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

SUMMER n 2016

FREE TO MEMBERS

Britain’s 6.5m unpaid workers

also in this issue: Workplace Flexible home workers still suffer back pain Lifestyle & home Assistive devices offer greater independence Public health Counting the cost of obesity prevention www.backcare.org.uk

2 TALKBACK NEWS

JOIN OUR GROWING NATIONAL NETWORK TODAY 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 branches@backcare.org.uk

TALKBACK l SUMMER 2016

CAMBRIDGE Contact: Ms Mary Griffiths Telephone: 07787 990214 Email: blincomary@gmail.com

READING Contact: Telephone: Email:

Mr David Laird 0118 947 0709 davidlaird@talktalk.net

DERBY Contact: Telephone: Email:

Mrs Christine Sissons 01332 763636 chris.sissons@btinternet.com

SALISBURY Contact: Telephone: Email:

Mrs Barbara White 01722 333925 white.alan@btinternet.com

ESSEX Contact: Telephone: Email:

Mrs Lyndee Oscar 01206 804353 lyndee@kidsbacks4thefuture.co.uk

SOUTHAMPTON Contact: Mrs Jo Goudge-Riley Telephone: 02380 464170 Email: goudgeriley@gmail.com

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

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

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

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

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

WEST MIDLANDS Contact: Mrs Thelma Pearson Telephone: 01902 783537

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

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

TALKBACK LEADER 3

Maintaining a healthy work-life balance A French worker made headlines recently when he took his former employer to a tribunal claiming his tedious job had turned him into a “professional zombie”. Ex-perfume company executive Frederic Desnard said he had been given so little to do that he suffered from “bore-out” (as distinct from burn-out which is usually associated with overwork), and described his four-year journey as a “descent into hell”. M. Desnard listed exhaustion, sleep problems and depression among a succession of health issues he’d experienced as a result of being sidelined with mind-numbingly dull work. Such symptoms, it so happens, just as readily apply to many a harassed employee struggling to cope with the physical and emotional demands of a job. Though seemingly polar opposites, these equally unwelcome aspects of the modern workplace can prove a significant source of stress, demotivating the individual and impairing performance. One design exercise to inspire bright ideas for workplaces of the future (page 16) showed that young people recognise the importance of maintaining a good work-life balance. With vivid imaginings of working pods that can be customised to suit the mood, interactive tablet desks, chairs that mould to your body, communal kitchens and on-site health centres, the project generated a wide range of ideas for helping employees remain stimulated, motivated and engaged.

Contents

In a change of tone, recognition that stress is an inevitable consequence of the (unpaid) job of a carer is the focal point for BackCare Awareness Week, taking place in October. Up to half of all carers experience stress and identifying its causes is an important part of self-care. Being a carer can be overwhelming and often involves major family adjustments, financial strain and huge personal sacrifice. The impact on a carer’s health can include headaches, back pain, fatigue, faintness and dizziness. In this edition (page 12), TalkBack helps identify the symptoms and discusses some simple steps to make sure you are getting the practical support you need.

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

New NICE guidelines for low back pain 5

Awards up for grabs for healthcare charities

9

Ensuring neck pain doesn’t impact on studies 19

Richard Sutton Editor

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

How to avoid “text neck” 20

Confidence through personal challenges

26

TALKBACK l SUMMER 2016

4 TALKBACK NEWS

Millions with care needs failing to adapt their homes More older people are living alone, but millions are failing to adapt their homes to help them live independently, according to the International Longevity Centre – UK (ILC-UK) in its new “State of the Nation’s Housing” report. Under half of those over 50 and with a limitation in an Activity of Daily Living (ADL) live in homes with any health-related adaptations, says the report. Estimates from 2012/13 suggest there were 1.86 million people over the age of 50 in England who had unmet needs. And yet, growing numbers of 45-74-year-olds are living alone, with around six million people living in houses with two or more excess bedrooms. Specialist retirement housing can offer more adaptations and play a part in supporting downsizing. However, the retirement housing supply gap is set to worsen, with analysts projecting a retirement housing gap of 160,000 homes by 2030. Baroness Sally Greengross, Chief Executive at ILC-UK, said: “Retirement housing could be a solution for some older people but we are building far too few of this type of housing. If older people are to live longer in their own homes, we must better support adaptations to allow them to continue to live independently.”

Approximately 87% of those in retirement housing have home adaptations, compared with around 60% of other housing. www.ilcuk.org.uk

• Over the last two years, 4% of people over the age of 50 moved home. • Of these movers, the highest proportion said the main reason was to move to a more suitable home (31.5%) which for the vast majority (65.5%) meant moving to a smaller home.

NHS delays increase risks for inflammatory arthritis sufferers Around four in every five patients with early inflammatory arthritis are at risk of preventable, long-term disability and reduced life expectancy due to delays in referrals to specialist advice and treatment services, according to an audit of rheumatology services across England and Wales. The first weeks and months after the onset of rheumatic disease symptoms are known as the “window of opportunity”, and it is crucial that patients get appropriate treatment in that time to maximise their chances of avoiding lasting complications. Early referral to, and assessment by, rheumatology services is vital and the report reveals that in most cases this does not happen. The National Rheumatoid and Early Inflammatory Arthritis Audit report, carried out by the British Society for Rheumatology (BSR), reveals that nationally just 20% of patients who see a GP with suspected

TALKBACK l SUMMER 2016

Greater awareness needed of the symptoms and the importance of quick treatment

rheumatoid and early inflammatory arthritis are referred to specialist services within the target three days set by the National Institute for Health and Care Excellence (NICE). Nationally, fewer than half of patients referred are seen by a specialist within the three-week time limit (also recommended by NICE). The report reveals considerable differences in achievement rates for the

standards across England and Wales. A postcode lottery means that, depending on where patients live, they are far more or less likely to access treatment at an early stage and hence prevent the disease becoming more advanced and lifeshortening. For example, patients in Wales are half as likely to see a specialist within three weeks as those living in London. There are significant personal and society costs linked with inflammatory and rheumatoid arthritis. Around 10 million people have a form of arthritis, of which almost 700,000 have rheumatoid arthritis. Around 12,000 children suffer from juvenile idiopathic arthritis. Arthritis can be so severe that some sufferers cannot bathe or dress themselves or perform simple tasks such as walking a short distance. Rheumatic conditions can also damage vital organs, including the lungs, heart, nervous system, kidneys, skin and eyes.

TALKBACK NEWS 5

The best practice statements will help inform patient expectations of their interaction with their osteopath based on national quality standards

Institute of Osteopathy introduces Patient Charter

New NICE guidelines for low back pain New guidelines for the management of low back pain and sciatica are due to be published in September. The updated draft from the National Institute of Clinical Excellence (NICE) was issued for consultation by stakeholder organisations in the spring. In formulating their response on behalf of the osteopathic profession, the Institute of Osteopathy (iO) and National Council for Osteopathic Research (NCOR) said they were encouraged by the inclusion of a combination of manual therapy and exercise for low back pain. The draft guideline recommends exercise, in all its forms (for example, stretching, strengthening, aerobic or yoga), as the first step in managing low back pain. Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to

show they are of benefit when used alone, says NICE. The draft guideline also recommends encouraging people to continue with normal activities as far as possible. The draft guideline no longer recommends acupuncture for treating low back pain (see Viewpoint, pages 6/7). Paracetamol on its own is no longer the first option for managing low back pain. Instead, the draft guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable. The updated draft guideline has been expanded to include people with sciatica, a condition typically caused by irritation or compression of the nerves that run from the lower back, through the legs and to the feet.

