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WalkingBack to Health 

A recent study led by Dr Natasha Pocovi (PhD) from Macquarie University focusing on the effectiveness and cost-effectiveness of individualised, progressing walking and education on low back pain has shown promising results. 

The randomised controlled trial findings have recent been published in the Lancet with promising results. 

Reoccurring low back pain is a significant problem and can severely impact the quality of life of those experiencing it. The WalkBack study focused on adults who had recently recovered from an episode of non-specific low back pain that wasn’t attributed to a specific diagnosis with the pain/episode lasting over 24 hours. The randomised control trial randomly assigned participants to one of two groups. Group one was an individualised, progressive walking and education intervention supported by a physiotherapist for 6 months. Group two received no treatment from the study team but were able to seek out any treatment or prevention strategies and use them during the trial. 

The researchers were investigating two effectiveness outcomes: 1. How many days from randomisation (that is being placed in Group 1 or Group 2) to the first recurrence of activity-limiting low back pain lasting at least 24hours and 2. An economic evaluation that included quality-adjusted life-year (QALYs) and costs associated with the delivery of the intervention (including health-care costs, work absenteeism etc.). 

The outcomes of the trial showed that the individualised, progressive walking and education intervention substantially reduced low back pain recurrence compared to no treatment. There were also reductions in back pain-related disability for up to 12 months in the participants who received the intervention. The findings also indicated the intervention had a high probability of being cost-effective. 

This research shows some promising findings that have the potential to help millions of Australians Walk Back to a life free from low back pain. 

For further information on WalkBack click HERE 

Contact our free national Helpline

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

Read more

 


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Self-care is a trending concept at the moment with many different definitions and uses.

You often see social media posts promoting self-care with pictures of day spas, yoga retreats and people exercising on the beach at sunset. All wonderful things, but when you live with a chronic condition, pain and sometimes-crippling exhaustion, life’s not always that glamorous!

So what is self-care?

The World Health Organisation defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker”.(1)

That’s a pretty dry definition, so for the everyday person with a musculoskeletal condition, we describe self-care as the things you consciously and deliberately do to take care of your physical, mental and emotional health and wellbeing.

It includes everything from exercising regularly and staying active, eating a healthy diet, getting a good night’s sleep, caring for your mental healthmanaging pain and fatigue, seeing your healthcare team regularly, learning about your musculoskeletal condition, and staying connected with family and friends. It also involves good hygiene, avoiding risky behaviours and actions, and using medicines and treatments appropriately.

The International Self-Care Foundation (ISF) has developed seven pillars of self-care. They aim to help people understand the breadth and importance of self-care, and provide information about the steps you can take to care for yourself better.

Let’s explore them.

Pillar 1. Knowledge and health literacy

Knowledge, as the saying goes, is power – so understanding your body, how it works, how it’s affected by your musculoskeletal condition/s, as well as any other health conditions you have – gives you the ability to make informed decisions about your healthcare.

Health literacy refers to how we “understand information about health and health care, and how we apply that information to our lives, use it to make decisions and act on it”.(2)

Together, health literacy and knowledge give you the tools you need to actively manage your healthcare. By understanding your body and health, you can discuss your options with your health professionals, critically evaluate information from various sources, adjust your lifestyle and behaviours, understand risk factors, and the appropriate use of treatments and tests.

In fact, research shows that people who have high levels of knowledge and health literacy have much better health outcomes.

If you want to know more about your health and musculoskeletal condition/s, or you need help to improve your health literacy, there are many people who can help you.

Talk with your doctor and other members of your healthcare team. Contact the MSK Help Line and speak with our nurses. Visit authoritative websites (like ours).

And never be afraid to ask questions.

Pillar 2. Mental wellbeing, self-awareness and agency

Incorporating things you enjoy and that make you feel good into your daily/weekly routine – such as mindfulness, exercise, alone time, relaxation, massage, and staying connected with family and friends – is a simple thing you can do to look after your mental wellbeing and increase your resilience.

Self-awareness involves taking your health knowledge and applying it to your specific circumstances. For example, if you’re having problems sleeping, and you know exercise can help, you can ensure you’re getting enough exercise each day. Or if you’re carrying more weight than you’d like, and this is causing increased knee pain and self-esteem issues, talk with your doctor about safe ways you can lose weight. Or if you have rheumatoid arthritis and a family history of osteoporosis, talk with your doctor about how you can look after your bone health.

Agency is the ability and intention to act on your knowledge and self-awareness.

