TalkBack, Issue 4 | 2014 (BackCare)

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

■ NEWS

■ EVENTS ■ COMMUNITY ISSUE 4 • 2014

FREE TO MEMBERS

Lifting technique Does one size fit all?

World summit Public health agenda

Awareness week

Getting the message across

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

2 TALKBACK EVENTS

BackCare Events Calendar 2014/15 ARMA Lecture “Meeting the Challenge of MSK Disorders” 10 DECEMBER

Annual winter lecture of the Arthritis and Musculoskeletal Alliance, at the Methodist Central Hall, Westminster, 5.30pm, given by Lord Hunt, Shadow Deputy Leader of the House of Lords. Visit www.arma.uk.net for more information.

BackCare Christmas Carol Concert 15 DECEMBER

Join us at The Queen’s Chapel of the Savoy, 6.30pm, for a rich tapestry of choral masterpieces by the Tredici Choir. Tickets £18 adults, £5 under-16s. Refreshments available. Box office: www.brandenburg.org.uk/christmas. Proceeds go to the charity.

ACTIVE Working Summit 8 JANUARY

“The Sedentary Office – A Case for Change” at More London Place, London (SE1 2AF). First annual conference exploring the health risks of prolonged sitting, featuring Dame Carol Black. Visit www.getbritainstanding.org for details and bookings.

British Orthopaedic Association, Instructional Course 10 – 11 JANUARY

Manchester Conference Centre. The annual instructional course is a highlight of the BOA’s training and education calendar, featuring a half day focused on the surgical treatment of critical spinal condition. More information at www.boa.ac.uk

Moving & Handling People 27 – 28 JANUARY

Human Rights Action Centre, London. Annual event of seminars and workshops for patient handling professionals. More information at www.movingandhandlingpeople.co.uk

Acupuncture Awareness Week 3 – 10 MARCH

Acupuncture is one of the most popular complimentary therapies practised in the UK, with 2.3 million treatments performed each year. Supported by the British Acupuncture Council. Find out more at www.introducingacupuncture.co.uk

British Chiropractic Association’s Spring Conference 7 MARCH

Roxburghe Crowne Plaza, Edinburgh. For more information and booking, contact Michelle Allen on 0118 950 5950 or email enquiries@chiropractic-uk.co.uk

British Association of Spine Surgeons Conference 18 – 20 MARCH

Bath Assembly Rooms. For further information, visit www.cvent.com/d/g4qd6m. For sponsorship opportunities, contact Julie Archer at BASS@archer-yates.co.uk; for membership and other queries, contact Julia Bloomfield at ukssb@boa.ac.uk

International Acupuncture Research Symposium 21 MARCH

“Bridging the Gap between Research and Practice” at King’s College London (Stand campus). Research and education seminars. Visit www.arrcsymposium.org.uk for more information.

British Scoliosis Society – Annual Meeting 21 – 23 APRIL

Sheffield City Hall. Further details will become available at: www.britscoliosissoc.org.uk/events.asp

John Bowlby Memorial Conference 25 – 26 APRIL

“Unlocking Pain – Disrupted Attachment and Chronic Physical Pain” at the Bowlby Centre, London. Psychophysiological perspectives from international leaders in the field. More information at www.thebowlbycentre.org.uk/cpd

Stress Illness Recovery Practitioners Association’s Annual Conference 26 APRIL

“Chronic Pain – To Suppress, Manage or Cure?” at the Royal Society of Medicine, London. Leading international speakers in the field of chronic pain recovery. More information at www.curepain2015.com

TALKBACK l ISSUE 4 2014

TALKBACK WELCOME 3

Welcome Welcome back. As another year draws to a close, it’s time to consolidate all that we have learned in preparation to receive upcoming opportunities. If you’re a new reader who has picked up this issue at an event or been handed it by a friend, we hope you’ll discover value in these pages. Those interested in becoming subscribers can complete and return the form at the back of the magazine.

Since we last convened, we’ve had a tremendously successful BackCare Awareness Week. The radio day reached around 10% of the UK population and we fulfilled several hundred orders for campaign packs. Special thanks to all who participated and to our official sponsors, ActiPatch. You can read the report on pages 6 and 7.

In this issue, we bring you news and commentary, including news of the first world summit dedicated to musculoskeletal health which took place in October. We also report on the research award winners from this year’s Society for Back Pain Research annual meeting (see pages 10-11).

In an attempt to build the BackCare community, I’ve invited several professional member organisations to contribute a page in this issue – the hope is that this will kick off a new series of multidisciplinary discussions as TalkBack features. I’ve also invited representatives from the BackCare branches (our national network of member-lead local support groups) to contribute a brief introduction to who they are and what they do – again, the hope is to establish a regular platform for their perspectives within TalkBack.

Contents

Sit-Stand & MOVE 9 hours per day – double the safe limit Prolonged sitting is strongly linked to back pain, diabetes, heart disease and cancer Even regular exercise cannot undo the effect of sitting The average British adult sits for

Dr Who? Did you know?

Reducing your daily sitting by just

Regular readers who may be looking for the latest instalment of the “Prevention is better than cure” educational series, please note that this series is currently on hiatus as I re-examine its founding assumptions. What I am consistently finding from feedback is that this series is most valued by readers who are already “on board” with its content, rather than individuals who could most benefit from it. So it’s back to the drawing board to re-think how to communicate challenging educational context more effectively – insight from other educators is more than welcome.

As always, we do welcome contributions – 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. Get in touch by email to yourstory@backcare.org.uk or by letter to the usual address.

With Christmas just around the corner, I’ll wish you all a merry one. Take care and I’ll see you all in the happy New Year!

www.backcare.org.uk

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Awareness week Sponsored by

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Approach to lifting 10-11

Predicting pain

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

Disciplines of practice 14-18

Around the branches 20-21 TALKBACK l ISSUE 4 2014

4 TALKBACK NEWS

‘Remedy a sick population before it generates its sick individuals’ As we’re often telling audiences, back pain is the leading cause of human disability worldwide. Indeed, the musculoskeletal health crisis has now escalated to the point of warranting its very own world summit, which took place in October.

BackCare was there among delegates from 30 countries at the Royal College of Surgeons in London to listen to representations from regional, national and international level advisors and keynoters.

The summit was held in partnership with ARMA (the Arthritis and Musculoskeletal Alliance) which is the UK ‘National Action Network’ of the Bone and Joint Decade – an international network of more than 1,000 patient, professional and scientific organisations. The event was coordinated with the publication of a new report from Arthritis Research UK called “Musculoskeletal Health – A public health approach” which served as a central theme.

The essential shift discussed was from treating symptoms medically as they arise to promoting health and preventing

disease on a whole-population scale through organised initiatives and efforts of society.

Indeed, addressing musculoskeletal conditions through public health affords unique opportunities not otherwise accessible via the primary care route.

Let’s take a look at a common case: “John” has acute back pain so he visits his GP who only now detects the psychological states and traits evidenced to predict incident back pain and long-term pain and disability (“yellow flags”).

Approaching musculoskeletal conditions through public health might mean reaching John and dealing with his subclinical psychological factors long before he ever gets back pain.

There was also important recognition that operating “upstream” to promote health through united activity would likely be more effective than separate initiatives to prevent specific conditions by tackling their own risk factors.

