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

AUTUMN n 2019


Optimism may hold secret to longer life also in this issue: News Short sessions of activity can have health benefits Children’s health Is your child’s back fit for the future? Swing easy Avoiding back and neck pain and injury in golf



BackCare Awareness Week 7-11 October 2019

BACK PAIN IN GOLF Golfers are the focus of this year’s BackCare Awareness Week, 7-11 October. Low back pain is a common golf injury and recurrent episodes can hinder your enjoyment of the sport and have a huge impact on your life in general. This year, BackCare will be shining a light on the subject and promoting good back health for everyone involved in the sport.


l Injury factors l Warm-ups and stretches l Treating the pain l Rehab and exercise l Supports and accessories


Charity No. 256751

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WE WANT TO HEAR FROM YOU! Tell us how you’d like to get involved. Contact info@backcare.org.uk


Working environments to suit the individual? MEDICAL professionals are as susceptible to back problems as the next person. A recent study showed that one in five surgeons across Europe and the USA may need to retire early because of musculoskeletal injuries sustained from carrying out modern surgical procedures1. Ergonomically, the work is far from ideal. Minimal access/keyhole surgical techniques, for example, often require surgeons to contort themselves into awkward positions for hours at a time. Many of those who regularly carry out such procedures experience musculoskeletal pain and need to seek medical help for these job-related injuries. Technological advances such as surgical robots will start to reduce the strain on surgeons and other health professionals, maximising ergonomic efficiency, improving comfort – and ultimately prolonging careers. In pretty much every industry, we can point to innovations that enhance our capabilities while removing stress and fatigue from routine and repetitive activity. Increasingly, we are able to shape our working environments to suit individual needs and build in practices that benefit our health. Why then, isn’t the same consideration afforded to young people? School is the ‘workplace’ of the child and yet little consideration is given to the postures children frequently adopt. They are given onesize-fits-all furniture and often have to twist to see the board; they can be found hunched over

laptops and, at home, are left to interact with hand-held devices for long periods. Unsurprisingly, back pain in children is becoming more common. Research reveals that 72% of primary aged children and 64% of secondary aged pupils have experienced back and/or neck pain in the past year. Back pain in children should never be considered normal, says physiotherapist Lorna Taylor. In this issue (p18-19), Lorna discusses the impact of our changing lifestyles and provides advice on how to help keep your child’s back strong and healthy. Children who suffer back pain are more likely to experience it as an adult, so it is essential to form good habits at an early age.


Patients open up about GPs, A&E and the internet 9

Partial knee replacements could save NHS £30m 16

Richard Sutton Editor LETTERS TO THE EDITOR:

Is you child’s back fit for the future? 18-19


1) www.cmrsurgical.com Cover image: senivpetro/Freepik

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

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

£250m investment in artificial intelligence in healthcare 21

Depression a growing problem for carers




“TAKING afternoon naps linked to healthy heart,” The Times reported recently. A study carried out in Switzerland suggested that people who had one or two afternoon naps a week were less likely to have a heart attack or stroke, compared with people who did not nap. Responding to the study, the NHS said it was unclear whether napping during the daytime was healthy or unhealthy. Some previous studies found a reduced risk of heart and circulation problems, while others found a higher risk. This study of 3,462 Swiss adults aimed to see whether the number of naps a week, and the length of time spent napping, could explain the conflicting results. While researchers found no link between length of naps and heart or circulation

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Can afternoon naps lower heart attack and stroke risk?

problems, they found that one or two naps might reduce risk but having more than one or two naps did not reduce risk. Sleeping in the daytime on most days

could be a sign of a health problem, such as sleep apnoea, which disrupts night-time sleep. If you’re very sleepy during the daytime and need to nap most days, it is recommended that you see your GP.

Five-year funding confirmed for inflammatory arthritis centre


said: “The work we do across all four universities aims to address the needs of the more than 430,000 people in the UK who are living with the pain and fatigue of this condition. “We believe that the best way to do that is by working together seamlessly, to discover why and how the body’s immune system attacks the joints, so we will one day achieve our shared goal of finding a cure for rheumatoid arthritis.” During this new phase, the RACE research team will “for the first time also target other forms of arthritis, especially psoriatic arthritis”. Image: kjpargeter/Freepik

THE Research into Inflammatory Arthritis Centre (RACE) has received a further five years of funding from Versus Arthritis to research more targeted treatments for people living with the conditions. Over the past five years, the universities of Glasgow, Birmingham and Newcastle have come together to form RACE, with the aim of understanding why inflammatory arthritis starts, why it attacks joints, and why it persists. Their other priority has been to establish why current treatments don’t work for some people when they work for others, with the overall aim of discovering and delivering better treatment for people with inflammatory conditions like rheumatoid arthritis. Oxford University has now joined RACE as its newest collaborating partner, bringing new expertise and a long-standing history of research into arthritis. The centre has already made significant steps forward in our understanding of inflammatory arthritis. These include exploring interactions between immune cells and tissue cells of the joint, to better understand how persistent inflammation happens and how it can lead to tissue breakdown. The research team is looking to develop a treatment that would prevent tissue breakdown. Further, a clinical study using dendritic cells (generated from patients’ own white blood cells) which are injected into the knee, aims to help control inflammation. An initial study has been completed in Newcastle showing it is safe to inject these cells. It is now moving forward to a second clinical study, to track where the cells end up and how they control inflammation in the knee. Lead researcher at Glasgow University, Professor Iain MacInnes

Exploring interactions between immune cells and tissue cells of the joint, to better understand how persistent inflammation happens


Short sessions of activity can have health benefits

Image: @azerbaijan-stockers

BackCare Christmas concert NOT to be missed this Christmas! BackCare’s Carol Concert takes place on Thursday 12 December in the Chapel Suite at the Wellington Hotel by Blue Orchid, 71 Vincent Square, Westminster, SW1P 2PA. The BackCare AGM will be at 6pm and the concert will follow from 7pm to approximately 9pm. Tickets will be £20, which can be purchased through Head Office. Details: 020 8977 5474

‘Optimists live longer’, says study “OPTIMISTS are more likely to live longer than those who have a more negative approach to life, a US study has found,” BBC News reported recently. The study used information collected from male war veterans and female nurses taking part in two long-running studies in the US. The participants were around 60 to 70 years old when they completed optimism questionnaires, and the researchers looked at whether optimism was linked to living longer. People who had the highest optimism scores had a lifespan about 9% longer than those with the lowest scores. However, the research cannot prove cause and effect. Optimism and lifespan may be influenced by many hereditary, health, lifestyle and personal factors. People with a good overall standard of health and wellbeing are probably more likely to be optimistic about their future.

