Muscle, bone and joint conditions

Hello, and welcome to our second inside health event of the year.

Today, we're gonna be talking about musculoskeletal conditions, which we'll often call MSK for short.

And these are conditions that affect muscles, bones, and joints.

And they're conditions that affect millions of people every day.

So it's a really important topic to cover.

And today, we are joined by Joseph Askew, who is Bupa's advanced physiotherapy lead, discussing the huge issue of arthritis.

Different types of arthritis, how people living with arthritis can manage their condition.

But also importantly, we'll be talking a bit about prevention as well.

And I'm also joined by Emily Partridge, and we'll be discussing my favorite topic of exercise and movement.

Emily is Bupa's Clinical Lead for MSK.

And we'll also be talking about what you can expect from the physiotherapy service too.

We'll be answering loads of your pre-submitted questions, but if you do have any more specific questions that relate to you, then please do feel free to get in touch with the Bupa team.

What is arthritis So my first guest, Joe.

Joseph Askew, you are the advanced physiotherapy lead at Bupa.

So your role provides customers with effective care navigation to ensure that they access the right clinician to manage their problem first time, every time, which is so important.

So welcome, Joe.

Thank you very much, Zoe.

So let's talk about arthritis.

It is a huge topic that affects so many people.

It affects in fact, more than 10 million people just in the UK.

And that includes people of all ages.

So it's a big concern for our viewers.

We chose to focus on this topic today, because it does affect so many people.

And I think let's start off.

First of all, can you explain what arthritis is?

We can.

So arthritis, the definition of the word just means inflammation of a joint.

And so we classically think of arthritis as being a problem that causes pain and swelling and inflammation affecting a joint or in most cases, several joints.

And historically, we've always thought of arthritis as being a process of thinning of the cartilage, where the cartilage is gradually affected and starts to narrow.

And we commonly see that with age.

One of the problems that we always encounter with medical language is that we use lots of different words interchangeably.

So you'll hear people describe arthritis as arthrosis or as arthralgia, that's quite common.

Historically, people have often referred to arthritis as wear and tear as well.

And you often hear people describing crumbling joints and degenerative joint disease.

And this is a really important thing for us as healthcare professionals to try and overcome, because the language that we use is so important in framing things for people, and the message that we're trying to confer.

And using that language around generation and where in tear, you risk instilling fear in people.

And particularly, fear about activity.

When activity, we know is really advantageous for people with arthritis.

Types of arthritis - Yeah, it's interesting, isn't it?

I think in a lot of the work I do, working with healthcare professionals, I'm encouraging people to stop saying, wear and tear, and talk about wear and repair.

Absolutely.

Because actually we know that activity, well, it's one of the main treatments for arthritis, isn't it?

It is.

Yeah.

And there are different types of arthritis.

So can you talk us through what are the many different types, but the main types of arthritis?

Yeah, so there's over 100 types of arthritis that's affect people right the way from childhood and early adolescents, right the way throughout our lifespan, by far the most common is osteoarthritis.

So we actually know that of that population of people with osteoarthritis, two out of every three of them will report that they will last pain free over a year ago.

So this has a huge effect on people, and it's a very disabling problem.

And osteoarthritis is this process of inflammation and swelling within the joints that causes pain and disability.

And we can think of this in two different ways, really.

We can think about it as a disease.

And so as healthcare professionals, we like to define things and we like to stage them.

And so disease helps us as healthcare professionals to talk about arthritis.

It's more important to think of it as an illness though, and that's the way that it affects people.

And so these are the symptoms that people experience of loss, of quality of life, of pain at night that stops 'em from sleeping, and of not being able to participate in the activities that they like to do.

And so that's by far the most common type of arthritis.

And that's kind of, I think when you were talking before about rheumatoid arthritis the less helpful language that might be used for the joint crumbling or wear and tear.

That's kind of we were talking about osteoarthritis there weren't we?

We are.

Because we see a very different picture- - Yes.

Yes.

In what I think you're probably gonna say next.

Oh yeah.

Which brings us onto rheumatoid arthritis, which is by far the more common of the inflammatory arthritis.

And this is a very different type of problem to osteoarthritis.

So and rheumatoid arthritis, is what we call an autoimmune disease.

Which is where the body's immune system starts to attack the joints themselves.

And this can cause quite marked erosion and destruction of a joint.

The inflammatory process, it goes alongside it.

And that's a huge problem.

We don't really know what triggers rheumatoid arthritis.

We know that there are some potential links, and some of these around lifestyle.

And we know that smoking is a potential real contributor to developing rheumatoid arthritis.

But there are also things like viral illness.

There are some links with diet that we'll discuss a little bit later.

There are also other kinds of inflammatory arthritis.

So there's psoriatic arthritis that's linked to people with psoriasis.

And then most people will have heard of gout.

And gout is also an inflammatory arthritis, where people have too much uric acid in their system.

And that starts to get deposited into the joints as a crystal structure.

And sometimes if that process is happening, they might knock their joint and stub their toe, is a common one, and that can disturb those crystals, and that causes a significance inflammatory response that's extremely painful, and is associated with a hot, swollen joint.

And I guess the big difference there is rheumatoid arthritis tend to usually affect a number of joints, whereas gout tends to just affect one joint at any one given time.

And usually it's the one that connects the foot to the big toe most commonly, but not always.

Okay, and I think one thing that is in common with all those, maybe not gout actually, but with osteoarthritis and rheumatoid arthritis, is that actually exercise and other elements of lifestyle are quite important management.

