Muscles and bones
Keeping active is important, but aches, pains and strains happen. Find guidance on a range of conditions, treatments and preventing future injury.
How can we help you?
Your questions answered about muscles, bones and joints
Transcript
Who are you?
Hi, I'm Mike Livesey.
I'm a specialist MSK physiotherapist
and clinical lead at Bupa.
Come and ask me a question about MSK conditions
and injuries
What does MSK stand for and what are some examples of conditions?
So MSK stands for musculoskeletal, so
that's anything to do with our body.
So we're looking at the joints in our body,
the muscles in our body, and anything that acts on it.
So it's looking at your function and how that's adapted.
So classically in clinic, we'll see lots
of problems coming in with back pain, neck pain, shoulder
and knees, and they're our top four.
The main sort of breakdown of injuries we tend
to see is more acute injuries,
so they may be traumatic sprains and strains,
or more chronic persistent issues like arthritis.
What's the difference between a ligament and tendon?
A ligament is a structure that fastens bone to bone.
So we'll see these around joints
to help stabilise the joint.
These are inert structures so they don't move.
They're set at a limit
and they have a limit at what they can work to.
So what I mean by that is if you stretch the ligament more
than it can tolerate, it'll break down and cause an injury.
So for example, we'll see that regularly with ankle sprains.
If you roll your ankle off a curb,
the ligament will be overloaded
and it will go beyond what it can tolerate and it will tear
and you'll start to get pain, injury and loss of function.
Now, tendons are structures that fasten muscles
to bone, and these are more contractile structures,
so they're more active structures with the muscle.
They act upon the joint
and allow the joint to move for you to be functional
or do the desired exercise that you want to do.
These injuries
or the injuries with tendons we see tend to be more
with overload injuries.
When you do too much too soon
and the body can't cope with it and it breaks down.
What's the difference between a fracture and break?
So we do get asked this a lot between fractures
and breaks, and there is no difference.
They're exactly the same.
It's just a mix in terminology
and clinically, we'll use fractures as the word,
and these can be categorised into a
few different subcategories.
So the least bony injury we see is a stress fracture,
and that might be caused from more repetitive strains.
Maybe with running a more impact exercise,
you'll also get an undisplaced fracture.
These maybe could be known as a green stick fracture
or a hairline fracture, worsening fractures.
You can get a displaced fracture
where the bone actually has moved out of position
and may need realigning surgically,
and we get even worse from that is a communed fracture
where we find that the bone breaks into several pieces
and very often that does need surgical repair in order
to reduce the bone back into position for the body to heal
and repair.
What's the difference between a tear and rupture?
So tears can be really, really simply in sort
of three categories.
So a grade one tear is
where we tear a small number of fibres.
So that's normally about less than 10%
of fibres in the structure that are damaged and torn.
So functionally, this doesn't have loads of impact on us.
It can cause pain. It'll cause maybe some mild swelling,
but it's rare that it impacts your function
apart from causing pain.
These are injuries that tend to resolve quickly with rest
with activity modification.
And it's rare that you need
to see a professional for support with this.
A grade two strain
or tear, it's something that
causes more disruption to the tissue.
And we'll see that between anywhere between 10%
and 90% of our tissue is damaged.
So that can cause, as you can imagine,
significant amounts of functional change.
And with that, we see swelling, we'll see bruising,
we'll see inability to move
or even inability to load that structure
because of the pain.
And as you can imagine, with more tissue damage, it's going
to take longer for those tissues to heal.
They should still heal because there are structures
or the part of the structure is still attached.
However, you may find that it takes a little bit longer.
You may need a little bit of professional support
through a physiotherapist to aid your recovery
so you can get back to your function or your sport.
And then finally, we can have a complete rupture,
which would be a grade three tear,
and that's where the structure is completely parted
and we're left with two parts of the structure.
Classically, if that's caused with a trauma, we'll go
and see an orthopaedic surgeon to get advice
and support on that as to see whether they feel
that they should repair that surgically
or whether it could be managed conservatively
with physiotherapy.
Why is my desk setup at work important?
Desk setups are really important
because we can spend between 30 and 50% of our day working.
And so if your work is inactive
and you are desk-based, it's a lot
of time potentially in a sitting position.
What we need to look at is we need
to look at the equipment that we've got around us.
You should be sitting comfortably
with our feet flat on the floor.
Our knees should be around 90 degrees,
maybe a little bit less,
and our hips slightly higher than our knees. When we're
sitting, sit in a supportive chair to make sure
that you've got the ability to rest your back
and sit back at the back of the chair.
And what we want is we want your elbows
to be relaxed comfortably by your sides,
your shoulders relaxed,
and your forearms being able
to rest comfortably on the desk in front of you.
Try and avoid reaching out in front of you to your keyboard
and make sure your screen height is looking at about eye
level when you sat at the desk.
I think the main thing though for me is movement is
don't stay at your desk for too long.
There's several studies
that say actually just being inactive,
whether you're in a good posture
or a bad posture, can lead
to musculoskeletal pain and injury.
So it's really important that we get up
and we move regularly.
Movement is medicine. Don't sit for too long.
Keep your joints moving and keep yourself healthy.
How often should I move when I work at my desk?
I think the take home message
for when we're sitting at our desk
and how often we move is move regularly
and keep it flexible.
If people are tied to their desks,
we definitely recommend moving every 30 to 40 minutes
to make sure that you're changing your posture regularly,
but it's safe to slouch.
Don't be worried about sitting in an awkward position.
Just make sure you're not there for too long.
Make sure you stand for a short period.
If you've got the ability to be able to have a sit
to stand desk, to stand for a short period, then
that's great and sit.
Use the front of the chair, use the back of the chair
and vary your position.
I think the take home message is the next posture is your
best posture.
What are the best ways to prevent muscle stiffness?
So muscle stiffness is often seen after exercise.
So if you overload
or you do too much with exercise,
you can develop muscle soreness, which can lead
to muscle stiffness.
Now, delayed onset muscle soreness is very common,
and if you don't manage that well, that can lead
to more persistent stiffness problems.
So how do we negate that?
Now, the best thing to do is make sure you manage your
exercise with adequate warmup and adequate cool down.
So what we want to look at doing with a warmup is we want
to gradually increase the heart rate.
We want to put the body through more dynamic movements.
The aim of a good warmup is
to get the blood flow into the muscles,
get the muscles switched on, get that link between brain
and body firing really quick, so we're reducing the risk
of the body not performing well,
and we know that that's going to mean
that you're less likely to fall or trip
and you're going to have better control of your movement.
The best way after exercise to cool down is
to gradually reduce your heart rate back to a resting level
and calming the tissues down.
So when we're performing,
movement muscles will naturally shorten to provide you
with movement and get the joints moving
so you can move forward or jump higher or move quicker.
What we want to do after that is we want
to return those muscles back to their normal length.
So that's where you can put in your static stretches,
stretching out all the muscle groups that you've used during
that activity to make sure it's specific to your sport
or to your activity,
and that will massively reduce the risk of
post-exercise stiffness and muscle stiffness.
Now, there's other things alongside managing exercise well.
So hydration's really important.
We tend to find when people are dehydrated,
they have a higher incidence of muscle cramps
and they're more likely to develop muscle
stiffness following that.
So keep yourself well hydrated if you know you've got a
performance or an activity or an event coming up.
There's a lot of research behind the effectiveness
of hyper hydrating, so putting plenty of fluid in your body
so it's able to perform well,
and the nutrition is supplied regularly through the body.
We classically see sort of muscle cramps at nighttime,
so good advice is to try
and keep flexible if you are prone to getting muscle cramps,
which we do see with people in later life is maybe look at
stretching before bed and waking up and trying to stretch it
and keep it moving in the morning.
But I think the main thing is adequate warmup,
adequate cool down, and keeping strength and flexibility.
How much should I exercise to prevent joint problems?
It is difficult to give you a generic answer on this
because we're all different.
So exercise is really individual.
Somebody who exercises regularly will need
to challenge their musculoskeletal system more in order
for it to adapt and get strong, as opposed
to somebody who's maybe more sedentary in their lifestyle,
who maybe will only have to exercise at a lower level.
The most important thing I think, is listen to your body.
If you start to exercise where you've not done before
and your body starts to give you signs of distress by pain
or getting aches, or you find it's affecting your function,
then modify your activities
and reduce what you're doing at that time.
Let your body build up slowly.
It takes about six to twelve weeks for our muscles
to get strong, and it's important that we have strength
around our joints to help keep them healthy.