Since psychosocial and lifestyle factors sit upstream of musculoskeletal diagnoses, it might mean initiatives to remedy a “sick population” before it generates its sick individuals. While these nonphysical factors are often cast off as optional extras, the clinical evidence gives an opposite account. As NHS England’s Dr Martin McShane put it, “the soft stuff is the hard stuff.”

Lottery win for BackCare

BackCare has been successful in its bid for Big Lottery funding. The financial award will support a vital redevelopment of the charity’s website. The new site is due for launch in early 2015 and will feature many upgraded features including an “Ask the Expert” forum, online membership processing, and improved access to educational resources.

TALKBACK l ISSUE 4 2014

The awards were held at BMA House in central London

NICK COMMENDED AT BMA AWARDS Congratulations to BackCare professional member and regular TalkBack contributor Nick Sinfield who received a commendation with BackCare at the British Medical Association’s Patient Information Awards in September for his booklet Top 10 Exercises for Back Pain Relief.

The annual awards ceremony was established in 1997 to encourage excellence in the

production and dissemination of accessible, well-designed and clinically-balanced patient information. The Resource of the Year 2014 award went to the Physical Health and Wellbeing Handbook from the South London and Maudsley NHS Foundation Trust, which aims to improve physical health in people with mental health problems.

TALKBACK NEWS 5

The best doctor you’ve never heard of…

What do American radio personality Howard Stern, comedian Larry David, journalist John Stossel, Senator Tom Harkin and professional golfer Ben Crane have in common?

They all suffered from debilitating pain until they met Dr John Sarno, a now-retired professor of rehabilitation medicine at New York University School of Medicine.

Now, acclaimed America filmmaker Michael Galinsky is set to release a documentary called All the Rage about the groundbreaking work of Dr Sarno who pioneered a curative approach to chronic pain.

Called the “best doctor you’ve never heard of” by Forbes Magazine, Dr Sarno sold hundreds of thousands of books and is reported to have cured thousands of patients based on the philosophy that the body can heal itself given the

Dr John Sarno

knowledge to do so. Ten years in the making, Galinsky’s documentary is now in post-production and the team is hoping to raise $75,000 on crowdfunding platform Kick Starter to fund marketing and distribution.

Dr Sarno’s “mindbody” or psychophysiological approach is very much consistent with the clinical evidence on back pain. Psychological factors remain the most consistentlyevidenced predictors of who will develop acute back pain, and which of these

cases will become chronic/long-term.

In fact, a 2005 study from Duke University which tracked 2,332 college students into mid-life showed that psychological factors could predict who would have a chronic pain condition three decades later.

Psychological factors play an important role in pain management where they are understood to influence the onset and outcome of back pain, often by influencing physical behaviours.

This is in considerable contrast to Dr Sarno’s approach, in which the mind is not only thought to influence pain but to most often cause it and be able to cure it. While Dr Sarno is much celebrated by his colleagues and patients, he is a controversial figure who evokes strong opposition from many who reject the causal role of psychology in their physical pain condition.

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6 TALKBACK AWARENESS WEEK

Spreading the message Awareness Week is the highlight of the BackCare calendar, where we combine national and regional events to spread our message and make a difference.

We want to help as many people as possible to gain an up-to-date understanding of back pain and what they can do to prevent it, treat it and recover from it.

We choose a timely theme each year to highlight particular at-risk groups. This year it was back pain in office workers. Key events included the radio day and the release of a campaign pack. These national level activities were complemented by dozens of local community events organised by BackCare supporters.

Local events Sit-Stand & MOVE 9 hours per day – double the safe limit Prolonged sitting is strongly linked to back pain, diabetes, heart disease and cancer Even regular exercise cannot undo the effect of sitting The average British adult sits for

Did you know?

Reducing your daily sitting by just

www.backcare.org.uk

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Commuting 1 hour can burn 1kg of fat per month

Solutions 80% of Scandinavian workers sit-stand at work, compared to only 1% of UK workers Visit www.getbritainstanding.org for sit-stand solutions

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Build positive new habits: 1. Stand on public transport 2. Park your car further from work 3. Take phone calls standing up 4. Experiment with walking meetings 5. Reduce your television watching

Sponsored by

Campaign pack bumper sales The campaign pack, sponsored by ActiPatch, went on sale a fortnight preceding the awareness week. The pack comprised key educational materials including the previous issue of TalkBack dedicated to the awareness week, a new booklet presenting the results of the National Back Pain Survey, and the new Sit-Stand & Move poster (pictured). The pack proved very popular with over 500 sold, including 50 packs bought by a UK county fire department.

TALKBACK l ISSUE 4 2014

Many supporters stepped up to put on events and run special offers during the awareness week, which we promoted on the BackCare website. Many thanks to all who participated – here were some of the highlights: l Mike Dilke from BackApp UK assembled a team of back pain experts for a round table discussion broadcast several times on UK Health Radio (pictured below). He also organised a back pain advice event at the Nuffield Health Gym in Bishop’s Stortford. l Beryl Kelsey and friends from BackCare’s Hull and East Riding Branch created a display at their local library and organised an open day as well as walking and aquatic exercise events. l The British School of Osteopathy in London offered a discount on consultations. l Chiropractors from Uttoxeter Chiropractic Clinic in Staffordshire put on a fundraiser, offering free advice and collecting donations for BackCare. l Osteopathy Plus in Telford offered free 30-minute back pain consultations.

l Dr Arif Soomro (pictured above) from Cliffs Chiropractic Clinic in Essex presented the results of BackCare’s National Back Pain Survey to the Essex Chambers of Commerce. l The European School of Osteopathy in Kent offered a discount on consultations. l The British College of Osteopathic Medicine in London offered a discount on consultations. l Spring Active offered free downloads and discounted books.

TALKBACK AWARENESS WEEK 7

Radio day cue sheet Most common disability

Back pain is now the world’s leading cause of disability, with around ¾ billion sufferers worldwide. It accounted for more than 15 million lost working days in the UK last year, and costs a staggering £50 million a day in NHS treatments, disability benefits and lost productivity.

BackCare Awareness Week is 6-12 October. Run by BackCare – the national back pain charity – the aim of the week is to get everybody up-to-date on back pain. This year’s particular focus is back pain in office workers.

Back in the Office

Most people of working age spend most of their waking lives at work. Indeed, work constitutes a major part of life and can have a major impact on health, for better or worse.

Overwhelming evidence tells us that psychological factors most consistently predict who will develop back pain – stress simply causes the body to behave more symptomatically.

Top-5 Stats

BackCare’s 2014 National Back Pain Survey reveals some startling statistics: 1) Half of UK adults have had back pain in the last four weeks.

2) Back pain is just as common in your 20s as it is in your 50s and 60s.

3) Back pain sufferers are three times more likely to depend regularly on prescription medication for stress.

4) 80% of people who very often feel frustrated and emotionally exhausted by their work also have back pain.

5) Stomach pain, chest pain, heart palpitations and trouble breathing are all three times more common if you have back pain.

About BackCare

BackCare is the UK’s national back pain charity. Through our research, education and outreach initiatives, we are working to turn the tide on back pain. There are many ways you can support our work. Find out more at www.BackCare.org.uk

Potential questions

What is the importance of BackCare Awareness Week?