Very much.

So, really important.

And we know that there are lots of lifestyle contributors particularly to osteoarthritis.

So what we see is that obesity is a real contributor to developing osteoarthritis.

Just, it's the load, isn't it?

The extra load that the joints are carrying.

It is, it is.

And also obesity tends to go hand in hand with other, what we describe as metabolic syndrome.

So you see more commonly raised levels of cholesterol.

You see more commonly diabetes, and you see more commonly high blood pressure.

And we know that all of those things are linked to developing osteoarthritis, as well as contributing to the symptoms that people experience from osteoarthritis, and also with rheumatoid arthritis.

And so anything that we can do to help with those and impact those, is a huge benefit for people with arthritis.

So obesity is a risk factor, age is a risk factor.

Although it can affect people of all ages, I think that's probably the number one as well, isn't that?

It can.

And with osteoarthritis, we tend to see that developing in people over the age of 45, really, because under the age of 45, that repair process that's happening in all of our tissues is able to keep up.

Whereas once we start to mature, the repair process can't keep up as well.

And we see that in all of our collagen tissues.

That's why we develop wrinkles and that's why we can start to develop issues within our joints.

diet and arthritis - Now, you mentioned earlier that you'd share with us more info on how diet is important when it comes to arthritis.

So can you tell us a bit more about that?

Yeah, so we know that with rheumatoid arthritis, that high caffeine diets, diets that are high in red meat, are potential contributors.

Seem to contribute to potentially developing rheumatoid arthritis.

We also know that obesity, as we've discussed is, has a huge impact on osteoarthritis, both developing osteoarthritis, and making the symptom profile that people experience worse.

And so anything that we can do to help to impact that can have a profound effect.

There was a relatively recent research study that showed that in people who were obese.

So in people who have a BMI of over 30, if they could reduce their weight by 10%, with a combination of diet and exercise, that their pain levels improved by 50%.

So you don't have to have a huge impact on BMI to start to have a big impact on the symptoms that people experience.

exercise doesnt cause harm - Yeah, I think there'll be many people who will be thinking easier said than done, especially when your joints hurt, but also, I think for a lot of people, just having that knowledge, that can be a real motivator.

That can be the thing that makes them think maybe they've tried things before they wanna have another go.

Absolutely, and I think one of the key messages from this is for people to understand that exercise doesn't cause harm when you have osteoarthritic joints.

Obviously it can be really difficult for people, because everyone's experience is different, and pain can be a real limitation for people.

But we know that with physiotherapy, we know that with exercise, and we know we've got good strategies to treat the illness.

And so if people reach out to healthcare professionals, there is a lot that can be done.

And people shouldn't be fearful of moving and exercise and activity.

I think the other thing in my experience joint replacement surgery is people are aware of joint replacements for needs and hips in particular.

And I think, sometimes people delay coming to the doctor or to the physio and seeking help, because they think that that's the only option and they don't feel ready for that.

They kind of think, "I've got another couple of years in these joints.

" But actually as soon as you're having problems that are impacting your quality of life, stopping you doing the things you want to do, there are so many things working with physiotherapists and other members of the team that can be put in place to help and support them, and maybe even prevent that surgery being required down the line.

Absolutely.

And I think there's a real perception that having a diagnosis of osteoarthritis, inevitably leads to a joint replacement surgery.

And that there's nothing that you can do in that middle ground.

You've just got to wait it out until your symptoms are such that you are offered surgery.

Whereas we know that's absolutely not the case.

It's actually, if we look at knee arthritis, knee osteoarthritis, it's actually quite a small percentage that progress to having a knee replacement.

Less than 10% in some studies.

So there's a lot of people out there that manage really well without surgery.

And some people do need surgery, and surgery for those people it's incredibly effective.

It's a great operation.

It really is.

Yeah.

advice for younger people I think a lot of people are worried about that operation.

But it's such a wonderful operation.

I remember an orthopedic surgeon when added my orthopedics rotation, the surgeon saying, "Tell your patients that the day after their operation, yes they'll feel pain, yes they might feel a bit woozy, but that joint, that's the best joint.

That's the best their joint's been for years.

And that joint's ready to get up and go.

" And to give them that confidence that actually, for so long it's felt unhealthy, but that joint is now good to go.

Joe, one of the common misconceptions is that arthritis is a condition that only affects older people.

But what advice can you give generally to younger people?

So arthritis much more commonly affects people over the age of 45, but we see it in younger people also.

And often that's as a result of injury.

So one thing that people can do is take part in injury for prevention activities, and people can guide that from a physio point of view.

There's also really important lifestyle considerations.

So healthy lifestyle, reducing obesity, reducing blood pressure, reducing cholesterol, we know contribute to reducing the lifetime risk of osteoarthritis.

symptoms of arthritis - When we're thinking generally about arthritis, and we're talking mostly about osteoarthritis here, we know pain.

Pain in the joint, and that pain can be in different places, can't it?

People can have arthritis in their knee, but they can feel the pain in their hip or the other way around.

What other symptoms do people report?

It's often such a broad thing, because people's experience of pain and people's experience of disability that can come with osteoarthritis can be really varied.

And so classically, it's pain and stiffness and a feeling of restricted range of movements.

So quite often, one of the things that people start to notice with hip arthritis, is that they can't bend forward to put their shoes on or their socks on because their movements starts to become a little bit restricted.

With people who develop arthritis in their shoulder, they can't get round to their back pocket or tuck the shirt in round at the back.

