Obituary – Prof Gordon Waddell

April 28, 2017 in General Interest, Uncategorized

Gordon WaddellI was recently informed by a colleague of the recent death of Prof Gordon Waddell. He was one of the pioneers in the revolution of back pain management, including with his book “The back pain revolution” [1].

Gordon wrote a seminal paper entitled “A new clinical model for the treatment of low-back pain” [2]. He introduced the biopsychosocial model of low back pain and was one of the first authors to make a distinction between pain and disability. This justified the need to address the various factors influencing pain including biological, psychological and social factors. His views and his work have contributed hugely to my research on the biopsychosocial model of low back pain. Unfortunately I didn’t get the chance to meet him, but the views of the director of studies for my thesis were hugely influenced by his work.The back pain revolution

Gordon kindly accepted the Honorary Post of Associate Professor at the British School of Osteopathy where I work, lending his support to the school as well as to osteopathy in general.

My sincere condolences to his family. He will be greatly missed.

 

[1] Waddell, Gordon. The back pain revolution. Elsevier Health Sciences, 2004. APA

[2] Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine. 1987;12:632–644. doi: 10.1097/00007632-198709000-00002.

Tendinitis

February 2, 2017 in General Interest, Pain posts, Uncategorized

Tendinopathy, tendinitis, tenosynovitis… many words that are often used interchangeably and may not mean much to you. It is often unclear what these words mean and patients are often unclear on what they should do if they have one of them. Blogs are often filled with stories of patients who may have suffered for prolonged periods and it can be distressing to read these stories. Tendinitis often refers to the inflammation of a tendon. Whilst that may be true initially, the inflammation tends to go away after approximately 12 weeks but the pain may persist. Different pain mechanisms can then occur.

I found this video very informative on what the different tendon problems can be and what the possible management options are.

Professional Doctorate in Osteopathy

February 2, 2017 in General Interest

Professional Doctorate in OsteopathyHaving trained as an osteopath and graduated in 2007, I was awarded a Professional Doctorate in Osteopathy at the end of 2016. During this five-year, part-time degree, I conducted research on low back pain.

  • I first looked at why we develop low back pain and what may stop us recovering from it.
  • I then used this research to develop an e-learning programme, offered to experienced osteopaths as a way of sharing up-to-date knowledge with them.
  • I lastly evaluated how these osteopaths’ attitudes to back pain changed following the e-learning.

I presented my research at several conferences and I am in the process of submitting manuscripts to peer-reviews journals. I won the Research In Practice award from the Institute in Osteopathy, more info here.

This was a fascinating and sometimes challenging journey. I learned many things that have changed the way I practise a lot, e.g. the fact that sitting does not predict that people will develop a first episode of back pain. This was a surprise to me as most of my patients report sitting as being the main cause of their discomfort. It has also helped me to know how to explain back pain to patients in a way that is helpful to them. It has also drastically changed how I manage patients with long-term pain (also known as persistent or chronic pain).

I was very lucky to have two extraordinary supervisors; Mr Steven Vogel and Dr Annette Bishop. Thank you to them both.

So now I’m a doctor but not a medical one! I’m still an osteopath.

Research in practice award

January 7, 2017 in General Interest

award-pictureOn 25/11/2016, the Institute of Osteopathy presented awards during their gala dinner. The panel that voted for the awards was composed of Prof. Dawn Carnes, NCOR director, Charles Hunt, BSO Principal and chief executive, Maurice J Hills, Osteopathic Education Foundation executive secretary, Maurice Cheng, Institute of Osteopathy chief executive, and Tim Walker, GOsC chief executive and registrar.

Dr Jerry Draper-Rodi was presented with the Research in practice award. Jerry was awarded for the work he did towards his professional doctorate in osteopathy that he completed in 2016. The professional doctorate is run in conjunction between the BSO and the University of Bedfordshire. His research supervisors were Steven Vogel (Vice-principal Research at the BSO) and Dr Annette Bishop (NIHR Research Fellow at Keele University). Jerry’s research was on the biopsychosocial management of patients with low back pain. After reviewing the literature, he developed an e-learning programme and then conducted a mixed methods feasibility study using the e-learning as a form of CPD for experienced osteopaths.

