C O MPASS Your Health and Wellbeing Guide AUTUMN 2022 PLUS... DNA testingEpigeneticand MORE+ Having an open conversation about stress Work-LifeBalance Turbulent Times,MindsTurbulent Is Pain Free Enough?
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DNA and Epigenetic testing Page 10-11
Compass Magazine 3 Compass Magazine is published by PAM Group Ltd Contact us 73-75, Sankey St, Warrington WA1 1SL All rights reserved - Reproduction is strictly prohibited - Copyright 2021 © For more information visit www.pamgroup.co.uk
Ergonomics at the office Page 6-7
Work-Life Balance Page 12-13
Is pain free enough? Page 14-15
Turbulent Times, Turbulent Minds Page 8-9
Is some claiming Neurodiversity as a superpower actually acting as other people's kryptonite? Page 16-17
The role of sleep in a healthy lifestyle Page 18
C ONTENTS C O MPASS Your Health and Wellbeing Guide Autumn 202 2
Having an conversationopenabout stress
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As a result, we end up bullying ourselves and telling ourselves we are useless. Sleep patterns can become disrupted, and we are more likely to be short-tempered. If we are not careful this becomes a pattern of
Thisbehaviour.iswhy
reaction to stress is to go into flight and fight mode. It produces stress hormones (adrenaline and cortisol) to hype the body into action. This is useful in the short term to get us out of danger. But unfortunately, this flight and fight mode also reduces our ability to concentrate, focus, remember, or adapt. We don’t need to think when running away from a
tiger, we just need to run. The fight and flight response can be a problem when it becomes a long-term or chronic response. When this happens, we tend not to perform as well as expected and are more likely to make mistakes. We often compensate by putting in more hours to achieve the same amount of work as before. This working in your own time is now commonly referred to as Leaverism.
The Health and Wellbeing at Work 2022 report (CPID 2022) shows that stress remains one of the top causes of absence from work. The HSE backs this up by reporting that work-related stress, depression, or anxiety accounted for 50% of all work-related ill health during 2020/21. Stress or burnout can happen to anyone and is not a sign of weakness or failure. Indeed, it often occurs in those who are committed to their role and very much care about doing an excellent job STEPHANIE FOSTER -
BY
CLINICAL TRAINING LEAD AT PAM GROUP Personal factors that can reduce resilience Personal factors that can increase resilience Having a long-term physical or mental health condition Helping others, as this releases feel good hormones Grieving, being lonely, or feeling isolated Mindfulness/ Taking Notice. Experiencing discrimination or abuse Connecting with others and maintaining relationships. Experiencing financial difficulties Learning something new. Being a Carer or lone parent due to the increased demands this may have on you. Being active and taking regular exercise
Having an open CONVERSATION about stress
As we put more pressure on ourselves to do better, we hit our adrenalin button again and release even more stress hormones. Elevated levels of these hormones tell our brain there must be a threat, so we start looking out for it. We experience this as anxiety. The inner critic is an adrenalin junkie and gets increasingly more vocal when levels are high.
What we find stressful and how we react in response to it is different for all of us. As also is our ability to cope with or adapt to stressful situations. It is important to realise that our resilience can be affected by many things and is not static. Dealing with personal stress can reduce our resilience to cope with workplace pressures, as well as the other way Ourround.body’s
it is important to stop and take notice and ask yourself regularly “How am I?” Dr Tim Cantopher, an expert on stress highlights in his book “It makes no sense to be kind to others but not yourself” (2007). Stop, take a few minutes out to reflect. Ploughing on regardless often makes us less productive. While having a short break resets the system and in the long run, increases productivity.
Change – how change is managed and (HSEcommunicated2022)
‘What Are the Management Standards? - Stress - HSE’. 2022. [online]. Available at: https://www.hse.gov.uk/stress/standards/ [accessed 14 Aug 2022].
‘Health and Wellbeing at Work’. 2022. CIPD [online]. Available at: https://www.cipd.co.uk/knowledge/culture/well-being/health-well-being-work [accessed 14 Aug 2022].
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References
– this includes issues such as workload, work patterns and the work environment
WAX, Ruby. 2016. A Mindfulness Guide for the Frazzled. London: Penguin Life.
Working through your feelings is important to help you understand and address your emotions. Talking things through with a friend or making use of your Employee Assistance Program is a good idea. If you are struggling at work, it is important you flag this up with your manager. They can only support you if they know that support is needed. This is especially important if you feel that workplace issues are a factor in you feeling stressed. Having an honest conversation is important to help find a solution and reduce the risk of sickness absence.
The DemandsstandardsManagementinclude:
Relationships – promoting positive working to avoid conflict and addressing unacceptable behaviour
When feeding back to your manager it can be helpful to use the approach of when “x” happens it makes me feel like this. It would help if we could try “y” instead. This is because your manager is human too and if they feel that you are criticising them, they too can have an emotional response and become defensive. A situation that does not then help either of you to find a solution.
If your manager refers you to Occupational Health due to perceived work-related stress, the clinician will suggest that you and your manager carry out a Stress Risk Assessment. Ideally, this should happen at the earliest chance so that a way forward can hopefully be found, allowing your stress to resolve. Using the HSE management standards as a framework you should have an honest conversation to help identify what is positive about work as well as any potential issues. Hopefully, this process will ensure that you feel you have been heard and that your concerns have been documented. Together you and your manager should explore feasible solutions. The risk assessment and plan should be regularly reviewed and adjusted if needed. If the predominant issue is that you feel that the relationship with your manager has broken down, then they will suggest that either HR or another line manager be involved.
