

The full report

The full report on the National Back Pain Survey 2014 is available as a booklet (“National Back Pain Survey: Back Pain and the Workplace”) which forms part of the BackCare Awareness Week campaign pack (and which you will also be able to purchase separately or download for free). References 1

2

3

4

5

Christensen, JO & Knardahl, S. Work and back pain: a prospective study of psychological, social and mechanical predictors of back pain severity. Eur. J. Pain Lond. Engl. 16, 921–933 (2012). Armon, G, Melamed, S, Shirom, A & Shapira, I. Elevated burnout predicts the onset of musculoskeletal pain among apparently healthy employees. J. Occup. Health Psychol. 15, 399–408 (2010). Larsen, K & Leboeuf-Yde, C. Coping and back problems: a prospective observational study of Danish military recruits. J. Manipulative Physiol. Ther. 29, 619–625 (2006). Viikari-Juntura, E. et al. A life-long prospective study on the role of psychosocial factors in neck-shoulder and low-back pain. Spine 16, 1056–1061 (1991). Badura-Brzoza, K., Matysiakiewicz, J., Piegza, M., Rycerski, W. & Hese, R. T. Sense of coherence in patients after limb amputation and in patients after spine surgery. Int. J. Psychiatry Clin. Pract. 12, 41–47 (2008).

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18 TALKBACK RESEARCH

In 2011, Alexander Technique (AT) teacher and researcher, Mireia Griso led a search for AT in the workplace. Her research, funded by the Foundation for the Prevention of Occupational Risks in Spain, explored international precedents where AT was being applied for the prevention of workplace musculoskeletal disorders. Here, we present her research summary, abridged.

Alexander Technique in the workplace Introduction

Back pain is the world’s leading cause of disability and with several million working days lost to back pain in the UK every year, there is substantial impetus to address the problem. The Alexander Technique (AT) is founded on a psychophysical model of human functioning and brings a new understanding of how the physical and mental habits of a worker impact his/her performance and health. In this context, the general aim of AT is to enable the worker to acquire the tools to change his/her habitual approach to posture, movement, stress management and general co-ordination. Rresearch shows that AT is successfully being used to ward off musculoskeletal symptoms in the long term.

Methodology

The research was carried out in five phases between February and November 2011. Phase 1: There was an exhaustive search for precedents of AT as a tool to prevent occupational risks, and every teacher affiliated with AT associations

ORIGINS OF THE ALEXANDER TECHNIQUE

The Alexander Technique (AT) was developed more than 100 years ago as a means of promoting performance. It is commonly taught to performers such as actors, dancers, musicians, athletes and public speakers, but today it is most commonly sought as a treatment for back pain. Indeed, medical research has demonstrated the effectiveness of AT in the treatment and management of chronic back pain.

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worldwide was invited to contribute. This created a database referencing more than 130 books, videos, company reports, scientific studies, pilot studies, case studies, and web pages. Precedents were then verified with the teachers. Phase 2: Precedents that met one or more of the following five criteria were included in the analysis:

1) recent or current precedents (from 2000 onwards) 2) more than 50 workers had been trained in AT 3) a documented evaluation of the implementation 4) a significant level of quality in the training methodology (those involving only an introduction to AT were discarded)

Table 1 Victorinox

Swiss knife company

Unicible

IT company

Siemens AG

AG electrical engineering company

Treuhand GmbH

Accountancy practices

Ville de Lausanne

Town services

D.E.V.K.