Jerry is an advocate of embracing research in practice and informing research from practice. His research was on the dissemination of research findings to clinicians. Learning from practice and knowing what osteopaths do are also at the heart of his research interests: he has been using the PROM app from NCOR for nearly over a year now. This research allows collecting data anonymously and to build up evidence for osteopathy and learn what we are doing well and where we can improve.

Jerry has just been offered a position within the research team and has CPD manager at the BSO. He is really exciting to start this new adventure at the BSO!

Why do your knuckles pop?

February 13, 2016 in General Interest, Treatments

You may be a knuckle-cracker or you may hate people doing it (it’s a bit like Marmite I guess, you either love it or hate it) but why do knuckles pop? In fact we could ask the same question about most joints in our body. Joint “self-cracking” brings relief to some people while it’s just a habit for others. The most common joints to self-crack are those in the fingers. There are different theories why it may happen and the video below (worth watching – quite fun) explains some of them. The noise is not always due to the joint: sometimes it’s due to a tendon snapping over a bone.

Dr Unger, a very interesting medical doctor and probably a slightly stubborn one, cracked the knuckles of one of his hands for 50 years (approximately 36500 times) and did not crack the knuckles of his other hand to use it as a control. He found no difference between his hands. He published a letter in the leading journal in rheumatology. While it provides a low level of evidence, it’s nevertheless interesting to know if you are a knuckle cracker: next time you hear someone telling you that you’ll get arthritis if you keep doing it, you can tell them about Dr Unger’s experiment.

Back Pain and Children

February 12, 2016 in babies, General Interest, Pain posts

Osteopathy and childrenLike adults, children can suffer from back pain as a result of their lifestyle and their activities.  And like adults, there are a number of things that parents and carers can do to prevent issues arising.

If your child does complain of back pain, it is important to seek advice from a qualified professional, such as an osteopath.  An osteopath will help to establish the cause of the problem and will provide advice on treatment, or refer you for further examinations if required.

Good school bags

Children are often required to carry bags full of books, PE kits, musical instruments and other equipment to and from school. Parents should try to limit the weight of school bags as much as possible and invest in a good quality back pack that the child should wear across both shoulders, ideally with a strap across the chest to keep the load close to their body. Packing the bag with the heaviest items (such as laptops and heavy books) closest to the child’s body, will also make carrying more comfortable and less likely to strain the muscles of the back.

 

Limit screen time

Looking down to use smart phones, tablets and laptops for an extended period can pull the back and neck into an unnatural posture, resulting in pain. Placing limits on the time spent using devices and encouraging regular breaks may help to avoid problems. If your child has to use a laptop for homework, consider purchasing a support that elevates the screen to a height that allows him or her to sit up straight to look at it.

 

Regular exercise

A sedentary lifestyle is known to contribute to the risk of developing back pain, as well as contributing to obesity. Regular physical activity helps to keep the core muscles that support the spine strong and maintain flexibility, which will help to avoid back pain. Encourage lots of active play, walking, running, swimming, cycling etc to keep your child fit and healthy.

 

The right bed and pillow

Good quality sleep is vital for both physical and mental development. Make sure that your child has a good sized comfortable bed with a firm mattress and a pillow that supports their head without lifting it too high.

 

Osteopathic Treatment for your child’s back pain

Your child’s back pain may benefit from osteopathic treatment. Osteopathic techniques are suitable for children at all stages of development; I will assess your child to see what might help. I can also provide lifestyle advice that may help to prevent the problem from coming back. I work under the principle that there may be a number of contributing factors to the symptoms and will therefore evaluate not only the area which is producing the symptoms, but also associated areas that may be contributing to the issue, including past trauma, environmental factors and the family’s health history.

Referral from the osteopath to your GP or other health professionals

February 12, 2016 in General Interest, Treatments

As a primary healthcare professional your osteopath, in addition to their osteopathic skills, have been trained to undertake detailed medical histories and a comprehensive range of clinical examinations in an effort to diagnReferralose the cause of your symptoms.
It is due to this extensive training that they are able to determine if you may need to be referred on for further tests to determine an accurate diagnosis, or if your condition may require the intervention of another health professional.

