Quarterly magazine of BackCare, the UK’s National Back Pain Association
SPRING n 2018
FREE TO MEMBERS
Under starter’s orders! BackCare runners prepare to hit the streets
also in this issue: News Cuts to prevention services counterproductive Health and fitness Stop hurting and start enjoying your gym sessions Research Huge disparities in rehab for hip fracture patients
www.backcare.org.uk
2 TALKBACK NEWS
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TALKBACK LEADER 3
Building more homes to support healthy ageing SUITABLY designed homes play a crucial role in the health and wellbeing of those living with chronic pain, limiting long-term illness (LLTI) or disability – conditions that affect as many as half of people over 65. As one-in-five of us will be over 65 in 10 years’ time, this also has significant implications for public spending. Welldesigned buildings help people live independently for as long as possible in their own homes, reducing hospital and residential care admissions along with the demands on adult social care. The case for more age-friendly housing is compelling. However, the vast majority of over-65s live in the mainstream housing market, according to the Local Government Association1 (LGA). Even when retirees would prefer to “rightsize” and live in retirement housing, they are impeded by the scarcity of desirable accommodation in the right locations. Similarly, fewer than one per cent live in housing with care – evidently 10 times less than in more mature retirement housing markets such as the USA and Australia. Government must encourage developers (p22) to build more homes that support “positive ageing” and councils need to set aside sufficient funding to adapt existing housing. Adaptations to your home might include widening doors, installing ramps and improving bathroom access, but less obvious changes like adapting heating and lighting
controls can also make life a lot easier. (For disabled people, facilities grants2 are available to help with these.) The LGA believes nothing short of a “residential revolution” will truly tackle the needs of our ageing population. In the meantime, innovative schemes do exist, such as Newcastle City Council’s older peoples housing delivery programme3, which provides adaptations ranging from stairlifts and shower units to ceiling track hoists for private homes and housing association properties. Importantly, it also proactively identifies opportunities for individuals to access other properties that are already adapted and may better suit their needs, and offers assistance with a managed move.
Richard Sutton Editor
Contents
Care system too reliant on vulnerable older carers 4
Removing the barriers to an active life 8
BackCare’s marathon runners ready for the off 9-15
LETTERS TO THE EDITOR:
richard.sutton@backcare.org.uk
1) www.local.gov.uk 2) www.gov.uk/disabled-facilities-grants 3) www.newcastle.gov.uk Cover image: 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 Severn, Gloucester.
Good habits to help you get the most out of yoga 20
Collar and brace service brings NHS savings 23 TALKBACK l SPRING 2018
4 TALKBACK NEWS
Social care system too reliant on vulnerable older carers NEW figures from Age UK reveal the extent to which millions of older people are being left to prop up the country’s disintegrating care system, with those aged 65 and over providing nearly 54 million hours of unpaid care each week in England in 2016. The figures highlight the rising demands being placed on older informal carers as government underfunding causes the social care safety net to shrink. In 2015/16, 2,299,200 people aged 65 and over provided care – a 16.6% increase on five years ago when 1,829,200 did so. More than 400,000 of these unpaid carers are from the oldest demographic in our society (aged 80 and over), and they provided 12.7
million hours of care in 2015/16 – a 12.7% increase from 2009/10. Most older people willingly take on the task of helping to care for a loved one. However, leaving older people to
shoulder too much, or sometimes all of the responsibility and hard work of looking after someone in declining health and with significant care needs is unfair. It can also put these older family carers’ own health at risk, says Age UK. The Government announced in November that it would be bringing forward proposals to strengthen social care and place it on a sustainable financial basis, though not until summer next year. But Age UK is concerned that the millions of older people who provide care, as well as who receive it, can’t wait and is equally worried by the prospect of more care services going before the end of the financial year.
Image: ijeab/Freepik
Independent doctors to be rated by the CQC CHANGES to healthcare inspection rules in England mean that, for the first time, independent doctors – along with all healthcare organisations that offer regulated care – will be rated by the Care Quality Commission (CQC). Organisations will have to display their inspection ratings so patients can clearly see safety standards. The CQC’s current ratings programme –
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which covers hospital care, social care and GPs – will be extended to include more than 800 additional providers. This includes independent doctors that offer primary care online. The ratings scheme has been “futureproofed” to cover services that may develop in the future. It will ensure that new services are also given a rating. The changes will bring the services
in line with the rest of the NHS. It will reassure patients who use digital GP apps provided by independent doctors about the quality and safety of the service they are choosing. The CQC will now develop an approach for how it will rate the additional services. The CQC will continue to inspect these services and publish its findings in the meantime. www.cqc.org.uk
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£12m boost for healthcare training in Wales Image: starline/Freepik
NHS to publish numbers of avoidable deaths THE NHS will become the first healthcare organisation in the world to publish estimates of how many patients may have died because of problems in their care. The decision follows a 2016 Care Quality Commission report that found the NHS was missing opportunities to learn from patient deaths, and that too many families were not being included or listened to when an investigation happened. The data will be published each quarter by individual trusts. Most trusts in England released their first estimates before the end of last year. Each will make its own assessment of the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems. The programme is likely to cover between
1,250 and 9,000 deaths, which research suggests is the number of deaths each year that may be down to problems in care – a fraction of the 19.7 million treatments and procedures carried out by the NHS in 2016 to 2017. These deaths range from rare but high-profile failings in care, to those which involve terminally ill patients who die earlier than expected. These deaths may make up a large number of those caused by problems in care, showing the need to continue to focus on improving all care, including end of life care. Executive Medical Director of NHS Improvement Dr Kathy McLean said: “Trusts across the country are improving how they engage and support bereaved families, how they ensure they learn from mistakes and share good practice. “We have been clear that the change required of trust boards is one of culture and leadership, rather than one of process and counting.” www.nhs.uk
THE Welsh government has announced plans to increase training places as part of a £12m package to support education and training programmes for healthcare professionals. This includes a 10% increase for physiotherapy, nursing and occupational health places. It will allow more than 3,500 new students to join healthcare education programmes across Wales. Responding to news of the initiative, Prof Karen Middleton, chief executive officer at the Chartered Society of Physiotherapy, said: “Increasing training places for physiotherapy students and nurses will help save money by relieving pressures on GPs, and providing more support in hospitals and the community. “It’s crucial the other nations do not focus on short-sighted cuts but instead implement new ways of working, such as first contact physios, to create a sustainable NHS.”