The iO has introduced a new Patient Charter to enable members to better illustrate their commitment to patients. The charter is intended to help raise the profile of the profession with key stakeholders, including service commissioners, insurance companies, other healthcare practitioners and patients. It will offer osteopaths: l a mechanism to demonstrate a commitment to providing quality patient care to a nationally recognised standard l evidence of iO and Osteopathic Development Group endorsement l a “gold standard” framework to benchmark their practice against l an opportunity for business development as a point of differentiation. The iO said: “We recognise the vast majority of osteopaths will already be applying all of the behaviours and values suggested by the charter and that minimal change in practice would be required in the majority of circumstances.”

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6 TALKBACK VIEWPOINT

Acupuncture and the NICE NICE is in the middle of reviewing its guidelines for the management of low back pain. But is it missing the point of what it is like to have a back problem, asks Paul Hitchcock, Chief Executive at the British Acupuncture Council.

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W

hile back pain is in itself a debilitating and potentially disabling condition, sufferers so often have a second or third long-term condition simply as a result of advancing age; in the language of clinicians, we patients have comorbidities. There is also, at last, recognition that it is not the “illness” or condition itself that is the problem but the effect that it has on our lives. We will all have seen it in our families and communities: once confidence is lost and independence compromised, the overall health of that person suffers. Hence my original question as to why are we still looking at single conditions? Read the strategy documents from NHS England (Five Year Forward View 2014, GP Forward View 2016) and the mantra is all about wellbeing. Look at where the government is investing in change in both health and care: the integration projects, the New Models of Care programme, emerging primary care changes and the most radical of all – Devo Manc (the irreverent nickname of a project to integrate all health and care services across the whole of Greater Manchester), and we have emerging systems where integration around the patient enables treatment and support to the patient as a person, not a collection of individual clinical problems.

So if the need is to help an individual manage his or her wellbeing, then the answer has to be more holistic than the reductionist method of identifying and treating single disorders that underpins the bio-medical model embraced by the NHS and the “medical establishment.” And it is here that two medical worlds collide. Traditional Chinese Medicine (TCM) looks at the whole patient and by restoring balance and wellbeing has an effect upon discrete identifiable conditions. In Western terminology, the whole TCM process can be said to be enhancing wellbeing in a holistic way, but it is the use of traditional acupuncture that most often offers an easily accessible route to improving overall health and wellbeing. The use of acupuncture is recognised in a number of NICE guidelines and perhaps the case could be argued for inclusion in more. But here we have that collision of two very different medical paradigms. NICE requires evidence based upon the western scientific model of statistically proved efficacy underpinned by randomised controlled trial methodology. It also expects the evidence it uses to have been published in an English language journal. Historically, research into the use of acupuncture has looked at the holistic

TALKBACK VIEWPOINT 7

guidelines

Why are we still looking at single conditions? effect upon the patient and often relies heavily on anecdotal reporting. Much of the published information started in Chinese-language research journals. However, as noted earlier, the two worlds have effectively arrived at the same point – the need to provide wellbeing for the patient that goes beyond a specific condition, not just your back pain but you as a person. At last, the way that we speak about evidence for a treatment or therapeutic approach is changing. Clinicians now talk

about PROMs (Patient Reported Outcome Measures) and PREMs (Patient Reported Experience Measures), ways of measuring and reporting developed by patients themselves. We are now approaching a shared language that can be used by patients, clinicians of every discipline including traditional acupuncture and by the guideline committees at NICE. This will make future conversations easier as all

parties start to look at the same examples of evidence that make a difference to real people who manage their back health on a daily, monthly, yearly and ongoing basis. So when it seems that the researchers disagree, or clinicians offer differing and apparently conflicting advice, it is important to remember that four out of five of us have had a back problem at some stage in our lives – researchers, clinicians and you and I; we all want the same thing.

Paul Hitchcock has recently been appointed as the Chief Executive at the British Acupuncture Council. He has had a varied career in a number of organisations in the public, private and professional sectors, most recently in an Academic Health Science Network, that part of the NHS tasked with spreading sustainable innovation at scale. He has managed a back condition for more than 30 years after damaging his back in a motorcycle accident when at university. www.acupuncture.org.uk

TALKBACK l SUMMER 2016

8 TALKBACK COMMUNITY

European recognition for chiropractic institution Veteran chiropractic institution, the AECC, scooped the prestigious European Chiropractors’ Union Honour award in May. The award, which has never before been handed to an institution, recognises outstanding service and leadership to the chiropractic profession in Europe. In its 51 years of existence, the college has established

Write about your experience and you could win a prize Individuals who suffer from Rheumatic and Musculoskeletal Diseases (RMDs) are being invited to write about their personal experience and submit the essay for the 2017 Edgar Stene Prize Competition. The European League Against Rheumatism (EULAR), the organiser, is encouraging its national member organisations to co-ordinate national competitions for people with RMDs, detailing how long they had to wait until their diagnosis was confirmed and how they coped with the uncertainty, pain and fear during that period. Do they have access to care and optimal treatment and management of their disease? What would an ideal situation look like and what is their reality? Entrants (minimum 16 years of age) are invited to submit an essay not exceeding two pages (A4) in their own language to their national EULAR member organisation by 31 December 2016. A EULAR Jury will select the 2017 overall Stene Prize winner, to be announced by 15 March 2017. The Stene Prize winner will be invited to attend the Opening Plenary Session of the EULAR Congress in Madrid and awarded a prize of €1,000. EULAR will provide the winner with travel to Madrid

TALKBACK l SUMMER 2016

a reputation for excellence in quality of education as well as clinical training and research. It is estimated that just over half of chiropractors practising in Europe hold a professional qualification from the AECC. www.aecc.ac.uk l Pictured are AECC staff, students and alumni with the ECU Honour

Facilitating return to work is high on the agenda

Conference examines health in the workplace

and hotel accommodation in Madrid for up to four nights as well as an invitation to the Congress Dinner. In addition, the second ranking essay will be awarded €700 and the third ranking essay €300. www.eular.org

Responsibility for health in the workplace is the key theme for the British Safety Council’s annual conference in October. The event “Health and work in a changing world”, to be held on 5 October at The King’s Fund in London, will feature a number of case studies of companies that are leading the industry with their record of managing health in the workplace and their commitment to facilitating the return Professor to work of employees Dame Carol with health conditions. Black Conference speakers will examine what employers should be doing and how they can encourage staff to manage and improve their health. The keynote speaker at the event will be Professor Dame Carol Black, a senior policy adviser on work and health to the government and a campaigner for enabling people with health conditions to return to work. www.britsafe.org

TALKBACK COMMUNITY 9

Winners are also offered training and leadership development support

Awards up for grabs for healthcare charities A national award for charities improving people’s health has opened its application process for 2017. Charities across the UK are invited to apply for the awards, run by healthcare giant GSK in partnership with the think tank The King’s Fund, which offer prizes of up to £40,000 of unrestricted funding. The GSK IMPACT Awards will celebrate their 20th anniversary in 2017. More than 400 healthcare charities have received an award and funding totalling more than £5.5m since 1997. Ten winners each year receive £30,000 and 10 runner-up organisations receive

£3,000 each. The overall winner is awarded an additional £10,000. Winners will also be offered an intensive training and leadership development programme and ongoing support through the Awards Network, which is valued at a further £6,000. The overall winner of the 2016 GSK IMPACT Awards was Groundswell, a charity enabling people who are homeless to take more control of their health and lives. People who are homeless are more likely to have physical and mental health problems than the general population but are much less likely to manage these well.

