TalkBack, Issue 4 | 2014 (BackCare)

ISSUE 4 bull 2014

NEWS EVENTS COMMUNITY

Lifting techniqueDoes one size fit all

World summitPublic health agenda

Awareness weekGetting the message across

The Charity for Back and Neck Pain

wwwbackcareorguk

FREE TO MEMBERSQuarterly magazine of BackCare the UKrsquos National Back Pain Association

TalkBack

2 TALKBACK EVENTS

ARMA Lecture ldquoMeeting the Challenge of MSK Disordersrdquo 10 DECEMBER

Annual winter lecture of the Arthritis and Musculoskeletal Alliance at the Methodist Central Hall Westminster 530pm given by Lord Hunt Shadow Deputy Leader of the House of Lords Visit wwwarmauknet for more information

BackCare Christmas Carol Concert 15 DECEMBER

Join us at The Queenrsquos Chapel of the Savoy 630pm for a rich tapestry of choral masterpieces by the Tredici Choir Tickets pound18 adults pound5 under-16s Refreshments available Box office wwwbrandenburgorgukchristmas Proceeds go to the charity

ACTIVE Working Summit8 JANUARY

ldquoThe Sedentary Office ndash A Case for Changerdquo at More London Place London (SE1 2AF) First annual conference exploring the health risks of prolonged sitting featuring Dame Carol Black Visit wwwgetbritainstandingorg for details and bookings

British Orthopaedic Association Instructional Course10 ndash 11 JANUARY

Manchester Conference Centre The annual instructional course is a highlight of the BOArsquos training and education calendar featuring a half day focused on the surgical treatment of critical spinal condition More information at wwwboaacuk

Moving amp Handling People27 ndash 28 JANUARY

Human Rights Action Centre London Annual event of seminars and workshops for patient handling professionals More information at wwwmovingandhandlingpeoplecouk

Acupuncture Awareness Week 3 ndash 10 MARCH

Acupuncture is one of the most popular complimentary therapies practised in the UK with 23 million treatments performed each year Supported by the British Acupuncture Council Find out more at wwwintroducingacupuncturecouk

British Chiropractic Associationrsquos Spring Conference7 MARCH

Roxburghe Crowne Plaza Edinburgh For more information and booking contact Michelle Allen on 0118 950 5950 or email enquirieschiropractic-ukcouk

British Association of Spine Surgeons Conference18 ndash 20 MARCH

Bath Assembly Rooms For further information visit wwwcventcomdg4qd6m For sponsorship opportunities contact Julie Archer at BASSarcher-yatescouk for membership and other queries contact Julia Bloomfield at ukssbboaacuk

International Acupuncture Research Symposium21 MARCH

ldquoBridging the Gap between Research and Practicerdquo at Kingrsquos College London (Stand campus) Research and education seminars Visit wwwarrcsymposiumorguk for more information

British Scoliosis Society ndash Annual Meeting21 ndash 23 APRIL

Sheffield City Hall Further details will become available at wwwbritscoliosissocorgukeventsasp

John Bowlby Memorial Conference25 ndash 26 APRIL

ldquoUnlocking Pain ndash Disrupted Attachment and Chronic Physical Painrdquo at the Bowlby Centre London Psychophysiological perspectives from international leaders in the field More information at wwwthebowlbycentreorgukcpd

Stress Illness Recovery Practitioners Associationrsquos Annual Conference26 APRIL

ldquoChronic Pain ndash To Suppress Manage or Curerdquo at the Royal Society of Medicine London Leading international speakers in the field of chronic pain recovery More information at wwwcurepain2015com

BackCare Events Calendar 201415

TALKBACK l ISSUE 4 2014

Dr Who 5

Awareness week 6-7

Approach to lifting 10-11

Around the branches 20-21

Predicting pain 12

Disciplines of practice 14-18

Did you know

The average British adult sits for 9 hours per day ndash double the safe limit

Prolonged sitting is strongly linked to back pain diabetes heart disease and cancerEven regular exercise cannot undo the effect of sitting

Eating[meal times coffee breaks]

Commuting [driving buses trains]

Working[at desk calls meetings]

Leisure[television online gaming]

Reducing your daily sitting by just 1 hour can burn 1kg of fat per month

How many hours do you sit

1 Stand on public transport

2 Park your car further from work

3 Take phone calls standing up

4 Experiment with walking meetings

5 Reduce your television watching

Solutions

Visit wwwgetbritainstandingorgfor sit-stand solutions

Build positive new habits

80 of Scandinavian workers sit-stand at work compared to only

1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by

Sit-Stand amp MOVE wwwbackcareorguk

Contents

3


TALKBACK WELCOME

BackCare16 Elmtree Road TeddingtonMiddlesex TW11 8STTel +44 (0)20 8977 5474Fax +44 (0)20 8943 53318Helpline +44 (0)845 130 2704Email infobackcareorgukWebsite wwwBackCareorgukTwitter TherealBackCareRegistered as the National Back Pain Association charity number 256751TalkBack is designed by Pages Creative wwwpagescreativecouk and printed by Severn Gloucester

We welcome articles from readers but reserve the right to edit submissions

Paid advertisements do not necessarily reflect the views of BackCare Products and services advertised in TalkBack may not be recommended by BackCare Please make your own judgement about whether a product or service can help you Where appropriate consult your doctor Any complaints about advertisements should be sent to the Head of Information and Research

All information in the magazine was believed to be correct at the time of going to press BackCare cannot be responsible for errors or omissions No part of this printed publication may be reproduced stored in a retrieval system or transmitted in any form or by any means without permission of the copyright holder BackCare copyBackCare

Welcome back As another year draws to a close itrsquos time to consolidate all that we have learned in preparation to receive upcoming opportunities If yoursquore a new reader who has picked up this issue at an event or been handed it by a friend we hope yoursquoll discover value in these pages Those interested in becoming subscribers can complete and return the form at the back of the magazine

Since we last convened wersquove had a tremendously successful BackCare Awareness Week The radio day reached around 10 of the UK population and we fulfilled several hundred orders for campaign packs Special thanks to all who participated and to our official sponsors ActiPatch You can read the report on pages 6 and 7

In this issue we bring you news and commentary including news of the first world summit dedicated to musculoskeletal health which took place in October We also report on the research award winners from this yearrsquos Society for Back Pain Research annual meeting (see pages 10-11)

In an attempt to build the BackCare community Irsquove invited several professional member organisations to contribute a page in this issue ndash the hope is that this will kick off a new series of multidisciplinary discussions as TalkBack features Irsquove also invited representatives from the BackCare branches (our national network of member-lead local support groups) to contribute a brief introduction to who they are and what they do ndash again the hope is to establish a regular platform for their perspectives within TalkBack

Regular readers who may be looking for the latest instalment of the ldquoPrevention is better than curerdquo educational series please note that this series is currently on hiatus as I re-examine its founding assumptions What I am consistently finding from feedback is that this series is most valued by readers who are already ldquoon boardrdquo with its content rather than individuals who could most benefit from it So itrsquos back to the drawing board to re-think how to communicate challenging educational context more effectively ndash insight from other educators is more than welcome

As always we do welcome contributions ndash whether you have back pain or treat people with back pain if you can inform and inspire others wersquod love to hear from you Get in touch by email to yourstorybackcareorguk or by letter to the usual address

With Christmas just around the corner Irsquoll wish you all a merry one Take care and Irsquoll see you all in the happy New Year

Welcome

Dr Adam Al-KashiHead of Research

amp Editor of TalkBack

4 TALKBACK NEWS


As wersquore often telling audiences back pain is the leading cause of human disability worldwide Indeed the musculoskeletal health crisis has now escalated to the point of warranting its very own world summit which took place in October

BackCare was there among delegates from 30 countries at the Royal College of Surgeons in London to listen to representations from regional national and international level advisors and keynoters

The summit was held in partnership with ARMA (the Arthritis and Musculoskeletal Alliance) which is the UK lsquoNational Action Networkrsquo of the Bone and Joint Decade ndash an international network of more than 1000 patient professional and scientific organisations The event was co-ordinated with the publication of a new report from Arthritis Research UK called ldquoMusculoskeletal Health ndash A public health approachrdquo which served as a central theme

The essential shift discussed was from treating symptoms medically as they arise to promoting health and preventing

disease on a whole-population scale through organised initiatives and efforts of society