What did the research reveal?

How do you think that back pain can be related to work stress?

How can people effectively manage their back pain?

Where can we get more information?

Interviews on air The radio day, sponsored by Pfizer, took place at the start of the week.

The goal was to report on the findings of BackCare latest research (The National Back Pain Survey 2014) and to get people talking about back pain.

Through interviews on two national stations, 20 regionals and nine locals, we were able to reach more than SIX MILLION listeners, around 10% of the UK population (see table below).

But what did we tell them? Take a look at the official radio cue sheet (left) upon which the interviews were based.

Station

Area

Radio 1035

London

Listener reach 53,000

UCB

National

250,000

Sunrise Radio

Yorkshire

350,000

BCB Radio

Bradford

18,000

BBC West Midlands

West Midlands

BBC Coventry & Warwickshire

Coventry & Warwickshire

240,000 85,000

BBC Jersey

Jersey

21,000

BBC Wales

Wales

438,000

BBC Guernsey

Guernsey

BBC Cambridge

Cambridge

119,000

21,000

BBC Cornwall

Cornwall

154,000

BBC Shropshire

Shropshire

116,000 278,000

BBC Newcastle

Newcastle

BBC Northampton

Northampton

BBC Merseyside

Merseyside

344,000

BBC Stoke

Stoke

156,000

BBC Hereford & Worcester

Hereford & Worcester

102,000 212,000

BBC Lancashire

Lancashire

BBC Oxford

Oxford

Lincs Group

Lincolnshire

Magic 1161

Hull

89,000

79,000 648,000 59,000

Downtown Radio

Ireland

318,000

96.4 Eagle

Surrey

145,000

Mix 96

Buckinghamshire

96.4 The Wave

Wales

39,000 188,000

107.6 Juice Liverpool

Liverpool

241,000

BFBS

National

540,000

Pirate FM

Cornwall

178,000

Heart Wales

Wales

491,000

Gen 106

East Midlands

404,000

TALKBACK l ISSUE 4 2014

8 TALKBACK ADVERTORIAL

The world of healthcare, let alone physiotherapy, is changing fast with increased costs, tighter budgets, technological advances, shifting service provision and a much more discerning client base.

YourPhysioPlan.com has responded by delivering a new, innovative and much-needed health service for the UK population. To put it simply, they provide access to highquality and affordable private physiotherapy through payment plans. Their members are in control of their healthcare, with freedom to choose their clinic and their treatment.

YourPhysioPlan.com avoids delay in receiving treatment by having no waiting lists, no need for GP referrals and no excess payments, as well as covering all pre-existing conditions. YourPhysioPlan.com is the only company in the UK offering inclusive Health and Wellbeing plans. YourPhysioPlan.com brings physiotherapy direct to the public in an affordable and accessible way, while simultaneously meeting a fast-growing need created by rapidly shrinking NHS physiotherapy budgets.

Affordable and accessible…

A proactive approach to managing aches and pains is being actively encouraged across the health sector.

YourPhysioPlan.com has arrived at just the right time and dovetails completely with this approach. Its focus is to give easy and regular access to preventative therapy rather than the costly, unpredictable and often painful option of curing a deeply ingrained injury.

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YourPhysioPlan’s sole aim is to put more patients requiring treatment in touch with physiotherapy professionals. Once achieved, YourPhysioPlan.com members gain quality of life, accessibility and reassurance through delivery of the following benefits: l Easy access to high-quality physiotherapy treatment on an affordable plan to maintain optimum health and help overcome injury and illness through treatment, massage, strength and conditioning. l Premium standards of care: all YourPhysioPlan.com physiotherapists will be required to have obtained, or be working towards, the Diploma in Orthopaedic Medicine, a benchmark postgraduate qualification run by the Society for Musculoskeletal Medicine. The YourPhysioPlan.com brand provides reassurance that clinic practitioners undertake continual professional development and meet high standards for customer care. l Choice of plans to suit different needs and budgets; ability to use 100% of their entitlement. l Prevention: unique access to a health professional before an illness or disorder occurs.

l Improved quality of life: YourPhysioPlan.com encourages members to establish an ongoing relationship with their practitioner for regular monitoring and early intervention. l Unrivalled offering – the only UK physiotherapy payment plan that does not require an excess or a referral and that also covers you for pre-existing conditions. l Control of their health care: members choose their treatment and their clinic. l Away from home care: the ability to see a practitioner even when members are away from home. l Preferential member rates on additional specialist treatment, for example MRI scans. l Members’ web-based application: to help members find out if physiotherapy can be of help to them, find their nearest YourPhysioPlan.com clinic, quickly access expert advice and access a wealth of quality health information. Easy to navigate with state-of-the-art interfaces.

The knock-on effect of people suffering musculoskeletal problems, especially back pain, is not inconsiderable:

TALKBACK ADVERTORIAL 9

Physiotherapy has long been recognised as a medical treatment that works with people to optimise their health. It delivers wellbeing and quality of life by identifying and maximising a patient’s ability to move and function – a key part of what it means to be healthy.

Physiotherapists are medically trained healthcare professionals who: l have real-life experience across a range of spectrums and l It has been reported that as many as 84% of the population will suffer from back pain at some point in their life. l In 2012, the prevalence of chronic back pain (back pain lasting more than 12 weeks) was 23% of the population and 11% of the population were disabled by low back pain. The 2010 Global Burden of Disease Study identifies back pain as the world’s leading cause of disability. l The 2014 Labour Force Survey estimates 2.8 million working days were lost in 2013/14 due to back disorders. l 2012 NICE Guidelines state that only 20% of back pain sufferers will consult their GP about it.

The impact of this is not lost on the co-founder of YourPhysioPlan.com, Denise Kesson (left), who says: “We have to start thinking of our

can manage all acute and long-term conditions l proactively maintain optimum health, preventing disease and strengthening and conditioning the body for optimum quality of life l manage pain, facilitate recovering from injury l manage chronic conditions and disability l are proven to reduce the number of sick days taken l resolve most acute injuries within six sessions.

bodies as mechanical and stop taking them for granted. For example, to get more mileage out of our car we regularly service it and take it to the mechanic when it first shows a warning light.”

As such, Denise recommends those without current issues form a relationship with their local physiotherapist and undergo an annual MOT. If you already have an existing complaint, you are likely to benefit hugely from regular contact with your local physiotherapist.

YourPhysioPlan.com makes this access easier by offering a plan to suit everyone, see below.

YourPhysioPlan.com’s timing is perfect.

Traditional service providers such as the NHS are overspending hugely and unsustainably on musculoskeletal services, leading to physiotherapy increasingly becoming “rationed” and access made more difficult.

In addition, outpatient physiotherapy budgets are being cut and many trusts will not be able to afford to provide physiotherapy services in the future.

The obvious implication of this is that all those who could benefit from physiotherapy will have to look to recommended private providers, such as YourPhysioPlan.com member clinics.

“YourPhysioPlan.com has joined forces with BackCare to support those with back pain. We are developing a Back Pain Plan that will enable members to access regular hands-on expert physiotherapy and receive the invaluable support of BackCare.”