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DIARY dates

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TAKING part in any physical activity is better than doing none at all – and even short bouts of exercise can be beneficial, according to new physical activity guidelines published by the UK’s Chief Medical Officer. The updated guidance takes new evidence into account, which shows that people can experience health benefits from lower volumes, intensities and frequencies of activity than had previously been thought. These new findings are of relevance for individuals with low levels of physical fitness and disabled adults. Each week, the guidelines advise that adults should aim to engage in: l at least two-and-half hours of moderate intensity activity, such as cycling or brisk walking l or 75 minutes of a vigorous intensity activity, such as running. The guidelines also state that, at least twice a week, all adults should take part in activities that increase or maintain their muscle strength and involve the use of major muscle groups in the upper and lower body.

While researchers attempted to adjust their analysis for these sorts of factors, it wasn’t possible to remove their influence fully. It’s also questionable how applicable the results of these optimism assessments, taken 15 to 30 years ago from very specific groups of older US nurses and war veterans, are to the general UK population. Nevertheless, say health experts, the research highlights the importance that mental health and wellbeing can have on physical health.



Simple changes to one’s lifestyle that encourage more exercise can improve mental as well as physical wellbeing

Helping GPs to encourage physical A NEW toolkit has been devised to help GPs encourage physical activity. Sport England has teamed up with the Royal College of GPs (RCGP) to launch the Active Practice Charter that inspires and celebrates GP practices that are taking steps to increase activity in their patients and staff. With one in four people saying they would be more active if it was recommended by a GP or nurse, the charter includes a toolkit that will support time-poor GPs to raise the subject of activity with patients and achieve Active Practice status. The charter will support around 8,000 GP practices in the UK and help them raise awareness of the simple changes that can be made to improve the physical and mental wellbeing of patients and staff. Physical inactivity is estimated to cost the nation £7.4 billion a year. Sport England chief executive Tim Hollingsworth said: “As trusted sources of information, GPs


Regular exercise can cut the risk of coronary heart disease and stroke by as much as 35% and practice teams have a real opportunity to start discussions that help it become the new normal in their community – for prevention as well as treatment. “This toolkit will help busy GPs talk to patients about getting active and recommend local opportunities as part of their routine practice.” Research shows that regular physical activity can reduce the risk of coronary heart disease and stroke by as much as 35% and decrease the risk of early death by as much as 30%. The charter builds on previous work

aiming to boost the nation’s activity levels, including an initiative that sees GP practices encouraged to develop closer links with their local parkrun to become certified “parkrun practices”. However, while many GPs already promote physical activity, barriers to prescribing exercise or discussing physical activity have been identified – for example, GPs not having enough time in consultations to have effective conversations with patients. “Busy GPs can’t be expected to do everything when it comes to getting the nation more active, but we can play a vital role in starting the conversation with patients,” said Dr Andrew Boyd, RCGP clinical champion for physical activity and lifestyle. “By making small changes in our own workplace – using standing desks, encouraging active transport for staff, and partnering with local physical


activity can lead to healthier lives activity providers, for example – we can demonstrate to patients that being more active is good for everyone’s physical and mental health.” Professor Helen Stokes-Lampard, chair of RCGP, added: “All GPs know that encouraging patients to be more active can have huge benefits on their health and wellbeing and, in some cases, drastically improve conditions such as diabetes and heart disease – even dementia. “But having the time to advise patients on lifestyle in the current 10-minute consultation can be a huge challenge, especially when there are often so many other things we need to discuss and when this probably wasn’t the reason the patient has made the appointment – so taking a practice-wide approach to encouraging healthier lifestyles, for all of us, is a great idea.” https://www.sportengland.org https://www.rcgp.org.uk

Prescribing physical activity can have huge benefits for health and wellbeing



First contact practitioners taking pressure off GPs The title FCP currently stands for ‘First Contact Physiotherapists’, but the term is set to change to ‘First Contact Practitioner’ (FCP) next year, opening the door for more chiropractors to work in FCP roles.

THE Nuffield Trust produced figures for the BBC this year which showed the first sustained drop in GP numbers for 50 years. Musculoskeletal (MSK) problems are addressed in one in eight GP appointments, and an estimated 29% of the UK population live with an MSK condition. As MSK specialists, chiropractors have a key role to play in relieving some of this pressure, but still in a First Contact role, providing ease for access for patients. There are currently two chiropractors working as FCPs, both members of the British Chiropractic Association. Hannah Fairris is one of them – now a champion for the profession just two years after graduation. Finding herself in a GP practice was a “happy accident” as she explains.

Musculoskeletal problems are addressed in one in eight GP appointments levels of satisfaction, GPs and Advanced Nurse Practitioners are happy. As you can imagine when there is a new skillset available within the team, there was some trepidation to start with. Of course, because NHS colleagues tend to have more experience of physiotherapists, some do think I am a physio or an osteopath, but by being here and working in this role I can champion the chiropractic profession. My NHS colleagues are impressed that our training is to such a high standard, and most importantly, I can help MSK patients to feel better quicker. To bring our skillset to the table benefits everyone all round.

