TalkBack, winter | 2021-22 (BackCare)

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

WINTER n 2021/2022

FREE TO MEMBERS

Building better back health also in this issue: Protect your back in winter Importance of vitamin D and exercise Spinal cord injuries Dancing molecules breakthrough Counter axial SpA Early diagnosis is key

www.backcare.org.uk

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TALKBACK LEADER 3

Take up the 2022 challenge We are in the depths of winter, when temperatures plummet, daylight is in short supply and the days can seem long and wearisome.

This edition of TalkBack focuses on back pain in these short, dark winter days and seeks to look at the treatments available.

A lot has also happened at BackCare since our last edition of TalkBack. After much uncertainty, the London Marathon went ahead. Several BackCare runners tied up their trainer laces and took to the streets of London to run this iconic race for us and raise several thousand pounds in the process. A big thank-you to each and every one of them for supporting our work.

Based on the success of the London Marathon, we have decided to make 2022 a very special year for BackCare and are encouraging our supporters to walk, run or cycle for us by participating in a range of different challenges taking place throughout the UK. Our BackCare Awareness Week 2021 (BCAW21), which took place from 4-8 October, was our most successful BackCare Awareness Week to date. We were delighted that some 500,000 employees had access to the materials we had created.

Based on the success of BCAW21, we are making BackCare Awareness into a full programme and liaising with even more

companies to promote important messaging on back injury prevention.

Our editorial and production teams have been working full on to get the long-awaited 7th edition of The Guide to the Handling of People (HOP7) across the finishing line. This has been a mammoth task and what an amazing start to 2022 to finally have HOP7 in print.

In this edition, we continue our commitment to working with other organisations who are also involved in back pain and we are delighted to welcome Catherine Quinn, President of the British Chiropractors Association, who talks about the findings of a recent survey they have conducted. We also have articles submitted by other organisations and charities too.

We always like to have a real-life story and for this issue we were excited to interview the talented singer, songwriter Talia Dean who shares her struggles living with axial spondyloarthritis and her coping mechanisms. We hope you find this edition informative and helpful, whether you are living with back pain, working within healthcare or are one of our supporters and keen to understand the work we do.

Membership enquiries contact Email membership@backcare.org.uk Tel 0208 977 5474

Avoid negative feelings

6/9

Acupuncture “has been a lifeline” 10/11

The BackCare team

CONTACTS Advertising enquiries contact Margaret Floate Advertising Manager Email margifloate@btinternet.com Tel 01483 824094

Contents

Media enquiries contact Email media@backcare.org.uk Tel 07751 667645

Scientists earn Nobel Prize

12/13

At home exercise

14/15

Ouch! I think I’ve slipped a disc

16/17

Other enquiries Denice Logan Rose Email denice.loganrose@backcare.org.uk Tel 07751 667645

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 29 Bridge Street Hitchin SG5 2DF 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 Tewkesbury Printing.

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4 TALKBACK BACKCARE NEWS

BackCare Awareness is now a programme Due to the overwhelming success of BackCare Awareness Week 2021 (BCAW21), with some 500,000 plus employees having access to the materials we created, BackCare has decided to make BackCare Awareness into its own programme.

“With a wealth of companies participating in BCAW21 and sharing our resources, a complete awareness programme seemed the perfect next step,” said Denice Logan Rose, Executive Director of BackCare.

“We are committed to making sure that as many people as possible have access to materials that could help prevent avoidable back injuries. Working with companies, organisations and other

charities is a good way to make this happen through a programme which is available throughout the year and not only for one week.

“It also provides the added bonus of more people realising that we are here to provide emotional and practical support should they or a loved one be living with back pain.”

To see how your company, organisation or charity could participate in the BackCare Awareness Programme, email info@ backcare.org.uk

HOP7 is here The publication of the 7th edition of The Guide to the Handling of People (HOP7) is almost here. A Pam Sim gold standard go-to manual for announc pson all those involved in the safe NBE Co es HOP7 at nference 2021 handling of people, protecting both the carer and the cared for alike.

Denice Logan Rose, Executive Director of BackCare, said: “Covid-19 has presented its challenges but both our editorial and publication teams have worked tirelessly through these to ensure that 2022 will deliver this important publication.

We thank them for their hard work and determination in producing what is set to be the gold standard in manual handling.”

To order your copy, contact info@backcare.org.uk

Our challenge can be your challenge After a little uncertainty, the London Marathon 2021 took place and our runners raised many thousands of pounds for BackCare in the process.

This event is a significant part of BackCare’s fundraising and led us to realise that we had to offer more opportunities for our athlete

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supporters. Together, we can raise even more valuable funds in other ways, and in other parts of the UK. BackCare has a lot of opportunities for you to walk, swim, run or cycle your way to support our important work.

For more information, contact us at: events@backcare.org.uk

Legacies are important to BackCare While no-one wants to think about dying, there is an argument for making financial plans for something that affects us all in the end, says Denice Logan Rose, Executive Director of BackCare.

In 2021, BackCare received two substantial legacies and we know that those who bequeathed the funds knew the difference these monies would make to a small, but nationwide, charity. All our work is funded by voluntary donations of one sort or another, be that bequests, in memoriams, memberships, one-off donations or as a result of participation in sponsored events.

We simply ask that you consider our work in any will you make or you think about giving an in memoriam donation on behalf of a deceased loved one. If you would like further information about how you can support our work in this way, contact legacies@backcare.org.uk

6 TALKBACK THINK POSITIVE

‘Don’t fall into the trap of negative Low back pain (LBP) is a very common condition that usually starts around adolescence and becomes more prevalent as we get older. There are lots of labels used to describe pain in the lower back including spinal arthritis, spondylosis, degenerative back pain, osteoarthritis of the spine, disc bulges, disc prolapses, lumbago and sacroiliac joint pain.

Having pain in the back can be quite disabling and although it can be scary, once the red flags have been ruled out, it is not life threatening. However, it may disrupt many aspects of a person’s life, be overwhelming and can lead to anxiety and depression.

For some people, the pain will persist and when it has been present for more than three months, it is called chronic low back pain (CLBP) – this affects 30-40% of the population.

Low back pain can be caused by inflammation, infection or cancer, but these are very rare (between 1-2%). Those conditions have red flags (specific signs and symptoms) which your healthcare professional will look out for and screen you for.

A specific cause of back pain has been found in less than 10% of cases, so for most of the time it may be described as non-specific back pain (i.e. not specific to one structure/ factor). It is, in fact, like all pain conditions, multifactorial in nature.

What causes low back pain?