Image: dashu83/Freepik
Cuts to prevention services counterproductive, says LGA CUTS to council public health budgets will load the pressure on the NHS and adult social care, councils have warned. While the Government announced an extra £2.8 billion for the NHS in the autumn budget, councils’ public health grant funding is being cut by £531m between 2015/16 and 2019/2020, taking money away from services which can be used to prevent illness and the need for treatment. Chairman of the Local Government Association’s Community Wellbeing Board, Izzi Seccombe, described the cuts as counterproductive. She said: “Further
reductions to the public health budget reinforces the view that central government sees prevention services as nice-to-do but ultimately non-essential. Interventions to tackle teenage pregnancy, child obesity, physical inactivity, sexually transmitted infections and substance misuse cannot be seen as an added extra for health budgets. “Local authorities were eager to pick up the mantle of public health in 2013, but many will now feel they have been handed all the responsibility but without the appropriate resources.” www.local.gov.uk
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6 TALKBACK HEALTH AND FITNESS
Stop hurting and start enjoying your gym sessions None of us intend to injure ourselves when we train – but it seems all too common. So, what can we do to help avoid it? Dai Richards, Alexander Technique teacher and gym enthusiast, shares a few thoughts.
UNKNOWINGLY, everyone builds up habits of movement during exercise that can range from the free and fabulous to the downright punishing. The problem is that, as habits, they will all feel “right”. The good ones are fine but the bad ones end up causing us pain and injury, especially when we put some force behind them. Changing those habits requires some help, and lessons in the Alexander Technique are a great way of getting that help. But some self-discovery is also useful. As a starter, here are three things to bring into your training: Maintain a great “head, neck, back” relationship in everything you do; move using the joints that are designed for that particular movement; and last but by no means least, take a moment to stop and enjoy your session.
The head-neck-back relationship Try this: Get a friend to take a full-length profile picture of you on your phone (so that your right shoulder is facing the camera). Stand easily upright, vertical and relaxed. Look at the picture afterwards and in your mind’s eye draw a smooth line from your forehead over the top of your head, down the back of your neck and along the first few centimetres of your spine. You will end up with a smooth S curve with a funny little tail on it. Let’s call that your “Today’s Neutral” head, neck, back relationship. Now pick one of your favourite gym movements which involves bending down
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and standing back up again (for example a bar-bell lift or a simple squat). As you go through that movement see if you can easily maintain the same S shape all the way through. Easy enough? As a test get your friend to video you from the same angle as before – in slow motion if your camera allows it (iPhones do). Now watch the video a couple of times and stop the video at various points in the movement. Check out that S curve – be quite honest with yourself – is it always there? It is surprisingly difficult. An easily maintained S shape will be kind to your spine! A little trick is to put an object such as your keys or a towel on the floor about six feet in front of you. As you begin your descent, let your eyes focus for just a brief moment on that object. It helps break the powerful habit of fixing on the horizon with your eyes – which in turn often leads to a very strong shortening of the neck muscles – leading to long term discomfort, strain and injury.
Find your hip joints If we move around using the joints as they are designed to be used, then all should be well. However, all too often we become injured because, out of habit, we use the wrong joints to achieve a movement.
Here is a game to play: Before you read the next sentence, stand up and within two seconds put your index fingers on your hip joints. If you did that without thinking you probably have a fairly honest indication of where you move from whenever you bend, run, jump, swim or do anything that involves moving around your mid-point. Your hip joints are actually buried deep in your groin a good few centimetres in and down from the level of the top of your bony points of the pelvis. Was this where you pointed?
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If not, again recruit your friendly camera operator. This time take a video of you going from standing to sitting on a stool or simple chair. First do it as you normally would. Take another video but this time from standing, initiate the movement by pushing your fingers strongly into your groin where the hip joints really are, and let those joints do the flexing. Experience, then see the difference! If we don’t use our hip joints to move, this leads (among other things) to hip, knee, low back and neck problems.
