TalkBack, Issue 1 | 2013

Page 1

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


■ EVENTS ■ COMMUNITY winter 2012/13


Official guide to the Back Pain Show 2013

2 Talkback news

BackCare Events Calendar 2013 Back Pain Show 2013 22-23 FeBrUAry 2013 – OlymPiA exhiBiTiON CeNTre, lONdON

Proudly sponsored by BackCare, the 2013 Back Pain Show brings together the latest in back care products, techniques and technologies in an exciting two-day event. Grab your two free tickets in this issue (page 24). Significant exhibitor’s discounts available, or 020 8977 5474.

Health and Wellbeing @ work 2013 5-6 mArCh 2013 – NeC, BirmiNghAm

Profiling the latest developments, with master-classes from leading experts in best practice, this professional conference is all about creating a healthy work environment and maximizing engagement and performance. BackCare will be hosting a mini-symposium on the second day. Visit for more information.

Virgin London Marathon 2013 21 APril 2013

It’s officially the world’s largest marathon and our proudest annual challenge event. Applications are now closed for 2013, but if you missed out and wish to run for Team BackCare in 2014, contact us at or 020 8977 5474.

Primary Care 2013 22-23 mAy 2013 – NeC, BirmiNghAm

Now in its 23rd successful year, Primary Care continues to be at the forefront of health care events as the UK’s leading conference and exhibition for GPs, commissioning groups and all healthcare professionals working in primary and community care. Find out more at

London 2 Brighton Challenge 25-26 mAy 2013

This challenge is like no other: walk, jog or run 100km city to coast. In 2012, 1,500 took the challenge, raising over £1 million for UK charities. An epic cross-country Ultra Marathon or the longest walk of your life, you choose! £85 to register + £400 fundraising pledge required. Full support checkpoints, hot meals provided en-route. Pace walkers, physiotherapists and medics on hand. Find out more at or 020 8977 5474.

Ride London 100 3 AUgUST 2013

August will see the debut of London’s newest mass-participation challenge event, Ride London 100. As many as 70,000 people are expected to participate, riding 100 miles from the Queen Elizabeth Olympic Park into central London through the scenic Surrey Hills before finishing on The Mall. BackCare has secured three guaranteed places of which one is already taken! Applicants must be confident cyclists who can ride safely in large groups. Find out more at or 020 8977 5474.

BackCare Awareness Week 2013 7-11 OCTOBer 2013

Did you know that there are six million carers in the UK? And that unpaid carers save the NHS and social services a staggering £87 billion every year? But our carers are at significant risk of back problems and 70% of them already suffer back pain. This year’s awareness week with focus on the back care needs of carers and what we can do to help.

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Talkback news 3



Hello and welcome to the first TalkBack of the new year. This is a special edition comprising the official exhibition programme of the Back Pain Show 2013, with a greatly increased print run to reach, not only our members, but everyone attending the show as well. So whether you’re a longstanding member or a first time show goer and perhaps future BackCare member, we hope the new year brings you ever greater possibilities for health, happiness and productivity. Our aim is, of course, to lessen the societal impact of back pain. Fulfilment of this mission involves a range of activities, many with an educational/informational dimension. So with the promise of reaching so many more people through this issue, I have decided to re-run four of the biggest stories from 2012, in addition to some newly-invited content from the field of back care. With the start of a bright new year, allow me to briefly update you on the progress of our campaign portfolio. As I mentioned in the last issue, we were on the verge of going international with the campaign against medically dangerous schoolbag loads. I can excitedly report that this has now happened – we have partnered up with Dr Winn Sams of North Carolina ( who has been campaigning for six years now and has several US states engaged in the process of drafting new legislation. Next, our campaign for effective manual handling training in the construction industry is set to step up a gear as we open talks with industry regulators in coming months. And finally, the theme of BackCare Awareness Week 2013 (7-11 October) will be back care in UK carers – did you know that there are six million carers in the UK and 70% of them suffer back pain? We feel that it’s an important issue which needs to be addressed, not least because they save the NHS over £80 billion every year! We’re re-running part one of the new educational series, ‘Prevention is better than cure’ in this issue (page 8-9), which introduces an upgrade to the way we conceptualise nutrition illustrated by a medicinal vegetable, the Asiatic pennywort. Stay tuned for part two, due out in the Spring 2013 issue. So until then, enjoy the magazine and enjoy the show!

Appeal for support


Computer says yes


new pathways


Asiatic Pennywort


Chronic pain


Yoga research


A way with pain


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

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

My Alexander Journey 18/19 Back from despair


the Back Pain Show


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4 support appeal

Help us to keep people pain free, doing the things they love Why BackCare? Some medical conditions cause untold pain and misery, yet they receive little attention. Back pain doesn’t kill, it tortures – destroying lives and livelihoods. It accounts for half of all chronic pain and is the leading cause of sickness absence from work, costing a staggering £19 billion every year in NHS treatments, disability benefits and loss to businesses. BackCare is the UK’s National Back Pain Association; it was founded more than 40 years ago, in 1968, by industrialist Stanley Grundy CBE who suffered back pain but was dissatisfied with the lack of available support. The charity’s mission is to lessen the burden of back and neck pain on society, which it seeks to achieve through its support, research, campaign and educational activities.

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We depend upon the generous donations, fundraising efforts and legacies of our supporters to make all this happen – none of our achievements to date would have been possible without them. Back pain strikes without warning, affecting young and old alike; tomorrow, it could be you or one of your loved ones. Help us stop back pain from destroying more lives. make a donation We’d like to thank the following people and organisations for making recent donations. l Brian Harris l Pfizer Limited l NAPP Pharmaceutical Group l The Medtronic Foundation l BackCare marathon team runners l Swansea Branch. There are several ways you can easily

make your donation to BackCare: l visit l make a bank transfer to account number 01691218, sort code 30-98-79 l pay by card by calling Head Office on 020 8977 5474 l pop a cheque in the post to BackCare, 16 Elmtree Road, Teddington, TW11 8ST. Become a member Whether you’re a back pain sufferer, carer, healthcare professional or corporate representative, we have membership packages to suit. Becoming a member means you want to participate in BackCare’s charity mission, as well as receive our quarterly TalkBack magazine and be kept up to date with news, events and latest developments. If you become a professional member or corporate partner, you’ll also gain access to collaborative opportunities. Email

support appeal 5 or call Head Office on 020 8977 5474 for more details. enter a challenge event Challenge events such as marathons, abseils and skydives are tremendously popular fundraising tools used by many charities. At the 2012 Virgin London Marathon, the BackCare team raised more than £47,000 for the charity. Our 2013 events portfolio currently includes the London Marathon, the 100-kilometre London 2 Brighton Challenge and Ride London 100. We’re also hoping to add the Great North Run in 2014. Take a look at our inside cover Events Calendar for more information.

according to a legal formula rather than according to your personal wishes. Therefore, once you have decided who will benefit, we strongly recommend that you consult a solicitor or other appropriate expert such as a professional will writer. There are two main ways you can leave a legacy to BackCare – pecuniary and residuary bequests.