Over the last decade, a lot of research has been done into the modifiable causes of low back pain. The results might surprise you, as the things we thought that caused LBP such

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by Johan Holte, Consultant Physiotherapist, Sussex MSK Partnership as posture, your job or weak core muscles are not directly associated with increased LBP. Instead, back pain may become a weathervane on your life, a barometer on your physical, emotional, mental, and even your fiscal, health.

We have learned that all pain is influenced by being stressed and overworked, lack of sleep, low mood, feeling of being run down, carrying excess weight, smoking, being inactive and deconditioned. These factors may not directly cause pain, but they make space for the pain to flourish.

Imagine feeling really stressed out and then going out to dig up the whole garden – a bit like saying you will start running and the first thing you do is a half-marathon. Would you be surprised you injured yourself?

Indeed, the back is no different.

A systematic review (a study of lots of studies) by Brinjikji and colleagues in 2015 has shown that, although degenerative

changes in the spine are commonly found in people with back pain, it is also found in pain-free subjects. They sought to study the images of individuals without any back pain and checked them for degenerative changes. They found that degeneration is present in a high proportion of these pain-free subjects, which increases with age. They concluded that degenerative changes are part of a normal ageing process and not associated with pain. This brings us back to the fact that a spine is unlikely to be damaged, but becomes sensitive. The good thing about this is that many of the findings we know are associated with pain can be modified.

What drives disability?

There is now emerging evidence that a negative mindset or illness perception can lead to further disability. For example, if

a person thinks they have done damage to their spine, that the cause of the pain is due to an underlying injury or faulty disc, or that the consequence of the pain is that they never will get any better and that there is no cure, these factors will lead to more disability and pain.

Dr Peter O’Sullivan and colleagues (https://bjsm.bmj. com/content/54/12/698) published 10 back facts every person should know (see page 8).

The authors examined evidence that challenged the negative and commonly-held beliefs about back pain. They suggested that these unhelpful beliefs may be associated with greater levels of pain, disability, work absenteeism, medication use and shopping around seeing different health professionals.

People who develop persistent pain usually adopted these strategies on how to manage the pain: rest for prolonged periods of time, protect (muscle guarding, core activation), avoiding movement or certain postures and get passive therapies such as massage or manipulation. These unhelpful behaviours lead to further painrelated fear and distress and are influenced by factors such as depression, work and family life. These persons opt for more invasive treatments but may not get any better.

When do I need to worry?

The spinal community usually has three broad categories in relation to spinal pain: nonspecific low back pain, serious/ systemic pathology, and specific pathology such as nerve root compression/stenosis or spondylolisthesis.

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feelings about your back pain’ Non-specific pathology Most people with back pain will get better on their own. In 90-95% of cases, a pathoanatomical cause cannot be found. This is called nonspecific low back pain. Imaging is usually not helpful, as the pain should settle in the given timeframes. Only if your pain changes or gets worse or you develop neurological deficit or red flags, should you seek urgent help.

Serious and/or systemic pathology In these instances, your pain is related to an underlying serious pathology such as cancer or infection. It is usually associated with certain symptoms such as significant weight loss, a history of cancer, severe unremitting pain and not being able to sleep at night because the pain keeps waking you up.

These symptoms are called red flags and every clinician is trained to look out for these.

Another condition that can give rise to pain that needs urgent attention is inflammatory back pain. According to the National Axial Spondyloarthritis Society, one in every 200 adults in the UK has axial spondyloarthritis (axial SpA).

Axial SpA usually affects young people as symptoms start during late teens to early twenties. It is not life threatening, although it is painful and progressive if left untreated.

The main symptoms to look out for are: feeling stiff in the morning for more than 30 minutes, feeling better with exercise and worse after rest, on-going fatigue and slow and gradual onset of back pain and stiffness over weeks and

months. If you experience any combination of these symptoms you need to get them checked out.

Specific pathology such as radiculopathy or stenosis The more commonly used term is sciatica, which relates to back and leg pain due to inflammation, with or without compression of the nerves that originate from the back.

Usually, the cause of the inflammation or sensitivity that occurs is because of a disc bulge or protrusion which narrows the canal where the nerve exits. This irritation can be caused due to compression, but can also be chemically induced. Once the nerve is sensitised, it doesn’t like being stretched and causes severe debilitating pain and distress. The muscle guarding that ensues, which is a protective mechanism, can often restrict movement and disrupt sleep, as you won’t be able to find a comfortable position. The natural history of sciatica, however, is very good.

Commonly, patients report that symptoms largely resolve within a three-month period. However, when the pain persists beyond three months further treatment can be sought.

Treatment of back pain If you have any red flags, you would have been urgently referred either to an accident and emergency department or to a specialised musculoskeletal assessment service who can request further investigations and give you a diagnosis.

Previously, it was believed if we could find the exact origin of the pain and label

it then we could direct a specific treatment to fix the problem. This approach is very important in treating diseases.

However, disease focused labels and theories about the origins and nature of back pain have led to the development of a plethora of interventions, devices and fads. Eighty per cent of the population will experience back pain at least once in their life and most will recover within six weeks to three months. This happens naturally without any novel device or treatment intervention. However, many in the back pain industry claim this recovery is because of its intervention/treatment.

Sciatica If you have sciatica, then the treatment usually consists of physiotherapy. In conjunction with this you can be prescribed specific medication such as neuropathics. You will need to see your General Practitioner (GP) for this. If the pain persists and you do not get any relief, you may benefit from an MRI scan to clarify if referral for an injection might help. The aim of the injection is to reduce the inflammation of the nerve.

As a last resort, should none of the above give you any relief, you can be referred for a surgical intervention. This is where a surgeon would try to reduce the compression of the nerve through surgical means.

As with all these invasive techniques, there are risks and benefits which need to be considered before going ahead with this.

If you have acute (less than six to 12 weeks) LBP, the best thing to do to aid your recovery is moving as comfortably as possible. It may take a few

weeks to get there, but that’s fine. Please remember what you would do if you sprained your ankle. You would hobble around the first few days and feel a bit sorry for yourself (perfectly normal!). Then you would gingerly start moving and taking weight back through the ankle. And, after a couple of weeks you would be attempting a gentle jog. The sprained back is not much different, so treat it the same.

In chronic back pain, we are unsure how much spondylosis, spinal arthritis, contributes to pain. It is commonly described as “wear and tear” of the spine. However, this is not a good descriptor of arthritis, as it implies that we “wear out” as we mature. “Wear, flare, and repair” is a better narrative to explain arthritis.

Tissues do wear and your body’s response is to attempt to repair with more robust and tougher tissue. This repair process is facilitated by inflammation which may be painful.

Avoidance Being too careful, avoiding the chance of wear, will in fact make a flare more likely to occur.

Keep this in mind if you develop back pain, the best approach is to keep active and strong to maintain toughness of tissues to allow you to do the things you enjoy. Pain relief may help you to do this.