Groundswell’s support enables them to access services, which can reduce NHS costs by up to 42% and improve their health dramatically. The awards are open to charities with an annual income of between £25,000 and £2m and which are at least three years old. The name “IMPACT” derives from the criteria that winners must have demonstrated in their application submissions: Innovation, Management, Partnership, Achievement, Community focus and Targeting need. The deadline for applications is Wednesday 21 September 2016. www.kingsfund.org.uk

Multidisciplinary event for occupational advisers A back-to-basics approach when teaching the fundamentals of posture is among the workshops at the National Back Exchange Conference & Exhibition at Hinckley Island Hotel, Leicestershire, 26-28 September. Marill Poole, Manual Handling Advisor for Berkshire Shared Services, is taking the session. Also on the bill is Dr Sally Barber who will be looking at why we should be reducing sitting time in workplaces and classrooms; while a “consistent and

standardised patient handling strategy” is the topic to be presented by physiotherapist Alison Shearsmith. The 2016 event, titled Erasing Boundaries, provides a multidisciplinary environment for those working to promote the health, safety and welfare of staff and patients including manual handling practitioners, back care advisers, ergonomists, academics, therapists, nurses and occupational advisers. www.nationalbackexchange.org

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10 TALKBACK COMMUNITY

Total

Finish time

Vic Aboudara

£2065.00

5:55:19

Robert Bailey

£1648.06

5:00:27

Samuel Burgess

£1550.00

3:40:19

Christian Butcher

£1543.75

5:15:23

Samantha Campbell

£1264.50

4:38:24

Caroline Chalk

£1511.25

3:20:48

Claire Colquhoun

£3444.50

4:32:09

Trevor Cording

£1698.68 3:13:34

Matt Dempsey

£1457.50

6:12:08

Andy Earnshaw

£1333.00

3:57:30

Andy Earp

£1240.50

6:13:55

Hannah Epps

£2879.00

5:50:11

Jo Gwynne

£1567.00

5:27:05

Stephen Hammond

£1455.67

4:58:45

Susan Hammond

£1708.50

4:58:45

Elizabeth Hillerby

£1362.40

4:53:48

Cath Hopkinson

£1296.25

7:13:04

Melissa Hughes

£1330.00

5:35:46

Sally Kiddie

£2272.36

4:41:03

Nicholas Le Neve Foster

£1462.50

3:46:52

Claire Colquhoun raised £3,444 from the London Marathon

Richard Limb

£2325.75

3:57:33

More than £60,000 raised by Team BackCare runners

Adam Louth

£2112.30

4:24:16

Su Matthews

£1685.01

4:19:58

Tracy McBride

£2108.75

4:03:19

Kevin Moossa

£1535.00

4:31:15

John Paton

£1623.25

5:02:09

Adam Pierson

£2192.50

4:32:39

Lara Pilgrim

£853.75

6:04:46

Louise Platt

£1638.75

6:05:25

Ben Roberts

£1793.25

4:41:30

Arrun Saunders

£1299.75

4:38:11

Alexandra Skinner

£1292.50

5:05:05

Kevin Smith

£2057.08

4:57:41

Angela Smith

£1904.89

5:07:19

Sacha Swanson

£2835.00

5:48:51

Jon White

£1535.00

3:48:25

Sophie Windmill

£2050.00

5:03:14

Chris Woods

£1313.15

3:59:06

Grand total

£66,246.10

Our congratulations and heartfelt thanks goes to those whose dedication and effort has resulted in more than £60,000 (including Gift Aid) for BackCare. This will so strengthen our work as we continue to support not only those who suffer the daily rigors of neck and back pain, but also the professionals, practitioners and supporters who treat them; not forgetting our network of the local branches which provide a forum for support

Name

and encouragement. Well done to Claire Colquhoun who raised the most of any runner with £3,444.50 (including Gift Aid). Well done to Trevor Cording, our fastest man with a time of 03:13:34 and our fastest woman, Caroline Chalk who finished in 03:20:48. We have guaranteed places for the 2017 London Marathon – don’t miss out. Join Team BackCare today at www.backcare. org.uk/london-marathon-2017

BOOKS

BACKCARE BRANCH NEWS

Functional Anatomy of the Pelvis and the Sacroiliac Joint: A Practical Guide by John Gibbons. This book focuses on one of the most important areas of the body: the pelvis and the sacroiliac joint. It helps the reader to recognise pain and dysfunctional patterns that arise from the pelvic girdle. Gibbons addresses key issues such as: the walking/gait cycle and its relationship to the pelvis; leg length discrepancy and its relationship to the kinetic chain and the pelvis; the laws of spinal mechanics; the relationship of the hip joint, gluteal muscles, lumbar spine to the pelvis; and sacroiliac joint screening.

TALKBACK l SUMMER 2016

l BackCare’s popular carol concert returns to the Queen’s Chapel of the Savoy this Christmas. This year’s concert is on Monday 12 December at 6.30pm. In addition, he provides stepby-step techniques to identify and correct a number of impaired patterns as well as functional exercises for the pelvis that promote recovery. John Gibbons is a registered osteopath, author and trainer, specialising in the assessment, treatment and rehabilitation of sports injuries for the University of Oxford sports teams.

l A must-visit for BackCare health practitioners and members next spring is The Back Show. The official event for BackCare, the UK’s National Back Pain Association, the event takes place on 19 and 20 May 2017 at St Andrews, home of Birmingham City FC. For details on how to get involved, visit www.backcare.org.uk l The next meeting of the BackCare Essex Branch will be on Friday 7-9pm 7 October 2016. In focus, Kids Backs 4 The Future has been working with 16 young people in producing a back care awareness short video from the perspective of the young people. Details: 01206 804353

TALKBACK PUBLIC HEALTH 11

Counting the cost of obesity prevention measures The fight against obesity is set to have cost councils more than half a billion pounds since taking over public health from the NHS three years ago. The Local Government Association (LGA), which represents more than 370 councils, says local authorities anticipate having spent £505m tackling obesity in adults and children, following the transfer of public health responsibility in April 2013. But councils are warning that the recent cuts by government to their public health grants are already having an impact on their ability to reduce obesity. Newlypublished figures for how much local authorities expect to spend tackling obesity in 2016/17 are forecast to be £127m – down on the £140m estimated for the previous year. Councils use the funding to, for example,

commission weight management services, exercise referral schemes and extend the offer of free or reduced-cost sport, such as swimming. The numbers also include the cost of running the Government’s National Child Measurement Programme, which councils are responsible for. This calculates a child’s BMI when they start and leave primary school. Most recent figures for England in 2014/15 found that one in 10 four- and fiveyear-olds and one in five 10- and 11-yearolds are obese. If current trends are not reversed, the overall cost to the economy of obesity and overweight conditions could increase from between £6 billion and £8 billion in 2015 to between £10 billion and £12 billion in 2030, reports have suggested. The LGA has previously called on

government to bring in measures to reduce sugar content in fizzy drinks, teaspoon sugar labelling to enable more informed choice, greater provision of tap water in schools and restaurants, and for councils to be given powers to ban junk food advertising near schools. The LGA’s Community Wellbeing spokesperson, Izzi Seccombe, said: “We would like assurances from the government’s new administration that the long-awaited childhood obesity strategy is still on track and that it includes tough measures that will help to reverse the rise in costs and children becoming obese. “Today’s obese children will be tomorrow’s obese adults, and with this comes a range of costly and debilitating major health conditions.” www.local.gov.uk