A pecuniary bequest specifies an amount of money, while a residuary bequest specifies the gift of the residual value of your estate once all other gifts have been considered – many people opt for the latter option as it is least affected by inflation. Whichever you chose, your gift will be greatly appreciated by all the millions of people who rely on our work.

leaving a legacy to BackCare This means writing a will, or, if you already have one, making an amendment or attaching a codicil. A will is a legal document. If all the legal formalities of preparing it are not followed accurately, a will could be declared null and void and your estate could be divided

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6 Talkback news

Computer predicts back pain with 76 per cent accuracy Researchers at Stanford University have designed computer algorithms capable of predicting with an accuracy of 76 per cent whether someone has lower back pain. “People have been looking for an objective pain detector – a ‘pain scanner’ – for a long time,” said Professor Sean Mackey, MD, PhD, chief of the Division of Pain Medicine at Stanford University. “Lower back pain is the most common chronic condition we deal with. What we have learned is that the problem may not be in the back, but in the amplification coming from the back to the brain and

nervous system. In this study, we identified brain regions we think are playing a role in this phenomenon.” The study involved MRI scans of 47 subjects who had lower back pain and 47 healthy subjects (average age 37). Both groups were screened for medication use and mood disorders. The method successfully predicted the patients with lower back pain 76 per cent of the time. The goal of the new study was to accurately identify patients with lower back pain versus healthy individuals on the basis

of structural changes to the brain. “Previous studies have shown that there are functional changes in the brain of a chronic pain patient, and we show that structural changes may be used to differentiate between those with chronic lower back pain and those without,” said Professor Mackey’s former research assistant Hoameng Ung. “This observation also suggests a role of the central nervous system in chronic pain, and that some types of chronic low back pain may reflect pathology not within the back, but instead within the brain.”


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Talkback news 7

new pain patient pathways on the map of medicine The British Pain Society has been working to produce several new pain patient pathways, with the aim of establishing best practice patterns of management for chronic pain sufferers. These are based on NICE guidelines, scientific evidence and other published guidelines where possible. The aim of the pathways is to support care and commissioning. There are five new pain patient pathways in total covering the initial assessment and early management of pain, spinal pain, pelvic pain, chronic widespread pain and neuropathic pain.

The pathways have been finalised and are now available on the Map of Medicine website (www.mapofmedicine. com), which is used by medics and commissioners. They also appear in abbreviated form on NHS Choices. The Map of Medicine is an online tool designed to improve interactions between primary and secondary care. The quality of referrals from primary to secondary care has a major impact on waiting times. Links to the versions of the pathways for patients will soon be available on the British Pain Society website (www., where you can

also find updates on the progress of the project. Chris Hughes, the founding manager of the BackCare Helpline and now a trustee of both Pain Concern and Pain UK (, and Liz Killick, a BackCare Helpline volunteer, represented patients on the spinal pain working group, and were able to feed in comments based on their experience of working with back pain sufferers. Liz has subsequently become a patient member of the British Pain Society Patient Liaison Committee. It publishes some very helpful guides for patients ( home.htm).

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8 talkback research

Prevention is better than cure nutrition and the adaptogen concept “Prevention is better than cure”, or so the old adage goes. And it’s perhaps not surprising to find that when it comes to safeguarding our future health and preventing illness, a lot of what’s important for healthy backs is also beneficial for our overall health. If we want to have a reasonable degree of control over our future health status, there are three key areas that we have to keep in check – our psychology, nutrition and physical training. As part of a new series of articles on preventative medicine, this article will focus on nutrition, introducing the adaptogen concept with a review of the medicinal food plant, the Asiatic pennywort. The distinction between food and medicine is open for debate. New research in the field of nutraceuticals (a contraction of nutritionals and pharmaceuticals) goes some way to bridge the gap with popular and effective products such as the margarines containing plant stanols which lower cholesterol. But medicinal foods needn’t involve any sort of artificial manipulation; there are many foods which naturally have bona fide medicinal properties. In fact, the Ancient Greek physician, Hippocrates (460BC – 370BC), who established the Hippocratic Oath and is credited as being the father of Western medicine, was recorded as saying, “Let food be thy medicine, and medicine be thy food”.

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The Asiatic pennywort (Latin name: Centella asiatica) is a small herbaceous creeper found in many tropical and subtropical countries, including India, Sri Lanka, Thailand, South Africa and Eastern Europe. It has a long history of use in the traditional Indian, Chinese and African medical systems but is also used as a leaf vegetable – much like spinach or kale – in Thai and Sri Lankan cuisine. In health stores, it’s often labelled as Gotu kola, meaning conical leaf in Sri Lanka’s Sinhalese language. On the backdrop of several thousand years of ethnobotanical use, Western research efforts into the potential therapeutic uses of the plant began in the late 1940s and 50s with the corroboration

Asiatic pennywort has a long history of medicinal use in the East

It appears to exert a harmonising and restorative effect on the entire human system of its traditional use in wound healing. Since then, the research literature has expanded to include over 300 published studies detailing the many beneficial properties of the herb. In fact, the herb exhibits so many distinct and seemingly unrelated benefits that it has been given the title of adaptogen. The term adaptogen was coined in 1947 by Russian-born pharmacologist Nikolai Lazarev and is used to describe a newly realised class of botanical compounds which confer a non-specific resistance to physical, biochemical and psychosocial stressors. In essence, adaptogens literally promote adaptation, adjustment and acclimatisation to our total environment (physical,

talkback research 9

M edicinal P roPerty

r eferences

c ognitive H ealtH – Enhances memory and learning in a rodent Alzheimer’s disease model and in human adults, and substantially improves child ADHD.

