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New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was <a href="https://theconversation.com/the-rise-of-ozempic-how-surprise-discoveries-and-lizard-venom-led-to-a-new-class-of-weight-loss-drugs-219721">originally developed</a> to help people with type 2 diabetes manage their blood sugar levels. However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032183">weight loss</a>, and hundreds of thousands of people around the world are using it <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">for this purpose</a>. Evidence has also shown the drug can help manage <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2306963">heart failure</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403347">chronic kidney disease</a> in people with obesity and type 2 diabetes. Now, a study published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">New England Journal of Medicine</a> has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked? <h2>Osteoarthritis and obesity</h2> Osteoarthritis is a common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. Most people with osteoarthritis <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">have pain</a> and find it difficult to perform common daily activities such as walking. The knee is <a href="https://pubmed.ncbi.nlm.nih.gov/37675071/">the joint most commonly affected</a> by osteoarthritis. Being overweight or obese is a <a href="https://pubmed.ncbi.nlm.nih.gov/25447976/">major risk factor</a> for osteoarthritis in the knee. The link between the two conditions <a href="https://pubmed.ncbi.nlm.nih.gov/26821091/">is complex</a>. It involves a combination of increased load on the knee, <a href="https://www.nature.com/articles/s41413-023-00301-9">metabolic factors</a> such as high cholesterol and high blood sugar, and inflammation. For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the <a href="https://pubmed.ncbi.nlm.nih.gov/30712918/">development of osteoarthritis</a>. Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. <a href="https://pubmed.ncbi.nlm.nih.gov/31908149/">International</a> and <a href="https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf">Australian guidelines</a> suggest losing as little as 5% of body weight can help. But losing weight with just diet and exercise can be difficult for many people. <a href="https://pubmed.ncbi.nlm.nih.gov/26180980/">One study</a> from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten. Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness. <h2>Semaglutide for osteoarthritis?</h2> The rationale for the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">recent study</a> was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight. They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight. As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group. The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group. This is much greater than the pain reduction in another <a href="https://pubmed.ncbi.nlm.nih.gov/36511925/">recent study</a> among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale. The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/35442752/">anti-inflammatories</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">opioids</a> and <a href="https://www.bmj.com/content/372/bmj.m4825">antidepressants</a>. Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test. <h2>How could semaglutide reduce knee pain?</h2> It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain. But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have <a href="https://www.sciencedirect.com/science/article/pii/S1043661822002651">anti-inflammatory</a> properties, and could even protect against <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6731440/">cartilage wear and tear</a>. While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not. The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis <a href="https://pubmed.ncbi.nlm.nih.gov/34527976/">are prescribed opioids</a>. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity. It’s also important to consider semaglutide can have a range of <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">side effects</a>, including gastrointestinal symptoms and fatigue. There are some concerns that semaglutide could reduce <a href="https://www.sciencealert.com/experts-are-concerned-drugs-like-ozempic-may-cause-muscle-loss">muscle mass</a> and <a href="https://www.healthline.com/health-news/ozempic-muscle-mass-loss">bone density</a>, though we’re still learning more about this. Further, it can be difficult to access. <h2>I have knee osteoarthritis, what should I do?</h2> Osteoarthritis is a disease caused by multiple factors, and it’s important to take <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard/information-consumers-osteoarthritis-knee-clinical-care-standard">a multifaceted approach</a> to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">self-management</a>. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243159/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, Associate Professor, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstocl This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/new-study-suggests-weight-loss-drugs-like-ozempic-could-help-with-knee-pain-heres-why-there-may-be-a-link-243159">original article</a>. </div>

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How hip pain led Sydney karate master to life-changing weight loss journey

<div> Sydney-based karate instructor and personal trainer Glenn Stephenson knows the toll that joint pain and extra weight can take on physical activity. Despite decades of experience as a martial arts coach, Glenn found himself increasingly limited by severe hip pain and unwanted weight gain. </div> <div> In 2021, at 95 kilograms, the 64-year-old’s arthritis and reduced mobility affected not only his work but also his confidence. “I couldn’t move around like I wanted to, and as a master instructor, it felt wrong to be teaching students while carrying so much extra weight,” he admits. </div> <div> Glenn’s pain and discomfort prompted him to make a drastic change. Instead of resorting to extreme dieting, he adopted a more sustainable approach to weight loss to reduce joint and liver inflammation, and regain his mobility. He shed 20 kilograms and now walks four kilometres daily. “I can move better, my mental health has improved, and I feel more capable of guiding my students,” he says. </div> <div> Today, Glenn encourages others struggling with weight to take a balanced approach to fitness and health. “I look the part now, which gives me confidence as a master instructor to show my students that staying active is achievable at any age.” </div> <div> Dietitian Kirby Sorenson, from health platform <a title="https://www.getmosh.com.au/?utm_term=mosh&utm_campaign=Cross_Search_Brand_Mosh&utm_source=paid-search&utm_medium=adwords&utm_content=100740202037&hsa_acc=5792635568&hsa_cam=1701000406&hsa_grp=100740202037&hsa_ad=697110582898&hsa_src=g&hsa_tgt=kwd-295213997936&hsa_kw=mosh&hsa_mt=p&hsa_net=adwords&hsa_ver=3&gclid=CjwKCAiAxKy5BhBbEiwAYiW--5qfGzQVQBG-CmA6baVMEeP5Zmk_oB_GOstA1n2vabFrLzbeDrEEnxoCM4YQAvD_BwE" href="https://www.getmosh.com.au/?utm_term=mosh&utm_campaign=Cross_Search_Brand_Mosh&utm_source=paid-search&utm_medium=adwords&utm_content=100740202037&hsa_acc=5792635568&hsa_cam=1701000406&hsa_grp=100740202037&hsa_ad=697110582898&hsa_src=g&hsa_tgt=kwd-295213997936&hsa_kw=mosh&hsa_mt=p&hsa_net=adwords&hsa_ver=3&gclid=CjwKCAiAxKy5BhBbEiwAYiW--5qfGzQVQBG-CmA6baVMEeP5Zmk_oB_GOstA1n2vabFrLzbeDrEEnxoCM4YQAvD_BwE" data-outlook-id="bc4b923a-a4a3-4af0-80db-e837cd64b4c7">Mosh</a>, is encouraging Australians to ditch the Body Mass Index (BMI) in favour of more modern diagnostics to determine the risk of disease linked to higher body fat, declaring it’s unfairly categorising people as being overweight. </div> <div> Ms Sorenson says knowing your Body Roundness Index (BRI) as well as your Basal Metabolic Rate (BMR) can more accurately predict the risk of diseases like high blood pressure, type 2 diabetes and heart disease because it works out body fat levels based on height and waist circumference, rather than the BMI method which relies on height and weight. </div> <div> “BMI has long been criticised for inaccurately categorising people as overweight or obese because it doesn’t differentiate between those who carry a lot of muscle and individuals with fat in the wrong places,” Ms Sorenson says. </div> <div> “The problem is that it only looks at overall weight, while the BRI focuses on fat held around the abdomen which is the riskiest fat in terms of overall health. </div> <div> Once the BRI is determined, Ms Sorenson says it can help to know your Basal Metabolic Rate, which is largely determined by your total lean mass to help determine a healthy path to maintaining a healthy weight range. </div> <div> “The basal metabolic rate or BMR gives you an idea of how many calories your body burns doing the bare minimum; breathing, blood circulation, brain and nerve function. It can vary greatly from person to person, which explains why individual weight loss journeys can be so different,” Ms Sorenson said. </div> <div> For more information visit Moshy’s online <a title="https://www.getmoshy.com.au/weight-loss/basal-metabolic-rate-calculator?srsltid=AfmBOoobS-PiI_4sJn2ykpEG6vzq6qkvQXammfLv4Rm-mS5nwll6EN0m" href="https://www.getmoshy.com.au/weight-loss/basal-metabolic-rate-calculator?srsltid=AfmBOoobS-PiI_4sJn2ykpEG6vzq6qkvQXammfLv4Rm-mS5nwll6EN0m" data-outlook-id="800f9af2-0a34-4ac4-801b-d16714c7ec2e">BMR calculator</a>. Image credits: Supplied </div>

