tag:theconversation.com,2011:/us/topics/musculoskeletal-pain-22785/articlesMusculoskeletal pain – The Conversation2022-07-06T03:38:00Ztag:theconversation.com,2011:article/1836192022-07-06T03:38:00Z2022-07-06T03:38:00ZIs netball actually bad for knees and ankles? What does the research say?<p>Netball is one of the biggest team sports in Australia with more than <a href="https://www.clearinghouseforsport.gov.au/kb/women-in-sport/current-state">1.2 million men, women and children playing each week</a>, underpinned by a nationwide footprint of more than 4,000 community clubs.</p>
<p>Across the world more than <a href="https://netball.sport/">20 million people play netball in more than 70 countries</a>. And it’s not just for young women; men play in mixed and male only competitions, 5-7 year olds play in the <a href="https://netball.com.au/woolworths-netsetgo">NEtSetGO</a> program and older players play in the <a href="https://www.playwalkingnetball.com.au/home/">Walking Netball competition</a>.</p>
<p>Despite its popularity, netball continually gets bad rap for joints. Time and time again in physiotherapy clinics, we hear patients say, “I have bad knees because I used to play netball” or “I’m scared of letting my child play netball – isn’t it terrible for joints?”</p>
<p>The research, however, shows a more nuanced story. </p>
<p>Yes, there is a risk of injuring yourself while playing netball but the overall risk of serious injury is relatively small – and far outweighed by the benefit of being fit, active and part of a team. </p>
<h2>What are the knee and ankle risks with netball?</h2>
<p>Unlike other court-based sports, netball has strict <a href="https://netball.com.au/sites/default/files/2020-02/INF-RulesofNetball2020.pdf">rules</a> on footwork.</p>
<p>Players can only take one and a half additional steps after receiving the ball.</p>
<p>They’re also restricted to certain areas of the court, depending on which position they’re playing. </p>
<p>The sudden braking required of netball players requires good strength, body control and footwork. </p>
<p>A recent <a href="https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-020-00290-7">systematic review</a> reports netball injuries in people aged over 15 predominantly occur in the lower limb, particularly the ankle and knee. Ligament sprains are the most common injury. </p>
<p>Ankle injuries are more common than knee injuries, the systematic review found. And younger players tend to experience more upper limb injuries (such as fractures) than lower limb injuries.</p>
<p>There are more injuries in matches than in training. Pain at the <a href="https://www.researchgate.net/publication/322264795_Incidence_and_prevalence_of_patellofemoral_pain_A_systematic_review_and_meta-analysis">front of the knee-cap</a> is also very common in adolescent girls who participate in jumping and pivoting sports such as netball. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/19236296">Insurance claim</a> data indicates damage to the ACL (<a href="https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)">anterior cruciate ligament</a>, a major stabiliser of the knee) represents about 13% of the most serious netball injuries presenting to emergency departments. </p>
<p>This equates to a rate of only one injury for every 2,500 participants. However, this figure likely underestimates the actual injury rate as many people with these injuries go straight to their GP or local physiotherapist (rather than hospital). </p>
<p>The limited data available makes it hard to accurately indicate the injury rate in community netball. But in similar court-based sports (such as handball or basketball), the ACL injury rate is <a href="https://pubmed.ncbi.nlm.nih.gov/18063176/">one in every 100-200 players per calendar year</a>. </p>
<p>Though ACL injuries are rare, they are a serious injury often requiring time off work or study and are costly to the <a href="https://pubmed.ncbi.nlm.nih.gov/30587436/">individual</a> and the <a href="https://pubmed.ncbi.nlm.nih.gov/33852440/">health care system</a> via increased risk of arthritis.</p>
<p>So is netball terribly much worse than other sports for joint injury risk? We don’t have enough data to conclusively answer this question. But what we can say from the limited evidence available is the overall risk of knee and joint injury in community netball is low.</p>
<h2>Can anything be done to reduce injury risk for netballers?</h2>
<p>Yes! There is great evidence <a href="https://pubmed.ncbi.nlm.nih.gov/29737024/">injury prevention programs work</a>, reducing ACL injuries in female athletes by up to 67%, other knee injuries by up to 50%, and all lower limb injuries by 30%.</p>
<p>Netball even has its own injury-prevention program, known as <a href="https://knee.netball.com.au/about/">the KNEE program</a> (KNEE stands for knee injury prevention for netballers to enhance performance and extend play).</p>
<p>The KNEE Program is an on court warm-up program aimed at all levels of netball. It aims to improve the way players run, change direction, jump and land (as this is how many knee and ankle injuries happen).</p>
<p>For pain at the front of the knee-cap (<a href="https://bjsm.bmj.com/content/bjsports/50/4/247.full.pdf">patellofemoral pain</a>), there is also great <a href="https://bjsm.bmj.com/content/52/18/1170">evidence</a> that exercises that strengthen the hip and knee muscles – combined with <a href="https://bmjopensem.bmj.com/content/2/1/e000086">advice about activity modification</a> – can help.</p>
<p>For adolescents, patellofemoral pain often occurs during periods of rapid growth, but it is important to see a health professional for exercises and advice, as <a href="https://doi.org/10.1136/bjsports-2016-096384">one in three</a> continue to experience pain 12 months down the track.</p>
<h2>Yes there are risks with netball, but the benefits far outweigh them</h2>
<p>As a fast moving non-contact sport, netball is fantastic way to keep active, improve hand eye coordination and reap the physical, mental, and social benefits of participating in a team sport.</p>
<p>Being physically fit and strong can improve your health and reduce your <a href="https://www.who.int/publications/i/item/9789240015128">risk of illness</a>. </p>
<p>Knees in particular like to be exercised; recreational runners have healthier knees than those who <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/">lead a sedentary lifestyle</a>. </p>
<p>Participation in sport is particularly important for adolescent girls, who are dropping out of sport at <a href="https://www.suncorp.com.au/learn-about/teamgirls/teamgirls-powered-by-suncorp-research.html">alarming rates</a>. </p>
<p>Girls who do play sport have a more positive body image and better states of <a href="https://www.suncorp.com.au/learn-about/teamgirls/teamgirls-powered-by-suncorp-research.html">psychological well-being</a>. </p>
<p>Being <a href="https://www.suncorp.com.au/learn-about/teamgirls/truth-about-teen-girls-and-sport.html">part of a team</a> also helps girls enjoy shared experiences, reduce isolation and be part of something bigger than themselves.</p>
<p>Many sports provide similar benefits but all sports have some risks. If you or your children enjoy netball, keep playing – the overall benefits of netball outweigh the possible risks. </p>
