This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Guest Blog

Guest blog by Catherine Pope, Chartered Society of Physiotherapy, Chair.

Jane left hospital after a stroke and was seen promptly at home by a physiotherapist, who worked with other members of the multidisciplinary team to develop a plan for her recovery.

Members of that team visited regularly, and Jane made strong progress – supported by her husband, Robert – towards achieving her goal of getting back out into her garden and getting her green fingers dirty.

Meanwhile, another Jane, in another part of the country – perhaps even the neighbouring town – realised no such goal.

It took weeks for her to be seen and even then, the service was so badly stretched that she and her husband, also called Robert, were largely left alone to make what limited progress they could.

You may have guessed by now that these stories are fictional, but both are based on the hard reality of the postcode lottery that patients face each year when leaving hospital after illness or injury.

They are the subject of a new film produced by the CSP, which we will launch later this month at a parliamentary event in Westminster.

It’s called “Rehab Matters” and is part of our broader campaign to raise the profile of community rehabilitation, particularly with politicians and healthcare decision-makers.

For too long, the issue has been overlooked in favour of acute sector problems.

We hope that by joining forces with ARMA and many other like-minded organisations, we can work towards a future in which no patient misses out on the truly transformative changes that high-quality rehabilitation delivers.

Guest Blog by Robin Lansman, President of the Institute of Osteopathy and practicing osteopath

As President of the Institute of Osteopathy (the professional body that represents osteopaths) I was delighted when I was recently invited to contribute to the ARMA blog. Part of our ambition is to work with healthcare colleagues to enhance UK public health and as such, when considering contributing to this blog I’ve personally reflected on what I see to be key recognition of these activities and the progress that the Institute of Osteopathy has made over recent months.

A key highlight for me has to be when I attended a meeting earlier this year representing the Institute of Osteopathy with my colleagues, Maurice Cheng and Matthew Rogers, where we formally accepted the invitation to join the Allied Health Professions on behalf of the osteopathic profession.

The Allied Health Professions represent the third largest workforce in the health and care system and osteopathy has joined the twelve other autonomous health professions that Suzanne Rastrick, the Chief Allied Health Professions officer of NHS England, represents.

AHP presentation photo

Suzanne Rastrick, Chief Allied Health Professions Officer of NHS England (centre, left) with The Institute of Osteopathy representatives (left to right) Maurice Cheng, Robin Lansman and Matthew Rogers.

This new relationship marks an important milestone for the osteopathic profession and indeed for the Institute of Osteopathy. A whole-person approach to health has always been at the core of osteopathic care and Suzanne’s continuing pledge to encourage innovation, multi-professional working and patient-centred care resonates well with these ambitions.

The Allied Health Professions are increasingly seen as key in transforming health, care and wellbeing, and increasing capacity across the healthcare system. Allied Health Professions into Action, a recently launched crowdsourcing strategy has been developed to unlock this potential, and osteopaths are delighted to now play their part in this initiative.

We look forward to working with other Allied Health Professions over coming months to strengthen the engagement of osteopaths with other healthcare professionals and in the transformation of service delivery to improve patient outcomes. We will keep you updated on our progress.

By Chris Graham, Chief Executive, Picker Institute Europe

Arguments about the pressures on the NHS at a system level are well rehearsed; rising demand, financial restraint, and challenges around staffing numbers are well reported. But what of the impact of caring on healthcare professionals as people?

The NHS Staff Survey is an annual survey that aims to help providers to understand how it feels to work in the health service. In 2016, it recorded the experiences of more than 423,000 members of NHS staff – and provides fascinating insight into the health and wellbeing of NHS staff.

Some of the findings are troubling. Over the autumn of 2016, 60% of staff came into work despite feeling physically unable to perform their duties. Musculoskeletal (MSK) problems were a particular issue, with one in four (25%) reporting MSK problems resulting from work activities. MSK problems were even more prevalent in ambulance trusts: here, 41% of respondents and three in five (60%) ambulance technicians reported experiencing work-related MSK problems in the last three months.

Encouragingly, the staff survey does provide evidence that organisations can help to reduce MSK problems for staff. Organisations where higher percentages of staff respondents said that their employer “definitely” took positive action on health and wellbeing perhaps unsurprisingly reported lower percentages of staff respondents reporting MSK problems. The strong association between these measures shows the beneficial impact of pro-active approaches to health and wellbeing.

picker logoHealthcare professionals provide an indispensable role, often under difficult circumstances. Their employers rightly have a duty to look after them – and this should include a holistic approach to health that emphasises wellbeing and harm avoidance rather than simply remedial action.