Try to make each gym session a pleasure Here’s a useful tip: As you walk into the gym, find a place where you can actually stop. Then, without trying to change anything, notice the way you are standing, notice the way you are breathing, then gently ask your neck and back to let go of any tension. Make a decision in that moment that you are going to enjoy the next 10 minutes without stress or tension. Then go ahead and get started. If you stop enjoying your workout, or you feel stress and tension building up – then stop – and go through the game again. Who knows, you may even start to smile! Stress and tension lead to dissatisfaction, pain and injury. If you get injured you will have to stop training, recover and restart... or give up. Where’s the fun in that? www.stophurting.co.uk
Main image: asierromero/Freepik Other photography: Elizabeth Dodgson
1) Standing 2) Bending – without the S curve 3) Bending – with the S curve 4) Hands on hips 5) Finding the hip joints
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8 TALKBACK HEALTH AND FITNESS
Women a key target for participation and activity SPORT England, which is responsible for implementing the Government’s sports participation strategy, wants to increase the number of women who are regularly active1 by 250,000 nationally by 2020. An additional target is to increase the number of people from lower socio-economic groups who are more active by 100,000 (within targeted locations) by making sure they have the right facilities, activities and mixture of opportunities. Central to this challenge is not only to get people into sport and physical activity in the first place, but once they’ve started, encouraging them to stay active. Sport England recognises that it needs to work
and think differently to address the inequalities that exist. “We’re working towards something that has never been achieved before,” Sport England chair Nick Bitel explained. “We’re changing long-term, deep-rooted behaviour around sport and physical activity across the population. “There’s no blueprint to do this and achieving success will require the sector to think and operate very differently, engage with people that it has never really engaged with before, and put those people, and their needs, at the heart of everything.” 1 People who are defined as “active” do 150 minutes or more of moderate intensity activity a week.
Image: Sport England
Removing the barriers that stop people getting active £100M of National Lottery funding will be invested over four years on solutions that make it easier for people to access sport and physical activity. By focusing intensely in 12 areas, Sport England wants to identify better ways to address stubborn inequalities and break down the barriers that stop people getting active, such as poor transport, safety, cost and confidence. It aims to encourage collaborative partnerships that look at how all parts of a community can better work together to help the most inactive – from transport links and street lighting to the quality of parks and open spaces, to how sport and activity is promoted by GPs. The 12 areas were selected following a rigorous selection process with partners including Public Health England. They
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Barriers may have little to do with the Image: Sport England activity itself cover a mix of geographies (urban, rural and coastal), and have varying population sizes and inequalities to address. They are: Birmingham and Solihull, Bradford, Calderdale, Doncaster, Essex, Great Exeter, Greater Manchester, Hackney, Pennine Lancashire, Redcar & Cleveland and Middlesbrough, Southall, and Withernsea.
Jennie Price, Sport England chief executive, said: “The barriers to getting active might have little to do with the activity itself, yet this is where we often start. “I talked to one older lady who was very keen to start swimming again, but to do so she needed someone to sit with her husband who had dementia, a bus that stopped on the right side of a busy junction for the leisure centre, and a session with people like her in the pool rather than lots of children for example. “Working with all of the partners in a local area means for the first time we can think about that broader range of issues and work right across the local system to address them.” www.sportengland.org
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BackCare runners are ready for the off! The 2018 Virgin Money London Marathon, taking place on 22 April, will showcase the extraordinary stories of its runners, volunteers and supporters. RUNNING the Marathon is so often described as a life-changing experience and the camaraderie and excitement felt by the participants and the hundreds of thousands of spectators lining the streets epitomises the “Spirit of London” theme of this year’s event. Each runner has their own reasons for running, whether it’s aiming for a time, beating the odds after illness or injury or achieving weight loss, at the same time raising money for the charity or cause that’s close to their hearts. This is the motivation that gets them through the cold, hard months of training. Once again, BackCare is strongly represented by its supporters and fundraisers. TalkBack looks at some of their stories…
following many years of service in the NHS. Running has major health benefits, many of which I benefit from personally.”
Kevin Gani “I started running when I signed up for a 5km in 2010. Completing my first race and crossing that finish line was life changing. I continued to run for general fitness before completing my first half marathon in 2014. Running became serious in 2016 when I secured a place to run a marathon and in the last two years, I have raised over £10k for BackCare, Cancer Research and Mind. “I recently qualified as a leader in running from English Athletics and now support others on a weekly basis. My charity place with BackCare is dedicated to my mother, who passed away in 2016 following a major illness in her lower back. Both my parents were nurses and frequently suffered with lower back pain
through running, meeting many good people and feeling positive and better about myself. So, through running, I would like to give something back, and help raise awareness and much needed funds for BackCare.”
Pratik Pradhan “Life has its ups and downs. I was going through some rough patches about five years ago. It was business as usual on the surface but the struggle inner self was getting tougher by the day. With some persuasion from friends, I took up running as a first step to bring some positivity to the situation. I joined my local park run and, have to admit, the first few runs were very tough. However, the sense of achievement crossing the finish line every time was incredible. Since then I have completed almost 150 park runs and numerous half marathons. “I have benefited greatly
Helen Prowse “Having had a discectomy with fusion for two separate herniated discs in my neck in both 2011 and 2014 and understanding the debilitating pain that can be caused by neck and back problems, I am very pleased to be running the London Marathon 2018 for BackCare and helping to support their cause.”
VITAL STATISTICS Course record men (2016) Eliud Kipchoge, KEN, 2:03:05
Alison Evans “I started running in January 2016. It was a New Year’s resolution to do something to get myself fitter and lose some weight, so I joined a local beginners group attending each week. I ran a few 5K races and park runs; then I joined another running club so I could run with people on two different nights. Later that year I ran my first 10K and then a half marathon and continued this pattern through 2017. “My dream to run the London Marathon is now becoming a reality with BackCare. A close friend has rods in her back and is very grateful for the care she has been given. I feel honoured to be running for this charity to help it to provide support and advice to those in need.”