We can avoid injuries to the joint
or problems to the joint by monitoring our weight as well.
There's a lot of strong research to say that people
that are overweight put more load through their hip
and their knee, and that can lead
to more degenerative conditions like osteoarthritis.
Should I avoid weight training exercise?
So weight train exercise is really important
in our weekly exercise routine, we talked about
physical activity recommendations, working aerobically,
but also there's evidence to say that we need
to be working with strength training.
Our bodies adapt to strength training by becoming stronger,
which means we can move our joints more effectively
and we become more functional.
The research shows that after the third
and fourth decade in life, we start
to lose muscle mass if we're inactive,
and that can range between three to 5%
of our muscle mass per decade.
So it's really important
that we keep regular strength training within our exercise
regime, and it's not too late to start.
There's research to show
that in later life if you still engage
with a strength programme, you can still
show strength improvements.
The key of it is ensuring that you do enough
that you do the high enough intensity in order for your body
to adapt and for it to change.
So take home message is stay strong.
Can too much exercise be bad for me?
So exercise is really important.
Too much exercise of course is bad for you,
but regular exercise isn't.
So when we get to a point
where we've done too much exercise,
our body start to tell us about it.
So what we find is we start
to get more post-exercise soreness
that doesn't resolve quickly.
So instead of your exercise soreness lasting maybe an hour
after exercise and having a little bit
of stiffness the following day, that you are in pain
for two days, three days,
and that recovery is taking longer then absolutely,
you've overloaded your body.
And that's when we tend to start seeing injuries
and people start to get pain,
and that affects their function.
So listen to your body as the take home message.
If you find that you're starting to get aches
and pains, adapt your exercise, modify it and reduce it.
Give your body time to adapt
and give your body time to recover.
I think the most important thing
with musculoskeletal adaptation is just being aware
that it is slow to respond.
Give your body time to respond, let it adapt,
and then we'll massively reduce the risks
of you developing any aches and pains from exercise.
Will repeated bending and twisting lead to a problem?
We get a lot of these questions,
particularly when people come in with back pain,
and that myth of bending
and twisting can cause pain, so I mustn't do it.
The problem with that is those myths create a fear,
and that fear prevents people from moving.
And the best way
and the strongest research behind managing back pain
is exercise.
So if we avoid exercise
and we stop bending, we stop twisting, we stopping provide
that rehabilitation that gets our bodies better.
So there's no link between bending and twisting
and recurrent injuries.
Is joint/muscle pain hereditary?
There's no consensus on this, whether the joint
and muscle pain is hereditary.
Age-related changes like osteoarthritis aren't hereditary.
However, there are certain autoimmune inflammatory
conditions that can be so for example,
rheumatoid arthritis is one of those.
So if you are close family members, if your mother
or father has rheumatoid arthritis,
you do have an increased predisposition to developing this.
The older I get, the more likely I'll develop a condition, is this true?
It is not completely true.
What you tend to find is there are age-related conditions
like osteoarthritis, which typically we'll see
the prevalence increases, age increases.
However, there are studies to suggest
that actually back pain reduces in prevalence in later life,
perhaps as our judge start to stiffen a little bit more,
they move less, so less likelihood of overloading them.
However, what we do see as we get older is
that our body's condition and our body's ability to move
and function and balance certainly does deteriorate.
Now, it's important that we help provide the body
with enough stimulus to stop that from happening.
So in later life, as our muscle strength reduces,
keep providing that your body
with enough resistance training, enough strength training
to prevent that deterioration.
It's really important as well,
that in later life you work on regular exercise
to help improve flexibility, to help improve balance.
Because if you are mobile and if you are more strong
and flexible, you're going to have less likelihood of slips,
trips, and falls, which can easily occur in later life
and cause significant impact to your function.
Can I prevent conditions like Osteoarthritis?
Osteoarthritis is typically an age-related condition
and a degenerative condition.
So as our bodies get older on the outside,
they also get older on the inside.
So what we can see in a mirror is grey hair and wrinkles.
And what we see on the inside is that smooth,
slippery cartilage that we have over our joint surfaces
that when we're in our younger years, is sort of glass like
and smooth becomes a lot more roughened,
a bit like a sandpaper.
And it can go through that gradings
of sandpaper as we get older.
And that can have more and more impact on
how your joint moves
and how your body functions,
which ultimately can result in pain
and you needing support to manage that.
So we can slow the progression of arthritis
by keeping good nutrition to our joint, keeping healthy
with a good weight.
So we know that people who are overweight
and carry more load have extra stress
thrown through their joints.
And there's a strong relation between high weight
and incidence of arthritis.
And can we ensure that our joints are kept active?
So regular exercise is another really good way
to help prevent the deterioration of the joint surface
and keeping the joint healthy.
And probably the best take home message with
that is strength training.
The stronger we can get our muscles around the joint,
the more that can offload the work
that the actual joint surface does and reduce that overload
and that deterioration in the joint.
So keeping an eye on weight,
making sure we keep our joints strong.
Also thinking about our other lifestyle choices.
So smoking, we know that has a deteriorating impact
of joint surfaces, so stopping smoking
and also excessive alcohol intake.
So try and make those lifestyle changes earlier on in life
and then we'll be able to keep our joints healthier in later
life.
Can a physiotherapist advise me on avoiding pains and injuries?
Physiotherapists are perfectly placed
to advise you on avoiding and preventing injuries.
Their advanced knowledge on injury management
and rehabilitation helps give them enough ingredients
and enough knowledge to help guide you back.
I think the most important thing is making sure
that you grade your exposure to exercise,
build it up gradually allow the body to adapt.
The research suggests it takes between six
and twelve weeks for muscle tissue to adapt, for muscle fibres,
to become more numerous, numerous, and to become fatter.
And that's what generates strength
and that is what will help keep us healthy, happy,
and functional.
How long should I self-manage any aches and pains?
A lot of injuries can be successfully self-managed,
and as physiotherapists,
we don't see every injury everybody has.
What you'll typically see is small sprains
and strains will resolve quickly within a couple of weeks
as long as you modify your activity and are sensible
and listen to your body.
However, anything that lasts beyond two weeks
that isn't showing signs
of improvement is when you should start
to seek some more support and some more advice,
particularly if your symptoms are deteriorating.
I wouldn't leave symptoms that are getting worse
for longer than 10 days.
However, if there are signs
that you're getting significant changes in muscle power
and you're finding that you're extremely weak,
really quickly seek advice very promptly.
And if you're noticing any abnormal symptoms, pins
and needles, or numbness, you're having difficulty sleeping
because you're waking regularly through the night
because of your pain, then seek some
professional advice soon.
It may be that some early simple intervention can help
manage your condition really quickly
and get you back to activity.
And if you ever find yourself in that stage,
if you're a Bupa customer,
contact our MSK Direct Access service.
Or if you're not a Bupa customer, get into your NHS GP,
or perhaps you can access some self-referral
to physiotherapy.
Does applying hot or cold therapy to aches or pains work?
It's a good question and it's something
that we're asked a lot about.
There's no real significant research to say
that one is better than the other.
However, I do give advice about it,
and I think the easiest way
to look at it is if you've got an acute traumatic injury
where you can see swelling
or bruising, that's a sign
that there's significant inflammation in that tissue.
You'll often feel that it gets hot.
And what does your brain tell you?
Put some cold on it, and that's what I'd go with is listen
to your body, get some cold on it.
Swelling is healthy because it brings nutrients to heal,
but persistent swelling, swelling that stays
around the joint for longer periods can have a big impact on
your recovery and how you function.
So get some ice on it, manage it regularly,
try and get movement back to it.
But ice is great for acute injuries like that
where we can see that swelling.
I'd use heat when we tend to see maybe more muscle injuries.
So perhaps you've overloaded the tissue in the gym
or exercising and it's feeling tight.
Maybe you've got a cramp or a spasm in the muscle.
That's where heat's really good.
Can we relax the muscle to get it back
to its original length and can we calm it down?
So ice in the acute period for those first sort of seven
to 10 days, calm down that swelling, then heat on it
to help try and warm up the muscles around it,
help return those muscles back to their original length
and regain the flexibility and ultimately your function.
How can I stop pains returning?
So management of an injury is really important
to prevent pains from returning as you engage
with the rehabilitation exercise
and get yourself back to normal function.
There's definitely an aspect of maintenance that's required.
Unfortunately, with musculoskeletal adaptations,
if we don't keep stimulating the body with that need
to get strong to help keep flexibility, then we can lose it.
So we hear the phrase that use it or lose it,
and there's definitely a bit of theory behind that.
