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

AUTUMN n 2018


Girl power

No fear. No judgement. Just get moving!

also in this issue: News Millions in research grants for innovation in social care Health and wellbeing How satisfied are you with your life nowadays? Care and carers Are you missing out on vital equipment in the home?




Debunking fitness myths and boosting participation WOMEN are more stoic than men, at least when it comes to back pain – a fact long suspected, though seldom admitted and usually overlooked – except now they’ve got the evidence to it back up. Researchers at the British Chiropractic Association1 have found that women, on average, develop back or neck pain six years earlier than men and experience it more regularly, and yet despite this, they take twice as long as men to seek help for their problems. What’s more, a quarter of women have never visited a health professional for their pain. The findings, while not entirely unexpected, do raise concerns that women too often neglect their own health, specifically their back health, which means that some may be missing important indicators that warrant further investigation. In most instances, though, simple lifestyle changes that introduce more movement into our daily routines can relieve the pain and protect us from future problems. Any physical activity will do to begin with, even if it’s just to take a break from your chair and walk around once in a while. Some activities, such as swimming, may be more suitable than others, as they put less pressure on the joints while allowing the body to move. Ultimately, the idea is to find a sport or exercise routine that makes you feel better about yourself. However, despite the compelling arguments and the seemingly innumerable opportunities to get more active, millions of women and girls continue to be put off exercise of any type because of fear of judgement – of their appearance, their abilities or even how they choose to spend their time. “This Girl Can”2, Sport England’s programme launched four years ago, set out to change attitudes and boost women’s confidence by rejecting stereotypical versions of women in lycra and highlighting the real

story of women of all shapes and sizes who play sport and have fun doing so, at whatever level. The campaign has taken hold and is increasing participation among previously hard-to-reach groups. This has been no easy challenge, not least as social media channels (no matter how well intentioned) so often perpetuate idealised images and unattainable goals. Recent studies3 of social media posts have revealed that while ‘fitspiration’ mantras and their like act as motivators for some people, they can also amplify body dissatisfaction and have the reverse effect on others. Significantly, This Girl Can places empathy at its core and sends a clear message to women and girls that there’s no one body type best suited for exercise. With age, back pain can be more complex and related to other physical and psychosocial changes. During BackCare Awareness Week, 8-12 October, BackCare will be raising awareness about the challenges associated with back pain in older adults and circulating new booklets, posters and information packs to support groups around the country.

Richard Sutton Editor


Partial knee replacements “better” for some 5

Better screening needed for shoulder pain 10

Creating offices that promote movement 12-13


1) 2) 3) Research at Griffith University, Macquarie University and the University of New South Wales Cover image: Sport England

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

BackCare BackCare, Monkey Puzzle House, 69-71 Windmill Road, Sunbury-on-Thames TW16 7DT Tel: +44 (0)20 8977 5474 Email: Website: Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751. TalkBack is designed by Pages Creative and printed by Severn, Gloucester.

Poor muscle strength raises risk of falls by 76% 17

A fascial understanding of chronic pain 18-19 TALKBACK l AUTUMN 2018


Council want parity for care and health services Image: Freepik

THE average number of delayed transfers of care days attributable to social care decreased over the last year to March (30.7% in 2018, compared to 37.2% 2017). Despite the improved figures, councils remain concerned about the growing funding gap in the sector and are calling for care needs to be put on an equal footing with the health service to ease the pressure on beds and reduce the numbers admitted to hospital in the first place. Izzi Seccombe, chair of the Local Government Association’s Community Wellbeing Board, said: “The Government needs to address immediate pressures and plug the funding gap facing adult social care which is set to exceed £3.5 billion by 2025, just to maintain existing standards of care, while latest figures show that councils in England receive 1.8 million new requests for adult social care a year – the equivalent of nearly 5,000 a day.”

COLLABORATIVE grants of between £1 million and £2 million are available for innovation in social care. The Economic and Social Research Council will fund social science-led research and knowledge exchange activity to understand how, why and where innovation happens in social care. Innovation can include systems, practices, organisations, processes, products and funding. Each research project should be highly collaborative, involving a range of disciplines and stakeholders. Applicants should explain how the proposed research and knowledge exchange activity will


enable the uptake, spread and adoption of change in social care to deliver improved individual and system outcomes, as well as evidence of cost benefit. Outline proposals should be made via the Joint Electronic Submission system ( and submitted by 16 October 2018. They must first be costed and approved by the relevant research organisation. Applicants of successful outline proposals will be invited to submit full proposals. Applicants should show how they can improve outcomes and deliver cost benefits

Image: jannoon028/Freepik

Millions in research grants available for innovation in social care


MANY more patients could be given a partial knee replacement instead of a total knee replacement, improving their quality of life and reducing costs for the healthcare system, say researchers at the University of Oxford. Researchers from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) used routinely collected data from the National Joint Registry (NJR) and found that partial replacements, also known as unicompartmental replacements (UKR), are better for patients who have only part of their knee affected by arthritis and could have either a partial or a total replacement. The procedure is less invasive, allows for a faster recovery, carries fewer postoperative risks and provides better function. It is also a cheaper intervention for the NHS, in both the short and long term. “The main strength of this study is that we were able to use real data, from very large numbers of people, about their actual operations, their GP visit, and their own reported quality of life outcomes in a way


Partial knee replacements are a better solution for half of patients

Partial replacement is less invasive, allows for faster recovery and is cheaper that is not always possible,” says co-lead researcher and NDORMS Senior Health Economist Dr Rafael Pinedo-Villanueva, who is funded by the National Institute of Health Research (NIHR), Oxford Biomedical Research Centre (BRC) and the Medical Research Council. “This has allowed us to provide strong proof that partial knee replacements are better for patients and cheaper for the NHS,” he added. The main reason for knee replacement