Remember, if your pain persists after three months, it is important to look at all factors involved in persistent (or chronic) pain. The principles are the same for everyone, but how it is managed will be very individual. continued on p8 >

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Avoid negative feelings The core principles are getting a good pain education, understanding how pain works, and finding new strategies on how to manage your pain and gradually restoring normal function. This goes hand in hand with lifestyle advice such as healthy living and exercising, eating and sleeping.

Don’t fall into the trap of negative feelings and thoughts about your back pain, avoiding movements and becoming deconditioned

but instead focus on the health of your spine, rather than damage. Engage in physical activities, maintain good body strength/weight and good sleep to optimise your spine health.

So, next time you have a flare of back pain and cannot relate it to something physical you have done, consider what else has changed in your life recently. Try to remain active and focus on doing something that makes you feel good.

About the author Johan Holte has a master’s degree in research (MRes) and has a special interest in spinal pain. He is a member of the Versus Arthritis MSK Champions cohort.

Furthermore, Johan is a Versus Arthritis Core Skills trainer in musculoskeletal care and teaches on the Vocational Training Scheme for General Practice.

Campaign to beat pain “We are Versus Arthritis, we’re the 10 million people living with arthritis. We’re the carers, researchers, healthcare professionals, parents, friends, runners and fundraisers all united in our ambition to make sure that one day, no-one will have to live with pain, fatigue and isolation that arthritis causes.”

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10 TALKBACK ACUPUNCTURE

How acupuncture is used as a viable Since the revision to the National Institute for Health and Care Excellence (NICE) guidelines in April to allow acupuncture as a viable treatment for chronic pain, the practice has thankfully shed some of its “sandals and candles” image.

A greater number of medical professionals and patients are now recognising its merit.

There are some 28 million people in Britain suffering from chronic back pain, according to research led by Imperial College London in the journal BMJ Open. Many physiotherapists already use acupuncture to help relieve a patient’s pain, almost always in conjunction with other treatments, and often with the benefit of not having to prescribe painkillers.

Decoding pain

By JONATHAN HOBBS, Chairman, Acupuncture Association of Chartered Physiotherapists (AACP)

There is, of course, no off-the-shelf treatment plan for back pain. Physiotherapists make an assessment to decode the causes of pain, taking into account the patient’s age, fitness and circumstances, before deciding on what will deliver the best patient outcome. At various levels, a combination of acupuncture, exercise and manual therapy can be employed.

Battle with back pain has had a major Chronic pain can be debilitating. Even the simplest task most of us take for granted like walking the dog or getting to sleep can cause excessive pain. So, when Andy Morris was told he would have to be on painkillers for the rest of his life, he decided to do something about it.

Andy, 40, from Wrexham, underwent spinal surgery in 1995 to treat scoliosis, a condition where the spine twists and curves to the sides. He had a titanium plate fitted and was overjoyed to find the operation was a success and years of discomfort were at an end.

The reprieve lasted until 2017 when he had a fall at work and landed on his lower back, hitting a pyramid-shaped footstool. He was obliged to give up work and has since had a constant battle with chronic back pain that he rates as “generally 11 out of 10”.

X-rays and ultrasounds showed no signs of broken bones or any root cause of pain.

Physio has helped, and his doctor prescribed medication to alleviate the pain. He takes two medications (Naproxen and Omeprazole) daily and additional paracetamol when the pain becomes too much.

“The initial course of physio did relieve the pain somewhat and meant I was able to go swimming, which also helped – but it was short-lived,” Andy said. “I don’t want to be reliant on painkillers, but I don’t have a choice.”

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CASE STUDY: Andy Morris

A dog owner who loves walking, Andy’s battle with chronic pain has had a big impact on his life. “Walks are generally not an option. My friends and family know when it is at its worst because I become very moody and take it out on them,” he said.

“The situation is made worse by the fact that lying down is especially painful, and so sleep becomes very difficult. I often wish I could sleep standing up.”

Since January of this year, Andy has discovered a lifeline in the form of

Acupuncture has been a lifeline for Andy Morris

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treatment for chronic back pain In decoding the cause of pain, we are often faced with the impacts of injury or surgery, but just as common are patients who have back pain because of inactivity or a sedentary lifestyle. We are just as likely to see patients who work in offices, for example, as work on building sites and, shockingly, we see patients as young as 10 suffering from back pain as a result of too many hours playing computer games.

The impact acupuncture can have will also vary considerably depending on the root cause of the pain. Whereas the loosening of tight muscles caused by inactivity can be immediate, the degenerative changes in an older person’s back may require half a dozen treatments for it to be successful.

Asking a physiotherapist how long it will take to cure back pain is akin to asking a car mechanic how long it will take to fix a car – it will depend on the problem, cause, condition and age of the car. This is not surprising when you consider that “back” pain starts at the top of the legs, with numerous “parts” (to continue

our automotive analogy) that are critical to major movement.

Exercise is critical Wherever possible, exercise is a critical part of a treatment plan. At the start of a programme, acupuncture will enable the patient to exercise, and through exercise the patient can realise the best outcomes, keeping the problem at bay.

Our end goal as physiotherapists is to return our patients to a pain-free life, and we strongly believe that acupuncture’s continued use and shedding of its ill-conceived “sandals and candles” image will further this goal. n Jonathan Hobbs has worked in a variety of NHS, private sector and professional sport physiotherapist roles. He is a Fellow of the Higher Education Academy, an accredited AACP tutor, and an external assessor, consultant and sessional lecturer to a number of universities throughout the UK. He is also a consultant to physiotherapists in Team GB, the FA and various Premiership football and rugby clubs.

impact on patient’s life acupuncture. His mother had been receiving treatment and recommended he give it a go.

His doctor would not prescribe it, so he went privately. During treatment, he says the pain almost disappears, and relief lasts for a few weeks.

“While I am hopeful that the doctor will prescribe me another course of physiotherapy, my main wish is that acupuncture could be prescribed – and the recent NICE guidelines suggest it can,” said Andy. “I have acupuncture when I can afford to, but that’s not enough to mean pain is not a big part of my life. Without it, however, I would be in continuous pain.”

Fundamental difference Andy says he was a bit nervous before his first acupuncture appointment as he just didn’t know what to expect: “Very quickly I was put at ease, and the results were instantaneous. After four sessions, I’m convinced of its effectiveness as a treatment for chronic pain.

“After acupuncture sessions I can do what I want and it makes a fundamental difference to my life. I really appreciate the basics – walking the dog and sleeping properly. And it’s an option that might mean I don’t have to take medication for the rest of my life.”