For those who are already members of BackCare, YourPhysioPlan.com is offering members their first month’s membership free! Enter the code ypp50ff when signing up through www.yourphysioplan.com The offer lasts until January 31 2015.

Your Basics

£2.90 per month

This entry level Health and Wellbeing plan provides you with an annual MOT at a YourPhysioPlan accredited clinic providing outstanding benefits, value for money and peace of mind

Your Essentials

£18.50 per month

You get six lessons to use at a YourPhysioPlan accredited clinic throughout the year which ensures a cost effective aid to fast recovery from an acute injury or flare up, or you can use the session for regular massages if you are not injured

Your Inclusive

£60.00 per month

An inclusive level Health and Wellbeing plan that gives you two sessions a month for physio or massage at a YourPhysioPlan accredited clinic

Your Elite

£70.00 per month

You receive two sessions a month at any of YourPhysioPlan’s accredited clinics. No matter where you are, you can be assured you can access excellent and consistent treatment or massage. Perfect for commuters

* All YourPhysioPlan.com plans provide the member with 24/7 physio support from our “Physio in your Pocket” app and 10% off treatment prices if additional sessions are needed to be purchased outside the member’s entitlement.

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10 TALKBACK RESEARCH

“Bend your knees and keep your back straight” is the mantra for lifting heavy objects, but new research led

by University of Aberdeen academics suggests this approach may not work for everyone when it comes to back care. Their work, which has just won the best paper at the annual meeting of the Society for Back Pain Research, reveals that the shape of our spines alters the way in which we can lift safely. The finding means that guidelines may work more successfully if tailored to suit individual shapes rather than a “one size fits all” approach…

Lifting – one size doesn’t fit all Anastasia Pavlova, lead author of the paper from the University of Aberdeen, said: “The bones making up our lower back – the lumbar spine – form an inward curve that makes the hollow of our back; and some of us are more curvy than others!

“What we showed was that the curve of our lower backs is specific to each individual, a bit like a fingerprint.

Interestingly, this affects the way we lift objects from the floor, so that those with ‘curvy’ spines tend to bend over, or stoop, to lift a box whereas those with straighter spines tend to bend their knees and squat.”

The research team, which also included Dr Judith R Meakin from the University of Exeter, Dr Kay Cooper from Robert Gordon University and Dr Rebecca J Barr and Professor Richard M Aspden from the University of Aberdeen, studied pain-free volunteers aged between 18 and 65.

Images were taken of their spines using a magnetic resonance imager (MRI) in six postures ranging from leaning backwards to bending forwards as if to touch their toes. A special computer method called “shape modelling” was used on each of

The degree to which spines were curvy or straight correlated with whether the volunteers stooped or squatted to lift the objects from the floor TALKBACK l ISSUE 4 2014

their images to describe the shape of their lumbar spine, whether curvy or straight.

The volunteers then attended a motion analysis laboratory where special cameras were used to video them while they lifted a box with weights inside it from the floor in the way they found most comfortable.

A weight that was “moderately heavy” was chosen by each person and these varied from six to 15kg. Researchers then compared how people with different spine shapes moved when lifting the box.

Professor Aspden added: “Our research showed that not only is the curve of our lower back specific to each individual, it also affects the way we lift objects from the floor. The degree to which spines were curvy or straight correlated with whether the volunteers stooped or squatted to lift

the objects from the floor.

“We’re clearly not all the same, so should guidelines be telling us to lift in the same way? Giving more attention to our individual spine shape could allow these guidelines to be better tailored to individuals.”

“Back pain is costly to the NHS and employers. It is common in manual occupations involving lifting and it can be devastating for the patient when they are no longer capable of performing their job.

Understanding the mechanisms behind occupational back pain can allow for more appropriate prevention strategies.”

Dr Adam Al-Kashi, Head of Research and Education for the charity BackCare, said: “We are all unique, yet we are all human, and somewhere in between we hope to strike a clinically-relevant balance.

TALKBACK RESEARCH 11

By challenging some popular myths about posture and lifting, this work serves to shift that balance towards a more tailored approach.”

The academic abstract titled “Intrinsic shape of the lumbar spine and its effect on lifting manoeuvres” was published in The Bone & Joint Journal, Orthopaedic Proceedings and can be viewed online at www.bjjprocs.boneandjoint.org.uk/ content/96-B/SUPP_4/17.abstract It was awarded best paper at the annual meeting of the Society for Back Pain Research supported by BackCare.

Anastasia Pavlova was supported by a PhD studentship donated by Roemex Ltd to the Aberdeen Centre of the Oliver Bird Rheumatism Programme at the Nuffield Foundation.

The University of Aberdeen’s Anastasia Pavlova, centre, with the award

Editor’s commentary In 2012, Dr Jos Verbeek and colleagues from the Finnish Institute of Occupational Health published a Cochrane systematic review entitled “Proper manual handling techniques to prevent low back pain” in the journal Work.

The abstract begins: “Training and provision of assistive devices are considered major interventions to prevent and treat low back pain among workers exposed to manual material handling.”

They reviewed 18 trials involving more than 21,000 workers. And the result?

“None of the included trials provided evidence that training and provision of assistive devices prevented low back pain when compared to no intervention or another intervention.”

These results would appear to suggest that if “proper” lifting techniques can prevent back pain, one size certainly does not fit all, and what may be best practice for one person may hold no advantage for their colleagues attending the same manual handling training.

Evidence in growing support of a tailored approach to preventative training perhaps parallels the clinical transition from authoritarian/one-size doctoring to the current standard of patient-centred care.

It may also parallel the compelling body of evidence showing that it is individual/ personal factors, rather than fixed external factors, that most powerfully predict and determine who will develop back pain and, indeed, who will not recover.

We can think of lifting technique as covering the transition between postures

under load in order to segue usefully from an ergonomist’s biomechanical perspective of manual handling into an Alexander Technique (AT) teacher’s psychophysical perspective of poise and performance.

In 2011, 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 Risk in Spain, explored international precedents where AT was being applied for the prevention of workplace musculoskeletal disorders (see pages 18-19, TalkBack, Issue #3, 2014). In contrast to Verbeek’s 2012 Cochrane review, Griso found that AT in the workplace setting afforded significant physical, psychosocial and business level benefits.

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.

Psychological benefits included stress management and improvements in: self-esteem; public speaking; creativity; concentration; teamworking; and the work environment.

Business benefits included: reduced work hours lost to illness; reduced accidents; reduced employment insurance; improved costs-profits relationship; and improved work performance.

A third perspective worth visiting briefly might be that of the powerlifting athlete.

Their business is simple – to become as strong as possible at performing three

movements: the deadlift (bending to lift a load off the ground); the squat (squatting and returning to standing with a load poised on the back of the neck); and the benchpress (lowering the load from outlocked arms to chest and pressing it back up while lying flat).

Having acquired a deep appreciation for their own unique body, the athlete will choose variations on a given movement to provide them with a competitive advantage, for example based on factors such as limb length ratios which govern leverages.

The “proper” technique is an individual choice from a number of variants, made to enhance performance. This movement will then be trained under conditions of progressive overloading to learn the motor pattern and get stronger. This template of training and performance combines universal principles (e.g. progressive overloading) with choices based on individual factors (e.g. movement variation selection).

