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.

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 healthcare 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.

Please do take time to fill in the customer survey.

We really do value your feedback and keep an eye out for more details on our next events coming soon.

Hello and welcome.

I'm Dr. Zoe Williams and I'm your host for this event.

This is the fourth event in the Bupa Inside Health Series, and today we're going to be focusing on mental health.

And in this segment, we'll be talking about anxiety, stress and CBT.

These events are exclusive for Bupa customers, and we really hope that you'll take away some helpful knowledge and advice.

And I'm joined by two incredible guests today.

Glenys Jackson, who is the Clinical Lead at Bupa for mental health, and also Ruby Wax OBE who has a master's in mindfulness based cognitive therapy.

She is a she has a lifetime fellowship at the mental health charity Mind, and Ruby is going to help us understand how we can control our critical minds.

so we've got loads to talk about Glenys if I can come to you first of all, so we're talking about stress and anxiety.

Can you define what we mean when we talk about stress and anxiety?

Yeah, lots of us get it confused, in terms of what stress is compared to what anxiety is.

But we always look at how people describe what they're experiencing.

And if you look at stress, stress has lots of physical symptoms.

Stress happens to us all, you know, we experience stress in many, many different ways.

And it's those physical and psychological symptoms that we experience that can trigger.

It can be triggered by all sorts of different events, you know, going and doing this today that can trigger a stressful feeling stressful thoughts?

You mean being sat next to Ruby Wax?

Yeah.

But in the nicest way, I'm anxious too sitting next to me.

But we can, you know, that that can dilute to some degree, you know, you can control that stress.

And we don't want to get that too confused with when that moves into an anxiety.

You can you can experience stress without experience the anxiety.

Anxiety really is, you know, people talk about having those persistent thoughts of being anxious of being overwhelmed.

And it's, you know, it goes to that extreme where you don't have that control over what you're thinking over what you're feeling.

And that's when you really know that that anxiety is present.

It's, you know, feeling anxious can be perfectly okay, can't it?

Yeah, but when it becomes that clinical feeling of anxiety, it's a very different experience, isn't it?

And that's when we need to then look at well, what help do we need to support that?

So when you I guess, when you're struggling to, to cope with it control, and it can come out in physical symptoms as well.

I know, my own anxiety was very much presented with physical symptoms rather than feeling anxious.

So the next question to follow up from that is, you know, what can people do about it?

If people have anxiety?

What can be done?

I think, first of all, it's really important to give yourself that permission.

Give yourself the permission, say I can be anxious.

Yeah.

Proud to be anxious, you need a T- shirt.

Yeah, you can.

Listen to what your body's actually saying.

You know, be in tune with your body, which is very hard to do.

It's very hard to learn to do that, isn't it?

I often use that the word PACE.

So I paced myself, I give myself the permission to say, you know, that old classic, I'm not okay.

I'm not feeling okay.

And it's okay not to feel all right.

I accept that I need to do something about it.

And the C of the PACE is the Cognitive element, how we think, what are we thinking?

What do we need to do about how we think to change that level of anxiety?

And the E is to explore.

So it works in two ways, really, that the pace is about slowing ourselves down, but also working through the permission, the acceptance, the cognitive way that we manage, and then obviously exploring what we can do.

So someone said to me, once it's about and I think the NHS website, use this an awful lot that you catch it, you check it, and you change it.

And I think when you reference to those snappy elements of what you're experiencing, it brings it down to a more realistic level, doesn't it?

Rather than something that is hard to understand, because we're all unique?

Our anxiety that sits within us is all very different, but something like pace and something like catching how you're feeling, checking in with yourself, and then looking how to change it.

It's about getting a good understanding, isn't it at the end of the day?

It's to understand what are my patterns?

And then not be ashamed of them.

Because it's not your fault, you got those patterns.

And that's about giving yourself that permission, isn't it?

Or saying it's not my fault.

Yeah.

And once once somebody is recognised, maybe you know, there is something going on and they want to make those changes.

Can you talk to us a little bit about the sort of self help things that people might be able to do for themselves?

But also, I mean, we're going to talk to Ruby in a little while about CBT, or cognitive behavioural therapy.

But are there other alternative therapies out there that people can access?

There are lots and lots and lots of alternative therapies.

And, you know, it's so important to get to know that individual have that conversation with that person to understand where they're at, in where in how they're thinking in relation to their anxiety, so that that person can make decisions as to what will be best for them.

You know, it's around, you know, going for a walk, will that help, you know, further through to looking at reflexology, looking at acupuncture, there's an awful lot of availability out there in terms of looking at something alternative to the usual pathways that people go down.

And because we are all so unique and so different, you know, we've got to pinpoint what would work for us.

And don't worry that if something hasn't worked, you know, try something else.

But it's having the confidence to do that, isn't it?

You know, looking at your symptoms, looking at what you've experienced, and how, you know, you might need to change the sort of technique that you use, what alternatives do you have?

And it's about being able to have a conversation with either your GP a friend, whomever that close, confident is talking about what is out there for you, and making sure that you know, it's right for you.

And I guess, you know, to bring it back to what you said at the start, it all starts with that acknowledgement that, you know, I have some anxiety here.

That's okay.

Because there are many things you can you do about it, but you've got to start with, you know, it's real, it's real, it's not, and then not be ashamed?

Because the shame piles it on?

Yeah, yeah.

Yeah.

How do you go about advising and acknowledging when perhaps the plan doesn't work?

You said there, you know, it's about trying different things.

But that can be difficult, because you're already in a place where you're struggling to some extent, your friend recommends, you know, doing whatever you try it, you don't feel any better.

You know, sometimes there's a shift from Plan A to Plan B, how do you go about that?

How do you advise people?

Well, we look at that in terms of hope, hope so, so important, and hope is, you know, instilling that hope in somebody through the conversation you're having, exploring that resilience, you know, it's very hard when you're experiencing that level of anxiety to even believe or think about resilience, but the resiliency is there.

And it's about enabling that person, to feel safe, to have that conversation, to look at their own self awareness of where they're at.

So that we can rebuild that resilience to enable them to then engage in something different, it's being realistic as well, you know, being really realistic about what approach is right in terms of, you know, balancing your own anxieties, with those anxieties of trying something new, because like you said, Ruby, it escalates then doesn't it in terms of feeling that you can't cope, but it's about feeling supported, it's about that person who you're who you're talking to, enabling that person to understand that it sits with them.

But there is support out there, you're not on your own.

I think in my clinical practice, as well, what I often find is that by the time a person comes to the point where that word anxiety, you know, that labels been put on it, actually, they've been struggling for a very, very long time.

And they often have a lot of solutions that they've been using and strategies that they've been using that have worked reasonably well.

And sometimes it can be finding out what those are and building on them as a starting point as well.

Definitely, I mean, lots of people that we speak to day in and day out, they'll different techniques will work for different people, it's like we use that traffic light sequence for breathing.

And, you know, that will work for somebody where it won't work for someone else, you know, it's, it's about being open to be able to encourage that individual to explore what it is for them.

Now I know if I was watching this episode, what is the traffic light system for breathing, The traffic light system for breathing is that you have to stop.

First of all, you have to put that red light on and have the confidence to either stand or sit down, stamp those feet so you're stamping that anxiety out really.

So that you're giving yourself what they call grounding.

I'm sure Ruby, you've you've fully aware of grounding techniques in terms of bringing yourself back into the current place.

Back into where we are at so that he can really then focus on the amber.

And that's about making sure that your breathing techniques are developing, that you're actually breathing from your tummy that you're taking that control through your nose out of your mouth so that you're breathing calmly.

And that then enables you to think a little bit clearer about what you want to do next.

And that's what the green is.

The green is being aware of how your breathing is enabling you to be a little bit more focused, Brilliant.

so that you can then make decisions as to what's next for yourself.

Thank you for explaining that I was doing that and she was explaining it.

Finally Glenys, what support is available through Bupa?

There's a whole plethora of support through Bupa depending on where you're at in terms of your own feelings and presentation.

Right from the digital platform.

There's lots and lots of advice and guidance on the mental health hub that people can go on have a look at have have a read, use some of the tips and techniques that sit there right through to them may be having the possibility of engaging with a therapist or counsellor, to the degree of also considering whether they need to go and see a medic Be it a, you know, a psychologist or a consultant psychiatrist.

So it's about having that opportunity to have a conversation around what you actually need.

Brilliant, thank you so much.

Ruby I'm going to come and talk to you but a first a little introduction.

So you're here we go.

Are you ready?

A trained actress, an incredibly accomplished comedian, best selling author, you've edited scripts for some of our favourite TV shows an incredible interviewer, you've interviewed some amazing people making me feel a little bit nervous right now.

But you've also turned to neuroscience and psychotherapy.

So you've got two master's degrees.

One is in mindfulness based cognitive therapy.

You're also an honorary Senior Fellow of Regents University London, your lecturer, you also have a master's degree in psychotherapy and counselling.

You're an ambassador for charity Mind, Time To Change and Sane.

And I've probably missed out a few of the so many things you've missed.

No, no, I'm kidding.

I know that you also did an incredible TED Talks had over 3 million views.

So there will be other things.

So what an incredible, diverse, accomplished career.

But what I want to ask you is, why was it that you turned your focus, you didn't turn your focus?

But why was it that you've developed yourself as an expert in matters around mental health?

Well, I was always interested in psychology, obviously, because I found out I come from a long line of people with mental illness that I didn't know that until I did that show, Who Do You Think You Are way, way, way, way back.

And then, because I did a terrible thing, I turned 50.

And that's not allowed on television.

And so I suddenly was, I mean, I could have gone on and done one of those reality shows, but that would have institutionalised me immediately, The opportunities just, just stopped?

You couldn't do big celebrities anymore, because that's not possible, you know, if there's too many PRs watching and you only have bite sized pieces, so I had a good time.