UK’s largest acupuncture professional organisation The AACP is the largest professional body for acupuncture in the UK. Founded in 1984, the Association has been operating for more than 35 years and has grown steadily to become the organisation it is today.

AACP forms the association for the practice of evidence based, western medical acupuncture (WMA) in physiotherapy.

We represent our members with law makers, the public, NHS and private health insurers and actively support them with clinical and legal advice, training and resources.

Integrating EvidenceBased Acupuncture into Physiotherapy for the Benefit of the Patient

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12 TALKBACK NEWS

Protein research may aid arthritis treatment

Professor David Julius addresses colleagues at UCSF’s Mission Bay campus while celebrating his Nobel Prize award. Photo by Noah Berger

Scientists’ studies earn Nobel Prize Two scientists behind groundbreaking research into how we sense temperature and touch have been awarded this year’s Nobel Prize in Physiology or Medicine.

David Julius and Ardem Patapoutian and their teams have unlocked one of the final mysteries around understanding sensation – how pain and pressure work at a molecular level.

Professor Julius, from the University of California, San Francisco (USCF), used capsaicin from chilies to identify a skin sensor that responds to heat.

Professor Patapoutian, from California’s Scripps Research Institute, discovered a class of sensors that react to mechanical stimuli in the skin and internal organs through investigating pressure sensitive cells. The sensors’ role includes regulating

blood pressure and bladder control, and helping sense body position and motion.

Both academics, who were working independently, also identified a skin sensor activated by cold.

Their work, carried out over the past decade but honoured at this autumn’s award, is being used to develop potential treatments for a range of disease conditions including chronic pain.

Drug aids spinal cord injury recovery A cholesterol drug could improve recovery after spinal cord injuries, new research has found.

The US study, published on the eLife website, involved giving mice with injured sensory neurons fenofibrate, which is usually used to treat high cholesterol.

The team at the Washington University School of Medicine in St Louis discovered the drug

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activated the support cells surrounding the neurons and helped them regrow about twice as fast as neurons in mice that received a placebo.

They are now planning to combine fenofibrate with other experimental regeneration promoting therapies targeting neurons or other aspects of the central nervous system to further enhance regeneration.

New treatments for a painful type of arthritis that affects the spine, joints, eyes, gut and skin are a step closer after researchers discovered more about the role a protein plays in its development.

The team studying axial spondyloarthritis (SpA) at Canada’s Schroeder Arthritis Institute focused on the macrophage migration inhibitory factor (MIF), which induces an inflammatory response in the body.

Immune system Their findings include the insight that neutrophils – a type of white blood cell that activates the immune system’s response – from SpA patients secreted more MIF compared to healthy subjects.

There are currently very few therapeutic options for most patients, but in a preclinical model, a MIF blocker called MIF098 successfully prevented and restricted the onset and development of SpA. The researchers’ next step is testing the potential of other MIF targeting therapies and running clinical trials.

Their recent work was published in the journal Science Translational Medicine.

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Online resource to help arthritis sufferers manage their condition A unique online resource has been launched to help people living with rheumatoid arthritis (RA) to self-manage their condition.

Around 400,000 people in the UK have the painful and complex autoimmune disease that can lead to irreversible joint damage and potential disability, without the right care and treatment.

And that’s where SMILE-RA comes in. The Self-Management Individualised Learning Environment in Rheumatoid Arthritis (SMILE-RA) supports people with RA to understand the condition better and help manage their own care and treatment.

The free, module-based programme has an easy-to-use interface and has been created by the National Rheumatoid Arthritis Society (NRAS).

After a foundation evaluation, registered users can choose any of its topics, which include medicines and treatment, and managing pain and flare-ups.

The interactive modules, which take 20 to 30 minutes, feature extensive video and voiceovers from health professionals, NRAS

staff and people with RA along with short quizzes.

SMILE-RA is also useful for professionals new to rheumatology who want to find out more and the importance of self-management.

NRAS founder and its national patient champion, Ailsa Bosworth MBE, said: “We have many more modules still to develop, but I only wish I’d had access to this kind of resource when I was diagnosed.”

Study results show less bone loss in post-menopausal women than expected The latest results from the world’s longest running study of bone mineral density changes in post-menopausal women has found bone loss is significantly lower than expected.

University of Eastern Finland researchers found the density of the femoral neck bone – at the top of the thigh or femur – fell by an average of 10% during their 25-year follow-up.

HRT Based on earlier reviews in the study, which monitors more than 17,000 women every five years, the bone loss rate had been estimated to be more than 20%.

The findings were published in the Journal of Bone and Mineral Research. They showed the most significant

factor protecting against bone loss was hormone replacement therapy, with weight gain also giving some protection.

Professor Heikki Kröger, from the university, said the results shed “significant new light on osteoporosis and bone research, and changes our

understanding of bone loss in older women”.

The research is continuing with the 30-year review currently under way.

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14 TALKBACK BACK HEALTH AFTER COVID

Building better back health Catherine Quinn has been President of the British Chiropractic Association since 2017.

She is the BCA’s youngest president and the third female president in its history, the others being in 1945 and 1970.

Catherine’s career in chiropractic started unexpectedly when she discovered the practice through a family friend for her own treatment. This was initially for neck pain and headaches and then later to support her competitive career in karate.

She continued to observe a number of physiotherapists, osteopaths and chiropractors while studying for a sport science degree at St Mary’s University, where she also worked for a number of professional clubs as a sports therapist, until she decided chiropractic was the profession for her.

Catherine first joined the BCA as a student member while at AECC University College. After she graduated, she became more involved in the BCA’s conference committee and was eventually asked by more senior members of the association to stand for a board position, which set a clear flightpath for her presidency.

Membership growth Already, Catherine has made a lasting impact on the BCA by breaking down some of the barriers and myths about the wider chiropractic profession, so that its breadth and support is better understood by a wide range of audiences.

She has introduced the use of social media to the Association, which has been commended by the European chiropractic community as a “best in class” demonstration of how to make chiropractic more accessible. This is just one way Catherine’s leadership has facilitated growth in membership numbers to more than 50% of the UK’s chiropractic profession, making the BCA the largest chiropractic professional association in the UK and Europe.

She hopes to continue to re-educate the public about chiropractic so they can make the best-informed decision about their health as well as consider chiropractic as a career, regardless of their background and education. Catherine has lectured across the world on the future of an integrated approach to a healthcare team and on

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Catherine Quinn the evidence base for the package of care chiropractors provide.

Catherine’s career as a chiropractor outside of the BCA has been just as fruitful.

Highlights include working for two weeks as a first responder at the London 2012 Olympic Games and treating the London Irish and New Zealand rugby league teams.

Catherine currently has a successful private practice alongside being the first team chiropractor to Queens Park Rangers Football Club. She is a Trustee of the St Mary’s University Students Union, where she assists the sabbatical and staff teams in strategy and policy decision making.