My first exposure to NHS triage was working with Dr Neil Osborne at What has been the biggest benefit? Christchurch hospital As a chiropractor in a GP practice, when I was a student MSK patients only wait one to at AECC University two days to see me, versus the College. When I one to two week wait time for became an associate a GP appointment. I get only after graduation, I positive comments about how Hannah Fairris: “I’m able to use realised that with the this integration works well for my diagnosis skills much more typical patient you see, everyone; obviously it was a step than I do in private practice” the diagnosis skills we change to go into GP practice, but are taught aren’t always this experience has shown myself used as much as I would have liked. and my colleagues that chiropractors are more Once I started my own private clinic, I thought confident than GPs in MSK diagnosis, so the that I’d use GP triage as a marketing opportunity level of reassurance is huge. but realised that as a patient recruitment initiative For me, the structure of the GP practice this wasn’t going to be successful as many of the provides lots of opportunities to treat and refer, NHS patients aren’t appropriate to refer to a private with all of the appropriate ‘safety nets’ in place clinic for a variety of reasons. But because I was because I’m working as part of a wider team. I delivering a better service for MSK patients at the will take history and do an examination and if the GP surgery, I took this on in an FCP capacity. issue is an MSK one, I will diagnose. If the issue is not an MSK issue, I arrange referral. So, what’s the experience been like? It has transformed my day-to-day experience I’m loving it! The variety of patients I see in the of work. Because I’m able to use my diagnosis Back and Joint clinic is different to those in skills much more than I do in private practice, private practice work, and it presents options for I meet lots of different people and I feel really career diversity I hadn’t anticipated. supported by the support network around me. Because I’m able to relieve some pressure in https://chiropractic-uk.co.uk the system and the patients have fed back high



Patients open up about using GPs, A&Es and the internet

MOST Britons think A&E services are overused and half think it is hard to get a GP appointment, says a new study. The first large-scale research into attitudes towards emergency care from the most recent British Social Attitudes Survey, carried out by The National Centre for Social Research and funded by the National Institute for Health Research, has revealed significant differences in perspectives by a range of sociodemographic factors. The Drivers of Demand for Emergency and Urgent Care study finds: l People living in deprived areas are more likely to prefer Accident & Emergency

departments (A&Es) over their GP to get tests done quickly, find it more difficult to get an appointment with their GP and think A&E doctors are more knowledgeable than GPs l Parents with children under five are most likely to have used an A&E in the last year, think it is hard to get an appointment with their GP, are less likely to trust their GP but are more likely to use the internet to try to decide what the problem might be l Men are less knowledgeable about how to contact a GP during out-of-office hours and less likely to use the internet to research a health problem. Researchers found that the population is fairly united (86%) in the belief that A&Es

are overused. When asked whether they had actually accessed A&E services in the previous 12 months for themselves or others, 32% of the public and more than half of parents with a child under five (54%) report they have done so at least once. In contrast, 29% of those without young children in the household say they have visited A&Es in the same period. Around half (51%) the population agrees that it is hard to get an appointment with a GP. Sixty-five per cent have confidence in GPs while 11% state they do not have much confidence. www.nihr.ac.uk www.bsa.natcen.ac.uk



PHYSIOTHERAPY should be provided, with other interventions such as community exercise groups, to all older people who have fallen or are at risk of falls, according to a new briefing from the Chartered Society of Physiotherapy (CSP). Physiotherapy works for falls: a community approach has been developed by the CSP in partnership with Agile, the professional network for physiotherapists working with older people. It highlights how a multifactorial approach to falls assessments and prevention, which includes physiotherapy, can reduce falls in older people. Evidence shows that providing multifactorial falls risk assessments can reduce falls by up to 24%. Furthermore, using evidence-based exercise programmes, which involve strength, balance and functional exercises, can lead to up to a 34% reduction in the rate of falls.

Image: Freepik

Physiotherapy and local exercise groups can help reduce falls

As well as providing quick reference data for physio staff, the briefing is designed to help make the case for a multifactorial approach to falls prevention to GPs and

health commissioners. Kate Bennett, chair of Agile, said: “The importance of producing, and using, documents like this cannot be underestimated when it comes to influencing commissioners and key decision makers around creating effective services that meet public need regarding falls prevention. “The evidence provided in the briefing is key to making the case for effective service provision.” The briefing is short and easy to read. It explains the key issues about falls prevention, provides evidence and relevant statistics and offers clear examples, which demonstrate the beneficial use of physiotherapy services. It also explains the clinical and cost effectiveness of a multifactorial approach, which includes physiotherapy, and the clear benefits it provides to falls patients.

Reablement and preventing premature admission to care


for many years. But as soon as people understood what we were trying to achieve, they bought into the project.” The award was launched to highlight the use of NICE guidance or quality standards in practice by either individuals or teams of allied health professionals. The judges were impressed by the significant impact of the project which included: l a reduction in length of stay from 20 days to 14 days l an increase in patients returning directly home (55% to 69%) l increased staff morale and skills l positive patient feedback. The intermediate care guideline, including reablement, covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital.