Theunchanged.Healthand Safety Executive (HSE) has carried out extensive research on the subject of workrelated stress. They have identified 6 areas of work design that have the greatest potential impact.
When workplace issues lead to time off work, some people are reluctant to maintain contact with work. They report feeling better while they do not think about work, but that the overwhelming feelings come flooding back as soon as they do. However prolonged time off work or refusing to talk to your manager about the issues can increase the risk of disengagement from work and make it harder, not easier to return in the long term. If your absence is due to perceived workplace issues, then
Support – the encouragement, training and resources provided
frank and open conversation to try and resolve those issues is the best way forward. Otherwise, the situation and your feelings are likely to remain
CANTOPHER, Tim. 2007. Stress-Related Illness: Advice for People Who Give Too Much. London: Sheldon Press.
Self-care strategies include exercise to burn off the excess adrenalin and substitute it with the feel-good hormone serotonin. Mindfulness can help turn down the sensitivity of the adrenalin button. As another expert åpoints out, one sit-up doesn’t give you a six-pack, the same goes for mindfulness. To achieve a mental health six-pack, you need to practice mindfulness on a regular basis (Wax 2016). To tackle the inner critic, acknowledging that those thoughts are adrenalin-fueled can help. Challenge and change any unhelpful thought patterns. E.g., by asking “is that thought helpful?”. “Is that fact or my opinion?”. This approach is a cornerstone of Cognitive Behavior Therapy (CBT).
Role – people understand their role and do not have conflicting demands
The HSE highlight that managers have a key part to play in how well a team copes with pressure. However, many feel they could benefit from more training to help them better support their team’s mental wellbeing (CIPD: 2022). Wellbeing support in the workplace can help us all to be the best we can be, benefiting individuals and business alike.
Control – how much say the person has in the way they do their work
ErgonomicsHEALTH at the Office
The correct posture at work with a computer relates specifically to the placement of your monitor, keyboard, and mouse.
The most common desk heights fall between 28 and 30 inches from the floor. This height is suitable for users between 5’8” and 5’10”, but is not ideal for anybody outside of that height range. This is why adjustable sit stand desks have become popular, and are recommended by ergonomic experts the world over.
Thenposture.your
How to set up your desk ergonomically
Correct posture at the computer
Office ergonomics has become a hot topic over recent years as people have become more and more aware of the potential dangers that come with spending hours sat down at a desk. And it can feel like the dangers are all around you! You have to sit in the right way, on the right chair, at the right desk, and if you don’t then you can be left with persistent lower back pain, among many other things.
And if you are too tall when sitting at your desk, then either use a riser on the surface of your desk to raise the contents higher or place four very sturdy objects underneath the desk legs.
In this article, we are going to go over all the information that you might need in order to ensure that you have the most ergonomic desk sitting posture, allowing you to work comfortably and pain free for as many years as possible.
There are multiple factors that come into play concerning how to sit at a desk ergonomically. This includes desk height, monitor height and position, chair height, and keyboard and mouse location.
Your monitor should be around an arm’s length away from you, and the screen should not exceed eye level. This means that you will be able to view the whole screen without straining your neck or needing to lean closer to the screen and distorting your
keyboard and mouse should be on your desk at around elbow height, so that you can use your computer without bending your wrists.
Well, luckily, office ergonomics is not as cut and dry as this. You are in fact safe to sit in a huge variety of chairs, at a plethora of desks, and you can even sit in many different positions too, provided that you are following just a few ergonomic best practices.
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However, we understand that at work you may not have much of a say in what desk you are provided, and fortunately you are able to make adjustments to your desk set up if your height does not match your desk. If you are too small for your desk, then you will hopefully be sat in a chair that has an adjustable height. So, adjust your height to a suitable level and then use a footrest if needed so your back can touch the backrest and your feet can touch the floor.
Lastly, your knees should be bent at roughly 90o. Do not cross your legs or feet under your desk, instead plant your feet flat on the floor. So keep the area under your desk clear so that there is enough room for both of your legs.
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This includes not reaching for objects while seated. It may seem harmless to lean to grab a pen or a drink, but this small strain on your muscle can result in an injury which will then impact the rest of your body and posture.
For ergonomic tips that you can use at work, or for ergonomic desk accessories, then get in touch with our experts at PAM Health and we would be happy to help.
Our posture is a habit that we fall into. If we fall into a bad habit of poor posture, then it can take some time to correct this. It can take anywhere from a month to six months before your new habit of sitting properly is cemented.
Next, if you spend long periods of time sitting at a desk then you should remember to take regular standing breaks. For example, for every hour you are seated, you should stand walk around for about five minutes. Include a gentle full body stretch if possible to keep your body in the best shape.
If you invest in good, ergonomically sound equipment and really force yourself to pay attention to your posture at the workplace, then slowly but surely you will begin to reap the rewards of good posture. Niggly pains in your back, neck, shoulders, or wrists should start to lessen, and you will be more comfortable as a result.
How long does it take to correct posture?