When this happens your osteopath can write to your GP outlining their findings and requesting further investigations or referral to an appropriate consultant.

In addition to referring to your GP, many osteopaths know their local medical community well, so are well placed to recommend treatment from other health professionals who are able to treat specific conditions, or even another osteopath with specialist knowledge of the condition.

Before your osteopath makes any referral, they will discuss with you their diagnosis and explain why they feel you need help from someone else.

If you are happy to be referred they will ask your permission to write to the person they are referring you to with details of your case notes and any other information from their examination that they feel might help the clinician to treat you most effectively. This may help you to get better or faster treatment because the next person to see you won’t be starting from scratch and will have the benefit of another expert’s insight into your condition. If you prefer, you can ask for a copy of your notes to take to your GP or another doctor.

If you are referred, do keep your osteopath informed about your ongoing treatment, and feel free to continue to consult him or her about any other aches and pains you’re experiencing.

Persistent pain

August 31, 2015 in General Interest, Pain posts, Treatments

Chronic painWe all feel pain from time to time. When someone injures themselves, specific nerves recognise this as pain, which in turn triggers the body’s repair mechanism. As the problem resolves, the pain tends to improve and usually disappears within 3-6 months. This type of pain could be argued to be beneficial: if it hurts, you are likely to try and avoid doing whatever it is that has caused the pain in the future, so you are less likely to injure yourself in that way again.

Occasionally the pain continues even after tissue healing has finished. When pain continues after this point, it becomes known as persistent (or is sometimes referred to as chronic) pain. This type of pain is not beneficial and is a result of the nerves becoming over-sensitised, which means that a painful response will be triggered much more easily than normal. This can be unpleasant, but doesn’t necessarily mean that you are doing yourself any harm simply by moving. You could think of this as a sensitive car alarm that goes off in error when someone walks past (for more information on how pain works, visit: https://www.youtube.com/watch?v=QUrKgv43W2c ).

Persistent pain is very common and effects over 14 million people
in the UK alone. It often does not respond to conventional medical interventions and needs a different kind of approach, but there are many things that you can do to manage your pain yourself with the support of your osteopath, your family and loved-ones. Keeping active, performing exercises and stretches can help, learning to pace your activities so that you don’t trigger a flare-up of your pain as well as setting goals and priorities are all very important and can help you to maintain a fulfilling lifestyle.

For more information on how to manage your persistent pain, speak to your osteopath or visit http://www.paintoolkit.org/

How to get the most out of your New Year’s resolution

January 29, 2015 in General Interest, Uncategorized

We all tend to over indulge a little at Christmas and doing a little more exercise is a common New Year’s resolution. But how do you get the most out of your gym routine and how much exercise should you do to stay healthy?

There is no denying that exercise is good for you. We know that those who perform a moderate amount of exercise on a regular basis are considerably less likely to suffer from diseases such as diabetes, stroke and heart attack or experience insomnia. Exercise helps older people maintain their independence and is one of the most effective methods of weight management, a growing problem in western societies. It is also very important for our psychological health, as it stimulates the release of endorphins, natural pain killing chemicals that can also improve our mood.

However, some people become a little disenchanted when the exercise they do doesn’t have the desired effect.

Most of the time, it’s because people are not clear on the type of exercises that are most likely to achieve their goals. Different types of exercise will be more appropriate, depending on what you’re hoping to accomplish.

As a general rule if you are trying to build larger muscles, the most effective method is to use a weight which you can manage to lift 8-10 times before the muscles fatigue, in order to get the desired effect. If you are looking for stronger, leaner muscles, a weight programme based upon 20 repetitions would be more appropriate.

If you are trying to lose weight, cardiovascular exercise (anything that gets your heart rate up such as running, swimming, dancing or football) is the way to go. In order to be most effective, this should be performed at 60 – 80% of your maximum heart rate, which is a lot less strenuous than you might think (Subtracting your age from 220 will give you your advised maximum heart rate. You can buy a heart rate monitors from most good sports shops or online to monitor this).