Pillar 3. Physical activity

OK, so this one’s fairly self-explanatory since we talk about the importance of exercise and being physically active all the time 😊.

Regular exercise helps us manage our musculoskeletal condition/s, pain, sleep, mood, weight, and joint health – and that’s just the tip of the iceberg! It keeps us moving, improves our posture and balance, helps us stay connected and helps prevent (or manage) other health conditions such as diabetes and heart disease.

Pillar 4. Healthy eating

This one’s also easy to understand, as along with exercise, healthy eating plays a vital role in our overall health and wellbeing.

Being overweight or obese increases the load on joints, causing increased pain and joint damage, especially on weight-bearing joints like hips, knees, ankles and feet. The amount of overall fat you carry can contribute to low but persistent levels of inflammation across your entire body, including the joints affected by your musculoskeletal condition, increasing the inflammation in these already painful, inflamed joints.

Being overweight or obese can also increase your risk of heart disease, diabetes, some forms of cancer, poor sleep and depression.

Being underweight also causes health issues. It can affect your immune system (meaning you’re more at risk of getting sick or an infection), and you may feel more tired than usual. Feeling tired and run down will affect your ability to be active and do the things you want to do.

If you need help to eat more healthfully or manage your weight, talk with your doctor or dietitian.

Pillar 5. Risk avoidance or mitigation

Simply put, this pillar is about taking responsibility for your actions and behaviours. In particular, those that increase your risk of injury, ill-health or death.

To avoid these risks, you can drink alcohol in moderation, drive carefully, wear a seatbelt, get vaccinated, protect yourself from the sun, quit smoking, wear a helmet when riding a bike, and practise safe sex.

Seeing your doctor and healthcare team regularly is also important to stay on top of any changes to your health.

Pillar 6. Good hygiene

You’re probably wondering what this has to do with self-care for people with musculoskeletal conditions living in Australia. After all, most Australians have access to clean water and clean living/working spaces.

However, the last few years have shown how vital good hygiene is for protecting all of us from bugs and germs. It’s even more important if your condition or meds have weakened your immune system.

Practising good hygiene is a simple thing you can do to reduce the risk of getting sick or developing infections. So continue to regularly wash your hands, cough/sneeze into your elbow, stay home when sick, and keep your home/work environment clean. And although they’re not yet mandated in most places, wearing a mask is recommended and a really good idea when you’re indoors and can’t physically distance yourself from others.

All of these things will help maintain good health and avoid catching (or spreading) any nasties.

Pillar 7. Rational and responsible use of products, services, diagnostics and medicines

Another fun one! 😁 Although the title doesn’t roll off the tongue, this is an important pillar.

ISF calls these self-care products and services the ‘tools’ of self‐care, as they support health awareness and healthy practices.

They include medicines (both prescription and over-the-counter), aids and equipment (e.g. TENS machine, heat or cold pack, walking stick), health services (e.g. physiotherapy, massage therapy), wellness services (e.g. exercise classes, weight loss groups), and complementary therapies.

ISF also says that the use of these tools should be ‘rational and responsible’. That means only using safe and effective products and services.

Contact our free national Helpline

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

More to explore

References

(1) Self-care interventions for health, World Health Organization.
(2) Health literacy, Australian Commission on Safety and Quality in Health Care


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I think there’s a reason we respond so positively to the memes, social media posts and jokes that poke fun at pain, chronic illness and the trials and tribulations that come from living with both.

Having a foggy brain isn’t particularly funny, being unable to sleep isn’t a joke, and pain – wow, that’s probably the un-funniest thing you can think of 😣. But we all tend to laugh at and share the well-crafted meme or post that pokes fun at these things because we identify with the truth behind them. And with the best ones, you can tell it’s been created by someone who knows what it’s like to live with pain and illness. You recognise a fellow traveller.

Laughter and humour are such powerful forces. Just think about the last time you had one of those huge, spontaneous belly laughs with family or friends. Something was said, a joke was told, or you all saw something ridiculous. You snort, giggle, and guffaw. Your eyes water, you gasp for breath, and your belly starts to hurt. When you look at each other, you laugh some more. When you finally do stop laughing, you feel euphoric. Everything seems better, and you feel happier 😊.