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10 TALKBACK LONDON MARATHON 2018
VITAL STATISTICS Course record women (2003) Paula Radcliffe, GBR, 2:15:25 (mixed race)
Miles Grinter
Wayne Goodlake
“I am really excited to be running for BackCare in this year’s London Marathon. Members of my family including myself have suffered from back issues in the past and it’s great to see a charity so focused in this area. I have completed several half marathons previously but I really think I can help raise a good sum of money by running the marathon. I think when you approach people for money, a marathon certainly has some gravitas.”
“Having run the London Marathon three times, my ultimate goal was always to run under 3hrs 30mins – my best and last run was 3hrs 43 mins. Having aged four years since then I will be delighted to break the four hours. “I have suffered with ankylosing spondylitis for many years (20 now I think) and have recently started some new treatment which has enabled me to get out running again and get my life back, with only minor discomfort and pain. With my other three runs I got by on massage and painkillers, so this time should be hopefully better for me. The biggest lift though will be having my three children and my Mum stationed around London to cheer me on.”
Warren Goodlake “I am 48 years young with two grown children and a brother Wayne who is my inspiration for my running. He is 47 and has ran London three times before and is also running for BackCare. He has backache and has to have pain-killing injections every eight weeks. I have been running for over a year and constantly push myself to new targets and Personal Bests. My partner Sam has the running bug too and just completed her first 10K. For me, running the London Marathon will be a huge achievement and I have set myself a target of 3 hours 45 minutes to complete it, I just hope I can control my excitement and finish the race too.”
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Gary Oakley “I started running in 2013 as I wanted to do something that didn’t involve me being in an office. My first race was the Bristol 10K in May 2013, it was really tough, but an amazing experience and got me hooked. For many months I ran on my own, and it was only when I plucked up the courage to speak to a group of people who met every Monday night, did I realise how rewarding running in a group was. Since joining Kingsway Runners, I have completed many 10Ks and several half-marathons, and as my confidence in
Image: © Virgin Money London Marathon
running grew, so did my desire to take on the daunting 26.2 mile adventure. “When the opportunity to run for BackCare came up, I knew this was my chance. In raising money for this fabulous charity, I can allow vital support to be provided to people like my father who has suffered back problems for many years.”
Chloe Smithers “After seeing a close friend suffer herniated discs and helping her through her rehabilitation period, I came to realise and understand how life changing neck/back injuries can be. When I decided to take part in the London Marathon 2018 with that same friend, I was delighted to support the fantastic work BackCare does and help raise awareness.”
VITAL STATISTICS Wheelchair record men (2009) Kurt Fearnley, AUS, 1:28:56
Keith Brighty “I will be running the Virgin London Marathon 2018 for the final time. This will be my 5th time at London, 13th overall and the end of my marathon career! I have chosen to raise money for the BackCare charity for whom I ran in 2007. “After suffering a serious back problem in 2006 and being hospitalised for two weeks with excruciating sciatic pain, I was operated on for a prolapsed disc in my lower back. BackCare was the obvious choice, as it offers advice and support for back pain sufferers throughout the UK with advice prevention and ways to alleviate back pain.”
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VITAL STATISTICS Wheelchair record women (2015) Tatyana McFadden, USA, 1:41:14
Andrea Daly “I’m 30 years old and work as a dental nurse in Caterham in Surrey. I’ve chosen to run the London Marathon for BackCare because of the excessive back problems myself and a vast number of dentists experience day to day, often resulting in early retirement. I believe it’s important to raise awareness of how troublesome back pain can be and what we can do to help reduce it.”
Antony Greensweig
runs I entered my first race, Bristol 10K, completing it in just under an hour. I was instantly hooked and continued to enter events, including Royal Parks half marathon, Great North Run and lots of other 10K races. In May 2017 I completed my first full marathon, in Edinburgh, in a time of 4:57. With Kingsway Runners, I was invited to become a leader 18 months ago. I chose to run for BackCare to support a small charity and raise its profile with my friends and colleagues. As an office-based worker I know that many days are lost each year to bad backs and necks and, to raise awareness as well as money for the cause makes me very happy.”
Amanda Preece
Eileen Grant
“I run in memory of my Dad who had dementia and passed away with dignity in 2015. I needed something to fill the void and the loss and, with my half century birthday approaching in 2016, I made the decision that I would learn to run. This challenge was huge for an overweight, unfit mum of four boys who needed a huge boost both physically and mentally. “So, I started my love/ hate relationship with a C25K podcast. I would swear at the voice in my ear telling me that I was doing great – it wasn’t great at all! I realised quickly that I needed help to achieve this mad challenge and joined my local running club, Kingsway Runners who have offered unconditional support and friendship. I soon mastered a 5K and gradually worked up to 10K and half marathon. Increasing my distance from 13.1 miles to 26.2 is daunting I will admit but I will cross that line even if I have to crawl over it. “I remember my Grandfather struggling with back pain, so much so that he would sleep on a board (the size of a door) under his mattress to give him some respite. I want to support BackCare in their endeavour to support all who suffer with pain or injury.”