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Commissioner speaks out after son's killer avoids jail

Police Commissioner Grant Stevens has shared an emotional statement outside of court after the young man accused of killing his son had his sentence suspended. Dhirren Randhawa, 19, was sentenced at Adelaide District Court to 13 months in prison for driving without due care and leaving the scene of an accident after crashing into 18-year-old Charlie Stevens in 2023. Charlie was celebrating schoolies with his friends, before being struck and suffering irreversible brain damage, as he died in hospital just days later. Judge Joanne Tracey suspended the sentence with a two-year good behaviour bond and a 10-year suspension of his license, citing many reasons why he should not be placed behind bars. Justice Tracey said Randhawa’s youth, lack of prior offending, the circumstances of the offending, his genuine remorse and his guilty pleas were all factors in her decision. “You have accepted there was more you could have done to avoid this tragic outcome,” she said on Tuesday. “It is, of course, the case you had no intention to harm anyone that night." “It is an offence any one of us as road users may commit if we do not take proper care or drive without proper attention.” Speaking after the sentence, Commissioner Stevens he and his family were “grateful” the court process had finished. “The judge said in summing up today … no matter what happens in the courtroom today, it’s not going to change anything for our family, and I think that’s a very true statement,” he said alongside his wife Emma. “We’re grateful this part of the entire process is over. Each court date that has come up has been difficult, stressful and emotional for our family." “We’re grateful Dhirren chose to plead guilty to his offence because that brought this part of it to a conclusion much more quickly." “It is one of those things, we are continuing to learn how to live with every single day without Charlie. It’s not getting any easier, as I’m sure people who have lost a child would appreciate." “We’re very grateful for the support and the sympathy we’ve received from the South Australian community … there’s no way we can acknowledge or repay that in any other format other than thanking people for their support.” Image credits: SA Police / Facebook

Caring

Charlise Mutten's grieving mother speaks out about her daughter's killer

The heartbroken mother of Charlise Mutten has spoken out about her "amazing little girl", and how she will never forgive herself for starting a relationship with the man who would go on to kill the nine-year-old. In her first TV interview, Kallista Mutten revealed what the final days were like between her, Charlise and Justin Stein - Kallista's partner - who was jailed for life in August after being found <a href="https://oversixty.com.au/finance/legal/unspeakably-vicious-judge-hands-down-verdict-to-justin-stein" target="_blank" rel="noopener">guilty</a> of Charlise's murder. In the days before the young girl's death in January 2022, the trio were celebrating Christmas in the Blue Mountains. Kallista revealed that during their holiday, Stein had asked Charlise to call him "daddy", saying he was “always going to be a father figure”. “That was a very touching moment for both of us because she’s always longed for a dad,” she told 60 Minutes. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/DBDz4pqhG4e/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/DBDz4pqhG4e/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by 60 Minutes Australia (@60minutes9)</a> </div> </blockquote> Kallista and Justin met in 2018 in prison and formed their relationship on wanting to build a better life together, but Kallista now says she will always hate herself for trusting him. “I am forced to live with the fact that I trusted someone with my daughter and that because of my trust in someone, I put my daughter in harm’s way,” She said. "I hate myself for it. I really do. It’s taken this for me to wake up and realise that I already had someone that loved me … He’s a monster, pure evil.” The grieving mum opened up about the nature of her relationship, admitting that her time with Stein had been erratic, in no small part due to their drug use, but she never believed he was capable of what happened. “The thought of what she had gone, would’ve gone through, that’s … that’s what breaks me,” Ms Mutten said. “There is just not enough justice that will make it better for me and my family.” Ms Mutten said she understands why she was judged by those who blamed her for her daughter's death and now knows “Charlise deserved more”. “I do take accountability of the things that I have done,” she said. “I wish I had been there more for her and, like, I see that now and I’ve got to live with that.” While Kallista continues to mourn the loss of her daughter, she hopes Charlise is remembered as a bundle of joy with a kind soul. “We just had this amazing connection and that she just absolutely, she was my number one fan,” she said. “She just was just the most incredible amazing little girl.” Image credits: 60 Minutes / NSW Police / Facebook

Legal

Helping alleviate the pain of arthritis

One in seven Australians, or 3.6 million people, are living with arthritis, a leading cause of chronic pain and the second most common cause of disability and early retirement due to ill health, according to Arthritis Australia. Mike Whitney is a big fan of Arborvitae after having spent years playing cricket for NSW and Australia resulting in many aches and pains throughout his body. The joys of sport that many people experience as they get older. Arborvitae Health and Wellbeing has spent years formulating a solution to target debilitating pain caused by arthritis and other chronic conditions. “We wanted it to be a natural product as well,” says Arborvitae Director Brendan Howell. Since it was founded in 2014, Arborvitae Health and Wellbeing, has used Pycnogenol (French maritime pine bark extract) as the main ingredient in its range of natural anti-inflammatory and antioxidant supplements. The natural plant extract, which grows on the coast of south-west France, is used alongside aloe vera, papain enzyme and honey. “Arborvitae’s unique formulation of natural ingredients provides a potent supplement and is based on years of research into the impact of inflammation in the human body,” Howell says. The company’s main product, Arborvitae Joint Health, may help provide relief from symptoms of mild-moderate arthritis, joint pain, inflammation, soreness and stiffness. ‘‘Arborvitae does make a difference, and that has been supported by over 160 clinical trials on its main ingredient Pycnogenol across a broad range of conditions and Arborvitae’s own clinical study,” Howell says. The recent clinical study on Arborvitae Joint Health has shown some exceptional results with pain relief (66% decrease in pain test scores), a 50% increase in walking distance, a 56% decrease in inflammation in blood tests (CRP), a 78% reduction in their use of on-demand medications and a 50% improvement in quality-of-life scores. <img class="alignnone size-full wp-image-71490" src="https://oversixtydev.blob.core.windows.net/media/2024/10/Infographic_1280.jpg" alt="" width="1280" height="899" /> “The customer feedback we receive also demonstrates the product's efficacy and enables us to provide real examples of its success when speaking with customers,” Brendan Howell said. As an example, Tracy from All Sort Cakes in Sydney is a regular Arborvitae customer and states: “Arborvitae has been a game changer for me. I’ve suffered with sore hands for years and I probably don’t have to tell all of you fellow cake makers how debilitating it can be. A friend suggested I try Arborvitae. So the first bottle I wasn’t sure but I was told to wait till I finish the second bottle to feel the full effects. And yep! Omg!!! The pain all but disappeared.” <img class="alignnone size-full wp-image-71488" src="https://oversixtydev.blob.core.windows.net/media/2024/10/Tracy-Wilson-May-2023_1280.jpg" alt="" width="1280" height="1477" /> Whilst Gary from Kenthurst, another regular customer, states: “To be told at 50 I may need a knee operation one day was an obvious shock. I run a small Forklift Business and 19 months ago became a grandfather, so I need to be mobile. Not wanting an operation at this point I needed an alternative, and what an alternative I found. In obvious pain I started my Arborvitae Joint Health treatment and after 2 weeks my pain and swelling had reduced. Now my pain is gone. If I am going to have a big day in the yard or in the bobcat I make sure I take my Arborvitae Joint Health first. What a fabulous product this is. No one should go through life in pain and I will tell anyone that will listen - if you have early onset mild Osteo Arthritis start taking Arborvitae Joint Health it has certainly helped me, and I can keep up with my grandson Max.” <img class="alignnone size-full wp-image-71487" src="https://www.readersdigest.com.au/wp-content/uploads/2024/10/Gary-copy-holding-new-blue-bottle_770.jpg" alt="" width="770" height="482" /> Arborvitae’s main product is Arborvitae Joint Health, however the other stars in the range are Arborvitae Health and Wellbeing Supplement for blood glucose, cholesterol and the immune system and Arborvitae Cognitive Function, Memory and Eye Health. Mr Howell said the natural anti-inflammatory comes in an easy to take daily liquid supplement that has been designed to reset the immune system and bring down inflammation in the body quickly and efficiently. The inflammation reduction (of 56%) at the cellular level is confirmed by the CRP results in the recent clinical study. This reduction in inflammation alone is significant. Supplements are sold via Arborvitae’s website and at over 2000 chemists and health food shops Australia wide – including Chemist Warehouse, TerryWhite Chemmart and Blooms The Chemist. To find the closest store near you, visit <a href="http://www.arborvitae.com.au/pages/where-to-buy" target="_blank" rel="noopener">www.arborvitae.com.au/pages/where-to-buy</a> To find out more on the clinical study and Arborvitae’s health supplements you can visit the website: <a href="http://www.arborvitae.com.au" target="_blank" rel="noopener">www.arborvitae.com.au</a> or call 1300 879 863. Always read the label and follow the directions for use. Images: Courtesy of Arborvitae This is a sponsored article produced in partnership with Arborvitae