We hope that you have found some of our advice on the correct desk sitting posture helpful, and that you have been encouraged to make positive changes for the benefit of your physical health.
Encouraging the correct office chair posture is more than sitting in the right position or being at the right height for your desk. There are rules that you should follow on top these to supplement your ergonomics and keep your body in the best shape.
Desk posture tips from PAM Health
If you are still experiencing pain that you think is a result of your posture, then it is advised that you see a doctor to ensure that your pain is not a symptom of any other issues.
Ergonomics advice
The best way to think of it is that you want to be able to sit correctly without thinking about it. Unfortunately, for most people, when they stop thinking about their posture their body resorts to slouching. This is why it is important to form good habits so that you can rely on your body to do good things for you.
When asked what worried people most for 2022 the top 5 concerns were (3):
3. Continuing presence of Covid-19
World Mental Health day (10th October 2022) provides an opportunity to reflect on how the turbulent times we live in have affected mental health, and how employers and employees can work together to enhance wellbeing.
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1. Prices and bills increasing
2. Pressure on health services
4. Climate change/environment
BY HAYLEY ROMAIN – MENTAL HEALTH TRAINER AT PAM WELLBEING
A recent report by University College and Kings College, London (1) found that the pandemic has had a lasting impact on people’s psychological distress, with the number of people in the UK suffering from distress in April 2022 being twice as high as it was before the pandemic. The reasons for this distress have changed over time, with a majority of people now being more concerned about finances than about catching Covid -19 (2)
5. Cuts in spending on public services
Turbulent Times,MindsTurbulent
These anxieties inevitably have a huge impact on working life. For example, 80% of UK employees believe that stress around their financial wellbeing can negatively impact their performance at work, with the figure rising to 88% among those who live in households with children (4). This raises a question about what can be done to limit the impacts of recent events on mental health and increase wellbeing within the workplace.
4. Empowerment
3. Proactive approach
3. https://www.britishfuture.org/publication/jubilee-britain
In conclusion, a broad range of specialist support may be required to allow employees to increase wellbeing and productivity. However, at the foundation of these kinds of support, are the key principles of open communication, reduced stigma, a aallandapproach,proactiveempowermentcollaborationwhichcometogethertocreateworkplacethatsupports people to flourish and achieve optimal mental health.
This involves creating an atmosphere where people feel they can bring their whole selves to work and be honest with their employer about issues that are affecting them. One way of doing this is to organise regular and consistent check-ins with staff that are specifically around wellbeing rather than performance.Encouraging people to communicate openly is often easier said than done, with more than two-thirds of employees (67 percent) admitting they did not tell their employer about their poor mental health (5). As we have seen, the cost of living is a top concern for many people and yet, just as people struggle to talk about poor mental health, they also struggle to talk about financial matters. A recent study revealed that people in the UK actually find it easier to discuss mental health and infertility than they do money (6). Therefore, not only is it important to provide opportunities for people to talk openly, but it is also important to reduce stigma.
References:
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Poor mental health can leave people feeling out of control. Therefore, it is important that staff feel empowered to take control of their own wellbeing. Open communication, reduced stigma and opportunities for education and training can all work together to help staff to understand their situation, learn self-care strategies and identify support options that they feel are appropriate for them.
Supporting Wellbeing in the workplace is most effective when employees and managers work together to empower the individual to take steps to improve their wellbeing. In addition, collaborative policy-making, where employees are given a voice about what goes into a wellbeing policy and what wellbeing support is implemented, means that staff will be more likely to engage with and see the relevance of the support on Asoffer.we
have seen, turbulent times can trigger anxieties around a range of complex issues so collaboration is even more important to provide a whole package of support for mental health. For example, in addition to line management and HR support, it may be beneficial for staff to be given access to a range of specialist
reduce stigma by highlighting the underlying reasons for poor mental health and dispelling myths and stereotypes. It can also increase selfawareness and highlight support options so that individuals have tools to manage their own mental health and signpost others to appropriate support.
1. https://inews.co.uk/news/science/covid-uk-psychological-crisis-adults-distress-pandemic-restrictions-17769488
Whilst there are a range of theories around improving wellbeing in the workplace, many are based on the same five principles:
Stigma often stems from existing social norms, lack of understanding and fear. Therefore, it is important to break from existing norms by talking openly about experiences of poor mental health as well as financial difficulty. If managers and colleagues are given opportunities to share their lived experiences, this often helps to break down the stigma felt by those around them. Education is also a key factor in reducing stigma. PAM Wellbeing currently provide a range of wellbeing training modules for all staff as well as wellbeing management training modules. Training for managers can help to build confidence in discussing wellbeing issues with team members, whilst training for all staff helps to
2. https://www.independent.co.uk/news/health/covid-uk-cost-of-living-crisis-money-b2055998.htmll
As a result of open communication and reduced stigma, managers will be more informed and therefore able to take a proactive approach to support employees. For example, being able to identify workplace adjustments and signpost promptly to prevent difficulties from escalating.
5. Collaboration
support such as those provided by PAM Wellbeing. For example, PAM Wellbeing’s Employee Assistance Programme provides access to an around-the-clock employee helpline offering life, legal & debt management advice, access to structured counselling & CBT, as well as access to a wellbeing app, live chat and computerised CBT.