“A full-time mother of three teenage children, I had previously worked for a large financial services firm and in various roles both at home and abroad. I love everything to do with the outdoors, hill walking, running, sailing and sampling the fine cuisine in my native Scotland. “In 2012, I suffered a large prolapsed disc which required back surgery. I know all too well both the physical and mental pain endured through such injury. For this reason, I am running in support of the national charity BackCare and hope to promote their message further.”
VITAL STATISTICS Total finishers (1981) 6,255 Total finishers (2016) 39,140
Jonathan Lee “I chose to run for BackCare for a couple of reasons, one being that my wife has suffered for many years with a bad back and on a regular basis needs to have physio, and struggles to walk. Also, I do a manual job and some heavy lifting and may well need care and treatment in later life. “I’m new to running – been training for approximately four months, run two to three times a week and my fitness has drastically improved. Just hope I don’t get injured before the big day.”
“I started running in early 2015, primarily to get fit and lose weight. Having done a few park
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Caroline Lowery
Lee Sessions “I completed my first half marathon in 2013. I have run several more since, but London 2018 represents my first marathon. Having always been employed in office-based roles, I am all too aware of the back and neck problems that occur from being sedentary for prolonged periods. When the opportunity came up to run as part of the team for BackCare, I saw it as an opportunity to give something back to family, friends and work colleagues who have struggled with back and neck problems.”
VITAL STATISTICS Oldest finisher (men) Fauja Singh 2004 (93)
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“I only started running in June 2016 when a new local running group opened up, the Sowerby Bridge Snails. The Snails are why I have decided I am ready to do this challenge. When two others completed it last year I sat watching in bed with my hot coffee thinking – I want to do that one day. “From that moment on I set about making it happen. It hasn’t been easy as a full time high school teacher and mum of two under-8s – the runs are often long and lonely, but I have my fellow Snails and family right behind me. My longer runs are normally completed the first half on my own and then meet a fellow Snail enroute to complete. It’s like two runs in one and gives me the motivation to keep going. “I have chosen to run for BackCare as I know a number of people who struggle with back complaints, including my mother-in-law and a close colleague.”
Paul Jones “I run for BackCare because when I was younger, I suffered from a bad back and was told regular exercise would be beneficial. In 2010, I completed my first marathon. Today, I have completed 15 marathons including London, Boston, Chicago and New York.”
found myself inspired by the people there to compete in some races. I completed my first half marathon in October 2016 and followed that with the Manchester marathon in April 2017. “I chose to run the London marathon for BackCare so that I could support this relatively small charity that provides fantastic support and advice for people that suffer from back pain (my sister-in-law being one of them).”
Bernadette McInnes Adam Gresty “After a few years of being pretty inactive, I decided to take up running in 2016 to try and regain some fitness. I joined a local running club (Kingsway Runners) and soon
“I used to weigh a hefty 17+ stone, running was not something I participated in, come to think of it exercise wasn’t something I participated in! I suffered with a series of issues that comes from carrying extra weight, and back
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pain was just one of them. At the age of 30 I gave birth to my daughter, she changed my life, from that moment on all that mattered was me being the best possible version of myself for her. “I didn’t have the confidence to hit a gym given my size so instead I bought some trainers and hit the streets. I lost 7 stone in 10 months through healthy eating, running and daily exercise. My first 10K was June 2017 in Enniskillen NI, and the buzz of running with others and the sense of achievement crossing the finish line was exhilarating. “From then I was hooked – over the next six months, I went on to complete a series of 10Ks, a 12-mile Tough Mudder and two half marathons each time besting myself. To run a marathon, a full 26.2 mile marathon, will be the ultimate accomplishment for me and to achieve it knowing I’ll have raised money for such an admirable cause will make every mile worth it.”
Images: © Virgin Money London Marathon
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VITAL STATISTICS Oldest finisher (women) Jenny Wood-Allen 2002 (90)
George Gavriel “As a GP I see the impact back conditions have on people every day. This includes the obvious pain and immobility but also the impact on mental health and on day to day life. “BackCare is important to me as I suffered a prolapsed disc myself in 2007. I needed
to take daily painkillers and the subsequent reduced activity made the condition even worse. I was lucky that my condition could be treated with surgery in 2009 and since then running regularly has allowed me to regain my fitness and I am now free from pain.”
www.virginmoneylondonmarathon.com www.backcare.org.uk
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RECORD BIDS This year, around 50 runners will be going for Guinness World Records. A gingerbread man, a strawberry, Minnie Mouse and a horse drawn carriage carrying a queen will be making their way from Blackheath to The Mall. You might also spot Batman and Robin locked together in one costume, a lobster, a telephone box, at least two nuns, a pair of monks and a handful of chefs.
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16 TALKBACK CAMPAIGNS
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Huge disparities regionally in rehab for hip fracture patients THERE is a huge regional variation in the amount of rehab given to people after a hip fracture, and how long patients had to wait for it, particularly on returning to the community, according to Hip Sprint, the biggest ever audit of UK physiotherapy. One of the problems identified by the new report is the lack of adequate staffing levels in some areas to provide rehab within an appropriate timeframe. On average, patients waited 15.2 days, and in five units more than one month, to start therapy at home. Nearly half (48%) had missed a day’s rehab in hospital because a physio was not available.