Large increase in Type 2 diabetes in young people Image: Freepik

THE number of children and young people being treated for Type 2 diabetes, which is normally seen in adults and often linked to obesity, has

Unlike Type 1 diabetes, Type 2 is largely preventable and closely linked to lifestyle, such as unhealthy eating or lack of exercise

increased by 40% in four years to more than 700 cases. While not every case of Type 2 diabetes is as a result of being overweight and obese, it is the single greatest risk factor. According to the latest figures for 2016/17 from the Royal College of Paediatrics and Child Health, 715 children and young people under the age of 25 received care for Type 2 diabetes from paediatric diabetes units in England and Wales, of whom 78.6% were also obese. As the figures relate only to those treated in paediatric practice and not, for example, primary care, the actual number of young people with Type 2 diabetes is likely to be higher.

surgery is osteoarthritis and about half of the patients needing knee replacement could be suitable for a partial replacement. However, according to data from the NJR, of the 98,147 knee replacements undertaken in 2016, only 9% were partial. The use of partial replacement varies greatly between different surgeons. Partial replacements done by surgeons using them for a small proportion of knee replacements provide worse outcomes than total replacements. Whereas partial replacements done by surgeons using them for a high proportion of knee replacements provide better outcomes and are cheaper for the NHS than total replacements. “This is an important finding,” co-lead researcher Professor David Murray said. “If surgeons aim to use partial knees in a quarter or more of their knee replacements this will substantially improve the results of knee replacement and will save money. In addition, more partial knee replacements will be done and more patients will benefit from this procedure.”


BackCare Awareness Week – 8-12 October Back pain is one of the major disabling health conditions among adults aged 60 years and older. Many causes of lower back pain are age-related with physical and psychosocial changes. There is a distinct lack of awareness, especially in older adults, of the causes and effects of back pain and pain management. BackCare’s latest updates, booklets and posters will shine a light on the subject during its awareness week in the second week of October. For more information, please email



PROGRESS in reducing mortality rates for heart and circulatory diseases in the UK has been stalling in recent years, the British Heart Foundation (BHF) has warned. New figures released by the Office for National Statistics show a significant slowdown in improvements in death rates for heart and circulatory diseases, including heart attack and stroke, since 2011. This follows 50 years of continual decline in death rates, in which time the number of people dying from heart and circulatory diseases every year has more than halved. The UK-based report, Changing Trends in Mortality: a cross-UK comparison, 1981 – 2016, looks at patterns in mortality by cause of death within each of the four UK countries between 2001 and 2016. For decades there had been steady increases in life expectancy. However, from around 2011, the figures show that those

Image: peoplecreations/Freepik

Progress is ‘stalling’ in cutting heart disease death rates

Heart and circulatory diseases are still responsible for 1 in 4 deaths in the UK increases have slowed, partly due to the slowdown in the decline of mortality rates for heart and circulatory diseases. The figures also show no improvement in mortality rates for people aged over 90

in recent years, largely due to increasing numbers of people developing conditions such as vascular dementia. Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “People now have an increased chance of surviving a heart attack as treatments have improved over the years. However, the likelihood of dying later in life from subsequent heart failure has increased. “The rising number of deaths from dementia is a growing concern, with a substantial number being the result of the damage caused by a stroke. With so many of these life-threatening conditions being connected, and a growing number of people living with more than one long-term condition, we all need to maintain better heart and circulatory health throughout our lives.”

‘Bad’ health a critical factor in wellbeing index


“There are inequalities in our society beyond the purely economic ones,” says Silvia Manclossi, Head of Quality of Life Team at the Office for National Statistics.

“Improving how people feel about their lives is important for the health of our society in so many ways – not least the social and economic implications.”

Four personal wellbeing questions Overall, how satisfied are you with your life nowadays? Overall, to what extent do you feel the things you do in your life are worthwhile? Overall, how happy did you feel yesterday? Overall, how anxious did you feel yesterday?

So how do you rate? The responses to all four questions are measured on a 0 to 10 scale where 0 is “not at all” and 10 is “completely”. Personal wellbeing for life satisfaction, worthwhile and happiness is deemed to be “poor” if there is a score of 4 or less, while for anxiety, a score of 6 or more is deemed to be “poor” (as it indicates higher anxiety). Previous analysis suggested that people rating their life satisfaction, worthwhile and happiness as 4 or below on the scale are much more likely to have the characteristics and circumstances typically associated with poor personal wellbeing than those rating these aspects of wellbeing even one point higher (5 or above)

Image: kues/Freepik

MORE than half a million people in the UK are experiencing the poorest levels of personal wellbeing, according to the Office for National Statistics (ONS). This means they have poor ratings across all four personal wellbeing measures: life satisfaction, feeling that the things they do in life are worthwhile, happiness and anxiety. The most significant factor associated with poorest personal wellbeing is having “bad” or “very bad” health – those people are almost 14 times more likely to report the poorest personal wellbeing than those with “very good” or “good” health. ONS also found that disabled people were almost twice as likely as others to report poor personal wellbeing across all the measures. The ONS has identified other individual factors associated with the lowest levels of personal wellbeing, besides health. These include: being economically inactive with long-term illness or disability; being middleaged, being single/separated/widowed or divorced; renting their home; having no, or basic, education.