12859423, 20677602, 20228219

a ffective H ealtH – Anti-anxiety effect in rodents and humans, and anti-depressant effect in rodents.

16488124, 20677602, 16209267, 15058206

n eurological H ealtH – Anti-epileptic and anti-convulsant activity, preventing fits and seizures in

20711371, 20144879

a nti - inflaMMatory

20606777, 3092715



a nalgesic e ffects – Demonstrated in rodents.

W ound H ealing – Promotes healing of incision and burn wounds in rodents, even reversing the suppression of healing by dexamethasone.

18484522, 22817824 16928669

u lcer H ealing – Promotes healing of physical, chemical and stress-induced gastric ulcers in rodents, and human skin ulcers.

11480209, 1293014 5153018

a ntibiotic e ffect – Natural antibiotic activity demonstrated in human leprosy and in fish columnaris

4480467, 20575361

a nti -c ancer e ffect – Kills rodent and human cancer cells.

20162036, 19865514

c irculatory H ealtH – Promotes circulatory health in the context of long-distance flight-induced oedema, chronic venous insufficiency and perhaps varicose veins.

11666121, 7936334 2150405

u ltraviolet r adioProtective – Protects against UVB radiation damage in human skin cells.

22948173, 23064234

g aMMa r adioProtective – Protects against gamma radiation poisoning, specifically weight loss, DNA damage, and radiation-induced taste aversion in rodents.

12458490, 19589237, 11399290

H eavy M etal d etoxification – Counteracts heavy metal poisoning, specifically lead and arsenic in

21843793, 17600859

(a common fish farm infection).


Reference numbers correspond to the PubMed archive at the US National Library of Medicine and can be accessed online by appending the number to

Nutritional information for the Asiatic pennywort Nutrient Beta-carotene (Vitamin A) Thiamin (Vitamin B1) Riboflavin (Vitamin B2) Ascorbic acid (Vitamin C) Calcium Chromium Iron Magnesium Manganese Phosphorus Fibre

Quantity (mg/100g)


34 0.8 0.7 21 880 1.0 16 320 23 155 11000

ND 70 51 26 110 2500 115 85 1135 22 33

Quantity data from the US Department of Agriculture, RDA data from the UK Department of Health; ND = Not Determined

biochemical and psychosocial). This implies an interesting relationship between their usage and the philosophy of preventative medicine which is all about alleviating stresses and correcting imbalances before they generate illness. In keeping with the concept of true adaptogens, the Asiatic pennywort is nontoxic and appears to exert a harmonising and restorative effect on the entire human system. This makes adaptogens entirely different from medicinal drugs (whether synthetic or naturally occurring, e.g. morphine) which are used to suppress biological functions, bringing an attempted

masking of symptoms but also the risk of side effects. In a sense, the adaptogen concept accommodates the highest ideals of medicine – namely to prevent and remedy illness while doing no harm. In closing, the Asiatic pennywort is a nutritious vegetable plant with a significant volume of modern scientific research to support its long history of traditional medicinal use. But beyond this, it serves as a valuable illustration of how richly nutrition can be upgraded from the basic macronutrient (carbohydrates, proteins, and fats) and micro-nutrient (vitamins and minerals) concepts.

peRsonaL eXpeRience with the asiatic pennywoRt I started using this herb as capsules of dried extract from health food stores. More recently, I discovered that the fresh plant material is much cheaper and far more effective. I found it available fresh in a local Sri Lankan food store as “Villarai” (its name in the Tamil language) and in a Thai food store as “Bua Bok” (the Thai name). I’ve also experimented with growing this vegetable myself and can report great success, even in our temperate climate. I have now incorporated it into my regular diet. I eat it raw, much like a salad leaf, and have noted several interesting effects: ■ greatly enhanced sleep quality when consumed before going to bed ■ performance enhancement during cardiovascular training ■ clearly noticeable reduction in psychological stress. Dr Adam Al-Kashi Head of Research at BackCare

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10 Talkback news

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Nicotine increases pain

Talkback news 11

Smoking dramatically reduces the success of surgical and non-surgical back pain treatments

Patients with severe back pain who quit smoking report less pain than patients who continue to smoke

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12 meet the professional

From conventional to

PIONEERING Georgie Oldfield MCSP is a physiotherapist whose approach to chronic pain completely altered after coming across the work of John E Sarno MD in 2007. Along with other specialists, Georgie’s findings are that where tissue damaging disorders are ruled out, chronic pain is often actually stress induced, or psychophysiological. As these conditions are reversible, she claims full recovery is possible


y journey as a physiotherapist began in 1983, although I have to say that the past five years have been the most rewarding. The main reason for this is that now I see so many life-changing results with people whose lives have been severely affected by chronic pain. So how did a physiotherapist like me come to specialise in a non-hands-on approach that caused a 360° turnaround in my understanding and treatment of chronic pain?

First steps

Quite by chance, I started off specialising in respiratory care, becoming a Superintendent Physiotherapist within six years and managing the physiotherapy respiratory services within a large city hospital. When I had my first child I decided I didn’t want to work full time and took a six-month position covering for someone on sabbatical, but ended up staying 15 years! The role expanded over the years, exposing me to a variety of conditions, patients and treatment approaches. Around the year 2000, I had become frustrated with how limited we were in treating pain. At this time, I developed severe pain in both thumbs and index fingers for no apparent reason, which caused me problems as a physiotherapist. My GP and I were concerned it might be rheumatoid arthritis (RA). Having seen and treated people with severe RA, this was a very frightening prospect. However, a colleague treated me with acupuncture and

to exciting new results, my NHS Trust asked me to run a pilot study. This was the start of another major change in my career as I decided to focus on helping people resolve pain; I set up my own private clinic in 2005, called the Pain Relief Centre. I also trained in a type of Bowen Therapy, called neurostructural integration technique (NST), which, alongside AdRT, became my most successful treatments. Using these complementary approaches over the years, I became increasingly aware of how important it is to treat the whole person, not just the part of the body that was hurting. I had also realised that my results were improving as my treatments became gentler and I was now able to spend more time with patients, improving the relationship and trust. I was also perplexed that, occasionally, a patient would burst into tears after a treatment and they were often considerably better the next time they came! I was becoming increasingly unsettled by the medical model’s explanation for my patients’ symptoms. Things weren’t adding up and, all too often, there were inconsistencies between a patient’s symptoms and their diagnosis. Most could not recall any injury and had often just woken with pain. On top of this, symptoms very often didn’t match the physical diagnosis: for example, symptoms blamed on a prolapsed disc compressing a nerve on one side would often cause symptoms involving numerous nerves and often swapped sides. I began to wonder why, if core stability is so important in preventing and resolving

Things weren’t adding up and there were inconsistencies between a patient’s symptoms and their diagnosis

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within two treatments the pain went and I had no further problems with my hands. I was so impressed with my own results that I decided to train in acupuncture. Looking back now, I realise I was going through a very stressful time in my own life and my recovery coincided with a rheumatologist informing me that I had osteoarthritis, not RA, which was a massive relief.