Then suddenly, I was out of a job.

And, you know, we have to reinvent because we just live on and on.

So I thought I always said, I'll go back to psychology.

And so I first I got a degree in psychotherapy, which I never was going to be, but I liked getting the potpourri of all the, you know, famous psychotherapists, and you know, psychoanalysts, I love that, but I never was going to be that, because when I'm with somebody, I had to do 200 hours, I'd go, Oh, come on, just cut to the punch.

I wasn't very good.

And then, and then I looked around, I became obsessed, because I have depression I knew there was no cure, but I I thought maybe there's some way that I could get early warning.

And that's everything.

You know, awareness is everything.

So it turned out that mindfulness and CBT had the most impressive results as far as depression, ADHD, OCD, bipolar, and just the generally anxious.

So I found the professor of mindfulness based cognitive therapy, both and he was at Oxford.

So I hunted him down.

And I said, I need to know what goes on in the brain because I can't if I can't smell it or taste it, I can't buy it.

And he said, You have to get into Oxford and get your Masters if you want to know what goes on in the brain.

So throw me the challenge.

And then I became obsessed.

And then my as my doctorate is my sorry, as my masters I did a show about the brain, and CBT and then I turn that into a comedy show.

So, that's how it happened.

And I became obsessed with how the mind works.

I've wrote five books about, you know, what it evolution to so that, you know, we are not our fault.

Evolution just wanted us to survive, it didn't really care about our happiness, and all these things that we think come with the human condition.

They don't, you know, these are we're aiming for things that we're not equipped for.

But if you want to learn how to be more compassionate, or you want to learn how to self regulate, we haven't got the facilities, you need training, it's like going to a gym, and you're not going to get a six pack with one sit up People always say, oh, what's your top tip?

What's your top tip for getting a bicep, you go to the gym every day so CBT.

Of course, mindfulness is a training that actually develops like a muscle parts of the brain.

Remember, we have one of those, it isn't just an air bubble with thoughts that develop those areas that give you focus where you want to focus, and more flexible thinking.

So you don't get locked in and breaking your patterns.

All of this is up here.

It's like I always say, it's like, we have a Ferrari on our heads.

But nobody gave us the keys.

Yeah, yeah.

So I love that, that you can train it and, and it's become an obsession.

It's like, it's like you say it's a skill.

It's a skill.

With skill, any skill you have, the more you practice, the better you get at it, and looking after ourselves in this ways is exactly like that as well.

It's not going to happen by magic.

No We don't come without blueprint do we?

No.

You know, you have.

If we had it, we would have used it.

And we wouldn't need Bupa.

I want to talk to you a little bit about I think, you know, a lot of people are sort of aware of the term CBT cognitive behavioural therapy.

Can you explain to us what that is, but also tell us a little bit about mindfulness?

Because that's what your specific qualification is.

Well Mark Williams, my professor, put them together with three other people and was the creator.

Now, I wrote a book just recently called The Mindfulness Guide for Survival, where it is a journal, it's interactive, and insight is everything, we need to know a little bit about what our habits are.

Otherwise, we repeat them and assume that I'll always see you as the bully.

Well, how do I know that I'm not coming from that position?

Yeah.

So that if I have, you know, the way we think in our heads is how we speak to other people.

And then we never think that you've come with your own luggage.

So CBT would be really understanding what our patterns are.

And again, knowledge is power.

So you, you know, you, you say, let's say for example, there's different exercises, for example, somebody you're walking down the street on the other side of the street is your friend looking the other way but she doesn't look at you.

So it's really interesting to know, what's your reaction?

Mine is she hates me and never wants to speak to me again.

Other people think, Oh, she's on the phone, other people with that.

Now, the thing is, I can't, I don't want to pick the scab, and go on and on why I think that, but to know that is to understand when I do public speaking, they don't hate me.

So you really start to write down this is my this is my default mode.

It's not who I am.

It's just maybe something happened when you were three maybe your parents treated with do you want to go on and figure it out?

That's just the way you are.

And by that awareness, and then also awareness of what's your?

What's your mode of thinking?

Is it catastrophizing?

Is it black and white?

Is it blaming?

Is it self blame?

Is it do withdraw?

Are you a victim?

Because however you define yourself, you're caging yourself in this little box?

And that's not living?

So I think CBT, Well, I know CBT is understanding, what are your, what are your defaults?

How do you, you know, when you see somebody, do you always fall in love?

Do you always feel rejected?

And then you understand, when I realised, this is what I, where I am, you kind of learn to forgive yourself, you know, it's not your fault you think it?

And also, if you get a little knowledge about, oh, that's my default.

When somebody's shouting at you, you think, well, they're listening to their own soundtrack.

So I don't have to take it so personally.

But otherwise, we come with this package of glitches.

Where do we get it?

It could be from evolution, it could be genes, I don't want to go into it.

But once you understand, these are my habits.

Well, the neurons reflect, you know, the 82 billion that's changed now reflect my habits of thinking.

But when you understand and this is mindfulness too when you understand, and you kind of lay back and learn to observe the thoughts rather than believe them.

Those neurons start to unwire and you can create better habits.

Yeah, you don't change your personality, but I know now my drug of choice is anger.

So I can feel the move, but because I sort of know that's my go to I can sometimes because I practice catch myself, because if I let it rip, it may feel really good for a second because adrenaline is delicious.

You know, we only get addicted to bad things, nobody gets addicted to kale.

I do that and it feels good at the time.

The next day, I've poisoned my whole immune system, I'm the one who's going to get sick, they're not.

So you know, this kind of knowledge.

It doesn't mean you repress it that because feelings explode, you know that.

That's impossible as well.

So I guess in that example, that you gave if you're walking down the street, your friend walks past me, they don't say hello, you would still think, Oh, she hates me, then immediately you would observe yourself having that thought and saying, that is what my brain does.

Whereas actually, I know that other things that are more likely such as she didn't see me, or she was on the phone, or she's in a room, And you right there, you know, with the CBT, with a good she'll say, Is this?

How hot is that?

Is it 100% you believe it?

Then you start to write, what are the other possibilities?

And then, as you go through, eventually you go, is it still 100%, so maybe gets to 30%.

So you start to understand its habits.

It's not who you are So that's cognitive behavioural therapy.

And you know, you've also studied and have a master's in mindfulness based cognitive therapies.

And I think sometimes people get a bit confused as to what is CBT?

What is mindfulness?

So can you in the beautiful way that you do explain to us what is mindfulness?

Well, mindfulness is just taking over the role of the therapist.

So as I said, the therapist says, you know, how do you react each time, mindfulness, it's much cheaper, you get rid of the therapist, and you learn to observe those thoughts.

They don't go away.

You know, every morning, I get up, and there's my mother's voice telling me, I'm not good enough, whatever.

But you learn to like a therapist, kind of sit back.

And if you watch them, you observe them.

You don't buy them so much.

But you have to do this, maybe two minutes a day just to observe.

Now, if you just sit back and watch, they'd continue, because that frazzled thinking, you know, stress about stress, your storyline will go on forever, you're not going to sleep.

And that's why people burn out.

But I love the science of it, because that's why I went to Oxford and they weren't teaching witchcraft is, you notice the thinking, the part of the brain, the amygdala is aroused, which gushes the cortisol.

I mean, it's more complicated.

But when you take your focus to one of your senses, which sight sound, taste, touch, smell, immediately, that amygdala deactivates cortisol cools down, and the insula activates.

Now, you're not going to stay in sense mode, right?

We can't humans think the thoughts come back up, but you gently pull it back down to let's say, breathing or another sense feet on the ground, bum on the chair, or listening.

If you focus that way, the cortisol comes down, because you're using a different part of the brain, thoughts come up.

And each time you do even for two minutes, that action, but it has to go, notice thoughts come back down again.

Because it's an anchor for the mind wandering, it's the equivalent of doing a sit up in a gym.

And that insula gets more and more buff, so that when I start to lose it, or you start to shout at me, and I know, my triggers being hit, because I'm used to it, I can sometimes not 100% start following my breath and pull in those those, those abusive voices go over me a little bit.

I mean, they're not gone.

But it's more like a radio in another room.

So mindfulness, married to cognitive just means you're cutting out the middleman.

And you only go for eight lessons, and then it's up to you.

And people go, Oh, I can't do it.

Will you do it?

Or don't do it see a therapist or don't see a therapist?

And how can how can people access mindfulness?

Because I think it's something that pretty much anyone can do.

You just need a bit of coaching and a bit of help to get started.

Well, I do a six week course on Rubywax.

net, where I teach you how to do mindfulness and take you through homework, and it's obviously mixed with CBT.

But I would go to the big boys, I would go to my professor Mark Williams, Jon Kabat Zinn was the creator of the whole thing, they make it really clear and they it's, it's, it's the real deal.

I wouldn't go into just a voice that has a little bit of a ting ting, you know everything, as you know, there's a sham to it.

So if you are looking for it, I'd look for somebody with a degree or somebody who's the teacher.

Headspace is really good.

Because it it reminds you to do it every day.

And but it is the it's got training wheels on eventually you need to take them off.

I think.

Yeah, I recommend Headspace and Calm as Apps to my patients all the time, because it's just a good way of getting started.

And he's so clear.

Yes and he kind of goes into explaining the science of it without science.

But you know what I think you have such an eloquent way of explaining what is actually quite complex science in a way that people can understand it kind of in the same way with your comedy, you take mental illness, which is actually not a funny subject, and you make it funny.

So I think there's a real skill and an art to that.

And the final thing I want to ask you about Ruby is really, can you give any tips and advice to our viewers who may be suffering or struggling themselves with stress and or anxiety?

Well, I would have to say, call a professional.

And if you don't recognise it, because when you have a mental illness, you're the last to know because your brain is ill.

There's no other brain standing outside.

So if you notice your friend or somebody at work, have those their eyes are quite dead.