Seemingly contrary perspectives and evidences cannot be ignored, not least because they are the very means through which we evolve any field of applied knowledge to tie the loose ends and render a more robust model. To reiterate my above quote in closing, we are all unique, yet we are all human, and somewhere in between we hope to strike a clinicallyrelevant balance. By challenging some popular myths about posture and lifting, this work serves to shift that balance towards a more tailored approach.

TALKBACK l ISSUE 4 2014

12 TALKBACK EDUCATION

Five common patterns that predict your back pain future Most episodes of back pain get better quickly and without needing treatment.

Unfortunately, for more than two million UK adults each year, the pain doesn’t go away. Now, growing evidence suggests that the way you think and feel can accurately predict whether or not you’ll recover from back pain…

How you feel about pain predicts your chances of making a speedy recovery

But how can psychology predict pain? Put simply, feeling stressed or anxious increases our stress hormone levels, making the body more symptomatic over time. And old-fashioned thinking about back pain can lead us to make bad health decisions that can block recovery.

The evidence is so strong that GPs and physiotherapists look for these barriers to

recovery (Yellow Flags) in order to best help those at high risk of developing long-term back pain. Early identification and management of psychological risk factors has been found to be effective at preventing long-term back pain. If you already have back pain and strongly agree with four out of these five statements, you are at high risk of developing chronic back pain.

1) “It’s not really safe for a person with a condition like mine to be physically active” Back pain itself is not harmful. The belief that back pain is harmful, or that it indicates damage or further injury, often causes people to avoid physical activities for fear they’ll make things worse. In fact, this kind of fear avoidance behaviour (kinesiophobia) predicts long-term pain and disability. A tailored programme of Cognitive Behavioural Therapy (CBT) which reduces fear and changes pain beliefs has been shown to increase the back pain recovery rate.

runaway thoughts; and cultivate new positive thought patterns. These kinds of techniques have been shown to be effective, but do require motivation and engagement.

2) “Worrying thoughts have been going through my head a lot of the time” Stress, tension and anxiety make you more likely to develop back pain and less likely to recover, so they’re really central to effective back pain prevention and treatment. The trouble is that stress is often invisible or becomes accepted as a normal part of our hectic lifestyles. Patients are naturally uncomfortable with the idea that stress is making their health worse, but often don’t realise that it makes all the difference. Talking therapies or self-help practices can be used whenever stress or anxiety are identified.

3) “I feel that my back pain is terrible and it’s never going to get any better” Assuming the worst (catastrophising) and repetitive thinking (ruminating) predicts long-term pain and disability. CBT can be used to tackle these negative thought patterns. The basic approach involves techniques to: become more aware about your mental activity; learn to halt

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4) “In general, I have not enjoyed the things that I used to enjoy” When back pain takes over it can become impossible to enjoy life. Unfortunately, struggling to cope with pain and disability (lower selfefficacy), is known to affect stress hormones and other systems in the body and ultimately predicts poor chances of recovery. Again, while the way people think and feel is commonly assumed to be a fixed part of their personality, evidence shows that CBT is an effective approach to increasing self-efficacy.

5) “Overall, my back pain has been very bothersome in the last two weeks” The more you are bothered or troubled or burdened by pain, the longer it will take to recover. This does not mean you should ignore pain and suffer in silence, but research shows that how you feel about the pain predicts your chances of making a speedy recovery.

BackCare’s own research has shown that it also predicts whether you’ll have other physical symptoms – compared to people who are “bothered a little” by their back pain, people who report being “bothered a lot” are around 50% more likely to also have stomach pain and chest pain. Again, burden is a function of coping, and approaches such as CBT are recommended.

TALKBACK ADVERTORIAL 13

&

Stand Up to Back Pain

A partnership between www.backcare.org.uk and www.varidesk.co.uk Prolonged sitting in the workplace is a hot topic at the moment and studies are revealing that the sedentary lifestyle can lead to serious health issues such as diabetes, obesity, heart disease and cancer.

What isn’t being focused on as much, and something that affects a big percentage of the population, is the effect that sitting all day can do to your posture. Sitting at a workstation, even when set up correctly (which a lot are not), can lead to neck and back pain. A simple solution is to install a sit to stand adjustable desk, which will allow the user to go from sitting to standing within seconds. It will also allow the monitor to be positioned at the correct eye level and keyboard tray at the right height, minimising any stoop or bad posture.

Back pain is not only physically debilitating to its sufferers, it is also damaging to the economy. According to the Work Foundation, it costs the EU (the UK included) a staggering €240bn (£200bn) a year. As part of musculoskeletal conditions, a range of bone and joint ailments, it’s responsible for lengthier absenteeism from work than other illnesses.

Among those advocating back pain awareness, the director of the Centre for Workforce Effectiveness at the Work Foundation, Professor Steve Bevan, explains how sitting has become a major cause of illness in the office. Sitting is the new smoke is now a proverbial statement, and it has its foundations in years of research. The sad fact, however, is that those who suffer from back pain as a result of sitting, might be relieved of their ailment later on, but there is still a danger of it becoming a long-term condition as a result of their persistent sedentary lifestyle.

To create awareness around back

pain in the UK, VARIDESK, together with BackCare, has launched the Stand Up to Back Pain Awareness Campaign.

VARIDESK is a sit to stand solution that sits on top of your existing desk. Mike Mayos, one of the company’s directors, said: “You’ve seen the figures. Back and neck pain is seriously hurting lives and damaging the economy.

“We’ve launched the campaign to try to create awareness around the condition, get more people involved and, ultimately, help everyone out of their chairs and become more active. It’s our vision to get people standing and we want to help everyone avoid or treat back pain effectively.”

Back and neck pain affects 60% to 80% of adults at some point in their lives WIN a free sit/stand desk and osteopath visit To launch the partnership between VARIDESK and BackCare, VARIDESK is giving 10 winners a free sit/stand desk and visit to an osteopath.

Entrants need to nominate someone they think would benefit from the free sit to stand workstation and osteopath session. Visit www.standuptobackpain.co.uk to complete your entry.

All you have to do is let VARIDESK know why the person you are nominating deserves the desk and osteopath session in 200 words or less. It could be: l your hardworking spouse or parent who’s been suffering from unbearable back problems l a teacher who puts their back into it, both in class and on the sports field, and is feeling the strain l an inspirational friend who is always hands on doing voluntary work for the community and those in need.

Entries will be mediated by a panel of BackCare judges who will pick the 10 most inspirational stories and send the winners a VARIDESK and free time with an osteopath. What’s more, VARIDESK has pledged to donate £2 for every desk it sells, with the proceeds going to BackCare efforts. Mike Mayos said: “We want to give as much to the community as we can, encourage a healthier, more productive lifestyle, and build values everyone can connect with. It’s an exciting time for us right now.”

The competition is open now; the first five winners will be announced on 23 December and a further five on 31 January 2015. l For more information, contact VARIDESK on sales@varidesk.co.uk or +44 20 7193 1197.

TALKBACK l ISSUE 4 2014

14 TALKBACK PARTNERS

DISCIPLINES OF PRACTICE More than a dozen therapeutic disciplines are represented among BackCare’s own professional members – including acupuncturists, Alexander Technique teachers, chiropractors, physiotherapists, Pilates instructors, psychological therapists, surgeons and yoga teachers.