Catherine currently works as a chiropractor at Cleve Chiropractic & Physiotherapy Centre in Bristol alongside a wider team of chiropractors and physiotherapists.

In her personal life, Catherine enjoys socialising with her family and friends, going to the gym and relaxing with yoga.

Singing has also been a passion of hers since secondary school, having performed in musicals like Sweet Charity and at several events over the years. Currently, she performs as part of a chiropractic band called Audible Release.

If you’re experiencing persistent back pain or mobility issues, you should always seek the advice of your GP or other health professional. To find a chiropractor near you, visit chiropracticuk.co.uk/find-a-chiropractor/

Here, Catherine tells BackCare about recently conducted research undertaken by the BCA on the impact long-term lockdown restrictions and remote working were having on the nation’s physical wellbeing and routines, which revealed a rise in the number of people experiencing more symptoms of back pain. Catherine discusses the root cause, as well as how to build better back health as many of us continue to work from home.

“We have all experienced change to our lifestyles during and post Covid-19, some lead more sedentary lifestyles, some took up new activities like Couch to 5K or Joe Wicks PE classes and so many of us were left working from potentially poor home office set-ups.

“Given these alterations to how we live our lives, this uplift in the number of people who are experiencing back pain across the UK perhaps isn’t too surprising. Interestingly, however, our research revealed 18 to 24-year-olds are experiencing more symptoms of back pain than over-55s.

“With poorer weather threatening to dampen people’s plans to get outside or go to the gym, as well as the possibility of returning Covid-19 restrictions, such as encouraged working from home, to keep the pandemic at bay this winter, it’s difficult not to predict another uplift in the number of people across all age groups experiencing new aches and pains.

“If we consider why young people in particular are experiencing back pain, compared to older age groups, students and young professionals are most likely to live in rented or shared accommodation – meaning they’re less likely to have a study area to work from separate from their main living space or bedroom.

“Added to this, compared to over-55s, many of whom will be retired and have more flexibility in how they use their day, young professionals and students are more bound to a work or study schedule, which makes it more challenging to build in weekday activities like regular exercise.

“The good news is that simple changes can make a big difference to all age groups.

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post Covid-19 It’s really positive to see people are still motivated to improve their movement routines, such as exercise and getting outside each day, as we all continue to return to ‘normality’. The research revealed that 47% of Britons are prioritising implementing a better exercise routine as restrictions continue to lift this year, while 42% are looking to spend less time sitting and more time outside.”

Top tips for better back health 1 Build a routine that’s realistic and works for your lifestyle: Incorporating movement into your day is so important, but many people set unmanageable goals for exercise. When we don’t achieve these goals, which are far reaching to start with, this then impacts our motivation, making us less likely to create new positive habits for our wellbeing.

It’s great to set longer-term intentions, but start small. For example, start by taking a 10-minute stretch during your lunch break. Over time, this will become an automatic habit and you can build it up from there – it’s about manageable, bitesize chunks.

2 Get some fresh air: With unpredictable weather, I know it might take a little more planning than usual to head outside for a walk, but it will be a great way to break up the day. One of my top tips for patients working from home, is to try having a morning “commute”. If that currently consists of going from your bedroom to the kitchen or home office, then why not leave the house for a 10-20 minute walk around the block or a local park so you can return to your home having cleared your head and in the frame of mind to work. You’ll get the benefit of adding in some movement to the morning, separate your work and home time, and get some fresh air too.

3 Mix up the position you work in: If you work at a desk or table, consider a laptop stand which will allow you to work standing up. It’s also fine to get creative – perhaps by using a kitchen counter or a chest of drawers as a DIY standing

Get some fresh air

At home exercise

desk, for example. The important thing is that your screen is eye level. Stacking books is a good way to easily add height if needed. If your workday passes by without looking at the clock, try scheduling a “standing hour” in your diary as a reminder to get up and moving.

4 Sleep tight: A great night’s sleep is a game changer. It’s too easy to scroll through social media from bed and before you know it an hour has passed. Try to protect the hour before you go to bed as your personal wind down time. My tips include avoiding blue light technology – most phones have a night-time mode, which changes the screen light and stops notifications coming through. I find reading a great way to fall asleep too – apps like Calm have bedtime stories

designed specifically to help you drift off, if you prefer to listen. The main thing is about consistency and sticking to similar timings each night, so you train your brain for your new routine.

5 At-home exercise: With poorer weather on the way, getting outside to exercise or going to the gym is harder. To look after your back health, there are lots of easy exercises you can do at home. One of my favourites is using a towel like a foam roller and lying with your back across it – this will really help to open up your chest.

Your body will love you for it if you tend to hunch over your keyboard. The BCA has created some easy bitesize videos with simple stretches and exercises you can do at home, which you can find at chiropractic-uk.co.uk/straighten-up-uk/

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16 TALKBACK WHAT TO DO FOR A SLIPPED DISC

Ouch! I think I’ve slipped a A herniated or “slipped” disc is among the most debilitating of back pain problems – sometimes with added symptoms such as the grinding leg pain of sciatica.

There are many levels of back and neck pain but a herniated or slipped disc is one of the most painful and can cause longterm immobility if it’s not treated correctly.

A slipped or herniated disc refers to a condition where the centre of a spinal disc bulges outwards and presses on to a nerve. The spinal discs act as shock absorbers and through a variety of causes, including injury, poor posture and general “wear and tear” (meaning gradual deterioration), the walls of the disc can become weaker.

If the centre of the disc pushes out, this can cause the disc wall to bulge and that can be when pain strikes.

There are six steps of management to consider in this situation: l painkillers l manual therapy l IDD Therapy l injections l surgery l other options including exercise and acupuncture.

Painkillers When you have a disc problem or simple back pain, the first thing the NHS recommends is to take some anti-inflammatories such as ibuprofen.

Relieving pain is the first step to being able to move, because if you can move, the mechanisms which keep our backs healthy can operate.

This will be what your GP will recommend, because in approximately 90% of cases, back pain resolves within six weeks. But if the pain isn’t going away or it is so severe you can’t carry out your normal functions, then some form of manual therapy is advisable.

Manual therapy There are various types of therapy and we typically think of physiotherapy, osteopathy and chiropractic. Where there is pain, the body usually limits how we move – it hurts!

Some conditions have built up over time, leaving the spine stiff and unable to move properly. This can put tremendous pressure

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by Neil Velleman of Atkins Physiotherapy Consultants on the discs. So, generally speaking, manual therapists will seek to ease muscle spasm and then, through either some manual mobilisation or manipulation, free the joints which may be stuck They will also look at how our bodies are moving.