Research findings highlight delays WHILE the average wait was 15 days, the research revealed that some patients have to wait up to 80 days. Further, the amount of rehabilitation patients received varied greatly, with some patients getting less than one hour a week. NICE guidelines state after surgery, hip fracture patients should be offered rehabilitation at least once a day. The survey revealed four out of ten (43%) missed a day’s therapy due to no physios being available. Professor Karen Middleton, chief executive of the CSP, said: “Hip fracture patients who do not receive rehab soon after leaving hospital risk depression, deteriorating health, and losing their mobility. This can bring not only further costs and pressures for the system, but more importantly, devastating consequences for the individual and their families.
“High quality and intensive rehab in the first week after surgery gives hip fracture patients the best chance of recovery, and at least 20 minutes of therapy a day could free up 1,000 hospital beds a year. Dr Antony Johansen, clinical lead, National Hip Fracture Database, Royal College of Physicians, said: “If frail and older patients are to return to their normal lives, they must be helped to get up as quickly as possible after surgery. This report shows that we are failing to achieve this for a third of people, with much poorer figures in some hospitals suggesting that they need to improve their multidisciplinary team-working.” www.csp.org.uk www.nhfd.co.uk
Experience The research project started last May, with members of the Chartered Society of Physiotherapy (CSP) working with the Royal College of Physicians to capture the experience of patients over a 120-day period after a hip fracture. By the end of the project, the CSP members in England and Wales had collected data on almost 6,000 patients’ experiences. In all, 580 physios took part and the data covered patients in 131 hospitals. The data represents 80% of all hip fracture patients in England and Wales. The audit has implications for physiotherapists working in many settings, who can use the information to fight for better services locally for their patients, says the CSP’s head of research and development, Ruth ten Hove. Importantly, the research demonstrates the need for continuity in rehab services from hospital to the community.
Patients who do not receive rehab soon after leaving hospital risk deteriorating health Image: pressfoto/Freepik
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18 TALKBACK RESEARCH
CHRONIC pain may be a by-product of human evolution, according to a clinical psychologist. Dr Amanda C de C Williams, a consultant clinical psychologist at University College London NHS Trust, told the Physiotherapy Pain Association study day in January about her research into evolutionary theory and its implications for gaining a better understanding of pain mechanisms and behaviours in animals and humans. Delegates heard that current research indicated that wild animals did not
Image: Shayne ch13/Freepik
appear to experience chronic pain, despite surviving major injuries. “Chronic pain has not been documented in wild animals, although it may exist and be undocumented,” said Dr Williams. “But we know it does occur in humans and farmed, companion and zoo animals. So is chronic pain an artefact of modern lifestyles? Or is it fostered by domestication?” Dr Williams suggested chronic pain could be due to a “mismatch” with our modern environments, or a maladaptive by-product of our acute pain mechanisms and neural
plasticity. Or it may have evolved as a “beneficial defence” that was designed to elicit help from others and promote survival. Non-human primates displayed rapid recovery and adaptation following injuries and only rarely show pain, she said. “Possibly this is because they are largely suppressing signs of pain because of the costs of showing it, in terms of their ranking and status within the group, or because there is no help available – and if no help is likely, then there is no point signalling need.” www.ppa.csp.org.uk
Spine deformity academics share research The next meeting of the International Research Society on Spinal Deformities (IRSSD) will be held in the historic city of Utrecht, the Netherlands, 14-16 June. The keynote lecture will be provided by Dr Jean Dubousset, a leading authority on spinal deformity, both from an etiological as well as a practical, treatment oriented (both conservative and surgical) perspective. Guest lectures will be given by Prof Marinus de Kleuver from The Netherlands and Dr Kariman Abelin Genevois from France. Invitations are being extended to everyone that has an interest in spinal deformities and the society is keen to
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attract young researchers and PhD students in this field. The meeting will be held in the Academy Building, in the same hall where in 1579 the Union of Utrecht was signed, which is considered as the beginning of the Netherlands as a state. The IRSSD was established in 1994 to provide a forum for the presentation and encouragement of research relating to spinal deformity and to disseminate the results of such research into the broader community. The society meets every two years, generally alternating between European and non-European venues. www.irssd2018.com
Image: kjpargeter/Freepik
Is chronic pain an artefact of modern lifestyles?