However, when you’re in the grips of pain, laughing is probably the last thing you feel like doing. But laughter can actually help you deal with your pain better. A good joke, a funny movie, or just seeing something silly can distract you from your pain and make you feel better, at least for a while.
Laughter also causes your brain to release some feel-good chemicals that boost your mood and make you feel more optimistic. They include endorphins, serotonin and dopamine. Endorphins are your body’s natural pain reliever; releasing them into the body temporarily reduces your feelings of pain. Serotonin produces feelings of calmness and happiness. And dopamine is part of your brain’s reward system and gives you a sense of pleasure. It also helps reduce feelings of anxiety.

Other health benefits of a good giggle

As well as helping you cope with your pain and the stress of living with chronic health issues, laughter has many other health benefits. Laughing regularly:

LOL ideas

To bring on the laughs, giggles, chortles, snickers, cackles and guffaws, give these ideas a go:

  • Watch/stream a funny movie or sitcom – check out these lists from Flickchart and Rolling Stone for their top picks.
  • Listen to a funny podcast – this list from Time Out will get you started if you need ideas.
  • Run through a sprinkler on a hot day.
  • Talk with a friend and reminisce about a funny experience you had together.
  • Watch cat / dog / panda videos (you’re welcome!). 😹
  • Grab the kids, friends, partner or housemates and play. Anything! … Keep a balloon off the floor. Throw a frisbee. Charades. Pub quizzes. Truth or dare. Never have I ever. The floor is lava…
  • Have a pillow fight.
  • Think about the funniest joke you ever heard or your best (worst) dad jokes.
  • Jump on a trampoline.
  • Take silly selfies and send them to your bestie.
  • Grab a microphone (or a hairbrush) and sing out loud!
  • Join a laughter club. Simply google ‘laughter clubs’ for your state or territory.

Sadly it’s not all fun and games

It’s important to remember that laughter and humour are temporary distractions from pain. They’re great, and we should definitely cram as much into our day as possible. Just for the sheer joy of it 🤡.

But when you have a chronic illness and persistent pain, a balanced treatment approach should include self-care, appropriate medications and medical care, a healthy lifestyle, exercise, mindfulness and, yes, laughter.

Laughter may not be the best medicine (as the old saying goes), but it’s pretty close to perfect.

So, make sure you take a dose (or better yet – several!) every day!

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

More to explore

Photo by MI PHAM on Unsplash


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Do you feel like your diet has gotten away from you? Have you spent the first part of winter eating yummy, warm and kilojoule dense foods? Are your clothes starting to fit a little more snugly than you’d like? Now may be a good time to review your eating habits to make sure you’re eating as well as you can to improve your health, energy levels and mood.

Here are some handy hints to help you get started.


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A PBS News Update

Ref: ** Pharmaceutical Benefits Scheme (PBS) | Closing the Gap (CTG) PBS Co-payment Program **

Expansion of the Closing the Gap Pharmaceutical Benefits Scheme Co-payment Program – Information for First Nations People

What is the Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment Program?

The CTG PBS Co-payment Program improves access to affordable PBS medicines for First Nations people living with, or at risk of, chronic disease.

Under this program, eligible First Nations people who are registered on the CTG PBS Co-payment Register and who would normally pay the full general PBS co-payment amount, pay the concessional rate when obtaining PBS medicines from their local community pharmacy, approved medical practitioner, or private hospital. Eligible patients who would normally pay the concessional rate receive their PBS medicines for free, without having to pay a co-payment.

What is changing?

From 1 July 2024 the CTG PBS Co-payment Program has been expanded to apply to all PBS medicines dispensed by community pharmacies, approved medical practitioners, and private hospitals.

Read more

Answers to Frequently Asked Questions and further information for First Nations people, community pharmacies, hospital pharmacies, prescribers and Aboriginal and Torres Strait Islander Health Practitioners are provided at the links below:

** Ref: Pharmaceutical Benefits Scheme (PBS) | Closing the Gap (CTG) PBS Co-payment Program **

Call our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available Monday to Thursday  between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

 


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MeTeOR2 Clinical Trial

The MeTeOR2 Clinical Trial compares meniscal allograft transplant surgery to a type of physiotherapy for people who experience post-meniscectomy pain.
Clinical trials 

Clinical trials are an important part in improving healthcare outcomes. If you are not familiar with what a clinical trial is, you’re not alone! Clinical trials are research studies involving people like you and me, to evaluate if a treatment is safe and helpful. The new treatment under testing may be a medicine, procedure, technique, vaccine, device, or lifestyle/behaviour. Clinical trials are carefully designed and must undergo a thorough review to ensure the procedures have merit, are safe and ethical. Ultimately, clinical trials are essential to help us improve the management of health conditions! 