This is where we consider the “cause”; what led the disc wall to get weak? Often, some gentle stretches and exercises can help to get movement back, all with the goal to help the body heal itself. Typically, four to six sessions are enough, although you may need additional exercise sessions.

IDD Therapy IDD Therapy is the next step when manual therapy and exercise alone aren’t enough.

IDD Therapy is a computer-controlled treatment which helps physiotherapists to decompress the specific spinal segment where the disc is “slipped” or herniated.

Patients lie on a treatment couch where they are connected to a machine with a pelvic harness and a chest harness.

The IDD Therapy machine then applies a gentle pulling force at a precise angle to take pressure off the targeted disc and gently mobilise the joint and surrounding muscles. The goal with IDD Therapy is to relieve muscle spasm, reduce or reverse disc bulging and gently stretch the tissues to free the movement in the spine. As pain subsides, therapists use gentle exercise and possibly some manual therapy to strengthen the back or neck to help avoid a recurrence.

Patients typically have a programme of IDD Therapy and long-term problems can need 20 sessions over a six-to-eight week period. IDD Therapy is still relatively new to the UK, but there is a network of providers around the country.

Injections Injections are quite controversial because until recently they have been given widely to people with long-term disc problems.

When a patient has a slipped disc and pain, there can be inflammation in the area. This inflammation can cause pain on its own.

There are different injections, but a steroid injection with or without some local anaesthetic may be given to reduce the inflammation. Injections can provide temporary relief with the goal to create a window of pain relief where the body can move or where therapists can work with a patient to address the causes of the problem.

The controversy about the effectiveness of injections is because injections do not address the causes of the problem. They can address inflammation, but a slipped or bulging disc will still be bulging after the injection. Hence the question of whether injections really help or not, and why many NHS trusts are scaling back the availability of injections as the cost/benefit is not clear.

Surgery Spinal surgery can be a very important step for patients with a slipped disc which has not responded to any of the treatments described. This is particularly the case if the disc is putting pressure on nerves to such an extent that it causes weakness in the legs or arms or, in very severe cases, if a slipped disc puts pressure on the spinal cord and affects our bowel or bladder control, then emergency surgery can be essential.

The most common surgery for a slipped disc is a “microdiscectomy”. If the disc material is stubbornly pressing on a nerve, the offending disc material may be cut out surgically and removed. Such surgery is commonly given for leg pain (sciatica) where the disc is pressing on the sciatic nerve and the pain is intolerable.

Surgery can remove the pain immediately.

However, it is not without risks and surgery does not address the causes which led to the weakness in the first place. Thus, some patients can get complete relief while for others the pain may remain or even get worse.

Generally, surgeons will operate as a last resort and it can be advisable to get a second opinion before embarking on surgery.

Other treatments Yoga and Pilates can be helpful in maintaining your body once you resolve the pain. It is important to find a teacher who

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disc... five treatment options suits you and understands your condition.

We hear a lot about “core muscles” and, while there is some debate about how important our core is, generally the more our muscles can support our spines and move freely, the better our discs are protected.

Acupuncture can relieve muscle spasm and back pain, though for a slipped disc it would work best in conjunction with manual therapy and IDD Therapy rather than as a stand-alone treatment.

What next for slipped discs?

We are potentially going to see more slipped discs because, generally, people are less active than they used to be and spend a lot more time sitting. Discs hate to be squashed!

There is a general move in healthcare away from invasive treatments such as injections and surgery, and the emergence of treatments like IDD Therapy, which has replaced traction, means that, combined with increased knowledge about the spine and exercise, we can keep more people on the non-invasive side of spine care.

If pain is persisting longer than six weeks, I would advise seeing a professional who works with spines, just to make sure something short term doesn’t progress into something more debilitating and long term.

About the author Neil Velleman is a back pain expert, IDD Therapy provider and owner of Atkins Physiotherapy Consultants in Essex.

Intervertebral Differential Dynamics, or IDD, Therapy is the fastest growing nonsurgical spinal treatment for intervertebral discs with more than 1,000 clinics worldwide and more than 40 clinics across the UK. Safe, gentle and non-invasive, IDD Therapy helps patients who need something more for their pain when manual therapy alone is insufficient to achieve lasting pain relief.

Web: http://iddtherapy.co.uk/ Facebook: IDD Therapy Europe Twitter: https://twitter.com/IDDTherapyDisc

There is a general move in healthcare away from invasive treatments such as injections and surgery

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18 TALKBACK VITAMIN D AND EXERCISE

How to protect your back

Image: the ROS

Osteoporosis and back pain As we Osteoporosis is a condition that causes bones to lose welcome strength and break more easily. It occurs when the structure of bone gets thinner, making it fragile and colder and likely to break easily. There are 3.5 million people darker days, more with the condition in the UK today. Osteoporosis itself the Royal doesn’t cause back pain or any other symptoms Osteoporosis unless you actually break a bone.

While most fractures happen after a fall, spinal Society (ROS) fractures can happen without an accident or fall.

Bones in the back squash down and become tells us why flattened or wedge shaped – sadly then staying in it’s more this changed shape even after healing has taken important than place. Spinal fractures can be asymptomatic or present with the generic symptom of back pain and ever to take loss of height. As a result, they are often wrongly positive action dismissed as an inevitable part of ageing. In fact, research estimates that two-thirds of spinal fractures towards our go undiagnosed. As many of them are not picked bone health up early, there are positive actions you can take to support your bone health and reduce the risk of as we enter spinal fractures. vitamin D blackout.

The importance of vitamin D

Sarah Leyland

Vitamin D helps your body absorb and use calcium, which gives your bones their strength and hardness.

Despite vitamin D being essential for healthy bones, only 37%1 of Brits realise that you can’t get vitamin D from sunlight between the end of September and beginning of April in the UK. Sarah Leyland, Clinical Advisor at the ROS, explained: “From April through the summer, we can get good amounts of vitamin D from sunlight. During these months, it’s recommended you expose your skin for short periods to direct sunlight for around 10 minutes, once or twice a day. It’s important not to get sunburnt though.

“From the end of September to the beginning of April though, we should all consider taking a daily 10 microgram vitamin D supplement because we can’t get it from sunlight.

“Getting adequate vitamin D helps us to absorb calcium and keeps our muscles and bones strong.

Without adequate vitamin D, our bones become weakened.”

Public health advice is that people consider taking a daily supplement of 10 micrograms (sometimes called 400 units) of vitamin D during the months when you can’t get it from sunlight. Yet the research shows that almost half of the nation (49%) is missing out on the vitamin D they need during autumn and winter by not supplementing their intake.

Fear of falls and fractures TALKBACK l WINTER 2021/2022

New figures published by the ROS show that 92% of people with osteoporosis are concerned about future

falls or fractures2. This can be heightened throughout winter due to slippery roads and pavements.