Indeed addressing musculoskeletal conditions through public health affords unique opportunities not otherwise accessible via the primary care route

Letrsquos take a look at a common case ldquoJohnrdquo has acute back pain so he visits his GP who only now detects the psychological states and traits evidenced to predict incident back pain and long-term pain and disability (ldquoyellow flagsrdquo)

Approaching musculoskeletal conditions through public health might mean reaching John and dealing with his subclinical psychological factors long before he ever gets back pain

There was also important recognition that operating ldquoupstreamrdquo to promote

health through united activity would likely be more effective than separate initiatives to prevent specific conditions by tackling their own risk factors

Since psychosocial and lifestyle factors sit upstream of musculoskeletal diagnoses it might mean initiatives to remedy a ldquosick populationrdquo before it generates its

sick individuals While these non-physical factors are often cast off as

optional extras the clinical evidence gives an opposite account As NHS Englandrsquos Dr Martin McShane put it ldquothe soft stuff is the hard stuffrdquo

BackCare has been successful in its bid for Big Lottery funding The financial award will support a vital redevelopment of the charityrsquos website The new site is due for launch in early 2015 and will feature many upgraded features including an ldquoAsk the Expertrdquo forum online membership processing and improved access to educational resources

lsquoRemedy a sick population before it generates its sick individualsrsquo

Lottery win for BackCare

NICK COMMENDED AT BMA AWARDS Congratulations to BackCare professional member and regular TalkBack contributor Nick Sinfield who received a commendation with BackCare at the British Medical Associationrsquos Patient Information Awards in September for his booklet Top 10 Exercises for Back Pain Relief

The annual awards ceremony was established in 1997 to encourage excellence in the

production and dissemination of accessible well-designed and clinically-balanced patient information The Resource of the Year 2014 award went to the Physical Health and Wellbeing Handbook from the South London and Maudsley NHS Foundation Trust which aims to improve physical health in people with mental health problems

The awards were held at BMA House in central London

5


TALKBACK NEWS

What do American radio personality Howard Stern comedian Larry David journalist John Stossel Senator Tom Harkin and professional golfer Ben Crane have in common

They all suffered from debilitating pain until they met Dr John Sarno a now-retired professor of rehabilitation medicine at New York University School of Medicine

Now acclaimed America filmmaker Michael Galinsky is set to release a documentary called All the Rage about the groundbreaking work of Dr Sarno who pioneered a curative approach to chronic pain

Called the ldquobest doctor yoursquove never heard ofrdquo by Forbes Magazine Dr Sarno sold hundreds of thousands of books and is reported to have cured thousands of patients based on the philosophy that the body can heal itself given the

knowledge to do so Ten years in the making Galinskyrsquos documentary is now in post-production and the team is hoping to raise $75000 on crowdfunding platform Kick Starter to fund marketing and distribution

Dr Sarnorsquos ldquomindbodyrdquo or psychophysiological approach is very much consistent with the clinical evidence on back pain Psychological factors remain the most consistently-evidenced predictors of who will develop acute back pain and which of these

cases will become chroniclong-termIn fact a 2005 study from Duke

University which tracked 2332 college students into mid-life showed that psychological factors could predict who would have a chronic pain condition three decades later

Psychological factors play an important role in pain management where they are understood to influence the onset and outcome of back pain often by influencing physical behaviours

This is in considerable contrast to Dr Sarnorsquos approach in which the mind is not only thought to influence pain but to most often cause it and be able to cure it While Dr Sarno is much celebrated by his colleagues and patients he is a controversial figure who evokes strong opposition from many who reject the causal role of psychology in their physical pain condition

The best doctor yoursquove never heard ofhellipDr John Sarno

6 TALKBACK AWARENESS WEEK


Awareness Week is the highlight of the BackCare calendar where we combine national and regional events to spread our message and make a difference We want to help as many people as possible to gain an up-to-date understanding of back pain and what they can do to prevent it treat it and recover from it

We choose a timely theme each year to highlight particular at-risk groups This year it was back pain in office workers Key events included the radio day and the release of a campaign pack These national level activities were complemented by dozens of local community events organised by BackCare supporters

Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by


Spreading the message

The campaign pack sponsored by ActiPatch went on sale a fortnight preceding the awareness week The pack comprised key educational materials including the previous issue of TalkBack dedicated to the awareness week a new booklet presenting the results of the National Back Pain Survey and the new Sit-Stand amp Move poster (pictured) The pack proved very popular with over 500 sold including 50 packs bought by a UK county fire department

Campaign pack bumper sales

Many supporters stepped up to put on events and run special offers during the awareness week which we promoted on the BackCare website Many thanks to all who participated ndash here were some of the highlightsl Mike Dilke from BackApp UK assembled a team of back pain experts for a round table discussion broadcast several times on UK Health Radio (pictured below) He also organised a back pain advice event at the Nuffield Health Gym in Bishoprsquos Stortford l Beryl Kelsey and friends from BackCarersquos Hull and East Riding Branch created a display at their local library and organised an open day as well as walking and aquatic exercise eventsl The British School of Osteopathy in London offered a discount on consultationsl Chiropractors from Uttoxeter Chiropractic Clinic in Staffordshire put on a fundraiser offering free advice and collecting donations for BackCarel Osteopathy Plus in Telford offered free 30-minute back pain consultations

l Dr Arif Soomro (pictured above) from Cliffs Chiropractic Clinic in Essex presented the results of BackCarersquos National Back Pain Survey to the Essex Chambers of Commercel The European School of Osteopathy in Kent offered a discount on consultationsl The British College of Osteopathic Medicine in London offered a discount on consultationsl Spring Active offered free downloads and discounted books

Local events

7TALKBACK AWARENESS WEEK


About BackCareBackCare is the UKrsquos national back pain charity Through our research education and outreach initiatives we are working to turn the tide on back pain There are many ways you can support our work Find out more at wwwBackCareorguk

Potential questions What is the importance of BackCare Awareness Week What did the research reveal How do you think that back pain can be related to work stress How can people effectively manage their back pain Where can we get more information

Top-5 Stats BackCarersquos 2014 National Back Pain Survey reveals some startling statistics1) Half of UK adults have had back pain in the last four weeks 2) Back pain is just as common in your 20s as it is in your 50s and 60s 3) Back pain sufferers are three times more likely to depend regularly on prescription medication for stress4) 80 of people who very often feel frustrated and emotionally exhausted by their work also have back pain 5) Stomach pain chest pain heart palpitations and trouble breathing are all three times more common if you have back pain

Most common disabilityBack pain is now the worldrsquos leading cause of disability with around frac34 billion sufferers worldwide It accounted for more than 15 million lost working days in the UK last year and costs a staggering pound50 million a day in NHS treatments disability benefits and lost productivity

BackCare Awareness Week is 6-12 October Run by BackCare ndash the national back pain charity ndash the aim of the week is to get everybody up-to-date on back pain This yearrsquos particular focus is back pain in office workers

Back in the OfficeMost people of working age spend most of their waking lives at work Indeed work constitutes a major part of life and can have a major impact on health for better or worse

Overwhelming evidence tells us that psychological factors most consistently predict who will develop back pain ndash stress simply causes the body to behave more symptomatically

Station Area Listener reach

Radio 1035 London 53000

UCB National 250000

Sunrise Radio Yorkshire 350000

BCB Radio Bradford 18000

BBC West Midlands West Midlands 240000

BBC Coventry amp Warwickshire Coventry amp Warwickshire 85000

BBC Jersey Jersey 21000

BBC Wales Wales 438000

BBC Guernsey Guernsey 21000

BBC Cambridge Cambridge 119000

BBC Cornwall Cornwall 154000

BBC Shropshire Shropshire 116000

BBC Newcastle Newcastle 278000

BBC Northampton Northampton 89000

BBC Merseyside Merseyside 344000

BBC Stoke Stoke 156000

BBC Hereford amp Worcester Hereford amp Worcester 102000

BBC Lancashire Lancashire 212000

BBC Oxford Oxford 79000

Lincs Group Lincolnshire 648000

Magic 1161 Hull 59000

Downtown Radio Ireland 318000

964 Eagle Surrey 145000

Mix 96 Buckinghamshire 39000

964 The Wave Wales 188000

1076 Juice Liverpool Liverpool 241000

BFBS National 540000

Pirate FM Cornwall 178000

Heart Wales Wales 491000

Gen 106 East Midlands 404000

Radio day cue sheet

The radio day sponsored by Pfizer took place at the start of the week The goal was to report on the findings of BackCare latest research (The National Back Pain Survey 2014) and to get people talking about back pain Through interviews on two national stations 20 regionals and nine locals we were able to reach more than SIX MILLION listeners around 10 of the UK population (see table below)But what did we tell them Take a look at the official radio cue sheet (left) upon which the interviews were based