Helping families tackle obesity A Healthy Living Family Pack has been developed by NRS Healthcare to help families with children who may be experiencing issues with overeating, inactivity or poor nutrition. The pack, which can be downloaded free of charge, has been designed to make parents aware of the complications childhood obesity

can cause during adulthood, while also providing them with practical and preventative solutions for helping the family to stay active. It includes activity cards, a day out wish list, daily chores calorie counter (for parents), and a chore chooser star chart (for children). www.nrshealthcare.co.uk

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12 TALKBACK CAMPAIGNS

Being a carer can provide great satisfaction, but it can also be very stressful. Up to half of all carers experience significant stress. Identifying the causes of stress is an important part of self-care and can also help you to seek appropriate support, which is one of the key messages of BackCare Awareness Week, taking place 3-8 October.

Caring for carers

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B

ecoming a carer for your parent, partner or child inevitably changes your relationship. This can be emotionally upsetting. Being a carer can be overwhelming, particularly if you’re worried about how you’ll manage or if there is financial strain. There can be stressful family adjustments that have to be made, perhaps causing disrupted routines or loss of privacy. It can also be stressful if your freedom is restricted or you have to change your personal plans – for example, if you could not go on holiday or had to turn down a job. Most people are familiar with the “tension headache”. Stress also increases your risk of developing back pain. A four-year study of nurses revealed that psychological stress was the most consistent predictor of which nurse would develop back pain. What we know from this and many similar studies is that our bodies develop more symptoms when we have stress and tension in our lives.

Stress increases your risk of developing back pain More than two thirds of carers already have back pain. Common symptoms that can be stressrelated include feeling low in energy, pain in the lower back, headaches, hot or cold spells, difficulty in breathing, faintness or dizziness, pains in the heart or chest, or heavy feeling in arms or legs.

TALKBACK CAMPAIGNS 13

YOUNG CARERS Did you know that there are as many as 700,000 young carers under the age of 18 in the UK? Many young carers feel that helping their family member is an important part of their life, but it is also important that young people are not taking on caring roles which might harm them. Being a young carer might have

So, what do you do if you have high stress levels? First of all, make sure you are getting the practical support you need. Make sure you have had a carer’s assessment from your local authority and that you are getting all the welfare benefits you are entitled to. Contact a local carer’s organisation, such as a carer’s centre, which can help you with this. Support from other carers can also be very helpful – they may be able to give you tips on how

an impact on your physical or mental health. Many young carers often find it difficult to keep up at school, or are even bullied about being a carer. If you are a young carer, it’s important to tell someone you trust, for example a teacher. You are entitled to an assessment of your needs and there is support available.

to cope, or just listen and help you feel less isolated. Make sure you get a break and keep up with some of the activities you enjoy which you may have stopped due to your caring role. Stay connected with your friends and family. Don’t be afraid to ask people to help you – sometimes people just don’t know what you need and may feel awkward about asking you. There is no physical health without mental health. IAPT (Improving Access to Psychological Therapies) is a government scheme that helps people who struggle with psychological issues. If you feel you would benefit from professional help to deal with stress, anxiety or depression, speak to you GP or search online for IAPT in your area.

Carer assessment As a carer, you are entitled to a carer’s assessment to help you talk through what would help you to cope. You can ask for one from your local authority. There are also likely to be specific services in your area to help you such as a carer’s centre, where you can get practical help and support from other carers in similar positions to yourself.

NHS LIFTING CHECKLIST The most common injuries carers experience are back injuries. Injuring your back will limit your movement and your ability to care for someone, says the NHS. It could take a long time for you to recover. Lifting someone incorrectly can also damage fragile skin, cause shoulder and neck injuries, increase existing breathing difficulties, or cause bruising or cuts. If you are regularly lifting someone, the NHS emphasises that it’s best to get trained or see the best techniques demonstrated. Before attempting to move someone, ask yourself: l Do they need help to move? l Do they require help or supervision? l Have you told them you’re moving them? l How heavy are they? l Are you healthy and strong enough to move them? l Is there anyone who could help you? l How long will it take?  l Is there enough space around you? l Are there any obstacles in the way? l Are you wearing suitable clothing and shoes – for example, if you are on a slippery or damp surface? If you have assessed the situation and have decided to move the person, make sure you: l never lift above shoulder height l make sure your feet are stable l take a firm hold l keep any weight close to your body l keep your back straight and bend your knees l lift as smoothly as possible. www.nhs.uk

GUIDANCE FOR NON-PROFESSIONALS BackCare publishes The Carer’s Guide, preventative guidance (distilled from our manual handling training manual HOP6) specially for non-professional caregivers – in other words, for unpaid carers in the home setting. Order your copy! The latest edition of The Carer’s Guide, which includes a dvd, can be ordered from www.backcare.org.uk

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14 TALKBACK ADVERTORIAL

Who else needs chronic Chronic pain is one of the most challenging and difficult conditions people face treating safely and effectively. There is now a new safe pain therapy device that is economical and effective for many individuals suffering with chronic back pain for many years. Pain itself often modifies the way the central nervous system works so that a person actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular – the brain and the spinal cord. It’s well understood that the

extent of tissue injury does not explain the level of pain, and chronic pain can be maintained even after an initial injury has healed. ActiPatch’s neuro stimulation continuously disrupts this signal to allow a good night’s sleep and restores daily activities. The Pain Management publication published a Registry Study of 5,000+ using an ActiPatch 7-Day trial device report a baseline VAS pain score of 8+ of which 2/3 had more than 57% pain relief. This reflects that many individuals respond poorly to drug therapies.

ACTIPATCH LONG-TERM USE: ● 2/3 (including opioid users) reported moderate to complete elimination of pain medications ● 2/3 reported improved sleep ● 3/4 increased physical activity ● 4/5 experienced a substantial improvement in overall quality of life.

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pain relief? This data demonstrates that ActiPatch has a higher response rate and is much more effective than common chronic pain drugs and other therapies for chronic back pain. ActiPatch is drug-free, and unlike medications, there are no adverse effects. It is safe for people with diabetes, the elderly, and those with heart and lung disease. ActiPatch can be used safely 24 hours a day for extended pain relief. ActiPatch long-lasting pain relief has been proven to help people get a good night’s rest. It’s the new pain reliever that lets you be your best! ActiPatch is now available at Lloyds Pharmacy, Boots, Superdrug and Gordons Chemist stores and costs only £24.99 for 720 hours of treatment.