It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care. NICE believes the approach will be transferable to other trusts around the country. https://www.nice.org.uk www.csp.org.uk https://agile.csp.org.uk Image: rawpixel.com/Freepik

AN innovative approach that gets patients back into their own homes after a hospital stay has won a national award. The project has allowed those in hospital to reduce their length of stay by an average of six days by promoting independence at every opportunity and preventing premature admission to care. Carolyne Hague was behind the programme which used NICE guidance on intermediate care, including reablement, to redesign the approach to bed-based intermediate care at Royal Devon and Exeter NHS Trust. The programme won the NICE into Action award at the Chief Allied Health Professions Officer’s awards ceremony in London. Carolyne said: “This project is all about collaboration and working as a team for the patients. “Initially it was quite daunting coming in and suggesting people might do something in a different way when they’ve been doing it in the same way

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Improving local strength and balance programmes NEW guidance from Public Health England (PHE) aims to improve the quality of strength and balance exercise programmes. Strength and balance quality markers: supporting improvement, has been produced by PHE in collaboration with the National Falls Prevention Coordination Group, which includes the Chartered Society of Physiotherapy (CSP) among its members. The document sets out seven quality markers for strength and balance exercise, which are designed to be used as criteria by commissioners and strategic leads in England as a tool to help them carry out self-audits in their local areas. It gives clinical commissioning groups (CCGs) and provider organisations the opportunity to self-assess their provision and

quality of strength and balance programmes. The CSP worked closely with Agile, the professional network for physiotherapists working with older people, and the Royal College of Physicians to develop the evidence-based recommendations.

Programmes to prevent falls To be effective, strength and balance programmes should include weekly sessions of at least two to three hours. The guidance advises that in order for strength and balance improvement programmes to be effective at preventing falls, they should include either oneto-one or group balance and task training exercises, plus resistance exercises delivered by an appropriately qualified instructor.

It also recommends that programmes should run for a minimum of 50 hours, include weekly sessions of at least two to three hours and provide exercises that are progressive, in terms of intensity and challenge, and tailored to each individual. In addition, it suggests that local commissioners and programme providers should: l raise awareness that falls are not an inevitable part of ageing and should provide suitable information about what older people can do to prevent them l establish effective referral pathways and encourage uptake to strength and exercise programmes l use a person-centred and evidence-based approach and monitor outcomes.

Evidence-based audit criteria The quality markers included in the guidance suggest auditing factors, such as: l the provision of evidencebased muscle strengthening and balance improvement exercise programmes in a local area l participant adherence and completion rates for strength and balance exercise programmes l outcomes that demonstrate improvements in gait and balance l what support participants receive to maintain physical activity levels. As well as being backed by the CSP, the guidance has also been endorsed by the British Geriatrics Society, the College of Podiatry, the Royal Society for the Prevention of Accidents and the National Audit of Inpatient Falls.



Golf is a favourite pastime for many across the nation. Whether you’re a seasoned player or new to the sport, it’s important to check your swing to avoid unnecessary injury, says the British Chiropractic Association.


Avoid back and neck ACHES and pains can make 18 holes seem like 108, and make every swing feel like an arduous and painful task. It can, of course, have a negative impact on the quality of your game and score. Poor technique, inadequate warm up before playing and carrying heavy golf bags are the main causes of injury, particularly to a player’s back or wrist. But these simple tips can help keep your swing feeling great.

Pressure points The lower back, neck and wrists are the most obvious joints at risk for golfers through the repetitive nature of the golf swing. But carrying a golf bag can also place a strain on your neck and put extra stress on your spine, leading to extra lactic acid build-up in your muscles and fatigue. When you’re fatigued, you’re more prone to injuries – not to mention a poorer performance! Take advantage of the latest golf accessories

designed to help, such as lighter bags and dual harness straps over shoulders to distribute the weight. If you’re using a golf cart, push it in front of you rather than pulling it behind as there is less twist through your spine.

Warm up Golfers often don’t warm up at all before playing. If muscles are not prepared by a good stretching routine, it can lead to a lack of flexibility and injury. The lower back is often the victim of reduced mobility in other areas


pain and injury in golf such as the mid-back and hips. If they cannot rotate enough during the golf swing, the lower back takes more of the stress. Spend two or three minutes warming up before teeing off to tease more movement out of all the structures needed in the swing, such as your hips, midback, hamstrings, quads, chest muscles and shoulders.

Posture Adopting a ‘C’ or ‘S’ posture during the golf swing can reduce the quality and consistency of

ball strike, distance, and can sometimes lead to back pain. Those in a ‘C’ posture have a hunched and rounded spine with tucked under hips, whereas those in a ‘S’ posture have a better hinge in their hips but an overarched lower back. The sweet spot is between those two postures. Ask a friend or your golf pro to take a photo or video of you as you swing to see which posture you are adopting.

(arching) in your lower back and lead to back pain. To avoid this, set up your golf stance and place one hand on the top of your belt (approximately the level of your pubic bone) and the other approximately 8-12 inches away under your bottom rib. Keeping your hands in place, move your body as if you were making slow, smooth swings. The distance between your hands should not change.

Swing technique

Getting around

Going way past parallel in your back swing can sometimes cause excessive extension

Contrary to popular belief, trolleys are not the best way to caddy clubs as they can cause unnecessary pressure

from pulling and bending in the wrong positions. A power or electric caddy is better. When it comes to picking up your golf bags and replacing the divots, bend from the knees and hips as well as the back. Finally, your shoes should not only provide a good foundation for your posture and swing, they should also allow you to walk comfortably for the 12,000 steps or so you walk in each round. By following these few simple tips, players can expect to play a better game of golf with less effort and risk of injury, while at the same time having more fun and hopefully a few more birdies!

Image: Bedneyimages/Freepik



Core exercises that can improve your game A PROFESSIONAL may recommend specific exercises, hands-on treatment, or rehabilitation. While it is important to be assessed to determine your specific strengths and weaknesses with regards to golf, these four core exercises can help to enhance your game by increasing the driving power of your swing.

l Tip: Place a tennis ball on your low back; try to keep it from falling off by keeping your back still.

l Using your support forearm, push into the floor to help you lift your hips up from the floor and forwards. Your body from the feet up should be aligned. If this is too difficult, perform this with your knees bent. l Maintain this position for 10 seconds, while maintaining normal breathing. Repeat for four to six holds on each side. Rest for 20 seconds. l Repeat the sequence but with two less holds each time. Listen to your body, work within your pain-free capacity. l Tip: Use your hand with your fingers spread to support your shoulder joint.