And so it's that restricted range of movement that then starts to lead to functional loss.

So you start to struggle with your normal day to day activities, and that can then start to impede quality of life.

But it's really important for us to remember that arthritis and any kind of arthritis is a whole person disease.

This isn't just centered on the joint itself, per say.

We've got to think about the impact that not sleeping has on people.

Because one of the really common symptoms of arthritis is night pain that wakes people up, and not sleeping can have a really profound impact.

These are often working age people, and that can have a really profound impact on work.

Can have an impact on your ability as a parent, and all the other things that we have to do day to day.

when to seek help - Joe, I think what the viewers would find quite helpful would be, how do you differentiate between the sort of normal aches and pains of getting older versus early signs of arthritis, When you should seek help and go and see someone?

There is some overlap between what would be early arthritis, and what would be normal aches and pains associated with starting to get a bit older and periods of increased activity.

I think the really important thing is for people to know and understand when to get help, and when to access help from their doctor, their GP, or when to access help from another healthcare professional, like a physiotherapist.

And really, that comes down to quality of life and their ability to function.

We tend to go off the patient's experience, and if they're starting to struggle with normal day to day things, and it's starting to impact their life and it's impacting their quality of life, that's the time to access help.

Because we know that we can put some strategies in place to help deal with that and do something about it.

The same goes for night pain.

I think, there can be several different things that can cause night pain.

But if people are experiencing night pain, then I think really they need to get in touch with their GP and have a chat about that.

stigma - And I will say if in doubt, just get it checked out.

I think that there's a lot of stigma, I think, associated with aging and a lot of acceptances of arthritis is just a condition that you get when you get older and you should just put up with it.

And I think, our main message here would be, don't put up with it because there are things that could be done to help.

So don't suffer in silence.

So what are the various treatments available there?

So really, the first line treatment with this is education, and advice, and understanding is speaking to someone to frame things in the right way and discuss what you can do, and what help you can access to manage these symptoms.

And that should be the first line treatment.

It can make all the difference to someone actually benefits of exercise just understanding more about their condition and what they can do themselves.

If exercise was a pill, everyone would take it.

Because it's not just the impact that this has on reducing your likelihood of developing osteoarthritis or reducing the symptoms of osteoarthritis that you experience.

Addressing those things also reduces your lifetime risk of developing dementia.

It reduces your lifetime risk of cardiovascular disease, heart attack, stroke- - Breast cancer, bowel cancer.

Yeah, mental health.

There are a myriad of things that this influences, and it's so important.

And so at the basic level, it comes down to that advice, education and exercise.

And it's that whole spectrum of care, isn't it?

Emily Partridge Available from the advice and understanding all the way through to surgery.

And that's why it's so important in your role that you are helping the individual person find the right clinician to help them right at the beginning.

That's it.

And to see where they fit along that spectrum.

Thanks, Joe.

That's so helpful.

So I'm now joined by Emily Partridge, who is Bupa's MSK Clinical Lead.

And Emily's a strong advocate of promoting health and wellbeing and providing a holistic approach to client care.

Hi Emily.

Hello.

So we're gonna start by talking about exercise and movement, because there's this common belief that if you have a condition that's affecting your muscles, bones, and joints, then the best thing to do is to stay still.

Now, I definitely disagree with that one.

Yeah, it can be a common misconception actually.

That if someone's diagnosed with a problem with their muscles or bones or joints, that they think, "Oh, I better rest.

" Going back many, many years, that probably was the advice about, for example, if you hurt your back to lie down, actually as physios now, that's the absolute opposite of what we'd be saying.

It's the worst thing you can do about.

Actually, it really is.

And actually, yeah, exercise is really good for you, and it's gonna have lots of benefits.

While the lack of exercise could potentially cause some harm, really.

There's so many benefits of exercise.

So you keep your joints nice and lubricated, moving freely.

You keep your muscles nice and strong, your stability, your balance.

But also, it's so much wider.

There's just so many benefits of exercise.

Things like improving your mood, your energy levels, your sleep, which we all know is super important.

Exercise can boost your immune system.

It's great for confidence.

It's great for maintaining your independence, and great for socializing as well.

So I'm definitely a massive advocate of exercise in all its benefits.

Absolutely.

How can you be sure you're doing the right types of exercise if you have particular condition, or maybe even if you have an MSK injury?

Yeah.

I mean, it depends on what that is.

And I'd always say, seek advice from a healthcare professional, such as a physio.

I'm going to be biased for physio, and Joe is too.

But we are very, very good at guiding people into the right type of exercise.

But generally, I'd say listen to your body.

If things are aching after exercise, actually that's a good sign.

It probably works.

It's working, it's doing something.

The changes that you want to happen are happening.

Absolutely, if suddenly your pain's getting significantly worse, I'd suggest we might need to adapt some things here.

That's not to say that we need to stop the exercise that you are doing, but there may be some things we just need to adapt maybe, the time that you're exercising, or how often, or let's say, if you' a runner, runners are quite notorious for just running.

And I get that, 'cause there's lots of advantages.

You just literally put on your stuff, go out the door and run for half an hour.

But I always say to runners, try and vary up a little bit.

Do some cycling or swimming.

Do some strengthening stuff, maybe bit of stability, mindfulness stuff as well.

So my general advice is seek help from a professional first of all.

Don't be disheartened by having an MSK condition, and really kind of think of it as motivation go forwards with it, listen to your body: aching spine.

If something's quite sore afterwards, don't worry.