Interviews on air

8


TALKBACK ADVERTORIAL

YourPhysioPlanrsquos sole aim is to put more patients requiring treatment in touch with physiotherapy professionals Once achieved YourPhysioPlancom members gain quality of life accessibility and reassurance through delivery of the following benefitsl Easy access to high-quality

physiotherapy treatment on an affordable plan to maintain optimum health and help overcome injury and illness through treatment massage strength and conditioning

l Premium standards of care all YourPhysioPlancom physiotherapists will be required to have obtained or be working towards the Diploma in Orthopaedic Medicine a benchmark postgraduate qualification run by the Society for Musculoskeletal Medicine The YourPhysioPlancom brand provides reassurance that clinic practitioners undertake continual professional development and meet high standards for customer care

l Choice of plans to suit different needs and budgets ability to use 100 of their entitlement

l Prevention unique access to a health professional before an illness or disorder occurs

l Improved quality of life YourPhysioPlancom encourages members to establish an ongoing relationship with their practitioner for regular monitoring and early intervention

l Unrivalled offering ndash the only UK physiotherapy payment plan that does not require an excess or a referral and that also covers you for pre-existing conditions

l Control of their health care members choose their treatment and their clinic

l Away from home care the ability to see a practitioner even when members are away from home

l Preferential member rates on additional specialist treatment for example MRI scans

l Membersrsquo web-based application to help members find out if physiotherapy can be of help to them find their nearest YourPhysioPlancom clinic quickly access expert advice and access a wealth of quality health information Easy to navigate with state-of-the-art interfaces

The knock-on effect of people suffering musculoskeletal problems especially back pain is not inconsiderable

A proactive approach to managing aches and pains is being actively encouraged across the health sector YourPhysioPlancom has arrived at just the right time and dovetails completely with this approach Its focus is to give easy and regular access to preventative therapy rather than the costly unpredictable and often painful option of curing a deeply ingrained injury

The world of healthcare let alone physiotherapy is changing fast with increased costs tighter budgets technological advances shifting service provision and a much more discerning client baseYourPhysioPlancom has responded by delivering a new innovative and much-needed health service for the UK population To put it simply they provide access to high-quality and affordable private physiotherapy through payment plans Their members are in control of their healthcare with freedom to choose their clinic and their treatment YourPhysioPlancom avoids delay in receiving treatment by having no waiting lists no need for GP referrals and no excess payments as well as covering all pre-existing conditions YourPhysioPlancom is the only company in the UK offering inclusive Health and Wellbeing plans YourPhysioPlancom brings physiotherapy direct to the public in an affordable and accessible way while simultaneously meeting a fast-growing need created by rapidly shrinking NHS physiotherapy budgets

Affordable and accessiblehellip

9


9

Physiotherapy has long been recognised as a medical treatment that works with people to optimise their health It delivers wellbeing and quality of life by identifying and maximising a patientrsquos ability to move and function ndash a key part of what it means to be healthy Physiotherapists are medically trained healthcare professionals whol have real-life experience across a range of spectrums and

can manage all acute and long-term conditionsl proactively maintain optimum health preventing disease and

strengthening and conditioning the body for optimum quality of life

l manage pain facilitate recovering from injuryl manage chronic conditions and disability l are proven to reduce the number of sick days taken l resolve most acute injuries within six sessions

l It has been reported that as many as 84 of the population will suffer from back pain at some point in their life

l In 2012 the prevalence of chronic back pain (back pain lasting more than 12 weeks) was 23 of the population and 11 of the population were disabled by low back pain The 2010 Global Burden of Disease Study identifies back pain as the worldrsquos leading cause of disability

l The 2014 Labour Force Survey estimates 28 million working days were lost in 201314 due to back disorders

l 2012 NICE Guidelines state that only 20 of back pain sufferers will consult their GP about it

The impact of this is not lost on the co-founder of YourPhysioPlancom Denise Kesson (left) who says ldquoWe have to start thinking of our

bodies as mechanical and stop taking them for granted For example to get more mileage out of our car we regularly service it and take it to the mechanic when it first shows a warning lightrdquo

As such Denise recommends those without current issues form a relationship with their local physiotherapist and undergo an annual MOT If you already have an existing complaint you are likely to benefit hugely from regular contact with your local physiotherapist

YourPhysioPlancom makes this access easier by offering a plan to suit everyone see below

YourPhysioPlancomrsquos timing is perfect Traditional service providers such as the NHS are overspending hugely and unsustainably on musculoskeletal services leading to physiotherapy increasingly becoming ldquorationedrdquo and access made more difficult

In addition outpatient physiotherapy budgets are being cut and many trusts will not be able to afford to provide physiotherapy services in the future

The obvious implication of this is that all those who could benefit from physiotherapy will have to look to recommended private providers such as YourPhysioPlancom member clinics

ldquoYourPhysioPlancom has joined forces with BackCare to support those with back pain We are developing a Back Pain Plan that will enable members to access regular hands-on expert physiotherapy and receive the invaluable support of BackCarerdquo

For those who are already members of BackCare YourPhysioPlancom is offering members their first monthrsquos membership free Enter the code ypp50ff when signing up through wwwyourphysioplancom The offer lasts until January 31 2015


Your Basics pound290 per month This entry level Health and Wellbeing plan provides you with an annual MOT at a YourPhysioPlan accredited clinic providing outstanding benefits value for money and peace of mind

Your Essentials pound1850 per month You get six lessons to use at a YourPhysioPlan accredited clinic throughout the year which ensures a cost effective aid to fast recovery from an acute injury or flare up or you can use the session for regular massages if you are not injured

Your Inclusive pound6000 per month An inclusive level Health and Wellbeing plan that gives you two sessions a month for physio or massage at a YourPhysioPlan accredited clinic

Your Elite pound7000 per month You receive two sessions a month at any of YourPhysioPlanrsquos accredited clinics No matter where you are you can be assured you can access excellent and consistent treatment or massage Perfect for commuters

All YourPhysioPlancom plans provide the member with 247 physio support from our ldquoPhysio in your Pocketrdquo app and 10 off treatment prices if additional sessions are needed to be purchased outside the memberrsquos entitlement

10


TALKBACK RESEARCH

Lifting ndash one size doesnrsquot fit allAnastasia Pavlova lead author of the paper from the University of Aberdeen said ldquoThe bones making up our lower back ndash the lumbar spine ndash form an inward curve that makes the hollow of our back and some of us are more curvy than others

ldquoWhat we showed was that the curve of our lower backs is specific to each individual a bit like a fingerprint Interestingly this affects the way we lift objects from the floor so that those with lsquocurvyrsquo spines tend to bend over or stoop to lift a box whereas those with straighter spines tend to bend their knees and squatrdquo

The research team which also included Dr Judith R Meakin from the University of Exeter Dr Kay Cooper from Robert Gordon University and Dr Rebecca J Barr and Professor Richard M Aspden from the University of Aberdeen studied pain-free volunteers aged between 18 and 65

Images were taken of their spines using a magnetic resonance imager (MRI) in six postures ranging from leaning backwards to bending forwards as if to touch their toes A special computer method called ldquoshape modellingrdquo was used on each of

their images to describe the shape of their lumbar spine whether curvy or straight

The volunteers then attended a motion analysis laboratory where special cameras were used to video them while they lifted a box with weights inside it from the floor in the way they found most comfortable A weight that was ldquomoderately heavyrdquo was chosen by each person and these varied from six to 15kg Researchers then compared how people with different spine shapes moved when lifting the box

Professor Aspden added ldquoOur research showed that not only is the curve of our lower back specific to each individual it also affects the way we lift objects from the floor The degree to which spines were curvy or straight correlated with whether the volunteers stooped or squatted to lift

the objects from the floorldquoWersquore clearly not all the same so should

guidelines be telling us to lift in the same way Giving more attention to our individual spine shape could allow these guidelines to be better tailored to individualsrdquo

ldquoBack pain is costly to the NHS and employers It is common in manual occupations involving lifting and it can be devastating for the patient when they are no longer capable of performing their job Understanding the mechanisms behind occupational back pain can allow for more appropriate prevention strategiesrdquo