<p>Importantly, netball in Australia can serve as a vehicle for empowerment, providing strong female roles models to inspire current and future generations.</p><img src="https://counter.theconversation.com/content/183619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kay Crossley receives funding from the National Health and Medical Research Council to investigate knee injuries in sport</span></em></p><p class="fine-print"><em><span>Brooke Patterson and Sallie Cowan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, there is a risk of injuring yourself while playing netball but the overall risk of serious injury is relatively small – and far outweighed by the benefit of being active and part of a team.Sallie Cowan, Senior Research Fellow and Musculoskeletal Physiotherapist, La Trobe UniversityBrooke Patterson, Research Fellow, La Trobe UniversityKay Crossley, Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777392022-03-30T19:08:58Z2022-03-30T19:08:58ZWe’re two physios who ran away with the circus. Here’s what we learned<p>Circus fuses extreme athletic performance, diverse artists and stunning spectacles with a truly global appeal. </p>
<p>Circus is exciting, although sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.</p>
<p>The task of looking after the health of circus performers is unique. And we’ve been privileged to do that, as physiotherapists treating and helping coordinate artists’ medical care. </p>
<p>We’ve done this in well over 100 cities through 30 countries across North and South America, Europe, Australasia, Asia and the Middle East. While we’ve mainly toured with professional circuses, we’ve also advised junior artists and circus training facilities.</p>
<p>This is what it’s like to work behind the scenes of some of the greatest shows on Earth.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/circus-oz-is-to-close-after-44-years-they-irrevocably-changed-australian-circus-and-brought-it-to-the-world-173586">Circus Oz is to close after 44 years. They irrevocably changed Australian circus, and brought it to the world</a>
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<h2>A diverse crew</h2>
<p>Circuses and their performers are diverse. Disciplines include ground acrobatics (for instance, tumbling, hand balancing, contortion); aerial acrobatics (trapeze, silks, straps); manipulation (juggling); character (clowning); and music. Rehearsals and performances may feature fire, ice, water, heights or a range of props and equipment.</p>
<p>You could compare the cast of a large show to an Olympic squad, with a variety of ages, body shapes, sizes and injury risk.</p>
<p>At the elite level, performers may come from a range of different countries, languages and cultural backgrounds. This can add potential challenges such as differing belief systems and attitudes about injury cause and management, training and performance.</p>
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<a href="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Circus performers, including clown, juggler" src="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Circuses and their performers are diverse, as are their injuries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/circus-226087540">Shutterstock</a></span>
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<h2>A diverse set of injuries</h2>
<p>While headline-grabbing falls and catastrophic injuries do occur, they are fortunately rare. Most injuries are chronic (long-term) injuries and less-serious acute ones. </p>
<p>The most commonly reported circus injuries are to the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">spine and ankle</a>. We also see sprains, strains, and sore lower backs and shoulders.</p>
<p>You might be familiar with many of these injuries. However, circus performers have unique skills, and sometimes require extreme ranges of movement, coordination and strength. They need their bodies to function in ways you or I don’t. This influences how we work with performers to get them back on their feet (or hands).</p>
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<strong>
Read more:
<a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">Hot pack or cold pack: which one to reach for when you're injured or in pain</a>
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<p>Circus injury rates are <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">7.37-9.27</a> per 1,000 artist exposures (the number of training/performance hours, or number of training sessions/shows). Acrobatic injuries are the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2014/00000029/00000004/art00010">most</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445642/">common</a>. </p>
<p>However, the limited research we have on circus injuries suggests
circus is safer then many other sports. That includes having lower injury rates than contact football (rugby, American football and Australian rules), and gymnastics. </p>
<p>In professional circus, <a href="https://journals.sagepub.com/doi/abs/10.1177/0363546508331138">injuries tend to be minor</a>, requiring seven or fewer treatment sessions and resulting in one or no missed shows. </p>
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<a href="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fit woman in exercise wear clutching sore lower back" src="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Injuries, such as sore backs, are common, and not always reported.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-sportswoman-sitting-on-mat-1745717915">Shutterstock</a></span>
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<p>However, injuries are likely under-reported. Common definitions of injury rely on artists missing training or shows, or seeking formal medical care. Some injuries don’t meet these criteria.</p>
<p><a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">Our research</a> looked at performers’ self-reported lower-limb problems, regardless of whether they missed work or saw a health-care practitioner. We asked them about injuries and/or symptoms such as pain, ache, stiffness, clicking/catching, swelling and instability.</p>
<p>In any given week, we found more than 50% of performers reported problems. In an 18-week period, 86% of performers reported having had at least one week with work-related lower limb problems.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/friday-essay-from-delicate-teens-to-fierce-women-simone-biles-athleticism-and-advocacy-have-changed-gymnastics-forever-124485">Friday essay: from delicate teens to fierce women, Simone Biles' athleticism and advocacy have changed gymnastics forever</a>
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<h2>A diverse range of issues</h2>
<p>Some performers also face barriers to recovering from their injuries. <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">One study</a> found financial constraints and a lack of health-care support were issues.</p>
<p>For instance, full-time artists may have access to travelling medical staff with experience working with circus performers. These artists may also have paid injury leave and comprehensive health insurance. </p>
<p>However, artists performing on short-term contracts or doing gig-based work may need to source their own medical care and are more likely to suffer financial loss if they miss performances. </p>