People participate in clinical trials for various reasons. Some people who are aware of clinical trials understand their participation helps inform how to manage health conditions. However, many may not be aware of the other benefits. These benefits include playing an active role in your healthcare, receiving treatment from leading medical practitioners, and accessing treatments for your condition which may not be possible otherwise. One clinical trial is the MeTeOR2 trial, which compares meniscal allograft transplant surgery to a type of physiotherapy for people who experience post-meniscectomy pain.  

What is a meniscectomy? 

The meniscus is a c-shaped cartilage that distributes loads at the knee joint. A torn meniscus is common, especially among young people engaged in sport activities. Conservative treatments are available including activity modification, medication (e.g., non-steroidal anti-inflammatories, paracetamol), and physiotherapy. Some tears may be surgically repaired depending on the location of the tear. Other tears cannot be repaired, so the torn parts are removed with a keyhole surgery called arthroscopic partial meniscectomy. Although this procedure can improve pain and locking symptoms in most people, some patients may still experience pain and functional limitations after the surgery. This scenario can be very disabling and emotionally distressing, particularly at a young age when people are expected to be active, healthy, and free of disability. When this is the case, only a few treatment options are available. 

Treating pain and functional limitation after a meniscectomy 

For people with considerable pain or functional limitations after meniscectomy, surgical and non-surgical treatment options are available. One surgical option is the meniscal allograft transplant (MAT), which involves inserting a donated meniscus into the injured knee. The MAT surgery is thought to improve symptoms by restoring normal load distribution within the knee, along with the rehabilitation after surgery. Non-surgical management, such as personalised rehabilitation – which consists of many different types of treatment, including exercise, weight management, and lifestyle and activity advice – is also a viable option. Although the mechanisms of how personalised rehabilitation reduces symptoms are unknown, improvements have been observed in people with post-meniscectomy pain. However, it is still unknown which treatment option is better, in terms of safety and cost-effectiveness, to improve health-related outcomes. 

The MeTeOR2 study 

MeTeOR2 is a clinical trial designed for people suffering from pain and/or functional limitations after partial meniscectomy. This study aims to compare two knee treatments – meniscal allograft transplant (MAT) surgery and personalised knee therapy (rehabilitation) and evaluate if one treatment is superior to another in improving knee pain and function. 

How to participate/who to contact 

If you are interested in the study and consent to participate, you will have a 50% chance of being put into one of the two groups. The first group will receive the meniscal allograft transplant (MAT) surgery, while the second group will receive personalised knee therapy (rehabilitation). Participants in both groups will be asked to complete a series of questionnaires at baseline and 3, 6, 12, 18, and 24 months following randomisation. 

 You may be eligible to participate in this study if you have: 

 Inclusion Criteria: 

  • Pain and / or functional limitation from the knee, severe enough to warrant potential meniscal allograft transplant. 
  • Previous meniscectomy ≥ six months ago. 

 Exclusion Criteria: 

  • Symptomatic ligament instability, not previously corrected, as determined by the assessing clinician. 
  • Coronal limb alignment that requires surgical correction, as determined by the assessing clinician. 
  • Age < 16, or if ≥ 16, open growth plate at the proximal tibia as judged by the clinical team on imaging as part of standard care. 
  • Full thickness cartilage loss (exposed bone) > 1 cm2, on routine clinical MRI, prior to surgery, or any other form of clinical imaging or evaluation. 
  • Inflammatory arthritis affecting the study knee as determined by the assessing clinician. 
  • Unable or unwilling to engage in rehabilitation. 
  • Unable to adhere to trial processes. 
  • Previous randomisation in the present trial, (i.e., the other knee). 

If you are interested in being part of this important and exciting clinical trial, please contact the study facilitator: meteor2.study@sydney.edu.au 

Contact our free national Helpline

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

 


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It’s 2am and you’ve been tossing and turning for hours. You’re so tired, but you just can’t sleep. You lay on your left side, but your neck hurts too much in that position. So you roll on to your back, but your lower back aches. You turn on to your right side, and success (!) that feels ok. But now your knees hurt, your brain’s counting down the hours until you have to get up for work, and you need to go to the toilet. Sigh.

Sound familiar? We’ve all experienced the dreaded ‘painsomnia’ – or insomnia caused by persistent pain.

Without the distractions of our daily activities, the dark of night can become a long, painful expanse of time. Even when we’re exhausted, sleep can be elusive. It might take longer to fall asleep, we can’t get comfortable, we wake frequently, or we just don’t get enough sleep. Or all of the above.