Dr Adam Al-Kashi Head of Research and Education for the charity BackCare said ldquoWe are all unique yet we are all human and somewhere in between we hope to strike a clinically-relevant balance

ldquoBend your knees and keep your back straightrdquo is the mantra for lifting heavy objects but new research led by University of Aberdeen academics suggests this approach may not work for everyone when it comes

to back care Their work which has just won the best paper at the annual meeting of the Society for Back Pain Research reveals that the shape of our spines alters the way in which we can lift safely The finding means that guidelines may work more successfully if tailored to suit individual shapes rather than a ldquoone size fits allrdquo approachhellip

The degree to which spines were curvy or

straight correlated with whether the

volunteers stooped or squatted to lift

the objects from the floor

11


TALKBACK RESEARCH

In 2012 Dr Jos Verbeek and colleagues from the Finnish Institute of Occupational Health published a Cochrane systematic review entitled ldquoProper manual handling techniques to prevent low back painrdquo in the journal Work

The abstract begins ldquoTraining and provision of assistive devices are considered major interventions to prevent and treat low back pain among workers exposed to manual material handlingrdquo

They reviewed 18 trials involving more than 21000 workers And the result ldquoNone of the included trials provided evidence that training and provision of assistive devices prevented low back pain when compared to no intervention or another interventionrdquo

These results would appear to suggest that if ldquoproperrdquo lifting techniques can prevent back pain one size certainly does not fit all and what may be best practice for one person may hold no advantage for their colleagues attending the same manual handling training

Evidence in growing support of a tailored approach to preventative training perhaps parallels the clinical transition from authoritarianone-size doctoring to the current standard of patient-centred care It may also parallel the compelling body of evidence showing that it is individualpersonal factors rather than fixed external factors that most powerfully predict and determine who will develop back pain and indeed who will not recover

We can think of lifting technique as covering the transition between postures

under load in order to segue usefully from an ergonomistrsquos biomechanical perspective of manual handling into an Alexander Technique (AT) teacherrsquos psychophysical perspective of poise and performance

In 2011 AT teacher and researcher Mireia Griso led a search for AT in the workplace Her research funded by the Foundation for the Prevention of Occupational Risk in Spain explored international precedents where AT was being applied for the prevention of workplace musculoskeletal disorders (see pages 18-19 TalkBack Issue 3 2014) In contrast to Verbeekrsquos 2012 Cochrane review Griso found that AT in the workplace setting afforded significant physical psychosocial and business level benefits

Physical benefits included reduced pain and disability improved muscle tone postural co-ordination and balance and significantly less muscle activation during both generic and specialised movements

Psychological benefits included stress management and improvements in self-esteem public speaking creativity concentration teamworking and the work environment

Business benefits included reduced work hours lost to illness reduced accidents reduced employment insurance improved costs-profits relationship and improved work performance

A third perspective worth visiting briefly might be that of the powerlifting athlete Their business is simple ndash to become as strong as possible at performing three

movements the deadlift (bending to lift a load off the ground) the squat (squatting and returning to standing with a load poised on the back of the neck) and the benchpress (lowering the load from out-locked arms to chest and pressing it back up while lying flat)

Having acquired a deep appreciation for their own unique body the athlete will choose variations on a given movement to provide them with a competitive advantage for example based on factors such as limb length ratios which govern leverages

The ldquoproperrdquo technique is an individual choice from a number of variants made to enhance performance This movement will then be trained under conditions of progressive overloading to learn the motor pattern and get stronger This template of training and performance combines universal principles (eg progressive overloading) with choices based on individual factors (eg movement variation selection)

Seemingly contrary perspectives and evidences cannot be ignored not least because they are the very means through which we evolve any field of applied knowledge to tie the loose ends and render a more robust model To reiterate my above quote in closing we are all unique yet we are all human and somewhere in between we hope to strike a clinically-relevant balance By challenging some popular myths about posture and lifting this work serves to shift that balance towards a more tailored approach

Editorrsquos commentary

By challenging some popular myths about posture and lifting this work serves to shift that balance towards a more tailored approachrdquo

The academic abstract titled ldquoIntrinsic shape of the lumbar spine and its effect on lifting manoeuvresrdquo was published in The Bone amp Joint Journal Orthopaedic Proceedings and can be viewed online at wwwbjjprocsboneandjointorgukcontent96-BSUPP_417abstract

It was awarded best paper at the annual meeting of the Society for Back Pain Research supported by BackCare

Anastasia Pavlova was supported by a PhD studentship donated by Roemex Ltd to the Aberdeen Centre of the Oliver Bird Rheumatism Programme at the Nuffield Foundation The University of Aberdeenrsquos Anastasia Pavlova centre with the award

12


TALKBACK EDUCATION

Five common patterns that predict your back pain future

How you feel about pain

predicts your chances

of making a speedy recovery

1) ldquoItrsquos not really safe for a person with a condition like mine to be physically activerdquoBack pain itself is not harmful The belief that back pain is harmful or that it indicates damage or further injury often causes people to avoid physical activities for fear theyrsquoll make things worse In fact this kind of fear avoidance behaviour (kinesiophobia) predicts long-term pain and disability A tailored programme of Cognitive Behavioural Therapy (CBT) which reduces fear and changes pain beliefs has been shown to increase the back pain recovery rate

2) ldquoWorrying thoughts have been going through my head a lot of the timerdquoStress tension and anxiety make you more likely to develop back pain and less likely to recover so theyrsquore really central to effective back pain prevention and treatment The trouble is that stress is often invisible or becomes accepted as a normal part of our hectic lifestyles Patients are naturally uncomfortable with the idea that stress is making their health worse but often donrsquot realise that it makes all the difference Talking therapies or self-help practices can be used whenever stress or anxiety are identified

3) ldquoI feel that my back pain is terrible and itrsquos never going to get any betterrdquoAssuming the worst (catastrophising) and repetitive thinking (ruminating) predicts long-term pain and disability CBT can be used to tackle these negative thought patterns The basic approach involves techniques to become more aware about your mental activity learn to halt

runaway thoughts and cultivate new positive thought patterns These kinds of techniques have been shown to be effective but do require motivation and engagement

4) ldquoIn general I have not enjoyed the things that I used to enjoyrdquoWhen back pain takes over it can become impossible to enjoy life Unfortunately struggling to cope with pain and disability (lower self-efficacy) is known to affect stress hormones and other systems in the body and ultimately predicts poor chances of recovery Again while the way people think and feel is commonly assumed to be a fixed part of their personality evidence shows that CBT is an effective approach to increasing self-efficacy

5) ldquoOverall my back pain has been very bothersome in the last two weeksrdquoThe more you are bothered or troubled or burdened by pain the longer it will take to recover This does not mean you should ignore pain and suffer in silence but research shows that how you feel about the pain predicts your chances of making a speedy recovery BackCarersquos own research has shown that it also predicts whether yoursquoll have other physical symptoms ndash compared to people who are ldquobothered a littlerdquo by their back pain people who report being ldquobothered a lotrdquo are around 50 more likely to also have stomach pain and chest pain Again burden is a function of coping and approaches such as CBT are recommended

Most episodes of back pain get better quickly and without needing treatment Unfortunately for more than two million UK adults each year the pain doesnrsquot go away Now growing evidence suggests that the way you think and feel can accurately predict whether or not yoursquoll recover from back painhellip

But how can psychology predict pain Put simply feeling stressed or anxious increases our stress hormone levels making the body more symptomatic over time And old-fashioned thinking about back pain can lead us to make bad health decisions that can block recoveryThe evidence is so strong that GPs and physiotherapists look for these barriers to

recovery (Yellow Flags) in order to best help those at high risk of developing long-term back pain Early identification and management of psychological risk factors has been found to be effective at preventing long-term back pain If you already have back pain and strongly agree with four out of these five statements you are at high risk of developing chronic back pain

13


Prolonged sitting in the workplace is a hot topic at the moment and studies are revealing that the sedentary lifestyle can lead to serious health issues such as diabetes obesity heart disease and cancer