<p>Other researchers have also reported how aspects of circus culture influence how we manage circus injuries. In <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">one study</a>, performers said they didn’t always trust health-care practitioners’ knowledge of work demands. This includes circus skill requirements, and training or show schedules. </p>
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<a href="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Athlete's taped wrist and ankle" src="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">To tape or not? Some performers may prefer colleagues’ and coaches’ advice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/injured-athlete-thumb-ankle-injuries-tape-1481951810">Shutterstock</a></span>
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<p>Some performers may prioritise advice from colleagues and coaches over medical recommendations. This may be partly because circus is a historic art form where, in many disciplines, training methods have been passed down through generations of performers. </p>
<p>For health-care practitioners, this knowledge can be valuable. So clinicians need to work with artists to come to a shared understanding of how to manage injuries. </p>
<p>Acknowledging the unique nature of circus training and performance, as well as the lack of evidence base to guide medical decision-making in the field, can also help build rapport and ensure a collaborative approach to managing injuries.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-clowns-scary-ha-ha-aaaargh-32492">Are clowns scary? Ha ha aaaargh</a>
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</em>
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<h2>Preventing injuries is the goal</h2>
<p>Circus performers are generally adept at managing their bodies, using strength, flexibility and conditioning training to try to prevent injuries and improve their acts.</p>
<p>We have worked with performers to promote self-management, using techniques from more established fields such as sports and dance medicine.</p>
<p>For instance, we looked at adding self-directed <a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">endurance exercises</a> to a performing, touring show. This was welcomed by many performers.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-ice-baths-after-sport-help-recovery-or-improve-results-44829">Health Check: do ice baths after sport help recovery or improve results?</a>
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<h2>A lot goes on behind the scenes</h2>
<p>For the shows to go on, much behind-the-scenes work is needed from the artists and dedicated support staff. </p>
<p>For those involved in the care of circus artists, this provides not only a uniquely challenging and fascinating workspace, but an amazing view of some of the greatest shows on Earth.</p><img src="https://counter.theconversation.com/content/177739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton is a research consultant for the National Institute of Circus Arts. Charlotte was previously employed for Cirque du Soleil in its performance medicine team.</span></em></p><p class="fine-print"><em><span>Michael Henry receives funding from the Australian Government in the form of RTPd fee offset and stipend scholarships. He was previously employed by Cirque du Soleil in its performance medicine team. </span></em></p>Circus is exciting, though sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.Charlotte Ganderton, Physiotherapy lecturer, Swinburne University of TechnologyMichael Henry, PhD candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1479872020-10-16T11:02:18Z2020-10-16T11:02:18ZWhat is osteopathic medicine? A D.O. explains<figure><img src="https://images.theconversation.com/files/363792/original/file-20201015-19-1k9z1ap.jpg?ixlib=rb-1.1.0&rect=73%2C5%2C3388%2C2057&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">D.O.s like Sean Conley, physician to the president, can face stigma from people who don't understand the practice.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/white-house-physician-sean-conley-answers-questions-news-photo/1228914747">Saul Loeb/AFP via Getty Images</a></span></figcaption></figure><p><em>When President Trump was diagnosed with COVID-19, many Americans noticed that his physician had the title D.O. stitched onto his white coat. Much confusion ensued about doctors of osteopathic medicine. As of a 2018 census, they made up <a href="https://doi.org/10.30770/2572-1852-105.2.7">9.1% of physicians in the United States</a>. How do they fit into the broader medical field?</em></p>
<p><em>Andrea Amalfitano is a D.O. and dean of the Michigan State University College of Osteopathic Medicine. He explains some of the foundations of the profession and its guiding principle: to use holistic approaches to care for and guide patients. And don’t worry, yes, D.O.s are “real doctors” and have full practice rights across the U.S.</em></p>
<h2>How did osteopathic medicine get started?</h2>
<p>In the years after the Civil War, without antibiotics and vaccines, many clinicians of the day relied on techniques like arsenic, castor oil, mercury and bloodletting to treat the ill. Unsanitary surgical practices were standard. These “treatments” promised cures but often led to more sickness and pain.</p>
<p>In response to that dreadful state of affairs, a group of American physicians <a href="https://www.aacom.org/become-a-doctor/about-osteopathic-medicine/history-of-osteopathic-medicine">founded the osteopathic medical profession</a>. They asserted that maintaining wellness and preventing disease was paramount. They believed that preserving health was best achieved via a holistic medical understanding of the individual patients, their families and their communities in mind, body and spirit. They rejected reductionist interactions meant to rapidly address only acute symptoms or problems.</p>
<p>They also embraced the concept that the human body has an inherent capacity to heal itself – decades before the immune system’s complexities were understood – and called for this ability to be respected and harnessed.</p>
<h2>What do osteopathic doctors do today?</h2>
<p>Doctors of osteopathic medicine – D.O.s, for short – can prescribe medication and practice all medical and surgical specialties just as their M.D. counterparts do. Because of the focus on preserving wellness rather than waiting to treat symptoms as they arise, more than half of D.O.s gravitate to primary care, including family practice and pediatrics, particularly <a href="https://www.healthaffairs.org/do/10.1377/hblog20171023.624111/full/">in rural and underserved areas</a>.</p>
<p>D.O. training embraces the logic that understanding anatomic structures can allow one to better understand how they function. For example, alongside contemporary medical and surgical preventive and treatment knowledge, all osteopathic physicians also learn strategies to treat musculoskeletal pain and disease. These techniques are known as “manual medicine,” or osteopathic manipulative treatment (OMT). They can provide patients an alternative to medications, including opioids, or invasive surgical interventions.</p>