McGill modified curlup l Lie on the floor, on your back. Bend one knee and place your foot in-line with the opposite knee. Place both hands underneath your low back with palms facing down. l Activate your core muscles by lightly pushing out your stomach muscles. l Lift your upper back and head off the floor. Unlike a crunch or sit-up, this movement is very small. l Hold for 10 seconds, maintain your breathing throughout, then lower back to the starting position. Repeat five times. Rest for 30 seconds. l Repeat the sequence three times in total, but with two fewer holds each time. l Tip: Avoid lifting your head off the floor more than one inch.

Side plank l Start by lying on your side with your support forearm directly below your shoulder.


ASSESSMENT by a welltrained professional can help you to determine your key areas of weakness or imbalance such as mobility or strength deficits.

Bird dog l Begin on your hands and knees with your shoulders positioned directly over your hands and your hips over your knees. l Make a fist with your hand and with the opposite leg push your heel behind you and fist in front of you as if you are pushing the wall away from you. Hold for five seconds. l Sweep the floor with your hand and knee to return to the starting position. Repeat on the opposite side. l Repeat the sequence 10 times.

Dead bug l Lie on the floor, on your back. Lift your knees so that your hips and knees are at 90°. l Activate your core muscles by lightly pushing out your stomach muscles. Ensure your low back is not flattened against the floor. l Maintaining the 90° position of your legs, slowly lower one foot towards the floor, tap the floor, but do not let your heel rest on it. l For increased difficulty, lower your arm towards the floor as you lower the opposite leg. l Repeat on the other side. Repeat the sequence 10 times. l Tip: To increase difficulty, allow your legs to straighten more in the lowered position.

On the fairway l Recent figures from England Golf reveal that more than two million people in England play golf at least twice a month. l The highest areas of increase in golf club memberships are with adult men and the over-65s. l 62% of adult male club members play weekly. https://chiropractic-uk.co.uk


Pharmacy bags take message to target audience IN the summer, the Royal Osteoporosis Society (ROS) tested a new way of reaching people with a diagnosis of osteoporosis – by advertising on pharmacy bags. The branded bag invited people with osteoporosis to get in touch with the

charity and find out more about the support available to them. The test took place in South West England, with 75,000 ROS pharmacy bags distributed across 75 LloydsPharmacy locations.

“Pharmacies are a perfect way to share our message,” said the ROS. “People are likely to have their minds on their health. This means they’re more likely to take the time to stop and read our message.” https://theros.org.uk

A RECENT study has raised the question of whether bone health may be affected by poor quality social relationships. Published in the Journal of Epidemiology and Community Health, the study measured bone density and psychosocial stress in more than 11,000 US postmenopausal women. The observational study followed the participants for six years and found that women with high levels of psychosocial stress were more likely to have lower bone density. The researchers suggested this may be due to stress-related hormone changes affecting the body’s process of making and repairing bone tissue. The Royal Osteoporosis Society, however, has cautioned

that there is insufficient evidence to prove a causal link. Its clinical adviser Professor Richard Eastell, Professor of Bone Metabolism at the University of Sheffield, said: “There may be an association between stress and bone loss, but this doesn’t prove one causes the other,” he said. “When people are stressed, they may smoke more, drink more alcohol and exercise less. The researchers have thought about some of these factors that could be the cause of lower bone density, but there may be others.” The study concludes with a recommendation that postmenopausal women may benefit from having access to better social support networks. https://theros.org.uk

Image: bearfotos/Freepik

Exploring the link between stress and bone health

Stress may have some impact on osteoporosis

Treatment extended for children with spinal muscular atrophy MORE children with the rare genetic disorder spinal muscular atrophy (SMA) can now be treated with Spinraza after the National Institute for Health and Care Excellence published amended draft guidance in July, following a proposal for extending the terms of the managed access agreement between NHS England and Biogen for funding it. The agreement will now include paediatric patients who have, in the previous 12 months, lost the ability to walk independently. This replaces the previous criteria that patients, who had previously gained ambulation, should

still be able to walk independently at the start of their treatment with Spinraza. Spinraza (also called nusinersen) is the first treatment that targets the underlying cause of SMA. SMA affects the nerves in the spinal cord controlling movement. This causes muscle weakness, progressive loss of movement, and difficulty breathing and swallowing. People with the most severe forms of SMA usually die before the age of two. Without nusinersen, the condition is managed through supportive care. www.nice.org.uk



Partial knee replacements could save the NHS £30m a year


e: Fre


Partial knee replacements (PKR) are as good as total knee replacements (TKR), while being more cost-effective, according to new research funded by the National Institute for Health Research

RESULTS from the TOPKAT study (Total or Partial Knee Arthroplasty Trial), led by researchers at the University of Oxford, suggest that over five years partial knee replacement has a similar, if not a slightly better, clinical outcome than total knee replacement. They also found the economic benefit of using PKR is substantial and could save the NHS about £30m a year based on an increase of 31% usage. At present, only 9% of joint replacements are PKR yet it is thought that around 40% of patients could be suitable candidates. The study, funded by the NIHR’s Health Technology Assessment (HTA) programme and supported by the NIHR’s Clinical Research Network (CRN) has been published in The Lancet. Chief Investigator Professor David Beard1, said: “Despite many previous studies and considerable data, we have never had a sufficiently large randomised clinical trial to answer this important question. TOPKAT has now definitively shown us that both operations provide benefit and are worthwhile but, given the option, PKR is probably the implant of


New adult social care research projects share £2.5m fund choice – providing sufficient expertise exists to implant it.” He added: “An important caveat is that the surgeries in the trial were performed by well trained, experienced surgeons in both groups. If any recommendation to increase the use of PKR is made, it will have to be accompanied by provision of adequate training and expertise for surgeons undertaking the technically more demanding PKR procedure.”