Sarah explains how people can prepare themselves ahead of winter to protect themselves from falling and injuring their backs.

“As it becomes wetter, colder and more icy, people become worried about slipping over and falling outside. They often avoid exercise or everyday activities due to fear of injury, yet most falls actually occur inside the house, However, there are steps we can take to prevent both types of falls from happening.

“Safe techniques for day-to-day moving and lifting are recommended to reduce the risk of back pain and spinal fractures, rather than instructions such as ‘don’t lift’ or ‘only lift up to a specific weight’. A straight upper back (and keeping the neck in line with the spine) is the key principle for all movements that involve bending and lifting.

Abdominal muscles should be engaged during movements, as this helps you to balance better and reduces the risk of falling.

“Exercises to improve muscle strength in the back are also recommended to improve posture and support the spine. People should aim to repeat exercises three to five times and hold for three to five seconds, at least two days a week.”

You can find information about specific exercises to reduce the risk of falling over as we get older by improving our balance and muscle strength. These exercises can be easily integrated into daily activities like standing on one leg with support if needed, sit to stand exercises and heel raises. See the ROS factsheet and video on Exercise to improve balance and muscle strength for more ideas, and to learn how to do these exercises safely.

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in the winter months Exercises are just as important on cold wintry days as fine summer days

Exercise for bone health If you are someone who has experienced back pain and curvature of the spine because of previous spinal fractures, then exercise can help with this.

Strengthening the back muscles improves posture and reduces back pain. It may also help to reduce the risk of vertebral fractures. These two principles of improved posture and strong back muscles can work together to promote positive outcomes.

“Maintaining physical activity and exercise is recommended to address pain and improve wellbeing,” said Sarah. “Muscles and bones need to be used and exercise is really important to improve the strength of both. Yoga, Pilates and similar exercise programmes should be considered to help with posture and pain by teaching form, alignment, muscle strength and relaxation. Breathing and pelvic floor exercises are also recommended to help with other symptoms that may be exacerbated by severe back pain.

“Doing daily exercises helps to improve muscle tone, strengthen back muscles, ease tension and reduce muscle spasms in your back. Some exercises to improve back strength include press-ups, squats and upper back rows. If you’re suffering from back pain, you will want to try more gentle exercises such as a shoulder squeeze, a glute bridge or a cat pose.

When exercising, you should aim for each exercise to

be held for three to five seconds and repeated up to 10 times.”

For further information on lifting techniques and exercises for your back, visit theros.org.uk/ information-and-support/osteoporosis/livingwith-osteoporosis/exercise-and-physical-activityfor-osteoporosis/caring-for-your-back, where you can find fact sheets on exercises mentioned above.

Further support The ROS is the only national charity dedicated to bone health and osteoporosis.

It runs a free helpline led by nurses with specialist knowledge of osteoporosis and bone health. If you feel you need information and support about how to manage back pain, the helpline is open Monday to Friday between 9am to 1pm and 2-5pm. The helpline is closed on Bank Holidays and during Christmas office closure between 25 December and 4 January.

The ROS also has support groups you can access in person or online, where you can connect with people in your area with similar experiences.

Find out more at theros.org.uk or call the charity’s free helpline on 0808 800 0035.

Walkies! A quick dog walk in winter is unlikely to be sufficient to provide enough sunshine to generate one’s daily requirement of vitamin D

References 1 ROS 2021 survey of 2082 adults. Fieldwork was undertaken between 21-22 April 2021. The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+).

2 The Life with Osteoporosis Report 2021: https://strwebprdmedia.blob.core. windows.net/media/h3wnxvdq/ros-life-with-osteoporosis-report-2021.pdf.

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20 TALKBACK NEWS

Millions ‘missing out’ on health care Millions living with osteoporosis are missing out on the healthcare they need, according to a new report from the Royal Osteoporosis Society (ROS).

Life with Osteoporosis, which uses survey responses from 3,266 people, follows on from a study carried out for the charity in 2014.

In the UK, more than 3.5 million have the condition, which causes bones to weaken and break easily.

Among the latest findings, fewer than half of respondents were confident they are on the right medication, and only 42% think their doctor takes osteoporosis seriously – an 18% drop since 2014.

Bacteria in gut link to arthritis

Under a third (32%) felt they were getting the level of monitoring and review they need, 15% fewer than in 2014.

The report highlights International Osteoporosis Foundation figures that show 64% of women and 43% of men are not getting the NHS treatment they need.

ROS Chief Executive Craig Jones said the condition has

been underestimated for decades and is one of the main obstacles to living well in old age.

“We’re all living longer, but the independence and social lives of many hundreds of thousands are being stolen by this cruel disease. The missed opportunities to respond to early warning signs lead to people slipping through the cracks every day,” said Craig.

Therapy treats ‘false alarm’ pain If you suffer with chronic back pain (CBP), being told “it’s all in your head” is not what you want to hear, but a new study shows a psychological treatment can deliver significant results.

While the discomfort in your back is very real, pain reprocessing therapy (PRT) focuses on how it’s perceived in the brain.

In the randomised trial, two thirds of people who had PRT said they were pain-free or nearly pain-free a year later compared to only 20% in a placebo injection group and 10% in a usual-care group.

Writing in the psychiatry Journal of the American Medical Association, the researchers say PRT “targets primary pain by shifting

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patients’ beliefs about the causes and threat value of pain”.

It aims to “promote patients’ reconceptualisation of primary chronic pain as a brain-generated false alarm”.

Through eight one-hour PRT sessions, participants learned to neutralise the “false alarm” by understanding their pain as safe, not a threat.

The research authors stress, though, the approach is for non-specific CBP, not for pain related to acute injury or disease.

The US study of 151 people is a collaboration involving the Weill Cornell Medical College, Dartmouth College and the University of Colorado Boulder.

New research into how our body clock affects immune cells responsible for swollen joints in rheumatoid arthritis (RA) will include looking at links to bacteria in the gut.

It’s thought the bacteria may affect our immune system and contribute to diseases like inflammatory arthritis.

Dr Julie Gibbs, from the University of Manchester, will investigate how daily symptom changes in RA – which affects around 400,000 in the UK – are influenced by the body’s 24-hour rhythms and the role gut bacteria play.

Her recent work, published in Nature Communications, includes the finding that antiinflammatory immune cells show a daily rhythm, with numbers peaking at night, which could explain why some people find relief from inflammation at night-time.

Versus Arthritis, who have funded the research, hope the new study will give a more complete picture of why pain and stiffness vary during the day or night. It said the results “could help target existing treatments better or lead to potential new targets for treatments in the gut bacteria”.