Getting this right is important for staff, but is also vital to reducing pressure on services; organisations that take steps to prevent their staff from becoming patients will prevent sickness absences from stretching their workforce further.

I’d encourage you to take a look at how your organisation faired in the 2016 NHS staff survey – you can see the results here: What do you think of them? Soon, the 2017 survey will be circulated and it will be your opportunity to help us all understand what it’s actually like to work in the NHS in 2017; we need your opinions.

See ARMA’s page of resources related to Working with MSK.

Guest blog by Liz Lingard, NHS RightCare Delivery Partner

Over the past 3 months I have joined the ‘Whole System MSK events’ that ARMA and NHS England have organised as the RightCare speaker. This was an opportunity to clarify the RightCare approach to everyone working across the system and how they can apply this in their local health economies. The core aim of RightCare aligns to what each of the ARMA partners aspires to achieve: ensure the right person is able to access the right care in the right place at the right time, making the best use of available resources to help deliver a sustainable NHS. Identifying unwarranted variation and a greater focus on population health is now central to many of the national programmes. It is only when you review population data across a whole pathway of care that you are able to begin to understand variation of risk factors, prevalence of conditions, healthcare utilisation and outcomes of care. Identifying where there are the greatest potential opportunities for improvement is just the first step and further investigation is required to triangulate high level RightCare data (indicative data) with other national provider and local data sources alongside qualitative information from patients and providers (evidential data).

Before working as a RightCare Delivery partner, I was a Public Health epidemiologist who believed that ‘data was beautiful’ and using measurement for improvement was the key to success. Nick Milton wrote that ‘social connection and discussion is 14 times more effective than written word, best practice guidance, databases and toolkits’. So while I continue to work with the RightCare Intelligence Team to provide a better narrative around the data we produce, I am increasingly convinced that the face-to-face narrative we have at a local level between providers, commissioners and patients is the real key for making transformational change that is sustainable happen.

As a RightCare Delivery Partner working with CCGs, I know the enormous pressures they are under to make financial savings and how healthcare providers across all sectors are concerned about what this will mean for their services and patient care. I also know that in some local health economies there has been some really innovative transformational work. There was strong clinical leadership with engagement from all provider organisations working alongside CCGs and local authorities to optimally design pathways of care and ensure that these pathways were implemented in year.

Al Mulley recently reminded me of the story of the Fosbury Flop. At the 1968 Summer Olympics, after years of high jumpers making incremental improvements to their jumps, Dick Fosbury dramatically increased the heights that could be reached. He used a different technique that then became the dominant style and is still used today. No one had tried it because it sounded so wrong; it turned out to be the right thing to do. We are at a Fosbury Flop moment for MSK care where we can no longer make incremental improvements. So I encourage everyone to connect with the MSK work happening in their local networks and be part of the discussion to transform pathways of care that will reach new heights.

Guest Blog by Neil Betteridge, co-chair, Chronic Pain Policy Coalition (CPPC)

As a former Chair of ARMA, it’s a great pleasure to be invited to write a piece for this month’s newsletter. Indeed, looking back to my seven years on the board, it is quite something to recall that the organisation entered the 21st century still called BLAR: the British League Against Rheumatism.

Apart from the name, much has changed in the world of rheumatic and musculoskeletal diseases since then, most of it for the better in my view. But one of the things about all 200 or so of these conditions that remains a huge challenge is the widespread prevalence of chronic pain. It is for this reason that, whilst CEO of Arthritis Care, I joined the Executive of the Chronic Pain Policy Coalition (CPPC), with whom I still serve, now as Co-Chair (together with Dr Martin Johnson, RCGP lead on chronic pain). ARMA and several of its members are affiliate members of the Coalition, and I strongly believe we should be working in tandem like this, given that around 70% of chronic pain is rooted in this family of disorders.

For those unfamiliar with our work, the name is pretty much self-explanatory. The focus is on the needs of people with long term, persistent pain; we operate exclusively in the policy domain; and our structure is that we are an umbrella body bringing together organisations that are stakeholders in chronic pain, be they voluntary sector or ‘patient’ groups, clinicians or other health professional bodies such as physios and occupational therapists.

Work is currently one of the Coalition’s top priorities. With the current interest in this area in England from the Dept. for Work and Pensions and the Dept. of Health, we see this as an opportunity to press for positive changes for people with any form of chronic pain who could be better supported in their efforts to get – or keep – a job suitable to their needs and wishes.

To facilitate views on this, during the recent consultation process on the Green Paper ‘Improving Lives: Work, Health and Disability’, the CPPC organised a roundtable chaired by Lord Luce. Officials from relevant government departments had the opportunity to hear the views of health care professionals and patient representatives from the chronic pain community, and the issues raised informed our formal written response.