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Exercise in middle age lowers risk of heart failure later in life THE middle-aged can reduce their risk of heart failure later in life by doing aerobic exercise, according to a study published in the journal Circulation1. Those who lead a sedentary lifestyle are at greater risk of heart disease. In fact, more than five million deaths worldwide are attributed to physical inactivity. Researchers at the Institute for Exercise and Environmental Medicine in the US analysed the hearts of 53 adults aged 4564 who were healthy but had no history of exercising regularly. The participants were divided into two groups, with one following
an aerobic exercise routine that progressed in intensity over two years and another doing yoga, balance training and weight training three times a week for two years. They found that over the two years, the aerobic exercise group had significantly decreased stiffness of the heart muscle, and showed improvements in how the body uses oxygen. The research team believe the optimal dose of exercise for late-middle aged people is four to five times a week. Commenting on the findings, Julie Ward, senior cardiac nurse at the British Heart Foundation, said a much larger study is
needed to evaluate people who are at risk of developing heart failure. “What we do know is that moderate intensity exercise, at any age, can improve your heart health as well as lowering your blood pressure, cholesterol and helping you lose excess weight. Just 20 to 30 minutes of exercise a day will make a big difference – anything that increases your heart rate and makes you breathe a little faster will improve your health.” Reversing the Cardiac Effects of Sedentary Aging in Middle Age 1
www.ieemphd.org www.bhf.org.uk
Osteoarthritis: two distinct groups of disease, study suggests OSTEOARTHRITIS could be treated more effectively by dividing patients into two distinct disease groups, according to new research carried out by the University of Manchester. The Arthritis Research UK-funded study has discovered that the current definition of osteoarthritis may actually encompass two separate groups with different disease activity patterns, and that developing new treatments for both versions may be more effective than the current one-size-fits-all approach. Published in the Annals of the Rheumatic Diseases, the research involved a mathematical analysis of thousands of genes expressed in the cartilage of 60 individual patients with knee osteoarthritis, with samples separated into categories based on the level of active metabolism in the diseased tissue. Key genetic differences were found between the two groups of patients that emerged, with a list of biomarkers also developed that could be used to help distinguish between them by analysing the synovial fluid, which is found in the cavities of joints. It is thought that the variations between these two categories could be used to predict different responses to treatment, and may explain why treating osteoarthritis as a single condition has proven unproductive. Dr Devi Sagar, research liaison manager at Arthritis Research UK, said: “We have known for some time that osteoarthritis is something of an umbrella term, with people having similar symptoms, but different responses to treatments. We welcome more research, like this study, that may eventually pave the way to better diagnosis and more targeted treatments.” www.arthritisresearchuk.org
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20 TALKBACK LIFESTYLE
Yoga is not a passive therapy. In order to enjoy its many benefits, you do actually have to do the practice! Yoga therapist Vicky Arundel offers her strategies to help you continue to be inspired and motivated by your home yoga routine.
Building good habits will help 1) Have a plan of action Have you ever unrolled the yoga mat, stared at its blankness and realised you have no idea what to do? It’s so important to have a plan of action for what you’re going to practise before you get out the mat, so that you can free your mind to just get on with the enjoyment of doing it. I email my clients bespoke home yoga sequences, giving an idea of main cues to watch for, as well as how long to hold the pose and how many repetitions to do.
2) Follow the Power of 5 Say you only have five minutes to practise yoga (which, by the way, is a perfectly respectable amount of time and can still be enormously beneficial). This is what you do. You need to choose: n One breathing practice – this could be anything ujjayi, belly breathing, alternate nostril. Practise for one minute. n Pick three of your favourite yoga poses – practise for one minute (or 30 seconds a side if you’re doing a pose with two sides). Choose the poses that make you feel good and that you enjoy. Some of my favourites would be a supine twist, cat-cow, downdog, low lunge, one minute of Sun Salutations, handstand at the wall
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n Finish with one minute of mindful stillness either in seated meditation or supine in savasana. This technique could be easily extended to 7, 10, 15 minutes. Just choose a few more poses and lengthen the breathing and savasana to 2-3 minutes each.
3) Tack your yoga practice on to a pre-existing habit This is a technique I learnt from Charles Duhigg’s The Power of Habit book. The idea is that you tack the new habit you want to build, such as creating a home yoga practice, on to the end of a habit that you already have well established. This is actually the way I developed my meditation practice – I simply added it on to the end of my well-established yoga practice. Examples of habits that yoga could precede or follow on from include: after you’ve brushed your teeth (morning or evening); once you return home from work; before breakfast; after your morning cup of coffee.
4) Put it top of the to-do list It’s very tempting to put off doing things
for your health until all the other things on the to-do list are done. Inevitably what happens is that the to-do list expands to fill all available time and space, and important health habits such as going for a walk, meditating or cooking a healthy meal, get pushed to the side.
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you get the most out of yoga To counter this I’ve been exploring doing the health habits first and the to-do list second. Initially, I was really worried that I’d start getting behind with work and things would start falling apart, but I found the opposite to be true. Since I now have less time to get stuff done, I’m more efficient, procrastinate less and actually get more things accomplished in the same amount of time.
mind for the day ahead. This all sounds lovely… unless you’re a night owl. I try to encourage my clients to let go of all the preconceived ideas about when they should be practising and instead experiment with different times to see what suits their bodies and their schedule best. If that means practising before you go to bed then go for it! The key is to find a time and then roughly stick to it.
5) Use an app to track progress
7) Use online classes
There are lots of apps out there that help you to stay on track with habits for anything from exercise to meditation. I currently use Sattva, an online meditation app that helps me to track my daily meditation practice. It reinforces my desire to continue by showing on average how many minutes I do each day, rewards me with trophies for reaching certain milestones (eg 100 minutes of meditation) and shows my best streaks – numbers of days meditated in a row. I don’t want to stop meditating because I’ll lose my best streak status and I can see how close I am to getting my next trophy. I don’t see why an app like Sattva couldn’t be used to track a home yoga practice either.