It's not anxious, it doesn't look stress, but it's glassy, and it goes on and on.

Then you call Bupa or Mind or whatever, because, and if there's a lot of shame, but you need to take somebody by the hand and get them help.

Don't tell them to perk up whatever you do.

Or pull you socks up Don't do that.

No They have enough shame but get them to somebody because I really believe mental illness needs help.

It doesn't disappear.

It doesn't.

And I think you know, the shame, and the stigma is improving.

But there's still so much there.

So I think that's really good advice.

I think people watching this maybe struggling themselves, but I think every single one of us will know somebody who is struggling at the very least we all know somebody, and you know, actually being there, asking them if you can help.

Yeah, And absolutely not saying be strong, buckle up No How to be either of you actually, if you think somebody in your workplace or in your family is struggling, how what's a way in?

What's a sentence that you can use to start that conversation?

Glenys?

I think it's really, it's really difficult unless you know that person well.

And it's, it's really about how are things going, you know, how are you at the moment?

It's trying not to be subjective, but enabling somebody to be open?

Isn't it?

Ruby in terms of, you know, offering that support, just going up to that person and saying, 'how are things'?

Or even if you've got the confidence to actually saying, I can see that things don't appear too good for you at the moment, you know that there are lots of different ways of positioning, you know, your way into that conversation, if you know somebody, well, it's very different, isn't it?

Because you can approach it in a very different way?

Will it work, you might want to write an email, because there might be too much shame and they might be fearful of getting fired.

But it's too bad.

Your friend can't tell you because if your parents do it, it sounds like nagging, sometimes.

It'd be so nice if somebody friend could say, are you okay?

A close friend, then, you know, it's the best thing to say I feel the same way.

I think sometimes I guess it's giving that person permission to share whatever is going on for them.

Isn't it just given that just opening that door?

And saying, Are you okay, are you really okay?

And you know, if you can go one step further, which is I feel as though perhaps something or even one step further is I feel it, I feel it too.

It's a club, find somebody else has got your depression, and then they'll feel much better.

You know?

Well, I'm so sorry.

But we've completely run out of time.

That was an incredible chat, and I really hope that people viewing will have found something useful to take away from it.

Thank you, Glenys.

Thank you.

Thank you Ruby.

And if you want to find out more information and guidance on these topics, then please do go to the mental health hub on the website.

Thank you.

Hello, and welcome.

I'm Dr. Zoe Williams, your host for this event.

This is the fourth event from the Bupa Inside Health Series, and today we're going to be talking about mental health.

And in this segment specifically about teen mental health, I'm joined by two excellent guests.

So we have Glenys Jackson, who is the clinical lead for mental health at Bupa, who's going to be sharing with us her knowledge and expertise.

And I'm also joined by Dr. Alex George, who is an A&E and TV doctor, and also the youth ambassador for mental health at number 10 Downing Street.

So Alex, I want to come to you first.

You've now become the Youth Mental Health ambassador, which is, it's a mouthful, but it's amazing.

And I want to say congratulations, because you created this position for yourself by campaigning because you recognised that there was a need for huge improvements to be made in support for young people when it comes to mental health.

And it kind of starts with your own personal experience.

Is it okay to ask you about that?

Yeah, sure.

First, thank you very much for supporting me I know you have on social media as well throughout the campaigning and stuff that I've done.

I mean, I think my first interest in mental health actually started at university.

I remember, in my fourth year, having gone to med school really enjoying it kind of coming off the rails a little bit, and I was stopping enjoying my studies and didn't sleep well, or see my friends, I wasn't eating very well, I just kind of felt quite lost, I look back and go Well, actually, I was depressed at the time, a bit of mild depression.

But I was really worried about speaking to anyone thought if I talk to med school, they'll say, oh, you can't be a doctor, you know, we'll we hold you back a year or whatever.

I'm not saying that's true, but at least it's the stigma that I thought that I'd experienced.

And so I didn't say anything until things got quite a bit worse.

Eventually, I did what all well, all struggling children should do.

I think initially speak to your parents and talk to someone and I rung my mum, and she gave me some great advice.

She's not medical at all that said, look, Alex, you're not really doing anything at the moment that's conducive with happiness, not really looking after yourself in that way.

So it's not surprising that you're struggling.

And so we kind of worked together, I planned to get up at the same time, go to bed at the same time, start exercising a little bit again.

So I talked to my friends planning things, and I kind of like made the lifestyle changes that you would with with mild depression.

But what was interesting is that at that age, as someone that was nearly graduating as a doctor, I had no idea really about how to look after myself, or how important self care actually is As a doctor as a soon to be Doctor?

Exactly and the second obviously shocking point was the fact that I genuinely thought that I went to the med school that they might penalise me for that.

So those are the two big things I learned at that point.

and when I started working in a&e in London, what surprised me the most was not the fact we see a lot of car crashes and whatever.

It's how much mental health that we I mean as a GP you, I'm sure you can back that up, we see so much of it.

and so many people that I see, I think we actually have we given the society, this person the tools to handle what they're going through, have we really prepared this person?

Do they know what to do?

Or where to go?

A lot of the time, I think, no is the answer.

And then, over the last few years, obviously pandemics been very hard and everyone I had my own personal experience, I lost my brother just over a year ago, I know that you were very kind and reached out to me at the time, you know, to suicide, which had been very hard, especially at the time where I was advocating a mental health pandemic as a big worry of mine and I know many of us in medical community are worried about that.

And it's really tough.

And so off the back of that as I need to do something, I need to use my platform to try and help and that's where I started campaigning, really for, for focus and attention to be put into supporting young people, both in terms of what to do when you're struggling with illness, but also how to look at mental health as a whole.

And that campaign led to the role that I'm in.

And, I mean, I think suicide and suicidality, which is linked to suicide, which is people who, who feel suicidal, it's much more common, I think, than people might think and I think, you know, most people, at some point in their lives will be touched either personally, or through a loved one, by suicidality.

I lost a friend to suicide and I think what would be really useful is what advice would you give to parents?

If they have a child or a teenager who seems to be struggling with their mental health?

How can they approach it?

How can they start that conversation?

Also, what are the signs to look out for?

I think you're right.

I mean, you will know that I think suicidality has been massively on the rise, you know, the thoughts and you know, even just imagining or thinking about suicide, and I was actually speaking to a support hub only the other day and they were saying how they've seen such a sharp rise in that.

So almost a sense that people are struggling, struggling more.

Now, during this pandemic, you know, we are seeing new emerging clinical levels of clinical anxiety or depression.

But for those who already have it, often it's getting, it's getting worse and that's really hard for like parents and families and people around this person seeing them struggling so much and I know it must be one of the things you're asked a lot as a GP, like, what do I do?

How do I how do I support that?

And it's really difficult, and I genuinely and you're asking you this question, I think I'm really intrigued to see what you say, because it is something I've struggled with over the past couple of years is finding the right words, in a world where there are real lack of tools and resources to support families, and it does perhaps often land with you as the GP, it's something I found really difficult.

Well, I think as a parent or family member, then the first thing is to realise it's not your job to fix that person, I think there's a friend or colleague, sometimes people think, you know, my friend is struggling, I need to fix them, actually, your role as a friend is to be a friend, to sit there to listen to support.

So I think as a parent, most powerful thing you can do is listen, I think often and again, this is from speaking to parents that have gone through the whole process that come out the other side, and, you know, also to kind of experts in this area and it's if you try and kind of fix that person, it can actually make them more closed up.

It has the opposing effect rather than going right, let's talk What are you thinking, what are you feeling, not jumping and say, No, don't worry about you know, your weight to look beautiful, and all this kind of stuff that that can actually make things worse.

So by just engaging and showing that you're listening supporting ear, then that's very helpful and then they're really I think it's signposting and saying like, where do we go now to get that, you know, you as this person, you know, my son, my daughter to get the support that you need.

And as you say, quite rightly, you know, big part of the focus of the role that I'm in is to increase love support, because I think things like waiting list for cameras and stuff is far too long.

I mean, in parts of the country, it's 260 days, some some, you know, and some in some places up to two years, which is very difficult.

But what is important, I guess, to focus on is that there is actually support out there are different levels.

And, yes, okay, we might want to see cams, waiting times come down.

But you know, a lot of charities and organisations provide amazing health support.

And actually, NHS has introduced a lot of new support that didn't exist a few years ago.

And there's now 70, new eating disorder services and hubs that didn't exist, you know, a year or so or two years ago, during the pandemic.

So very important to kind of learn where you can signpost to, but I think as a parent, that primary thing for you is to be that support sense of support, listening, keeping that conversation trying to prevent that situation where people close up, because that's when I guess it's quite dangerous, isn't it?

I think, I guess, as parents as doctors, there's that automatic, but we've kind of got used to fixing things, haven't we, and giving advice and saying, This is what you should do.

And this is what you should do.

And I think sometimes, with mental health, particularly with young people, you have to stop yourself.

And if you're giving statements, that's not great.

If you're asking questions, then that's likely to be more helpful, isn't it?

Whereas there is that temptation often to try and fix it?

Yeah, but a lot of is asking them.

What do you think that would help?

What would you like to do?

Who would you like to talk to and it's like, you know, I'm big fan of this hub of hope is quite a new kind of service.

But it basically they've collected all the support that's out there, NHS charity and otherwise into a search engine, but the post could have tells you all the support that's available.

I really like that because it's almost like a catalogue of what is available out there.

And what do you want access to some kids might want us tech services, other ones want to see therapists face to face.

I think the old adage like like this march you down to the doctor or march you to therapists might not be the way that helps that that person and I guess, as friends, family, you know, parents, if you want to help I think a lot of it is the listening but also trying to encourage things that are helpful for mental health.

So it's like reconnecting with nature.

Is it encouraging daily positive wellbeing habits of the family that you all do together?

Is it creating a way that you can communicate, and the way you're comfortable?