Body

Police commissioner faces his son's killer in court

The South Australian police commissioner has faced the young man accused of killing his son in a hit and run in an Adelaide court, sharing an emotional statement about his family's grief. Randhawa, 19, was behind the wheel when he struck Charlie Stevens, 18, who was out celebrating schoolies with his friends. Randhawa has pleaded guilty to aggravated driving without due care and leaving an accident scene after causing death, as Charlie died from his irreversible brain injuries following the crash. “Not a single day goes by when we don’t talk about Charlie, when we don’t talk about him together, there is not a day when we don’t shed a tear thinking about our son and how much we miss him,” Commissioner Grant Stevens said. “Charlie would have been 19 on the 28th of April this year, but instead of celebrating it, it took all our efforts just to get through the day. And we know that that grief is with us for the rest of our lives.” Mr Stevens then addressed Randhawa directly as he said, “We acknowledge you have taken responsibility for what you have done and we are sure this has been difficult for you.” “But you get to move on and the people close to you still have you in their lives. We don’t have Charlie and we want you to remember that.” Charlie’s sister Sophie Tregloan also addressed Randhawa, saying, “Do I hate you? Yes, I absolutely do – but what I hate most is what you’ve taken from myself and my family.” “You have taken so much from us in a split second dumb decision. It’s Charlie’s heart I will miss the most. He was kind, inclusive of all, a pillar of strength.” Randhawa then delivered an emotional apology to the Stevens’ family, saying, “You’re always on my mind and so is Charlie and you will be forever.” “There’s so much I’d like to say but mostly I want to say I’m sorry, and I’m sorry Charlie.” Judge Joanne Tracey is still considering an appropriate sentence for Randhawa, who is out on bail. Image credits: SA Police / Facebook

Family & Pets

Readers response: What's a pain you can't truly explain until you've endured it?

When it comes to experiencing pain, many of us are used to hearing people say "I know how you feel" while they're empathising with your suffering. However, there are some kinds of pain - either physical or emotional - that cannot be understood until you experience them yourself. We asked our readers what pain you can't truly explain until you've endured it yourself, and the response was overwhelming. Here's what they said. Anne Hare - Shingles! Absolutely excruciating. I seriously considered topping myself until I was finally prescribed Lyrica. Took five months to recover as misdiagnosed twice so antivirals prescribed too late. Have the shot! Karen Ambrose - Childbirth. 15.5 hours of agony. Annette Maree - Pain from a dying nerve in a tooth. Royce Jowett - The worst pain is always the one you are currently experiencing, especially as you get older and forgetful. Julia Santos - Hip pain is hard to explain how it affects your whole day. Even trying to sleep is an adventure. And sneezing while your hips are inflamed is always fun. Betty Weller Edwards - Gallbladder stones. I would rather go through labor for 12 hours than have 4 hours off gallbladder pain. Sandra Morris - The loss of your child. Kevin Chapman - Chronic arthritis. The pain is 24/7, it never goes away. Danny Bennett - Divorce. Patricia White - Dislocated shoulder. Jill Harker - A couple of bulging discs in my back! Linda Charlton - Clot in the lungs, couldn't breathe thought I was having a heart attack in my 30's. Other than that, definitely childbirth. George Dworcowyi - Back spasms after a 7 hour operation on my broken spine. Maxine Cuevas - Losing two adult children at separate times. Josephine Broughton - White tail spider bite. Shelley Woolley - Ruptured ovarian cysts. Image credits: Shutterstock

Body

Why is pain so exhausting?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/michael-henry-1321395">Michael Henry</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them. In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the <a href="https://weareundefeatable.co.uk/campaign-hub/latest-from-us/the-bridging-the-gap-report/">two biggest barriers</a> to an active and meaningful life. But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours. <h2>Short-term pain can protect you</h2> Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe. Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us. When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it. The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us <a href="https://pubmed.ncbi.nlm.nih.gov/35934276/">they learned</a> that helped them recover. <h2>But long-term pain can overprotect you</h2> In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes. But persistent pain can overprotect us and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jabr.12124">prevent recovery</a>. People in pain have called this “<a href="https://www.jpain.org/article/S1526-5900(22)00379-0/fulltext">pain system hypersensitivity</a>”. Think of this as your pain system being on red alert. And this is where exhaustion comes in. When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued. <a href="https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary">About 80%</a> of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like. Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties. Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy. Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying. <h2>No wonder pain is exhausting</h2> In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go <a href="https://www.noigroup.com/product/explain-pain-supercharged/">hand in hand</a> with chronic pain. Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems. Loss of sleep is also a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289983/">factor</a> in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain. In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting. <h2>What actually works?</h2> People with chronic pain are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633893/">stigmatised, dismissed</a> and <a href="https://www.jpain.org/article/S1526-5900(13)01367-9/fulltext">misunderstood</a>, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage. So we need better access to evidence-based care, with high-quality education for people with chronic pain. There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/abstract">helps</a>. The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising. Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong <a href="https://jamanetwork.com/journals/jama/article-abstract/2794765">supportive evidence</a> from <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/abstract">clinical trials</a>. <h2>Every bit of support helps</h2> The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted. So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey. <hr /> More information about chronic pain is available from <a href="https://www.painrevolution.org/painfacts">Pain Revolution</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/238417/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-henry-1321395">Michael Henry</a>, Physiotherapist and PhD candidate, Body in Mind Research Group, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-is-pain-so-exhausting-238417">original article</a>. </div>

Body

Hunter Valley crash survivor's demands of killer bus driver

A man who survived the devastating bus crash in the Hunter Valley in June 2023 that claimed the lives of 10 people has confronted the man who was behind the wheel with an emotional victim statement in court. On that fateful day, Brett Button was transporting wedding guests to the reception venue when the bus flipped at a roundabout at Greta, with the crash claiming the lives of 10 people and injuring another 25 passengers. As a result, Button, 59, has pleaded guilty to 19 charges, including dangerous driving occasioning death and grievous bodily harm, appearing before Newcastle District Court on Tuesday to hear emotional victim statements from survivors and family members of those who were killed. Taking the stand to deliver his impact statement following a day and a half of hearings, one survivor demanded Button look at him before telling him he'd trapped him in a “bus of hell”. “My friends didn’t deserve to die, the others didn’t deserve to die,” he said. “The families here don’t deserve to be here. My future has been destroyed because of your actions. I can no longer be the person I was. The intergenerational trauma you have caused is enormous.” Earlier on Tuesday, Steve Symons, whose son Kane died in the crash, fought back tears to tell Button about how his son had seized on a “second chance” after a childhood injury only to have it “cruelly” robbed from him. “Kane’s death has shattered our lives. It has left an unrepairable void. He was a vibrant and ambitious young man who had been given a rare second chance at life,” Mr Symons told the court. “He lived with an acute awareness of just how precious life is and embraced every moment of it. To lose him now after he was given that second chance at life is both cruel and unjust.” Zachary Bray was also given a “second chance” after a battle with stage-3 bowel cancer, as his mother, Jackie, said he “always chose the right path” in another emotional statement. “In many ways, Zac was the perfect child if there ever was one. He just wanted to please and did so his entire life, making his family, friends and colleagues proud in everything he did,” she said. “He and his friends did what they were told to do: have a plan B. They trusted the bus driver would get them home safely, but my son who did everything right still didn’t make it home." “Zac got a death sentence, and his family and friends got a life sentence.” At least 35 people are expected to provide witness impact statements to the court during a marathon three-day sentence hearing that began on Monday morning before Judge Roy Ellis, who is expected to hand down his sentence to Button on Wednesday. Andrew Scott, 35, and wife Lynan Scott, 33, Nadene McBride, 52, daughter Kyah McBride, 22, and her partner, Kane Symons, 21, Darcy Bulman, 30, Rebecca Mullen, 26, Zachary Bray, 29, Tori Cowburn, 29, and Angus Craig, 28, were killed in the crash on June 11th 2023, with the crash now known as one of Australia's worst ever fatal road incidents. Image credits: Getty Images