1. Open Communication
Pam Wellbeing can also provide return to work services, management advice on how best to support staff, as well as specialist services such as critical incident support, workplace mental health assessments, workplace mediation and trauma support services. The complexities of mental health in the modern world, mean that this kind of collaborative approach is often required to give staff access to the specialist support that they require, at a time and in a format that is right for them.
4. https://happiful.com/80-of-workers-say-money-worries-affect-their-performance/
2. Reduce Stigma
5. 6.admitted,it%20would%20harm%20their%20career%20%2819%20per%20cent%29https://www.peoplemanagement.co.uk/article/1744931/employees-scared-open-up-about-mental-health#:~:text=However%2C%20more%20than%20two-thirds%20%2867%20per%20cent%29%20https://www.independent.co.uk/life-style/money-mental-health-social-norms-poll-a8893021.html
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these changes before illnesses occur, instead of after. Interestingly, 78% of employees believe their employer is responsible for their health and wellbeing. A further 1 in 3 see wellbeing advice based on genetic data as valuable (PAM Group, 2021). With more employees delaying retirement age, and with an ageing work population, the risk of getting and managing chronic disease with the subsequent impact on work and life, is much higher.
DNAToHealth and Epigenetic testing
What is DNA & Epigenetics?
If you find yourself scratching your head at this point, you’re not alone. As humans, we each have between 20,000 and 25,000 genes, and most genes are the same in all of us. It's the differences in less than 1% of our genes, that make us unique. Understanding what these small differences mean, holds the secret to our health & wellbeing.
DNA is the ‘blueprint’ of the body. It cannot be changed and holds the essential information for development,
By enabling employees to understand their predisposition toward disease, employers can empower their workforce to make positive, pre-emptive lifestyle changes earlier, avoiding the commencement of disease. DNA and epigenetics testing will support making
function and growth. Tiny variations affect how muscles form and behave, how the body uses the major food groups and the likelihood of lacking certain vitamins or minerals.
As a practical example, why is it that identical twins develop different diseases? They have the exact same genetic code yet they are epigenetically distinct by the time of birth. These differences become more pronounced with age, lifestyle and different environmental exposures… the answers lie in epigenetics (Carey, 2011).
We are living longer than ever before, yet we’re not necessarily living healthier. Non-communicable diseases such as cancer and diabetes account for 71% of global deaths each year.
Epigenetics is the study of how our lifestyle behaviours and environment can cause changes that affect the way our genes work. Epigenetics changes the activity of DNA. It does not alter genes but rather, offers an additional layer of information, letting employees play the cards they have been dealt, to their advantage.
isandthedeliverycontinuingwell.we’re-extendingshouldto2021).interventionslifestyle(WHO,Ratherthantryingextendlifespan,weinsteadfocuson‘healthspan’thenumberofyearslivinghealthyandWiththepandemictodisrupttheofhealthcare,needforpreventiveproactiveinnovationdemonstrated.
These deaths are largely preventable through appropriate
THE NEXT FRONTIER FOR OCCUPATIONAL HEALTH AND WORKPLACE WELLBEING
•
• Immune
DNA & Epigenetics in Occupational Health & Workplace Wellbeing
health is responsible for ensuring that controls put in place by employers protect workers from unacceptable exposures and injuries. New advances in technology allow employers and their organisations to take positive steps towards preventing employees from becoming sick in the first place by identifying individuals who might be at a greater risk due to their genetic predisposition. This means that new innovations, such as DNA and epigenetic testing are set to become key features for both occupational health and workplace wellbeing to shift from the treatment of just one disease (i.e. being reactive) towards the prevention of multiple diseases (i.e. being proactive). Already we’re seeing DNA testing used in cases of repeated sickness absence to understand the root causes of such absences (Brazier, 2021). This makes for a proactive employee care pathway.
We’re human after all so being scared or sceptical is a completely normal response; however, the risks epigenetic data tells us can be addressed and Knowingimproved.this advanced and hyperpersonalised information really does help us to reduce the risk of preventable disease and age more healthily. Genetic screening is a non-invasive and efficient technique that allows the prevention and diagnosis of multiple conditions that could prove to be severe. Genome and exome sequencing are anticipated to become the main diagnostic tool to detect and prevent genetic conditions. Though some concerns remain, genetic screening has proven and continues to prove its efficiency for multiple users and is a guideline for disease prevention and a healthier lifestyle.
• Skin
• Mental
• Heart
• Muscle
The growing understanding of genetic predispositions and the effect of environmental influences seem to suggest that many occupational disorders share causal roots in gene–environment interactions (Magnavita & Chirico, 2020). This extra layer of information offers personalised prevention strategies, in favour of hypersensitive workers to ultimately lead to better worker protection through the development of more targeted occupational exposure limits (Schulte, Whittaker & Curren, 2015).
• Gut
Knowledge is power, OR is it too much?
Proactive organisations and employers should be encouraged to take Occupational Health and Workplace Wellbeing one step further, with DNA and epigenetic screening, to improve employee health.
•
The way in which employees are seeking to access healthcare has changed and offering a simple saliva test unlocks unlimited health potential and provides the ideal provision for employees to deal with the health conditions responsible for driving costs Occupationalup.