Physio services can reduce healthcare costs and absenteeism

Interventions can improve outcomes and reduce further investigations and treatment INVESTMENT in physiotherapy services for musculoskeletal conditions improves patient outcomes and reduces overall healthcare costs, a new report from the National Institute for Health Research (NIHR) shows. Musculoskeletal conditions are the leading cause of pain and disability in the UK, affecting more than one in four people. The evidence from the report Moving Forward: Physiotherapy for Musculoskeletal Health and Wellbeing highlights the importance of physiotherapy for treating these conditions. This themed review brings together more than 30 physiotherapy related published studies funded by the NIHR and selected studies from other research organisations,

which have made a difference to musculoskeletal care in conditions such as rheumatoid arthritis, low back pain and chronic knee joint pain. Moving Forward is particularly aimed at physiotherapy staff involved in direct clinical practice but is also relevant to other clinicians in the musculoskeletal care team. The findings show: l Investment in high quality rehabilitation adapted to individual patient need leads to better outcomes, reduces further investigations and treatment, and reduces costs. l Physiotherapists offering advice on lower back pain reduced absence from work by an average of around five days.

l Telephone assessment by physiotherapists meant people waited an average of seven days for contact with a physio, compared to a usual average waiting time of 34 days. Stretching and strengthening hand exercises improved function for people with rheumatoid arthritis. l There is overwhelming evidence that exercise and activity are effective and should be a core treatment in musculoskeletal pain. An NIHR review of over 60 trials – most for knee osteoarthritis – showed clear benefit of exercise. l A rehabilitation programme including targeted exercise reduced knee joint pain and healthcare costs.



Women more stoic than men 

Image: Shayne_ch13/ Freepik

Women could be neglecting their back or neck health, clinicians are warning, as new research shows they take twice as long – six weeks on average – to seek help for their pain, while men take just three.


ON average, women develop back or neck pain at the age of 27, six years younger than men, and experience it more regularly, according to findings from the British Chiropractic Association (BCA). Despite this, a quarter of women have never visited a health professional for their pain. More than a third of women are turning to over-the-counter medication as a first port of call, 12% more than their male counterparts, ignoring simple fixes such as exercise and stretching which can prevent and improve back or neck pain. In contrast, men are most likely to turn to their GP when initially experiencing pain. And while women are least likely to seek help, the BCA found that overall more than a third (34%) of Brits would wait a month or more to seek professional help for back or neck pain. Moreover, one in 10 Brits would continue to suffer in silence, not seeking help at all. Simple lifestyle changes, such as stretching and incorporating more movement into your daily routine, can be an easy and effective way to keep back pain at bay, yet only 11% of men and women make these changes to their routine when they start to experience back pain. This trend for women to “keep calm and carry on” is also reflected in their delay in seeking help for other health conditions, with men seeking professional help for joint pain, strains, and headaches more quickly than women. BCA chiropractor Tim Button said: “I often find that my patients have been struggling with back or neck pain for weeks or even months before seeking help, some having tried a number of alternative treatment methods, while others wait to seek help until the pain starts to have a detrimental impact on their day-to-day lives. Many people think that back or neck pain is a part of everyday life, but this isn’t


 when it comes to back pain the case and it’s often possible to reduce uncomplicated pain with a simple plan of treatment and lifestyle advice.”

Prevention tips If you have been experiencing pain for more than a few weeks, Tim suggests seeking professional help. However, he adds, “prevention is always better than cure, so my advice for everyone is to incorporate more movement into your daily lives where you can, reducing the amount of time spent sitting in one position and taking time to stretch regularly.” Here are Tim’s top tips for women with back or neck pain: l Keep moving: Almost half (47%) of female respondents pointed to sitting still for a long time as a key trigger for their pain. If you are required to sit in one position for

extended periods of time, at work or on a long drive for example, try to take breaks to walk around, stretch and move your joints and muscles every 30-60 minutes l Hit the gym: Incorporating moderate exercise into your lifestyle will help you to build a stronger body that is better placed for dealing with the demands you make of it. If pain is preventing you from exercising, try a form of exercise, such as swimming, which will put less pressure on the joints while allowing your body to move l Stretch it out: Stretching can be a beneficial way to keep your joints and muscles active. The BCA’s Straighten Up programme of simple exercises can be incorporated into your daily routine to promote movement, strength and flexibility in the spine l Get a good night’s sleep: After a busy

day sleep is essential, so I suggest taking some simple steps to ensure you sleep in a comfortable position. The Sleep Council recommend replacing your mattress every seven years and, when you do, pick one that provides the right support for your body type and pillows that suit your sleeping position l Keep it light: Almost a third (32%) of women cite that carrying their bag is a key trigger for their back or neck pain. If you are one of those people, then think about trying a different bag or about what you’re loading it up with! Choosing a bag that can be worn as a backpack or across the body may help to spread the load. Keeping your bag light and emptying it of unnecessary items each day can also help prevent unnecessary weight.

Image: Sport England

Conquer your fear of judgement and get active! MILLIONS of women and girls continue to be put off exercising because of fear of judgement – of their appearance, their ability or how they choose to spend their time. It was this realisation that inspired “This Girl Can”, the nationwide campaign launched four years ago, to get women and girls moving. The campaign, developed by Sport England, set out to tell the real story of women who play sport by using images that are the opposite of the idealised and stylised

versions of women we are accustomed to seeing. The new approach, which has featured sparky campaign posters such as “a kick right in the stereotypes”, aims to change attitudes and boost women’s confidence. Fewer women than men play sport regularly, although the gender gap is beginning to close, as This Girl Can gains momentum. Operators looking to get involved can sign up for a toolkit to access the logo, partner images and branding guidelines.

Four key questions for clubs and centre managers How are you talking to women? Is your sport environment welcoming to women? If they were to visit your club, facility or group for the first time, what is it that would make them come back again? Are your activities relevant? Do they offer flexibility for busy schedules, mums, and so on?