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<a href="https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman manipulating a man lying on a treatment table" src="https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363793/original/file-20201015-15-wqcgp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An osteopathic medical student practices an adjustment that is part of osteopathic manipulative treatment.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sarah-fang-a-3rd-year-osteopathic-medical-student-does-a-news-photo/566007125">Gary Friedman/Los Angeles Times via Getty Images</a></span>
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<p>D.O.s pride themselves on making sure their patients feel they’re treated as a whole person and not simply reduced to a symptom or blood test to be rapidly dealt with and then dismissed. We say we aspire to care for “people, not patients,” with an empathetic attitude and an emphasis on making sure those closest to those in their care, such as family and loved ones, as well as other social factors, are all taken into account.</p>
<h2>What’s different between a D.O. and an M.D.?</h2>
<p>The osteopathic philosophy around prevention and wellness might seem like common sense today, but it was revolutionary. Aspects of osteopathic medicine, including the use of alternative therapies such as OMT, were originally met with skepticism or outright hostility by some medical doctors who questioned their scientific bases. Indeed, in 1961, the <a href="https://doi.org/10.1001/jama.1961.73040370010008">American Medical Association’s code of ethics declared it “unethical”</a> for an M.D. physician to professionally associate with doctors of osteopathy.</p>
<p>So with the guidance of the American Osteopathic Association, D.O.s created their own D.O. hospitals, residency and fellowship programs, and four-year D.O. degree-granting medical schools. Instruction around the current science of health and illness is similar between D.O.s and M.D.s – it’s the philosophical delivery of that knowledge that’s different.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<p>Certainly a holistic approach to health is no longer exclusive to D.O.s. In fact, many M.D., nursing, physician assistant and other health professional schools now embrace parts of it as they deliver care. And now, D.O.s and M.D.s often work side by side in medical settings across the country. More recently, the AMA has recently <a href="https://www.ama-assn.org/residents-students/usmle/comlex-do-matching-and-gme-accreditation-what-you-need-know">recognized the D.O. licensing exams as equivalent</a> to the exams M.D.s take. D.O.s compete for the same training residencies as M.D.s and, eventually, the same jobs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="crowd of D.O. students wearing their white coats" src="https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363796/original/file-20201015-13-1uopo9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Michigan State University College of Osteopathic Medicine students take the osteopathic pledge.</span>
<span class="attribution"><span class="source">Michigan State University</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>How prevalent is osteopathic medicine today?</h2>
<p>Osteopathic medicine is now <a href="https://www.healthaffairs.org/do/10.1377/hblog20171023.624111/full/">one of the fastest-growing health professions</a>, with over 150,000 D.O.s and D.O. medical students practicing in the U.S. and internationally. <a href="https://osteopathic.org/wp-content/uploads/OMP2019-Report_Web_FINAL.pdf">One in four newly minted U.S. physicians</a> <a href="https://www.aamc.org/data-reports/students-residents/interactive-data/2019-facts-enrollment-graduates-and-md-phd-data">in the class of 2019</a> graduated from an osteopathic medical school.</p>
<p>Osteopathic medicine is now a mainstay of contemporary medical practice, with D.O.s active in all aspects of the nation’s health care systems.</p><img src="https://counter.theconversation.com/content/147987/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Amalfitano is Dean of the College of Osteopathic Medicine, and the Osteopathic Heritage Foundation Professor of Pediatrics, Microbiology and Molecular Genetics at Michigan State University. Dr Amalfitano also consults for ImmunityBio, Etubics Corp., and Avasure Inc, and has received external funding from a number of government, corporate, foundational, and private sources, including the NIH, MDA, and AMDA.</span></em></p>Almost 10% of physicians in the US are doctors of osteopathic medicine, and that proportion is rising. Their medical knowledge matches that of other doctors; the difference is the philosophy behind it.Andrea Amalfitano, Dean of the MSU College of Osteopathic Medicine and Professor of Pediatrics, Microbiology and Molecular Genetics, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/918292018-02-19T18:48:00Z2018-02-19T18:48:00ZNeedless treatments: spinal fusion surgery for lower back pain is costly and there’s little evidence it’ll work<figure><img src="https://images.theconversation.com/files/206904/original/file-20180219-75987-p1xpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Back pain affects one-quarter of Australians.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>From time to time, we hear or read about medical procedures that can be ineffective and needlessly drive up the nation’s health-care costs. This occasional series explores such <a href="https://theconversation.com/au/topics/needless-treatments-or-procedures-62784">needless treatments or procedures</a> individually and explains why they could cause more harm than good in particular circumstances.</em></p>
<hr>
<p>Back pain affects <a href="https://www.ncbi.nlm.nih.gov/pubmed/15148462">one in four</a> Australians. It’s so common, nearly all of us (<a href="https://www.ncbi.nlm.nih.gov/pubmed/27745712">about 85%</a>) will have at least one episode at some stage of our lives. It’s one of the most common reasons <a href="https://www.ncbi.nlm.nih.gov/pubmed/23529466">to visit a GP</a> and the main health condition forcing older Australians to <a href="https://www.ncbi.nlm.nih.gov/pubmed/18928439">retire prematurely</a> from the workforce. </p>
<p>Treatment costs for back pain in Australia total almost <a href="https://trove.nla.gov.au/work/185011445?q&versionId=201465733">A$5 billion</a> every year. A great proportion of this is spent on spinal surgical procedures. Recently, Choosing Wisely, the campaign to educate medical professionals and the public about tests, treatments and procedures that have little benefit, or lead to harm, <a href="http://www.choosingwisely.org.au/recommendations/fpm">added spinal fusion</a> for lower back pain to its list.</p>
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<strong>
Read more:
<a href="https://theconversation.com/australians-are-undergoing-unnecessary-surgery-heres-what-we-can-do-about-it-46089">Australians are undergoing unnecessary surgery – here's what we can do about it</a>
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<p>This is because, despite rates of the procedure being on the rise, current evidence doesn’t support spinal fusion for back pain. Randomised trials (regarded as studies providing the highest-quality evidence) suggest <a href="https://www.ncbi.nlm.nih.gov/pubmed/24346052">spinal fusion has little advantage</a> over a well-structured rehabilitation program, or psychological interventions, for back pain.</p>
<h2>What is spinal fusion?</h2>