And I really like the traffic light idea.

And I think all families should do this.

And, you know, they all sit around the table and we're like we are now and you know, the traffic light.

You got amber, green and red and go around.

Now, I might say Right, I'm green today.

It's been great.

Why has it has been great.

Well, I'd be able to exercise I think my friends and I enjoyed work today or school, whatever.

You might go.

I'm Amber today, you know, this is why Didn't sleep well.

bit stressed this thing's coming up, and a bit sad about something And then you might say I'm red, but why do you feel red and it's amazing cuz it breaks down barriers and families and, you know, I guess traditional idea of like, you know, father, children, some of that kind of.

It enables that conversation happened, doesn't it?

Yeah.

And it creates a feel.

Like and actually this is this has been used in intensive care departments.

A lot of the intensive care actually, I think was St.

Thomas's ITU that they were using it in the mornings to handover to identify nurses that were fatigued and struggling.

And I was like, that's such a great idea and we should like to do it.

So there's ways you can kind of integrate that into the family.

I think What I love about that is it gets you away from that question.

Are you okay?

Which we always have that automatic response?

Yes.

Whether we are or not where it's actually you're asking somebody, are you red amber or green?

You know, Change the word say, how's the weather?

You know, today is sunny.

I feel, you know, sunny today.

Oh, no, it's rainy or a bit cloudy or overcast a little bit, sometimes just moving away to words that are less emotive, you know, are you feeling really depressed today is quite heavy.

If you're feeling that way, it's very hot as it requires energy.

Because, you know, the next thing is like, why and all this kind of stuff?

You just wanted to say, It also helps people to reflect as well, isn't it?

Actually where they're at at that moment?

When they are thinking about the traffic, lights, sequencing?

It just put them in a different place that they're not under that same pressure.

They've got a tool to use It removes your most of that direct kind of judgement of where you actually are in that space.

But I think yeah, there's, I think that the question that's common is like, how would you?

What do you do if you think the child's struggling is very common, as well, but the same with colleagues at work?

And again, I will say, first thing is trust your gut.

So if you think someone struggling trust that instinct, because often you're right, and obviously, you know, you'd be able to talk more about but at least from what I've seen, it's people's behaviours, you can often recognise changing, so not sleeping very well, they don't want to come out of the room, or they don't want to play or they've stopped wanting to go to sports classes or whatever.

Go with your gut on that.

I think approach in a way, that's a sensible time and place doing it late at night, we've got homework on and they get up early, or ask at the Tesco queue, probably not a smart thing to do, do it an environment that you've that you think this person will be most comfortable in at a time that they're going to be most open.

And I think then being quite direct isn't I think so you can skirt around the issue.

You know, I feel that you have you, You seem a bit different.

I'm worried that you not yourself.

How are you doing?

Very key that you did there, you didn't say you are behaving different you are sad, you said I feel as though so that's You just open that door.

And I think if that person wants to speak at that time, they will, if they don't speak so I'm always here.

And I think that's right, I think if you if your gut is telling you something's not right, it's better to open up that conversation, even if you're wrong, and they're actually fine, then to sit back and wait and let things get worse until you're certain that something's wrong.

And actually, whilst we're talking about that, I'd love for us to put a myth to bed right now, which is bringing up the topic of suicide, if you are worried about somebody you care about, and you think that they may be suicidal, or having those types of thoughts.

By bringing up and saying the word suicide, you are not going to make somebody more likely to do it.

I think people sometimes have that fear and actually, the evidence says you're not going to increase their risk.

In fact, the opposite is true.

Yeah, you've given them the opportunity.

A lot of times, it sounds very hard to say, you know, you have different ways of saying but you want to say, you know, have you had any dark thoughts?

Are you thinking about harming yourself?

Or do you feel unsafe?

There's lots of ways that people might say it, but I think vocalising is, is really important, because actually sometimes if you skirt around and don't ask that question, you might miss an opportunity, actually, to give them the chance to say, Alex, what I want to ask you about now is the incredible work you're doing at number 10 Downing Street, how is that going?

What changes are going to happen?

But also in the future what are your aspirations.

What would you like to see change?

Because yeah, as a GP, I know that the current service availability and the support, especially for young people, is is just not good enough?

Yeah, I think it's not I think most people across the sector would agree it's not what we want it to be I think everyone quite universally on that agreement.

You know, my my, what I wanted to do with this role was be in the middle I guess of being a voice film people and using my platform to amplify you know, what they want basically and take that to a level that we can you know, people can who can make decisions can hear that and also to work with experts and go Well what do you what do you think is the answer, the solutions How can I kind of help and so the last kind of six, seven months I've worked on campaigns that we made wellbeing videos that went across all to all the schools in the country that they can learn a bit about sleep, bit about exercise or you know, nature, social media Starting a little bit education a show and actually teaching around mental health doesn't have to be boring, it can be interesting, it can be really beneficial thing.

You know, we've targeted a few things at anti bullying campaigns you know, we know that at any one time 50% of kids at school are being bullied and it's one into any one time we know the issue is growing and children are bullied at home you know we're not we your social media wasn't an issue go home you like bullied at school but you get away from it now.

People that bully at school the people bullying online Different for adults, tend to be different people but Day and night Day and night it doesn't stop and it's a huge issue our mental it's a huge problem with mental health.

So I focused on those So really I've tried to do as target areas, I think that we can can help and in terms of kind of funding, and the model at the moment got the child adolescent mental health services CAMS, which is there to support young people but of course its own design for a small percentage.

Those whe are really, really struggling Exactly.

You know, I really wanted to see the rollout of this mental health support teams speeding up teams of psychologists and support workers to essentially provide support at schools when they need it.

So if a teacher identifies a child that struggling, you've actually got someone that can be there and see them and intervene early.

But really, you know, of course, honestly, funding into CAMs is there's a lot of work to be done, I think, to kind of bring that service and bring the waiting time down and bring it up to where you want it to be.

But I do think we need to, I'd love to hear your thoughts.

I think we do need to move towards early intervention, as much as possible.

CAMs is designed for a couple of percent.

You know, that model doesn't work for everyone.

We know it doesn't work.

And so early intervention is important.

And that's why I'm really, really want the government to fund early support hubs having a place in each community, which is very important, not a clinical space that young people can go, they can feel comfortable with remove barriers around, you know, them being comfortable to talk to people, you have the youth centred approach and have access to services that work alongside CAMs, but it very much in a way of basically looking at the 360 degree view degree view of this child and saying, What can we do to support them to prevent them ended up in situation they need out from CAMs?

So that's been a speedy as I can put it into those kind of focuses.

And I think over the next few years, that the focus for me is around this early intervention, you know, that we need to shift towards that model.

But I'd love to hear your thoughts on that I could be wrong.

No, I think you're very right, it's really important to have that hub and spoke really where, that young person is at the centre, and that they're able to go to centres, you know, you know, youth club type, environments that feels that feels safe.

We established in very long time ago, streetwise, 2000.

All in 1999, actually, and what it enabled was people, young people to just go and engage and have those conversations that are quite tricky.

You know, the talk about suicide, the talk about I don't feel well, but it gave that sort of beanbags sort of relaxed atmosphere for that young person.

And it made it a normal thing to do to talk about how you're feeling from a mental health point of view, as well as a physical, A lot of the you know, I suppose I've been going around visiting hubs, because there's a lot of examples around the country, the ones that don't really really great.

What we want to do, we're not recreating the wheel here, we want to lift and national and have a standardised level, which I think you can some areas got amazing hubs and others, nothing.

Find out what works and then make sure everybody has access.

Actually it's a very, it's compared to the cost of CAMs very cheap way as economically, the numbers stack up as well.

But it's, you know, speaking to young people, you know, one of the biggest barriers that I hear from young people is the fear of the kind of white coat the going into this clinical space.

As an adult, it's scared off you're struggling the mental health to go and see your GP I am on Sertraline for anxiety and I'm having therapy and stuff.

I was like, you know, pick up the phone to the GP and speaking what's it like for a 12 year old to kind of pick up the courage to speak to a grown up, just speak to another grown up and then go to a clinic eight months, nine months down the line be told you're not sick enough to be there?

I mean, it's just.

and that's the reality of what's happened.

The reality is, as you've outlined, most are not going to do that, especially if they're struggling with their mental health, which adds additional barriers, you know, due to their motivation and makes it even more of a mountain to climb, to ask for that help.

So, absolutely, I think as you've said, the early intervention and having professionals like teachers who see these young people and know them well, being able to identify some problems before it really spirals.

Alex, thanks so much, honestly, for everything that you're doing.

And I'm so glad that there is somebody like you in number 10 Downing Street, you know, campaigning for those who perhaps don't have a voice, so you're, you know, amplifying their voices and keep supporting, I'm sure, Glenys is would agree.

It's amazing.

It is amazing.

Absolutely.

Fabulous work, Alex, Thank you.

So Glennis coming to you with your expertise, you've been working in mental health now for many, many years, you've had a lot of practice, when it comes to having that conversation with somebody about how they're doing, and how, how, what, what is a good way to approach that?

I think it's really, you know, you don't always know the person that you're speaking to, obviously, as a parent, you know, your team best.

So it's about how you manufacture that communication with them.

It's about sitting on your parent hands rarely, and which is very hard to do.

My parents, myself, my eldest daughter really did struggle with her own anxiety.

And it was about sitting on my hands because I would have been instructional, I would have gone into that mode of Annie to help like you're saying before Alex, and Dr.

Zoe, you were saying, weren't you that, you know, you will go into that, do this, do that and the automatic of course and you need to sit on those parenting, those professional hands.

So that control shifts onto that young person so that they can then feel that actually I'm being listened to here, there's some warmth here that they may not be feeling at that time.