Better screening and decision making needed for shoulder pain A £2.7M research programme is seeking to personalise care for people with shoulder pain, to make sure that patients receive the care that is best for them and avoid unnecessary investigations and treatments. The new initiative, jointly funded by NIHR Programme Grants for Applied Research and Arthritis Research UK, aims to develop a more effective way of ensuring that patients receive treatments they are most likely to benefit from. Shoulder problems, such as shoulder impingement and frozen shoulder, affect one in five adults in the UK. The conditions can be very painful, affecting sleep, work, and day-to-day life. In England, about 1.5 million people visit their GP for shoulder pain each year. However, 40% experience ongoing pain despite treatment. Most patients with shoulder pain are treated with exercises, shoulder injection, or surgery. Although there is little evidence that surgery provides better results than non-surgical treatments, seven times more people are undergoing surgery than 10 years ago. In this new NIHR programme of work, researchers at the Arthritis Research UK Primary Care Centre at Keele University, in collaboration with the University of Oxford, will review existing research to identify what factors influence whether patients are likely to benefit from specific treatments. They’ll then follow 1,000 patients who have consulted their GP or a physiotherapist for shoulder pain to develop a screening and decision-making tool for treatment, which will be tested in a randomised trial. The researchers hope that the tool will help to stratify how doctors assess the likely cause and future outcome of shoulder problems, so that patients can be offered personalised treatments that match their characteristics. Principal investigator Professor Danielle van der Windt, Professor of Primary Care


Epidemiology at Keele University, said: “Many patients with shoulder pain recover quickly, but in others the pain does not diminish and can affect sleep, work and everyday life for many months. At the moment, we don’t have good evidence that can help clinicians to identify patients at increased risk and make decisions about which treatment is likely to be best. “This NIHR programme of research aims to provide such evidence. This means that, in future, patients who need it can be offered optimal treatment early on, whereas those who are likely to do well without treatment can be reassured and given good advice on how to manage their shoulder pain, so that unnecessary investigations or treatments can be avoided.” Image: Freepik


Men given access to osteoporosis drug

Around 4,000 men will now benefit from access to Teriparatide every year

THOUSANDS of men previously denied access to the osteoporosis drug Teriparatide will now be able to get the medication following an NHS 70th anniversary push to make a range of innovative new treatments available. Teriparatide, a parathyroid hormone treatment, was previously only available for use in women and is an effective medication for treating osteoporosis, particularly among those who have suffered vertebral fractures. Around 4,000 men will now benefit from access to this drug every year. The decision to make the drug more widely available was due, in part, to influencing work from National Osteoporosis Society (NOS), which welcomed the move. Professor Neil Gittoes,

NOS Trustee and Consultant and Honorary Professor of Endocrinology at the University of Birmingham, said the work to widen access of Teriparatide to men was “a great example” of not accepting inequity of access to an important therapy and sticking with the cause.” “This initiative addresses a big problem, and now men across England should be assured that they have legitimate access to the most powerful anti-fracture agents available to us.”

FACT One in every five men in the UK will break a bone as a result of osteoporosis

Improving the support network for adults with cerebral palsy NICE has published a draft guideline on the care and support for adults with cerebral palsy, to ensure they have easy access to equitable, cost-efficient services. It outlines the steps needed to address the variation in the provision of specific services for adults with cerebral palsy and aims to help local and regional services to provide consistent clear pathways of clinical and social care. Professor Mark Baker, director of the centre for guidelines at NICE, said: “Adults with cerebral palsy have a wide range of abilities – from full independence in everyday life to needing 24-hour care and attention. But irrespective of their level of disability, adults with cerebral palsy should be able to be as functionally independent as possible. Many may wish to go into further education, gain employment, participate in leisure activities and

contribute fully to society. Barriers to these goals should be minimised so that adults with cerebral palsy have equal access to all opportunities.” l Recommendations in the draft guideline include: Specialist services should develop pathways that allow adults with cerebral palsy access to a local network of care (for example specialist physiotherapy and occupational therapy services, wheelchair services) l Recognise and address barriers to accessing primary and secondary care for adults with cerebral palsy (these may include physical access to buildings, difficulties with transport, inadequate time given in appointments to allow, for example, hoisting and dressing, and communication challenges) l Provide information about national screening services (for example breast,

colon and cervical cancer screening) to adults with cerebral palsy l Consider regular reviews for adults with cerebral palsy, tailored to their needs and preferences. Agree with the person the frequency of review and which services should be involved based on their needs and preferences. Adults with cerebral palsy can have a decrease in their mobility because of factors such as muscle tone, weakness and pain. These, as well as other symptoms associated with cerebral palsy such as pain, mental health problems, communication difficulties and nutritional problems, are also a high priority for management and are therefore covered in the draft guideline. Last year NICE published a guideline on cerebral palsy in children and young people aged under 25.



Work environments can help those with arthritis maintain their health, wellbeing and job satisfaction.