Caring

How long does back pain last? And how can learning about pain increase the chance of recovery?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>. Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain. Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access. <h2>More pain doesn’t mean a more serious injury</h2> Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease. There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system. The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. <h2>Reduce your chance of lasting pain</h2> Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain: <ul> <li> understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </li> <li> reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal. </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover. But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>. </div>

Body

Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">updated treatment guidelines</a> from the Australian Commission on Safety and Quality in Health Care. So what is knee osteoarthritis and what are the best ways to manage it? <h2>More than 2 million Australians have osteoarthritis</h2> Osteoarthritis is the most common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. It <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">costs the economy</a> A$4.3 billion each year. Osteoarthritis commonly <a href="https://pubmed.ncbi.nlm.nih.gov/33560326/">affects</a> the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles. Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs. <h2>Is it caused by ‘wear and tear’?</h2> Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is <a href="https://pubmed.ncbi.nlm.nih.gov/31192807/">not caused by</a> “wear and tear”. <a href="https://pubmed.ncbi.nlm.nih.gov/21281726/">Research shows</a> the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">not required</a> to diagnose knee osteoarthritis or guide treatment decisions. Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have <a href="https://pubmed.ncbi.nlm.nih.gov/37795555/">shown this</a> in people with osteoarthritis, and other common pain conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545091/">back</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/33789444/">shoulder</a> pain. This has led to a global call for a <a href="https://pubmed.ncbi.nlm.nih.gov/38354847/">change in the way</a> we think and communicate about osteoarthritis. <h2>What’s the best way to manage osteoarthritis?</h2> Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">include</a> education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines. Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms. Health professionals who use positive and reassuring language <a href="https://pubmed.ncbi.nlm.nih.gov/35750241/">can improve</a> people’s knowledge and beliefs about osteoarthritis and its management. Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/36593092/">paracetamol and anti-inflammatories</a> and can <a href="https://pubmed.ncbi.nlm.nih.gov/26488691/">prevent or delay</a> the need for joint replacement surgery in the future. Many types of exercise <a href="https://pubmed.ncbi.nlm.nih.gov/30830561/">are effective</a> for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you. Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time. Weight management is important for those who are overweight or obese. Weight loss <a href="https://pubmed.ncbi.nlm.nih.gov/34843383/">can reduce knee pain and disability</a>, particularly when combined with exercise. Losing as little as 5–10% of your body weight <a href="https://pubmed.ncbi.nlm.nih.gov/36474793/">can be beneficial</a>. Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. <a href="https://pubmed.ncbi.nlm.nih.gov/33786837/">Recommended medicines</a> include paracetamol and non-steroidal anti-inflammatory drugs. Opioids are <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">not recommended</a>. The risk of harm outweighs any potential benefits. <h2>What about surgery?</h2> People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement. Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain. However, high-quality research <a href="https://pubmed.ncbi.nlm.nih.gov/24369076/">has shown</a> arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis. Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">53,500 Australians</a> had a knee replacement for their osteoarthritis. Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management. The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments. <h2>I have knee osteoarthritis. What should I do?</h2> The <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> links to free evidence-based resources to support people with osteoarthritis. These include: <ul> <li>education, such as a <a href="https://www.england.nhs.uk/wp-content/uploads/2023/07/making-a-decision-about-knee-osteoarthritis-v1.pdf.pdf">decision aid</a> and <a href="http://www.futurelearn.com/courses/taking-control-hip-and-knee-osteoarthritis">four-week online course</a></li> <li>self-directed <a href="https://healthsciences.unimelb.edu.au/departments/physiotherapy/chesm/patient-resources/my-knee-exercise">online exercise</a> and <a href="https://myjointyoga.com.au/">yoga</a> programs</li> <li><a href="https://www.gethealthynsw.com.au/program/standard-coaching/">weight management support</a></li> <li>pain management strategies, such as <a href="https://www.myjointpain.org.au/">MyJointPain</a> and <a href="http://www.paintrainer.org/">painTRAINER</a>.</li> </ul> If you have osteoarthritis, you can use the <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> to inform discussions with your health-care provider, and to make informed decisions about your care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236779/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, Postdoctoral research fellow in physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, Professor in Physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">original article</a>. </div>

Body

Thinking about trying physiotherapy for endometriosis pain? Here’s what to expect