So making sure you keep exercising regularly.
There are a few studies that say to maintain strength,
you can exercise a couple of times a week to help make sure
that the body doesn't deteriorate further.
So I always recommend when people have resolved their
injury, that there's an ongoing maintenance thing.
Now, that doesn't have to be continued with your exercises
that you've been given by your physio.
It may be get into an activity,
get into a sport that you want to do.
It's really important that you enjoy what you're doing,
and if you don't enjoy the exercise, it's very unlikely
that you're going to maintain it.
So enjoy your exercise.
Find something that you want to do
because you'll keep to it.
And if it's new, build yourself up to it.
Let the body adapt. Let the body change.
Try to listen to your body and don't overload it.
Give that body time to adapt and keep it strong
and that'll avoid any recurrence in your injuries.
What's the difference between acute and chronic pain?
So acute pain is pain
that typically will resolve within healing timeframes.
So what I mean by that is tissues responding
to the body's natural progression
and natural laying down of new fibres.
So that may be anywhere between six and twelve weeks timeframe.
Chronic pain is something that's classified as pain
that lasts beyond that timeframe,
and that's where it can become a little bit more complex.
Chronic pain isn't always linked to just the amount
of tissue damage that has occurred,
and chronic pain can be influenced by a lot
of bio-psychosocial issues.
So it may be your beliefs about your injury,
what your initial thoughts are of how to manage it.
It may be your consequences at home, at life,
your mental health at the time,
and all these very complex aspects
of pain can feed into your pain becoming more persistent
or becoming more chronic.
How long can back pain last?
Recovery for back pain can be really varied,
and this may be due to sort
of the amount of tissue that's damaged.
So if we are looking at a small injury, a sprain
or strain where not many fibres have been involved,
we expect those to resolve reasonably quickly
with modification of activities,
perhaps some pain relief in order to help get you back
to moving and functioning well.
Or maybe if there's more tissue damage
that has a more significant impact on your function,
that you need to let your body have a little bit
more time to adapt.
And those will normally occur between six and 12 weeks.
Now, after that 12 week mark, pain isn't always linked
to the amount of tissue damage that can occur.
And we can find that tissues are actually healing on the
inside, but there is no influence to our pain.
And so the research in the last five
to 10 years has very much looked at persistent
and chronic pain to say that there is no correlation
between pain and tissue damage.
And so what does that mean to you in your recovery?
Basically, listen to your body,
but don't be fearful of pain.
If we're fearful of pain, we're not going to move well,
which means we're not going to recover.
A movement is the best way to recover from back pain.
Our national guidelines recommend exercise
as the premier sort of activity in order
to manage back pain.
So exercising regularly is really important.
Understanding and taking on board that pain
and tissue damage at that stage
of your recovery isn't always linked.
So listen to your pain, but work with it.
Try and focus a little bit more on function.
If you are able to walk for five minutes, day one,
see if we can start to look at progressing that gradually.
And that's the important thing
with our musculoskeletal system.
Give it time to adapt.
So what we'd look at is say five minutes, day one,
let's try seven minutes at day three
and 10 minutes at day 10.
Build it up gradually let your body adapt.
You'll find that your function will improve
and in time your pain will start to reduce.
How can I keep my muscles, bones, and joints healthy?
So keeping our muscles, bones, and joints healthy.
The take home messages, keep active,
that's the most important thing.
Sit less and move more.
There are loads of physical activity guidelines.
The World Health Organisation recommends
we exercise around 150 minutes a week.
So that's looking at 20 minutes at least a day
of cardiovascular exercise.
So that's exercise of moderate intensity, getting you
to a level where you're slightly breathless, still able
to hold a conversation, but maybe having to take a breath
to continue that conversation.
And that should be done regularly
to help improve cardiovascular health,
to help improve muscle and joint health as well.
And I think one thing that's often forgotten
with exercise is strength training.
As we get older in later life, we tend to lose muscle mass
and we tend to lose strength.
So keep in part of that strength programme during your week
and during your exercise is so important.
So keep active, move more, stay less,
and that's the best way to keep your bones
and joints healthy.
What are the key tips for healthy bones and joints?
So keeping healthy bones and joints is really important.
The early we start this, the better the impact.
So we know that keeping joints healthy comes about
by keeping the joint strong.
So we need to make sure that the muscles around
that joint are strong, making sure
that we don't excessively load that joint.
So monitoring
and keeping an eye on your weight is really important.
And also giving the joint enough nutrition, calcium,
and vitamin D are really important.
If we go to the strength training, it's important
and we recommend to people
that they're doing strength training at least twice a week
to overload that muscle in order to keep the joint supported
and keep the muscles strong.
With weight. We know that people
who are overweight put more stress
and more load through the joint surfaces.
So if we look for example at running
where we are massively increasing the load
and the research suggests that can be up
to five times our body weight through our lower limbs.
If you've got an extra kilogramme
or three of weight going through that joint,
you can imagine the stresses
and strains that are going to go through that
and the impact that diet might have,
and also diet and nutrition.
So calcium is really important to make sure that
that's in our diet to help lay down good healthy bones.
As we get older, our bone density reduces
and we see that also in post-menopausal women.
The hormonal support in order
to help keep bone density isn't there.
And so we need to make sure that we have enough calcium
to help support that.
Now calcium doesn't help to provide strong bones on its own
and it needs vitamin D and we absorb that from the sun.
So in the summer months in the uk, we're okay.
We might be covered if there's enough skin exposure.
However, in the winter months when we not have
as much skin exposure, it's important
to supplement your diet with vitamin D
to help reduce the risks of changes in bone density.
So to summarise, keep strong,
make sure you're not carrying excess weight.
Keep nutrition to the joints.
And I think the other things to keep in mind of is
not taking too much excessive alcohol and avoid smoking.
Where can I go for useful information about muscles and bones?
I always recommend people look for sources
that are ratified and that are trusted, so go to Bupa.
We know that the literature
that's published on our website has been ratified
by professionals, and it's been reviewed to make sure
that it's in line with good recent evidence-based practise.
Of course, we've got lots of research
and sources through the NHS as well that you could look at.
So look at reputable names that
provide good sound health advice.
When should I seek professional advice and treatment?
So I'd always encourage people
to seek urgent advice if they're finding
that their symptoms are deteriorating quickly.
If you're noticing that you've got any neurological
compromise, what I mean by that is if you're seeing signs
that you're getting any numbness in the body part,
if you notice any pins
and needles, if you find
that you're getting any deteriorating muscle power
or urgent weakness, seek urgent advice.
Any other abnormal systemic symptoms as well.
So if you're starting to develop a temperature, a fever
that might be causing night sweats,
or you're starting to see a significant weight loss,
always go and seek urgent medical advice.
And that may be if you're a Bupa customer,
contacting us at MSK direct access service,
or if you're not seeking advice
and support through your NHS GP
or maybe your self-referral physiotherapy.
How do I access support through Bupa?
If you're a Bupa customer, we can help you
through our MSK direct access,
or you can speak to a physiotherapist
through our digital GP app,
or you can access our Anytime Healthline nurses
who are available 24/7.
Muscle, bone and joint conditions
Information on conditions, as well as symptoms, causes and possible treatments.
Treatments for muscles, bones and joints
Information on how you can treat muscle, bone and joint conditions.
Do you need physiotherapy?
With or without insurance, we can help you
If you’re a Bupa health insurance customer
You can book physiotherapy appointments using our Bupa Blua Health app.†
You can also call us on 0345 609 0111∧ to discuss your aches, pains or an injury. Depending on your symptoms and cover, we may arrange a telephone or video call appointment with a physiotherapist.
If you don’t have health insurance with us
No problem. We can still help you on a pay-as-you-go basis. Just pay for the treatment you need, when you need it.
Call 0343 252 8868∧∧ to find a physiotherapist near you.
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Try these simple back stretches at home to ease your aches and pains.
How to prevent shoulder injuries
Hear from a physiotherapist about common injuries and how to avoid them.
Inside Health:
Joint health and movement with Dr Zoe Williams
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Watch in 56 mins
Dr Zoe and Bupa's physiotherapists discuss the causes and symptoms of arthritis, myths around movement, exercise and more.
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 presubmitted 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.
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.
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 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 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.
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.
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 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.
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.
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.
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.
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 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?
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 handson.
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 handson 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 selfmanaged 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 selfrefer.
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 selfmanagement 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 selfmanagement 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 overthecounter 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 selfmanagement 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 overthecounter 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 loadingbased 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.