Pieces of the puzzle

I then completed training in reflexology and adapted reflex therapy (AdRT) and, due

meet the professional 13

back pain, I was seeing so many patients who had already worked for months on core stability programmes. At other times, symptoms would move around the body, bearing no relation to any physical “abnormality” that might have been found on MRI. There were also frequent occasions over the years when patients would become completely pain free, despite still having the severe degeneration that had been attributed to the pain. As well as observing my patients’ anomalies, I myself developed severe sciatica soon after leaving the NHS to set up my own clinic, yet I had had no injury. It became clear to me that this was completely related to the stress I was feeling due to setting up my own business and not having a monthly salary any more. In 2007, after years of searching for an answer, I received an email from Amazon recommending a book by John E Sarno MD. I don’t often look at these, but something made me click on the link and read the reviews. I remember thinking it all sounded too good to be true, but by then I was so open-minded I decided to buy the book and see what it was all about. This was the beginning of another major change in direction for me, yet I might not have been open to it if I had read it 10 years earlier.

Making connections

As it was, it answered all the questions I had about my own pain and that of so many of my patients. Dr Sarno is a Rehabilitation Specialist in New York and has been pioneering his work since the 1970s with the condition he called Tension Myositis Syndrome (TMS). Briefly, his theory is that repressed emotions can trigger the unconscious part of the nervous system to create pain, just as emotions such as fear trigger an automatic reaction in the body. In other words, as we go through life we tend to cope, but we often bottle up how we really feel. These can build up and often during, or soon after, a stressful period the emerging emotions require an escape and the emotional brain reacts by creating pain, or another symptom, via the nervous system. These symptoms, and our fears related to them, can end up becoming the focus of our attention and become a distraction from the actual underlying cause. Interestingly, while reading the book, I woke up one morning with severe neck pain. I could work out what inner turmoil was causing it, although unfortunately I

I now focus my whole work on this approach, but accept there will continue to be resistance because we are pushing boundaries and long-held beliefs about the cause of chronic pain hadn’t reached the point in the book which told me what to do! I was in pain for three days because I was unable to continue with the book, yet once the issue resolved my pain disappeared within an hour. This was powerful enough for me to really take on board all Dr Sarno was saying in his book and I recognised that there didn’t even have to be an obvious “trauma” to trigger a symptom. However happy our upbringing, there are always going to be situations when our “buttons are pressed” and personality plays a huge part in how we react to what’s happening around us, which then affects how much inner turmoil we might feel. We are also so used to the pace of life these days that we often don’t recognise how stressed we are feeling because it has become the norm as we continue to cope with what’s happening in our lives.

Breaking through

Over the next few months, I came to understand just how many of my own recurring health problems were actually stress induced and was able to resolve them all. It became very interesting looking at a timeline of when I had symptoms and what was going on in my life at the time. This reinforced for me the potential for this approach and I went from going for treatment for various recurring problems every three months or so, especially since

setting up my own business, to none at all since that time, yet being fitter than ever. During my research I came across numerous studies demonstrating that spinal degeneration found on MRI scans is often coincidental and is common in people with or without back pain ( Studies like this, plus what I was observing with my patients and my own health, reinforced the importance of this work and that it wasn’t just a placebo effect. I arranged to study with Dr Sarno in November 2007 and set up my own TMS Recovery Programme (http://www.sirpauk. com) on my return. Since then, I have returned to the States twice more and built relationships and peer support links. There is a strong movement now to raise awareness and millions of dollars have been granted for further research. I now also train other practitioners to integrate this approach into their own work. Since I changed my whole understanding about the cause and treatment of chronic pain, I am not only healthier than I have ever been, but I am now able to help so many people not just manage, but resolve, their pain. I also love the fact that it is all about education and self-empowerment once an individual accepts the possibility that this might be an answer to their own symptoms, which therefore also has massive cost-saving benefits.

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14 talkback research

Have you ever wondered whether you should try yoga to help your back pain, but been unsure how to begin? Now there is an evidence-based, entry-point yoga programme designed to enable those with a history of general low back pain to gradually learn how to improve their health, as ALISON TREWHELA explains…

Yoga is ‘a cost-effective way to manage back pain’ It is now understood that people with back pain need to keep physically active, to learn to improve posture, and to address emotional issues and stress factors. We therefore know that back pain requires a biopsychosocial approach and it seems that yoga manages to combine all these multi-disciplinary factors within one package. research-proven yoga The University of York’s Department of Health Sciences led the largest yoga research trial (2006-2011), generously funded by Arthritis Research UK, and a standardised yoga programme was designed and taught successfully by the specially-trained teachers. This Yoga for Healthy Lower Backs gradually-progressing programme was designed to be appropriate for beginners with a tendency for recurring low back pain. The randomised controlled trial’s positive results were published in November 2011 in one of the top international medical journals – The Annals of Internal Medicine – which concluded that it is “a safe and effective activity that clinicians could consider recommending for patients with a history of low back pain”. The published paper compared this yoga programme to other rigorously-tested treatment options and found it to be more effective (session for session) than all of them and 30 per cent better than “usual care”.