When you add anxiety about sleep into the mix, it becomes a vicious cycle. Poor sleep lowers your pain threshold which affects the quality of your sleep. Pain can affect your ability to be active – which affects your sleep quality and your pain levels. This can make you anxious or stressed – which again will affect how well you sleep and the amount of pain you experience.

And when you’re stuck in this cycle, exhausted and in pain, it affects your mood, your ability to concentrate and it’s very easy to become depressed. So it’s important that you act quickly as soon as you start having issues sleeping.

The good news is there are many things you can do to break the cycle. The not-so-good news is they may not work immediately. And they’ll require some effort on your part. But they’re all tried and true ways to develop good sleep habits and get the good night’s sleep you crave.

  • Acknowledge your painsomnia. Although it’s tempting to pull the covers over your head and ignore the problem, that won’t make it go away. Actually acknowledging the situation, and that there are things you can do to change it, is the first important step.
  • Develop a sleep routine. There’s a reason we do this with babies and small children – it works! As often as possible, go to bed and get up at the same time each day. Your body will become used to this routine and you’ll find it’s easier to fall asleep and stay asleep.
  • Manage your pain. You can’t have painsomnia if your pain is under control. Check out our A-Z pain management guide for simple, practical ways you can take control of your pain.
  • Try some relaxation techniques. There are as many ways to relax as there are stars in the night sky (well, almost) so there’s bound to be something that suits you. Try a warm bath before bed, reading (though nothing too engrossing!), deep breathing, listening to music, mindfulness, or visualisation. These techniques will help you become more relaxed so that when you go to sleep, you sleep well.
  • Exercise and be active during the day. As well as the many other benefits of regular exercise, it’ll help you fall asleep and stay asleep longer.
  • Don’t look at the clock. Constantly checking the time can make you anxious, which makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.
  • Manage your thoughts, all of the pesky voices in your head that are focusing on the things you need to do tomorrow, or the current state of the world, or the latest stress of the day. One way to deal with them is to write them down and get them out of your head. Put them down on paper and tell yourself you’ll deal with them tomorrow when you’re rested and have the brain power to deal with them.
  • Get out of bed. Don’t lie in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or breathing exercises and go back to bed when you feel more comfortable.
  • Avoid tech before bed. It’s easy to get caught up in news, social media and emails, and before you know it you’ve lost a few hours. Also the blue light on our devices suppresses the hormone (melatonin) that makes us sleepy at night, so be sure to stop screen use at least one hour before bed. That being said, there are some useful apps that may help you with your painsomnia – including sleep diaries, apps that provide soothing sounds to help block out other noises (like traffic or snoring), and apps that help you relax so you fall asleep more easily.
  • Consider cognitive behavioural therapy for insomnia (CBTI). This is a therapy that aims to challenge and change unhelpful ways of thinking about sleep. It also changes your behaviours when it comes to sleep. Find out more about CBTI in this article from the Mayo Clinic.
  • Evaluate your environment. What’s your bed like? Too hard, too soft or just right? Do you need to make some changes to your mattress, pillows and/or linen that will make your bed as comfortable as possible? Is there too much light or noise? Can you control that with simple fixes such as eye masks or earplugs? Is your room too hot? A slightly cool room is the best for a good night’s sleep. Consider all of these things as you take a long, hard look at your bedroom.
  • Get professional help. If pain is constantly keeping you awake at night, talk with your doctor about other things you can do to manage your pain and get some decent sleep.

Call our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available Monday to Thursday  between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

More to explore


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Not just a fashion statement from the 70s!

From time-to-time many of us experience a flare, when symptoms like pain, inflammation and fatigue are worse, or more intense. This is a flare.

Flares are temporary, but can be frustrating and painful while they last. We don’t always know why they happen – and sometimes they seem to come out of the blue.

So it’s important that you have a plan for how you manage a flare when it happens.