Maybe just seek advice and adapt it a little bit.

So generally then, I think, we've all agreed that for most people getting moving is definitely advisable.

Does it matter how old we are, or how active we've been in the past?

Is it ever too late to get started?

Never.

Never, no.

Absolutely, no.

It doesn't matter how old you are, whether you've exercised before, hand or whether this is something new that you wanna start doing, it's never too late.

I'd just say, look forward, try it, try different types.

Make sure you choose one that you enjoy, and then just reap all the benefits from it.

And if people are apprehensive, maybe because of their age, or it's been a long time since they've done anything, or because they do have joints that are sore, how can they get started?

Or how can you give them the confidence to take that first step?

What sort of things can they begin with?

Yeah, so I think that's where seeing someone like a physio is really helpful.

That might give you that confidence.

'Cause if you are worried that you're going to cause harm, for example, then already you're starting on the back foot a little bit.

You wanna feel really positive about it.

So I definitely sort of seek that guidance, first of all.

Talking to people as well.

Again, I talk about socializing with exercise.

Speak to friends.

See what they like, go and join with them.

Sometimes if you're walking into a class on your own, that can be quite daunting.

Well, if you're going with a friend, it's a great chance to catch up as well and you can join it.

Your friend might like it and you might not like it, doesn't matter.

Nothing's been lost as it you've given it a go.

Also means you're committed as well, doesn't it?

Once you've made that plan with a friend.

Yeah, once you've said it out loud- - It can work out.

Yeah, absolutely.

So it's a good way of making a commitment.

So moving on then Emily, are there any exercises that you should absolutely avoid if you have an MSK condition?

I think running is an example, I hear lots of patients say that, "I've been told I shouldn't run anymore, I should cycle instead.

" Yeah.

So you hear quite a lot about how running causes arthritis.

And actually that's really not the case.

Evidence these days shows that if you are running, enjoy running and you've got arthritis, please continue to run 'cause actually it can reduce your pain.

That's interesting, isn't it?

Really interesting.

A lot of people will be, I think, confused by that.

Yes, and I think I was actually at spin class the other day and there was a gentleman next to me, and he's got sore knees, and he's like, "Oh, it's all the exercise I've done in the past.

" And I had a good chat with him about actually, "No, that exercise didn't cause your knee problems.

In fact it probably prevented more knee problems than you've than you've got now.

" So I think running gets a bit of a bad name, and actually there's no reason for that.

If you are a runner, or you want to start running and enjoy running, please do, go ahead.

That's also to say running isn't the answer to everything.

Again, try a different.

If you don't want to try running, try something else, try this.

The beauty of exercise is there's so much variety.

Whether that's outdoors, whether it's indoors, whether it's at home, whether it's in a gym, whether it's in a class.

So yeah.

I wouldn't say there's anything particularly to avoid.

Again, depending what that condition is, I'd always caveat that if you are seeing a health professional, they may be able to guide you and say, "Maybe just right now, maybe don't do this just while you're recovering.

" That's not to say you can never do it.

But there might be just some adaptations that you need to make short term.

So in summary then, Emily, all of us can benefit from exercise.

Irrespective of our age, irrespective of what MSK conditions we might have.

And I think sometimes getting a bit of advice from a professional like yourself, can really help give confidence and guide people further.

Yeah, and it might just be just a one off appointment with someone like a physiotherapist, that can absolutely be your key aim for going for physio, can be just, "I'm okay with whatever my condition is, but the purpose of why I've come here is I just want some guidance about what exercise do.

" Physios will love that.

They will absolutely embrace that a person has come with that motivation.

So yeah, they'll be more than happy to see you.

Brilliant, thank you very much.

I wanna move on now to talking a little bit more about physiotherapy, your role as a physiotherapist, what it entails, what people can expect when they go to see a physio, and also what sort of treatments that you you might do if somebody is referred for having issues with their bones, muscles, and joints.

First of all, physios are health professionals who specialize, if I talk about MSK physios, specialize in the assessment and treatment of conditions affecting muscles, bones, and joints.

And what we do, is we work very closely as a partnership with the patient to help to restore movement and function and reduce pain.

A variety of different tools that we use are very much education, exercise prescription.

There may be some hands-on.

So joint mobilizations, massage techniques, were appropriate.

But it's that real partnership between the clinician, the physio and the patient, to really set goals according to what the patient wants to achieve.

And then working together with them to achieve them.

So if I, for example, get referred by my GP for a course of physiotherapy, what can I expect to happen?

Okay.

So you'll come and see the physiotherapist.

And first of all, they'll have a really good chat with you.

So that will be all about.

They'll be asking questions about the condition or the symptoms that you're getting, how they affect you?

what makes them worse?

What makes them better?

But really importantly, we find that about the person.

So you never just a knee or just a back, you're a person with knee pain or a person with back pain.

And I think physios are very, very good at that.

And often we have the time to do it in the appointment, as well to really find out about that person.

So what do they do if they're working?

What do they do work wise?

What do they do in their leisure time?

Have they got any dependents?

What's their sleep like?

What's their stress levels like?

Are there any past medical history, so other conditions to do with their health that might be contributing?

So we find out all about the person, first of all.

And I think really importantly, what makes them tick?

As well What do they think's going on?

What do they think's causing it?

And what would they like to achieve from physiotherapy?

So once we've had a good chat, then have a look.

So again, depends on what the person's coming with.

Overall, we look at posture, we look at movement, we look at muscle length, muscle strength, stability, balance, and get a really nice overall picture.