6) Do it at the time of day that suits you Yogis are famed for their love of pre-dawn starts and of course the whole idea of Sun Salutations is that they’re practised as a way to greet the sun and prepare the body-
It’s usually tricky for me to get to public classes and I’ll be honest I prefer practising on my own anyway. However, I do still love instruction and learning new things from teachers. This is where the plethora of online yoga platforms has been such a godsend. There are lots to choose from – some are free, others charge a small monthly fee but give you the chance to try them out for a couple of weeks before committing. The key is to try a few and see which you prefer. Here are some of my favourite options for online classes: www.yogaglo. com ($18 a month, free two-week trial); www.yogainternational.com (£12 a month, free 30-day trial); www.doyogawithme.com (free). www.surreyyogatherapy.co.uk
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22 TALKBACK COMMUNITY
THE number of specialist homes for older people will need to increase by 400,000 units in less than 20 years as a result of our ageing population, recent analysis by the Local Government Association has shown. With one in five of the population in England set to be over 65 in a decade, a “residential revolution” will be required to provide more homes that support our ageing population. Only 0.6% of the over-65s live in specialised accommodation, with a form of care support such as 24/7 on-site staff. This is 10 times less than in more developed retirement housing markets such as the US or Australia. At least 80% of the homes we will inhabit in 2050 have already been built so it is crucial that councils have sufficient funding to adapt existing housing, which is a vital component in supporting older people’s independence, health and wellbeing. There is a chronic under-supply of desirable, affordable and age-friendly homes with enough space for older people to get around, and the ability for easy adaptations to be made, to cope with care needs. This is leaving retirees
Image: mindandi/Freepik
Chronic under-supply of suitable housing for ageing population
There needs to be a greater focus on homes that support positive ageing wanting to “right-size” to more manageable accommodation unable to do so. Councils want planning powers to ensure developers build quality homes and infrastructure that are well designed
to support positive ageing, and long-term funding to adapt existing homes to help support older people to remain in their homes for longer. www.local.gov.uk
Campaign aims to change children’s snacking habits
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also provide tasty and healthy snacking products, making it easier for customers to make healthier choices on the go. Parents can also get money-off vouchers from Change4Life to
help them try healthier snack options, including malt loaf, lower-sugar fromage frais, and drinks with no added sugar. Justine Roberts, chief executive officer and founder of Image: topntp26/Freepik
A NEW Change4Life campaign is encouraging parents to “look for 100-calorie snacks, two a day max” to cut children’s sugar intake. On average, children consume at least three unhealthy snacks and sugary drinks a day, with around a third consuming four or more. The result is that children consume three times more sugar than is recommended, leading to obesity and dental decay. A number of supermarkets are supporting the campaign. Tesco will help parents – instore and online – choose affordable, healthier snacks that are 100 calories or less. Co-op will
It can often be difficult to distinguish which snacks are healthy and which aren’t
Mumsnet, said: “The amount of sugar that children are getting from snacks and sugary drinks alone is pretty mind-blowing, and it can often be difficult to distinguish which snacks are healthy and which aren’t. The rule of thumb from Change4Life will help parents make healthier choices.” PHE’s improved Change4Life “Food Scanner” app also shows parents how many calories and how much sugar, salt and saturated fat is in their food, to help make healthier choices easier. It can be downloaded from the App Store or Google Play. www.nhs.uk/change4life
Art competition launched by Scoliosis Association AILIE Harrison, who co-founded Scoliosis Association UK (SAUK) with Stephanie Clark in 1981, passed away in 2014. Ailie was a talented artist and the charity has launched a competition to celebrate her tireless commitment to SAUK throughout her life. The Ailie Harrison 2018 Art Competition is inviting its members
to design some of its Christmas cards which will be sold in 2018 to raise funds for SAUK. There are three prizes: Under-12s prize – £75 Lego voucher; 13-18s prize – £75 PC World voucher; Over-18s prize – £75 cash prize. The closing date is 30 March and winners will be announced in late June. www.sauk.org.uk
Collar and brace aftercare service provides savings for NHS PHYSIO-led aftercare for people who leave hospital with unstable injuries to the spine is saving thousands of pounds for the NHS in east London. Barking, Havering and Redbridge NHS Trust launched the collar and brace aftercare service in June 2017. Based on a cost of £500 a day for inpatient care, the trust has calculated that in late 2017 the service saved nearly £110,000 and more than 200 bed-days in relation to four patients, by delivering orthosis support at home. Service lead Jennie Ward, a band 7 physiotherapist with 16 years’ experience in neuro sciences and specialised medicine, described the £500-a-day cost as “conservative”. She said it did not include nursing and medical support and that commissioners had estimated the cost of interim placements for patients at nearly £800 a day. For patients, the benefits include remaining in their home environment, not being at risk of hospital-acquired infections and avoiding becoming bed-bound. Currently, Ms Ward and a therapy assistant visit patients at home two or three times a week to change collars and check their recovery. “Most of our patients are unstable and require a head hold while the collar is being taken off and replaced, so it is a two-person job,” she said. Where needed, they can call in other staff; for example, if a patient develops pressure sores or their condition deteriorates. The service started after trust staff reported persistent delays in discharging patients who had sustained either an unstable fracture or injury to the spine that required spinal orthosis. “These mostly elderly patients were often staying in hospital between three and six months, until the collar could be taken off,” Jennie Ward added. “Or we might find a nursing home to take them, but waiting for places and identifying funding took a long time.” One alternative was that they were discharged
“For patients, the benefits include remaining in their home environment”
Image: kjpargeter/Freepik
Image: nuchylee/Freepik
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with ad hoc therapy support as an outpatient. However, there was no additional funding for this service so physiotherapy staff were taking time out of ward duties, diminishing their capacity to care for inpatients. In addition, there was no clear pathway to address any evolving hygiene and skin issues as a result of orthoses and no point of contact for advice after patients left hospital. Jennie Ward is now helping to create a further business case for the aftercare service calling for more staff: an additional band 6 physiotherapist, an occupational therapist and one more therapy assistant. www.csp.org.uk
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24 TALKBACK NEWS
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