Wellness room Adjustable desks

Accessible office spaces that  EMPLOYERS are being urged to make workplace adjustments for people with arthritis. The call to action came from the Minister for Disabled People, Health and Work, Sarah Newton, following her recent visit to the offices of Arthritis Research UK to discuss the charity’s approach to promoting health and wellbeing in the workplace. The minister met staff who have arthritis to understand how their condition affects their working lives – from travelling to work and managing daily tasks. One of the employees is Collette McColgan, 28, who has worked for Arthritis Research UK for nearly two years. She said: “I’ve struggled in the past to find a job that could work around my condition. It can be unpredictable and I don’t know when I’m going to have a flare-up. “People here understand how arthritis affects you. The flexible working means I can change my hours around appointments and start later in the day or work from home if I’m having a flare-up. I also have a


desk that I can raise, so I can stand up and stretch my legs if I need to. “I think it’s important more employers are flexible, so more people with arthritis and other health problems can feel comfortable at work.” Minister Sarah Newton’s appeal to

employers comes as the Government launches a £4.2 million Challenge Fund aimed at testing new approaches to help people with musculoskeletal conditions or mental health issues to remain in employment. She said: “We know there is a gap between disabled people who want to

Work and health challenge fund THE Work and Health Unit (WHU), which is jointly managed by the Department for Work and Pensions and the Department of Health and Social Care, is using the £4.2m Challenge Fund to test new approaches that can help people experiencing mental health and/or musculoskeletal (MSK) issues stay in work. Around 20 initiatives will help to improve understanding of what works in the following areas: l Helping people stay in work by increasing their ability to self-manage their conditions l Helping people access advice and support about what sort of work they might be capable of doing given their wider needs and circumstances l Developing new approaches to help employers and individuals develop workplace solutions, or ways of working that facilitate greater participation of people experiencing these conditions l Improving systems by joining up services to strengthen communication, liaison or joint action.




Photos courtesy of Arthritis Research UK London office

Retreat room

 promote movement work and those who have the opportunity to do so, and employers like Arthritis Research UK set a great example by showing that small adjustments can often go a long way in creating a more inclusive workplace. “78% of people acquire their disability or health condition during their adult life, which is why we’ve launched the Challenge Fund to support those disabled people who want to work to stay in or return to employment.” According to the latest statistics, arthritis and related conditions such as back pain account for 30 million working days lost each year. Arthritis Research UK promotes good musculoskeletal health at work and encourages employers to take action. Together with people with arthritis, the charity has co-developed an approach to flexible working, and created an office space that is inclusive and promotes movement. The office caters for a wide spectrum of different working styles and levels of privacy, including a number of focus pods, media booths and open plan project spaces, while dedicated “retreat” and “wellness”

rooms provide relaxed environments for contemplation, stretching and gentle exercise. As well as these “activity-based working” environments, a number of desks can be converted into standing desks and height adjustable for each individual’s needs. Liam O’Toole, Chief Executive at Arthritis Research UK, said: “Arthritis and related conditions, like back pain, affect around 17.8 million people in the UK. We know arthritis can have a devastating impact and too often takes away the freedoms most of us take for granted. We are determined to help people with arthritis to maintain their health, wellbeing and independence, and we know that work is fundamental to that. “Our own flexible working environment confirms that the right adjustments can make all the difference. This can be about helping people to work at times and in locations that suit them, training managers or creating working environments that promote movement and wellbeing.”

Social element may provide key to workplace fitness PHYSICAL inactivity among the working population is costing us around £7.4 billion a year in lost productivity, say Government health experts. But what kind of workplace interventions have the best chance of getting employees moving? Writing for the Sport Englandfunded Workplace Challenge programme, Dr Davina Deniszczyc, primary care medical director at Nuffield Health said that (despite a distinct lack of strong evidence on the subject), the most effective techniques appear to be a combination of workspace supervised exercise classes and group support. “These practices are more efficient because they introduce a social element to exercise,” she said. “Forming bonds with individuals provides many people with extra motivation to reach group health goals.” Dr Deniszczyc emphasised that physical activity needs to be engrained in workplace culture from the top down. “There is no substitute for the C-suite getting personally involved,” she added. “Serving as a role model can be particularly effective for wellness-related programs, but the process needs to be a priority for every manager and fostering a culture that then champions those on the shop floor to bring that culture to life.”



Aids and adaptations in the home improve quality of life and independence

Image: Freepik

Are you missing out on equipment in the home? People with arthritis are missing out on aids and adaptations they are entitled to from local authorities, putting their independence and safety at risk, according to a new report from Arthritis Research UK.

THE charity Arthritis Research UK says as many as eight in 10 people eligible for support may be missing out on life-changing equipment, such as grab rails, raised toilet seats or non-slip shower mats. Aids and adaptations in the home play a vital role in helping people with arthritis and related conditions lead more independent lives and reduce the risk of them needing more formal care or even A&E services. Almost everyone with arthritis that the charity surveyed (95%) who currently uses aids and adaptations, said they improved their quality of life. However, almost a fifth of those eligible are not using aids or adaptations at all. Although local authorities have a duty to make aids and adaptations available, more than half of survey respondents with arthritis and eligible for support are buying equipment themselves, missing out on their entitlement. The average cost of an aid in the charity’s study was £200. The report argues that too many people are unaware of their rights because councils are not

providing adequate information. Of survey respondents who were eligible, but not currently using aids and adaptations, over 85% were unaware their local authority has a duty to provide this type of equipment. While a third of people sought information, only 1 in 10 surveyed said their local authority was their main source of advice, despite councils’ duty to make information accessible. Arthritis Research UK is calling on local authorities to ensure people with arthritis and related conditions are assessed and, if eligible, given aids and minor adaptations free of charge. Morgan Vine, Campaigns Manager at Arthritis Research UK, said: “Aids and adaptations are at the front line of UK’s social care system. It’s not fair that of the 17.8m people with arthritis and related conditions, so few are aware that this support is out there and even fewer have been assessed and provided with the equipment they need and should be getting for free. Adapting someone’s bathroom so that they can get up from the toilet can lead to fewer slips and falls, potentially avoiding emergency care.”