Professor Alan Silman, Medical Director of Arthritis Research UK, said the following in a press statement in August 2012 (view “We welcome the fact that not only has yoga been found to help people manage their back pain, but that it is also cost effective and results in fewer sick days. “It is another option for people who are struggling to manage their condition, and one that encourages the move to self-management. Yoga is an intervention that has been proven to make their everyday lives easier and their pain more manageable. We’d hope that, on the back of this, more people with back pain are encouraged to take up the yoga programme.” A good choice for patient self-management Yoga is a mind-body discipline that aims to affect your day-to-day life positively with its postural, mindfulness, relaxation and breathing techniques. The gentle and user-friendly Yoga for Healthy Lower Backs (YHLB) programme emphasises self-management and selfempowers for holistic health, i.e. those practising the yoga are likely to suffer less depression, less hip pain and less stressrelated symptoms. The 12 differing weekly group YHLB classes, the book, four-track Relaxations CD and handouts give people the tools to look after their back health for the long

term. Within the research, the biggest improvement in back function was shown immediately post-intervention, but the effects were maintained at the 12-month follow-up point. Nine months after completing the 12-class YHLB course, participants were still benefiting and this was most likely helped by the fact that more than half of them had learnt and been motivated enough to practise at home the recommended 30 minutes twice a week. This suggests that this one-off, 12-week course has the potential to give lifelong benefits for future health. “Why can’t everyone be offered this?” asks one devotee of YHLB. Although, anecdotally, yoga students and teachers already knew appropriate yoga could be beneficial for spinal health, there had only been small studies aiming to prove this until Karen Sherman, et al’s RCT trial. These results, published in 2004, led to yoga becoming a nationally-approved recommended treatment option in the USA (NIH). Now in the UK, it is likely that specialised yoga might soon become a first-line choice for those willing to help themselves to better back health. yoga on the NhS Another University of York research paper was published in Spine journal in August 2012 showing that YHLB would be “cost-effective if offered within the NHS” compared to other treatment methods.

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Alison Trewhela is hoping that government bodies will soon acknowledge yoga’s far-reaching potential

At a cost of £292 per patient (including the book, CD and handouts), this one-off, patient-centred treatment option would reduce the number of patients continually re-presenting in GP surgeries and the number ending up in expensive secondary care. “We welcome this as an innovative, evidence-based, cost-saving approach to this heart-sink, prevalent problem,” said a GP, and he is not alone in this opinion.

potential benefits to the economy: over the 12 months studied the yoga group had only 3.83 days off work compared to 12.29 days in the non-yoga control group. Occupational Health and HR departments should consider not only the estimated £800 per person in productivity lost, but also the additional benefits that encouraging staff to regularly practice group yoga might bring, e.g. better teamworking, less workplace stress.

great choice for employers The Spine journal’s “economic evaluation” showed YHLB to be a “dominant treatment for society”. There are far-reaching

Spreading this yoga (and the yhlB Relaxations Cd) for the benefit of others Arthritis Research UK and the University

of York have supported the setting up of a social enterprise by two of the yoga teacher/therapist consultants on the trial team. The website has been set up to promote YHLB. It is the first point of reference for anyone wanting to: l know more about the four research papers that have been published l view a video showing an overview of the yoga l find a qualified teacher l learn more about the yoga l know how to access the evidencebased published book Yoga for Healthy Lower Backs. The YHLB Relaxations CD is found here and sales income from this standalone, user-friendly item is ploughed back into developmental and promotional work. Yoga relaxation is the initial crucial and foundational element to making the body and mind more at ease before allowing further improvements to happen, so it can be a useful first tool for stress, tension and pain relief. Track 1, designed and narrated by a yoga teacher with more than three decades of teaching experience, is especially appropriate for those with back pain, but the whole family can benefit from using a track or two at times of stress. Approximately 200 professional and already-experienced yoga teachers from different schools and methods in the UK have been trained by the programme designer in the same way as for the research itself and future training courses are booked. Teachers are finding it rewarding and interesting to teach this course to new students who might previously have been sceptical about yoga. Many of them are working in teams, realising they can help more people in this way. education needed for innovation and improvement There is much educational work to be done for GPs, health commissioners and the general public to know where to access this appropriate evidence-based yoga. YHLB is available in the private sector, but soon we hope to see government bodies acknowledging yoga’s far-reaching potential. Visit social enterprise website for more information.

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16 your stories

No-one wants sympathy

just acknowledgement M

y back problems really began following a car accident in July 2005. From this point on, I can honestly say I have never experienced a totally painfree day. However, during this time, my symptoms were largely kept under control through physiotherapy at a fantastic local practice. An MRI scan in the spring of 2009 showed degenerative changes at L4/5 and L5/S1 with small disc protrusions at both these levels and small annular tears. I had a steroid injection into my right hip and carried on as “normal”, working a busy job supporting young people for a local charity, and enjoying a good social life when pain and time allowed. This was until May 2010 when the pain in my lower right hand side of my back became so extreme I was left crawling around my flat on my hands and knees unable to stand up. A physiotherapy session helped me to function once more, albeit with a somewhat stiff back! At work, I found I was having to sit tilted forward as my coccyx kept going numb when I sat for any length of time. By the end of June 2010, in addition to my usual pain, I became increasingly aware of some discomfort around the groin area on my right hand side reaching into the top part of my right leg. Just over a week later the pain was considerably worse and now extended the full length of my right leg into the foot. Pins and needles were also present. From this point on my life became a blur of hospital appointments and I was put on heavy medication to help with the pain, including Tramadol, Co-Codamol, Ibuprofen, Diazepam, Amitriptyline and Gabapentin. My last day at work was on Friday, 9 July… this date will stay with me forever. My life felt as though it was spiralling completely out of control. The sheer pain and meds meant I could no longer drive, so I became totally reliant upon my recently retired parents to ferry me to my neverending stream of medical appointments. I could no longer manage living on my

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JULIA KELLY explains how her own experiences with chronic back pain have led her to launch a website to help fellow sufferers… own so, once more, my loving parents came to the rescue, took me in and became my carers. Not being able to work meant having to give up the home I’d worked so hard for, and my much-loved and taken for granted independence evaporated right there and then. The impact upon my immediate family was also profound. I underwent the following procedures: l 16 July 2010 – MRI scan, results of which were inconclusive l 26 July 2010 – facet joint injections and nerve root block, to no positive effect l 6 September 2010 – lumbar epidural. Brought four hours of relief, but then the pain returned with a vengeance l 1 October 2010 – lower lumbar discography which clearly showed toxic liquid had been passing from the disc out of the annular tear and on to the nerve roots, causing the pain. Following the discography findings, I had (in layman’s terms) my lower two discs removed and a spinal fusion carried out on 15 October 2010. Otherwise known as a “two-level spinal decompression and interbody fusion”. Finally, I was getting somewhere and, for a short time after the major surgery, I appeared to be doing well. This was confirmed by the post op X-rays. My thoughts started to move towards the excitement of going back to work, regaining my independence and getting my life back on track. However, six weeks post op I began experiencing pain once more in my back and down the right leg. At this point I had no flexibility at all in my back and this continued despite regular physiotherapy, doing exercises in the pool, and walking twice a day as part of the recovery programme. After everything I’d been through, it all seemed in vain and the initial optimism post op seemed a distant memory. It was