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/peter-stubbs-1531259">Peter Stubbs</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/caroline-wanderley-souto-ferreira-1563754">Caroline Wanderley Souto Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Endometriosis is a condition that affects women and girls. It occurs when tissue similar to the lining of the uterus ends up in other areas of the body. These areas <a href="https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656">include</a> the ovaries, bladder, bowel and digestive tract. Endometriosis will <a href="https://endometriosisaustralia.org/understanding-endometriosis/">affect</a> nearly one million Australian women and girls in their lifetime. Many high-profile Australians are affected by endometriosis including <a href="https://www.endofound.org/bindi-irwin-shares-her-endometriosis-story-in-detail-as-she-prepares-to-receive-endofounds-blossom-a">Bindi Irwin</a>, <a href="https://www.endofound.org/actress-sophie-monk-reveals-endometriosis-diagnosis">Sophie Monk</a> and former Yellow Wiggle, <a href="https://endometriosisaustralia.org/emma-watkins-ambassador/">Emma Watkins</a>. <a href="https://www.sciencedirect.com/science/article/pii/S0092867421005766">Symptoms</a> of endometriosis include intense pelvic, abdominal or low back pain (that is often worse during menstruation), bladder and bowel problems, pain during sex and infertility. But women and girls wait an average of <a href="https://www.epworth.org.au/newsroom/reducing-time-to-an-endometriosis-diagnosis">seven years to receive a diagnosis</a>. Many are living with the burden of endometriosis and not receiving treatments that could improve their quality of life. This includes physiotherapy. <h2>How is endometriosis treated?</h2> No treatments cure endometriosis. Symptoms can be reduced by taking <a href="https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment">medications</a> such as non-steriodal anti-inflammatories (ibuprofen, aspirin or naproxen) and hormonal medicines. Surgery is sometimes used to diagnose endometriosis, remove endometrial lesions, reduce pain and improve fertility. But these lesions can <a href="https://pubmed.ncbi.nlm.nih.gov/39098538/">grow back</a>. Whether they take medication or have surgery, many women and girls continue to experience pain and other symptoms. Pelvic health physiotherapy is <a href="https://australian.physio/inmotion/physiotherapists-can-help-endometriosis">often recommended</a> as a non-drug management technique to manage endometriosis pain, <a href="https://www1.racgp.org.au/ajgp/2024/january-february/endometriosis">in consultation</a> with a gynaecologist or general practitioner. The goal of physiotherapy treatment depends on the symptoms but is usually to reduce and manage pain, improve ability to do activities, and ultimately improve quality of life. <h2>What could you expect from your first appointment?</h2> Physiotherapy management can differ based on the severity and location of symptoms. Prior to physical tests and treatments, your physiotherapist will comprehensively explain what is going to happen and seek your permission. They will ask questions to better understand your case and specific needs. These will include your age, weight, height as well as the presence, location and intensity of symptoms. You will also be asked about the history of your period pain, your first period, the length of your menstrual cycle, urinary and bowel symptoms, sexual function and details of any previous treatments and tests. They may also assess your posture and movement to see how your muscles have changed because of the related symptoms. They will press on your lower back and pelvic muscles to spot painful areas (trigger points) and muscle tightness. If you consent to a vaginal examination, the physiotherapist will use one to two gloved fingers to assess the area inside and around your vagina. They will also test your ability to coordinate, contract and relax your pelvic muscles. <h2>What type of treatments could you receive?</h2> Depending on your symptoms, your physiotherapist may use the following treatments: General education Your physiotherapist will give your details about the disease, pelvic floor anatomy, the types of treatment and how these can improve pain and other symptoms. They might <a href="https://pubmed.ncbi.nlm.nih.gov/38452219/">teach you about</a> the changes to the brain and nerves as a result of being in long-term pain. They will provide guidance to improve your ability to perform daily activities, including getting quality sleep. If you experience pain during sex or difficulty using tampons, they may teach you how to use vaginal dilators to improve flexibility of those muscles. Pelvic muscle exercises Pelvic muscles often contract too hard as a result of pain. <a href="https://www.physio-pedia.com/Pelvic_Floor_Exercises">Pelvic floor exercises</a> will help you contract and relax muscles appropriately and provide an awareness of how hard muscles are contracting. This can be combined with machines that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843943/">monitor muscle activity or vaginal pressure</a> to provide detailed information on how the muscles are working. Yoga, stretching and low-impact exercises <a href="https://pubmed.ncbi.nlm.nih.gov/27869485/">Yoga</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/37467936/">stretching and low impact aerobic exercise</a> can improve fitness, flexibility, pain and blood circulation. These have <a href="https://pubmed.ncbi.nlm.nih.gov/28369946/">general pain-relieving properties</a> and can be a great way to contract and relax bigger muscles affected by long-term endometriosis. These exercises can help you regain function and control with a gradual progression to perform daily activities with reduced pain. Hydrotherapy (physiotherapy in warm water) Performing exercises in water improves blood circulation and muscle relaxation due to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/">pressure and warmth of the water</a>. Hydrotherapy allows you to perform aerobic exercise with low impact, which will reduce pain while exercising. However, while hydrotherapy shows positive results clinically, scientific studies to show its effectiveness studies <a href="https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001611112">are ongoing</a>. Manual therapy Women frequently have small areas of muscle that are tight and painful (trigger points) inside and outside the vagina. Pain can be temporarily reduced by <a href="https://pubmed.ncbi.nlm.nih.gov/37176750/">pressing, massaging or putting heat on</a> the muscles. Physiotherapists can teach patients how to do these techniques by themselves at home. <h2>What does the evidence say?</h2> Overall, patients report <a href="https://www.wmhp.com.au/blog/endo-story">positive experiences</a> pelvic health physiotherapists treatments. In a <a href="https://pubmed.ncbi.nlm.nih.gov/37176750/">study of 42 women</a>, 80% of those who received manual therapy had “much improved pain”. In studies investigating yoga, one study <a href="https://pubmed.ncbi.nlm.nih.gov/27869485/">showed</a> pain was reduced in 28 patients by an average of 30 points on a 100-point pain scale. Another study showed yoga was beneficial for pain in <a href="https://pubmed.ncbi.nlm.nih.gov/27552065/">all 15 patients</a>. But while some studies show this treatment <a href="https://pubmed.ncbi.nlm.nih.gov/36571475/">is effective</a>, a review <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/">concluded</a> more studies were needed and the use of physiotherapy was “underestimated and underpublicised”. <h2>What else do you need to know?</h2> If you have or suspect you have endometriosis, consult your gynaecologist or GP. They may be able to suggest a pelvic health physiotherapist to help you manage your symptoms and improve quality of life. As endometriosis is a chronic condition you <a href="https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10960">may be entitled</a> to five subsidised or free sessions per calendar year in clinics that accept Medicare. If you go to a private pelvic health physiotherapist, you won’t need a referral from a gynaecologist or GP. Physiotherapy rebates can be available to those with private health insurance. The Australian Physiotherapy Association has a <a href="https://choose.physio/find-a-physio">Find a Physio</a> section where you can search for women’s and pelvic physiotherapists. <a href="https://endometriosisaustralia.org/">Endometriosis Australia</a> also provides assistance and advice to women with Endometriosis. Thanks to UTS Masters students Phoebe Walker and Kasey Collins, who are researching physiotherapy treatments for endometriosis, for their contribution to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236328/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-stubbs-1531259">Peter Stubbs</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/caroline-wanderley-souto-ferreira-1563754">Caroline Wanderley Souto Ferreira</a>, Visiting Professor of Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-about-trying-physiotherapy-for-endometriosis-pain-heres-what-to-expect-236328">original article</a>. </div>

Body

No, your aches and pains don’t get worse in the cold. So why do we think they do?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It’s cold and wet outside. As you get out of bed, you can feel it in your bones. Your right knee is flaring up again. That’ll make it harder for you to walk the dog or go to the gym. You think it must be because of the weather. It’s a common idea, but a myth. When we looked at the evidence, <a href="https://www.sciencedirect.com/science/article/pii/S0049017224000337">we found</a> no direct link between most common aches and pains and the weather. In the first study of its kind, we found no direct link between the temperature or humidity with most joint or muscle aches and pains. So why are so many of us convinced the weather’s to blame? Here’s what we think is really going on. <h2>Weather can be linked to your health</h2> The weather is often associated with the risk of new and ongoing health conditions. For example, cold temperatures <a href="https://pubmed.ncbi.nlm.nih.gov/27021573/">may worsen</a> asthma symptoms. Hot temperatures <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00117-6/fulltext">increase the risk</a> of heart problems, such as arrhythmia (irregular heartbeat), cardiac arrest and coronary heart disease. Many people are also convinced the weather is linked to their aches and pains. For example, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8077.2004.00099.x?casa_token=jvpSbA4szqoAAAAA%3ATyHyGaqXmfevWyuJe6LW_3Pap3IPHC8HSMTl3RN63mFzNO0X7ozQjBb6Bi3yVFuPjqkrf-WlB-J5A1q1">two in every three</a> people with knee, hip or hand osteoarthritis <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-66">say</a> cold temperatures trigger their symptoms. Musculoskeletal conditions affect more than <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions-comorbidity-australia/summary">seven million Australians</a>. So we set out to find out whether weather is really the culprit behind winter flare-ups. <h2>What we did</h2> Very few studies have been specifically and appropriately designed to look for any direct link between weather changes and joint or muscle pain. And ours is the first to evaluate data from these particular studies. We looked at data from more than 15,000 people from around the world. Together, these people reported more than 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. People with rheumatoid arthritis and gout were also included. We then compared the frequency of those pain reports between different types of weather: hot or cold, humid or dry, rainy, windy, as well as some combinations (for example, hot and humid versus cold and dry). <h2>What we found</h2> We found changes in air temperature, humidity, air pressure and rainfall do not increase the risk of knee, hip or lower back pain symptoms and are not associated with people seeking care for a new episode of arthritis. The results of this study suggest we do not experience joint or muscle pain flare-ups as a result of changes in the weather, and a cold day will not increase our risk of having knee or back pain. In order words, there is no direct link between the weather and back, knee or hip pain, nor will it give you arthritis. It is important to note, though, that very cold air temperatures (under 10°C) were rarely studied so we cannot make conclusions about worsening symptoms in more extreme changes in the weather. The only exception to our findings was for gout, an inflammatory type of arthritis that can come and go. Here, pain increased in warmer, dry conditions. Gout has a very different underlying biological mechanism to back pain or knee and hip osteoarthritis, which may explain our results. The combination of warm and dry weather may lead to increased dehydration and consequently increased concentration of uric acid in the blood, and deposition of uric acid crystals in the joint in people with gout, resulting in a flare-up. <h2>Why do people blame the weather?</h2> The weather can influence other factors and behaviours that consequently shape how we perceive and manage pain. For example, some people may change their physical activity routine during winter, choosing the couch over the gym. And we know <a href="https://pubmed.ncbi.nlm.nih.gov/28700451/">prolonged sitting</a>, for instance, is directly linked to worse back pain. Others may change their sleep routine or sleep less well when it is either too cold or too warm. Once again, a bad night’s sleep can trigger your <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. Likewise, changes in mood, often experienced in cold weather, trigger increases in both <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. So these changes in behaviour over winter may contribute to more aches and pains, and not the weather itself. Believing our pain will feel worse in winter (even if this is not the case) may also make us feel worse in winter. This is known as the <a href="https://link.springer.com/article/10.1186/s12891-018-1943-8">nocebo effect</a>. <h2>What to do about winter aches and pains?</h2> It’s best to focus on risk factors for pain you can control and modify, rather than ones you can’t (such as the weather). You can: <ul> <li> become more physically active. This winter, and throughout the year, aim to walk more, or talk to your health-care provider about gentle exercises you can safely do at home, with a physiotherapist, personal trainer or at the pool </li> <li> lose weight if obese or overweight, as this is linked to <a href="https://jamanetwork.com/journals/jama/article-abstract/2799405">lower levels</a> of joint pain and better physical function </li> <li> keep your body warm in winter if you feel some muscle tension in uncomfortably cold conditions. Also ensure your bedroom is nice and warm as we tend to sleep <a href="https://www.sciencedirect.com/science/article/pii/S0033350623003359">less well</a> in cold rooms </li> <li> maintain a healthy diet and <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">avoid smoking</a> or drinking high levels of alcohol. These are among <a href="https://ard.bmj.com/content/annrheumdis/82/1/48.full.pdf">key lifestyle recommendations</a> to better manage many types of arthritis and musculoskeletal conditions. For people with back pain, for example, a healthy lifestyle is linked with <a href="https://pubmed.ncbi.nlm.nih.gov/36208321/">higher levels</a> of physical function.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235117/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, Professor of Musculoskeletal Health, Head of Musculoskeletal Program, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, Rheumatologist and Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-your-aches-and-pains-dont-get-worse-in-the-cold-so-why-do-we-think-they-do-235117">original article</a>. </div>