As a patient seeking medical care, it’s important to gain some understanding of the different approaches available as they each offer their own unique perspectives, evidences and outcomes.

As a practitioner, it can be useful to touch base with other communities of practice to gain deeper clarity through comparative study – often the most powerful evidences are the ones that serve to question our own current outlook. Interestingly, there are also, typically, multiple sub-schools of thought within each discipline of practice and these are often represented by distinct organisations.

The NICE clinical guidelines on the management of non-specific low back pain (CG88) were published in May 2009 and are due for revision republication in November 2016.

The current version outlines recommendations for the treatment of low back pain in adults that has lasted between six weeks and 12 months and is not the result of cancer, fracture, infection, auto-immune disease or red flag conditions such as cauda equina syndrome. Among the current recommendations are acupuncture and manual therapies.

In this issue, we have invited four professional member organisations representing acupuncture and manual therapies to present something from their perspective: the Institute of Osteopathy (formerly the British Osteopathic Association, on the page opposite); the British Acupuncture Council (p16); the British Medical Acupuncture Society (p17); and the British Chiropractic Association (p18).

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TALKBACK PARTNERS 15

The Institute of Osteopathy

Eleven things you may not know about osteopathy 1) Osteopaths don’t just treat backs They take a whole body approach to your health and treat a wide range of conditions. They use manual therapy, which includes massage, mobilisation, stretching muscles and relieving tension in the body, to help create the conditions your body needs to heal. An osteopath may also be able to identify whether a pain in one part of your body is caused by a problem somewhere else.

4) They are regulated Osteopaths are regulated by the General Osteopathic Council1 (GOsC), which works to ensure that high standards of care and patient safety are maintained. In the UK, it is illegal for anyone to call themselves an osteopath if they are not registered with the GOsC.

8) Osteopaths can work with your GP or other health professionals Osteopathy can complement the treatment you receive from other health professionals, including your GP. With your permission, your osteopath can share their notes about your condition and the treatment they have provided with other people involved in your care to ensure that you get the best possible treatment. They are also able to interpret test results, scans and x-rays that may inform their diagnosis and treatment of your condition.

5) It has an excellent safety record Serious adverse effects as a result of osteopathic treatment are very rare, between one and two patients in 100,000 will experience a major adverse event as a result of osteopathic manipulation3.

Osteopaths take special care to check patients before treatment for existing conditions or symptoms that may indicate it might not be appropriate to treat a patient.

9) They can refer you for further investigations or treatment Osteopaths can’t treat every condition, but are educated in who might be better able to.

They can refer you to a more appropriate health professional and prepare a report on your symptoms and the treatment they provided. If you prefer, you can ask for a copy of your notes to take back to your GP or show to someone else who is treating you.

1) www.osteopathy.org.uk 2) http://www.nice.org.uk/guidance/cg88/chapter/guidance 3) Carnes D et al – 2009, Adverse events in manual therapy: a systematic review. http://bit.ly/11yes6Z 4) iO osteopathic census 2014

2) They are qualified to degree level, and above To qualify as an osteopath they must study for at least four years, learning about anatomy, physiology, pharmacology, pathology, nutrition, psychology and medical imaging as well as osteopathic technique.

Osteopaths must, by law, continue their training after they graduate to keep up to date. Many osteopaths will achieve further qualifications to specialise in treating specific patient groups or conditions.

3) It’s very gentle Although some manipulation techniques may occasionally result in an audible click, most people find osteopathy gentle and painless.

Because osteopaths take a full medical history and complete a thorough examination before starting treatment, they can ensure they use the most appropriate and safe techniques for each patient.

6) You won’t have to wait If you are self-referring, you can usually get an appointment to see an osteopath within 48 hours.

Early intervention can promote faster recovery and get you back to health quickly.

7) It’s approved by the NHS NICE guidelines2 recommend manual therapy, provided by an osteopath, for treatment of low back pain and there are an increasing number of osteopaths employed by the NHS to provide musculoskeletal treatment to patients.

10) You don’t need a referral from your GP If you are paying for your own treatment, you can make an appointment with an osteopath without the need for a referral from your doctor. Osteopaths are primary healthcare professionals, which means that, because of their knowledge and the way they take a comprehensive medical history when assessing your health, they can provide treatment to most patients without the need for information from your doctor.

11) It’s not as expensive as you might think The average fee4 for an initial consultation is £48 and subsequent appointments average at £42. Most osteopaths provide some treatment during your first appointment and will discuss how many further appointments you are likely to need.

To find out more about osteopathy and locate your nearest osteopath, visit www.osteopathy.org The Institute of Osteopathy (iO) is the professional body for registered osteopaths in the UK.

TALKBACK l ISSUE 4 2014

BAcC brand with a top right corner crop

On your artwork please ensure you align our b with your top right corner crop mark

16 TALKBACK PARTNERS

DISCIPLINES OF PRACTICE British Acupuncture Council

Unique system can play its part on road to recovery Acupuncture has come a long way from the days when it was perceived as a cranky alternative – many orthodox healthcare professionals like doctors and physiotherapists regularly use acupuncture within their own work.

However, traditional acupuncturists, trained to degree level and drawing on the 2,500-year history of Chinese medicine, provide the great majority of professionals who practise full time. Of these, the British Acupuncture Council (BAcC) represents the largest number, with more than 3,000 members.

Formed in 1995 from five associations which were themselves created as early as the 1960s, the BAcC’s primary aim is to protect the public interest, even above looking after its members’ interests.

So successful has it been in setting exemplary standards, that it was one of the first two professional bodies to be accredited by the Professional Standards Authority under its Assured Voluntary Register scheme. Anyone being treated by a BAcC member can be certain that the treatment is safe and effective, that the practitioner is personally accountable for their standards and has “gold standard” professional indemnity insurance, and that the BAcC is there to provide support, information and redress, if any is needed.

Acupuncture treatment is a great deal more than simply sticking needles in where it hurts. Traditional Chinese medicine was more concerned to see symptoms in the wider context of someone’s overall patterns of health.

When the great Canadian physician William Osler said: “It is much more important to know what sort of person has a disease than what sort of disease a patient has,” he could have been describing the diagnostic processes of Chinese medicine.

Practitioners take a detailed case history covering all aspects of the patient’s health, and use a number of techniques – Eastern, like taking the pulse and looking at the tongue, and Western, like taking blood

TALKBACK l ISSUE 4 2014

pressure – to form a view of the most elegant and simple way to begin to restore balance in the system. It is not a truism to say each person is unique and different; 20 people presenting with the same symptom might well be treated in 20 different ways.

Treatment involves the insertion of single-use, ultra-fine needles into the skin.

Treatment is usually given once weekly for four or five weeks, and most practitioners will review progress at this point or even before this.

Our surveys show that treatment of lower back pain is among the more frequent reasons for people to visit a traditional acupuncturist. The evidence for its use is good enough for NICE (the National Institute for Clinical Excellence) to have included it within the recommendations for chronic low back pain, migraines and tension-type headaches and we find more and more healthcare professionals working in concert with our members to ensure

joined-up treatment.

In ancient times, the Chinese doctor was paid to keep you well, not to get you better. Going to the doctor when you were already sick was, they said, like forging a spear after the battle had started or digging a well when you were already thirsty. This message is gradually getting through. We used to say, get better and stay well. Now the message is stay well and get better.