The key issues to emerge were: highlighting the importance of work for the everyday lives of those with chronic pain; stressing the importance of empowerment, and of integrated support for people with chronic pain; and encouraging the provision of localised information and other support such as self-management for those living with chronic pain, in order that GPs can direct their patients to these resources in a timely way.

More information on this, and the work of the CPPC overall, is available at

Going forward, we will shortly be conducting policy work into the ways in which opioids are currently prescribed. If any ARMA members are interested in this topic and would like to engage with our work in this area, please contact our Manager Katherine Perry via

It is free to become an affiliate member of the CPPC so if you wish your organisation to lend its name to the fight against the invisible epidemic that is chronic pain, please join us.

Guest Blog by Lesley Giles, Director, Work Foundation

I am delighted to contribute to this edition of the Newsletter in my new role as Director at the Work Foundation. I think after 6 months I can probably just about still call myself new, not least as time has flown by in a whirlwind. It’s one of those roles that really is a great privilege to do. What is there not to like? I have the opportunity to research and promote something I am passionate about – the importance of good work! The importance of more positive working lives, creating meaningful work, and good working practices, with happy and healthy working environments, which engage employees, as a route to more successful businesses. This continues a tradition built up for nearly a century. In this increasingly more complex, fast-moving, technological driven age, we now even more than ever need to take action at work that treats and values people as human beings not machines.

The Work Foundation undertakes high-quality applied research and analysis that tackles the issues of the moment in work and working lives, to propose solutions which can change policy and working practices for the better and supports people’s health and wellbeing at work. We draw on our long heritage and deep expertise to open a window on the future, anticipate emerging trends and their implications for change and disruption and to ensure we can secure positive outcomes.

This is not an individual endeavour but something we seek to do in partnership, working not only with individual people and businesses but wider stakeholders across cities, regions and the economy at large. In this time of ongoing change, transformation and reinvention, it is vital that we can preserve and retain continuity in key areas, where we have established strong networking, good working practices, and have effectively shared ideas and knowledge of what works over time. One such area, where I am particularly looking forward to supporting is our ongoing role is in the Fit for Work Initiatives.

This year I have taken over the Chair of the Fit for Work UK Coalition. This Initiative has built successfully on the launch of the original ‘Fit for Work’ report in 2007 by convening experts and opinion-leaders to promote the profile of MSK conditions among policymakers and practitioners. This UK Coalition is playing a vital role contributing to policy development and the evidence base and I am keen to ensure it continues to grow in future. One example is through our latest project supported by AbbVie aiming to tackle weaknesses in our knowledge-base on the effectiveness of early intervention services. The Work Foundation is conducting a review of the Leeds ‘Early Intervention Clinic’. Led by Steve Brennan, the Clinic is designed to enable quick referrals from primary care, allowing patients signed off work with an MSK to access a specialist within five days and make an early return to work. The review will offer insight into the number of patients seen by the Clinic, the nature of the appointments, patients’ conditions, how long each patient was absent from work for (temporary work disability), and highlight some of the barriers encountered when setting up the service. This will serve as a future best-practice example for wide-scale implementation of such services and we would be happy to share results in a later edition. Our work in the UK is also complemented by the international arm of the Initiative.

The Work Foundation is also supported by AbbVie to work on the Fit for Work Global Alliance – a multi-stakeholder initiative driving policy and practice change across the work and health agendas in Europe and worldwide. Our involvement has enabled the development of an ‘Early Intervention Toolkit’ – an example of the Global Alliance’s helping and making the case for more investment in sustainable healthcare. The Toolkit is a unique resource which, using the example of musculoskeletal (MSK) conditions, illustrates why there is an increasingly urgent need for early intervention services across the Europe and, in turn, demonstrates how such services could be implemented, with best practice examples, in a range of countries and health systems. It is available online ( and designed to be used by a range of stakeholders including: individuals and their families; healthcare professionals; healthcare providers; and policymakers. If you want to learn more please visit our site. We would love to hear your feedback, too.

Guest Blog by Dr Jo Larkin, Sport and Exercise Medicine Consultant FFSEM

The knowledge and principles used to treat elite professional athletes in Sport and Exercise Medicine can be used to treat injuries occurring in the rest of the population.

The musculoskeletal (MSK) rehabilitation plan must consider the fact that the objective of the patient is to return to the same activity and environment in which the injury occurred. Functional capacity after rehabilitation should at the minimum be to at the same level, if not better, than before injury. The goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate the disability.