• Injury
•
There are three types of epigenetics markers – histone modifications, noncoding RNA’s and DNA methylation. It is the latter that is key to health and how our DNA is read. DNA methylation can be heavily influenced by our environment such as exposure to metals, air pollutants and endocrinedisrupting toxicants, as well as our lifestyle. This includes what we eat, drink, physical activity we do levels of stress and habits such as smoking or drinking alcohol. All of these factors can change the activity of a DNA segment without changing the sequence. They rather turn “on” or turn “off” genes.
Epigenetics has been phenomenal in measuring the ageing process and determining an individual’s biological age. It effectively portrays how lifestyle and environment affect us at both a cellular and genetic level, as well as providing the status of our internal health, such as our: Eye health health health function risk health health health Sleep heath Stress Epigeneticsresponsetestingprovides hyperpersonalised and actionable insights to support an individual’s lifestyle, all through a simple, non-invasive saliva sample. When accompanied by an app, users can access personalised genetic action plans for their diet, exercise and lifestyle, as well as tailored recipes and training programmes. What’s more, lifestyle tracking enables individuals to connect their wearable devices to track steps, sleep, activity, heart rate, water intake and calorie intake with their genetic profile. Better yet, it can be measured over time, allowing individuals to see the effects of lifestyle on reducing long-term disease.
Scientists in both academic and commercial sectors are waking up to the enormous impact that epigenetics can have on human health, but the question still lies of, can we know too much?
The 2nd November 2022 is National Stress Awareness Day.
If we’re honest, very few, if any, of us would have thought of implementing a strong, work-life boundary when we
first started our professional careers; it’s something that we gradually developed, without even thinking about. For many of us it involved the journey home from work; perhaps listening to music on the drive home and a switch in our head flipped from ‘work mode’ to ‘home mode’.
Work-LifeBalance
Every year it is used to highlight how stress can affect people, and what you can do to manage your stress before it becomes a problem.
BY KENNY RALPH – DEPUTY TRAUMA MANAGER AT PAM WELLBEING
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Many of us lost these boundaries during the pandemic when we started working from home, or hybrid working. Hence the need for this article!
Millions around the UK experience stress and it is damaging to both our physical health and mental wellbeing. We’re looking more specifically in this article at work-life balance, the ways it can present in our lives, and what we can do to try and counter the impact of poor worklife balance.
A healthy balance will mean different things to different people but it might look like:
This sounds simple to some but it can be challenging if, for example, we also have caring responsibilities, a demanding boss or health difficulties. Furthermore we may have a healthy work-life balance but it may not take too much for us to lose it; a family illness, uncertainty about employment, any number of things.
Perhaps a good starting place would be to explain what work-life balance actually is: In short, work-life balance is the state of equilibrium where a person equally prioritizes the demands of one's career and the demands of one's personal life.
• meeting your deadlines at work while still having time for friends and hobbies
2. Your relationships, both inside and outside of work, will begin to suffer. You may be easily irritated with colleagues and distant with loved ones.
One more general piece of advice is that these symptoms generally happen by degrees, so trying to be aware of these small changes can be really beneficial. So, if for example, you notice that you’ve been enjoying a favourite hobby a little less than usual, or if you notice a reluctance to socialise, you may want to think about your work-life balance; ask yourself, has work been particularly stressful recently? Or has something happened outside of work that could have thrown your balance off? The sooner we notice, the sooner we can take action.
We need to notice the signs and symptoms of a poor work-life balance and they are as follows:
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5. You find it increasingly difficult to do your daily tasks. Your laundry, dishes, and mail pile up, waiting for the day when you “have time” to get around to them.
4. When you’re not at work, everything seems uninteresting or unimportant. You just don’t feel like doing anything unless you have to. You find less joy in hobbies and activities than you previously did.
3. You don’t feel like yourself. You may have unexplained aches and pains and you may rarely have energy or find it difficult to focus when at work.
A slightly fuller but hopefully more tangible description would be: A healthy work-life balance means different things to us all. It’s not about splitting your time 50/50 between work and leisure but making sure you feel fulfilled and content in both areas of your life.
So, what can we do to get that equilibrium that is so beneficial. Well, there are a number of things. Firstly though, we must notice that we’re struggling, and that is easier said than done, particularly when it comes to work-life balance as, by its very nature it means that we have less time to sit back and reflect; we’re too busy ‘doing’.
• having enough time to sleep properly and eat well • not worrying about work when you’re at home.
1. You can’t stop thinking about work when you’re not at work.
“Hi mate, how you getting on?” “Really well, pain-free” “Oh, that’s brilliant. How’s your return to full duties been?” “Oh, I I can’t do that. Doing that job is what put me here so I’m never doing those movements again it will break me. I need to take it easy”. My daily consultations put me through a rollercoaster of emotions.
In an attempt to explain the limitations of these approaches I use a phrase with my patients “the worst thing about rest is that it works!”. When the desired effect is solely to reduce the sensation of pain, rest is perfect.
Is Pain Free Enough?
Compass Magazine14 BY LUKE GRIFFITHS - MSK Clinician AT PAM PHYSIO SOLUTIONS
reducing pain is sufficient and truly patient-centered? With an aim to open up a further discussion that suggests some potentially more appropriate ways we can aim for a full recovery beyond a reduction in sensation.