Your flare plan

  • Write down what you were doing before the flare as this can help you identify potential triggers.
  • Talk with your doctor about what you should do when you have a flare. You may need to adjust your medications, or alter the dosage during a flare.
  • Have a plan in place for how you will deal with your commitments – family, work, social activities – when you’re in the middle of a flare. Can you alter your work hours, work from home, get your family to help out?
  • Prioritise your tasks and activities. This can reduce the risk of overdoing things.
  • Pace yourself. If the flare is the result of overdoing things, think about getting people to help you, or spread the activity over a greater period of time, e.g. if you want to clean your house, get the family involved and give each person a room or zone that they’re responsible for; or spread the job over a few weekends and assign yourself a room, a zone or a period of time to clean that’s achievable for you. When you’ve cleaned that area, or reached that time limit, stop. You can go back to it later.
  • Manage your stress, it can increase your pain levels. If you feel yourself becoming stressed, try relaxation techniques such as meditation, breathing exercises and visualisation.
  • Pull out all of your pain management strategies. Use heat or cold packs, get a massage, go for a walk, distract yourself…use all the things you know help you manage your pain.
  • Rest when your body needs it – but not for too long. Going to bed and not being active during a flare can make your pain and fatigue worse. Continue to exercise, but at a lesser intensity than usual. Listen to your body.
  • Use aids and other gadgets when your joints are painful and swollen. This will help protect your joints, and reduce some of the pain you feel when doing everyday tasks.

Some of the suggestions listed here are easy, however others involve a bit of thought, as well as input from others. But taking the time to work out a plan that works for you will help you manage your flares better, and with less disruption to your life.

Get advice from your doctor, and others in your healthcare team. Or, contact our free helpline on 1800 263 265 and speak with a nurse or email us at helpline@muscha.org

MORE INFORMATION

NPS MedicineWise: Managing Your Flare

 

 


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In this edition of Connected tISSUES we are shining a spotlight on the complex and often serious musculoskeletal condition, psoriatic arthritis (PsA). PsA is a condition that presents differently in different people. In simple terms, PsA causes pain and inflammation in the joints and is usually associated with the skin condition psoriasis (but it can occur without someone experiencing this…we told you it was complex!) 

Psoriatic arthritis can be challenging to recognise because of the varied ways it can present and because of overlapping symptoms with other conditions. This difficulty can sometimes lead to a delay in diagnosis and treatment. Our on-demand webinar Psoriatic Arthritis Diagnosis and Management by Dr Adam Rischin is a great resource for anyone seeking information on PsA, its symptoms, tests that can assist with diagnosis and effective treatment options. 

PsA can affect anyone. Our nurse recalls a 30-year-old male contacting the free Musculoskeletal Health Australia B.A.M. Helpline because he was struggling with the effects of his psoriatic arthritis. The impact this condition was having on his life was heartbreaking.  He was living with quite severe plaque psoriasis (plaques appear as raised, inflamed, and scaly patches of dry skin that may be itchy and painful). This young mans mental health, financial security, social, personal and professional life had also been negatively impacted by his condition. It was sad to learn that he had left his job due to the embarrassment he felt, embarrassment that was caused by a symptom of his condition (he was extremely conscious of the silvery flakes of skin he ‘was leaving’ on the chair at work and he didn’t want other people to have to sit on that after him). He was living with chronic pain due to the inflammation in his joints. His quality of life had been severely impacted and he was desperately looking for understanding, help and connection. 

Whilst there are a number of treatment options available to people living with PsA most recently a medication called Apremiast (OTEZLA) was added to the PBS. Apremiast is showing some positive results for plaque psoriasis which is good news as up to 30% of people with psoriasis will develop psoriatic arthritis. 

For more information on Psoriatic arthritis (PsA) go to the Musculoskeletal Health Australia website and download the PsA Information Sheet. For those living with PsA, make sure you access our self-care plan to help you understand, manage and live well with your condition, or call our helpline and speak to our nurse (Monday to Thursday 9am to 5pm) on 1800 263 265 or email helpline@muscha.org

Other sources of information on PsA:

 


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Tips for preventing falls

The 80’s song ‘catch me I’m falling’ could have been my family anthem. We’re clumsy, uncoordinated, and with two left feet, always slipping, tripping, and falling. 😁

It‘s just the way we are. I’ve even gotten to the point of doing a ‘ta-da’ after a trip, extending my arms over my head like a gymnast at the end of a routine.😀

But now, as I’m getting older, it’s not so amusing. I’m conscious of the more serious repercussions of falling. In fact, just last week, I tripped over my cat, whacked the side of my head on the kitchen counter and broke my glasses. Fortunately, I wasn’t seriously injured. But it made me take stock, stop thinking about falls as something I have to put up with and start being more proactive in preventing them.

Because the good news is that falls aren’t inevitable. They can often be prevented, or at the least, any injuries that occur can be minimised.