Insurance company

Steuerberaterverband Schleswig-Holstein

Tax consultancy

Alliance Insurance Corporation

Insurance company

Chevron-Texaco

Energy company

Cincinnati Children’s Hospital Medical Center

Hospital

Israeli Air Force

Army

BBC Bristol

Communications company

Commonwealth Department of Parliamentary Reporting Staff

Australian government department

Holsteiner Catering

Restaurants

Kampovsky

Windows factory

Zurich Financial Services

Insurance company

Palau de la Música Valencia

Orchestra

Kommunal

Trade union

NHS UK

National Health Service

UMassFive College Federal Credit Union

Independent non-profit making financial co-operative

Fundació Collserola

School

CEIP Fontanelles

School

De Hartekamp Groep

Foundation for handicapped people


TALKBACK RESEARCH 19

5) the reference of the AT teacher who implemented the training activity. Around 40 precedents met one or more of these criteria. Teachers and organisations were sent questionnaires to establish information about the organisation, the specific detail of the AT programme and its results. The researchers obtained first hand information from 23 precedents, including the NHS and BBC Bristol (see Table 1). Phase 3: Cases which fulfilled one or more of the following criteria were selected for in-depth analysis: 1) an evaluation of the implementation by the organisation 2) continuity: seen by the organisation as a necessary initiative within the organisation’s policy framework for a minimum of three years 3) first-hand collaboration and contribution of information from the organisation and the teacher undertaking the implementation 4) examples involving different sizes and types of organisations. This analysis was carried out by collecting information via interviews with the teachers and their collaborators within the organisations (by telephone, Skype or in person). Ten precedents passed this phase: l Victorinox l Unicible l Siemens AG l Treuhand GmbH l Ville de Lausanne l D.E.V.K. l Steuerberaterverband Schleswig-Holstein l Alliance Insurance Corporation l Chevron-Texaco l Cincinnati Children’s Hospital Medical Center. Phase 4: In the fourth phase, the researchers compared and analysed precedents to generate an evaluation, conclusions and future recommendations. Phase 5: The methods of this study were presented at the International Congress of Alexander Technique Teachers, August 2011, Lugano, Switzerland. A full report and an English summary were published online. [Ed. – This article was abridged and adapted from the English summary].

Evaluation

Workplace AT training is widespread across all sizes, types and sectors of organisation. Workers performed very different roles with

different ergonomic and psychosocial risk factors. They were mainly office workers with high levels of time pressure and computer usage, but included assembly production workers, workers with a high degree of physical work (e.g. woodcutters and refuse collectors), and hyper-specialised workers (e.g. surgeons and musicians) – all of whom had unique circumstances. The main organisational motivation was to deal with musculoskeletal risk, although there were also psychosocial motivations (e.g. stress management and job satisfaction) and business motivations (e.g. retaining talent and reducing errors). Most AT teachers reported that workers are increasingly aware of the need to improve their quality of life and work. The majority of workers developed a very positive attitude towards AT over time, despite initial resistance. Worker feedback was positive – they believed they had leant something useful which could be put into practice in the workplace and in their daily life. The precedents provided evidence that AT has physical, psychosocial and business level benefits: l Physical benefits included: reduced pain and disability; improved muscle tone; postural co-ordination and balance; and significantly less muscle activation during both generic and specialised movements. l Psychological benefits included stress management and improvements in: self-esteem; public speaking; creativity; concentration; teamworking; and the work environment. l Business benefits included: reduced work hours lost to illness; reduced accidents; reduced employment insurance; improved costs-profits relationship; and improved work performance. Precedents all used the AT base methodology: individual, verbal instruction and hands-on guidance by a qualified teacher. Sometimes this was complimented by group classes. AT proved positive in all cases, despite variations. The researchers believe this is because AT adapts to the individual. AT was being used as part of the Health & Safety programme in 74% of the organisations studied, and improved worker behaviours towards health and health policy. However, despite results, AT training was typically discontinued when the administrator changed jobs, highlighting the need to build commitment at higher levels. Active involvement of the organisation was linked to best overall results.

Conclusions from organisations

Victorinox: “The Alexander Technique is a major tool in workplace health and for preventing musculoskeletal disorders. Workers had problems with tendinitis and excessive muscular tension. The Alexander Technique seemed like the appropriate solution, given that it involves a process of learning and encourages people to take charge of their own health. Our experience is that if the employees LEARN, it works.” Unicible: “We would recommend this training to increase behavioural flexibility and assertiveness, to allow better dialogue and public speaking, to reduce muscular and emotional tension and to achieve more ergonomic conditions at work.” Siemens AG: “Its expansion to all the areas of production is highly recommended. There are good indications that this positive change will be maintained.” Treuhand GmbH: “It seems to be a good preventative measure against illness. It continues to be very well accepted, despite the workers having to pay half the costs.” D.E.V.K.: “Initially, the training was given in a group format. Then, on not giving the expected result, individual training was instigated, which gave a very satisfactory result.”

Discussion from the researchers

These precedents demonstrate that AT can be applied as a preventative training in organisations of any type, sector or size where ergonomic or psychosocial risks have been detected. AT has proven a simple and practical method that improves the co-ordination, freedom of movement, flexibility, support and balance through changing habits. Practising AT increases the worker’s perception and autonomy, bringing a control that is fluid and alive instead of rigid. It provides a means whereby the use and function of one part of the body improves, through looking after the overall use and function of the body. The application of AT does not imply a dependence on the technique, but rather a process of unlearning habits in order to function from a new perspective that delivers mental and physical flexibility when adapting to challenges.