Inside Health:
Muscles, bones and joints with Channel 4’s Dr Helen Lawal
Pain management | Arthritis | Posture | Exercise
Watch in 56 mins
Bringing together physiotherapists, elite athletes and Bupa’s clinical team to help you understand how to keep your muscles, bones and joints healthy.
Hello, Welcome and thank you for joining us. I'm Dr. Helen Lawal and I'm an NHS GP and I'm your host for today.
So the focus of today's event is musculoskeletal health, also known as MSK. So you'll hear me refer to it as MSK throughout as we go along.
So we're going to be looking at muscles, bones and joint health which are really commonly presenting conditions that can
affect us all at any point during our life. We've got hundreds of questions that you sent in.
So thank you for sending those in and we're hoping to address those during live interviews with our experts
and also in a quickfire round at the end we're gonna have a quick Q & A round right at the end of the event, so stick with us.
So first to make sure we're sitting comfortably we've got the help of Mike Livesey, now Mike is Bupa's specialist physio
Then moving on we'll be speaking to Dr. Petra Simic, Petra is the Medical Director of Bupa Global and UK Insurance,
and she's also a very experienced GP. So she's going to be giving us an overview of musculoskeletal health,
looking at common aches and pains and what we can do to manage pain and common conditions like arthritis, tendonitis, and osteoporosis.
Moving on, we'll hear from Bupa's UK Sports Ambassadors who will be sharing what we can learn from elite sports.
Then we have our second expert of the day joining us remotely, Judith Smith. Judith is Bupa's UK Insurance, Advanced Physio and Clinical Lead.
She's going to be discussing the importance of building mobility and getting started with exercise.
Then we'll have Mike again for a short demo on exercises we can do at home to prevent and treat common muscle, bone and joint injuries.
And finally, last but not least, we'll have Mr. Damian McClelland Now Damian is an orthopaedic surgeon
And he's also Bupa's Clinical Director of MSK. We're going to be having a really interesting discussion on the impact of surgery,
Why not always the answer, and how to prepare and get fit for surgery.
So to begin with, we've got specialist physiotherapist Mike Livesey, who's going to be showing us how we can sit comfortably.
Thanks, Helen. Hi, everyone joining us today, I just wanted us to get started with some simple exercises,
a little bit of advice about seating posture to make sure you're nice and comfortable. What we tend to see a lot of in clinic is
people coming in with spinal pain or shoulder pain because of poor seating position.
So where do we get started to help correct that? A good place to start is thinking about your spinal posture
and you spinal position and that supporting as much as possible. The spine as you know, has curves throughout the spine.
So if we can support them, and that will help offload the work that the muscles are trying to do to maintain that position.
If you're sat at home in an ergonomic chair with sort of ergonomic design, like I am, with a built in lumbar support,
make sure you're using it appropriately. You need to sit all the way back in the chair for that lumbar support to be in the right position.
That allows then the upper back to be in a much better position, the shoulders to sit back more comfortably
and the elbows dropped by our sides so we can get nice and close into the desk and the forearms to be supported.
If you're sitting at home on the sofa, use a towel or use a small cushion to roll up and just keep that support in that lower back.
But what happens if we don't have that is we slump, the shoulders drop forward, and the head comes forward and it goes a lot of unwanted stress
at the base of the neck. So try and get that spinal posture supported, helps you sit in a much better position.
Another good tip is try and get your feet flat on the floor. When we're rotated or feet up on the sofa or chair or legs crossed,
puts different stresses and strains on the knees and the hip. So it you're there for sustained periods of time that could start to become uncomfortable.
So feet flat on the floor helps knee and hip alignment alongside that spinal position keep you in a really good starting point.
A couple of simple things to remember though is movement. Get up, step away from your chair and step away from your sofa
for as much as you can. Don't stay for longer than 30 to 40 minutes ideally. If you can't get up and move around that much,
then do some simple exercises in your chair. So try and join with me, sit forwards at the front third of your chair.
I want you to sit up nice and straight, squeeze the shoulder blades together you might feel a bit of pull through the front of the chest that's quite normal.
hold that position for 10 seconds, and then relax. Again sit up tall. Second exercise, fold your arms across the chest
so your hands on your shoulders sitting straight and going to twist over one side as far as you can,
and then back to centre and then again the other side,
and back to centre. That's a great way to help mobilise that mid back and just get it moving if you are sitting for long periods of time through the day.
Roll and stretch out your neck by taking your ear down to your shoulder, feeling a stretch on the opposite side.
Hold for a few seconds and come back up and again even yourself out. Repeat it over to the other side and come back up.
Final movement is just simple turns over one shoulder, back to the centre and again repeat the other side.
Back to the centre. These should just cause a mild pull shouldn't be causing any pain.
So if you are getting anything like it might be worth seeking a little bit of advice from your physiotherapist.
But these are a couple of simple tips to go away and think about this morning, and get you started I'll be back with you
later with a couple of other exercise tips. So back to you Helen Thanks Mike, some really useful tips there.
So I'd like to start by welcoming Petra. Hello Petra, good to see you. So thank you for joining us today to talk all things MSK.
So let's start by exploring some of the common areas that tend to affect people when it comes to their MSK health.
So muscles, bones, joints and often it tends to be three areas at least that's what we've heard from customers,
arthritis, tendonitis, and osteoporosis that actually Bupa customers are interested to learn about.
I'm also hoping we can touch on pain management as well, because that's a big in something, which really impacts on the quality of life.
Sure Helen, well you know it's no surprise to you, you know that in practice, MSK conditions are really common.
In fact, they make up about one in five of the consultations that we see as GPs and then the most common joints affected are
backs, necks, shoulders, and knees and I'd say those are things that people come to us with pain in most commonly.
And certainly, the last year, I've seen a slightly different pattern and two broad groups of people coming to see us.
So we're seeing groups of people coming to see us who've increased their exercise really use the pandemic as an opportunity to focus on
their physical health, which is admirable and something that we really promote as doctors, but often they're overdoing things.
So we're seeing people that are gaining injuries, through taking up sports that maybe they haven't done for some years
or doing things too much and not listening to their bodies when they're getting aches and pains. So we're definitely seeing
groups of people coming into surgery who have injured themselves through doing new sports or using home equipment
incorrectly or unsupervised yoga. So they're developing joint aches and pains that we have to help them try and fix.
The second group of people we're seeing a lot is those who used to exercise more in their everyday life than they
perhaps realise. So their commute to work their jobs with they've been furloughed, and for those people that have been
shielding, their level of activity has dropped hugely. And that affects joints too, joints like to move and
mobility is really important. So reducing levels of activity have meant that some people have developed aches and pains that they
weren't expecting and either during the period of being more sedentary or when they go back to doing exercise people are
noticing that they're getting pains where they weren't expecting it or didn't have before.
So those are the kinds of things that we're seeing. You know, the human body,
we expected just to work and to do what we asked and we often don't think about what good condition we're in how much exercise we
should do, and slowly building that up and certainly rest and recovery are not things that we're always that good at doing.
So it's important that we really reflect on the exercise we want to do and make sure we do it in a in a graduated way.
I think we tend to take our bodies for granted don't we until something starts to go wrong and the aches and pains to creep in.
Absolutely. So talk to us about arthritis and by arthritis we mean osteoarthritis. So wear and tear arthritis.
Tell us more about that? Well wear and tear arthritis, osteoarthritis, again, incredibly common. If you've been diagnosed with it, you're
in really good company. I think it's again about one in five people over 45 will have signs or symptoms of knee arthritis but
the problem is that phrase wear and tear arthritis. So if you had a washing machine, and the engineer said it was suffering
from wear and tear, you're very likely to not want to use your washing machine as much because understandably you think well
the more I use it, the worse it will get but it's not the case with with osteoarthritis.
The important thing to try and resolve osteoarthritis, reduce its progression and improve
things like pain and function is keeping that joint mobile. So keeping mobile is really important. Offloading any excess
pressure onto a joint so particularly on the lower limbs if you're carrying any excess body weight that can really
affect pain and function on your knee or hip or ankle so if you are overweight, losing weight that can make a dramatic
difference to any pain you might be suffering with your arthritis
and strengthening and this is something that I think often we don't talk about enough so if we can strengthen the muscles
around an affected joint and sometimes the joint above or below, the stronger we get, the more it offloads that joint
and the better the joint functions, the less it degenerates and progresses and the better performance that you can get out
of the joint. So, those things are really important. Often I find patients feel a bit disappointed if they're
offered painkillers for their osteoarthritis but using painkillers can really help you function more normally and use
the joint more because it's less painful, and that in turn improves the outcome of your osteoarthritis.