So being aware of you control when you are communicating, think about what is the best way of communicating with that young person, they may prefer not to have a face to face, like you were saying before use technology use text, obviously, you got to be very careful because as we all know, we can receive a text and think what knows that person you know, talking about, it's how we interpret it, isn't it.

So think about the technology, think about the way that you can communicate.

You know, lots of parents that ring into Bupa often we talk about go for a walk you were talking before about, you know, doing those things that are natural, the mindfulness element of being in the here and now, go for a walk, have that conversation that isn't necessarily face to face, but bring in all the connections.

So you are making that connection with that young person, that connectivity feels warm to them, it feels real, they're then going to drop those barriers down a little bit, and be able to have that open conversation.

I mean, there's so this is quite intense, isn't it, if there's something like a mental health problem in the air between a parent and a child, this can feel so even walking and being side by side and I have an eye contact, I was once talking to a family as well.

And they spoke, they always had their more difficult conversations in the car.

Because there's a little bit of music in the background, you're driving, there's something else going on, you're not you know, you can have those little glances in the mirror there in the back.

But it's a bit less intense.

It feels like a slightly safer, easier environment.

You were saying about tech.

But I mean voice note as well, I've heard young people saying that speak to speak to parents put stuff on, they're gonna have difficult talk, they'll just do it over Voice Note.

You can take your time to say what you want to say you're uninterrupted and the person can listen to it.

And you have the time I guess a parent not related to sitting on the hands not to rush.

And you could be in that safe space can't you as as the young person, if you're in your own room, or you are out walking and you're messaging, you know, you can be there taking that control.

And that's so powerful, isn't it?

And Glenys, of course, in the real world, often the case that children, young people, they're not going to stick their hand up and let you know, there's a problem.

So what signs or symptoms can parents look out for?

It's like Alex was saying before, it's changes in behaviour, changes in what you have been used to seeing.

And those changes could be anything around routine.

And it could be where the young person is becoming withdrawn.

They're isolating themselves.

Irritability is a huge one.

Because, you know, lots of parents say, I don't know why they're responding in this way, you know, the irritable, that talking to me rather rudely, or That can be tricky, because that's a normal teenager as well.

It is, And you've got to look at that balance you've got to look at, let's not take it out of context.

But it's a real good point Zoe because it's about when there's a consistent change to the variable, that is normal teenage behaviour.

And it's when those darker moments come in, where they are self isolating, they are taking themselves away a lot more, those snappy, argumentative times, yes, they're natural.

But it's when does that mood change, when somebody is obviously feeling in a very difficult place in a different place to where they'd normally be.

So you need to be very aware of what's going on, you need to look at what you're observing, don't make assumptions, in terms of what you're seeing.

And be able to, if you can, I mean, I'm a parent myself.

So remaining calm is, is quite difficult.

Because you you'd like we've said before, your immediate response would be to get in there and help.

But like, we say, you've got to sit on your parenting in hands.

You've got to enable your teenager to be able to open up to you and have that conversation around you know, what it's like for them, what does it feel like for them, we've talked about that traffic, like sequence use techniques that aren't really focusing on them as individuals, but it's enabling them to feel more confident in being able to talk to you.

Talk about what's happening, talk about how they feel physically, because sometimes young people teenagers can say, you know, they can eat loads of food can't they or they can actually go off their food, appetite, sleep, all those sorts of changes that you notice you've you've got to sit down and have that opportunity to explore that further and like we said, again, use different techniques, use different communication styles, you know your child best you know that teenager well, what works for them and expand on that.

Go for that walk in the you know, you know, in the woods, feel that mindfulness air and living in that moment, so that you can actually start that conversation with them about what's going on in their thought process in and how they're feeling and how that actually impacts on them.

Okay, I guess as a parent, you're kind of an expert in your child, aren't you?

So you're gut, but also you know how to comfort them, perhaps make them feel safe but also recognising that it's your child who is the expert in whatever this mental health thing is that's going on for them and really, therefore, doing the best you can to lightly say, sit on your hands and let them talk about it.

Ask them lots of questions, but don't try.

Well, as tempting as it is, don't try and go in and fix it.

It's changing that conversation structure, isn't it that we're also used to?

And it's creatively thinking right, how is my approach going to be received, preempt, in some ways how you think they're going to react, and it's probably going to be totally the opposite.

But it's about being aware, being consistent, being kind, Maybe not responding straightaway because your reflex automatic reaction might not be the best one, but sort of take a little bit time to think about it and as you say, think well, how will this proceed?

You know, when I was a teenager?

How would I have received that?

It's very, very hard, isn't it, but you yourself, as the parent has to use that traffic light sequence in terms of using red, so that you can not get angry?

but actually put a stop to where you're talking.

Slow it down.

Just give that thinking time.

Use the exclamation mark to say, Okay, I need to change direction here but I've got to have some thinking time usually erms, you know, it's, it's okay to it's so easy to go away and you know, run away with the conversation but you've really like you're saying, you've really got to try and slow it down, stop, and give yourself some thinking time in order to be able then to structure what you want to say next.

And what would you say what are the main causes of problems when it comes to mental health in teens?

Because we're seeing this huge increase in issues?

I think, I mean, if we knew what the causes were it'd be great wouldn't it.

Because there are so so many reasons and triggers why our children and young people really struggle with their mental health.

You look at young people being in those stressful situations through the pandemic, they become isolated, they're on the media more, they're using media more as their mode of conversation and communication, which they would do anyway but they're not having that break from it.

So social media is really quite a powerful tool in very many positive ways but also in very many negative ways.

And we've had many conversations with parents, whereby the use of social media has had such a negative effect, talking before about bullying, cyber bullying, and, you know, parents don't know what to do with it, because they don't have the control.

However, talking through it and saying, Well, you know, let's have a family plan about the use of social media, let's look at what that actually means for us as a family and for you as that individual teen.

Because teenagers will be on there all day wouldn't they?

All day and all night long.

We don't know what's going on in those conversations.

I think I think parents use social media in a different way to young people as well.

So they don't fully they're not fully able to grasp I guess the.

just how significant that can be or how detrimental that can be to one's mental health.

Do you think it's important that do you think children should be educated?

Should this be part of mainstream education that children are, I guess, warned of the dangers of social media and I guess, learnt the skill of how to use social media so that it doesn't impact you negatively and can even perhaps be a positive influence?

Without a doubt, Zoe, I mean, it should be on the curriculum.

Shouldn't it really shouldn't be on the school.

Do youagree with that?

I can feel it.

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

It should really be on the curriculum, you know, the high pressures that young people are under and face, you know, the code of use the safe use those family media plans?

You know, it's all about where did they learn this?

And at the moment, it's, you know, it's very few and far between structures that are there to enable a family to know what to do.

So let's get in at that first port of call reception, nursery, reception.

Going through from year six transition into high school, you're then prepared.

If you've learned from a very young age, what is cyber bullying?

How do I manage those that information coming through what is safe to look out what isn't safe to look at?

Yes, we can all talk to our young people and our children about, you know what is safe, but normally, as a parent, they'll not listen to you to the same degree as it being managed within their peer group at school.

And if it's delivered through the education channel, they'll see it and accept it in a very different way.

You wouldn't fly a plane without lessons would you?

We're all flying around in these planes?

I mean, I came off Love Island and I never really use social media particularly 200 followers, and I suddenly had a million or whatever.

And having to like kind of learn, I went through that whole process of like, oh, my gosh, and then you get affected by this, and you look at this stuff.

And you, I learned the hard way on how, and I'm in my 20s, how is a child that's coming through and of course, we know the limit the age limit that kids should be on social media, but let's be honest, that 10, 11 years old, they're on social media.

So we should be teaching at school, about how to use it.

If we look at the next I'd love to, you know, look into the future and see but I'd imagine in 50 years time, almost all of our jobs will be.

I mean, look at medicine, for example.

You know, we've got so many more doctors are on social media but also providing healthcare over.

There's still social media platforms, whatever app you want to call it.

So you know, we have to teach these kids not just about the dangers but how to use it effectively, because it will be a lot of your jobs in the future.

I once learned a skill from a psychologist, we were having a similar conversation to this.

And she said is that this is just one little nugget that I've always found so helpful is that we tend to if we're feeling a bit low, and we're not in a great place, we tend to scroll and look at other people's content.

Whereas if we're feeling quite good, that's when we tend to post.

So even I was thinking that now if I'm scrolling a lot, it's like, I probably don't need to be on here.

This is not good for my mental health but if I'm actively posting then it's a positive thing.

And that's just one tiny little skill that we should be teaching all of these skills to young people.

Look at how the mind works, you know, you'll know better than I do, about the development of the brain and how vulnerable it is for children and younger people.

And yet they're absorbing all that information, aren't they?

So it's so important to actually be able to educate, so that that vulnerability reduces.

Was reading the day and they're doing this study looking into how like if I say something that's hurtful to someone or I write it and they read it, it sinks much deeper into their brain if it's read.

So like say if you're on Twitter, so when something about your body, you're like, how you look, when you read it, it sinks so much further into your subconscious than if it was said face to face and you can contextualise it or whatever you're just reading this thing.

And you're like, it's almost like when you get a text and you interpret it you are interpreting that in the most harmful way Actually make someone make a very light comment about you and saying anyone should be, but they might but you will take that to the depths in your mind.

It's also if you have 100 comments on your posts and 99 are positive and one is negative, we focus on the negative and that doesn't happen in the real world, you know, that just that scenario never arises.

I want to talk a bit about change, because change is difficult for all of us but for children and young people understanding and coping with change is can be particularly difficult.

What advice can you give around that?

I think it's really important.

Obviously, we know, like you say, change is inevitable.

It's in everyday life, you know, it's an ongoing process and I think first of all, you know, if you're looking at the younger child before they get to that teenage space, we've got to have those conversations with our younger children around change, that change happens and changes, okay.

You know, sometimes we'll make a mistake, and we have to change things, we have to change what we're doing and that's all right.