Pain is a complex issue that is multi-factorial and involves social, contextual, physical, and psychological factors; yet a large approach of the treatment frequently provided by musculoskeletal clinicians is focused on simply reducing the sensation of pain. This is an approach that is also favoured by patients as a study by Setchell et al. in 2019 demonstrated that patients with persistent pain view passive modalities such as ice, heat, and manual therapy more than active modalities such as exercise. While not validating an individual’s experience and never focusing on reducing pain would be reductionist and unhelpful, there is an argument that solely focusing on reducing pain with passive modalities could be dualistic and not address the multi-factorial nature of pain. I ask during this article whether an approach that solely focuses on
Pain is having a large economical, societal, and individual effect on governments, employers, and individuals. Pain is extremely distressing and statistics show a strong correlation with suicide, long-term sickness absence, and unemployment further shining the light on how pain worms its way into an individual’s life and spreads until it impacts all factors of wellbeing. Interesting research has shown that it is not just the sensation that causes people to feel down, depressed and isolated, it is the perceived limitation that comes with the experience of being in pain, shaped by thoughts, beliefs,
memories, and self-efficacy. While I appreciate focusing on desensitization in the short term is essential for an individual’s lifestyle and overall wellbeing, I would argue that the passive modalities and some frequently used strategies for communication are not beneficial for long-term health, potentially contributing to the perceived limitations of sufferers as they fail to address the physical, psychological, and contextual barriers that are posed by full rounded recovery, especially in cases where a long-term history of pain is present. is present (2,10).
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• Modify hobbies and work tasks to create new, more positive experiences
Ultimately, the reason I’m writing this article is due to the frustration I feel with patients who have been given advice in the past that contributes to fear around returning to activities they enjoy due to reinforcing perceived weakness and fragility.
• Encourage individuals that pain does not mean that they are broken
During this time they start to notice specific movements that replicate their symptoms and as this happens more frequently thoughts and feelings towards these movements develop such as “I know my shoulder will be painful when I work overhead” or “doing the overhead movement is really bad for my shoulder which shows something is seriously wrong”. As more time passes, these thoughts and feelings are reinforced every time their symptoms increase, so “doing anything overhead is bad for my shoulder so I should never ever under any circumstances do overhead activities and this job is the sole reason I’m struggling now” becomes deeply imbedded and absolutely true. On the flip side, the individual is advised to try heat to reduce the discomfort so a hot wheat bag is placed on the affected area. As they relax with the nice feeling of the heat on their shoulder, the pain reduces almost instantly. Thoughts of “heat is really good, and really helped to reduce my pain” develop. Over time, a similar reward process is created with the result that “heat is the best thing since sliced bread”. The complexity with this is that the heat has failed to address any of the beliefs about the movements required to fulfill the demands of their role, and the context alongside the implementation of these attempts to reduce discomfort is forgotten; even though the amount the patient enjoys their job could be a nocebo, and the comfortable environment with the heat application could be a placebo. This can be problematic as the thoughts,
feelings, memories, and beliefs of the patient may eventually influence their future employment and overall wellbeing. We can see the negative impact and shortcomings of solely focusing on pain as an outcome in this short example alone.
• Inspire people to continue with the things that they enjoy
The individual will find a comfortable position and the symptoms will reduce over time. As a result, this approach seems marvelous. It’s only when we start to consider other factors that influence recovery, such as deconditioning and fear avoidance, we realise that this approach falls desperately short. Now let’s use heat intervention vs a graded exposure intervention to explain this concept
I hope that this article has given you some food for thought for your future practice because if I have to hear 1 more person tell me they are fully recovered but just can’t do a task they enjoy as their ‘body can’t handle it’ I think I will burst.
replicative of the necessity for us to eat? There is a discrepancy between what our body tells us and reality; this also applies to pain. As musculoskeletal clinicians we are blessed that we have more time with patients than most health professionals, especially in private practice and occupational health. This is valuable time that can allow a patient to be heard so we can work towards suitable goals.
Especially as the issue is not that nothing works to reduce pain, the issue is that the research shows that most things work for reducing pain we just don’t know why they work. As humans in general we have strong beliefs about causal effect, and as clinicians, this is reinforced through University as we are told to be detectives and find the route of the pain, then fix it. This is great initially as we can seemingly help people directly and get lots of praise for this, but this approach can make some into guru-like healers that provide outdated treatments and advice filled with confirmation bias and post-hoc reasoning, rarely addressing the complexity of the situation. Challengingly, this approach also fits in with patient expectations and the beliefs of the family members and friends of the patient, but I refer back to my previous point, does an approach that simplifies an individual’s struggle to a single factor that only you as a clinician can fix really help restore function in the heterogenous population we are exposed to in Occupational Health? Is patient-centered care offering a menu for patients to select their preferred treatment without any evidence-based education? Ultimately, we do not know, and may never fully understand exactly why an onset of pain happens, or why specific treatments work, but it is unlikely to be as simple as solely posture, lifting technique, a lack of strength, or tight muscles.
• Explain the non-physical benefits of the treatments that we choose
an individual presents with shoulder pain and following assessment, the clinician provides some advice and education to support continuing with all activities by reducing the load to a more manageable level. For an unspecified reason, this approach does not provide instant relief and the patient’s symptoms continue to worsen.