What isnrsquot being focused on as much and something that affects a big percentage of the population is the effect that sitting all day can do to your posture Sitting at a workstation even when set up correctly (which a lot are not) can lead to neck and back pain A simple solution is to install a sit to stand adjustable desk which will allow the user to go from sitting to standing within seconds It will also allow the monitor to be positioned at the correct eye level and keyboard tray at the right height minimising any stoop or bad posture

Back pain is not only physically debilitating to its sufferers it is also damaging to the economy According to the Work Foundation it costs the EU (the UK included) a staggering euro240bn (pound200bn) a year As part of musculoskeletal conditions a range of bone and joint ailments itrsquos responsible for lengthier absenteeism from work than other illnesses

Among those advocating back pain awareness the director of the Centre for Workforce Effectiveness at the Work Foundation Professor Steve Bevan explains how sitting has become a major cause of illness in the office Sitting is the new smoke is now a proverbial statement and it has its foundations in years of research The sad fact however is that those who suffer from back pain as a result of sitting might be relieved of their ailment later on but there is still a danger of it becoming a long-term condition as a result of their persistent sedentary lifestyle

To create awareness around back

pain in the UK VARIDESK together with BackCare has launched the Stand Up to Back Pain Awareness Campaign VARIDESK is a sit to stand solution that sits on top of your existing desk Mike Mayos one of the companyrsquos directors said ldquoYoursquove seen the figures Back and neck pain is seriously hurting lives and damaging the economy

ldquoWersquove launched the campaign to try to create awareness around the condition get more people involved and ultimately help everyone out of their chairs and become more active Itrsquos our vision to get people standing and we want to help everyone avoid or treat back pain effectivelyrdquo


Stand Up to Back Painamp

A partnership between wwwbackcareorguk and wwwvarideskcouk

To launch the partnership between VARIDESK and BackCare VARIDESK is giving 10 winners a free sitstand desk and visit to an osteopath

Entrants need to nominate someone they think would benefit from the free sit to stand workstation and osteopath session Visit wwwstanduptobackpaincouk to complete your entry

All you have to do is let VARIDESK know why the person you are nominating deserves the desk and osteopath session in 200 words or less It could bel your hardworking spouse or parent whorsquos been suffering from unbearable

back problems l a teacher who puts their back into it both in class and on the sports field and is

feeling the strainl an inspirational friend who is always hands on doing voluntary work for the

community and those in needEntries will be mediated by a panel of BackCare judges who will pick the 10

most inspirational stories and send the winners a VARIDESK and free time with an osteopath Whatrsquos more VARIDESK has pledged to donate pound2 for every desk it sells with the proceeds going to BackCare efforts Mike Mayos said ldquoWe want to give as much to the community as we can encourage a healthier more productive lifestyle and build values everyone can connect with Itrsquos an exciting time for us right nowrdquo

The competition is open now the first five winners will be announced on 23 December and a further five on 31 January 2015 l For more information contact VARIDESK on salesvarideskcouk or +44 20 7193 1197

WIN a free sitstand desk and osteopath visit

Back and neck pain affects 60 to 80

of adults at some point in their lives

14


TALKBACK PARTNERS

More than a dozen therapeutic disciplines are represented among BackCarersquos own professional members ndash including acupuncturists Alexander Technique teachers chiropractors physiotherapists Pilates instructors psychological therapists surgeons and yoga teachers

As a patient seeking medical care itrsquos important to gain some understanding of the different approaches available as they each offer their own unique perspectives evidences and outcomes

As a practitioner it can be useful to touch base with other communities of practice to gain deeper clarity through comparative study ndash often the most powerful evidences are the ones that serve to question our own current outlook Interestingly there are also typically multiple sub-schools of thought within each discipline of practice and these are often represented by distinct organisations

The NICE clinical guidelines on the management of non-specific low back pain (CG88) were published in May 2009 and are due for revision republication in November 2016

The current version outlines recommendations for the treatment of low back pain in adults that has lasted between six weeks and 12 months and is not the result of cancer fracture infection auto-immune disease or red flag conditions such as cauda equina syndrome Among the current recommendations are acupuncture and manual therapiesIn this issue we have invited four professional member organisations representing acupuncture and manual therapies to present something from their perspective the Institute of Osteopathy (formerly the British Osteopathic Association on the page opposite) the British Acupuncture Council (p16) the British Medical Acupuncture Society (p17) and the British Chiropractic Association (p18)

DISCIPLINES OF PRACTICE


TALKBACK PARTNERS 15

The Institute of Osteopathy

To find out more about osteopathy and locate your nearest osteopath visit wwwosteopathyorg The Institute of Osteopathy (iO) is the professional body for registered osteopaths in the UK 1) wwwosteopathyorguk

2) httpwwwniceorgukguidancecg88chapterguidance3) Carnes D et al ndash 2009 Adverse events in manual therapy a systematic review httpbitly11yes6Z4) iO osteopathic census 2014

Eleven things you may not know about osteopathy

1) Osteopaths donrsquot just treat backsThey take a whole body approach to your health and treat a wide range of conditions They use manual therapy which includes massage mobilisation stretching muscles and relieving tension in the body to help create the conditions your body needs to heal An osteopath may also be able to identify whether a pain in one part of your body is caused by a problem somewhere else

7) Itrsquos approved by the NHSNICE guidelines2 recommend manual therapy provided by an osteopath for treatment of low back pain and there are an increasing number of osteopaths employed by the NHS to provide musculoskeletal treatment to patients

10) You donrsquot need a referral from your GPIf you are paying for your own treatment you can make an appointment with an osteopath without the need for a referral from your doctor Osteopaths are primary healthcare professionals which means that because of their knowledge and the way they take a comprehensive medical history when assessing your health they can provide treatment to most patients without the need for information from your doctor

2) They are qualified to degree level and aboveTo qualify as an osteopath they must study for at least four years learning about anatomy physiology pharmacology pathology nutrition psychology and medical imaging as well as osteopathic technique Osteopaths must by law continue their training after they graduate to keep up to date Many osteopaths will achieve further qualifications to specialise in treating specific patient groups or conditions

3) Itrsquos very gentleAlthough some manipulation techniques may occasionally result in an audible click most people find osteopathy gentle and painless Because osteopaths take a full medical history and complete a thorough examination before starting treatment they can ensure they use the most appropriate and safe techniques for each patient

4) They are regulatedOsteopaths are regulated by the General Osteopathic Council1 (GOsC) which works to ensure that high standards of care and patient safety are maintained In the UK it is illegal for anyone to call themselves an osteopath if they are not registered with the GOsC

8) Osteopaths can work with your GP or other health professionalsOsteopathy can complement the treatment you receive from other health professionals including your GP With your permission your osteopath can share their notes about your condition and the treatment they have provided with other people involved in your care to ensure that you get the best possible treatment They are also able to interpret test results scans and x-rays that may inform their diagnosis and treatment of your condition

5) It has an excellent safety recordSerious adverse effects as a result of osteopathic treatment are very rare between one and two patients in 100000 will experience a major adverse event as a result of osteopathic manipulation3Osteopaths take special care to check patients before treatment for existing conditions or symptoms that may indicate it might not be appropriate to treat a patient

9) They can refer you for further investigations or treatmentOsteopaths canrsquot treat every condition but are educated in who might be better able to They can refer you to a more appropriate health professional and prepare a report on your symptoms and the treatment they provided If you prefer you can ask for a copy of your notes to take back to your GP or show to someone else who is treating you

11) Itrsquos not as expensive as you might thinkThe average fee4 for an initial consultation is pound48 and subsequent appointments average at pound42 Most osteopaths provide some treatment during your first appointment and will discuss how many further appointments you are likely to need

6) You wonrsquot have to waitIf you are self-referring you can usually get an appointment to see an osteopath within 48 hours Early intervention can promote faster recovery and get you back to health quickly

16


BAcC brand with a top right corner crop markOn your artwork please ensure you align our brand

with your top right corner crop mark

TALKBACK PARTNERS


British Acupuncture Council

Unique system can play its part on road to recoveryAcupuncture has come a long way from the days when it was perceived as a cranky alternative ndash many orthodox healthcare professionals like doctors and physiotherapists regularly use acupuncture within their own work

However traditional acupuncturists trained to degree level and drawing on the 2500-year history of Chinese medicine provide the great majority of professionals who practise full time Of these the British Acupuncture Council (BAcC) represents the largest number with more than 3000 members