So painkillers can be an important step. I think the other thing that may be a bit
misunderstood is how important surgery is and osteoarthritis because the vast majority of people will improve
with things like physio, strengthening exercises, graded exercise
and only a very small proportion of people will benefit from surgery in the long term.
What often happens when patients when they're in pain, and they've got arthritis or they are overweight and have been told to lose weight, how can I because I'm in pain? Or how can I
it's difficult to exercise? So hopefully our expert physiotherapist can guide us on how to approach exercise safely later on.
So talk to us more about tendinitis. What does it actually mean? And how can we really manage this at home or
even prevent it at home. So tendinitis is a different type of condition to osteoarthritis and you have to treat it quite differently.
Although as a patient, it might feel quite similar, because it's often a painful joint and the joint can feel quite stiff too.
But it's an inflammation of the tendon and the tendon is a tough bit of connective tissue that joins muscle to bone.
and essentially it's an overuse condition. It's when we've used a muscle group either over and over again for the same activity
and tired it or we've used a muscle group that's not strong enough for what we're asking it to do.
So it is something that sometimes you do need an expert like a physio to help you diagnose,
but the most important thing for tendonitis is rest. So where as for conditions like arthritis we might encourage
activity, for tendinitis, certainly at the beginning, rest is an essential part of letting that muscle group
heal and recover. And the next thing to do is to then kind of
recuperate the area. So if you've have tendinitis, that tells you something, it says something is not right.
Either your muscle group is too weak for what you want it to do or you're doing something in a way that irritates it. So you really
need to look at whether it's the ergonomics of your desk or your swing in tennis. Your tennis elbow is a tendinitis and going
to see a physio to see which muscle groups need strengthening to prevent it happening again because what I see in general
practice, and I'm sure you do, is people have episode of tendinitis, they recover and then six months later you see
them again and they've done no work in strengthening their muscle groups in between the episodes.
Painkillers can be helpful, anti inflammatories really useful. Sometimes the joint is so inflamed that the only thing that will help you
are things like steroid injections. But at the end of the day it's rest and then that kind of recuperation and
rehabilitation afterwards can prevent it becoming a recurrent problem. Actually, the body's really clever, isn't it? It's the
body's way of giving us a warning sign and saying, hang on a minute, something you're doing or not doing isn't quite right
here and I think it's really important to get help in those early stages. You're absolutely right and I think this is a real example of
when people say, "No pain, no gain." It's not the case when it comes to tendonitis. If it hurts, you must stop and change
what you're doing, there's no benefit from going through the pain, especially in a case of tendinitis.
So moving on then to talk about osteoporosis, which is a very different type of condition. Talk to us more about that.
So osteoporosis just means porous bones, spongy bones
and I think it's important to understand a little bit about our bones and how they change through our lives.
So, our bones much like most of the cells in our bodies are constantly
renewing themselves and our bone regeneration as a child and
adolescent is amazing. It allows for us to grow and we've all seen children falling off their skateboards and their bikes and
the climbing frames, and they have a few bruises and they just jumped straight up again. So incredibly strong bones
when you're in that kind of growth phase. And then in adulthood, your bones continue to renew itself and actually,
you're although it's a constant state of renewal, you get a new skeleton around every 7 to 10 years, which I think is fascinating.
But from the age of 40 that bone regeneration slows down and everyone suffers a degree of bone density loss.
Now osteoporosis is just a phrase for low bone density and as a
condition gives you no symptoms until you have a fracture. So often you might not know you have osteoporosis until you have
a particular type of fracture and the type of fractures that we think about that are linked to weak bones are hip fractures.
So if you think about it, you don't hear about young people falling over and breaking their hips. It's very much a condition
of people as they get older. Wrist fractures, particularly if just falling from a stood up height and falling out onto an
outstretched arm. And for some people, if they lose heights as they get older or get a curvature of the spine that can
be a sign of osteoporosis, where the vertebrae are actually crushing down, which sounds very dramatic, but often with no pain at all.
So osteoporosis is a condition of thinner bones, making you more liable to fracture. The good news is that
although most of us will have reduced bone density as we get older, there are things we can do to reduce that risk.
So keeping a healthy BMI actually it's one of the few times as doctors we talk about being slightly overweight
actually reduces your risk of having and when you say BMI, you mean? Body mass index, so how much weight you carry on your body
and it's to do with that the harder the bones have to work, the stronger they get and that's also the case with what
we describe as weight bearing exercise. I think that's often misunderstood. I think people think that means lifting
weights and it doesn't it just means putting impact through bones. So even brisk walking, dancing, certainly things like tennis
or running are what we call weight bearing exercises and they can really help the bones to grow in a strong way.
Having a calcium rich diet, that's really important. So those are things you can do to really keep good bone health.
But there are things that you can't help. So as you get older, it reduces your bone density. If you're a postmenopausal women
not taking HRT, we know that that increases your risk of having osteoporosis. If you're someone who's always been very
lean, having a low body weight, that will increase your risk of osteoporosis as well smoking or drinking a lot of alcohol.
And anyone that's taken oral steroids for long periods of time, that will increase their risk. And if you've got a family history
of osteoporosis that can increase your risk and people often don't know about that, they'll know that their
mum had a hip fracture but no one quite explained to them that meant that their mum had osteoporosis and so having a
family history of osteoporosis can increase your risk. If you have a diagnosis of osteoporosis, the good news is
there are some really effective treatments and medications that you can take to strengthen your bones. If you think you've got
risk factors for osteoporosis, then it's a good idea to have a chat with your GP. You might benefit from a bone density scan to see
how strong your bones are. And if you are one of your loved ones that has had one of these fractures or is losing height
curving in the spine, it's probably again worth a conversation with your GP to establish does this person have
a reason for having the fractures something like osteoporosis and are there treatments that can prevent them
having a fracture should they fall again sometime in the future?
And finally, it'd be really great to get your thoughts on when is the right time to seek help, especially thinking of people who maybe they have a job or an occupation, which is you
know, being impacted by some of the symptoms they're getting and they want to prevent it worsening, so it doesn't impact
on their work. So this is quite common in general practice that people will present with joint problems that are affecting their ability
to earn a living. And what I try to impress upon people is the importance of getting help early that their bodies are as an
important tool as their laptop or their mobile phone and if it's not working properly and starting to niggle not to wait
for it to get worse because often treating these things early prevent them becoming such huge problems that they
have to pause work or take time off work or even stop work for a while which can have quite a dramatic effect on people's
ability to earn a living. Thank you I think that's really great advice and the key message there is really don't ignore your body, seek help
there is help out there and act quickly so that we can hopefully prevent some of these conditions developing and progressing
and worsening Absolutely. As part of Bupa's partnership with UK sports, we're going to
be hearing from some of the UK Sports Ambassadors, sharing their journey and also how they use injury prevention in their
daily lives.
I think one of the biggest things people neglect is mobility and flexibility. You know it's often time when a
muscle is pulled, it's probably because they've got into a position that their body is not used to. So if you can stretch
and do some form of mobility and flexibility every single day that is paramount for staying injury free, without a doubt.
I've been training now for 14 years, a long time and so far,
touchwood, I have never had an injury. So I must be quite good at injury prevention I don't know, or not training hard enough
One of the two.. I literally tore my cruciate ligament on Strictly I jumped
off the table and tore in the rehearsal and then it was hard to recover because like all the gym shut all the physio shut,
So I had to do my rehab on my own and I didn't realise how big of operation it was. Every day I'm like trying to learn about my
injury, like still now it's like year and a half after the operation, and like, I'm still managing my knee, like every day.
My first real experience of injury was when I was 14 I had
a double stress fracture in my lower back I had to do a rehab. When I was 18, I tore me cartilage off the bone on my
wrist had a surgery and had to do a rehab. When I was 21 I snapped my ankle ligaments had a surgery and had to do a rehab.
At this point, I'm sort of used to the process. It never gets easier But it's right. This is real. What can I control?
That's what you do you, you control the controllables. You try and just focus on that. Everyday I can do my rehab,
There's always some positive that you can take out
It was straightaway drummed into me that you always get a good warm up, always get a good cooldown, always have the
recovery you need between reps. So it's something that I've just kind of carried with me through through my years. And you know,
so many people just want to "I have done my session now" "I'm off, I'm done". Always do stretching, always make sure
that you've done those little things because it makes such a big difference.
We have physios that are based here full time so that we can use that as much as we want. Obviously, for my conditions,
it's important to us that when I can I get really stiff joints and to have that opportunity to use the physios is massive.