Osteoarthritis Over 300,000 knee replacements are performed in the UK each year, mainly for osteoarthritis. Surgeons and patients face a choice of which type of operation to perform or undergo for medial compartment (one area in the joint) arthritis. TKR replaces all parts of the joint whereas a PKR replaces only the diseased area and retains as much soft tissue as possible. TKR is fully established and used most often whereas PKR is less common and has been in widespread use for a shorter period. The multidisciplinary team from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, and the Health Services Research Unit at the University of Aberdeen, with the support of the British Association of Knee Surgeons (BASK), found the failure or revision rate for PKR to be identical to that of TKP (both with revision rates of 4%). These findings contrast with previous research based on national registries, which showed PKR to have a higher revision rate. The study was started in 2010 and 528 patients from 27 hospital sites were followed up at five years. They were asked questions about pain, function, activity levels and satisfaction. 1) Professor David Beard is Rosetrees/Royal College of Surgeons Director of the Surgical Interventional Research Unit at the University of Oxford

THE NIHR Research for Patient Benefit programme has funded £2.5m of new research into adult social care. Twelve new projects have been funded, ranging from work to find the best ways to care for people in their own homes, to online tools aimed at teaching adults with learning disabilities how to read. Research proposals and funded projects were submitted from leaders in the field to early career researchers. Following this successful call, the NIHR will be investing in future social care research under the banner of Research for Social Care (RfSC). The RfSC call, planned to launch in September, will have a budget of £3m. NIHR’s ongoing efforts to build and improve social care research in England has seen just under £20m committed over five years. This includes £1.8m specifically targeted on building research capacity, with PhDs, career development awards and internships planned. Lyn Romeo, Chief Social Worker at the Department of Health and Social Care, said: “Access to high-quality research and evidence is essential if we are to understand the approaches and interventions that work and why. As social workers and social care professionals, we must always remember to challenge ingrained thinking and consider how we can improve our decision-making and the habits and systems we take for granted in our everyday work.” Newly-funded projects include: Stacey Rand, University of Kent – £150,000 Stacey Rand’s research is helping to find out what types of services in the community are most useful in helping people with dementia to live in their own homes. The researchers are testing a questionnaire they’ve designed that carers can fill out on behalf of a close friend or relative with dementia, to help understand how different services affect their lives, as well as a version for carers themselves. They want to make sure the questionnaires are easy to complete and collect the right information – helping to understand which services help these people the most. Professor Chris Hatton, University of Lancaster – £350,000 Adults with learning disabilities often live in residential facilities or in supported living. Many want to be more independent, but at the moment it’s not clear what support is most cost-effective and which is best for these adults. Professor Hatton wants to find out more about the quality and costs of these two types of support, by talking to adults with learning disabilities and their families and working with different service providers in England. The research aims to gather information and evidence to help healthcare commissioners provide services, and help families lobby for the best support. Dr Phillip Whitehead, Northumbria University Newcastle – £150,000 Some people who need care at home may need more than one person to help them move around – for example getting out of bed and into a chair. ‘Double-handed’ homecare packages offer this help, but there isn’t much evidence on how well this care works or how it should be monitored and reviewed, for example when it’s put in place after an accident or illness. Dr Whitehead’s research is looking at the best way to review this type of care, so that councils can make sure they are providing cost-effective support for people living at home. www.nihr.ac.uk www.pssru.ac.uk www.lancaster.ac.uk www.northumbria.ac.uk



How best to carry books; to retrieve something at a low level; to use a tablet while sitting at a desk; and best posture when using a computer

More and more children and young people are experiencing back and neck pain. Lorna Taylor, a paediatric physiotherapist from Jolly Back, explains why changing lifestyles are affecting young, growing spines and offers practical tips to help you and your child.


Is your child’s back RECENT research shows that 72% of primary aged children and 64% of secondary aged pupils have experienced back and neck pain in the past year. Back pain in children is becoming more common, but it should never be considered normal. All episodes of back pain lasting more than two weeks should be reported to a GP. As a society we have become increasingly sedentary. ICT now plays a huge part of our children’s lives at school and at home. However, little consideration is given to the postures children frequently adopt – hunched over handheld mobile devices, working at laptops while sitting on the floor, sitting on one-sizefits-all furniture, spending more time sitting in the car going to structured activities and to/from school because of safety fears. For younger children, there is less opportunity to simply play

The formation of good, healthy habits early on is essential and develop the strong core muscles they need to maintain a healthy spine. Studies show that children who suffer back pain are four times more likely to experience it as an adult. Prevention through the formation of good, healthy habits early on is essential. So how can you help keep your child’s back strong and healthy? 1) Remember healthy posture. A healthy spine from the side looks like a letter “S” with three curves – rather than a curved, damaging “C” shape. From behind, a healthy spine is straight upright. It’s important to remember this throughout all our daily activities. Think “tall” when sitting, standing and walking.

2) Encourage physical activity. To help build up the core muscles to help protect the spine, a healthy spine likes to move. Movement is also needed to increase blood flow to remove the build-up of toxins and to nourish the spine. Can you walk/cycle/scooter all or part of the way to school? Ensure schools are offering PE sessions and break-times, rather than keeping children in for extra work. Children who play sport should also ensure they have good technique, supportive footwear and warm up/cool down adequately. 3) Support healthy sitting. Encourage your child to arrange their workstation so they are comfortable before they begin. When working at a laptop/


fit for the future? computer: sit at a desk which is level with your forearms (with elbows bent to 90 degrees). Ensure that the top of the screen is level with your eyes and that if using a laptop, you use a separate keyboard. Ensure your feet are supported. When using a tablet, make sure it has a stand so that it is not used on a flat desk. Complete the free www.ergonomics4kids. co.uk course online to learn more about healthy ICT use for children and share with your school. When sitting at school: encourage your child to tell you or their teacher if they are uncomfortable at school. School is the “workplace of the child”, children should be comfortable and be able to concentrate and limit damaging postures with associated back/neck strain. Check if your child has a clear view of the board, or do they have to twist around to see it?