ABOUT THE AUTHOR Ian Rawe is the Director of Clinical Research at BioElectronics Corporation, the manufacturer of ActiPatch® Therapy.

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16 TALKBACK WORKPLACE

Visions of the workplace of the future Hanging pods to work in, interactive tablet desks which turn into beds and chairs that mould to your body shape are among the radical ideas young Londoners came up with when asked to design their future workplace

H

ow “Generation Z” imagines the office environment of the future is a creative workshop devised by Norwegian furniture brand HÅG – with leading architectural practices providing students with the tools to bring their vision to life. Four key themes revealed how the young people felt about their future workplace – health, the environment, technology and innovative workspaces. A clear trend was the continued blurring between personal and work life, while many participants stressed the need for relaxation in the workplace. This involved creating an underground “holiday room” which contained a beach and swimming pool,

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“Netflix area” and holograms which could project a tranquil environment on the walls. The future office would have a health centre and gym – including a doctor’s surgery where you could book appointments at work. Allotments would be provided where you could make your lunch from fresh produce and colleagues would have a “Bake Off” style kitchen to cook together. The young people didn’t share the current trend of shared workspaces but wanted a mix of collaborative areas combined with isolated working pods that they could customise for their own requirements and mood. When employees need to focus on their work in

peace and quiet they would climb into their hanging pod where they would work alone on an interactive desk. They saw a high ceiling as wasted space and decided that these hanging pods could be placed there, creating more room for socialising and leisure. The students were committed to the idea of health and fitness in the workplace, but at the same time wanted simple tasks such as moving around the office to be as effortless as possible, such as using Segways or chairs that mould to your body shape. One participant proposed a swinging chair with

a built-in desk computer – the kinetic motion of the chair generating its own energy. HÅG Managing Director Jorgen Josefsson believes the design exercise underlined the importance of a good work-life balance and reflected the HÅG philosophy which is based on the fact that the human body is not made for sitting still but for movement and variation. He said: “It is clear to see that Generation Z expect their employers to look after their wellbeing by designing spaces that enhance this and provide areas suitable for a variety of different tasks.”

EVOLVING OFFICE CHAIR DESIGN Eliminating the physical discomforts and negative posturerelated symptoms associated with long hours spent seated is the chief goal of the seating designer, says HÅG. The company’s Futu chair design incorporates what it calls “inBalance” technology – a floating seat mechanism that ensures that you sit comfortably and in balance regardless of whether you are short and light or tall and heavy. The chair follows your movement – when stretching back or leaning forward – following you naturally into your next seating position. www.hag-uk.co.uk

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Flexible home workers don’t escape back and neck pain Work has been cited as a trigger of back or neck pain by nearly a fifth (19%) of sufferers, but despite this, more than a quarter (26%) of workers admit to taking no proactive measures to protect their back while at work; whether at home or in an office. The British Chiropractic Association (BCA) is urging UK workers to pay more attention to the environments they work in – especially when taking advantage of flexible working. The number of people working from home, either full or part time, rose to more than 4.2 million in 2015, with home workers now making up 13.7% of the population. These workers could be risking their back health by not working in posture-friendly environments, say leading chiropractors. New findings suggest that many are opting for home comforts over health – with nearly a fifth (19%) of those working remotely on a laptop /desktop computer admitting to working from the sofa and

more than one in ten (11%) saying they work from their bed. Workers may not realise that their home environments, while perhaps seemingly more comfortable, could be putting serious strain on their back, says BCA chiropractor Tim Hutchful. “While it may be tempting to work slumped on the sofa or lying in bed when given the opportunity, workers need to realise that they could be doing damage to their spine. “By making a few simple changes to their work stations, workers can embrace the benefits of flexible working without putting themselves at risk of developing back and neck problems.”

Good practice

If possible, designate an area in your home for working and always work at a table, sitting on a chair, rather than on the sofa or in bed, the BCA advises. The top of your screen should be level with your eyebrows and if you are working from a laptop, make sure you are not hunching over it. Using a detachable keyboard and mouse will ensure that your movement is not restricted and that you are not placing unnecessary strain on your back. Taking regular breaks is extremely important and the BCA recommends workers move around every 20-30 minutes. www.chiropractic-uk.co.uk

Reducing fatigue from standing for long periods Sit-stand practices may be increasingly significant to office staff, but what about other workers, such as those in commercial and industrial applications? Standing up is a natural human posture but anyone stood in the same position for a long time will soon find it uncomfortable due to the strain it can have on the feet, legs, lower back, neck and shoulders. Ideally, workers should be able to adopt a variety of positions during the day that may include a combination of sitting and standing.  “It’s also important that workers standing up think about their surroundings and conditions,” said Lee Wright, Group Sales and Marketing Director at workplace equipment supplier Slingsby. “Standing on a soft floor surface is far more preferable than a very hard floor, such as a concrete or metal surface, and changing footwear or using antifatigue matting and specialist stools can often make life much more comfortable for workers that are standing up for long periods.” www.slingsby.com

Anti-fatigue safety edge matting: Alleviating stress to back and legs by cushioning the areas where people have to continually stand or walk. Features a dense rubber cushion encapsulated within solid nitrile rubber. Gripper backs minimise mat movement and for added safety they have low profile, colour-coded bevelled edges

Support stool: Adjustable from 580-800mm, with a cushioned polyurethane seat pad, this helps reduce operator fatigue when standing for long periods CONTINUED➜

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18 TALKBACK WORKPLACE from page 17

The Work2 Sit-Stand range

Why we need to sit-stand correctly Sit-stand workstations and meeting tables can improve productivity and wellbeing, but without proper guidance these potential benefits could be overshadowed by risks arising from poor posture and excessive standing. Just as sitting has been declared “the new smoking” by some, counterclaims also state that excessive standing can compromise health and wellbeing, too. Tim Hanwell, osteopath and co-founder of office ergonomics and design consultancy Officeworks, explained: “Alternating between a sitting and standing position is a personal choice, but changing every 20-30 minutes is a good idea. “The real benefit of sit-stand is not just in mitigating the long-term side-effects of sitting in a chair for prolonged periods over many years. The key is in the regular movement

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it facilitates, even encourages.” Software packages integrated with electronic sit-stand desks such as the Work2 Sit-Stand collection from KI Europe can be a useful way of reminding users when to make the change, and can also be set to remember a user’s ideal sitting and standing height. This can help to avoid incorrect adjustments to the desk height when switching between the sitting and standing positions. For workers in offices that exercise flexible working, this presents another advantage in that the pre-programmed height memories are carried with the worker’s laptop, rather than being set to one particular position. Tim Hanwell continues: “With the introduction of sit-stand desks, I have witnessed dramatic improvements to the health and

wellbeing of a number of my patients. But it is essential to use these workstations appropriately in order to realise their potential benefits, rather than creating new risks in the office environment.” www.kieurope.com www.officeworks.co.uk

GET BACK ON YOUR FEET… Get Britain Standing and the British Heart Foundation, which are actively encouraging UK workers to spend more time on their feet, surveyed 2,000 office workers and revealed that 45% of women and 37% of men spend less than 30 minutes a day standing at work. Some recommendations suggest that workers should aim to stand for at least two hours each day which they can increase once they’re used to it. In Scandinavia it’s estimated that 80% of office workers now have adjustable desks which means they can choose whether to sit or stand and change positions throughout the day.