When I'm working with the physio, a lot of the exercises that we do with them in the gym is like helping
prevent injuries because like I'm trying to get stronger and that will like therefore hold my legs in position better and I
won't get that tear or anything like that. If I'm the stronger am like physically the less likely I'm going to get an injury.
I know gyms are open now and we all can't wait to get back in but don't just run in and go straight to the benchpress machine.
Go in, do a little stretch, do a little warm up. So maybe you know, little run on the treadmill, a slow one.
I think just be very aware of your own fitness levels. I had physio every week when I wasn't injured and it that was a
preventative. It was sort of making sure that, certain areas where I get tight I keep loose.
If you've got any kind of injuries or little niggles always go to professionals you know don't try and self treat it
because it can only make it worse. For you have to learn how to manage your body and yeah,
still learning. It's really great to hear from Will, Nile and Hannah there,
sharing their experiences and learning as elite athletes. and also from their point of view on how important physiotherapists
were in, getting them fighting fit and ready, and how important it is for us all to take care of ourselves.
So now here's your opportunity to take part in our poll, and the option should come up on the screen in front of you.
So what one thing do you want to focus on to improve your muscle, bone and joint health?
Is it to lose weight? Start exercising? seeking help for an existing issue? changing your diet or all of the above?
Next I'd like to welcome Judith, who's Bupa's Advanced Physiotherapist and Clinical Lead.
So Judith, we've had lots and lots of questions on mobility and strength. So can you share some tips on really how the audience and people at
home can use exercise to help them build up their mobility and strength? Yes, thank you, Helen. That's a really great question to start with
as strength mobility plays a crucial role in keeping muscles, bones and joints healthy and preventing injury.
Strengthening activity is as important as aerobic exercise. but recently a study showed that only 30% of people actually
meeting both the aerobic and muscle strengthening guidelines and we are least likely to meet the strengthening component.
Strength is often referred to in fact as the forgotten guideline in comparison to the much better known recommendation for aerobic exercise
and the Physical Activity Guidelines tell us that muscle strengthening activities should be completed on at least
two days per week for the major muscle groups including the legs, hips, back, and shoulders. As well as balance and
flexibility activities to build strength and mobility. Adults should be physically active every day, reducing the amount
of time spent sitting and breaking up long periods of not moving, such as desk based rolls of activity.
Being active can can have an enormous benefit on the overall health and it doesn't need to be difficult or expensive.
Whatever your situation, there are some simple ways to get started and improve your health in way that is right for you. You can start to aim
for small bouts of 10 minutes of brisk activity throughout the day and what we're aiming for is about 150 minutes of moderate
exercise over the week plus the specific strengthening exercises.
If you're new to strengthening, shortly, Mike will show us some easy ways to get started and just remember
that it's never too late to start increasing your strength. In fact, one study showed us that after a 12 week strengthing
programme for a group of 90 year olds, they were able to double their muscle strength. The fit principle gives us four ways to
progress the amount of activity that we do. So fit stands for frequency, intensity, time and type. Frequency, this means
increasing the number of times per week that you're active. Intensity, walking a little bit faster, cycling a little bit harder,
digging harder in the garden, and time, increase the amount of time that you spend on each of the exercises and then
the type. So if you're comfortable with the exercise that you're currently doing, try something a little bit more demanding. This is especially important after the events of
last year where people have experienced deconditioning due to reduced activity levels. Make sure also that you find an
activity that you enjoy the chances are you'll stick to a new activity if you're enjoying it and don't worry if it's not
the most taxing to start with. Because the best activity is one that you will actually do. Start gradually give yourself small
goals and set realistic targets and you'll soon see the positive effects of exercise without overdoing it.
That's brilliant Judith. I think that's really really good advice and love fit, frequency, intensity and time, it's a
really easy way to remember and like you said, it's about building exercise into your day to day isn't it, it shouldn't
have to be a chore and 10 minutes here can really work. I think the key really is to find something that suits you that
you enjoy. And that you can incorporate into your daily life, whether that be an active commute, you know, walking
instead of driving to work, and even things that we don't think about like gardening and things can actually count towards our
physical activity. Absolutely and also increasing with strength, gardening is
a fantastic exercise because it's going to give you both the aerobic component and the strengthening part is often missing
Just clarify you use the word aerobic there just explain to us what the different main differences between aerobic
and strengthening exercise. So when we're working on aerobic exercise we're wanting to
increase our heart rate slightly. So you should feel slightly out of breath, you should be needing to take a rest
to complete a full sentence. So you know that you're getting a little bit of a sweat perhaps. and your heart rate is slightly
increased. Strengthening exercises and more for loading the bones and strengthening the muscles so they can be they
don't need to be things that you do in a gym. They can be things that you can do at home using your own body weight, doing squats
working more on the function of the muscle. You mentioned that about the 150 minutes that we should all
be aiming for 150 minutes of moderate intensity exercise a week That sounds like quite a lot. Can we build up to that gradually?
Absolutely and that's where we starting with if you start with small bouts of 10 minutes of brisk activity throughout the day.
That doesn't need to be done every single day but it's good if you can do a little bit every day. Just as you said bringing it
into your commute so that can be using the stairs at work instead of using the lift. Getting off the bus one stop early and doing
an extra 10 minutes walking in the morning. Just gradually building up with small bouts of activity to be able to bet over
the whole week do a 150 minutes. Some great ideas there and I know we've got Mike coming up
later and he's going to be doing some demos and exercises we can do at home as well. So moving on your physiotherapist, tell us
why sometimes seeing the physiotherapist before seeing the GP is actually the best option for patients?
Yes that's right. A big shift has happened recently in health care of the last few years. Physiotherapists now recommend as the first
point of contact when it comes to bone, muscle and joint problems.
This model is taking pressure off GP services as musculoskeletal issues can take up to 30% of GP appointments.
So seeing a physiotherapist first can be the best and the quickest routes to treatment, as it allows people to get straight to
the professional whose expertise is focused on bone, muscle and joint systems.
Physiotherapists are the third largest group of qualified health professionals, after doctors and nurses and
qualified to train, assess and treat undiagnosed bone, muscle
and joint conditions. A physiotherapist will spend time assessing and diagnosing and will also be able to give you
expert advice on how to begin managing and treating your condition right from the start. If needed, physios can also
refer to specialist services such as orthopaedics, and they're skilled in deciding after the assessment and
discussion with you, which is the most appropriate treatment path for your particular problem. A physio will assess
soft tissue injuries such as sprains, strains, sports injuries,
as well as arthritis and joint problems. Problems with tendons, spinal pain, such as low back pain and neck pain
and sciatic pain. Seeing a physiotherapists first for these conditions will give you faster access to diagnosis and you will
get exercises and treatments straightaway. It's been demonstrated that rapid access to physios can actually reduce
the amount of time people need to take off work and it's an effective way of preventing acute problems from becoming
longer lasting problems. And in some circumstances, actually seeing a physiotherapist after they've diagnosed your problem,
you're confident enough, they may be able to give you advice and exercises to manage your recovery yourself at home.
So as a GPI must say that physiotherapist really don't get enough credit and you could wait potentially weeks and weeks to
see a GP and in that time, he could have seen the physiotherapy and they could have sorted you out.
So moving on then. Bone mineral density, is it just an age thing or is it
something that actually we can we can work towards and do something to prevent and manage in our younger years too?
Yes, absolutely, our bone density is 90% developed by the
time we're 20 years of age and the actual reaches a peak by 30. So being fit and active in your younger years is the best way
that you can maximise your longer term bone density. From 30 years onwards the bone strength will naturally start to
decline over time. And at about a rate of about 3–8% per decade
of your life. That might sound like a bleak picture but it is part of the natural ageing process and the good news is
that bone density loss can be significantly slowed down by lifestyle choices. Bone is the living tissue and it can be
improved by exercise and weight bearing exercise as Petra describes earlier which involves staying on your feet, working
your bones against gravity. Such as brisk walking, dancing, jogging, aerobics alongside the strengthening exercises are
particularly good at improving bone density. The other lifestyle changes that you can do yourself to influence have
healthier bones are things like your diet, reducing alcohol intake, stopping smoking altogether, these can have a
significant negative effect on your bone health and for women,
especially around the time of menopause when oestrogen levels fall.
This can play a crucial part on the regulation of bone production and turnover. So at this time, it really becomes
important to keep your bone strength up by exercise and
lifestyle. I think especially for the postmenopausal women when we see a big drop in bone mineral density, around that time, it is
okay to ask your GP for trial HRT as well because we know that's a really effective way of slowing the progression of the
bone mineral density in postmenopausal women as well. I think the lifestyle stuff is great, isn't it, but sometimes
it is also important to consider what our medical options are as well. Absolutely. Brilliant, thank you so much. Such really insightful stuff there
Over to you Mike.