Back pain is so common that it sometimes gets less acknowledgement than it should. “Oh, everybody gets that from time to time,” they say, but, as we know only too well, it can be a source of great misery and despair. We are grateful we have a unique system of medicine which can play its part on the road to recovery.

To find more details or to find a registered practitioner in your area, visit www.acupuncture.org.uk or call 020 8735 0400.

p mark

brand

TALKBACK PARTNERS 17

British Medical Acupuncture Society

Ancient knowledge still relevant in 21st century Acupuncture has probably been around almost as long as back pain has.

When the 5,000-year-old mummified body of a man was found in the Austrian/ Italian Alps in the 1990s, scientists noticed marks tattooed into his skin at a number of points where an acupuncturist now might choose to needle a patient for low back pain and knee pain (pictured right).

Just as we might instinctively press or rub that sore or tight place in our aching back, Ötzi the Iceman seems to have markings on his skin at points where needling or pressure could have given him relief from his pain.

But a 21st century patient might wonder whether a treatment as old as Ötzi the Iceman can really be useful in the modern world.

Researchers have shown that acupuncture can, indeed, affect the central nervous system, modulating how pain is experienced by the individual patient, as well as in other ways such as helping to release painfully tight muscles.

We are starting to understand just how acupuncture works in the context of the anatomy and physiology we know today.

The British Medical Acupuncture Society (BMAS) was formed more than 30 years ago by a group of doctors who recognised the potential of acupuncture within contemporary medicine and wanted to promote education and research into its mechanisms.

Today, membership of BMAS is open to a range of healthcare professionals.

You might find your GP can offer acupuncture for your back pain, but he or she might refer you to a physiotherapist who can incorporate it into their treatment for your back. If your pain is more intractable, you might be referred to a pain clinic and receive acupuncture from a nurse as part of your care there.

Acupuncture is increasingly accepted in mainstream healthcare and NICE guidelines currently include acupuncture as one option for the treatment of low back pain.

So you think you might like to try acupuncture? NICE guidelines advise a course of up to 10 treatments for low back pain, and it is worth persevering if you don’t get instant results at the first session.

Most patients notice an improvement within six sessions if acupuncture is going to be of benefit. As with most medical treatments, there are some patients who just don’t respond or don’t get on with acupuncture. But for those who do, and for their acupuncturist, the results can be very rewarding.

Acupuncture needles are sterile, singleuse needles. They are very fine and much less traumatic than needles used for giving injections or taking blood. Treatment might involve inserting as few as one or two needles, but could be 10 or more, dependent upon the nature of the pain.

Needles are usually inserted as close to the pain or source of pain as possible, but often treatment will also include needling of the limbs which can add to the effect.

Needles are usually left in for a few minutes and sometimes stimulated to increase the benefit, either manually or by applying an electrical current between pairs of needles.

Any side effects are usually short-term and might include very slight bleeding or bruising, sedation or, occasionally, fainting.

Your acupuncturist should take extra care if needling the upper back or chest area to avoid the needle entering your lung.

If you receive acupuncture treatment within the NHS, it will be provided by a regulated health professional who is bound by a code of practice to needle safely.

Where acupuncture is offered privately, you are advised to check that the practitioner is registered with an organisation which regulates its members.

The larger organisations in the UK are the British Medical Acupuncture Society, the Acupuncture Association of Chartered Physiotherapists and the British Acupuncture Council, all of which have websites with a search option to help you find a practitioner near you.

The British Medical Acupuncture Society offers training in medical acupuncture for regulated health professionals.

Allyson Brown BMAS London Office bmaslondon@aol.com USEFUL WEB ADDRESSES British Medical Acupuncture Society www.medical-acupuncture.co.uk Acupuncture Association of Chartered Physiotherapists www.aacp.org.uk

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18 TALKBACK PARTNERS

DISCIPLINES OF PRACTICE British Chiropractic Association

Chiropractors – the spinal care experts The British Chiropractic Association, which celebrates its 90th anniversary in 2015, is Europe’s largest national chiropractic association.

With nearly 1,400 members, the BCA represents over half of the UK’s practising chiropractors. It is a key stakeholder within European chiropractic and is regularly consulted on issues affecting the profession. The Association’s mission is to support its members and promote the profession as spinal care experts.

Chiropractic is a registered primary healthcare profession. Chiropractors are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints and muscles); they have a specialist interest in neck and back pain. Chiropractors use a range of techniques to reduce pain, improve function and increase mobility, including hands-on manipulation of the spine.

Far from being considered as a complementary or alternative medicine, chiropractic is now respected as a mainstream healthcare profession providing expert spinal care.

The evidence supporting chiropractic, statutory regulation and a university level Masters level education all ensure the public is protected and that today’s

TALKBACK l ISSUE 4 2014

chiropractors are trained to the highest standards.

The recommendation of spinal manipulation for persistent low back pain in the 2009 NICE guidelines and the recommendations of the BEAM (back pain, exercise and manipulation) trial suggest that not only is the provision of chiropractic care clinically indicated for back pain, it is a cost-effective intervention for a condition estimated to cost the UK £5bn each year.

A study conducted by the North East Essex PCT offered patients a choice of providers of chiropractic, physiotherapy or osteopathy, prompt access to care and easier access. With appointments provided within two weeks and up to four sessions of treatment, the results of the pilot study were staggering. Analysis of the 2,810 patients taking part revealed reduced costs, fewer inappropriate referrals and improved outcomes. Most significantly, referrals to spinal surgeons were reduced by more than 25 per cent.

In 2012, for the first time in Olympic history, chiropractic was offered as a service within the polyclinic at the London 2012 Games. This, and the inclusion of chiropractic within multidisciplinary care teams of many athletes and professional teams, illustrates the positive impact

of chiropractic within elite sport, both on athletic performance and injury management.

Modern chiropractors embrace the concept of interprofessional collaboration and teamwork. Many work within GP practices or closely with GP colleagues in local communities. Increasingly recognised for their expertise in spinal management in general and manipulation in particular, chiropractors are now called upon to provide input in both acute and chronic back pain cases.

At the first visit, a chiropractor carries out a thorough assessment and asks the patient about their current condition, medical history and overall health. They will then carry out a physical examination and perform a range of tests. If the chiropractor is unable to help, or feels that some other treatment would be more beneficial, the patient will be referred to a GP or to another appropriate healthcare professional. Further investigations may be indicated and the chiropractor will explain why they are necessary.

The chiropractor will then explain what is wrong and discuss a care plan, which will set out what can be expected when receiving chiropractic care. Chiropractors will provide a package of care for their patients and this can include manipulation – where the chiropractor uses their hands to apply quick, precise thrusts to the restricted joints of the spine – as well as massage, stretching, electrotherapy and the gradual moving of joints (“mobilisation”).

Some chiropractors use medical acupuncture techniques. Self-help advice and rehabilitative care form an important part of chiropractic treatment and patients are given advice on how to manage the condition and prevent it from recurring.

Patients want and deserve choice in the treatment of their back pain. The availability of more trusted and safe treatment options can only serve to meet that need and start to make significant steps forward in the successful treatment of this prevalent and debilitating problem.