How the costs can mount up Christine Walker, an osteoarthritis sufferer since the age of 19, said: “Just making a cup of tea and other tasks around the kitchen can be complicated, but aids and gadgets have revolutionised my life. The cost has really mounted up over the years – the adaptations in my bathroom alone came to £3,000, but it was necessary, so we just had to get on with it.” “I was shocked to discover that I might be entitled to some of these items from my local authority. I know councils are under pressure, but these aids and adaptations are invaluable, helping people like me manage my condition at home.”



Number of people needing care continues to rise THE number of older people not getting the care and support they need has risen to 1.4m – an increase of almost 20% in just two years, according to Age UK. Of the older people affected, more than 300,000 need help with three or more essential everyday tasks, like getting out of bed, going to the toilet or getting dressed. More than half of these people get no help at all from paid carers, family members or friends. “If an older person needs social care but can’t get it this is a surefire recipe for

them to become weaker and less well,” said Caroline Abrahams, Age UK’s charity director. “They are at far greater risk of not eating enough and of falling and hurting themselves because of trying to do more than they really should.” The number of delayed discharges due to a lack of social care is going down; however, these are still costing the NHS £500 every minute, according to Age UK’s analysis.

Image: Freepik

Improvements to social housing can reduce emergency admissions UPGRADES to social housing could help to reduce emergency hospital admissions, researchers from the University of Swansea have found. Cold houses are thought to be behind 33% of respiratory and 40% of cardiovascular diseases, and it is estimated that 12.8 excess deaths per 100,000 occur due to living in inadequately heated houses. The researchers worked with data from residents of nearly 9,000 council homes in Carmarthenshire, South Wales, between 2007 and 2016. Residents received improvements to their homes, including new heating and electrical systems, wall and loft insulation, new kitchens and bathrooms, windows and doors, and garden paths. Hospital admission data were linked to information provided by Carmarthenshire County Council on each of the homes that received improvements. Researchers then compared the number of hospital admissions for tenants who lived in homes with the improvements to those whose homes had not yet been improved. They found substantial decreases in the number of hospital admissions for those in the improved homes. Findings showed a substantial decrease of up to 39% in emergency admissions for cardiovascular and respiratory illnesses,

Image: Freepik

Significant implications for falls and burn injuries along with cardiovascular and respiratory illnesses as well as fall and burn injuries. This was for tenants aged 60 and over, but there were similar results for all ages. Prescribed asthma medications and GP visits also dropped for residents of all ages. Linda Evans, Carmarthenshire County Council Executive Board Member for Housing, said: “We have already used

the health evaluation results and study team recommendations to update our development plans. Making small changes in housing policy improves health, which also carries social, economic and environmental benefits for all.”



Helping people with long-term conditions to stay physically active £1.3 MILLION has been awarded by Sport England to members of the Richmond Group of Charities for a series of pilot projects that use physical activity to help manage long-term health conditions. The eight charities that will benefit from the funding include Age UK, Alzheimer’s Society, Breast Cancer Now, British Lung Foundation, MS Society, Rethink Mental Illness, Stroke Association and Diabetes UK. Their projects will identify and challenge the barriers to activity that people face. “Exercising when you have a long-term health condition can be hugely beneficial to your mental and physical wellbeing, but it can also be daunting,” said Jennie Price, Sport England chief executive. “We have chosen to work with the leading health charities to help people get active, because the charities already have the confidence of the people living with long-term health conditions. Together, we want to help people answer those questions they might have about which activities are suitable, or how much exercise they should do for example.” Forty-eight-year-old Bob Swindell was diagnosed with Type 2 diabetes in 2013. Diabetes UK’s initiative is now a prime example of how physical activity can help manage long-term health conditions. Since diagnosis, he has lost weight and

now uses exercise and diet to control his diabetes to such an extent that he no longer has to use medication. Running has been the key for Bob and he champions parkrun as one way people with diabetes can build activity into their lives. “I’d be the first to admit that I didn’t have the healthiest lifestyle,” he said. “But it was using the Know Your Risk tool at a Diabetes UK roadshow event that gave me the nudge I needed to see my GP and begin making some changes to my health. “My diagnosis came as a shock but without it who knows what my health would be like today, or what serious complications I may have faced.” Bob is among the estimated 15 million

people living in England with one or more common long-term health condition.

MS Society helpline The MS Society will be testing a helpline response programme, recruiting a dedicated information and support officer. They will be available via the helpline as a physical activity and behaviour change expert, who will work with callers to the helpline to change their behaviour. Michelle Mitchell, MS Society CEO said: “Research tells us that exercise is safe and beneficial for people with MS and can improve mobility and muscle strength, mood, and some MS symptoms.”

Seven in 10 disabled people want to be more active £450,000 of Lottery cash has been allocated to the Activity Alliance (formerly the English Federation of Disability Sport) to enable disabled people to get active. Seven in 10 disabled people want to be more active and the new Inclusive Activity Programme (IAP) will engage key groups, including coaches, local community activators and healthcare professionals, in training to provide those people with advice and pathways to get more active. The IAP will look to build on the success of its predecessor, the Sainsbury’s


Inclusive Community Training initiative. Over the programme’s three years, it will deliver more than 600 practical, face-toface workshops and provide access to ongoing learning and development opportunities for 8,500 people. The end goal is for trainees to be given the tools to tailor their own activity delivery to a variety of audiences, thereby increasing the likelihood of disabled people, and those with long-term health conditions, getting and staying active.