Can they turn their chair around or move position? 30:30 stretch and wriggle: encourage your child to get up and move for 30secs after sitting for 30mins. 4) Eat sensibly and stay hydrated. The shock-absorbing discs of the spine are 90% water, so regular hydration helps keep them in tip top condition. A healthy weight limits extra stress on the many joints and muscles of the spine. 5) Remember safer lifting. Bend your knees and not your back when you pick something up and put it down. Get close to the object, get a good grip and avoid twisting and stooping because, over time, this will make your back very unhappy. Children should limit lifting siblings and other children. 6) School bag considerations: l Design: a mono/single strap bag should be worn across the body (not on one shoulder) and

remember to swap carrying sides regularly. A rucksack should be worn over both shoulders – this will keep the spine symmetrical and upright. l Correct adjustment: a mono strap bag should be adjusted so that the top of the bag is level with the hip/belt. A rucksack should be worn close to the body and higher up the back (so that the bottom of the bag is level or above the waist). A chest and waist strap will help if walking long distances. A wheeled trolley bag or lightweight wheeled backpack can be useful purchases if your child’s school has few stairs. l Packing: keep the bag balanced, with heaviest items packed first and closest to the spine. It’s important to carry only what is needed, so repack the bag each evening to keep it as light as possible. School bags should weigh approximately 10% of a child’s

body weight. It has been suggested that above 15% will be damaging (BackCare. org). Talk to your child’s school to ensure they do not get into trouble if they accidently forget a book. Detentions for forgetting a book or piece of equipment are not helpful as this encourages children to overpack their bags. Can current work be placed in lighter folders, rather than carrying all work? Lockers and safe storage areas are beneficial, especially once in secondary school. This is particularly helpful for Year 7 pupils who are often lightest but have to carry similar amounts to larger Year 10 pupils. Can “school bag advice” be given during Year 6 transition to help pupils and their families prepare best? Remember to safely lift and put down your bag too! www.jollyback.com



Arthritis too often ‘dismissed or overlooked’ by Government The Government is inviting views on how we can live longer, healthier lives. There are some positive proposals for people with arthritis – but Versus Arthritis (VA) will continue to demand more action to help people look after their musculoskeletal health, says the charity’s Senior Policy Manager Laura Boothman. IN 2018, the Government set a mission to ensure that by 2035, people can enjoy at least five extra healthy, independent years of life and to narrow the gap between the richest and poorest in the country. On 22 July 2019, ‘Advancing our health: prevention in the 2020s’ was released. This official green paper sets out the Government’s suggestions to tackle preventable ill health and invites people to give their views. So, what does this mean for people with arthritis? The green paper highlights that, for the last 30 years, musculoskeletal conditions that cause problems with joints, bones and muscles have been the most common reason for years lived with disability in England. We know that too often arthritis is simply dismissed or overlooked, so this recognition by Government is important. However, we were also expecting concrete actions that would make a real difference and help people to look after their musculoskeletal health. We know that people with arthritis often want to work but can find this difficult. That’s why VA is campaigning so that people have better support to be in work. VA welcomes proposals in the paper that the Government will bring together experts to review guidance for employers, develop a package of tools for employers to use to support their employees, and how these can be better promoted and used. These ideas, and proposals to address job loss due to ill-health, are


a start, though more needs to be done to put suggestions into practice and to build understanding of the impact arthritis has on people’s working lives. Several other proposals are promising for people with arthritis, including: l a call for evidence on musculoskeletal conditions, including priority areas for action such as awareness raising, physical activity, behaviour change programmes and links between mental and musculoskeletal health. Government is also interested in what data should be routinely collected about musculoskeletal conditions l a digital design challenge for strength and balance exercises, focused on people with health conditions l work with charities and Sport England on a new physical activity campaign l a ‘Home of 2030’ design competition to explore how more energy efficient, accessible and adaptable homes can be designed.

What happens next? The consultation runs until midOctober and VA’s policy and public affairs team will be working to ensure that the views of people with arthritis are heard by Government through this process. VA does not accept that these proposals are enough and will demand more to tackle the pain, fatigue and isolation that arthritis causes. www.versusarthritis.org

Image: rawpixel.com/Freepik


Artificial intelligence can use predictive models to better estimate future needs of beds, drugs, devices or surgeries

Image: jcomp/Freepik

£250m investment in artificial intelligence in healthcare A NEW National Artificial Intelligence Lab will use the power of artificial intelligence (AI) to improve the health and lives of patients. The AI Lab will bring together the industry’s best academics, specialists and technology companies to work on some of the biggest challenges in health and care, including earlier cancer detection, new dementia treatments and more personalised care. AI is already being developed in some hospitals, predicting cancer survival rates and cutting the number of missed appointments. The AI Lab’s work is expected to improve cancer screening by speeding up the results of tests, including mammograms, brain scans, eye scans and heart monitoring. It can use predictive models to better estimate future needs of beds, drugs, devices or surgeries. It could help to identify which patients could be more easily treated in the community, reducing the pressure on the NHS and helping patients receive treatment closer to home. It could also help to identify patients most at risk of diseases such as heart disease or dementia, allowing for earlier diagnosis and cheaper, more focused, personalised prevention. The AI Lab will build systems to detect people at risk of post-operative complications, infections or requiring follow-up from clinicians, improving patient safety and reducing readmission rates. It will inspect algorithms already used by the NHS to increase the standards of AI safety, making systems fairer, more robust and ensuring patient confidentiality is protected. It will also automate routine

admin tasks to free up clinicians so more time can be spent with patients. The lab will sit within NHSX, the new organisation that will oversee the digitisation of the health and care system, in partnership with the Accelerated Access Collaborative. The investment will support the ambitions in the NHS Long Term Plan, which includes pledges to use AI to help clinicians eliminate variations in care. Simon Stevens, NHS England Chief Executive, said: “Carefully targeted AI is now ready for practical application in health services. This is another step in the right direction to help the NHS become a world leader in using these important technologies.”