And from there, we try and formulate a clinical impression as to what we think might be going on.

We'll then sit down with the patient and talk to them.

And again, this bit's really important as well.

Talk to them about what we think might be going on, but in a way that someone can easily understand.

To try and sort of de medicalize things as well to normalize things, I think, is really important.

And also give the opportunity for the patient to ask questions as well.

That's super important.

From there we'll work.

So we'll put it all together.

It's like a jigsaw puzzle.

So finding out, if the patient is worried about something or actually, can we talk about that?

Are there only reassurances that we can give to them?

From there, we'll start to formulate a treatment plan.

And that's very much just shared decision making.

So not one size doesn't fit all.

So there may be different treatment techniques available.

We might give those sort of choices to the patient, and then work together as to what we might try first of all.

We set goals as well.

So functional goals, realistic goals.

So that there's a real sort of target to aim for.

So the aim is when the patient comes out, they know what's sort of going on.

Its sort of a clinical impression.

And feel quite empowered by that, and quite comfortable in that they've had their questions answered, they've got a plan, and they know sort of what they can do about it going forwards.

This is quite a lot then that goes on in that first consultation.

Really is.

And that really holistic view where there are two experts.

There's physiotherapist, but also the patient, and recognizing the knowledge and the ideas that they have.

It's much, much more than the physio's got healing hands and can cure you after few appointments.

Oh, no, no, no.

Sadly that's not the case.

So what should a person consider, or how can they prepare as well prior to coming for a physio appointment?

So the main thing, I would say, is that commitment and making sure that they they've got the time and the motivation to be involved with physio.

So yeah, physio is absolutely a partnership.

You mentioned there about the healing hands.

So I mean, I'm sure I've had many experiences and Joe, I'm sure you have as well, where you get a patient coming in and they sort of dive for the bed.

(Zoe laughing) - Thinking that you are going for- - Is this where I lay for my massage.

Yeah, exactly.

And these wonderful magic healing hands are just going to sort of touch you and make you all better.

We're not magicians.

It's not that easy.

There is a place for hands-on therapy, not for everyone, but for some there is.

In the world of physio, there's all sorts of debates that go on about sort of hands on or not hands on.

And I personally think that there's a room for everything and it's that individualized approach.

But I think it's that commitment.

You could do some massage techniques or joint mobilizations.

Likely the patient's going to feel, "Oh, I feel nice.

" And walk out the door and think, "Oh, how wonderful that was.

" But if they then don't do their exercises, or change their lifestyle, or change their posture, they might feel better for the rest of that day, but it's likely, to be honest, that after that day, their symptoms will probably return.

You've got to get to the root cause of things.

And joint stiffness or a tight muscle, is often a symptom rather than the cause.

So yeah, if you're going to go down the physio route, I think it's knowing that from the start.

Don't dive for the bed and expect a magician's healing hands.

Be committed to it.

But actually know that that partnership can work really well and really long term benefits.

I think it's so important that people know that this does require work.

It requires effort.

And sometimes it might not be the best time to therefore be going to physiotherapy.

If you're gonna be traveling abroad a lot or whatever, but actually having said that, physiotherapy, because it's actually predominantly not hands on, it can be delivered in lots of different ways.

You don't actually physically need to be with a person in the room, do you?

You can do it virtually.

And I think probably the pandemic has shown as just what is possible.

So what different ways could you treat somebody?

So this is really exciting, I think.

So traditionally, physio has been face to face.

There will always be a place for face to face physio, and rightly.

So there's certain conditions or certain assessment techniques that we would like to do as a physio, or treatment technique for certain people that we'd like to see them face to face.

However, much of what we do in face to face physio, we can actually do now virtual.

And you're right, the pandemic really brought that to the forefront.

And actually Bupa works at the head of the curve on it.

We've had telephone triage physios for about 10 years now.

The fantastic customer feedback too.

But definitely now post pandemic, the video capability, as well as apps that come in.

So if you think a normal physio session is, as I say, finding out about the person, you can actually do that over the screen.

You can look at their posture, their movement, their balance, you can even assess muscle strength by getting them to lift certain things.

Look at the way they're moving those sorts of things.

You can talk about a treatment plan.

You can set goals all virtually.

The beauty of virtual is, let's say your appointment's half an hour.

Well actually, literally virtually it takes 30 minutes of a day.

If you go to face to face, you've got to travel somewhere.

We all think, "what if there's traffic, we leave time.

" "Oh, I better get there a bit early if there's any-" - Okay.

Yeah.

And actually, that half an hour might be an hour and a half, two hours of your day, while there.

Exactly what time, you can go about your daily business.

You log on, you do your stuff, have a great conversation with the physio, know exactly what you do, log off and carry on with general life again.

So another change in the physio world as well, is I think, historically people think that they're going to come for a course of physiotherapy and that can put people off thinking, "I've just not got time to go to five sessions of physiotherapy.

" So actually a lot of people can come now for maybe one session, maybe two sessions, where they just want that expert advice for the guidance.

We can then send them some exercises via email.

They can either read the script of which explain tells to the exercises and there's pictures, or they can play a video as well.

And I think talking about exercises, it's really important to say that physios are humans as well.

I think at times, people think physios are sports mad, and eat super healthily all the time.

And they may feel a little bit intimidated by coming, or think we're gonna give 20 odd exercises.

Now that's not the case too.

We are, as I say, humans.

We are short for time, just like anyone else.

We have dependence just like anyone else.