replaced by feelings of hopelessness, loneliness and despair – despite a loving family and great friends (although some friends drifted away as time went on and there was no recovery in sight). I felt totally useless, a complete burden on everyone and, quite frankly, an emotional basket case. I found night times to be the worst, as they seemed so long and I couldn’t sleep for the pain. I was lucky if I got a couple of hours’ sleep so I soon felt like a zombie – and a snappy one at that! So, it was back on the neuropathic painkillers as well as the Tramadol, Diclofenic and Paracetamol – this time Lyrica which had no positive effect for me. So, it was back to the Gabapentin and Amitriptyline (now replaced with Trimipramine which I find more effective at inducing sleep and has less side effects for me). I tried other drugs during this time, too, but nothing seemed to really take the endless pain away. I was so tired and exhausted, physically and emotionally. Mobility wise, I was just so restricted that even the simplest of tasks such as tying a shoelace or cutting my toenails was now impossible. On 14 February 2011 I had a further nerve root block to no avail and, following a further MRI scan, I was put on a “short, sharp” course of steroids which, yes, allowed me to do more but the blasted right leg pain remained. My dear nan, who I shared a very close bond with, also passed away during this time, I was with her when she died. Towards the end of 2011 I was referred to a neurologist and, following yet another MRI scan in early 2012, it was concluded that my pain was neuropathic pain (caused by ongoing damage to the nerves), and it was now affecting my left leg too. So, despite a wonderful consultant and team, I was referred to a specialist

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unched website ‘a way with pain

Julia Kelly and, inset, her newly-la

in chronic pain. The consultant was so supportive, but I was beginning to realise that I had to face facts, pain would always be a part of my life. I’d always wanted a family and, being single, I worried “who would want to be with me now like this?” Everything just seemed so far out of reach. I also experienced problems claiming ESA despite overwhelming medical evidence supporting my claim. I had to go through two tribunals (soon to be three). This placed another enormous pressure upon me when I was already struggling to cope. I needed help and, fortunately, help came. My pain specialist recommended a pain management introductory day, which has led to having six much-needed sessions with a psychologist who has helped me to come to terms with things. Alongside this, I explored other avenues including hypnotherapy, yoga (including yoga nidra), relaxation classes, meditation, gong baths, angelic massage, reiki, oesteopathy and am about to try the

Bowen Technique. These have all helped me enormously alongside the traditional drugs which I still need. I still have flare ups and find Tramadol helps with the nerve pain and Diazepam is great when the back pain becomes unbearable, although I try and avoid using these drugs where possible due to their addictive nature and side effects. I have had to change my car to an automatic and can only drive short distances aided by a coccyx wedge cushion and back support. I cannot sit back into chairs as my coccyx and lower back feel like they are crumbling and the nerve pain increases to an unbearable level. The slightest sudden, or awkward movement can trigger horrendous pain in my lower back so I have to be careful how I move. I have no idea how I am going to be from one day to the next and therefore have to take things one day at a time. But, despite all this, I am slowly gaining some control back into my life, I guess I am what they call “work in progress”.

Looking back I can now see that I was going through my own bereavement process, I had to let go of the life I once had and focus on the life I have now. I think (and sincerely hope) that people see me as “Julia” a character regaining her lust for life, just at a different pace, and not just someone with a bad back. No-one wants sympathy, just acknowledgement, and to dispel the myth that because someone looks well, they therefore cannot be in pain. As a result of my own experiences I have developed a website called “a way with pain” which helps to support people suffering with chronic pain – this currently affects around eight million people in the UK alone. It is an invisible illness that is so misunderstood. The website is informative and interactive with a forum – I want it to be a one stop shop where people can find solace and hope. The site is now live so please visit us at

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t is often the case that a person’s chosen profession grows out of a personal need or unmistakable longing. My longing was to find a solution to my low back pain. In 1960, aged eight or nine, I found I couldn’t keep up with the family walks as my legs seemed to hold me back with nagging discomfort. In my teens it didn’t get any better and I had pain in my back. I had congenital spondylolisthesis (meaning slippage of a vertebra). In the 70s an operation was suggested but the prognosis was poor. The general advice given was to “learn to live with it”. To find some relief from pain and discomfort, I followed everything the NHS had to offer and then continued with the alternative therapies route. I was not doing very well at learning to live with it. My interests lay in music, dance and drama and by a circuitous route I found what I was looking for in the Alexander Technique. This was not just another alternative therapy, this was REALLY learning to live with it. This was a technique that involved the practical HOW to do the

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my life-changing

Alexander journey

mARY RAWsON explains why the Alexander Technique continues to be the basis on which she lives her life… everyday things, as well as specific skills, without making matters worse. In 1983, I trained as a teacher of the technique and experienced such a significant reduction in pain that, for a good number of years, I could say I didn’t really have a problem. Life generally improved and I had found a lifetime solution and a

passion to help others, as my teacher had helped me. I have now been teaching the Alexander Technique for 25 years. I have found that most people come for lessons for back, neck and shoulder problems, which are mostly related to habitual misuse and poor posture. However, some people have similar


problems as a result of an accident and others come pre- and/or post-operative. Results from the practical hands-on contact of the teacher and finding out how to put new ways of learning into practice, continue to have positive results (see below). There are positive and negative sides to habit. The positive side is that we can repeat things we have learned, like how to ride a bike. The restrictive nature of habit prevents us from progressing in a skill or improving our lot, if what we have learned was wrong or could have been better. If we can identify the habits of thought and action that are putting us wrong, then we

can learn to stop them and choose to put new learning in its place. In 2008, research (ATEAM) was carried out to determine the effectiveness of Alexander Technique for patients with chronic or recurrent back pain. The conclusion reported that one-to-one lessons in Alexander Technique had longterm benefits and the results were published in the British Medical Journal in 2008 (see summary below, or read the full paper at www.bitly.