Can we use this time to build meaningful relationships and provide essential education? From my experience, here are a few ways we can maximise our clinical time:
• Provide short and long term goals during your treatment
Initially,further:
• Alter the contextual factors of pain where possible through positive communication
This is where our job as clinicians is so important as we have the opportunity to open up a patient’s viewpoint. I believe that as a clinician we should provide a plan to patients with short and long term goals that reassures and builds confidence to reduce the reliance on specific modalities and increase selfefficacy to ensure the individual that they are strong, capable, and robust. Individuals do not have to be pain free to return to work or live their lives. How often is the amount of anxiety we feel actually the amount of danger we’re in? The amount of hunger we feel
I believe that our experiences in life are the most important thing and as musculoskeletal clinicians, we have a real opportunity to promote health and well-being, and support individuals in creating positive experiences. So, in summary:
• Listen and be empathetic to a patient’s experience of being in pain, beyond the sensation
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must first understand the current societal context in which it was said. Neurodiversity, although a term only coined relatively recently by renowned sociologist Judy Singer, is getting more attention than ever before, which in no small part is thanks to the attention Branson and other highprofile individuals have brought to the concept, which is and should always be seen as, incredibly commendable.
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Amongst many other high-profile individuals who have been incredibly open about their neurodiverse conditions (Greta Thurnburg, Elon Musk, Steve Jobs to name but a few), Richard Branson has acted as a role model for many, bringing awareness and acceptance of neurodiversity, not just in business but to the wider world as Thatwell.being said, Richard Branson recently sat down with The Times and proudly stated “dyslexia is my superpower”. Now, he’s not the first person to promote neurodiversity as a superpower, but he is probably one of the most famous. And that could be a Beforeproblem.understanding why Sir Branson’s particular brand of advocacy might be harmful, we
In fact, over the last five years searches for the term “Neurodiversity” have increased by 7,100% and then a further 300% in the first half of 2022 alone.
ACTUALLY ACTING AS OTHER PEOPLE’S KRYPTONITE?
Many companies are even changing their recruitment practices to help support neurodiverse employees from the very start of their journey.
With this attention, we have seen a plethora of changes being brought in to support neurodiverse individuals, particularly in the workplace. More and more companies are implementing neurodiverse-friendly practices in the office, the range of assistive technology and software available to employers is wider than ever and, more importantly, some would say, easier to access than ever.
Branson – he’s the CEO and founder of Virgin Group, he’s worth an estimated $4 billion, and he’s neurodiverse.
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ISSOMECLAIMING NEURODIVERSITYASA
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• Acknowledging that some students experience digital fatigue and may need to turn cameras off during longer online sessions.
With neurodiverse individuals already being more susceptible to stress and poor mental health, do we really need to be adding more to that pile? Especially when it comes from the very movement that’s meant to be improving Companiesthings.being
Again, we can see trailblazers in this aspect, Rolls Royce for example, who recently adjusted their internship selection process to be more neurodiverse inclusive, by making only a few small minor changes:
By doing so, Rolls Royce ensures that every single applicant has a level playing field, allowing every single participant to show their skills fairly, neurodiverse or otherwise. This is just one of many examples of ways that companies are now recognising the need for neurodiversity policies.
Richard Branson stated, “dyslexia is my superpower” and that’s fantastic. Dyslexia has helped Richard Branson see the world through a different lens and achieve amazing feats. But the keyword there isn’t actually ‘dyslexia’, but ‘my’ – what has been an incredibly powerful asset for one, may not be the case for another.
• Ensuring information was as accessible as possible and using clear, easy-to-read fonts and phrasing.
more aware of an increasingly neurodiverse workforce is a fantastic thing, but expecting productivity to increase and solutions to become more innovative overnight, just because they’ve hired a Dyslexic member of staff is about as realistic as expecting people to figure out that Superman is just Clark Kent without the glasses. Neurodiverse individuals are just that – they’re individuals. Support, awareness and acceptance of neurodiversity must be made on an individual basis, without sweeping generalisations or stereotypes, even if they are in the positive mindset of having a superpower.
And that’s just it – humans are complex. Sure, many neurodiverse individuals have achieved phenomenal achievements, and many more will continue to do so. But some won’t. Some are just regular people, albeit with a little bit of different wiring compared to what society determines as “normal”. And there’s absolutely nothing wrong with that.
• Recognising that judging tone of voice and levels of eye contact can be inappropriate for neurodiverse applicants.
• Giving applicants advanced sight of information in problem-solving scenarios, reflecting the time they would have in the workplace.
With all that being said, surely Richard Branson’s comments pushing neurodiversity as a superpower is a good thing? Not necessarily. The idea of being a superhero – someone who’s magically better than most people, who can do no wrong and can solve problems with just a swoop of their cape remains on the pages of comic books for a reason. Because it’s not real. Sure, some people with Dyslexia are powerhouse creatives, imagining incredible dreamscapes –but then again, some are not. Some people who have ADHD can be laserfocused, spotting minute coding errors in behemoth programs – but then again, others cannot.
Going back to Judy Singer discussing this very topic in 2019, she said “The overselling of neurodivergent strengths is an inevitable reaction and a necessary correction to the historical devaluation of neurodivergent people. And just as inevitably, time and experience will reality test its claims. Despite the ambitious goals of ‘Neurodiversity in the Workplace’, I am pretty sure that what will eventually be discovered is that there is nothing new under the sun, nobody is perfect, and humans are complex and difficult.”