Formed in 1995 from five associations which were themselves created as early as the 1960s the BAcCrsquos primary aim is to protect the public interest even above looking after its membersrsquo interests

So successful has it been in setting exemplary standards that it was one of the first two professional bodies to be accredited by the Professional Standards Authority under its Assured Voluntary Register scheme Anyone being treated by a BAcC member can be certain that the treatment is safe and effective that the practitioner is personally accountable for their standards and has ldquogold standardrdquo professional indemnity insurance and that the BAcC is there to provide support information and redress if any is needed

Acupuncture treatment is a great deal more than simply sticking needles in where it hurts Traditional Chinese medicine was more concerned to see symptoms in the wider context of someonersquos overall patterns of health

When the great Canadian physician William Osler said ldquoIt is much more important to know what sort of person has a disease than what sort of disease a patient hasrdquo he could have been describing the diagnostic processes of Chinese medicine

Practitioners take a detailed case history covering all aspects of the patientrsquos health and use a number of techniques ndash Eastern like taking the pulse and looking at the tongue and Western like taking blood

pressure ndash to form a view of the most elegant and simple way to begin to restore balance in the system It is not a truism to say each person is unique and different 20 people presenting with the same symptom might well be treated in 20 different ways

Treatment involves the insertion of single-use ultra-fine needles into the skin Treatment is usually given once weekly for four or five weeks and most practitioners will review progress at this point or even before this

Our surveys show that treatment of lower back pain is among the more frequent reasons for people to visit a traditional acupuncturist The evidence for its use is good enough for NICE (the National Institute for Clinical Excellence) to have included it within the recommendations for chronic low back pain migraines and tension-type headaches and we find more and more healthcare professionals working in concert with our members to ensure

joined-up treatment In ancient times the Chinese doctor

was paid to keep you well not to get you better Going to the doctor when you were already sick was they said like forging a spear after the battle had started or digging a well when you were already thirsty This message is gradually getting through We used to say get better and stay well Now the message is stay well and get better

Back pain is so common that it sometimes gets less acknowledgement than it should ldquoOh everybody gets that from time to timerdquo they say but as we know only too well it can be a source of great misery and despair We are grateful we have a unique system of medicine which can play its part on the road to recovery

To find more details or to find a registered practitioner in your area visit wwwacupunctureorguk or call 020 8735 0400

17




TALKBACK PARTNERS


British Medical Acupuncture Society

Ancient knowledge still relevant in 21st centuryAcupuncture has probably been around almost as long as back pain has

When the 5000-year-old mummified body of a man was found in the AustrianItalian Alps in the 1990s scientists noticed marks tattooed into his skin at a number of points where an acupuncturist now might choose to needle a patient for low back pain and knee pain (pictured right)

Just as we might instinctively press or rub that sore or tight place in our aching back Oumltzi the Iceman seems to have markings on his skin at points where needling or pressure could have given him relief from his pain

But a 21st century patient might wonder whether a treatment as old as Oumltzi the Iceman can really be useful in the modern world

Researchers have shown that acupuncture can indeed affect the central nervous system modulating how pain is experienced by the individual patient as well as in other ways such as helping to release painfully tight muscles We are starting to understand just how acupuncture works in the context of the anatomy and physiology we know today

The British Medical Acupuncture Society (BMAS) was formed more than 30 years ago by a group of doctors who recognised the potential of acupuncture within contemporary medicine and wanted to promote education and research into its mechanisms

Today membership of BMAS is open to a range of healthcare professionals

You might find your GP can offer acupuncture for your back pain but he or she might refer you to a physiotherapist who can incorporate it into their treatment for your back If your pain is more intractable you might be referred to a pain clinic and receive acupuncture from a nurse as part of your care there

Acupuncture is increasingly accepted in mainstream healthcare and NICE guidelines currently include acupuncture as one option for the treatment of low back pain

So you think you might like to try acupuncture NICE guidelines advise a course of up to 10 treatments for low back pain and it is worth persevering if you donrsquot get instant results at the first session Most patients notice an improvement within six sessions if acupuncture is going to be of benefit As with most medical treatments there are some patients who just donrsquot respond or donrsquot get on with acupuncture But for those who do and for their acupuncturist the results can be very rewarding

Acupuncture needles are sterile single-use needles They are very fine and much less traumatic than needles used for giving injections or taking blood Treatment might involve inserting as few as one or two needles but could be 10 or more dependent upon the nature of the pain Needles are usually inserted as close to the pain or source of pain as possible but often treatment will also include needling of the limbs which can add to the effect Needles are usually left in for a few minutes and sometimes stimulated to increase the benefit either manually or by applying an electrical current between pairs of needles

Any side effects are usually short-term and might include very slight bleeding or bruising sedation or occasionally fainting

Your acupuncturist should take extra care if needling the upper back or chest area to avoid the needle entering your lung

If you receive acupuncture treatment within the NHS it will be provided by a regulated health professional who is bound by a code of practice to needle safely Where acupuncture is offered privately you are advised to check that the practitioner is registered with an organisation which regulates its members

The larger organisations in the UK are the British Medical Acupuncture Society the Acupuncture Association of Chartered Physiotherapists and the British Acupuncture Council all of which have websites with a search option to help you find a practitioner near you

The British Medical Acupuncture Society offers training in medical acupuncture for regulated health professionals

Allyson BrownBMAS London Office

bmaslondonaolcom

USEFUL WEB ADDRESSESBritish Medical Acupuncture Society wwwmedical-acupuncturecoukAcupuncture Association of Chartered Physiotherapists wwwaacporguk

18


TALKBACK PARTNERS


British Chiropractic Association

Chiropractors ndash the spinal care expertsThe British Chiropractic Association which celebrates its 90th anniversary in 2015 is Europersquos largest national chiropractic association

With nearly 1400 members the BCA represents over half of the UKrsquos practising chiropractors It is a key stakeholder within European chiropractic and is regularly consulted on issues affecting the profession The Associationrsquos mission is to support its members and promote the profession as spinal care experts

Chiropractic is a registered primary healthcare profession Chiropractors are trained to diagnose treat manage and prevent disorders of the musculoskeletal system (bones joints and muscles) they have a specialist interest in neck and back pain Chiropractors use a range of techniques to reduce pain improve function and increase mobility including hands-on manipulation of the spine

Far from being considered as a complementary or alternative medicine chiropractic is now respected as a mainstream healthcare profession providing expert spinal care

The evidence supporting chiropractic statutory regulation and a university level Masters level education all ensure the public is protected and that todayrsquos

chiropractors are trained to the highest standards

The recommendation of spinal manipulation for persistent low back pain in the 2009 NICE guidelines and the recommendations of the BEAM (back pain exercise and manipulation) trial suggest that not only is the provision of chiropractic care clinically indicated for back pain it is a cost-effective intervention for a condition estimated to cost the UK pound5bn each year

A study conducted by the North East Essex PCT offered patients a choice of providers of chiropractic physiotherapy or osteopathy prompt access to care and easier access With appointments provided within two weeks and up to four sessions of treatment the results of the pilot study were staggering Analysis of the 2810 patients taking part revealed reduced costs fewer inappropriate referrals and improved outcomes Most significantly referrals to spinal surgeons were reduced by more than 25 per cent

In 2012 for the first time in Olympic history chiropractic was offered as a service within the polyclinic at the London 2012 Games This and the inclusion of chiropractic within multidisciplinary care teams of many athletes and professional teams illustrates the positive impact

of chiropractic within elite sport both on athletic performance and injury management

Modern chiropractors embrace the concept of interprofessional collaboration and teamwork Many work within GP practices or closely with GP colleagues in local communities Increasingly recognised for their expertise in spinal management in general and manipulation in particular chiropractors are now called upon to provide input in both acute and chronic back pain cases

At the first visit a chiropractor carries out a thorough assessment and asks the patient about their current condition medical history and overall health They will then carry out a physical examination and perform a range of tests If the chiropractor is unable to help or feels that some other treatment would be more beneficial the patient will be referred to a GP or to another appropriate healthcare professional Further investigations may be indicated and the chiropractor will explain why they are necessary