Let’s start with some facts

Data from the Australian Institute of Health and Welfare shows that falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths.(1) More than half of the hospitalisations were due to broken bones – often hips, vertebrae and wrists.

Falls can happen anywhere and to anyone, but a fall that lands you in hospital is more common in older people and most likely to occur in the home.

The stats are alarming, and like me, you may think these were falls from a height or down stairs. But the truth is, ‘over half of all falls leading to hospitalisation occurred on a single-level surface (for example, by slipping), and only 7% of falls leading to hospitalisation involved stairs or steps.’(1) 😱

And if you have osteoporosis and your bones are already fragile, the risk of breaking a bone due to a fall is much greater.

So to avoid becoming one of these stats, we can’t see falls as an inevitable part of life and getting older. They’re a serious problem, and we all need to take steps to prevent them.

We know that falls can result in broken bones, but they can also cause:

  • Dislocated joints (e.g. shoulder)
  • Head injuries
  • Bruises, scrapes and sprains
  • A loss of confidence which can lead to restricting activities due to the fear of falling. For example, avoiding walks in the park or going into places that are unfamiliar, crowded or have stairs/steps due to fear of falls,

What causes people to fall?

Health issues

  • If you’ve fallen more than once in the past 6 months, you’re more likely to fall again.(2)
  • Medical conditions that lead to reduced strength and endurance (e.g. arthritis), loss of sensation (e.g. diabetic neuropathy), impaired balance (e.g. Parkinson’s disease) and cognitive impairment (e.g. dementia).
  • Medicine side effects, especially if you’re taking several medicines.
  • Poor eyesight and vision problems.
  • Incontinence. Rushing to the toilet can increase your risk of falling, especially at night.

The environment

  • Trip hazards in your home and the community, e.g. clutter, cords and cables, wet and/or slippery floors, uneven footpaths, and pets.
  • Poor lighting.
  • Inappropriate or ill-fitting footwear and clothing.

Reducing your risk

Falls are usually caused by a combination of factors. Changing some of these factors can lower your chances of falling. Or, if you do fall, reduce your risk of serious injury.

Exercise regularly

Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. Exercise is vital for good health, maintaining independence, and lowering your risk of falls and fall-related injuries. Physical activity helps to maintain and improve your mobility, strength, posture, coordination, balance and flexibility.

People with better posture, better balance and stronger muscles are less likely to fall or be injured. On the other hand, people who aren’t very active are more likely to fall and be injured than those who are more active.

Talk with your doctor, physiotherapist or exercise physiologist for information and advice about how you can safely become more active.

And read Exercise for preventing falls by The Royal Australian College of General Practitioners for more info.

Look after your health

  • Talk with your doctor about your medicines. Some medicines can help reduce falls, such as pain-relievers that decrease your pain and allow you to move more comfortably and be more active. However, some medicines or combinations of medicines can cause dizziness, drowsiness or confusion, which increases your risk of falling. Understanding your medicines and how they affect you is an important strategy for reducing this risk.
  • Eat a healthy, balanced diet with regular meals throughout the day to avoid feeling lightheaded, weak or dizzy. Stay hydrated and drink plenty of water each day.
  • Limit alcohol intake as it can affect your balance and coordination and increase your risk of falling.
  • Have your eyes tested regularly by an optometrist. If you wear glasses, keep them clean. If you have different glasses for different situations, e.g. reading or distance glasses, make sure you use the appropriate ones for the task. Be careful when going up and down stairs if you wear multifocals.
  • Wear sunglasses outside to minimise glare and squinting and to protect your eyes from UV damage.
  • When moving from a light to a dark space, or vice versa, allow time for your eyes to adjust.
  • See a podiatrist if you have problems with your feet that affect your balance or how you walk; for example, pins and needles, pain, swelling, or poor circulation. They can help you address these issues. They can also give you advice about appropriate footwear.
  • Take time to regain your balance after lying down or standing up after sitting.

Move around safely

  • If you’re unsteady on your feet or have painful feet, hips or knees, you may need some support to get around. A physiotherapist or occupational therapist can help you decide if a mobility aid (e.g. a walking stick or walker) is appropriate for you. They’ll also help you learn how to use it correctly and adjust it to your requirements.
  • Plan your outings to fit how you’re feeling. For example, if you’re at the shopping centre and feel tired or your feet begin to hurt, you might need to sit and rest for a while. Or, avoid going for a long walk if you’re having a day when your pain and fatigue levels are high. Take a shorter walk instead.
  • Be aware of the weather and how it can affect your environment. For example, footpaths are often slippery when wet, especially if there are wet leaves on them. Or, on sunny days, sun glare can make visibility more difficult, and you may not be able to see as clearly as usual.