Getting the basics right Allied Health Professionals, including the Chartered Society of Physiotherapy (CSP), welcomed the £250m boost for the NHS but suggested the government also needs to focus on more basic IT and data-related issues, such as ensuring that all community-based staff have digital access to patients’ health records, as well as the necessary hardware to allow them to work efficiently and offer the best care to their patients. Euan McComiskie, CSP health informatics lead, said: “With three quarters of NHS computers still running Windows 7 just a few months before support is cut off, and 2,300 computers running Windows XP for which support ended five years ago, there is still much to do at a basic level for frontline clinicians.” https://www.nhsx.nhs.uk https://www.csp.org.uk


Image: jcomp/Freepik


Stress and depression a growing problem for adult carers AS MANY as 60.6% of carers reported feeling stressed in 2018-19 (up from 58.7% in 2016-17), according to a survey of 50,800 adult carers in England, published by NHS Digital. The proportion of carers who reported feeling depressed increased from 43.4% in 2016-17 to 45.1% in 2018-19. Of all the carers surveyed, 77.8% reported ‘feeling tired’ (an increase from 76% in 2016-17) and 66% said they experienced ‘disturbed sleep’ (an increase from 64% in 2016-17). More than three-quarters of people surveyed (76%) said they spend more than 20 hours a week looking after the cared-for person, with 38.7% spending more than 100 hours a week on their caring duties. The Personal Social Services Survey of Adult Carers in England 2018-19 reports on the views of 50,800 carers who are caring for a person aged 18 or over. The biennial survey of carers provides


The largest age band of carers was 55-64 years, which accounted for 23.8% of the eligible population vital information about the impact of people’s caring responsibilities on their quality of life. The results of the survey showed that the percentage of carers who were not in paid work because of their caring responsibilities increased from 21% in 2016-17 to 22.6% in 2018-19. 10.6% of respondents reported that caring had caused them a lot of financial difficulties in the past 12 months, which is an increase from 2016-17, when the figure was 9.6%. The report also provides information

relating to the carer and their wider experiences of providing care: l The majority of carers were female (67.8%) l The largest age band of carers was 5564 years, which accounted for 23.8% of the eligible population. The smallest group, 18-24 years, accounted for 1.6% of the eligible population l The majority of carers surveyed (65.4%) have been carers for more than five years. Almost a quarter (23.5%) have been caring for 20 years or more l Most carers who responded to the survey were caring for a person with a physical disability (51.4%), with the nextlargest group caring for someone with a long-standing illness (39.7%) l 38.6% of carers were extremely or very satisfied with the support or services they received, compared to 7.2% who were extremely or very dissatisfied. www.digital.nhs.uk


The National Institute for Health and Care Excellence (NICE) has published new draft guidance which aims to improve the wellbeing of adults who provide unpaid care for people over 16 years old. The recommendations emphasise what local authorities and health and social care practitioners can do to support carers. For practitioners, this involves identifying people who are unpaid carers so they can direct them to the appropriate financial, social and emotional support that is available. The guideline advises practitioners to encourage carers to discuss supportive working arrangements with their employers. This might include flexible hours or providing a private space to take personal phone calls.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Many carers are not aware of the help available to them, therefore it’s important that health and social care practitioners are at the forefront of identifying and supporting them. “Caring for a loved one can bring a whole host of responsibilities and worries. This guidance hopes to address those concerns and ensure that carers feel supported enough to provide the best possible care for those they look after.” The guideline also calls on health and social care commissioners to ensure replacement care services are available locally so carers can stay in, enter or return

Image: Freepik

Unpaid carers need more financial and emotional support to work, education or training. Approximately 6.5 million carers in the UK are unpaid with three million balancing work with caring responsibilities. It is estimated that unpaid care saves the UK £132 billion a year in care costs, but a recent report by Carers UK found that more than two-thirds of carers are using their own income and savings to cover the cost of care and two in five say they struggle to make ends meet. Currently, a carer’s allowance is £66.15 a week which equates to £1.89 an hour. www.nice.org.uk

Technology helping to make care tasks easier MORE than 7,500 carers shared their experiences and helped inform the State of Caring 2019 report, from Carers UK. Key findings include:

Finances l Almost two in five (39%) carers say they are struggling to make ends meet l More than half of carers receiving Carer’s Allowance (53%) are struggling to make ends meet l Over two thirds of carers (68%) regularly use their own money to pay for care or support services, equipment or products for the person they care for l One in eight carers (12%) reported that they or those they support received less care or support services during the

previous year due to a reduction in the amount of support from social services l 53% of carers said they are not able to save for their retirement l Almost two thirds of carers (64%) say they have focused on the care needs of the person they care for, and not on their own needs.

Use of technology l Four in five carers reported using technology to help them in their caring role l Of these, 27% use remote health care such as online GP appointments, repeat prescriptions, online video consultations, or online mental health services l 19% of carers who use technology

said they used remote monitoring and alerts such as motion sensors, fall detectors, personal alarm, or GPS trackers, while 12% use medication management tools such as medication dispensers or reminders l 8% of carers are using environmental monitoring such as heating and lighting control, door video systems, or smart appliances. 13% of those who use technology use vital signs monitoring such as blood pressure monitor, blood glucose monitor, and heart rate monitors. 4% of carers are using apps, including those which help with pain management, mood management and care co-ordination. www.carersuk.org




Profile for BackCare

TalkBack, autumn | 2019 (BackCare)  

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

TalkBack, autumn | 2019 (BackCare)  

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

Profile for backcare