We need to start so very, very young, in getting that across, that change will happen and sometimes it's good, sometimes it's bad.

But managing that change is what we want to enable our young people, our teenagers to get to a point where they're resilient, You know, perhaps using those four C's, where as a family within your family life, whatever formation that may be that you have a curriculum of conversation, that you're able to have those special times where you could use a traffic light sequence in terms of how somebody is feeling about a certain change, or you can have those conversations whereby you're all out for a walk on the weekend and there's a change pending.

Have that exploratory, of, you know, opportunity to explore what that makes people feel like what does that teenager in your family feel like?

How are they responding to that, to show that you're caring to show that you are communicating with them put in on their terms.

So it's about, you know, making sure that what you are saying mean something to them, and it's not your control over that you're getting their opinion, and then obviously exploring and looking at the tips and techniques for managing conflict, because nobody really likes conflict.

You know, young teenagers perhaps will look at it in a different way and view it in a different way that they revel within conflict, but not when it's associated to change that directly impacts them.

And again, it's about building up that resilience to be able to cope.

So the four C's then in relation to change our Curriculum of family life, Caring, Communication, Conflict.

Brilliant and Glenys finally what what help and support is available through Bupa?

Okay, through Bupa, we have the Family Mental Health Line, which is a remote service for parents, grandparents, carers to call in and have a conversation about their child or young person.

That may be struggling they've may be identified some of those changes those behavioural changes.

The level observed different traits in their children, especially through the pandemic as well.

Then looking and seeking to have that conversation where they can get tips, advice and guidance from the trained children and adolescent mental health nurses.

Brilliant.

Well, we've run out of time, but thank you so much, Alex.

Thank you Glenys and I hope that you found something in there really useful.

If you want more advice on this topic, please do go to the Mental Health Hub.

Thank you.

Hello and welcome.

I'm Dr. Zoe Williams and I'm going to be your host for this event.

This is the fourth virtual event in the Bupa inside Health Series.

And for this event, we're going to be focusing on mental health and in this segment specifically, loss and loneliness.

These events are exclusively for Bupa customers to give you access and give you some insights and some advice directly from our expert team at Bupa and today I'm joined by Glenys Jackson who is clinical lead for mental health at Bupa and she is going to be given us some of her expertise to guiding us through loss and loneliness and also, Simon Thomas is a TV presenter and advocate for loss and loneliness.

So Glenys, if we can start with you what help and support is available to people.

And if they're experiencing loss, bereavement or also loneliness?

Well, obviously, it's very, very, very difficult time to people and the most important thing in terms of support is the fact that they can call in and have a conversation.

I think it's really important that people understand that being able to talk is of paramount importance, because you go for so long, following bereavement following loss through that grief process, whereby you think there's nobody there for you, there's no help there for you.

But it's about making that first step, making that first step into making that call, being able to talk to somebody, even if it's only just to say a few words and then most of that conversation time is spent crying or being upset.

It's really about being able to engage in a conversation, to have that chat to have that talk to go through what's really happening for you.

And then once that doors been been opened, I guess and that person is given somebody an opportunity to help them.

What are the strategies that are available?

What the coping strategies for people in this really difficult time?

Well, it's really important to think about that there's no right or wrong way.

Because we are all unique in how we think and how we feel and how we respond to situations.

So it's really important that we are responsive, we think about okay, I need to talk about what I need to talk about, I need to look at what help is out there.

So we really have that conversation around scoping what's right for that individual?

Is it that you know, they could use something like Cruse or is it that they need to go to a face to face group?

Or is it that they need to do something online where they're not exposing their conversation to a wider audience, a wider group?

It's really about pinpointing what's right for them and only through those conversations, will you identify what is the best thing for them.

And then again, reflect it there's no right or wrong, something you think, yes, that will work for you but in actual fact, it's too hard.

That person's experience is still too raw and that's when we look at time.

I mean people say times a great healer, it is but as long as you're getting that support that you need.

And I think sometimes as a GP we find it difficult to differentiate, you know, what is bereavement and what would be classed as I guess, I hate the term normal, but you know, normal symptoms of bereavement versus when as something like a mental illness like depression or anxiety or PTSD.

How do you differentiate what is it a time difference?

There's many different aspects to whether something when you experience grief or experience when you experience loss, that the grief that you're feeling is that actually, you know, going into a condition.

But what we've got to realise at the beginning is that as you will know, and through many people that you've spoken to that, you know, grief is normal and we're not to take that away You know, our reactions that we experience when we have loss, we've got to let them let it happen and let that time evolve.

Those periods of those overwhelming rollercoaster of emotions, you know, let that happen.

Because it needs to, don't try and block it out.

And if that you get to the point where okay, I can see a little bit of light.

I can see a little bit of time where I'm actually thinking I'm okay.

I've actually had 10 minutes where haven't felt exhausted or haven't felt overwhelmed.

That's the indicator that you're actually going to start on that path of recovery and not necessarily going down that clinical path.

Because of course, if you do go down that clinical path, that's when you do need to engage with your GP, you do need to have that conversation around, I am not coping with these feelings and thoughts that I do have, They are extending out of that normal reaction to loss and the grief is really eating me up, and I need to do something different about it, because it could slip into that depressive mood disorder, it could slip into where I can't cope with my anxiety, it's up there, and I'm not I'm not coping at all, you know, it can develop into that PTSD, post traumatic element of thinking, and you can't control it.

So I always look at that, you know, if you're managing to control those emotions, and you're letting the main and the overwhelmingness is reducing, that's when you starting to make some inroads into that grief process.

If you can't, that's when you need to engage with your GP and have a conversation about what do I actually need now?

Are there any specific signs or symptoms that people can look out for that might be a clue that actually, you know what this is?

Not okay and I really should, you know, reach out.

For some professional support, I always use the old scenario about a rubber band, that when you when you look at a rubber band and you stretch the rubber band out and out and out, and it's that rubber band is full of your symptoms It's full of that overwhelming feeling of anxiety, of mood thoughts, that are really concerning for you.

Those moments where the feelings are intense, and you have you don't have that control, your sleep is so disturbed that you're not sleeping at all, you have no appetite whatsoever, you've no motivation whatsoever and it's when those are significantly impacting on what you do.

Day in day out, I can remember somebody telling me about just sitting there and not being able to move, because they were was so they were was so wrapped up in their own grief that they had no work, no outlet.

And it's when the severity of it is really impacting your everyday life that you do need them to engage in real professional help.

What about if it's going on for very long time?

Is there a is there a cut off obviously there isn't a firm cut off because everybody's different?

But would you say if this if these symptoms and these feelings, you're not starting to see any light at the end of the tunnel, By what point would you expect that to be happening?

You would hope that somebody would find some relief from the grief symptoms, anything between six and 18 months, depending on their own, you know, physiological, psychological makeup really.

That it really does depend on them as an individual, like you say, we are all unique.

And it's really around knowing themselves.

So it's about being able to get in touch with you as an individual and being brave, to say, this isn't right, this isn't going the right way.

And having that conversation using those organisations that are out there, either nationally or locally, talk to your GP about how you're actually feeling so that it can be measured, it can be assessed in terms of where you're at and how you think and feel within that sort of volcano of loss.

You know, you've got to enable that volcano to erupt, to be able to let all that emotion out so that you can start repairing yourself.

But like you say, when it goes to the extent of this isn't going away, and you're you're 8-12 months down the line, then it's about No, I do need to check this out.

And there is help and support available.

What I love, I love what you said there about being brave enough to actually admit that this isn't going okay and I do need help.

I love that because it is actually I think people worry that the brave thing to do is bury your head in the sand and get on with it and let the world see you shining as if everything's fine and that's not the brave thing to do is actually to, to ask for support and help.

We often say don't we when somebody asks us, are you okay?

After loss?

And you just go yes, yes and we're not we're not okay at all, we then turn away and cry or turn away and just feel very, very sad.

There is in my opinion, there's no treatment for sadness.

There's kindness, yes, listening.

But there's no real treatment for sadness.

Until it gets to that extreme where you do need that professional help of course, but it's about being honest with you giving yourself that permission to say I don't feel right.

I'm not coping with this, and I need that support.

And then finally, how would you do you have any recommendations for people as to approaching life after the loss of a very close family member, maybe a spouse or you know, and somebody, it's got the rest of their lives ahead of them.

Yeah.

How do you approach that?

I think that is you've got to be very realistic.

You've got to look at what's happened to you.

What the impact has been?

has, you know, has there been impact on other people in your family due to that loss?

And it's really looking at that whole picture of who you are, and who your connectors are.

And it's about making that connectivity again, isn't it?

It's really looking at taking small steps and taking little bite sizes really And reflecting back on that to say, you know, yes, have had just had five minutes OK time actually.

Where I've actually felt brighter.

You can feel your mood changing and it's being aware of that, isn't it?

So things like mindfulness, aware you have to be in the moment.

It takes lots of practice, of course, but it's actually been in that moment to actually say, I'm actually feeling okay for this five minute spell.

And then you go slumped down again but you've got to try and remember that you've had that five minute of kindness.

Brilliant.

Thank you so much.

Simon, there are a number of times their I could almoust sense.

Can see me nodding.

Agreeing, I couldn't see you but I could, I could almost hear you nodding.

And so you know, you've become kind of an expert and a real advocate for supporting people through grief, bereavement and loss and it all started with your own personal experience.

Can you tell us a little bit about about that?

Yes, it was back in 2017 and I'd been married since 2005.

My first wife was called Gemma, and an eight year old boy, Ethan still got my boy, he's not eight anymore.

He was eight at the time and it was the the autumn of 2017 actually interesting.

When you were talking Glenys about with the question that was asked about that kind of confusing period as to what is grief?

What's mental health issues?

I was going through some really pronounced mental health problems before Gemma fell ill.

So I was working for SkySports at the time, I had to come off work with very pronounced anxiety and panic attacks, and then I couldn't work anymore.