So why should we do this? Whether you are an elite athlete, weekend warrior or just someone that wants to remain active, the care pathway and rehabilitation in MSK Medicine is the same. Stakeholders such as coaches and corporate bosses should invest in allowing the time for this to take place because there is evidence to show physical activity has multiple health benefits.



Open full size infographic ‘Physical activity benefits for adults and older adults’:


Focusing on the workplace, Business Harvard Review published a document on work effectiveness and performance. It demonstrated that both effectiveness and performance was higher in people that regularly exercise. Exercise has also been show to elevate mood, which has serious implications for workplace performance.

A further study from the Leeds Metropolitan University, demonstrated that on the days that employees visited the gym, their experience at work changed. They reported managing their time more effectively, being more productive, and having smoother interactions with their colleagues. Interestingly this then lead to the individual feeling more satisfied at the end of the day, thus in theory could have a beneficial effect on the individuals’ home life.

Keeping the workforce working is key no matter if you are an international athlete, office worker or manual worker. Therefore, carefully mapping out the MSK care pathway for the individual is no different. The aim of rehabilitation is to restore function. This is done in very simple steps and starts with a correct and early diagnosis. Once this is established the basic parameters of any rehabilitation programme is to restore the range of movement, strength and then functional progression. The latter phase is generally sport, exercise and position specific. The goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate the disability. Within the elite sport setting this is carried out by a multidisciplinary team in order to address all facets of the individual’s rehabilitation programme and optimise health outcomes, as this is an opportunistic time with the patient.

There are many ways to approach designing a rehabilitation programme and it should occur as soon as the injury takes place. I have provided an example below:

The Acute Phase – there will be some restriction in loading and range to allow for reduction in swelling and pain. However, the practitioner needs to continue to find ways of maintaining cardiovascular fitness.

The Restoration Stage – the programme will focus on range of movement and strength.

The Reacquisition Stage – where the focus will be progression of strength and initiation of the functional sport and exercise specific tasks.

The Refinement Phase – is to focus on building confidence, developing the complicated skills, progress the cardiovascular drills i.e. graduated return to running or activity. Increase capacity, both endurance and strength of the tissues.

The stages are designed to ensure functions of rehabilitation are systematically undertaken to ensure the patient has best potential return to normal activity.

The government has recently acknowledged the importance of managing MSK issues effectively in the joint green paper “Improving Lives. The Work, Health and Disability Green Paper” with the Department for Work and Pensions and the Department of Health. Therefore, it is imperative we draw on our knowledge from how we rehabilitate the sporting population and utilise our skills for the general population; but instead of using a return to sport as our objective end marker, we use the individual’s goals and link these with occupational return-to-work goals.

Instead of viewing exercise as something we do for ourselves, a personal indulgence that takes us away from our work, it’s time we started considering physical activity as part of the work itself and have this supported within the workplace. In summary, there are many similarities between the care pathway for returning sportspeople to activity and returning working people to their occupation.

Guest blog by Dr Brian Hammond D.O.D.C Ph.D. FCC (Orth) PG Cert, Chair of BackCare

There are very many back and neck pain sufferers in the UK.  The cost to the Exchequer and industry is staggering.  In this country, about 2.5 million people experience back pain every day of the year.  Although statistics vary, treatment for back pain and disability payments as a result of back problems costs the tax payer billions of pounds a year.  As a consequence, millions of working days are lost.  Relatively recent figures indicate that every year nearly 10 million working days are missed because people are experiencing back pain and that this costs the British economy the enormous figure of over £1 billion.

Back Pain is one of the leading causes of disability, affecting around 1 in 10 people.  It is more common as people increase in age.  Chronic back pain is made worse due to our increasingly sedentary lifestyles.  Sitting in the same position for long periods of time puts tension on the lower back.   Back pain also arises from poor posture, over exertion, and incorrect lifting, pulling or pushing of items.

BackCare (, the national Back Pain charity, provides authoritative advice and information to people who want to avoid or manage back pain.  It advocates taking responsibility for your body through improving your posture; watching your diet and eating the right foods; lifting correctly; drinking lots of water; exercising; medication; and use of back protection devices, and heat and ice packs.

The charity is holding a Back Pain Show at St Andrews Stadium, Birmingham on 19 and 20 May. This iconic show is free for back pain sufferers and their carers, as well as professional practitioners.  There will be access to presentations by leading experts on the latest developments in managing back pain and opportunities to meet a wide range of companies and professional individuals focused on providing treatment services, support and products for back pain sufferers.  Both public and professionals can register for the event and book any of the talks and lectures – at