Body

Mysterious leg pain that’s quietly killing older Australians

Peripheral Artery Disease (PAD) has long been overshadowed by its more widely recognised counterparts, such as heart attacks and strokes. Often referred to as the “poor cousin” or “Cinderella” of cardiovascular diseases, PAD affects one in five older Australians, yet it remains largely under-diagnosed and misunderstood. However, a wave of optimism is sweeping through the medical community with the launch of <a href="https://www.hri.org.au/our-research/centreforpad" target="_blank" rel="noopener">The Centre for Peripheral Artery Disease</a>, an Australian-first facility dedicated to pioneering research and improving patient outcomes. Spearheaded by the Heart Research Institute, the Centre for Peripheral Artery Disease, marks a significant step forward in addressing the challenges posed by PAD. The centre aims to fill critical gaps in our understanding of the disease, which is responsible for a limb amputation in Australia every two hours. This initiative promises to enhance diagnosis, transform patient care, and raise awareness about PAD. Associate Professor Mary Kavurma, the Centre Lead, is at the forefront of this ground-breaking effort. “We’re supercharging research into PAD because there are still many unknowns about the disease’s biology that could unlock new methods for early detection and better management,” she explains. This research is particularly urgent given the prevalence of PAD among women and First Nations Australians, groups that remain disproportionately affected by this condition. The centre’s mission is to develop a simple blood test for early diagnosis and explore novel therapies that could reduce the need for limb amputations and significantly improve patients’ quality of life. Unlike current treatments that primarily focus on symptom management, this new approach seeks to prevent the disease from progressing. One of the most inspiring aspects of the centre is its commitment to involving patients and their families in the research process. At the inaugural consumer meeting, nearly 20 patients and their carers shared their personal experiences with PAD. Take the story of Simon Josephson, a renowned advertising guru – who famously designed the Solo logo. PAD almost cost him his life after taking more than five years to diagnose. He woke up one morning with a sore leg, thinking he’d overdone it exercising but the 73-year-old – who was otherwise healthy and active – unknowingly had Peripheral Artery Disease, caused by a build-up of plaque in his arteries causing them to narrow and stiffen. It wasn’t until a trip to the hospital emergency department years later that doctors would discover his aorta had expanded to more than twice the usual size and was at risk of rupturing. He immediately underwent open heart surgery and has faced a lengthy recovery. The launch of <a href="https://www.hri.org.au/our-research/centreforpad" target="_blank" rel="noopener">The Centre for Peripheral Artery Disease</a> heralds a new era of hope and progress in the fight against PAD. Through world-leading research, community engagement, and a commitment to patient-centred care, the CPAD is poised to make a profound impact on the lives of many Australians. As Assoc Prof Kavurma aptly put it, “By understanding more about this debilitating condition, we are paving the way for better health outcomes and a brighter future for all those affected by PAD.” Images: CPAD

Caring

"The pain is unbearable": Nick Campo's family speaks out

The parents of a Perth teenager who tragically died in a car crash have started an emotional campaign for road safety in the name of their late son. Budding footballer Nick Campo, who had just turned 18, was the rear passenger in a Toyota HiLux that rolled and collided with a Jeep Patriot in Perth’s southern suburbs on Saturday night and was pronounced <a href="https://www.oversixty.com.au/health/caring/rising-star-footy-player-dies-at-just-18" target="_blank" rel="noopener">dead</a> at the scene. Campo's parents Daniel and Bianca told <a href="https://www.9news.com.au/national/nick-campo-parents-speak-of-unbearable-pain-after-losing-son-to-horror-crash/a5ab695f-d536-4fbb-9a95-088e155e3cba" target="_blank" rel="noopener">9News</a> of their "unbearable pain" since the sudden and tragic loss of their son. "My Nick, he was definitely one of a kind," his mum Bianca said. "I knew he was special, but he was really special to a lot of people." "And he was a beautiful boy, and he's going to be missed by so many, so many people." His father Daniel said his son was "the complete package" but was best known for his quick wit cheekiness. "If you had to sum Nick up in one word, 'cheeky'," he said. "From day dot .... Cheeky, cheeky." Sitting in the ute alongside Nick at the time of the crash were two of his teammates from the South Fremantle Football club, as well as the 17-year-old driver and one other young man. "He loved footy, he loved cricket, he just was so committed," his mum said. "He loved getting around all the boys, you know all the teammates. He loved being in the clubs." The 17-year-old boy accused of being behind the wheel, who was also injured in the crash alongside one of the other passengers, is facing serious charges. Another boy is fighting for his life in Royal Perth Hospital. Nick's parents are praying their son's friend pulls through and don't want other families to go through what they have gone through. "(Because) It is, it is the worst nightmare that you can imagine and the pain is unbearable," his mum said. The family is now channelling their grief towards a road safety campaign called "Call Out for Nick". "If it doesn't look right, that person doesn't look right to drive, the habits - it's got to be called out," his father said. "We see it every day - young kids they think they're bulletproof, they're not." Image credits: Nine

Caring

Tastes from our past can spark memories, trigger pain or boost wellbeing. Here’s how to embrace food nostalgia