Hi again, everyone. So just wanted to discuss with you a little bit about injury prevention and a couple of tips
and exercises that are useful when you are exercising. Couple of injuries are impossible to avoid things like slips, trips
and traumatic injuries. However, we see a lot of people in clinic coming in with overload injuries where they train too much and
they've exceeded what their body can tolerate. So a couple of things to help avoid that is a warm up. So anything before your
activity to encourage blood flow, encourage heart rate and oxygen to the muscles in really important. The aim of a good
warm up is to help prime those nerve endings and those muscles so we get a better relationship between them and they perform
more effectively, which result in better and more efficient movement. Better improvements in your balance and your
coordination. So a couple of great exercises to go away with are things like squats exercises. So let's start off
with that. So you start with your feet shoulder width apart. Nice and comfortable, soft knees, you're going to sit
slowly down by bending your knees and your hips into that squat position. Keeping the weight into the back in the
heels where possible. It's good to have your arms out in front because that will encourage you to distribute that weight A little bit further back. Try to keep your chest high to the back
straight as well and avoid any unwanted stresses. Don't squat too deep and make sure it's comfortable. A great progression
on from that exercise is coming into a split squat or what we commonly will know as a lunge. So with that you're going to
stride with one leg forward, one leg back. It's really important
to help maintain your balance with it. So what we want to try and think about doing is keeping the knees straight with this movement. We're going to slowly bend both knees down to about 90
degrees if that's comfortable and then come back up and repeat so we're looking for the knees to stay in line with the front
portion of the foot so your second or your third toe. You can make this more challenging by offsetting your balance by
folding your arms or raising the arms up high.
Again it makes you look more unstable, engages a little bit more muscle through your trunk and through your core. So they're really good for
hip and knee warmups in order to get you moving if you do any lower limb exercises. Then another brilliant one for hips
and the backs, again to get strong and get moving, so you can use this to strength as well as the wall is a bridge exercise.
So we're going to lie on our backs with our feet bent up well our knees bent up sorry and our feet on the floor.
So you're going to have your kness bent comfortably, about shoulder width apart and you're going to raise the pelvis up off the floor
and then come down. Avoid any pinching or any pain through the back or through the hips. And you can hold the position for a
few seconds or longer if you want to get some strength benefits from this exercise and then come back down.
While we're on the mat a couple of other really good exercises, a couple of yoga stretching is fantastic for sort of hit and low back
mobility. So again, if you stick in these areas, these can lead to injuries as well. So start in a four point kneeling position.
and we're going to sit back onto our heels, bringing the hips back, bringing the chest and the head down slowly to the floor
and you'll feel comfortable stretching the lower part of the back and maybe into the hips. And then you're going to come
out of that stretch back to that start point and repeat and you can hold the stretch for as long as you want in order to help
improve that flexibility in your lower back and in your heads. I think the final tip to just go away with, is again a bit of a
core and a hip exercise in this four point kneeling position while you're on the floor. It's called a superman exercise, I'm
going to come down on to four point kneeling and I'm going to stretch opposite arm and opposite leg away from the body.
So back nice and straight and we slowly move away with arm and leg and back in trying to keep the trunk as still as possible
throughout the movement. Again, should be comfortable. If we get any pain in shoulder wrists or hands, then just ease off that
exercise. It might be a bit too challenging for you to start with. So think warm up, prepare the body for exercise and get
stronger, It's a great way to get tissues nice and robust, so they're less likely to injure. Okay Helen, back to you.
That's great. Thank you, Mike.
So next we have Damian. Damian thank you for joining us today. You're an orthopaedic surgeon. So I thought might be useful to start with. When is surgery the
right option? And also, are there any instances when it might not necessarily be the best option for the patient? The vast majority of people that get referred with a
musculoskeletal problem are not candidates for surgery, most people can be managed with non surgical options. So when we see
somebody we've accurately diagnosed them with appropriate investigations and examination, the next stage to do is consider
what we can do with that person. And it's always a joint discussion with the patient obviously how we manage that problem.
So the first option always is to do nothing if they have a diagnosis, and they just came because they were a bit concerned that we had a particular problem, and their fear
has been assuaged, then we can just leave it. Then option one is to do nothing. Option two is physiotherapy. So if somebody
has a joint related issue, or balance related issues, such as an unstable shoulder, then you can have physiotherapy,
physiotherapy can balance the muscles around a particular joint, help with the pain and therefore avoid the need for surgery.
If there's a local problem, such as an inflammation such as subacromial impingement say, and there's a bit of a bursitis
then you can treat that temporary problem with an injection. So you have injections to help either with
diagnosis and or with treatment. So that's the third option and it's only when you've exhausted those that you come to the final option
which is surgery. So surgery is a last resort is what you're saying and in some instances?
Yes, unless there's an urgent reason to move to surgery such as a fracture or a tumour or something like that, then yes,
people tend to move down, the algorithm of less invasive, less risky
down to the more risky and obviously, when you've exhausted all the less risky options you come to the surgical procedures. So the first option always is to do nothing if the
patient has a diagnosis and they've been concerned that they may have had something more serious. But in actual fact when the diagnosis has been made, they haven't. If they're happy
to live with the symptoms they have, then we can leave it at that and do nothing. That's option one. Option two is
physiotherapy, so in many cases, if people have, say, an unstable shoulder, then it just requires some balance around the muscles
of the shoulder if they haven't had a traumatic injury. Then they can go to physiotherapy, the physiotherapist can balance the muscles around the shoulder and that can solve the
solve the problem. Option two. Option three is injections. Injections fall into two main categories. The first is the
treatment and the second is a diagnosis. So if you have pain around a particular joint and you're not quite sure where the
pain is coming from, you can use the injections as a treatment for targeted treatments with ultrasound
guidance or image guidance. And that can help to diagnose the problem and also can help to treat the problems. So if somebody
say has inflammation around the AC joints, you can inject it and that can help to treat the issue as option three, it's only when
those three options have been managed or used that you come on to option four, which is the surgical option
So surgery is often a bit of a last resort then for some patients? Yes, it's a last resort for most cases of elective presentation.
If somebody has a fracture, obviously, then that that's got a more of an emergent treatment option as a different treatment
path then. But for the elective procedures, yes, it's always a last option. And what are the processes that and procedures that patients
will go through in the run up to surgery and after surgery? In general, the patient needs to be prepared for the surgery and
you can do that in two main ways. You can prepare them generally and you can prepare them specifically. In general,
if they're waiting, say for a knee replacement and common procedure that gets done in the UK, and they need to be healthy
for the anaesthetic. So they can contact the GP they can find out
if the medication is okay if the blood pressure is being controlled if the thyroid function is is satisfactory.
So all those general things we can optimise their medical health before they come in for the anaesthetic and then
specifically around the joint that they're having operated on. So if they can get some so called prehabilitation. So they
can have some physiotherapy before their operation to optimise the muscle function that will be looking after the
knee replacement once it's in, then that can hasten the recovery for them after the operation and if they contact
the physiotherapist, they'll be quite happy to provide them with some exercise regimes and perhaps weights that they can do
in the meantime. As long as it's tolerated. So the weeks and the months in the run up to surgery are actually really important for the success of the surgery itself?
Absolutely. A bit of time spent in the preparation can pay dividends later. Absolutely. And how about after surgery, what support and rehab is
available for patients after the operation? After the operation, we have a number of different available
options. You can get physiotherapists involved beforehand. With the physiotherapy teams reviewing
you, you would have been able to identify if you had any particular requirements for your home circumstances. So perhaps
your bed may need to be brought down in short term or seat raises for toilets, things like that. Those kinds of
interventions can be assessed preoperatively and it makes the post operative recovery a little bit easier.
And actually, I guess surgery is just the beginning anyway, isn't it? It's about then helping and supporting patients to
live a better life and higher quality of life after surgery and adapt at home
Absolutely. Surgery is just a tiny part of the whole process and it starts from when the diagnosis is made, and then
is the run up to that process of the surgery, and then afterwards the run off afterwards to make sure that all the follow up is
okay the physiotherapist improving and their patients recovering, that's the level that they hope to achieve.
And for the audience at home, is there anything else that they can do in addition to what you've mentioned in the run up to an operation?