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Ensuring neck pain doesn’t impact on studies More than half (54%) of 16-24 year olds have struggled with back or neck pain at some time – and, of those who have suffered, 51% said they experience back or neck pain when they feel stressed. The stress and discomfort experienced during the exam season has subsided for the time being, however for those students who generally find it difficult to switch off, the back experts at the British Chiropractic Association (BCA) suggest some simple steps to introduce into the daily routine to ensure back or neck pain doesn’t impact on their studies. BCA chiropractor Rishi Loatey said: “While stress doesn’t cause back and neck pain it can exacerbate the symptoms, so it’s important that students take steps to ensure this doesn’t affect their work. “Simple actions such as taking breaks during long stretches of revision and ensuring you’re not sitting hunched over your notes or laptop could make a big difference.”

TIPS FOR STUDENTS: • Sit up, look sharp – always work at a table, sitting on a chair, rather than on the sofa or in bed. Relax when sitting into your chair, making sure you have your bottom against the seat back with your shoulder blades touching the back rest of the chair. • Take a break – taking regular revision breaks is extremely important and the BCA recommends students move around every 20-30 minutes – stand up to stretch, change position and walk around a little. • Check it! – it can be tempting to carry around all your notes and books, but make sure you check your bag every day so you’re only carrying the things you really need. • Walk tall – look for opportunities to exercise during the day. Why not try walking to the library instead of getting the bus or driving? • Keep hydrated – don’t forget to drink lots of water. • Stretch it out – if you’re revising at home, embrace the privacy by doing regular stretches. www.chiropractic-uk.co.uk

YOUNGER PUPILS – BAG CHECK How children carry their school bags can make a big difference to preventing back pain. Nearly a third (31%) use a onestrapped bag which can load significant weight onto one shoulder, potentially causing long-term discomfort. Look out for bags which can be carried on both shoulders, with adjustable straps which will hold the contents close to their back and distribute weight evenly. If your child insists on carrying a bag with one strap, encourage them to alternate which shoulder they carry it on and to carry it across their body. Overloaded school bags are a common trigger. Spending just a few minutes each evening removing unnecessary items for their day’s activities is an obvious step, but also try to ensure that any weight is equally distributed – see that the heavier items are at the top not the bottom of the bag otherwise the rucksack can pull shoulders backwards, creating discomfort and more imbalance.

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20 TALKBACK SELF HELP

PHOTOS COURTESY OF JULIA WOODMAN

How the Alexander Technique can Learning the Alexander Technique has been shown by randomised controlled clinical trials to have longterm benefits for people with chronic back pain, as well as for those with chronic neck pain. While learning the Alexander Technique involves one-toone lessons, there are many practical tips we can take away and explore by ourselves. Researcher and Alexander Technique teacher, Julia Woodman continues this series of articles with some practical advice on how to put less stress and strain on our spines as we go about our daily lives.

H

ave you ever noticed what happens to your head, neck and back when you pick up your mobile phone to text someone? Next time, see if you can take a moment to be aware of how you’re looking at the phone and how you’re holding it. If you get the chance, have a sideways peek at yourself in a mirror. Then, when you’re out and about, look around to

see how other people are using their mobiles. Whether they’re on the bus or walking down the street, you’ll probably see the same pattern. So what are we doing to ourselves when we use a mobile like this? Well most of the bending is happening in the neck itself. Now that’s interesting because that isn’t where the major joint is, in other words that’s not where

Our usual way of looking down to use a mobile

Discovering how to use a mobile without putting the usual strain on the spine

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TALKBACK SELF HELP 21

help you avoid ‘text neck’ the head actually sits on top of the spine. It’s almost as if we’ve come to subconsciously believe that the head and neck are one thing, when, of course, the neck is part of the spine along with the back. When we move “as nature intended”, you’ll see a different pattern, more like that in the next photo (you’ll also notice that the young woman has made things easier by bringing the phone a bit closer to her head). Now find your own head/neck joint. Gently place a couple of fingers behind each ear lobe and find those prominent bony bits. Imagine that you could draw a line through your head between these two bony parts. That’s the level at which your head sits on top of your spine

−in other words, that’s where your head ends and your neck begins. It’s much further up than we usually think and it’s one of our most important joints. It’s called the atlanto-occipital joint, which simply means where the top vertebra (the Atlas, after the Greek god who in mythology held up the world) meets the bottom of the skull (the occiput). But knowing its name is not important, whereas having a basic practical understanding and awareness of it is. You can see how the head sits poised on top of the spine in the image below. Because we usually only see ourselves from the front, it’s easy to subconsciously form the idea that our necks end at

Where we usually bend from when we look down (bottom arrow in red) and where the natural pivot point is (top arrow in green)

about the same level as our chins but, as you can see, the top of the spine is much higher up. So, bearing in mind where your head really sits on top of your spine, think of it like the pivot point on a seesaw. Now gently allow your nose to drop from this pivot point. The important word here is ‘allow’ − the head is heavy, it’s the weight of a bowling ball (about 4.5kg), so you don’t need to pull your head down, just allow the nose to gently drop with gravity. Then slowly and gently look upwards again (back to looking straight ahead) with the movement again centred on the pivot point. What do you notice? Is the movement easy?

Changing the habits that we’ve had for most of our lives is not easy and this is where working with an Alexander teacher can be so helpful

So why does this matter? Our spines are amazingly strong and flexible, and we need that flexibility to be able to make all the complex movements that we do as we go about our daily lives. But, if we form the habit of always moving from within the spine rather than from the head/ neck joint, then, in the long run we are more likely to end up with problems such as neck pain. And, of course, it’s not just when we use our mobile phones that we tend to move in this way, it’s every time we look down and that’s quite a lot of times in the average day! With the Alexander Technique we learn how we can carry out our daily activities with more freedom and less strain on our spine and joints. Changing the habits that we’ve had for most of our lives is not easy and this is where working with an Alexander teacher can be so helpful.

The Alexander Technique is a taught self-care approach which offers people of any age or ability a way to improve their health and wellbeing. It can be applied in all situations in everyday life and can lead to better balance, co-ordination and freedom of movement www.julia-woodman.co.uk www.alexandertechnique. co.uk

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22 TALKBACK LIFESTYLE & HOME

Showering for vulnerable users Inclusive showering and bathroom developments reflect the diversity in the population and enable designers and builders to meet the needs of all vulnerable users, including the elderly, wheelchair users and those with severe MSD and other health conditions. Products should allow less able people to wash and shower independently. The design considerations for showering, bathing and handwashing are addressed in a wide range of accreditations that relate to access, safety, temperature and flow control – including TMV2, TMV3, BEAB Care and endorsement from the RNIB. TMV2 and TMV3 controls guard against scalding, which kills around 20 people and

injures nearly 600 each year. In meeting these marks, Mira supplies the Excel EV thermostatic mixer with thermostatic temperature control, a maximum temperature stop and a manual override button for safer showering. The company’s Advance ATL Flex One is an electric shower with the BEAB CARE mark for safety. Its inclusive design makes it easy for anyone to use and, if the temperature ever rises above a pre-set level, the shower turns off automatically. The same thinking can be seen in Mira’s Flight Safe range of anti-slip shower trays which exceeds the anti-slip, barefoot ramp test, providing peace of mind for users and caregivers. www.mirashowers.co.uk