Choose your clothing and footwear carefully

  • Avoid long trousers or skirts that may get caught underfoot or on furniture.
  • Wear well-fitting, supportive shoes with non-slip soles. Avoid high heels, floppy slippers, shoes with slick soles, and walking around in your socks.
  • Hip protectors may be an option for people with osteoporosis or those who fall often. They’re plastic shields or foam pads that fit into the pockets of specially designed underwear and reduce hip fractures from a fall. Your doctor can give you more information about hip protectors.

Reduce the hazards in your home

  • Make sure mats, rugs and carpet edges are lying flat on the ground and well secured. If they’re loose or curled up, they can cause you to trip.
  • Clean up spills from the floor immediately. If you have balance issues and bending over is a problem, ask someone else to clean the floor or use a light mop.
  • Ensure your walkways are clear of clutter, and you have plenty of space to walk between furniture without anything getting in your way.
  • Remove cords and cables from walkways. Secure them to skirting boards or close to the wall.
  • Install non-slip mats in the bathroom.
  • Pets can be a trip hazard (as I learned the hard way), especially if they like to be close to you or it’s meal time. 😼 So be aware of where they are when you’re up and about. 🐶
  • Make sure your home is well-lit so you can always see where you’re going. If you get up in the night frequently to go to the toilet, make sure you have a bright bedside light or use a torch so you can see clearly. Motion sensor lights are also handy and can be plugged into power points on the way to the toilet.
  • Consider installing a handrail on at least one side of any stairs and next to baths, showers and toilets.
  • Safety strips on the edges of outdoor stairs are also a good idea. They provide additional grip and help you see exactly where the edge of the step is.

What to do if you fall

Sometimes, no matter how careful you are, you can still have a fall.

So if you have a fall, it’s important that you try not to panic (easier said than done 😑). And although your first reaction may be to get up quickly, especially if you’re in public, because you’re embarrassed (been there, done that), take a moment.

  • Assess the situation. Are you hurt? Is it safe to get up? Have you damaged your glasses? Or lost your walking stick?
  • Make a decision whether or not to try to get up. Factoring into your decision will be whether you’re safe where you are, e.g. have you fallen onto a footpath or the road?

If you can get up:

  • Take time to recover. Sit and let yourself get over the shock. Drink some water. Take stock of your injuries.
  • Tell someone you’ve had a fall and/or seek medical advice. Don’t just brush it off. Falls can signify that something’s wrong – e.g. medicine side effects, balance problems, or a new health issue.

If you can’t get up:

  • Try sliding or crawling to seek help.
  • Use your phone or personal alarm, call for help or make a loud noise to attract attention.
  • Make yourself as comfortable as possible until help arrives
  • Seek medical advice/or call an ambulance.

Services to help keep you safe

If you’ve done all you can to prevent falls and are still concerned about your risk, there are services available to help you.

  • Falls and balance clinics provide multidisciplinary assessment and management planning for people who’ve had falls and have mobility and balance problems. People receive information on making their homes safer and are referred to physiotherapy, occupational therapy, exercise classes and other allied health professionals. Talk with your doctor about whether this might be an option for you.
  • Personal alarms. There are two basic personal alarm options; a pendant you wear around your neck and a smartwatch worn on your wrist. Pressing the button on the alarm will trigger contact with the service company, who’ll then contact your nominated relative, friend, neighbour or a response service. Some people can access free or reduced-cost personal alarms through government schemes such as the Commonwealth Home Support Program, National Disability Insurance Scheme (NDIS) and Department of Veterans’ Affairs. Visit their websites or speak with your doctor to see if you’re eligible. A variety of private companies provide this service for a fee if you don’t qualify for the free service.
  • Red Cross Telecross is a free service offered by the Australian Red Cross. It aims to provide people who live alone and are at risk of illness or accident the peace of mind that someone is looking out for them. Each morning, every day of the year, trained volunteers make a short call to people’s homes. If the call goes unanswered, Red Cross will take action to make sure that the person is OK. For information about accessing Telecross, call Red Cross on 1300 885 698.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

More to explore

References

(1) Falls, Australian Institute of Health and Welfare, 2022.
(2) Falls and the elderly, healthdirect, 2020.

 

Originally written and published by Lisa Bywaters 2022.


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