<p>Spinal surgery is most commonly performed to remove pressure on nerves that causes pain and other nerve symptoms in the legs. This surgery is called decompression. The next most common procedure is spinal fusion, where two or more vertebrae are joined together (using such methods as transplanted bone from the patient, a donor or artificial bone substitutes) to stop them moving on each other and make one solid bone.</p>
<p>Spinal fusion may be performed for fractures, dislocations and tumours, and is commonly performed in conjunction with decompression. For back pain, it’s performed when the origin of the pain is thought to be related to abnormal or painful movement between the vertebrae (from degenerative joints and discs, for example).</p>
<p>Rates of spinal fusions <a href="https://www.ncbi.nlm.nih.gov/pubmed/17077740">have been rising</a> and continue to increase, outstripping other surgical procedures for back pain. In the United States, rates of spinal fusion more than doubled from 2000 to 2009. In Australia, rates <a href="https://www.ncbi.nlm.nih.gov/pubmed/25281920">increased </a> by 167% in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/20078526">private sector</a> between 1997 and 2006, despite almost no increase in the public sector.</p>
<p>Spinal fusion rates <a href="https://www.safetyandquality.gov.au/atlas/atlas-2015/">differ significantly</a> between regions of Australia, with the highest being in Tasmania and the lowest in South Australia: a seven-fold variation. Significant variations are also seen between countries. For instance, spinal fusion rates in the United States are <a href="https://www.ncbi.nlm.nih.gov/pubmed/8747260">eight times</a> those in the United Kingdom.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206911/original/file-20180219-75974-agn2n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Rates of spinal surgery are on the rise, despite little evidence of effectiveness.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>The greatest increase in the use of spinal fusion has been in <a href="https://www.ncbi.nlm.nih.gov/pubmed/28441309">older Australians</a>, often in conjunction with decompression surgery for spinal stenosis – a condition that causes narrowing of the spinal canal (the cavity that runs through the spinal cord). </p>
<p>Differences in clinical training, professional opinion, and local practices are likely to play a role in such variations.</p>
<h2>Evidence for spinal surgery</h2>
<p>There is little high-quality evidence to support the use of spinal fusion for most back-related conditions, including <a href="https://www.ncbi.nlm.nih.gov/pubmed/27801521">spinal stenosis</a>. And there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/12211665">disagreement between surgeons</a> on when spinal fusion surgery should be performed, not only for back pain but also for more acute conditions such as tumours and spine fractures. </p>
<p>There have also been no studies comparing spinal fusion to a placebo procedure. Most research to date compares one fusion technique to <a href="https://www.ncbi.nlm.nih.gov/pubmed/29367001">another technique</a> or to a form of <a href="https://www.ncbi.nlm.nih.gov/pubmed/24346052">non-surgical treatment</a>, so we still don’t know whether spine fusion is effective against placebo.</p>
<p>We also know that spine fusion surgery is expensive and associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/20371784">more complications</a> than decompression surgery. And the surgery often fails. Around <a href="https://www.ncbi.nlm.nih.gov/pubmed/17268274">one in five</a> patients who undergo spine fusion will have revision surgery within ten years. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/20736894">Research also shows</a> most patients having spine fusion surgery under workers’ compensation won’t return to the usual job, will still be having physiotherapy and be on opioid medication two years after surgery.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-taking-opioids-for-low-back-pain-heres-what-you-need-to-know-88012">Thinking of taking opioids for low back pain? Here's what you need to know</a>
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<h2>So why are rates going up?</h2>
<p>There are <a href="https://www.ncbi.nlm.nih.gov/pubmed/14960750">several factors</a>, including an ageing population, that may contribute to the rapid increase in spinal fusion despite the lack of evidence supporting its use. Financial incentives might also explain the differences in rates between private and public sectors in Australia and between the United Kingdom and the United States.</p>
<p>We don’t have high-quality evidence on the benefits and harms of spinal fusion. This means there is uncertainty, which allows practitioners to continue doing the procedures they were trained to do unchallenged. This then leads to overtreatment, particularly where reimbursement rates are high, such as in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24210578">workers’ compensation</a> setting. </p>
<p>Uncertainty about the appropriateness of spine fusion results in practice variation, wastes scarce health care resources and leads to worse patient outcomes. </p>
<p>We need better research in this area. This means research efforts should shift from studies looking at different ways of performing the surgery and focus on investigating whether or not it works better than non-operative treatments or a placebo, and, if so, whether the benefits outweigh the harms.</p>
<p>In the absence of such evidence, patients can consider other evidence-based and less costly treatments, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/27745712">exercise, cognitive behavioural therapy and physiotherapy</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ouch-the-drugs-dont-work-for-back-pain-but-heres-what-does-72283">Ouch! The drugs don't work for back pain, but here's what does</a>
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<img src="https://counter.theconversation.com/content/91829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gustavo Machado receives funding from the National Health and Medical Research Council for his fellowship.</span></em></p><p class="fine-print"><em><span>Christine Lin receives funding from the National Health and Research Council for her fellowship and a current project investigating the effects of opioid analgesics in spinal pain.</span></em></p><p class="fine-print"><em><span>Ian Harris receives a salary from UNSW and South Western Sydney Local Health District and income from surgical practice. His research unit has received competitive grant funding from the NHMRC, the Medical Research Futures Fund, State Insurance Regulatory Authority (NSW), HCF Research Foundation, Australian Orthopaedic Association, the Lincoln Foundation, and the AO Foundation. He receives royalties from a book: Surgery, the Ultimate Placebo.</span></em></p>Rates of spinal fusion surgery for back pain are on the rise. This is despite little evidence that it’s an effective procedure and studies showing many will have revision surgery within ten years.Gustavo Machado, NHMRC Early Career Fellow, University of SydneyChristine Lin, Principal Research Fellow and Associate Professor, University of SydneyIan Harris, Professor of Orthopaedic Surgery, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/801382017-06-29T03:50:56Z2017-06-29T03:50:56ZThe yoga paradox: how yoga can cause pain and treat it<figure><img src="https://images.theconversation.com/files/175968/original/file-20170628-15714-5x6iec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Yoga moves like downward dog put strain on your hands, wrists, elbows and shoulders.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=SqZdRAsPESxkYRnkOqC1cQ-1-0">from www.shutterstock.com</a></span></figcaption></figure><p>Yoga carries with it a higher than expected risk of a painful wrist, elbow and shoulder, possibly due to poses like downward dog, new research suggests.</p>