The chiropractor will then explain what is wrong and discuss a care plan which will set out what can be expected when receiving chiropractic care Chiropractors will provide a package of care for their patients and this can include manipulation ndash where the chiropractor uses their hands to apply quick precise thrusts to the restricted joints of the spine ndash as well as massage stretching electrotherapy and the gradual moving of joints (ldquomobilisationrdquo) Some chiropractors use medical acupuncture techniques Self-help advice and rehabilitative care form an important part of chiropractic treatment and patients are given advice on how to manage the condition and prevent it from recurring

Patients want and deserve choice in the treatment of their back pain The availability of more trusted and safe treatment options can only serve to meet that need and start to make significant steps forward in the successful treatment of this prevalent and debilitating problem

19


ThirstyThirst

is a poor test for

dehydration

Even mild dehydration puts stress on the body

Dehydration increases

pain anxiety and fatigue

Aim for five clear urinations

per dayYou may

need to drink more than

yoursquore used to

Use a bottle to

build positive habits easily

20


TALKBACK BRANCHES

CAMBRIDGE bull 56 membersContact Ms Mary GriffithsTelephone 07787 990214Email blincomaryhotmailcouk

SOUTHAMPTON bull 32 membersContact Mrs Irene BowronTelephone 01794 340256Email irenemacgregors-shadeplantscouk

DERBY bull 61 membersContact Mrs Christine SissonsTelephone 01332 763636Email chrississonsbtinternetcom

WEST LONDON bull 15 membersContact Mrs Teresa SawickaTelephone 020 8997 4848Email tere_ssyahoocouk

HARROGATE amp DISTRICT bull 32 membersContact Mrs Lin TippeyTelephone 01423 865946Email keithandlin2btinternetcom

WEST MIDLANDS bull 11 membersContact Mrs Thelma PearsonTelephone 01902 783537

HULL amp EAST RIDING bull 90 membersContact Mrs Beryl KelseyTelephone 01482 353547Email kelsey59kelsey59karoocouk

WINCHESTER bull 39 membersContact Ms Gillian RoweTelephone 023 8025 2626Email gillianmrowehotmailcom

POOLE amp BOURNEMOUTH bull 5 membersContact Mrs Patricia BowmanTelephone 01202 710308Email patriciabowmanntlworldcom

LOTHIAN (SCOTLAND) bull 66 membersContact Mrs Jean HoustonTelephone 0131 441 3611 Email jeanhoustonblueyondercouk

READING bull 24 membersContact Mr David LairdTelephone 0118 947 0709Email davidlairdtalktalknet

SWANSEA (WALES) bull 56 membersContact Ms Gloria MorganTelephone 01792 208290Email gloriamorgantalktalknet

SALISBURY bull 122 membersContact Mrs Barbara WhiteTelephone 01722 333925Email whitealanbtinternetcom

The BackCare branches are a network of local support groups up and down the country They are run by local members who organise educational social and fundraising events You can find your local branch in the listing right

If yoursquod like to start a branch in your area please contact infobackcareorguk

BACKCARE BRANCHES

Reading BranchReading branch of Back Care was formed some years ago and originally met at the Battle Hospital hydro pool Since it closed they have been at Pulse 8 at Winnersh

We have a strong membership which meets every Tuesday evening accommodating some 11 people at each of 11 sessions with the aim of improving core body strength under the tuitioninstruction of a physiotherapist and a helper The sessions run for six-week periods with any holiday gaps by members being filled by potential new members having a trial taster session We also have a couple of social evenings a year just to have a good catch-up

Richard Goddard

West London BranchThe West London Branch was set up in 1999 and originally started by holding monthly talks on ldquobackrdquo subjects It then also ran hydrotherapy classes locally until the hospital hydrotherapy pool closed down

Currently we run a stretch and relaxation class every Tuesday morning (1055-1155am term time only) The class costs pound5 (subsidised by the branch) and is held at St Andrews Church Centre Mount Park Road London W5 not far from Ealing Broadway Centre

Everyone is welcome and you just need to ring and say you wish to try it out Just remember to wear easy clothing and bring a mat to lie on The class is based on a hospital stretch and relaxation programme

Teresa Sawicka

Hull and East Riding BranchThe branch was formed in 1995 (our 20th birthday next year) with a walking group and exercise in a hydrotherapy pool After our official launch we started monthly speaker meetings and an equipment loan service Later there followed an easy line dancing group and healing days

All these sections continue to thrive They are all organised by their own sub-committees so the main committee has comparatively few responsibilities ndash mainly the membership list organising open days and the AGM

Probably the reason for our longevity is the emphasis we put on the social side Each group organises a social event usually a meal or party and many branch events have been held such as barbecues petanque tournaments and a dinner dance at Christmas Even the speaker meeting has a social side with a quiz and time to chat

Beryl Kelsey

Harrogate and District BranchTwenty-five years ago when Harrogate BackCare began 49 people joined as members in its first year Today the branch still has 32 active members including four from the original team Our principal activity now is hydrotherapy which is helping many members to reduce and manage their back pain We use the facilities of a hydrotherapy pool in Ripon where our experienced instructors provide a programme of back exercises designed specifically to benefit our members

Members also enjoy the regular social events we organise throughout the year ndash a monthly luncheon group summer party Christmas lunch and annual fundraising raffle

Lin Tippey

21


TALKBACK BRANCHES 21

Lothian Branch ScotlandLothian is the only branch of BackCare in Scotland It has been running in Edinburgh for 30 years currently has 66 members and is run by a committee of volunteers

We organise the opportunity for warm water exercise sessions in a hydrotherapy pool with a lifeguard and physiotherapist in attendance These sessions are available once a week throughout the year There is also a swimming club held in a full-sized warm water pool giving the opportunity to swim as well as do exercises This runs once a week during school terms

These are our main activities As well as offering the undoubted physical benefits a lot of mutual support is exchanged as people share ideas and experiences and benefit from realising that you are not alone and there is always someone worse off than you are The social aspect is very important

We publish a local newsletter three times a year and arrange occasional social events We have an annual fundraising coffee morning for BackCare week Last year we supported three marathon runners and made a contribution to the BackCare helpline with the funds raised We hope to do the same this year

Jean Houston

Swansea BranchSwansea BackCare is now in its 22nd year and has nearly 60 members The branch is particularly fortunate to have as its President Gary Coates MCSP SRP who is very active and supportive in all we do

The annual programme consists of a mixture of evening talks associated with back care but also with social events plus hydrotherapy classes which are run for us at Singleton Hospital by its Physiotherapy Department

There are four (hour-long) classes each week and 38 members take advantage of these classes which have become a focal point for the branch

A highlight in the programme is the annual walk along Swansearsquos beautiful promenade when members after free coffee walk a distance to suit them around the bay and then meet up for lunch The Summer Social aims to raise funds for BackCarersquos research and the branch normally donates about pound500 annually to the charity

Tony Davies

Southampton BranchSouthampton branch was set up more than 32 years ago with the help of physiotherapists and other senior staff at Southampton General Hospital to provide help for people with back pain

The branch has 32 members and gives support through hydrotherapy sessions friendly help and practical advice Weekly sessions are held on Mondays at Southampton General Hospital where the two one-hour sessions run from 6-8pm These sessions are valuable for the exercise programme regular social interaction and ongoing practical help and advice from qualified physiotherapists

There is an annual spring lunch and speakers are invited to talk about back-related issues at the AGM Dr Lisa Roberts is our vice-chairman and consultant physiotherapist Through her members are encouraged to volunteer and take part in ongoing research programmes about back-related topics Newsletters with information and details of events are sent to all members three times a year

Irene Bowron

Members of the Swansea BackCare Branch on their summer stroll

TALKBACK ADVERTORIAL22



23TALKBACK ADVERTISING AND SUBSCRIPTIONS

Subscribe to TalkBack magazine for only pound2250 per yearIf yoursquove picked up this magazine at an event and would like to become a subscriber simply complete and return this form By becoming a subscriber yoursquoll get the latest news research and educational content delivered to your doorstep quarterly and you help to support the work of BackCare the UKrsquos national back and neck pain charity

Name

Address

Email

Telephone

Where you got this copy

Send to BackCare Membership 16 Elmtree Road Teddington Middlesex TW11 8STAlternatively you can scan and email this form to membershipbackcareorguk or phone in your details to 020 8977 5474

CreditDebit Card

Expiry Date

Start Date

Talkback is the only back pain magazine in the UK It is published by BackCare the charity for back and neck pain for more than two decades It caters for the increasing number of people who are suffering from back pain ndash nearly 80 of the UK population ndash and healthcare professionals