So we will, on the whole, set maybe three or four exercises to do.

It's way more about quality rather than quantity.

We'd rather be realistic and know that the patient's going to feel on board and empowered, and feeling good about those exercises, than we give them 20 odd things to do that they may be really good at doing day one, and then life gets in the way, and they don't quite get round to it.

And then they're dreading coming back to the physio thinking, "Oh, crikey, I've not done my exercises.

" And all that side.

So yeah, physio's changed a lot, but I think my main message with it is, as I say, that real partnership, it's a really positive experience, I would say.

And it's really that empowerment of the patient.

And it's just your experience as well.

You've worked with so many different people from so many different backgrounds, that whatever anyone shares with you, whether it's the lack of time, you've heard it all before.

Absolutely.

You're able to adjust an amend to fit a person.

Yeah.

Yeah.

I think it's a real honor to be a physio actually, because we get to spend- - Same as a GP.

Yeah, we get to spend a lot of time with people.

And I've always found really learning about the person in front them being really interesting.

And at university, you think that these patients all fit really nicely into boxes.

If you're this about the knee, you treat it this way, and this is exactly what's gonna happen.

You soon realize that that is not the case because different characters, there's different stress levels.

And I think, the beauty of it and the real, it's finding that sweet spot of giving a patient something that they really feel excited about, empowered by, and that it's realistic and that they see results as well.

Because now as interesting as folk, as they say.

But I think now you've outlined all of that.

My question is, what would you then say to somebody who feels afraid or is holding back from seeking help if they've got pain, and instead they're choosing to Google it and self diagnose and self treat, is that advisable?

I mean, the world we live in is fantastic, isn't it?

The information is just at our fingertips.

When it comes to health, though, I think it really depends where you are looking, and why you are looking.

So if you are trying to get a diagnosis, I'd probably steer away, because it's likely you'll find something, and I will put my hands up.

I have done it myself.

Where you sort of, you Google something and you suddenly think, "Oh my goodness, I've got some horrendous disease going on.

" Well, for example, Google chest pain, first thing that'll come up is a heart attack.

Exactly.

Exactly.

It's not communis causing chest pain.

Which is going to increase all your symptoms and worry.

And it's just not a healthy way to go.

So I would say from a sort of diagnosis point of view, I'd always advocate going to a healthcare professional.

So it may be just a one off appointment that's needed to give that reassurance expert advice set you on your way.

If you are going to sort of access healthcare via the internet, Just make sure it's a reliable source.

So things like the NHS websites, very good, things like patient info versus arthritis, if you have had that diagnosis of arthritis.

And things like the Bupa website, it's full of health content that's written by clinicians, it's reviewed regularly.

So it's all up to date as well, because otherwise you can really convince yourself that you've got something horrible, when actually, it really might not be.

Yeah, and of course, for Bupa customers as well, if there is something more specific, they want advice or they're not sure where best to go, they can contact Bupa and just put an inquiry and find out what to do from there as well.

What about kind of the more small and niggles and pains, the things where we don't need to seek help, how should we tackle those?

Yeah, so if it's a niggle that you've experienced before, and you've sort of self-managed before, I'd try whatever you tried beforehand, and see if that works again.

If it's something where you think, "Oh, my back's got a bit of a niggle but actually when I think about it.

It's probably because yesterday I was all day on the laptop on endless conference calls, and/or I moved to house last week.

" Have a think about what you've been doing and see, if I give the example at that laptop, well, for the next few days, I mean, ideally forever more, but particularly the next few days, really have a think about your posture.

Get up regularly, do your work calls walking around, for example.

And just see if it's settled.

And most of the time, those small niggles and pains will settle.

If they don't settle, then I'd say, yeah, go and go and get that reassurance.

Get someone to look at it, give that reassurance.

And particularly you're worried about it.

I think, worry can make symptoms so much worse than they are.

And it can sort of create quite a snowball.

So if you worry, just go and seek help, and have a chat with a healthcare professional who can reassure you.

Yeah, definitely.

I think it's important that, isn't it?

Thinking I think often we accept these niggles that, "Oh, my back's sore again.

" Thinking about the root cause, "Why is my back sore?

" It's fine taking painkillers every now and again, and doing some exercise and stretches as to remedy it.

But it's also worth just having that thought about, well, what could be causing this.

I never used to get this problem, what's changed.

Final question, can you tell us what support is available to Bupa customers?

Okay, Lots, lots is my answer.

So the great news about if you are Bupa customer and you want to access physios, you don't need to go to your GP first of all.

Which is, I mean, it would've been great in sort of normal times, particularly right now.

We all know how difficult it is at times to get to seek GP advice.

And one in three GP consultations apparently are about musculoskeletal conditions.

So the great news with Bupa, is you don't need to go down that route, you can self-refer.

When you ring Bupa insurance, they will then book you in with one of our virtual triage physiotherapists, which is normally within about 24 hours as well.

So that's great.

You can speak to someone really quickly, really experienced physiotherapists.

They will triage you.

So that is sort of deciding what the best next steps are.

That might be in a very small number of cases, but might be that you have to go to.

They might recommend you go to an accident in emergency department.

It may be to see a consultant.

The vast majority will be either sort of physio, osteopathy sort down the therapies line, or this self-management group as well.

And we actually find now with our virtual triage physios, that about 20% of people who are calling, actually go down that self-management route with really fantastic, as said before, customer feedback about, great I access someone really quickly, I nipped it in the bud, I feel empowered.

I've got my exercises to do.