Guarding against scalding, which kills around 20 people and injures nearly 600 each year

Accessible bathing a viable alternative to showers Accessible bathing is a viable alternative to adaptive showering. However, many Disabled Facilities Grant (DFG) approvals and professional recommendations can tend towards bathroom showering adaptations instead of new hi-lo baths. It may be that an adapted shower is not first choice for the disabled bather and their families, but budget-conscious local authorities can take the view that an assisted bath is more expensive to specify than conversion of an existing bathroom to an accessible wet room. And yet in many situations this is not the case, according to Abacus Healthcare. The company’s “BathingIsBetter” campaign discusses the options for hi-lo baths with

transfer seats and bathing platforms that deliver enhanced care, dignity, comfort and safety. The information, aimed at professionals and consumers, covers legislation, safety, wellbeing and cost savings. Supporting the campaign, OT Kate Sheehan said: “I regularly meet families and disabled children who prefer bathing. However, many are only offered a wet room or shower conversion through a DFG. “There is clear legislation to support the case for bath provision. DFG legislation itself actually states that ‘…a bath or shower (or both), can be grant funded…’ which is backed up by The Housing Grants, Construction and Regeneration Act 1996 and the Children’s Act 1989.” www.abacushealthcare.co.uk

Assistive devices offer increased independence This soft and secure wall-mounted shower seat, which can come with a back rest and swivel armrests, is suitable for users who sit on the shower seat for long periods of time and/or who have sensitive or vulnerable skin. The LinidoSolutions Soft seat supplied by Handicare can be folded up after use. It has an open front which facilitates performance of intimate hygiene tasks without standing up. The seat is

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fitted with toilet rails and can be used with a bucket or bedpan. The back rest has a strong textile covering, firmly attached round the frame and which adapts to the body temperature during use. The ergonomically-designed armrests offer comfortable support for the forearms while sitting and are long enough to provide safe support when sitting down or getting up. www.handicare.co.uk

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Don’t let movement become more difficult In the modern world, we tend to expect things to be easily accessible with minimal fuss. We come home, sit on our nice comfortable chairs and – thanks to technology – we can continue to work, order our shopping, book a holiday, pay the bills, even switch on the heating. Of course, while we appear to be operating in a highly efficient manner, at no point are we moving. We all know that lack of exercise can have a major impact on the body. If we don’t move our joints through the range of movement they are capable of, then these functions will decline. If we don’t stay active, movement will inevitably become harder over time and this is where people are more susceptible to injury, says Julie Jennings, occupational therapist at HSL Chairs. “People who are active have a lower risk of heart disease, strokes, type 2 diabetes, some cancers, depression and dementia.

“If we want to increase our chances of being pain free, reduce our risk of mental illness and remain independent well into older age, we are advised to keep moving.” Though exercise may be harder to achieve with age, regular movement should still be encouraged. Walking up and down the stairs, tending to the back garden or simply engaging in household chores helps to keep the body active and the mind strong.

Take a break

When asking the question of what sort of person could benefit from putting the limbs and joints into “neutral” for a while, the short answer is that we all could. The reality is that sitting is a huge part of our everyday lives, whether we are learning, working, relaxing, eating or socialising – not forgetting that good quality rest will enable us all to stay more mobile and active.

We all must consider the way we sit and the type of support that the body requires. This kind of support can be found in an array of furniture which not only helps to achieve postural support but also can help to alleviate painful conditions such as back and neck pain, arthritis and aching and sore joints. When selecting a chair, there are some factors to consider, says HSL. For example, does it provide good lumbar support in all positions, and is your head supported comfortably as you sit down and read or watch TV? Are the armrests at a height that enables you to relax your shoulders? Importantly, is the height and width of the chair right for you? To sit most comfortably, your body and thighs should be in an “L” position with your feet touching the floor. This takes the pressure off your back and knees, allowing muscles to relax. www.hslchairs.com

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24 TALKBACK PRACTITIONER

Got hip dysfunction? Many individuals will experience hip problems related to prolonged sitting, inactivity, or injury. These situations will lead to and perpetuate non-optimal use of the hips, which contributes to chronic tightness, discomfort and the loss of optimal performance. While there are many great exercises to improve hip function, there are some strategies that will actually perpetuate or directly contribute to hip dysfunction. The first part of this article, in the last edition of TalkBack, looked at how non-optimal posture and movement habits contribute to hip dysfunction, and how the Pilates instructor can use the principle of Alignment to improve their client’s hip function. In this second part, we deal with Breathing and Control.

Part 2: Breathing

Benefits: Restore optimal threedimensional breathing for stability and control of neutral alignment and reduce compensations created by non-optimal breathing habits. Once the individual achieves neutral alignment of the pelvis and lumbar spine, three-dimensional breathing begins the process of teaching them how to control this position. Three-dimensional breathing regulates internal pressure within the thoracic and abdominal cavities which is essential to stabilising the thorax, lumbar spine and pelvis. Additionally, it activates the muscles of the deep myofascial system – muscles like the psoas which fascially blend with diaphragm and pelvic floor and the transversus abdominus which also fascially blends with diaphragm. These two factors are crucial in the control of neutral alignment and developing optimal core stability. Most individuals either have or can achieve a decent belly (abdominal) breathing strategy with very little training. In fact, many individuals have over-developed their ability to belly breathe at the expense

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By Dr Evan Osar of costal breathing (breathing into the ribcage). This over-reliance on belly breathing strategy inhibits the psoas and abdominal wall and perpetuates thoracic rigidity. Over time this compromises control of neutral alignment and the ability to access the deep stabilizers resulting in chronic tightness and compensatory movement. To restore optimal three-dimensional breathing in the supine position, have the client place their hands lightly around their ribcage. They lightly breathe in through the nose and imagine filling up a balloon between their hands. Ensure the breath goes side to side as well as front to back in the ribcage. As they breathe out, their hands should approximate each other and the front of the ribcage should move gently towards the pelvis. The exhalation should last about twice as long as the inhalation

and the overall breathing pattern should be relatively effortless and not forced. Perform three to five sets of three to five breaths per set. Allow the individual to return to their normal breathing pattern for 60 seconds in between each set so that they don’t hyperventilate.

Control

Benefits: Integrate myofascial control of neutral alignment and three-dimensional breathing and develop balance between the deep and superficial muscles. Now that the individual has developed optimal alignment and breathing, they must learn how to control neutral alignment and breathing by co-ordinating their deep and superficial muscles. Many individuals have developed non-optimal posture and movement by overusing their superficial muscles to essentially grip their way into various positions and activities. By developing the awareness and ability to let go of chronic gripping, activate their deep muscles and move with less effort, they can restore balance between their deep and superficial muscles. A variety of positions and patterns should be used

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Start with the A, B, Cs

to develop control between the two myofascial systems. Continuing in the supine position from above, the individual will activate their deeper core muscles (pelvic floor, diaphragm, psoas, etc) and begin lifting a leg (pictured left) or raising their arms. They control neutral alignment of their trunk, spine and pelvic positions as they move their legs or arms and try to use less effort than they are accustomed to in completing the requisite numbers of sets and reps. They should be made aware when they are moving from neutral alignment, compromising their breathing, or losing optimal control. If they cannot be easily cued into better alignment, breathing and control they should be regressed so they can develop the right awareness and patterning before moving to higher level progressions. As mentioned above, cuing is a very important component to maintaining optimal alignment and control of the pelvis and spine. In the table above are common cues and those found to be more effective in helping to maintain optimal alignment and control.