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/megan-lee-490875">Megan Lee</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>; <a href="https://theconversation.com/profiles/doug-angus-1542552">Doug Angus</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>, and <a href="https://theconversation.com/profiles/kate-simpson-1542551">Kate Simpson</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Have you ever tried to bring back fond memories by eating or drinking something unique to that time and place? It could be a Pina Colada that recalls an island holiday? Or a steaming bowl of pho just like the one you had in Vietnam? Perhaps eating a favourite dish reminds you of a lost loved one – like the sticky date pudding Nanna used to make? If you have, you have tapped into <a href="https://www.tandfonline.com/doi/full/10.1080/02699931.2022.2142525">food-evoked nostalgia</a>. As researchers, we are exploring how eating and drinking certain things from your past may be important for your mood and mental health. <h2>Bittersweet longing</h2> First named in 1688 by Swiss medical student, <a href="https://www.jstor.org/stable/44437799">Johannes Hoffer</a>, <a href="https://compass.onlinelibrary.wiley.com/doi/10.1111/spc3.12070">nostalgia</a> is that bittersweet, sentimental longing for the past. It is experienced <a href="https://journals.sagepub.com/doi/10.1111/j.1467-8721.2008.00595.x">universally</a> across different cultures and lifespans from childhood into older age. But nostalgia does not just involve positive or happy memories – we can also experience nostalgia for <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-3514.91.5.975">sad and unhappy moments</a> in our lives. In the <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">short and long term</a>, nostalgia can positively impact our health by improving <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025167">mood</a> and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">wellbeing</a>, fostering <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0017597">social connection</a> and increasing quality of life. It can also trigger feelings of <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">loneliness or meaninglessness</a>. We can use nostalgia to <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025167">turn around a negative mood</a> or enhance our sense of <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">self, meaning and positivity</a>. Research suggests nostalgia alters activity in the <a href="https://academic.oup.com/scan/article/17/12/1131/6585517">brain regions associated with reward processing</a> – the same areas involved when we seek and receive things we like. This could explain the <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352250X22002445?via%3Dihub">positive feelings</a> it can bring. Nostalgia can also increase feelings of loneliness and sadness, particularly if the memories highlight dissatisfaction, grieving, loss, or wistful feelings for the past. This is likely due to activation of <a href="https://www.sciencedirect.com/science/article/pii/S2352250X22002445?casa_token=V31ORDWcsx4AAAAA:Vef9hiwUz9506f5PYGsXH-JxCcnsptQnVPNaAGares2xTU5JbKSHakwGpLxSRO2dNckrdFGubA">brain areas</a> such as the amygdala, responsible for processing emotions and the prefrontal cortex that helps us integrate feelings and memories and regulate emotion. <h2>How to get back there</h2> There are several ways we can <a href="https://psycnet.apa.org/fulltext/2006-20034-013.html">trigger</a> or tap into nostalgia. Conversations with family and friends who have shared experiences, unique objects like photos, and smells can <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352250X23000076">transport us back</a> to old times or places. So can a favourite song or old TV show, reunions with former classmates, even social media <a href="https://www.theverge.com/2015/3/24/8284703/facebook-on-this-day-nostalgia-recap">posts and anniversaries</a>. What we eat and drink can trigger <a href="https://www.emerald.com/insight/content/doi/10.1108/QMR-06-2012-0027/full/html">food-evoked nostalgia</a>. For instance, when we think of something as “<a href="https://theconversation.com/health-check-why-do-we-crave-comfort-food-in-winter-118776">comfort food</a>”, there are likely elements of nostalgia at play. Foods you found comforting as a child can evoke memories of being cared for and nurtured by loved ones. The form of these foods and the stories we tell about them may have been handed down through generations. Food-evoked nostalgia can be very powerful because it engages multiple senses: taste, smell, texture, sight and sound. The sense of <a href="https://www.tandfonline.com/doi/full/10.1080/09658211.2013.876048?casa_token=wqShWbRXJaYAAAAA%3AqJabgHtEbPtEQp7qHnl7wOb527bpGxzIJ_JwQX8eAyq1IrM_HQFIng8ELAMyuoFoeZyiX1zeJTPf">smell</a> is closely linked to the limbic system in the brain responsible for emotion and memory making food-related memories particularly vivid and emotionally charged. But, food-evoked nostalgia can also give rise to <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.873">negative memories</a>, such as of being forced to eat a certain vegetable you disliked as a child, or a food eaten during a sad moment like a loved ones funeral. Understanding why these foods <a href="https://www.tandfonline.com/doi/full/10.1080/02699931.2022.2142525?casa_token=16kAPHUQTukAAAAA%3A9IDvre8yUT8UsuiR_ltsG-3qgE2sdkIFgcrdH3T5EYbVEP9JZwPcsbmsPLT6Kch5EFFs9RPsMTNn">evoke negative memories</a> could help us process and overcome some of our adult food aversions. Encountering these foods in a positive light may help us reframe the memory associated with them. <h2>What people told us about food and nostalgia</h2> Recently <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.873">we interviewed eight Australians</a> and asked them about their experiences with food-evoked nostalgia and the influence on their mood. We wanted to find out whether they experienced food-evoked nostalgia and if so, what foods triggered pleasant and unpleasant memories and feelings for them. They reported they could use foods that were linked to times in their past to manipulate and influence their mood. Common foods they described as particularly nostalgia triggering were homemade meals, foods from school camp, cultural and ethnic foods, childhood favourites, comfort foods, special treats and snacks they were allowed as children, and holiday or celebration foods. One participant commented: <blockquote> I guess part of this nostalgia is maybe […] The healing qualities that food has in mental wellbeing. I think food heals for us. </blockquote> Another explained <blockquote> I feel really happy, and I guess fortunate to have these kinds of foods that I can turn to, and they have these memories, and I love the feeling of nostalgia and reminiscing and things that remind me of good times. </blockquote> Understanding food-evoked nostalgia is valuable because it provides us with an insight into how our sensory experiences and emotions intertwine with our memories and identity. While we know a lot about how food triggers nostalgic memories, there is still much to learn about the specific brain areas involved and the differences in food-evoked nostalgia in different cultures. In the future we may be able to use the science behind food-evoked nostalgia to help people experiencing dementia to tap into lost memories or in psychological therapy to help people reframe negative experiences. So, if you are ever feeling a little down and want to improve your mood, consider turning to one of your favourite comfort foods that remind you of home, your loved ones or a holiday long ago. Transporting yourself back to those times could help turn things around.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/232826/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/megan-lee-490875">Megan Lee</a>, Senior Teaching Fellow, Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>; <a href="https://theconversation.com/profiles/doug-angus-1542552">Doug Angus</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>, and <a href="https://theconversation.com/profiles/kate-simpson-1542551">Kate Simpson</a>, Sessional academic, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/tastes-from-our-past-can-spark-memories-trigger-pain-or-boost-wellbeing-heres-how-to-embrace-food-nostalgia-232826">original article</a>. </div>