That's all I wanted, really.

So that's our sort of virtual physiotherapy route.

Then if you have seen a GP and they've recommended you that you see a consultant.

So for example, a trauma and orthopedic surgeon or a neurosurgeon, when you ring up to get your authorization code, they will offer you a call with Joe's team, our advanced physio practitioners.

And that's amazing service that we've started about a year ago with amazing customer feedback.

Where actually it's, again, a talk with an expert to really delve down a little bit deeper into this issues, and really make sure that the consultant referral is the right referral.

As you were saying earlier, about seeing the right clinician at the right time.

And sometimes- - Well, I think a lot of.

Everybody's energy and time can be wasted and conditions can deteriorate if you're seeing the wrong person in the first instance.

Exactly, yeah.

So they'll have a really good discussion.

If the advanced physio practitioner thinks that you still need to see the consultant, fine.

And actually you are then, still seeing the consultants, you're still getting on the same line, but you're armed probably with a bit more information.

They may give you sort of a bit of stuff that you can be starting to get on with while you're waiting for the consultant.

But there's also a big proportion now, actually they have that conversation, and they decide together that something like physiotherapy might be a good route if they've not tried it before.

So that's a really good service that we've started now.

We've got the Bupa website, as I mentioned earlier, which has got a wealth of content on about all sorts of musculoskeletal conditions.

So have a look there, and then we've also got our Bupa health centers as well.

So these are centers dotted all around the country with regards to MSK.

We have teams there of physiotherapists, osteopath, podiatrist, and our MSK physicians who are consultants who specialize in sports and exercise medicine.

So you mentioned the start about that holistic view that I love.

And that's what I love about working in the Bupa center is that real sort multidisciplinary team, we work as a team treating that individual person with them at the center, and them involved in their care.

So our Bupa customers can access those Bupa health centers as well.

Well, thanks for that, Emily.

Obviously a great range of help available for people.

And next, I'm gonna bring Joe back in.

Actually, I'm gonna chat to both of you 'cause we've got some questions from our viewers.

So as ever with these events we've received a whole bunch of questions from customers.

So we're gonna get through as many as we can in 10 minutes.

And the first one probably for you, Emily, I'm a runner.

Is running on certain types of surfaces better or worse for your joints?

For example, is grass better than running on a road?

Okay, so it's a question that's often asked, that one.

There's pros and cons of different running surfaces, to be honest.

So road running.

The advantages are, most roads, although I caveat out that with potholes, are smooth and they're sort of even generally.

So that's an advantage.

The downside is that there's less shock absorption when you road run.

So potentially you're putting more stresses through your body, which may potentially cause more injuries.

If you then consider something like grass, it's softer.

So you've got the advantage of more shock absorption, but then you get into the realms of, is it uneven?

if it's been raining, then the grass is slippery.

So I wouldn't say that there's an ideal running surface out there.

As a general rule, probably vary it up.

Because actually when you're running on different surfaces as well, you're using slightly different muscles.

So that's good.

It gives a more overall sort of workout, I would say, and potentially prevent injury, rather than just pounding in either just purely on ground or purely on grass.

Okay, I love that.

Mix it up.

Mix it up.

Yes.

What advice can we give about coping with managing sciatica pain?

Who wants that one?

I'll take that one.

I would say, seek help from a health professional in the first instance, just so that.

There are lots of different causes of sciatic pain, so pain down the back of the leg.

And I think that's really important as a starting point.

Is to work out what's causing that.

So go and see GP physio for that sort of expert assessment, and then sort treatment techniques.

They'll be able to guide you on with regards to sort of pain management strategies, exercise you might need to do, adaptations to your daily life.

And then that'll set you on the right road that potentially you can then do things at home by yourself, but get that expert opinion first of all.

Yeah, I agree with that.

And I think sometimes, the typical over-the-counter painkillers can be less effective at treating this sciatic pain because it's actually from irritation of the nerves.

The GP can sometimes support with prescriptions where appropriate as well.

Why might I have one hip joint that is so bad, it needs to be replaced, yet the other hip joint is in perfect condition?

Oh, so I might take that one.

So this is something that we see quite commonly.

And I think quite often as clinicians, it's equally as confusing for us as it is for our patients.

And sometimes, there's no real rhyme or reason to it.

Sometimes all of our joints are shaped slightly differently.

My hip joints will be shaped slightly differently with hip joints, for example.

And we also see within people that sometimes their joint called morphology, the structure of their joint, is slightly different on one side to the other.

And that in combination with their occupation or in combination with injury in the past or activity, can result in one side being affected, and the other side not being affected by arthritis.

But again, sometimes we just don't know sometimes.

Yeah.

Next question.

What might be causing inconsistent shoulder pain which comes and goes?

So we've spent most of today talking about osteoarthritis, and osteoarthritis does affect the shoulder joint as well, but we see it less commonly than we do in some of the other big joints, like the hips and knees.

Inconsistent variable shoulder pain, is much more likely to be related to what we call tendinopathy.

And this is something that we see affecting younger people, as well as older people for slightly different reasons.

And so tendinopathy is a problem.

The tendon is the part that's attaching the muscle onto the bone.

And so it transmits all of the force generated by the muscle, into the bone.

And it's constantly responding to that load on a day to day basis.

And sometimes that cycle become affected.

And the structure of the tendon changes a little bit.

And sometimes, that's due to what people call repetitive strain or overload.

And we see this in people, for example, with tennis elbow who type a lot or in the shoulder, it can be, we see it in decorators and window cleaners and people like that.