<p>But it’s not all bad news. The same <a href="http://www.sciencedirect.com/science/article/pii/S1360859217301225">study</a> adds to growing evidence yoga can help manage low back and neck pain.</p>
<p>These findings highlight the complex relationship between yoga and musculoskeletal pain, the <a href="http://ard.bmj.com/content/73/6/949">second most common</a> cause of disability worldwide. </p>
<p>Our findings are not only important for people who do yoga or are thinking of taking it up, but also for yoga teachers and health care professionals who treat patients with musculoskeletal problems.</p>
<h2>What did we do?</h2>
<p>We surveyed 354 people who took at least one yoga class in the previous year in a yoga studio with two locations in suburban New York City. Participants were mainly women (95%) and were on average 45 years old. The studio offers classes in <a href="https://www.theguardian.com/lifeandstyle/2014/jan/10/yoga-beginners-guide-different-styles">Vinyasa-style yoga, Iyengar yoga</a> and prenatal yoga, among others.</p>
<p>Participants completed an online electronic questionnaire so we could assess their musculoskeletal pain at the start. We then contacted them again a year later to assess the effect of yoga on bone, joint and muscle pain in any body region. </p>
<p>At that point, we asked about the effect of yoga on their pain (whether they thought yoga had caused it, made it worse, had no effect, or made it better) and the intensity of pain. </p>
<p>When people reported yoga caused pain we asked them to tell us if they felt the pain during yoga class (and in what position), within an hour after yoga class or the next day.</p>
<h2>What did we find?</h2>
<p>Almost 87% of participants reported musculoskeletal pain within a year. Of those
who reported pain in at least one body region, most (66%) said yoga improved their bone, muscle and joint pain, particularly neck and back pain.</p>
<p>However, 21% said yoga made their pain worse and more than 10% said yoga had caused the pain particularly to the upper limbs (hand, wrist, elbow, shoulder). This was possibly due to poses, like downward dog, that need you to put weight on this part of the body. </p>
<p>A large number (44%) said yoga did not affect their pain. As participants were instructed to check all body regions where they had pain, some participants may have reported yoga helps in one region but causes pain in another region, so these numbers exceed 100%.</p>
<p>More than half of injuries were minor, while others resulted in time away from yoga (39%) or pain lasting for longer than three months (42%). People who had yoga-related musculoskeletal pain rated their pain between two and five (on a scale of zero to ten).</p>
<p>While we didn’t ask how these injuries came about, previous research suggests overexertion, inadequate instruction and poor technique <a href="http://iaytjournals.org/doi/abs/10.17761/ijyt.19.1.922087896t1h2180?code=iayt-site">increases the risk</a> of injury.</p>
<h2>How does this compare to other research?</h2>
<p>Our study, which shows yoga causes pain in 10% of people over a year, has much higher pain rates than other studies, which have previously reported levels of <a href="http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2014;volume=7;issue=2;spage=152;epage=154;aulast=Holton">1%</a> and <a href="http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2012;volume=5;issue=2;spage=92;epage=101;aulast=Penman">2.4%</a>.</p>
<p>One reason for our higher numbers could be because we followed up participants over one year, which provides a more accurate estimate than previous studies that assessed people at one point in time.</p>
<p>Yet our study has good news for people who do yoga as it backs a common belief that yoga can help with neck and back pain. Our study also confirms <a href="http://annals.org/aim/article/2633222/yoga-physical-therapy-education-chronic-low-back-pain-randomized-noninferiority">recent research</a> that shows the beneficial effects of yoga for chronic low back pain.</p>
<p>While our research goes part-way to investigating the complex relationship between yoga and pain, our sample was limited. So future research needs to look at yoga injuries among male and younger participants, which may be more typical of those who practice yoga in urban centres.</p>
<h2>So, what’s the take-home message?</h2>
<ul>
<li><p>People should practice yoga conscientiously and should be aware of the potential for injury. They should limit the time spent with weight on the arms (such as downward dog posture), especially if they had a previous injury</p></li>
<li><p>yoga teachers should inform participants about the potential for injury and encourage them to move out of positions that are uncomfortable or feel unsafe. They should communicate with physiotherapists to modify positions when participants are recovering from injury</p></li>
<li><p>patients should discuss with physiotherapists and doctors if they intend to practice yoga and assess the potential risks, benefits and modifications that may make yoga practice safer.</p></li>
</ul><img src="https://counter.theconversation.com/content/80138/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research shows yoga can improve back and neck pain, but can put strain on the body in some poses.Evangelos Pappas, Sr. Lecturer of Musculoskeletal Physiotherapy, University of SydneyMarc Campo, Professor, Physical Therapy, Mercy CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/763902017-04-21T00:21:02Z2017-04-21T00:21:02ZMyths about musculoskeletal pain and Aboriginal Australians prevent high quality care<p>Musculoskeletal pain (such as low back pain, osteoarthritis, neck, knee and shoulder pain) is the number one cause of disability in Australia and affects <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547729">28% of Australians</a>. It is one of nine <a href="http://aihw.gov.au/national-health-priority-areas/">national priorities</a> in health.</p>
<p><a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551289">Some 20% of Aboriginal Australians</a> suffer long term musculoskeletal pain and to date it has received little attention or recognition.</p>
<p>Aboriginal Australians face many pressing health issues including a <a href="http://www.aihw.gov.au/deaths/life-expectancy/#indigenous">substantial gap in life expectancy</a>. Musculoskeletal pain does not commonly contribute to reduced life expectancy, unlike other conditions such as heart disease, diabetes, lung disease and cancer. </p>
<p>It makes sense to direct resources toward conditions that reduce life. But musculoskeletal pain causes substantial disability and suffering and is often present alongside other long term health conditions that cause death. For example 41% of individuals with heart disease and diabetes <a href="http://www.aihw.gov.au/chronic-diseases/comorbidity/">also report arthritis</a>, and 29% of people with diabetes <a href="http://www.aihw.gov.au/chronic-diseases/comorbidity/">report back pain</a>. </p>