Mind

I’ve been given opioids after surgery to take at home. What do I need to know?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home. These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence. However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery. <h2>Which types of opioids are most common?</h2> The <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">most commonly prescribed</a> opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia). In fact, <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.16063">about half</a> of new oxycodone prescriptions in Australia occur after a recent hospital visit. <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">Most commonly</a>, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain. Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels. Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box. Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery. Controlling your pain after surgery is <a href="https://www.nps.org.au/assets/4811a27845042173-00a4ff09097b-postoperative-pain-management_36-202.pdf">important</a>. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots. Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover. <h2>But there are also risks</h2> As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over. Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use. But up to <a href="https://pubmed.ncbi.nlm.nih.gov/35545810/">one in ten</a> Australians still take them up to four months after surgery. <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1837">One study</a> found people didn’t know how to safely stop taking opioids. Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect. Dependency and side effects are also more common with <a href="https://www.anzca.edu.au/getattachment/535097e6-9f50-4d09-bd7f-ffa8faf02cdd/Prescribing-slow-release-opioids-4-april-2018#:%7E:text=%E2%80%9CSlow%2Drelease%20opioids%20are%20not,its%20Faculty%20of%20Pain%20Medicine.">slow-release opioids</a> than immediate-release opioids. This is because people are usually on slow-release opioids for longer. Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">more than twice</a> the amount they needed. This results in unused opioids at home, which <a href="https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management">can be dangerous</a> to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision. <h2>How to mimimise the risks</h2> Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac). These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed. Other techniques to manage pain include physiotherapy, exercise, <a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">heat packs or ice packs</a>. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most. However, if you do need opioids, there are some ways to make sure you use them <a href="https://www.safetyandquality.gov.au/sites/default/files/2022-04/opioid-analgesic-stewardship-in-acute-pain-clinical-care-standard.pdf">safely and effectively</a>: <ul> <li> ask for <a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16085">immediate-release</a> rather than slow-release opioids to lower your risk of side effects </li> <li> do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing </li> <li> as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen </li> <li> before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time. </li> </ul> <h2>If you’re concerned about side effects</h2> If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include: <ul> <li> <a href="https://theconversation.com/health-check-what-causes-constipation-114290">constipation</a> – your pharmacist will be able to give you lifestyle advice and recommend laxatives </li> <li> drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor </li> <li> weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately. </li> </ul> <h2>If you’re having trouble stopping opioids</h2> Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose. You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these. <h2>How about leftover opioids?</h2> After you have finished using opioids, take any leftovers to your local pharmacy to <a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">dispose of them safely</a>, free of charge. Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children. <hr /> For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has <a href="https://www.choosingwisely.org.au/resources/consumers-and-carers/patient-guide-to-managing-pain-and-opioid-medicines">free online information</a> about managing pain and opioid medicines.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228615/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, Professor, Sydney School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, Senior lecturer, School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ive-been-given-opioids-after-surgery-to-take-at-home-what-do-i-need-to-know-228615">original article</a>. </div>

Body

Walking can prevent low back pain, a new study shows

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly <a href="https://pubmed.ncbi.nlm.nih.gov/31208917/">70% of people</a> who recover from an episode of low back pain will experience a new episode in the following year. The recurrent nature of low back pain is a major contributor to the <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">enormous burden</a> low back pain places on individuals and the health-care system. In our new study, published today in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext">The Lancet</a>, we found that a program combining walking and education can effectively reduce the recurrence of low back pain. <h2>The WalkBack trial</h2> We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control). Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences. The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls. The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program. Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred. People in the control group received no preventative treatment or education. This reflects what <a href="https://www.sciencedirect.com/science/article/abs/pii/S2468781222001308?via%3Dihub">typically occurs</a> after people recover from an episode of low back pain and are discharged from care. <h2>What the results showed</h2> We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services. The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%. Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group. Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group. This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings. Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians. <h2>Walking has multiple benefits</h2> We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all <a href="https://www.sciencedirect.com/science/article/pii/S0140673618304896?via%3Dihub">previous studies</a> have focused on treating episodes of pain, not preventing future back pain. A limited number of <a href="https://pubmed.ncbi.nlm.nih.gov/26752509/">small studies</a> have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals. On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care. Walking also delivers many other <a href="https://www.vichealth.vic.gov.au/sites/default/files/VH_Benefits-of-Walking-Summary2020.pdf">health benefits</a>, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases. While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants <a href="https://pubmed.ncbi.nlm.nih.gov/37271689/">reported</a> that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently. <h2>Why is walking helpful for low back pain?</h2> We don’t know exactly why walking is effective for preventing back pain, but <a href="https://www.e-jer.org/journal/view.php?number=2013600295">possible reasons</a> could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which <a href="https://my.clevelandclinic.org/health/body/23040-endorphins">block pain signals</a> between your body and brain – essentially turning down the dial on pain. It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, <a href="https://pubmed.ncbi.nlm.nih.gov/34783263/">no studies</a> have investigated this. Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231682/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, Postdoctoral research fellow, Department of Health Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, Institute for Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, Associate Professor, School of Mathematical and Physical Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, Professor of Musculoskeletal Disorders, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/walking-can-prevent-low-back-pain-a-new-study-shows-231682">original article</a>. </div>

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Alleged killer cop files lawsuit against NSW Police

The former police officer accused of murder has now filed a lawsuit against the NSW Police for bullying and harassment. Former NSW Police senior constable Beau Lamarre-Condon is accused of shooting Jesse Baird, 26, and his partner Luke Davies, 29, at Baird’s Paddington house in February and disposing of the bodies on a rural property near Goulburn. While still awaiting trial over the alleged murders, the suit against the police force has been filed, with Sunrise newsreader Edwina Bartholomew sharing the updates. “The defence lawyer for accused killer cop Beau Lamarre-Condon says his client is continuing with a lawsuit against the NSW Police Force for bullying and harassment while he was a constable,” Bartholomew said. Lamarre-Condon's lawyer John Walford confirmed the move to <a href="https://www.dailytelegraph.com.au/subscribe/news/1/?sourceCode=DTWEB_WRE170_a_TCA&dest=https%3A%2F%2Fwww.dailytelegraph.com.au%2Ftruecrimeaustralia%2Fpolice-courts-nsw%2Fchilling-unseen-photos-of-beau-lamarrecondon-cosying-up-with-exlover-he-allegedly-killed%2Fnews-story%2F4fdbac4f0dac6d7ea38b3094e808e3ab&memtype=anonymous&mode=premium&v21=LOW-Segment-1-SCORE" target="_blank" rel="noopener">The Daily Telegraph</a>, saying, “Yes, action against police is continuing … it’s huge.” The former officer has been in protective custody at the Metropolitan Remand and Reception Centre at Silverwater in Sydney's west for the past four months and sources close to the 28-year-old say his mental state is deteriorating. "He's not doing real well at the moment," a source told <a href="https://www.dailymail.co.uk/news/article-13471215/Beau-Lamarre-Condon-Chilling-pictures-accused-killer-Jesse-Baird-Luke-Davies.html" target="_blank" rel="noopener">Daily Mail Australia</a> in April. "Obviously it's set in now - what's happened and the allegations and where he is. I think the rot's set in mentally-wise. He's at a low point at the moment. He's very down. He's hit the lows." Lamarre-Condon is expected to front court again on June 18th. Image credits: 7News / Shutterstock

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"Repeatedly ignored": Daughter of Perth gunman breaks her silence

The daughter of the Perth man who has been accused of murdering a 59-year-old woman and her 18-year-old daughter has broken her silence. Mark Bombara <a href="https://oversixty.com.au/health/caring/the-most-gorgeous-family-tributes-flow-for-slain-mother-and-daughter" target="_blank" rel="noopener">shot and killed</a> Jennifer Petelczyc and her youngest daughter Gretl at their home in Floreat, Western Australia, on Friday afternoon while searching for his ex-wife before taking his own life. Now, his daughter Ariel has released a powerful statement sharing how she repeatedly warned police of the danger he posed as a licensed firearms holder, admitting that her and her mother had feared for their lives. "We were ignored by five different male officers across three occasions of reporting," Ms Bombara said. "By that point we felt completely helpless and I had to focus on getting mum to safety." "I did everything I could to protect my mother, and when my father couldn't find us he murdered her best friend and her best friend's daughter." Ms Bombara explained that her and her mother fled their family home on March 28th, "in fear of our lives and to remove ourselves from an abusive situation", and over the span of four days, contacted police three times to notify them about her father's gun collection. "I felt there was a real and imminent threat to our lives," she said. "I specifically mentioned that there was a Glock handgun which was unaccounted for," Ms Bombara said. "My understanding is this ultimately would be one of the weapons my father used take the lives of two innocent women." She was adamant that the deaths of Jennifer and Gretl Petelczyc were "an act of domestic violence". "My mother and I made clear that lives were at risk, and we were repeatedly ignored. Repeatedly failed. Those failures have cost the lives of two incredible women." "My father should always be considered accountable for his actions. They were his and his alone, however, there are authorities who should have helped us stop him, and they failed." "I want answers." Following the deaths of Ms Petelczyc and her daughter, WA Police did not classify them as domestic violence-related. A police spokesperson said in a statement, "Police have always accepted that the motivation for these crimes were family and domestic violence (FDV) related, however the crimes committed were murder, and ultimately the contributing factors will be a matter for the coroner to consider." Image credits: ABC News / 9News

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