TALKBACK NEWS 21

Images © Samuel I Stupp Laboratory/ Northwestern University

Longitudinal spinal cord section treated with the most bioactive therapeutic scaffold, captured 12 weeks after injury. Blood vessels (red) regenerated within the lesion. Laminin is stained in green and cells are stained in blue

‘Dancing molecules’ shown to repair spinal cord injuries A breakthrough treatment that harnesses “dancing molecules” to reverse paralysis and repair tissue after severe spinal cord injuries has been developed in the US. When researchers at Northwestern University used the injection on tissues around the spinal cords of paralysed mice, they regained the ability to walk in just four weeks.

The therapy uses a liquid that gels into ultra-thin fibres to mimic the environment around the spinal cord. The synthetic materials effectively

Human stem cells (red and green) treated with a therapeutic material that was modified to have a high degree of “supramolecular motion.” The cells began to differentiate into neurons (white) in the presence of the material

communicate with cells to promote regeneration.

Samuel Stupp, who led the work, is Board of Trustees Professor of Materials Science and Engineering, Chemistry, Medicine and Biomedical Engineering.

“Receptors in neurons and other cells constantly move around,” said Prof Stupp, who is also founding director of the Simpson Querrey Institute for BioNanotechnology at the university and its affiliated Center for Regenerative Nanomedicine.

“The key innovation in our

research is to control the collective motion of more than 100,000 molecules within our nanofibres.

“By making them move, ‘dance’ or even leap temporarily out of these structures, known as supramolecular polymers, they are able to connect more effectively with receptors.”

Prof Stupp is “very excited” about starting the process of getting the treatment approved for human patients.

The study was published in Science, a journal of the American Association for the Advancement of Sciences.

A new injectable therapy forms nanofibers with two different bioactive signals (green and orange) that communicate with cells to initiate repair of the injured spinal cord. Illustration by Mark Seniw

Professor Samuel Stupp

Regenerated axons (red) and glial cells (green) in the centre of the lesion

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22 TALKBACK AXIAL SPA

Early diagnosis is the key As an only child, Talia Dean learnt to occupy herself and discovered her love of music from an early age. Fascinated by cinematic music she became lost in her own world.

She fitted words into rhythms, playing the keyboard and the guitar – an instrument she was to become particularly gifted at.

“That’s how I whiled away the boredom and how I best express my emotions,” she says when we talk about her success as a singer-songwriter.

Some might remember Talia for her time on The X Factor. She was mentored by Nicole Scherzinger, while Sharon Osbourne said of her: “You just put it right there on the stage, your heart, your soul, your everything.” But Talia has more to her than one TV show. She is gifted and has steely determination that has seen her succeed in a difficult and competitive world.

Friendship She has had the privilege of being mentored by, and striking up a friendship with, Queen guitarist Brian May with whom she has collaborated. She reached the top of the UK iTunes charts with her former band Kings Daughters and in 2021 became a solo artist.

Talia’s third single went to number one in the UK Blues Chart and her fourth, Nemesis, reached number one in the Soundtrack Chart. Talia’s debut album will be released in spring 2022.

As well as enjoying success, Talia has faced some exceptionally tough times. In 2020, 15 years after her first symptoms began, she was diagnosed with axial SpA, an inflammatory disease that causes severe back pain, fatigue and spinal fusion.

She believes the symptoms started when she was 18 when, in her first year studying music, dance and theatre at West Thames College, she had a tremendous ache in her hip. It was elusive and when she couldn’t find its exact location, she remembers thinking: “I’ve got this pain in my bum, but then it’s in my hip and then it’s in my side.

I’d always press and try to find it but just couldn’t pinpoint the source.”

She put it down to growing pains, but it was relentless to the point that there were times when she couldn’t put any weight on her leg. A girl who lived for dance suddenly felt old before her time when she struggled

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TalkBack talks to talented singer songwriter Talia Dean about her experience with getting an axial SpA diagnosis. even to get out of a car. She would end up in A&E simply saying: “I can’t walk, it really hurts.” So, at 18, she was on crutches for a while and no-one could identify why.

As the pain progressed, she had to leave the course. Things started to settle and for a few years she seemed fine, but by the time she was 23, she had a pain in her lower back. She tried painkillers and made excuses to herself. “The whole world has backache so I didn’t really think anything of it,” she says.

Over the next six years she had MRIs and numerous x-rays. She saw rheumatologists, urologists, osteopaths and acupuncturists and all the time her symptoms were getting worse, to the point there were times when she couldn’t turn over in bed and getting up in the morning brought her close to tears.

At 29, Talia had a complete breakdown, thinking “there is something wrong with me, I’m dying and they can’t find it,” she says.

She also developed a fear of doctors and blood tests, deciding she would prefer not to know what was wrong with her.

When she became pregnant with her son, the symptoms abated but returned after the birth. This time, the pain was in the middle of her back. She also noticed that when she looked in the mirror she was “wonky”, unusual for someone who, as a dancer and being on stage, had always had great posture. She struggled to lift her son out of his cot and noticed that she couldn’t wiggle her hips or twerk and felt as though someone had glued a rod to her.

Then something happened to make her change her mind about pursuing a diagnosis. After so many failed attempts, she knew she had to seek medical attention once again. The change of heart came when she was lifting her son out of the bath and her back suddenly gave way. She fell forward and smashed her face on the taps.

She realised it was time to look at her spine

It was so preventable, it is so preventable, and I want to make sure other young people don’t wait 15 years before they are diagnosed and, as a result, suffer irreversible damage.”

in more detail.

The devastating news about her axial SpA diagnosis arrived on her 34th birthday. In the 15 years since her first symptoms, the vertebrae in her spine had fused together.

For those 15 years, Talia had felt like she was going mad. “It was the worst time of my life, ever. I was so mentally unwell. I was fragile, scared, constantly knowing there was something wrong but always being told it was all in my head. I’ve reached a stage where I’ve accepted my circumstances but, without the dance, I will always feel like

TALKBACK AXIAL SPA 23

to counter axial SpA

there’s a huge part of me missing. With my diagnosis in hand, I’m now on the right medication and am doing everything I can to make sure the condition doesn’t get worse.”

The dance might have stopped for Talia, but her rich, raw and powerful vocals are as strong as ever and she wants to use her influence to make sure others receive the treatment they need early.

“I’m determined to get young people talking about axial SpA, so they can identify the symptoms early and get help as soon as possible,” she says.

Check if your pain is axial SpA NASS is calling for all adults under 40 who are living with persistent back pain, pain that causes night time waking but eases with movement, to check their symptoms to see if they could have axial SpA. People who think they might have axial SpA should see their GP for a diagnosis. You can check your symptoms at: www.actonaxialspa.com

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