But also just people who maybe go out one day and start throwing a ball for the dog, or throw a stick for the dog, and that overload tendon and that generates pain.

And again, this is something that we can really successfully treat from a physiotherapy point of view.

Excellent, if I'm having muscle or joint pain, which is best, warm or cold?

That good old question.

So heat increases blood flow to the area.

Tends to be good for relaxing muscles.

It feels nice if you're feeling all sort of tense from your aches and pains, then a nice, hot bath, a hot water bottle or a heat pad that you sort stick to your skin, would tend to give symptom relief.

Cold tends to restrict the blood flow to the area.

So if somethings sort of hot and angry, if you put heat on it, it can sort of aggravate it.

Yeah, make it more throbby and- - Exactly, Yeah.

So you might wanna sort of cool that one down with an ice pack.

If it's for generalized aches and pains, I'd say people have got their preference, they tend to.

I'd definitely be one for the warmth, but I've definitely had patients in the past who love putting an ice pack on their back.

They say it gives it relief.

Personally, I think it would make me more tense.

So individual preference for generalized aches and pains.

But if something's inflamed, I tend to go down this sort of cooling it route.

If something's more, a bit tense, I'd tend to go down the heat route.

So I think people probably then, depending on what their symptoms are and how they feel, use their intuition and it's the one that they feel will be most comfortable.

Try both of them at different times, or you may find if you like both, than one day put heat on.

Yeah, the next day put cold.

Excellent answer.

I've been told I have plantar fasciitis.

How do I best manage this slash curate?

Okay, so you're plantar fascia, the thick band of tissue that runs along the soul of your foot into your heel.

So most people who have problems in that area, complain of sharp pain after a period of rest.

So classically, as they get up and put their foot to the floor first thing in the morning, or if they've been sat for a long period of time, then when they go to stand up, they tend to hobble a little bit for the first few steps.

Things tend to then sort of warm up and relax.

And then they tend to their symptoms calm down a little bit.

But then if they do prolonged walking, prolonged running, prolonged standing, it tends to bring it on again.

So from a self-management perspective, there are things like, I tend to tell people to put small water bottle into a freezer and then roll your foot along it.

And you'll sort of.

It's of a double impact there that you've got the cold, but also the massage can tend to help.

Looking at your footwear is really important.

So good supportive footwear, calf stretches, plantar fascia stretches, are good to do.

Trainers are important.

If you are one that exercises, then I'd always recommend going to somewhere like a running shop.

You don't need to be a runner to go to a running shop, but the great thing there is to have a vast array of trainers.

You can go on the treadmill and try them out.

And different makes have just got different shapes to them as well.

And then even within one make, you've got different levels of control.

And when I talk about control, it's sometimes with plantar fascia problems, it can be that someone's foot over pronates.

It means that they roll a little bit too much inwards before they push off through their toe and propel forwards.

When you start getting into those rounds, I'd probably recommend you go and see a physio or a podiatrist.

They can have a good look at your foot posture, they may get you on a treadmill, or they may get you walking along what we call like, a gait analysis pattern, which looks at where you sort of wait there.

And from that, they may either give you trainer advice, where advice, or they may start to talk about insults or orthotics either over-the-counter or made ones.

Individually made ones.

They will also look at you higher up as well.

So we're all connected.

So what's going on in our knees.

What's going on in our hips as well, or likely have an effect on what's going on in our foot.

So they'll look at your muscle strength and your muscle length, all the way up, and see if there's any imbalances there that could be contributing.

Weight as well.

So the more weight you've got going through, can irritate your plantar fascia.

So think that's where exercise comes in, again.

It's like keeping that healthy weight.

So not too much weight is going through our bodies than needs to.

Okay, so a whole diverse range of things there.

Thank you, Emily.

What about tennis elbow, what can somebody do for that?

So tennis elbow, again, is a tendinopathy.

And by far the most common cause for tennis elbow that we see is this repetitive strain.

Well, it does affect quite a high percentage of high level tennis players, yeah.

But it's much more common just in people who spend a lot of time at a keyboard.

People who spend a lot of time using a mouse.

We see it really commonly in electricians, people who use screwdrivers and do a lot of gripping.

And this occurs because in order to be able to grip properly, our wrist needs to be cocked back a little bit.

That puts the muscles into the right position to be able to generate force.

You can't grip something if your wrists flex down like this.

And so if you are doing things that require gripping and require finger activity for long periods of the day, that can start to overload the tendon up at the top of the elbow here on the outside of the elbow where all of those muscles attached.

So as four muscles come up and attach into one single point here.

When people get tendinopathy, it's a change in the structure of the tendon.

And we know that with work and efforts and exercise, what we call loading-based exercise, we can change and remodel the structure of that tendon.

There's a lot of evidence about this looking at this process.

And so from a physiotherapy point of view, there are two core treatments for how we look at managing tendinopathy.

One is trying to modify the activity and what we call optimize the load.

We need to exercise it, but we need to tinker with things a little bit to try and make sure that we reduce the activities to aggravate things.

And the final question is, if there was one thing you would recommend people do to prevent problems developing with their muscles, tendons, and bones, and actually let's say also to treat any problems that they have that are musculoskeletal, what would it be?

It's regular exercise.

100% regular exercise.

I would also say regular exercise.

Emily, Joe, thank you so, so much for joining us.

And if you do want any more information about what you can access from a physiotherapy point of view or general advice on musculoskeletal care, do go to the Bupa website.