com/alexander2008). In 2010, I chose to have a spinal fusion (SPLIF) as the slippage had got worse and wasn’t going to get any better. A difficult decision, but one I have not regretted. Within less than a year I climbed mountains and started to go jogging. The Alexander Technique continues to be the basis on which I live my life. For a definitive guide from the Society for Teachers of the Alexander Technique, visit mary rawson mSTAT, CNhC, member of BackCare

rANdOmiSed CONTrOlled TriAl OF AlexANder TeChNiQUe leSSONS, exerCiSe,ANd mASSAge (ATeAm) FOr ChrONiC ANd reCUrreNT BACK PAiN (ACCePTed: 26 mAy, 2008) Objective To determine the effectiveness of lessons in the Alexander Technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse-delivered behavioural counselling for patients with chronic or recurrent back pain. design Factorial randomised trial. Setting 64 general practices in England. Participants 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander Technique lessons, and 144 to 24 Alexander Technique lessons; half of each of these groups was randomised to exercise prescription.

interventions Normal care (control), six sessions of massage, six or 24 lessons in the Alexander Technique, and prescription for exercise from a doctor with nursedelivered behavioural counselling. Main outcome measures Roland Morris disability score (number of activities impaired by pain) and number of days in pain. results Exercise and lessons in the Alexander Technique, but not massage, remained effective at one year: compared with control Roland disability score 8.1: massage −0.58 (95% confidence interval −1.94 to 0.77), six lessons −1.40 (−2.77 to −0.03), 24 lessons −3.4 (−4.76;−2.03), and exercise −1.29 (−2.25 to −0.34). Exercise after six lessons achieved 72

per cent of the effect of 24 lessons alone (Roland disability score −2.98 and −4.14, respectively). Number of days with back pain in the past four weeks were lower after lessons (compared with control median 21 days: 24 lessons −18, six lessons −10, massage −7) and quality of life improved significantly. No significant harms were reported. Conclusions One-to-one lessons in the Alexander Technique from registered teachers have long-term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons. Correspondence Professor Paul Little, University of Southampton,

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20 your stories

This was the first time I had slept for more than about 20 minutes in a couple of months. I couldn’t stand up straight at all… I pretty much struggled to walk from one end of the house to the other.

How I overcame


marie in hospital


fter about 10 years of mild intermittent back pain, I had built up a fear of it becoming worse. At the start, my GP had told me: “What can you expect when you weigh as much as you do? And now you have a bad back it will probably only get worse.” In December 2009, it got worse and then much worse in March 2010. During that time I was prescribed more and more painkillers until by May I was taking high doses of four different drugs, including a nerve blocker. I cried each day, sometimes every hour. I was waking up 20 times a night in extreme pain. I didn’t sleep for more than about 20 minutes at a stretch. I could sometimes get into a position in a chair or kneeling where the pain dissipated, but I knew it would be agony when I had to move. I felt my life was over and in truth I reached the point where I hoped it would be, as I literally could not stand the pain anymore.

Family breadwinner

I cried over everything that I felt I had lost – all the things I would never be able to do and for my poor children whom I felt had lost their mother. Wherever I looked I would see an image or a reminder – for big things like cycling or dancing, simple things like cuddling up to my kids on the sofa and mundane things like cooking, washing my own feet or helping my Dad – and would tell myself, “I’ll never do that again”. As for work, I assumed that I would have to give up, which was especially worrying as I am the main family breadwinner. In May 2010, I ended up in A&E in Durham after five months of visiting doctors and physiotherapists. After that, I had an MRI scan done which showed a massive prolapsed disc compressing the nerves on both sides, even though I mainly had pain down one leg. It was suggested I be referred for surgery, but in the meantime

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pain and the depths of


Back pain sufferer marie tells how Tms and exercise gave her back her life… I heard about something called Tension Myoneural Syndrome (TMS) and joined a Stress Illness Recovery Programme, and started to see some symptoms lessening. When the physiotherapist called me to tell me the results of the MRI scan, she couldn’t believe that I was feeling a little better, so held off on the surgical referral and gave me some exercises instead. When this picture was taken (top of the page), I had paracetamol going into my veins, followed by morphine, with more morphine by mouth, a good few breaths of entonox, and diclofenac suppositories. All of that just so that they could examine me. This was the first time I slept for more than about 20 minutes in a couple of months.

I couldn’t stand up straight at all. I was in pain all the time from December 2009 until the middle of the TMS support group at the end of May. I pretty much struggled to walk from one end of the house to the other.

Turning point

I followed the TMS programme and did the exercises – but frankly I don’t think even the physiotherapist expected the exercises to work… I remember the day when she asked if I thought a session in their hydrotherapy pool would help and I had to tell her that I had been swimming. She was pleased and encouraging and didn’t dismiss the TMS approach, although she did tell me to keep all the painkillers handy,

READ UP ON TMS – YOU’VE NOTHING TO LOSE I would urge everyone to read about the TMS and Stress Illness Recovery Programme approach, which you can do for free by getting the books from the library, researching online or chatting with Georgie [BackCare Professional member, Georgie Oldfield; Ed]. There’s no commitment and no money needed unless you feel that the full programme will help. If it feels like it doesn’t fit your situation then you have lost nothing, but if it sounds like it might be for you then what have you got to lose?

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happier times… marie and

her son Tristan

not to push myself and to have a plan ready for flare-ups. It certainly wasn’t a magic wand; some of the techniques on the programme did not work for me and some (the ones I was most sceptical about) I think were the most helpful. But generally believing that things could get better was the turning point. In July 2010, me and my youngest, Tristan, went out with his friends on a bike ride. They were very impressed I went over the jumps! I still obviously have the prolapsed disc and for a while I couldn’t walk too fast, due to some leftover muscle weakness in my leg, but I could go anywhere I wanted virtually pain free by bike... or could swim there!