And obviously what happened next, my doctors say we can no longer tell what is grief and what was happening before the ballparks change.

But in amongst all that Gemma just fell ill very suddenly a lot of recurring headaches and I know when we've met this on this morning together, I've spoken about this and she became very fatigued and went downhill very quickly over the space of a week and eventually we took it to a&e and reading and it was discovered in the early hours of a Monday morning that she had a blood cancer of some sort and we didn't know what it was but as you'll know when anyone mentions the word cancer and it's it's your own personal situation.

It's a it's a moment that will haunt you forever and we were transfer very quickly the next day to Oxford, where she was diagnosed with a rare but aggressive former leukaemia called acute myeloid leukaemia, which affects around about 3000 in the UK every year.

And the treatment began immediately we knew the outlook was was was tough, it was 5050 Whether she pulled through and by the Friday, he had a really awful complication in her brain because of the damage that the explosion of white blood cells had done to her blood vessels in her brain and she died by quarter to six on the Friday.

So within the space of a week, we've gone from finding out she's got cancer to her being gone and then I'm plunged into this just horrendous period of obviously my own grief and pain but alongside that, I've got an eight year old boy who's now lost his mum out of nowhere.

So I've gone in the space of a week from from having a wife and Ethan having a mum to Gemma's gone and suddenly plunged into this awful confusing world of grief in very little time.

and that's what, you know, my counselling others would call traumatic grief where there's been zero time to prepare and suddenly you're in it, and it's the best word I'd come up with.

It was a nightmare.

Yeah.

Gosh, I can't even imagine how just traumatic that must have been.

Ethan being, did you say, is eight years old?

Yeah.

How?

How did you approach or how did you manage coping with a child and their loss?

Gosh, this is a good question because there was there was no time to prepare.

In terms of me or Ethan, you know, we couldn't meet with charities to prepare for his mum dying.

It just happens in the space of sort of four days and there was no time to pick a book up.

How do you help a kid through this?

Obviously, we had a lot of support from family and friends but again, they don't they don't know what to do.

They don't know what the best thing to say to him is or how to comfort him.

There were lots of lessons I learned very, very quickly.

One of the biggest lessons I learned very early on is that a child's grief will be quite different to an adult's grief.

The best way it was described to me by the charity that began working with him is that a child's grief is a little bit like the way in which a child jumps in and out of a puddle.

So they can jump into a puddle.

Hopefully they're willing to boots on and if they've had enough they can jump back out and that's a little bit how their grief works and I find it very confusing at first.

Because even in the early days, you know, his cousins were around lots of family around and one minute you'd hear kind of laughter and chatter coming from the lounge or he's playing with his cousin on the PlayStation.

The next minute, he's in tears.

And he's asking questions about what's going to happen future wise, what's gonna happen with your work, daddy, you you go away weekends I spend time and money what happens now.

And then he jumped back out again.

So it's when the pain gets too much a child is able to jump back out for an adult that for me, there was no escape, no escape from the from the pain of grief, but also the myriad of questions that are coming in as How is life going to work?

How am I going to look after him?

If I carry on working?

How do we pay the mortgage?

And all the questions if they actually I shouldn't be asking these right now, because it seems insensitive.

She's only been gone 48 hours, but they just come at you.

So I learned that very quickly that his grief will be different to mine.

There was times over that first Christmas, it had moments and I wrote about this in the book I wrote about it where I felt jealous of him.

I wanted to be him for an hour.

So I could jump out of that puddle.

Just for that slight bit of relif Just be free for if it was like for 10 minutes not to have all these worries crashing in.

The other thing I learned was that the importance of going there with them when the questions come.

Now I found with Ethan it will be different than the kids but what they will try to do very early on is begin to try and work out what life is going to look like going forward.

They're trying to make sense of this bizarre new world, they find themselves and they've learned very young that the world can be a cruel place.

And that's what happened to Ethan in 2017.

He learned that really bad things can happen and it's happened to him.

So he had a myriad of questions very early on about life going forward.

So within three days, he's asking me, What are we going to do mummy's clothes?

I'm not ready even to begin that conversation yet.

So my temptation was to shut him down again.

Ethan, we're not going there.

No, no, no, no.

Why are you bringing that up?

But I didn't began to talk to him about it.

A week in he just said to me one night as I'm putting him to bed, he said Daddy, you could die tonight.

What?

He said, But mummy died in three days.

So actually a totally.

Okay, question.

That's, that's the reality of his world.

I just said, Well, we've now found out as time has gone on that mummy was seriously ill, we just didn't know it and it came too late for her, which is why she went so quickly.

I feel very tired.

Because you were talking to us about the lack of sleep, I could get to sleep just couldn't stay asleep.

You know, a bad night was I was up at 2:30, I lie-in I think till it was 4:30 for about nine months.

But on that occasion, I went there again with a question and just said, Look, I feel okay.

Mummy wasn't.

So I think I'll be okay.

Because the other lesson you have to learn very early on with the kid is you want to promise them the world.

You want to promise them that nothing bad will ever happen again and one of the first things the counsellor said to me is, as a parent, you want to say I will always be here for you.

It's a lie.

Yeah.

Because he won't.

He's just learned that for his mum.

So you want to say all these comforting things, but you can't You still have to keep it honest.

Yeah, you got to keep it honest and so I just learned to go there with the questions when they came, answer them, even if you feel really uncomfortable, because if you don't, then eventually he will just feel Daddy never wants to talk about this.

So eventually the door shuts.

Well, then where does he go with those questions?

So I just felt right from the off whatever the question was, he asked me within 10 days, would I get married again, again, come from, but it's a child trying to make it they want to feel a sense of security.

No family life will never be the same again.

Yeah.

But can they have some semblance of the security of family structure brings?

Again, at some point, which is why is asking that question.

I suppose it's you answering those questions he had?

Yeah.

In the way that you did.

Gave him that comfort?

Yeah.

Instead of blocking it out and say, No, I'm not.

I'm not going to go there.

Yeah.

Which is our natural response.

Yeah Totally.

It sounds like it was a really fine balance between his questions had to be answered and then he could put them away and he had that security but also not overstepping the mark and not over promising and actually being, being honest.

And it's really difficult.

It's a hard balance to strike and because we had no time to prepare didn't have kind of things to think back on sessions we've had with with counsellors because there are lots of organisations that are amazing and preparing children and families for this moment, I think is more needs to be done, but there is much more out there.

So if Gemma be given a diagnosis of say, a year to live, you know, there are organisations that will help you as a family prepare for that and think through the kind of questions that may come from a child.

There's no time for that.

So you're just just trying to answer them When they came with a big gulp.

And interesting that Ethan asked you if you would get married again, you did get married again.

So congratulations.

Well, just a little side note on that.

Congratulations.

So when you were in this really difficult, awful nightmare as you described it, and you've said you already had some mental health problems going on and then you add grief on top of that, and it all become how did you manage how did you cope?

I mean, you're here today.

What were your coping strategies?

Who helped you who you, how did you get through it?

Well, I think one of the biggest things was in the early days after, Gemma died, we just had an incredible amount of support around us from family and friends.

It was like this army sort of arrived at the house, and just looked after so many different things.

and I remember a story that really struck me where I realised that this actually wasn't necessarily the norm.

That actually an awful lot of people go through something like this and it's a very different story for them.

There's lots of really unpleasant but necessary things you have to do when someone dies, which is, in order to have the funeral, you've got to have a death certificate.

So we were back in Oxford, where she died on the Tuesday she died on Friday, we were back back on the Tuesday to pick up the death certificate.

And it's, you know, it's one of the most sobering moments in life, you know, when you're seeing a registrar, noting down all the details, and then writing the word widower into the description of me, you know, moments you'd never expect to have when you wife just forty So horrendous moment, but I went with three friends.

So I had these three friends there with me in the room and the registrar, while she was signing just looked at me said Do you mind me asking who these guys are with you assuming they're your friends?

Yer they're not just random, attracting off the ward, Taxi driver Bus Driver, works in the coffee shop and I said, these were mates.

These are kind of team Thomas, as we call them.

She said that she that?

That's amazing.

So you know, you are very lucky.

I say now I am.

Yeah, I know that.

I said.

Well, what's the story for a lot of people who come to this office, she said, Well, we find a lot of people who come will tend to come on their own.

Now some come on their own out of choice but others come on their own because they don't have someone alongside to support.

I just thought my goodness me, I can't even begin to imagine coming to a place like this for a moment like this and just being on your own.

So that that support around me was was really, really important and a massive help because they looked after so many things that you can't even begin to think about like just putting tea on the table for even like thinking for a shop like a friend just sat down and went through all the administrative things like shutting down Gemma's bank accounts, the phone and all just all the grim things you have to do.

So that was massively important.

I think picking up on something that Glenys mentioned earlier.

You know, people will manage this in different ways, they will respond in different ways.

I don't know, I just had a feeling that the most important thing was is I just let it out, you know, in whatever shape or form that takes.

So I was a very angry man for quite a while, but I would tend to take my anger away from Ethan.

So you would have if you'd been living close to me where I was in Reading at the time where the house was by the River Thames, I would be down the end of the garden near the Thames, just shouting into the into the morning mists, just letting this anger flood out and there were joggers the other side of of the Thames looking Who is that it is dressing gown and wellington boots but I felt it was really important to do that.

Because as time's going on to realise that if you don't, it's like sort of shaking a bottle of pop, the pressure will build and build and build over time and I remember speaking to a close friend of ours, and she never told me the story, but she'd lost her mum and she was quite young, not as young as Ethan and had never really ever properly grieved for her mum.

And then many years later, the grief suddenly hit and I said, Well, when it hit all those years later, what was it like?

She said an utter mess?

So I just felt this need to kind of let it out.

I think when Glenys saying you know, there's no wrong way to do it.