Common cue

More optimal cuing

“pull your abs in and flatten your spine”

“gently activate your abdominal wall while maintaining your spinal curves” “maintain a long spine position as if you are being gently pulled towards the sky from the back of your head”

“squeeze your butt and tuck your tailbone under”

“activate your glutes and maintain your neutral curves” “keep your tailbone heavy and your spine long as if you are gently being pulled toward the ceiling from the back of your head”

Once the individual develops optimal alignment, breathing and control they must co-ordinate these into their Pilates patterns. Bird-Dog, Hundreds, and Reformer work can all be used to provide a variety of challenges to the individual’s control of neutral alignment. Only after developing neutral alignment through a variety of patterns and progressions should the individual be progressed to moving out of neutral alignment. This ensures they are able to meet the demands required for these more dynamic ranges of motion and have developed the control required to perform optimal movement without compensation.

Many clients will seek out Pilates as a method for solving their chronic hip tightness and discomfort. Improving hip strength and length can be developed by helping individuals achieve optimal alignment, breathing, and control of their pelvis and lumbar spine. Developing alignment, breathing and control of the pelvis and lumbar spine helps improve the ability to activate the muscles required for optimal hip function. By developing control of the deep and superficial myofascial systems, an individual can be strategically progressed through a Pilates programme that improves their hip strength and length and without common compensations that lead to the loss of performance.

About the author Dr Evan Osar is an internationally recognised lecturer, author and expert on assessment, corrective exercise and integrative movement. Dr Osar and his wife Jenice Mattek created the Institute for Integrative Health and Fitness Education™, which provides advanced-level live education and free online resources incorporating assessment, corrective exercise and functional exercise. Dr Osar has authored one of the most

highly acclaimed industry resources on corrective exercise – Corrective Exercise Solutions – and recently co-authored Functional Anatomy of the Pilates Core. He has developed the industry’s most advanced training certifications – Integrative Corrective Exercise Instructor™ and Integrative Movement Specialist™. For more information, including free educational resources, visit www.IIHFE.com

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26 TALKBACK OUTDOORS

Since breaking her back, Gillian Fowler discovered the type of pain management that suits her best is exercise – building strength in her core and daily stamina. This has enabled her body to be more resilient to the pain created by the complicated spinal trauma issues.

Building confidence through personal challenge

‘‘

It’s not an easy process. It has involved slowly building up fitness, with small walks and working through the increased pain of protesting muscles. But over time, the pain has lessened and my strength has increased enormously in that I can enjoy many forms of exercise – particularly outdoors. BackStrong Adventures has recently launched activities in Scotland, offering one-day and multi-day outings, and with a bespoke service to give clients their desired challenge or outing. From our experience of walking in Scotland with small groups of mixed abilities we have witnessed the joy

Lisa Cockburn, Gillian Fowler, Rae MacAskill and Kay Morgan at the summit of Lochnagar

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of those achieving a personal goal, and the realisation of what is possible. One such outing saw four of us head to the hills – two experienced hillwalkers Kay Morgan and Rae MacAskill, and Lisa Cockburn, who has the love for the outdoors but health has meant she has been very limited to what she could do. Lisa had a major surgery in 2014 and she also has severe back pain which continues to this day. Lisa’s health issues have affected her confidence, yet her desire to get back in the hills and enjoy walking has remained. One enduring ambition of Lisa’s had

been to climb Lochnagar, a majestic Munro situated in the Cairngorms area. She attempted it once, yet never quite made the summit, so this outing was one that would prove monumental for building confidence and self-belief once again. We took our time, taking rests regularly. Lisa was not only coping well but also began to realise just how strong she was mentally and physically. We rested on the shoulder of Lochnagar and took in the beautiful view and something to eat before the final push up the ‘ladder’, on to the plateau and finally the summit. To witness someone’s own personal battle towards a significant goal is an honour. I know this was extremely challenging for Lisa, yet she kept moving forward and made it to the summit and the buzz of her achievement was something we were all able to share. I vividly remember the day I climbed and stood on the top of Ben Nevis in 2014, six and a half years after breaking my back. The feelings are incredible – self-belief, pride and a deep, body-aching satisfaction – and these are the feelings we want to share during our overseas trips and activities in the UK. Despite the permanent effects of my own spinal injuries, I feel I can continue to defy preconceptions about what is and what is not possible or realistic – pushing beyond boundaries, exploring, and loving every second of the outdoors.

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Gillian Fowler’s biggest challenge to date is to climb Mt Kilimanjaro in Tanzania. Training for this particular adventure has been spread over nearly a year, and she has had to manage it through varying levels of pain. This included intense nerve pain which lasted more than four weeks, during which time no training could take place.

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SHORT, MODERATE PACE WALKS TO INCREASE HEALTH GAINS Walking is one of the easiest ways you can start to improve your physical activity. Walking for Health is an England-wide network of health walk schemes that delivers free, regular, short group-walks that are open to all. The programme aims to reach people who are currently inactive, or who need support to remain active, to improve their health and wellbeing. Walking for Health schemes are funded and delivered at a local level. Each scheme has a co-ordinator who oversees and develops the scheme, supported by a number of volunteers including walk leaders and cascade trainers. A rigorous process of accreditation has been a key focus of the national programme team, which has been hosted by the Ramblers in partnership with Macmillan since 2012. All schemes should now meet the requirement of providing at least one walk between 10-30 minutes per month, walks that last no longer than 90 minutes, and walks set at a moderate pace that make walkers feel warmer, breathe harder and their heart beat faster (while still being able to talk to others around them).

FUNDING TREND The latest available data suggests that individual schemes are economical to run, with average annual funding of around ÂŁ11,000 (increasing to budgets of up to ÂŁ85,000 for the largest schemes). Within this context, the majority of schemes (53%) were funded by local authorities (an increase from 38% in 2012), while 11% were funded by NHS bodies (a decrease from 25% in 2012). This reflects the switching of responsibilities for public health from the NHS to local authorities, as a result of the Health and Social Care Act 2012. SOURCE: Evaluation of the national Walking for Health programme, July 2016

www.walkingforhealth.org.uk

A training wal k for Kilimanjaro re sults in a trek in the sn ow

day in A beautiful h hills the Scottis r during winte

BackStrong Adventures specialises in challenges for those with an adventurous spirit, and especially welcomes enquiries from those celebrating life, who have experienced trauma, injuries, loss, depression, disability, disease and any other life-changing ailment. www.backstrongadventures.com

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28 TALKBACK NEWS

participate! Calling all BackCare members! Would you like to: l become an advisor on research steering committees l give independent feedback on clinical trial protocols l participate in the development of new medical devices l take part in research questionnaires and surveys?

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If you suffer from back pain and would like to get involved with research, please visit www.backcare.org.uk/research