TalkBack is produced quarterly and generally includes the following editorial contentl Latest developments and approach to back pain and in its managementl Health and exercise l Articles aimed at prevention of back painl Patient centred approaches to treatment l Research news l Sections specially targeted to BackCare professionals and therapistsl Readers lettersl BackCare branch news and eventsl Back product testing and the latest gadgets

All costs include VAT

2rdquo times 2rdquo Box Advert pound100

QUARTER PAGE pound150

HALF PAGE pound300

FULL PAGE pound600

INSIDE FRONT COVER pound800

OUTSIDE BACK COVER pound800

ADVERTORIAL ndash FULL PAGE pound800

LOOSE INSERTS pound150

Rates

Issues and dates

Advertising in TalkBack

Talkback is quarterly ie four issues a yearIssue 1 ndash published in March (advertising deadline 15 February)Issue 2 ndash published in June (advertising deadline 15 May)Issue 3 ndash published in SeptemberThis is a special bumper edition in line with the theme of BackCare Awareness Week campaign for the year (advertising deadline 15 August)Issue 4 ndash published in December (advertising deadline 15 November)Circulation 3000 plus 50000 digital

For artwork specifications to book your space or for more information email Sri Seshadri chief operating officer at sribackcareorguk

Why Back Pain

Why BackCare

Why Not Donate

The Charity for Back and Neck Painorgukwww

There is a disease spreading across the UK claiming 7000 new victims every day It increases your risk of fatal heart attack and terminal cancer It causes structural changes to the brain and increases your risk of suicide Itrsquos also resistant to conventional NHS treatments

Sounds like a horror movie right Actually wersquore talking about highly disabling chronic back pain which now affects around 1-in-20 people and millions more every year

Because back pain is so common most people have no idea how serious it can be Yes most back pain is not serious and goes away by itself just like headaches and the common cold But for hundreds of millions of people worldwide the pain becomes chronic and never goes away For many it is torture all day every day forever

Not only can back pain destroy lives but it also costs huge amounts of money in NHS treatments disability benefits and sickness absence ndash more than pound50 million a day In fact the amount of money the UK spends on back pain in just one year would solve the entire water crisis in Africa where 4000 children die each day from contaminated water Makes you think doesnrsquot it

BackCare is the UKrsquos national back pain charity Our mission is to turn the tide on back pain through our research education and outreach initiatives We are a unique charity and no one else is doing the same work Just by reading and sharing this magazine you are helping to support our work ndash thank you

Back pain is a major global health problem By donating to BackCare you are helping a very worthy cause We are very grateful for all donations and people can donate their time effort or money in many different ways ndash whether thatrsquos volunteering your skills organising a fundraiser running the marathon or simply popping a cheque in the post

Why not get in touch to find out how you can get involved

Call us today on 0208 8977 5475 or email yourstorybackcareorguk

2 TALKBACK EVENTS

ARMA Lecture ldquoMeeting the Challenge of MSK Disordersrdquo 10 DECEMBER

Annual winter lecture of the Arthritis and Musculoskeletal Alliance at the Methodist Central Hall Westminster 530pm given by Lord Hunt Shadow Deputy Leader of the House of Lords Visit wwwarmauknet for more information

BackCare Christmas Carol Concert 15 DECEMBER

Join us at The Queenrsquos Chapel of the Savoy 630pm for a rich tapestry of choral masterpieces by the Tredici Choir Tickets pound18 adults pound5 under-16s Refreshments available Box office wwwbrandenburgorgukchristmas Proceeds go to the charity

ACTIVE Working Summit8 JANUARY

ldquoThe Sedentary Office ndash A Case for Changerdquo at More London Place London (SE1 2AF) First annual conference exploring the health risks of prolonged sitting featuring Dame Carol Black Visit wwwgetbritainstandingorg for details and bookings

British Orthopaedic Association Instructional Course10 ndash 11 JANUARY

Manchester Conference Centre The annual instructional course is a highlight of the BOArsquos training and education calendar featuring a half day focused on the surgical treatment of critical spinal condition More information at wwwboaacuk

Moving amp Handling People27 ndash 28 JANUARY

Human Rights Action Centre London Annual event of seminars and workshops for patient handling professionals More information at wwwmovingandhandlingpeoplecouk

Acupuncture Awareness Week 3 ndash 10 MARCH

Acupuncture is one of the most popular complimentary therapies practised in the UK with 23 million treatments performed each year Supported by the British Acupuncture Council Find out more at wwwintroducingacupuncturecouk

British Chiropractic Associationrsquos Spring Conference7 MARCH

Roxburghe Crowne Plaza Edinburgh For more information and booking contact Michelle Allen on 0118 950 5950 or email enquirieschiropractic-ukcouk

British Association of Spine Surgeons Conference18 ndash 20 MARCH

Bath Assembly Rooms For further information visit wwwcventcomdg4qd6m For sponsorship opportunities contact Julie Archer at BASSarcher-yatescouk for membership and other queries contact Julia Bloomfield at ukssbboaacuk

International Acupuncture Research Symposium21 MARCH

ldquoBridging the Gap between Research and Practicerdquo at Kingrsquos College London (Stand campus) Research and education seminars Visit wwwarrcsymposiumorguk for more information

British Scoliosis Society ndash Annual Meeting21 ndash 23 APRIL

Sheffield City Hall Further details will become available at wwwbritscoliosissocorgukeventsasp

John Bowlby Memorial Conference25 ndash 26 APRIL

ldquoUnlocking Pain ndash Disrupted Attachment and Chronic Physical Painrdquo at the Bowlby Centre London Psychophysiological perspectives from international leaders in the field More information at wwwthebowlbycentreorgukcpd

Stress Illness Recovery Practitioners Associationrsquos Annual Conference26 APRIL

ldquoChronic Pain ndash To Suppress Manage or Curerdquo at the Royal Society of Medicine London Leading international speakers in the field of chronic pain recovery More information at wwwcurepain2015com

BackCare Events Calendar 201415


Dr Who 5

Awareness week 6-7



Predicting pain 12


Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by


Contents

3


TALKBACK WELCOME












Welcome



4 TALKBACK NEWS






















5


TALKBACK NEWS
















Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by







Local events












UCB National 250000





























Radio day cue sheet


Interviews on air

8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










Dr Who 5

Awareness week 6-7



Predicting pain 12


Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by


Contents

3


TALKBACK WELCOME












Welcome



4 TALKBACK NEWS






















5


TALKBACK NEWS
















Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by







Local events












UCB National 250000





























Radio day cue sheet


Interviews on air

8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










4 TALKBACK NEWS






















5


TALKBACK NEWS
















Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by







Local events












UCB National 250000





























Radio day cue sheet


Interviews on air

8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










5


TALKBACK NEWS
















Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by







Local events












UCB National 250000





























Radio day cue sheet


Interviews on air

8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate














Did you know














Solutions




1 of UK workers

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

0 1 2 3 4 5 6

Sponsored by







Local events












UCB National 250000





























Radio day cue sheet


Interviews on air

8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate





















UCB National 250000





























Radio day cue sheet


Interviews on air

8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










8


















9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










9


9
























10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










10


TALKBACK RESEARCH


















11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










11


TALKBACK RESEARCH






















12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










12


TALKBACK EDUCATION














13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










13























14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










14


TALKBACK PARTNERS
























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate



























16




TALKBACK PARTNERS

















17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










17




TALKBACK PARTNERS




















bmaslondonaolcom


18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










18


TALKBACK PARTNERS

















19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










19


ThirstyThirst

is a poor test for

dehydration





per dayYou may


yoursquore used to

Use a bottle to


20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










20


TALKBACK BRANCHES
















BACKCARE BRANCHES



Richard Goddard




Teresa Sawicka




Beryl Kelsey



Lin Tippey

21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










21







Jean Houston





Tony Davies




Irene Bowron







Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate















Name

Address

Email

Telephone



CreditDebit Card

Expiry Date

Start Date






HALF PAGE pound300

FULL PAGE pound600





Rates

Issues and dates




Why Back Pain

Why BackCare

Why Not Donate










Why Back Pain

Why BackCare

Why Not Donate










TalkBack, Issue 4 | 2014 (BackCare)

Documents

Transcript of TalkBack, Issue 4 | 2014 (BackCare)