<p>Musculoskeletal pain may prevent people from managing their other health issues. For example a person who has heart disease may not be able to exercise (which is a cornerstone of management) if they have a painful back or a stiff, painful osteoarthritic knee.</p>
<p>Musculoskeletal pain in Aboriginal people is an area that hasn’t received enough attention. This could be based on a couple of enduring myths.</p>
<h2>Myth 1: musculoskeletal pain has less of an impact on Aboriginal people</h2>
<p>Something we’ve often heard in clinical practice is that Aboriginal patients put up with pain, that they are tough, and inherently stoic. This has also been reported in research. For example a <a href="https://www.ncbi.nlm.nih.gov/pubmed/13575330">1958 study</a> stated Aboriginal people possess a “stoic indifference to pain, often commented on and displayed”.</p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pubmed/8779015">study</a> of low back pain in a remote central Australian community concluded that, despite almost half of community members reporting back pain when asked, few community members complained about it, ostensibly because low back pain was not considered to be a health issue.</p>
<p>However these findings differ markedly to what we have found. In <a href="https://www.ncbi.nlm.nih.gov/pubmed/22392923">one study</a> we talked to Aboriginal people about their low back pain. Aboriginal men and women talked about the impact of their pain on employment and sport (particularly men), family, daily functions, their emotions and cultural participation. </p>
<p>Cultural participation included the inability to “go bush” to connect to country and hunt, attend funerals, or cultural meetings. Another <a href="https://www.ncbi.nlm.nih.gov/pubmed/15124258">study</a> found 8% of residents in a Queensland semi-rural community were limited in their activities due to musculoskeletal pain.</p>
<p>Aboriginal people are <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442460004">1.5 times more likely</a> to have osteoarthritis than non-Aboriginal people, and have an overall higher burden of disease. This means instead of less impact, musculoskeletal pain is likely to be more complex and be of greater impact.</p>
<h2>Myth 2: Aboriginal people don’t want to access care</h2>
<p>Health access data would appear to support the myth that Aboriginal people with musculoskeletal pain don’t want health care. Compared to non-Aboriginal Australians, Aboriginal Australians are less than <a href="https://www.ncbi.nlm.nih.gov/pubmed/24127305">half as likely</a> to see a GP for knee osteoarthritis. They’re also between <a href="https://www.ncbi.nlm.nih.gov/pubmed/21299795">one fifth to one half</a> as likely to have hip or knee replacement surgery due to osteoarthritis, and <a href="http://www.aihw.gov.au/publication-detail/?id=60129547205">0.8 times as likely</a> to be hospitalised for musculoskeletal pain.</p>
<p>But reasons why Aboriginal people aren’t accessing care become more evident when you look at their experiences of health care for musculoskeletal pain. Experiences are often, but not exclusively, negative and this deters Aboriginal people from accessing care.</p>
<p><a href="http://www.racgp.org.au/afp/2014/may/i-can-sit-and-talk-to-her/">We found</a> poor quality or an absence of communication was a major reason Aboriginal people with low back pain chose not to access care.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25945587">Another study</a> found the attitude of health professionals deterred Aboriginal people from reporting pain, especially when Aboriginal patients felt they were being stereotyped or stigmatised.</p>
<p>Thus current evidence points to issues in the way care is delivered, rather than Aboriginal people with musculoskeletal pain not wishing to access care in itself.</p>
<h2>What does this mean for musculoskeletal pain?</h2>
<p>There needs to be more of a focus on musculoskeletal pain in Aboriginal communities. Researchers and health services need to examine the quality of care provided to Aboriginal people. For example <a href="https://www.ncbi.nlm.nih.gov/pubmed/26118466">a recent study</a> found Aboriginal people were 2.2 times more likely to be prescribed opioids (pain killers such as codeine) by GP trainees than non-Aboriginal patients. This is a concerning finding given the <a href="https://theconversation.com/can-we-curb-the-opioid-abuse-epidemic-by-rethinking-chronic-pain-52663">epidemic</a> of opioid dependence. </p>
<p>Health care services and practitioners need to critically examine how they are providing care. Ways of working in Aboriginal contexts including more effective <a href="http://www.publish.csiro.au/py/PY16051">communication</a> and realigning services to be <a href="https://search.informit.com.au/documentSummary;dn=955665869609324;res=IELFSC">more culturally secure</a> for Aboriginal people. This means health and community services are delivered in a way that ensures Aboriginal cultural rights, views and values are maintained.</p><img src="https://counter.theconversation.com/content/76390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivan Lin receives funding from Australia's National Health and Medical Research Council and is a member of the Australian Physiotherapy Association and Australian Pain Society. </span></em></p><p class="fine-print"><em><span>Juli Coffin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some 20% of Aboriginal Australians suffer long term musculoskeletal pain and to date it has received little attention or recognition.Ivan Lin, Senior Lecturer/NHMRC Early Career Research Fellow, The University of Western AustraliaJuli Coffin, Professor, Head of Campus, Director, University of Notre Dame AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673002016-11-24T19:25:06Z2016-11-24T19:25:06ZCan the way we move after injury lead to chronic pain?<figure><img src="https://images.theconversation.com/files/147308/original/image-20161124-15356-1tusozi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our brains tell our bodies to move differently when we have pain.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>When people suffer musculoskeletal pain – that is, pain arising from muscles, ligaments, bones or joints – they <a href="https://www.ncbi.nlm.nih.gov/pubmed/24709625">change the way they move</a>. Sometimes these changes include completely avoiding certain movements, and sometimes they are more subtle.</p>
<p>Someone with knee pain might walk with a limp, for instance, whereas someone with hand pain might pick up an object differently, while someone with neck pain might refrain from turning their head to one side. </p>
<p>Our brains tell our bodies to move differently when we have pain. But there is growing evidence that changing the way we move might actually contribute to the development of pain that lasts for months or years.</p>
<h2>Moving differently</h2>
<p>Whether changing the way you move when you have pain is helpful or harmful probably depends on how long you have been experiencing pain. </p>
<p>When pain is short-lived (minutes to hours), changes in the way we move are thought to protect us from further injury by restricting movement of the damaged part. </p>