The programme will engage key groups, including coaches and local community activators


Structured exercise regimes offer significant health benefits

Poor muscle strength raises the risk of a fall by 76% IN OLDER adults, aged 65 and over, poor muscle strength increases the risk of a fall by 76% and those who have already had a fall are three times more likely to fall again. Strengthening and balance activities not only help to prevent this, but also help improve your mood, sleeping patterns, increase your energy levels and reduce the risk of an early death. An evidence review commissioned by Public Health England and the Centre for Ageing Better has found that muscle and bone strengthening and balance activities continue to have great health benefits for all adults, and suggests these are done at least twice a week alongside aerobic exercise. Currently, only one in three men and one in four women are currently doing enough

of the right types of exercise for healthy muscles and bones. Activities found to have the most benefit for muscle and bone strengthening include ball games, racket sports, dance, Nordic walking and resistance training (usually training with weights but including body weight exercises which can be performed anywhere). For those at risk of falls or fracture, supervised structured exercise is also recommended at a pace that suits the individual to help maintain independence and support healthy ageing. Jess Kuehne from the Centre for Ageing Better, said: “It’s clear that we need to give equal weighting to activities that boost muscle and bone strength and improve

Images: courtesy of Sport England

balance rather than simply focusing on aerobic exercise. “There is significant potential to make savings to health and social care services if we do more to promote muscle strengthening and balance activities and recognise their role in helping to keep people healthy and independent for longer, particularly as they age. “Current statistics show that falls are responsible for around 95% of all hip fractures, costing the NHS more than £1 billion a year. For employers and the economy, musculoskeletal health conditions are the second most common cause of sickness absence in the UK, accounting for 30.8 million days lost in work.”



Many ordinary people suffer from a wide range of chronic pain conditions. They are not necessarily athletes, they are not super fit, and they have not developed their pain as a result of deliberately pushing their body to its limit. For most of them, their pain has developed as a result of restrictions in their fascia caused by their everyday lives. AMANDA OSWALD reports.

Image: onlyyouqj/Freepik

By progressively moving into a stretch and holding it for at least 90 seconds you are helping to release the fascial restrictions that may be causing your pain

Myofascial Release: a fascial FASCIA is the main connective tissue in the body, connecting everything to everything else, creating a body-wide web. The ligaments that hold our joints together and the tendons that connect the muscles to the bones are all made of fascia. But it does not stop there. As we examine the body more closely we find that fascia wraps around and runs through every one of its structures, protecting them and giving them shape. Fascia encases and runs through organs such as our heart, blood vessels, nerves and the muscles that make our limbs work. Going deeper, fascia holds together every cell and every fibre that makes up those organs, connecting each of them to its neighbours and, through a vast network, connecting everything with everything else. Your knee bone is indeed connected to your thigh bone, but not in the way you think. In its healthy state, fascia moves fluidly and seamlessly to distribute tension and maintain balance in the body. However, like every other part of us, fascia can be


damaged causing the fascial web to snag, become misshapen, and lose its flexibility and ability to move. This causes fascial restrictions that lead to limited movement, pressure and pain. Some of the most common causes of fascial restrictions are:

Accident All of us will experience a variety of accidents and injuries during our lives, from childhood through to old age. A major trauma will usually be remembered long after the event and can have long-lasting effects. Even everyday minor incidents, such as bumping into a kitchen cupboard, missing your footing as you step off a kerb, or stubbing your toe, can also create fascial injuries that are communicated deeper into the body. These effects may be apparent immediately after an accident, but they can also emerge years later, having been carried in the fascia long after superficial healing takes place.

Surgery and scar tissue Scars may form as a result of accidents and injuries or, for many of us, they are the result of surgical procedures. Surface scarring, particularly minor scarring, may heal and disappear as the surrounding area returns to normal. In other cases, the scars remain, looking and feeling different from the surrounding tissues. Bigger scars are multi-layered – what you see and feel on the surface of your skin is the tip of the fascial iceberg. Unseen, under the surface of the skin, it is very common for these scars to expand, growing along lines of fascial tension and creating adhesions which can cause obstructions and problems of their own and lead to chronic pain.

Overuse and underuse As fluid beings, we are designed to move and to use our bodies. However, as our world has become more advanced, systems, machines, and gadgets have been invented that have changed our lifestyles and how we move.


Image: yanalya/Freepik

Being stuck in one position working at a computer day after day creates changes to the fascia which sticks together forming fascial restrictions that cause pain Seen under a microscope, fascia looks fragile like a spider’s web with dewdrops on, but don’t be fooled as this amazing tissue has a tensile strength of two tonnes per square inch! Image: Dr JC Guimberteau

 understanding of chronic pain Overuse and underuse are related and growing problems arising from our modern lifestyles, including work and leisure. Both can cause fascial injuries. The underuse of being stuck in one position working at a computer or on a production line, hour after hour, day after day, for months and years creates more and more layers of fascia which stick together forming fascial restrictions that cause pain. The overuse of the exercise we do to counteract our jobs often creates microtears in the tissues, like tiny scars, that can build up and harden and develop into adhesions.

Posture When functioning properly, the body is held upright by ligaments and fascia rather than by muscles. It can maintain an upright position without conscious postural control or muscle fatigue. Poor posture can develop as a result of holding unnatural postures for prolonged periods, for example sitting at a desk. As our fascia tightens to maintain

this position, exerting new forces within our body, the fascia becomes less fluid and more rigid, effectively forming a type of scar tissue.

spread the pain to other areas or magnify it. So what can we do to counteract the problems caused by fascial restrictions and the resulting chronic pain?


One approach is myofascial release which is a gentle hands-on bodywork technique that works to restore normal movement to the body by releasing restrictions caused by stuck fascia that has become dehydrated and hardened. This process relieves abnormal pressure on muscles, bones, nerves and organs, resolving chronic pain. With a better understanding of fascia it is also possible for anyone to help themselves out of chronic pain using simple yet effective myofascial self-help techniques. You can learn more about fascia, myofascial release and self-help techniques in Living Pain Free: Healing Chronic Pain with Myofascial Release by Amanda Oswald, or visit for more information about myofascial release therapy.