Thank you for saving my wife’s life Marie’s husband, Tony I had just played a small (sedentary) part in my theatre group’s summer show (another thing I had given up and thought was gone forever) and that night I went out and boogied like it was July 2010 – doing something else that just a few months before I thought I would never do again (a friend’s birthday disco where I dressed as the London tube map!). By January 2011, I was virtually pain free. I could do everything that I used to do. I had achieved most of the goals that I set during the programme. I remember my

disbelief when I looked back at my notes at the time; one reads “a good night’s sleep; only woke up five times”! When I was in pain it seemed as though it had lasted forever and would never end. A year later, January 2012, I still had a little numbness in my right foot but I mostly didn’t even notice it. I have had no back pain or sciatica for a year! In the past year I have taken up Zumba and open water swimming – swimming a mile in Loch Ness in September. I have realised how often over the years I said to myself and family ‘be careful’ when they had to lift or bend. Last winter I shovelled snow without worry and with just a few twinges – all the time saying “this will make my back stronger” – and it did! Marie, East Durham

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Developing nicely… October 8-12 was, of course, BackCare Awareness Week. This year, we launched a new campaign focused on back injuries in the construction industry. We undertook several campaign activities generously supported by Pfizer Limited

Dedicated campaign website We launched a dedicated website as a portal for the campaign, featuring campaign artwork and functions allowing people to get involved and use social media channels to continue spreading the word. As the campaign builds momentum, more and more content will be added to the site, including content contributed by people who have been personally affected by back pain in the construction industry and those already active in attempts to remedy it. If you haven’t visited the site yet, you can do so at

and pushing) is the biggest cause of injuries. People tend not to know their own safe limits and aren’t strong enough or fit enough for the tasks they put their bodies through. They also tend not to warm up or stretch as you normally would before sports or exercise. But most importantly, people tend not to know proper technique or apply it. 2. how can people prevent getting back pain themselves? If you want to have a reasonable degree of control over your future back health and also health in general, there are three main areas that you need to get to

grips with – these are your psychology, your nutrition and your physical exercise. People who harbour unprocessed negative emotions such as regret, remorse and resentment are more likely to succumb to ill health and less likely to recover. Obesity and malnutrition is extremely common in our society and again predisposes you to ill health and the inability to recover fully. When it comes to physical exercise, everyone seems to know that cardiovascular fitness is important. However, more recent research has established that our muscles do not simply move our arms and legs; they also

Campaign radio day At the start of the week, we conducted a day of live radio interviews, appearing on 20 local and regional stations across the UK. The total weekly reach figure for these stations adds up to 1.8 million people. We also recorded an audio feature which went out to a further several dozen radio stations, boosting the impact of this campaign activity and bringing the total weekly reach figure to more than 8 million – this indicates that we successfully harnessed major media to get the BackCare message across. The interviews and audio feature were based on a preconceived cue sheet of five questions that was sent out to the radio presenters. Here are the questions along with an outline of our responses. 1. What are the main causes of back injuries in the construction industry and at home doing diy? Manual handling (lifting, carrying, pulling

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STATiON Wythenshawe FM, Greater Manchester ALL FM 96.9, Manchester Colourful Radio, London BBC Radio Kent Q101.2, County Tyrone Q102.9, Londonderry Q97.2, Causeway Coast

Q100.5, County Down Q106, County Armagh Q107, County Antrim Swansea Sound 96.5 Bolton FM, Greater Manchester Swindon 105.5, Wiltshire BBC Radio Nottingham BBC Radio Coventry and Warwickshire BBC Radio Derby BBC Radio Hereford and Worcester BBC Radio Leicester BBC Radio Shropshire BBC Radio Stoke

WeeKly reACh


14,000 15,000 103,000 258,000

09:30 – Simultaneous broadcast 10:40 10:50

90,000 86,000 86,000 17,000 11,000 14,000 62,000 50,000 15,000 185,000 88,000 154,000 99,000 180,000 102,000 156,000

11:10 – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast 11:30 12:15 13:05 19.35 – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast – Simultaneous broadcast


release hormones into the blood stream affecting the brain and every other organ of the body. Gaining some muscle mass and training to increase your physical strength has enormously positive health implications. 3. What can the construction industry do to prevent workers suffering back injuries? Prevention is the key here. It’s often said that prevention is more effective than treatment, but it’s actually much cheaper too. In 2007, a Danish doctor calculated the financial cost of a single worker permanently injuring their back aged 35 to be over £2 million. We’ve teamed up with world leaders in manual handling, Pristine Condition, whose track record has made it clear that effective training can reduce injuries by 88-100%. And if healtheffective and cost-effective training has been proven, we’d like to see it become a national standard. 4. in what ways can back pain affect people in their day-to-day lives? Back pain doesn’t kill, but it tortures – destroying lives and livelihoods. Many people with persistent back pain find themselves literally disabled by the pain, unable to work, earn a living, function socially. It’s not surprising that clinical depression is so common in chronic pain sufferers. 5. Where can i get more information? You can visit the dedicated campaign website at where you can keep updated as the campaign unfolds and sign the petition for effective and mandatory Governmentfunded manual handling training. You can also come down to meet us in person at

the Back Pain Show, London Olympia, 22-23 February 2013.

Dedicated awareness pack We created a pack of materials designed specifically to give people access to the campaign and telling them why and how to get involved. The pack contains an A5 booklet accompanied by an A3 poster featuring an x-ray of a person lifting using improper technique. The skeleton figure is wearing a brightly coloured hard hat and work boots, and the slogan reads “All The Gear, But No Idea” with the aim of being catchy and amusing to draw attention to the underlying issue. Key facts and statistics supporting the campaign are presented in a side column. The goal of the poster is to attract attention, educate the viewer and direct them to the campaign website where they are encouraged to participate. The pack also includes two designs of sticker,

again with attention-grabbing images and slogans directing people into the campaign. The packs are still available to buy on the campaign website and are also being sent out to organisations within the industry as part of the ongoing campaign activities.

Government e-petition We submitted an application for an electronic petition on the Government’s website. The application was approved and the e-petition became available to sign online just before the awareness week. Government e-petitions expire after 12 months so we have until 4 October 2013 to get 100,000 signatures, which could lead to it being debated in the House of Commons – so please do take the time to sign it if you agree with our proposal and share it with your friends, family and colleagues to give them an opportunity to participate.

FUND MANUAL HANDLING TRAINING FOR ALL CONSTRUCTION WORKERS Construction has the highest rate of manual handling incidents and reports more than 25,000 back injuries every year. Nearly half of construction workers over 50 now suffer persistent back pain. According to the Institute of Occupational Medicine, half of construction employers offer no manual handling training to their workers. The CITB’s levy-funded ‘Health, Safety and Environment Test’ only claims to “ensure that workers have a MINIMUM level of health, safety and environmental awareness”. Considering back pain costs us £19 BILLION every year, I think that a certification of manual handling training, employing the most efficacious methodologies evidenced, should be mandatory for all UK construction workers and should be Government funded. Prevention is far cheaper than treatment.

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