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Regulates moods. You have experienced how lack of sleep impacts upon your general mood. If you are feeling physically tired and run down, you are more likely to experience negative emotions such as anger, irritation, frustration or sadness.
Supports the endocrine system. Many of the body’s hormonal functions occur during sleep and lack of sleep can impact upon the release of growth hormones as well as fertility hormones.
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Gives us a break from thinking. We all need a break from the pressures and thoughts of each day. Drifting off into a comfortable and sufficient sleep, helps us to relax and unwind, ready to resume when we wake.
The Role of Sleep in a Healthy Lifestyle
. The average adult needs between 7-9 hours of sleep per night, depending on the individual. Sometimes it is just not possible, and we have all experienced how not getting enough sleep can impact upon how we feel for the rest of the day. Yet there are many other reasons why getting a healthy amount of sleep each night is so important. These include:
So, when working on improving and maintaining your healthy lifestyle, by evaluating your diet and exercise regimen, be sure that you are incorporating adequate sleep into the equation!
Regulates weight. Having a healthy amount of sleep each night helps regulate weight by ensuring that when we are awake, we have the energy needed to move about and get things done. Consistent lack of sleep, or too much sleep leaves us feeling lethargic, sluggish and fuzzy headed, as well as makes us more inclined to make ‘comfort’ choices when it comes to foods.
Getting the right amount of sleep each night does more than just ensure that your eyes are not red and baggy, it also works to support you both physically and mentally, as well as improve your overall well-being and attitude.
Supporting growth and development. When participating in resistance training exercises, the body’s muscle fibres are being stressed and torn. The body uses this sleep period to help build and repair the damaged fibres as well as work on general cell growth and development throughout the whole body.
Exercise is a fantastic way to help regulate your sleep patterns. With regular exercise, consisting of both endurance and resistance training, your body will naturally feel more exhausted in the evening times. Remember that participating in a workout straight before you go to sleep will stimulate your body and mind, so try to leave a couple of hours between your last workout/sports activity and the time you go to bed.
Eating early instead of just before you go to sleep will help ensure that your digestive system is not still powering away at metabolising your last meal. Avoid stimulants for up to 4 hours before you go to bed, such as refined sugars and caffeine products, as these will impact upon your ability to get a good long sleep.
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When reflecting on whether we are living a healthy lifestyle, we tend to immediately focus on what types of foods we have been eating and how much exercise we have been participating in lately. Even though diet and exercise do play particularly important roles in our health and wellbeing, sleep is an equally key factor that often gets overlooked.
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Sharpens your attention and improves memory. Lack of sleep and oversleeping can both leave you feeling sluggish and impair your brain’s ability to absorb, retain and recall information. – Regulates the immune system. Insufficient amounts of sleep affect the production of cytokine within the body, which can result in lowered immune response. So, you are more likely to catch a cold or the flu when you have been neglecting your shut eye over a refined period.
Create a routine. The circadian rhythms of the body work best when we incorporate an element of routine into our lifestyle. So, try to set yourself specific times to go to bed and then wake up each day. If you are used to an erratic pattern, then you may find it can take time adjusting. But by forcing yourself to wake up at a specific time each day, your body will begin to adjust, and you will notice more consistency in your physical and mental well-being.
Improves heart function. Regular healthy sleep patterns work to regulate blood pressure. Because most people’s blood pressure drops whilst they are asleep, building up a sleep debt over a period stresses the body causing it to release stress hormones such as cortisol and adrenaline, which can also lead to an increased risk of cardiovascular disease.
HOW CAN I INCORPORATE HEALTHY SLEEP PATTERNS INTO MY LIFE?
SO, WHAT MAKES SLEEP SO
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We work strategically to implement proactive workplace mental health and wellbeing solutions, to help organisations and their people thrive.
PAM OH Solutions is a national Occupational Health provider. We work with clients across all industry sectors, delivering a flexible range of high quality, pro-active and cost-effective services. Combining the traditional values of professional integrity and good customer service with a modern progressive approach to service delivery.
Working in partnership with all of PAM Group, we provide a range of products to assist with continued occupational health processes. From ergonomic chairs to sit/stand desks and everything in between.
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We deliver efficient and fit for purpose Occupational Health solutions to improve attendance and reduce absence in full compliance with legislation. Our approach extends beyond simply providing a reactive management referral service, we aim to forge strong working relationships with our clients, working in partnership to deliver tailored absence management solutions.
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PAM Wellbeing was born out of a need to support our customers and their employees from a holistic health and wellbeing perspective in 2009, expanding on the physical health and rehabilitation services that our occupational health sister company has expertly provided since 2004.
a strategic wellbeing partner to support their employee’s whole health and wellbeing needs, and for their employees to benefit from the multidisciplinary expertise of our extensive team.
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Compass Magazine wishes to thank its contributors from PAM Groups businesses:
Our suite of mental health, psychological and wellbeing solutions enables organisations the option to engage with
PAM Health is one of the UK’s leading healthcare-product suppliers. Based in Liverpool, providing a wide range of solutions to workplace-health challenges including: Posture and musculoskeletal problems Chronic neck and back pain Carpal tunnel syndrome Headaches and migraines Injuries to employees
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Holly House, 73-75 Sankey Street, Warrington, WA1 1SL
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