I kind of agree to an extent but there are some definitely things I'd say don't do.

You know, I developed way too heavy reliance on alcohol when things got too painful.

As that kind of initial support began to disperse as people had to get back to life again and you were left on your own more and more.

That was often something I went to just to numb the pain for a bit.

but the problem when you do that is the other pain numbs for an hour or so.

But the danger then is you begin to bomb down this slope that takes you to a really really dark place.

So if anybody ever asked me about coping strategies to say that that is one to avoid, that's definitely the wrong way to do it but I understand why people do do it.

And it was just it was just letting the expressing myself I got counselling very early on when every single week and I found that massively helpful.

He was just so good at pinpointing why be feeling the way I was on a certain day like the day I decided to leave SkySports to look after Ethan.

I was lucky enough to have a big life insurance payout.

So I had the financial security to do that.

I know that others don't have that and I can't begin to imagine what that's like.

But on that day I stepped away from sky we planned it I decided a month before but I'm that not morning when the press release is coming out.

I felt awful.

Just on edge.

It was mid April 2018.

A few months later on edge tearful at the school gate.

Actually one point kicked the school gate in anger.

Some of the parents again heck's going on and they know what's going on but why is he in this state this morning?

Fortunately I was going my counsellor literally after dropped Ethan off.

and he's got on those ring doorbells.

So as I press that he can see my face.

So he's already working out I'm in a bad place.

Just for my image on the ring doorbell I sit down.

He says you're not in a good place are you?

I went no.

He said why do you think that is?

And I said well, I don't know.

He said what's going on today and I told him about sky and straightaway said the reason why you're feeling like you are is because this is another loss on top of the greater loss, which was Gemma.

And that's something that sometimes I found hard that wasn't acknowledged by friends and family is that when something like this happens, there's a lot of secondary losses, that in normal life, the loss of your job, even though yes, I decided to turn them, you know, step away from it is massive, Especially when it's a career that you've worked so hard for.

Took me 11 years to get to the Premier League at Sky, then it's gone in a season and a half.

But people look at the greater loss and when they look at that the other thing seemed a little bit immaterial but you are dealing with all those he just said, that's why you're feeling the way you are, we unpacked it.

So I found that massively helpful.

As you're talking, Simon, the word that keeps just popping up in my brain is brave.

I think, as you were saying, Glenys, it is so brave to admit that this is not okay, that this is difficult that you need help.

It sounds like that's one of the things that helped you, you know, turning up with three of your mates great that those mates are so supportive, but also brave, that you were open enough to allow them in to help you.

And that standing at the river and shouting, it just makes me think about the many cultures, especially in the developing world, you know, in Africa, or South Asia, where, you know, we see those images of people wailing, and really, you know, physically letting the emotions be expressed.

It's very British of us to keep that inside, isn't it and cry our tears behind closed doors.

So it's really interesting, and just Yeah, I just think it's so brave and obviously what you've gone on to do since then, which is to support and help other people from what you've learned through your own experiences, incredibly brave as well, because you have to keep bringing up your own story, which is not easy, And you don't feel like you're being brave and I remember the time the phrase that really wound me up it was it was always online, like when I put up the first post on Facebook, just let friends know that that that she died.

So many comments, and this was a recurring comment.

Whether it was on Facebook or Instagram or in person over the next few months was be strong.

Be strong for Ethan be strong for your family, whatever it is.

It used to really confused me.

So how on earth can you be strong in a situation such as this?

Yeah, it's not like I'm choosing to be weak.

No, I'm gonna get up and flex muscles.

Then come on today, I'm getting through this.

Some days, like you couldn't get to the school and then just go back to bed and be in there probably till he finished school and go and get him again.

But actually, I as I began to learn is actually is being vulnerable enough to go today I'm feeling awful being vulnerable enough to go I'm okay to cry being vulnerable enough to go today.

I'm just gonna let it all out.

Yeah, I'm going to shout at a river passing me by and the joggers are the other side.

Obviously, I wasn't shouting to them but I'm I'm vulnerable enough to go.

This is where I'm at today.

This is how I'm feeling and that That's being strong.

That's the strength and what I think particularly when it comes to men, and particularly mental health is that and I think we're beginning to change the narrative on this.

This the vulnerability is still seen as a bit of a dirty word.

It's seen as weakness and there's a number of people out there trying to flip that on its head and say, no, actually just unclench that fist for change as a guy and say, today, I'm just not okay, today, I'm struggling with the sheer weight of loss, and I'm a mess and there's bravery and strength for me.

I have to say that whereas the Britishness you talked about, Zoe, is that I am fine.

Stiff upper lip and, you know, I've seen the damage it's done to people where they've adopted that, you know, my boss at sky at the time came to see me a few months after she died.

and and I'd always wondered about him why he was quite a schizophrenic character, really charming, one meeting you'd have with him.

Absolute nightmare, the next is like weird.

And then he sat down when we came for lunch, to see how I was and then began to tell his story.

He lost his mum, when he was five, his brother was seven.

And once the funeral came and went, his dad never allowed there to be any conversation around his mum in the house ever again.

Gosh, This guy had it bottled up.

And as I began to hear this thing, this does explain a little bit.

Why he's become the person he has, because so many emotions have been buried.

And then so many things trigger.

Goes back to that volcano.

Again, doesn't it I love that analogy?

You know you put the lid on that volcano.

At some point, it will erupt.

It's gonna erupt, yeah.

And if you leave it and leave it and leave it, what a mess that will be.

You need let it sort of just spill out gradually over time.

Final question, Simon.

You know, you have now kind of devoted part of yourself to helping other people through grief and loss and of course, everybody's different and the solutions for different people will be different.

but are there any sort of generic words of advice or coping strategies that in a short space of time you could recommend to people?

Yeah, the one is when it comes to if you're lucky enough to be offered support.

Don't be too proud to take care.

You know, sometimes people won't go now I don't I don't need this, I don't need that, you know, just just take all the support you can get, you know that I've always say that be be brave enough to talk, you know, whether that is getting a counsellor or finding a friend that you can really confide in.

I'd always say push into that lean on as many people as you can, there will be moments when you won't want to be around anybody, you'll just want to be on your own.

You won't want to answer that voicemail message or that text message.

And that's okay.

And the people around you need to understand that that's not you pushing them away.

It's just in that moment, you're not ready to talk.

But talking is really important.

And actually, it's okay to feel all of these things.

You know, it's okay to be angry.

One minute I was I PTSD for months after it happened, you know, just inexplicable highs and lows, one minute I was doing okay, the next minute, I'm in a supermarket in floods of tears, you know, you just bounce around all the time.

To let those emotions out is really important.

There's a lot of help out there.

You know, we've talked about some of the charity, whether it's Cruse, there's ataloss.

org There's lots of really good kids bereavement charities Ethan's done loads of work with Grief Encounter, who just brilliant it was really important to tap into that .

There's Widowed and Young, which is an amazing organisation that reaches out to young men and women who've been bereaved, below the age of 50 because, you know, that's, you know, we go through, we'll all go through loss at some point, but reaches out to that specific group, don't be too proud to reach out.

And I'll always say to people is, and I sometimes when I heard this, I felt really like angry with someone would say this, it's a one day it will, it will feel different, it will get better, the sun will shine again, when you're in the midst of grief when that volcanoes going off, and everything feels very dark and doesn't feel like the clouds ever clear for very long, you cannot even begin to believe that will happen.

But it does.

And it's bit by bit, sometimes you'll have fleeting moments, suddenly, if I feel right in this moment, and then the clouds back in, but over time, the clouds clearer, more and more.

And I just say to people, it is possible to have a happy and fulfilled life again, that doesn't mean you have to, you know, get remarried or whatever that might be.

That's the path that I've ended up on.

It's brought me huge, you know, fulfilment and love again in my life, but there's lots of different paths that lead to a fulfilled life again, you can have that, you know, it's it's not suddenly shut off to the bereaved.

And I think the last thing I'd probably say to people is, is something I learned over time is that relationships are going to change.

I think, particularly when bereavement comes at the wrong time in life.

When we lose a parent, I lost my dad 18 months ago, it's really hard.

But people have a reference point because his late 70s he hadn't been well for a while and we expect it at that time in life.

So the usual cliches can be readily applied, you know, great innings, what a wonderful man who has gotten things, and someone goes in their early 40s.

Half time in life, our reference points is a much harder and for people at that stage of life, there's been sudden loss and the loss years, relationships do change and I was told this very early on didn't want to hear it, a woman who'd been through the loss of her husband, when she was a similar age to me, said, your friendships will change.

Some will deepen, some will drift away, and you'll find new people come into my life, new people definitely came into my life.

My best man at my wedding was a guy I didn't know before Gemma died, he's now one of my best mates.

Relationships did change.

Some of our best friendships are no longer the same.

Some people were very much part of that initial support I've never heard from again, probably three or more years.

And I think it's this and I'll just say to people going through, it's a hard thing to understand.

But my counsellor said a really, really good thing when I say I don't understand why people aren't around me anymore.

He said, It's like this, when you try and look at the sun, you can look at it for a while, not for very long and then you have to turn away because it's too painful.

And people can look upon your pain and your loss for a while.

But in the end, they have to begin to look away and there'll be only a handful of people who can continue to look at that pain and walk with you long term.

So I've just say to people, it's a hard thing to digest the idea that in your darkest hour, your lowest point that you're going to lose some friendships that people aren't going to walk with you.

I'm afraid it's just it's just the way it happens.

I experienced it and so many others do and when I put the comment on Widowed and Young about this, I'd say 90% of people got back to me said yeah, I've gone through exactly the same thing.

So so much will change, but life can still be good again.

Sadly, that's all we have time for.

Thank you, Glen.

Thank you, Simon for it's just been such an incredible chat and I hope you've all learned something really useful from that and if you'd like more advice and support, please do go on to the Mental Health Hub.

Thank you