It’s also important not to train every day. The body needs time to respond to the strain of the training, and it’s during the recovery period that the gain takes place.

But going to the gym for two weeks before you go on your summer holidays to shed a few pounds is likely to end in frustration. It takes 4-6 weeks to start noticing the health benefits of excercise. Doing something you enjoy makes it more likely that you will persist, which is important if you don’t want all that hard work to go to waste.

But how much exercise do you need to do to be healthy? If you are aged between 19 and 64, research suggests that you perform at least 150 minutes of moderate-intensity, or 75 minutes of vigorous-intensity cardiovascular exercise each week plus muscle strengthening exercises on at least two separate days of that week. The good news is that this exercises does not need to be all in one go, and activities such as walking briskly to work (if your journey is more than 10 minutes) counts as part of the total.

If you want to know more about what would class as moderate or vigorous exercises, or if you are outside of this age group, visit the NHS choices website at: http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx

Jerry is a member of the Institute of Osteopathy and can be found at Osteopathy Abingdon. They can be contacted at: 01235 533487 / jerryrodi@gmail.com

http://www.osteopathyabingdon.co.uk

Low back pain: what exercises can I do to help?

January 29, 2015 in Exercises, General Interest, Pain posts, Treatments

Back exercisesPatients often ask me “What can I do to avoid my back pain coming back?” An excellent question that probably sounds like easy to answer, and you would expect me or any other health professionals answer it easily. The trouble is, there is no definite answer or I should say there was no definite answer. There has been a debate for decades about whether we should stretch or strengthen bad backs. There were lots of different opinions but no clear evidence on which might be better. A very big study (1) was very recently published in one of the leading back research journals. They assessed whether strengthening or stretching was more effective for patients with recurrent episodes of low-back pain. To do this, they followed 600 hundred patients over 10 years. They were divided in four groups:

  • 150 patients performed strengthening exercises,
  • 150 patients performed stretching/flexibility exercises,
  • 150 patients performed strengthening exercises and used abdominal bracing* (this refers to contracting muscles – not to wearing a lumbar support! See at the end of the article for more information on bracing) in daily activities/exercises,
  • 150 patients performed flexibility exercises and used abdominal bracing in daily activities/exercises.

 

To compare the effects of these exercises, they assessed the 600 patients over 10 years on 6 outcomes:

  • frequency, intensity, and duration of pain,
  • frequency, intensity, and duration of exercises.

 

And their results were….. drum roll….

  • No differences between the strengthening and stretching groups
  • The bracing groups improved more than the non-bracing groups on: pain intensity (almost 2 times lower), pain frequency (more than 1.5 times lower) and pain duration (more than 1.5 times shorter)
  • Interestingly, the bracing groups did their exercises more frequently than the non-bracing groups. The intensity and duration were similar.

In other words, the activity performed by people who have recurrent low back pain may not be that relevant to pain outcomes but more how often the activity is performed! Of course the activity still needs to either strengthen or stretch (any kind of sport or classes including Pilates or Yoga, etc).

Abdominal bracing may be helpful, but in this study it may have played a role in reminding patients to perform their exercises regularly rather than having a mechanical effect. This study can’t tell us how abdominal bracing may have affected the outcomes.

 

Low back pain is affected by many factors other than purely mechanical ones (more information here). Tackling these factors alongside doing some physical activity would of course be more beneficial!

 

(1) Aleksiev, A. R. Ten-Year Follow-up of Strengthening Versus Flexibility Exercises With or Without Abdominal Bracing in Recurrent Low Back Pain. SPINE 2014;39(13):997 – 1003

 

* The authors define bracing as such: “The abdominal bracing groups received additional training to incorporate bracing in daily living activities and exercises without interrupting the breathing “brace and breathe.” The most important requirement was to initiate abdominal bracing immediately before any whole-body movement/exercise, shifting the body center of gravity away from the bearing surface. Bracing intensity and duration was dependent on the individual judgment and the situation—the higher/longer the physical demand the higher/longer the bracing intensity. Every patient received instructions to self-perform the learned bracing and/or exercise as frequently as possible throughout the day with self-judged duration and intensity.”