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

19

Dehydration increases pain, anxiety and fatigue

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

TALKBACK l ISSUE 4 2014

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 right.

If you’d like to start a branch in your area, please contact info@backcare.org.uk

West London Branch The West London Branch was set up in 1999 and originally started by holding monthly talks on “back” subjects. It then also ran hydrotherapy classes locally until the hospital hydrotherapy pool closed down.

Currently, we run a stretch and relaxation class every Tuesday morning (10.55-11.55am, term time only). The class costs £5 (subsidised by the branch) and is held at St Andrews Church Centre, Mount Park Road, London W5, not far from Ealing Broadway Centre.

Everyone is welcome and you just need to ring and say you wish to try it out. Just remember to wear easy clothing and bring a mat to lie on.

The class is based on a hospital stretch and relaxation programme.

Teresa Sawicka

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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 763636 Email: chris.sissons@btinternet.com

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

HARROGATE & DISTRICT • 32 members Contact: Mrs Lin Tippey Telephone: 01423 865946 Email: keithandlin2@btinternet.com

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

HULL & EAST RIDING • 90 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

Hull and East Riding Branch The branch was formed in 1995 (our 20th birthday next year!) with a walking group and exercise in a hydrotherapy pool. After our official launch, we started monthly speaker meetings and an equipment loan service. Later, there followed an easy line dancing group and healing days.

All these sections continue to thrive. They are all organised by their own sub-committees so the main committee has comparatively few responsibilities – mainly the membership list, organising open days and the AGM. Probably the reason for our longevity is the emphasis we put on the social side. Each group organises a social event, usually a meal or party, and many branch events have been held such as barbecues, petanque tournaments and a dinner dance at Christmas. Even the speaker meeting has a social side with a quiz and time to chat.

Beryl Kelsey

Reading Branch Reading branch of Back Care was formed some years ago and originally met at the Battle Hospital hydro pool.

Since it closed, they have been at Pulse 8 at Winnersh.

We have a strong membership which meets every Tuesday evening, accommodating some 11 people, at each of 11 sessions, with the aim of improving core body strength under the tuition/instruction of a physiotherapist and a helper. The sessions run for sixweek periods, with any holiday gaps by members being filled by potential new members having a trial taster session. We also have a couple of social evenings a year, just to have a good catch-up.

Richard Goddard

Harrogate and District Branch Twenty-five years ago when Harrogate BackCare began, 49 people joined as members in its first year.

Today, the branch still has 32 active members including four from the original team. Our principal activity now is hydrotherapy which is helping many members to reduce and manage their back pain. We use the facilities of a hydrotherapy pool in Ripon where our experienced instructors provide a programme of back exercises designed specifically to benefit our members.

Members also enjoy the regular social events we organise throughout the year – a monthly luncheon group, summer party, Christmas lunch and annual fundraising raffle.

Lin Tippey

TALKBACK BRANCHES 21

sea BackCare Branch

Members of the Swan

Southampton Branch Southampton branch was set up more than 32 years ago with the help of physiotherapists and other senior staff at Southampton General Hospital to provide help for people with back pain.

The branch has 32 members and gives support through hydrotherapy sessions, friendly help and practical advice. Weekly sessions are held on Mondays at Southampton General Hospital, where the two one-hour sessions run from 6-8pm. These sessions are valuable for the exercise programme, regular social interaction and ongoing practical help and advice from qualified physiotherapists.

There is an annual spring lunch and speakers are invited to talk about back-related issues at the AGM. Dr Lisa Roberts is our vice-chairman and consultant physiotherapist.

Through her, members are encouraged to volunteer and take part in ongoing research programmes about backrelated topics. Newsletters with information and details of events are sent to all members three times a year.

Irene Bowron

on their summer stroll

Lothian Branch, Scotland Lothian is the only branch of BackCare in Scotland. It has been running in Edinburgh for 30 years, currently has 66 members, and is run by a committee of volunteers.

We organise the opportunity for warm water exercise sessions in a hydrotherapy pool with a lifeguard and physiotherapist in attendance. These sessions are available once a week throughout the year. There is also a swimming club held in a full-sized warm water pool, giving the opportunity to swim as well as do exercises. This runs once a week during school terms.

These are our main activities. As well as offering the undoubted physical benefits, a lot of mutual support is exchanged as people share ideas and experiences and benefit from realising that you are not alone and there is always someone worse off than you are! The social aspect is very important.

We publish a local newsletter three times a year and arrange occasional social events. We have an annual fundraising coffee morning for BackCare week. Last year, we supported three marathon runners and made a contribution to the BackCare helpline with the funds raised. We hope to do the same this year.

Jean Houston

Swansea Branch Swansea BackCare is now in its 22nd year and has nearly 60 members. The branch is particularly fortunate to have as its President, Gary Coates MCSP SRP, who is very active and supportive in all we do.

The annual programme consists of a mixture of evening talks associated with back care but also with social events, plus hydrotherapy classes which are run for us at Singleton Hospital by its Physiotherapy Department.

There are four (hour-long) classes each week and 38 members take advantage of these classes which have become a focal point for the branch.

A highlight in the programme is the annual walk along Swansea’s beautiful promenade when members, after free coffee, walk a distance to suit them around the bay and then meet up for lunch. The Summer Social aims to raise funds for BackCare’s research and the branch normally donates about £500 annually to the charity.

Tony Davies

TALKBACK l ISSUE 4 2014

22 TALKBACK ADVERTORIAL

TALKBACK l ISSUE 4 2014

TALKBACK ADVERTISING AND SUBSCRIPTIONS 23

Advertising in TalkBack Talkback is the only back pain magazine in the UK. It is published by BackCare, the charity for back and neck pain for more than two decades. It caters for the increasing number of people who are suffering from back pain – nearly 80% of the UK population – and healthcare professionals.

TalkBack is produced quarterly and generally includes the following editorial content: l Latest developments and approach to back pain and in its management l Health and exercise l Articles aimed at prevention of back pain l Patient centred approaches to treatment l Research news l Sections specially targeted to BackCare professionals and therapists l Readers letters l BackCare branch news and events l Back product testing and the latest gadgets For artwork specifications, to book your space, or for more information, email Sri Seshadri, chief operating officer, at sri@backcare.org.uk

Rates 2” × 2” Box Advert

£100

QUARTER PAGE

£150

HALF PAGE

£300

FULL PAGE

£600

INSIDE FRONT COVER

£800

OUTSIDE BACK COVER

£800

ADVERTORIAL – FULL PAGE

£800

LOOSE INSERTS

£150

All costs include VAT

Issues and dates

Talkback is quarterly, i.e. four issues a year.

Issue 1 – published in March (advertising deadline 15 February).

Issue 2 – published in June (advertising deadline 15 May).

Issue 3 – published in September This is a special bumper edition in line with the theme of BackCare Awareness Week campaign for the year (advertising deadline 15 August).

Issue 4 – published in December (advertising deadline 15 November).

Circulation: 3,000 plus 50,000 digital.

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.

Credit/Debit Card

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Expiry Date

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Start Date

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Email

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Telephone

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Name

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Address

Where you got this copy.................................................................................

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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.

TALKBACK l ISSUE 4 2014

Why Back Pain?

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