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20 TALKBACK BRANCHES

BACKCARE BRANCHES The BackCare branches are a network of local support groups up and down the country. They are run by local members who organise educational, social and fundraising events. You can find your local branch in the listing opposite. If you’d like to start a branch in your area, please contact info@backcare.org.uk

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CAMBRIDGE • 56 members Contact: Ms Mary Griffiths Telephone: 07787 990214 Email: blincomary@hotmail.co.uk

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

DERBY • 61 members Contact: Mrs Christine Sissons Telephone: 01332 763 636 Email: chris.sissons@btinternet.com

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

HARROGATE Contact: Telephone: Email:

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

• 38 members Mrs Linda Tippey 01423 865946 keithandlin2@btinternet.com

HULL & EAST RIDING • 76 members Contact: Mrs Beryl Kelsey Telephone: 01482 353547 Email: kelsey59@kelsey59.karoo.co.uk

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

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

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

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

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

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


TALKBACK EDUCATION 21

Prevention is better than cure PART 7

Theanine “Prevention is better than cure”, or so the old adage goes. In this mini-instalment, we take a brief look at the naturally occurring amino acid, ‘L-Theanine’ and how it could relate to back pain. What is Theanine?

Theanine is a naturally occurring amino acid, most notably found in tea. A few hundred studies to date have explored the biological activity of theanine, suggesting

potential roles in medicine. However, the amount of theanine found in the typical cup of tea (20-50 milligrams) falls below the dose range found effective in research (50-200 milligrams). Furthermore, simply drinking

large quantities of tea to reach the effective dose of theanine may incur other problems as you’ll also be consuming large quantities of caffeine. In recent years, pure theanine has become widely available as a health supplement.

What does it do? Theanine significantly alters brain activity as demonstrated by anxiety scores, task performance, salivary stress markers, and electroencephalogram (EEG; measures electrical activity in the brain). From an electrophysiological

perspective, EEG studies have shown it to induce alpha wave activity (which correlates to relaxed wakefulness or calm inner focus as might occur during quiet reflection or meditation). From a biochemical perspective, theanine is known to bind to the human brain glutamate receptor, which is involved in learning, memory, pain and anxiety. Current “glutamatergic” medications include pregabalin and gabapentin, which are both used for pain and anxiety. There have been no studies to date that directly demonstrate the usefulness of theanine in pain treatment or prevention. However, stress remains the most consistent predictor of back pain and what we know about theanine makes it an interesting remedial candidate.

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22 TALKBACK

www.thebadbackcompany.co.uk

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Why Back Pain?

TALKBACK CAMPAIGN 23

There is a disease spreading across the UK, claiming 7,000 new victims every day. It increases your risk of fatal heart attack and terminal cancer. It causes structural changes to the brain and increases your risk of suicide. It’s also resistant to conventional NHS treatments. Sounds like a horror movie, right? Actually, we’re talking about highly disabling chronic back pain, which now affects around 1-in-20 people and millions more every year. Because back pain is so common, most people have no idea how serious it can be. Yes, most back pain is not serious and goes away by itself just like headaches and the common cold. But for hundreds of millions of people worldwide, the pain becomes chronic and never goes away. For many it is torture, all day, every day, forever. Not only can back pain destroy lives, but it also costs huge amounts of money in NHS treatments, disability benefits and sickness absence – more than £50 million a day. In fact, the amount of money the UK spends on back pain in just one year would solve the entire water crisis in Africa where 4,000 children die each day from contaminated water. Makes you think, doesn’t it?

Why BackCare? BackCare is the UK’s national back pain charity. Our mission is to turn the tide on back pain through our research, education and outreach initiatives. We are a unique charity and no one else is doing the same work. Just by reading and sharing this magazine, you are helping to support our work – thank you.

Why Not Donate? Back pain is a major global health problem. By donating to BackCare you are helping a very worthy cause. We are very grateful for all donations and people can donate their time, effort or money in many different ways – whether that’s volunteering your skills, organising a fundraiser, running the marathon or simply popping a cheque in the post. Why not get in touch to find out how you can get involved? Call us today on 0208 8977 5475 or email yourstory@backcare.org.uk

www.

The Charity for Back and Neck Pain

.org.uk

TALKBACK l ISSUE 3 2014


TalkBack, Issue 3 | 2014 (BackCare)  

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

TalkBack, Issue 3 | 2014 (BackCare)  

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