Stress is a natural phenomenon and a physiological response to real and perceived danger. Some stress can be good. Running to avoid a speeding car as you cross the road can save your life. The stress of a virus entering your system will trigger your immune system to kick in and resolve the temporary illness, which is a good thing. But after just seven days of sustained increased stress, such as from prolonged pain, the mind-body goes into a state of exhaustion in which normal protective immune responses are no longer triggered and the body is vulnerable to disease and injury. Over time, this changes the mind-body from a balanced self-regulating system into an unstable environment where eventually even the slightest additional stress can



A SYSTEMATIC review, published in BMJ Open1, showed that continuity of care resulted in “significantly fewer deaths” among patients and halved the risk of an emergency hospital admission. In the wake of this recent review, alternative medicine practitioners have been among those arguing for more co-ordinated care models to help ease the pressure on the NHS. The British Acupuncture Council (BAcC) states that regular acupuncture, delivered by the same practitioner, can help relieve symptoms, reduce medication and improve the wellbeing of elderly patients. Acupuncture can offer a useful additional resource, says Mark Bovey, research manager at the BAcC. “National health services across the developed world are struggling to cope with increasing numbers of old people with chronic illnesses. Conventional health and social care resources are overstretched and

Alternative therapies and treatments can help support the totality of individuals’ health need polypharmacy is rife, with its attendant side effects and interaction complications.” Acupuncture is used to help relieve pain in a range of musculoskeletal complaints. A study carried out in California last year and published in the Journal of Alternative and Complementary Medicine2, involved 15 patients aged 60 years and older suffering from at least two chronic conditions. This showed that a substantial number of participants were able to reduce their medication and maintain physical and

mental health. In addition, they developed a strong trust in the clinic’s ability to support the totality of their health as individuals. Significantly for Bovey, alongside the diagnosis and treatment “there was social and emotional support, practical advice and referral to other community resources,” helping to meet patients’ wider needs. 1) Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality 2) Long-term Acupuncture therapy for low-income older adults with multimorbidity: a qualitative study of patient perceptions

Campaign prompts HPV vaccination programme for boys RESEARCH by a Kingston University professor has contributed to the imminent UK decision to extend the national HPV vaccination programme to include adolescent boys. The Joint Committee of Vaccinations and Immunisations (JCVI), which looks at the financial implications of public health programmes, has advised government that immunising boys as well as girls against HPV is a cost-effective option for improving public health. Professor Giampiero Favato – Director of the Institute for Leadership and Management in Health – modelled the complexities of human sexual behaviour and the impact this could have on the transmission of HPV. The results demonstrated the limitations of previous research in to the cost-effectiveness of HPV vaccination and raised the concern that public healthcare policy might have been built upon incomplete studies. HPV stands for Human Papilloma Virus and is one of a group of viruses affecting the body’s moist membranes. High-risk strains of HPV could cause cervical cancer, with more than eight women a day being diagnosed with this in the UK. “This is why 12-year-old girls are vaccinated against HPV but what most people don’t realise is that HPV can also lead to cancer of the mouth, throat, penis and anus – so only vaccinating girls


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Immunisation offers a cost-effective option for improving public health has been putting boys and men at risk,” Professor Favato said. “Now that the JCVI has positively recommended this course of action, the Government is likely to approve its implementation and hopefully boys in England will begin to be vaccinated against HPV in 2019.” Scotland and Wales had already announced that they would be implementing vaccination for boys by next year. Once England follows suit, almost 400,000 boys a year in the UK will be protected against the virus.

Image: British Acupuncture Council

Continuity of care helps reduce demands on hospital services


Check out what’s on in BackCare Awareness Week BACKCARE is supporting initiatives across the country that are helping to raise awareness of the disabling effects of back pain, especially in older adults, during BackCare Awareness Week, 8-10 October. Many causes of back pain can be agerelated, including osteoporotic vertebral fractures, lumbar spinal stenosis and osteoarthritis – which can be accompanied by other physical, psychological and mental changes – making life a misery for a growing proportion of the population. Despite the plethora of information in

circulation among clinicians, there remains a distinct lack of awareness among the older population about the causes of their back pain and options for its assessment, treatment and management. BackCare is committed to reducing the burden of back and neck pain on society by providing

information, guidance and advice to health professionals and the public. For BackCare Awareness Week, campaigners will be receiving the latest updates, booklets and posters to help plan activities and get the message out there. Contact us today at:

Image: jannoon028/Freepik

Harnessing technology can pave the way to improved patient pathways

Using real-time analytics to unlock better care for patients BIG DATA technology is enabling primary care provider The Practice Group to improve services to patients by facilitating the efficient consolidation, analysis and reporting of information to practices. The Group’s chief executive officer Allan Johnson said: “Our system integrates data from a diverse number of sources to provide powerful information to help surgery teams across the country to

identify, implement and communicate with patients regarding potential new ways of working based on previous trends.” To date, each surgery receives a monthly report providing information on potential service improvements or new ways of interacting with patients. Examples of the results achieved include the finding that in surgeries across north west London, more than 3,000 patients with a history

of mental health illnesses have been identified and entered into a local scheme to provide them with additional support, all commissioned by the CCG. Johnson added: “Our data analytics solution can identify trends and issues occurring within individual surgeries’ locations so they can take action on aspects of patient care where improvements are possible.”



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28 APRIL 2019

Call Sri on 020 8977 5474 TALKBACK l AUTUMN 2018





TalkBack, autumn | 2018 (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, autumn | 2018 (BackCare)  

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