I suppose general things that they could do. We've already mentioned that going to general practitioners to make sure that medication is ok. Make sure that the current treatments for
the medical conditions are optimised but also you can pop to see the dentist so if you've got a bit dodgy tooth for a while
and it's occasionally gets infected or flares up and that can be a source of infection potentially for a joint
replacement. So you need to go see a general practitioner. If people have podiatry problems, perhaps it can see a podiatrist.
get any bunions or any things that are causing recurrent infections. Those are the things that we mainly worry about with
joint replacements. So surgery is one of a number of different options when looking at MSK problems. And actually it presents a real opportunity
doesn't it to review your general health and get a number of different things sorted when it comes to health?
Absolutely, it's a real opportunity to take a good look at yourself and sort things out at the same time. Thank you, Damian. That was really really insightful.
My pleasure.
So now this is the opportunity for the questions you've asked to be answered. We're going to do a quick fire round with our experts. So starting first on lifestyle, diet and supplements.
So Judith, I'm gonna come to you first, how do you deal with muscle and leg cramps at nighttime?
So leg cramps are really common and usually harmless. They can happen at any time but often happen at night when you're
resting. The pain happens when the muscles shortened rapidly and often only lasts a few seconds, it can be really
unpleasant to experience, but generally nothing to worry about. Cramps commonly affect the muscles of the calf and the
foot. During the cramp, you can try to gently massage the muscle
move the affected limb if possible, try to encourage the cramp to pass. After the cramp there is often muscle soreness,
you can use heat massage again just to try and allow that muscle soreness to wear off. They do become more common as we
age, so helping things with drinking plenty of fluids keeping well hydrated, avoid alcohol, and keeping the muscles
flexible and strong. There are some medications that can affect cramps. So if cramps are becoming problematic and
regularly disturbing your sleep. It may be worth discussing this further with your GP.
Thank you, Judith, I think that's gonna be really helpful because it's one of those things that can really impact on quality of life. Next, a bit of a controversial one for you,
Petra, what do you think of glucosamine? Well I get asked this quite commonly in practice and I think the
short answer is, we haven't been able to prove that it really helps anyone. There's been lots of studies done on glucosamine
but some of the higher quality studies show that the effects of glucosamine are exactly the same as if you were taking a sugar
pill or a placebo. So although some people really are absolutely certain that taking glucosamine has helped their
joints. My advice is if people want to try it, they may try it. But if they're not seeing any benefit, after a couple of
months there is no point in continuing to take it and people be better off spending that money on a Pilates class or
seeing a physio or doing some kind of exercise regime, than continuing with the medication because there's no good evidence
that it makes a significant difference. And what do you think of supplements in general? Well, I think if you've been advised to take supplements
because you have a very restrictive diet, or you have
vitamin deficiencies is obviously very important. However, for most of us, if we've got a well balanced diet,
we're getting plenty of sunlight and exercise there's very limited evidence that taking supplements benefit our bones
and certainly nowhere near the benefits we get from regular exercise, strengthening exercises and keeping mobile so
as far as I'm concerned, unless you're advised to for medical reasons, it's probably not worth it.
And vitamin D is one of the common vitamins that has had a lot of media attention in recent times. Damian coming to you.
How important is vitamin D for bone health? Vitamin D is essential for bone health because it facilitates
the absorption of calcium from the gut into the metabolism.
So it allows the calcium to enter and then be applied to the bones. So it actually strengthens the bones over
A period of time. If you don't have enough sun exposure which is a good source of vitamin D or if you don't have if you have a
dietary deficiency of Vitamin D, then this can lead to significant medical issues
Regardless of whether we have an MSK case or not, I believe the advice is all of us should be taking vitamin D supplements over the winter months. Is that right?
Yes, there's there's been some suggestion that the sunlight in the UK is only good enough between the summer months to
provide enough vitamin D for our day to day bone health. Brilliant. Thank you. So moving on then to mobility and pain
management. Judith, we're going to come back to you on this question. What's your best advice for maintaining muscle
bone and joint health as the body ages and gets older, Just keeping active including 150 minutes of aerobic exercise
a week, minimum two days a week including some strengthening exercises for your bone, muscle and joint health. Take a healthy
diet and lifestyle, maintain a healthy weight, avoid smoking and reduce alcohol intake and remember that it's never too
late to get started on strength and aerobic exercises. Just brilliant. Thank you. We've got some great questions coming
in here. So Damian, how can you prevent knees from clicking and grinding when walking, really common, it can be a bit sort of
disheartening when it happens. I'm not sure we can actually prevent it from clicking and grinding necessarily but clicking can occur and be not
much of a problem so you can get a bit of soft tissue catching behind the kneecap and as long as it goes away, then we tend
not to worry too much about those. Grinding can be more of a problem. So if you look at the back of the kneecap,
patellofeoral joints, the kneecap is shaped a bit like a keel of a boat and runs on the front of the femur against two of the parts
of the knee joint called condyles. The muscles on the inside of the knee have to be balanced with the muscles on the
outside of the knee and that allows the kneecap to then glide between those two condyles. If the muscle on the outside which are commonly stronger
than the muscles on the inside they tend to pull it over starts to cause some abnormal rubbing If that grinding persists an doesn't recover with
physiotherapy or doesn't improve with physiotherapy, then it may require treatment from from orthopaedic surgeon.
Okay, great explanation there. Thank you. And then Judith coming back to you does physiotherapy always have to be
delivered face to face for it to be effective? So remote telephone or video consultation is often a great
starting place for physiotherapy assessment on treatment. During an assessment up to 70% will involve taking the detailed
history from you with the onset of your problem, mechanism of injury, detailed questions about your symptoms and how to respond
to certain activities throughout the day. Now all of this information can be captured remotely and the physiotherapist
might also ask you to perform some simple movements to demonstrate how your joint moves for example and which activities
you're struggling with. At this stage the physio will be able to give you some advice and exercises that you can try at
home to see how that your problem responds over time. The physio can then also follow you up with another remote call.
If you're not progressing as expected or there is not a clear cut diagnosis, it is possible to move to face to face after
assessment for more detailed examination. Thank you and of course most of the work with physio is done at
home by the patient in the home rather than face to face with the expert. So moving on then a lot of us have spent a lot more
time working from home in recent times. It's really difficult, isn't it when you spending so long sitting you can feel really
stiff in the hips and achy in the neck? What can people do to avoid these sorts of issues and injuries?
I think you have to remember to try and keep natural breaks in the day. So we those of us who have gone to homeworking in the
last year realise how much we moved. Whether it was just getting to work, whether that be walking to your car or walking
to a tube or a bus. And then how when we were at work, how much movement we did in our natural day, whether it was speaking to
a colleague or going into a meeting or performing our job itself. So if you are working from home, it's really important
to include lots of natural breaks, and to go up and downstairs a few times and to introduce walking, if you can
during your day. So where you're not commuting, perhaps to go out for a walk first thing in the morning at lunchtime or at the
end of the day or ideally all three can really help if you're doing meetings or conversations with people if you can do them
whilst you're walking has a really great way to get some movement into the day. And perhaps also look at your
ergonomic setup. So a laptop on that on a dining table might be fine for a week or two but a few months later, that may not be a
great way to be set for your posture and your shoulders and your neck. So making sure that if you've got a desk setup at
home, you've done that as ergonomically as possible and even think about standing desk I think they're a great a great
option for people. Thank you. A personal favourite minor walking meetings as well either on the phone and then scheduling it in a walk or
trying to meet a colleague face to face think they're a great one to get up and get moving. Right Damian coming to you
lastly then. Frozen shoulder can it be caused by an activity? So when we are doing a lot of sitting, can that bring it on
and you know can being at home and not being my usual routine actually precipitate it? The honest answer is No one knows what causes a frozen
shoulder. So, it could be it may well be, but we don't really know. It was first described in 1934 by a surgeon in the States
called Codman and he described 12 particular features that he'd noticed with what we now know is frozen shoulder. Starts
insidiously usually with an aching around the shoulder and it becomes inflamed. Because it's inflamed, we tend not to
move it. The shoulder surrounded by an elastic capsule that stretches which allows us to have the best range of motion of
any joints in the body, but doesn't dislocate that often compared to the amount of times it's move. With the
inflammation because you don't move it because it's painful that elasticity starts to shrink and that's what
causes the stiffness in the frozen shoulder and over a period of time, it will settle down by itself, but most people
who attend our clinics can't cope with that time taken to
recover by itself, so they may require some treatments. Thank you. Thank you to all of you some really useful insights
and advice for our audience at home. Thank you for joining us today for our musculoskeletal event.
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