<p>This important protective strategy is mirrored by altered activity in our brains. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/26913474">large body of evidence</a> shows that short-term pain causes a reduction in activity in the regions of our brains that control movement.</p>
<p>But for pain that lasts longer than a few days, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25609242">a recent study has shown</a> activity in the regions of our brain that control movement is actually increased - the opposite of what happens with pain lasting minutes or hours. </p>
<p>This is thought to reflect your brain’s search for a new way to move, now that the pain is not going away. This new way of moving likely aims to maximise your performance of daily activities while reducing pain as much as possible.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147318/original/image-20161124-15368-1dw15tv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Changes in the way we move are thought to protect us from further injury.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/8122113">changes we see in the brain</a> at this stage of pain are similar to when you are learning a new movement skill – such as a tennis backhand or tango dancing. This supports the idea that once pain has persisted for a few days, <a href="https://www.ncbi.nlm.nih.gov/pubmed/7500130">your brain’s goal</a> is to learn to move differently.</p>
<p>So when pain has persisted for months or years, are changes in movement still helpful?</p>
<h2>Brain networks</h2>
<p>Changes to the way we move that are helpful in the early stages of pain may have negative long-term consequences.</p>
<p>For example, moving differently for a prolonged period of time will alter the loading on surrounding muscles, ligaments and joints, potentially adding more stress to the body region that was initially injured. </p>
<p>This may in turn lead to persistent or recurrent pain, perhaps interspersed with only short periods that are pain-free.</p>
<p>Evidence from several studies shows that people who have been experiencing pain for more than three months <a href="https://www.ncbi.nlm.nih.gov/pubmed/25102290">frequently use more simple ways of moving</a> (see also <a href="https://www.ncbi.nlm.nih.gov/pubmed/25893342">here</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/21508892">here</a>). </p>
<p>For example, when climbing stairs, people with pain on the outside of the hip move their hips, trunk and pelvis <a href="https://www.ncbi.nlm.nih.gov/pubmed/27816023">differently to people without pain</a>. People with persistent elbow pain, meanwhile, show <a href="https://www.ncbi.nlm.nih.gov/pubmed/27179317">changes in muscle coordination</a> while gripping an object. </p>
<p>These more simple ways of moving ultimately result in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25893342">fewer peaks in brain activity</a> than usual. This is similar to what happens when you have perfected your tennis backhand and the skill becomes more automatic, suggesting that simplified ways of moving might become ingrained in the brains of those with long-term pain.</p>
<p>Importantly, <a href="https://www.ncbi.nlm.nih.gov/pubmed/19186001">changes in movement persist</a> in people who have recurring episodes of pain even when these people are usually pain-free. As a result, it <a href="https://www-ncbi-nlm-nih-gov.ezproxy.library.uq.edu.au/pubmed/21306915">has been suggested</a> that moving differently, even when free of pain, could predispose you to another episode of pain. </p>
<p>Although we need more research to confirm this link, it is clear that there is a relationship between movement and pain.</p>
<p>Treatments that aim to retrain they way we move, such as physical activity and exercise, are the cornerstone of treatment in musculoskeletal pain. Yet the type, duration and quantity of activity or exercise needed to promote recovery from pain is surprisingly unclear. </p>
<p>We know that moving too little or too much can each have negative consequences for people in pain. But we need more research to understand exactly why people move differently when in pain, and how we can use this to treat or perhaps even prevent persistent pain in future.</p><img src="https://counter.theconversation.com/content/67300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siobhan Schabrun receives funding from The National Health and Medical Research Council of Australia.</span></em></p>Our brains tell our bodies to move differently when we have pain. And there is emerging evidence to show changing how we move could actually contribute to the development of chronic pain.Siobhan Schabrun, Research Fellow in Brain Plasticity and Rehabilitation, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/475622015-12-08T19:12:56Z2015-12-08T19:12:56ZSociety is also to blame for thalidomiders’ worsening health<figure><img src="https://images.theconversation.com/files/102586/original/image-20151120-10414-1adagwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fewer than 3,000 thalidomide survivors are alive today.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/shankbone/6179642170/in/photolist-fFxaYR-bjhCnK-dbvsSA-dbvsQd-4q4mXi-fHEYxH-9VgFsy-aq5hjE-atDsVx-4RHi1M-6nqtot-6nuDim-6nuCpb-x842So-6nuDjw-6nuCPS-TECo1-EgG7q-4RMDum-a96Rfj-bjhR1z-ecmdaE-7wwzT3-8yc7kE-4pbUtb-4RHoVa-7y3QwM-6xcF5U-8NxJ6R-7o28p5-5vopM1-bT66D-7zbmGD-6nuC1m-iKQUFL-rhFRL-4ny7Fg-7LpCXQ-j6F7n-xvAUg-9eAXcB-FWb6z-5JYSS8-rAwBgw-4DDWR8-7mn8Hm">David Shankbone/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Thalidomide was sold in the 1950s and 60s, initially as a sleeping pill and later to alleviate morning sickness. But when women took the drug during certain stages of their pregnancy, it had the potential to <a href="http://toxsci.oxfordjournals.org/content/122/1/1.full.pdf+html">interfere with the development</a> of the embryo or foetus.</p>
<p>Depending on the stage of embryo or foetal development at which the drug was taken, babies were born with morphological differences such as missing or shortened limbs; or differences to the ears, or internal organs.</p>
<p>In a large number of cases, if thalidomide was taken during the stage when essential organs were developing, the foetus was <a href="http://www.peoplesrecord.org.uk/items/show/4332">stillborn</a>.</p>
<p>Worldwide, around 12,000 babies were born with body differences resulting from their mother taking the drug. It is estimated <a href="http://www.bbc.com/news/magazine-15536544">fewer than 3,000</a> are alive today. Their <a href="http://www.researchgate.net/publication/49806795_What_has_happened_to_people_affected_by_thalidomide_50_years_on">health is rapidly deteriorating</a>, and many experience reduced mobility, joint degradation and chronic pain.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102599/original/image-20151120-10452-aq85ui.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many children affected by thalidomide were bullied at school and learnt coping mechanisms to get by.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/vivacomopuder/2531635433/in/photolist-fFxaYR-bjhCnK-dbvsSA-dbvsQd-4q4mXi-fHEYxH-9VgFsy-aq5hjE-TECo1-atDsVx-EgG7q-4RMDum-a96Rfj-bjhR1z-ecmdaE-x842So-4pbUtb-4RHi1M-7wwzT3-8yc7kE-6nqtot-6nuDim-6nuCpb-6nuDjw-6nuCPS-6nuC1m-rhFRL-6xcF5U-j6F7n-xvAUg-9eAXcB-5vopM1-7zbmGD-5JYSS8-4DDWR8-iKQUFL-4RHoVa-4ny7Fg-7LpCXQ-7y3QwM-8NxJ6R-7o28p5-bT66D-FWb6z-rAwBgw-7mn8Hm">Luciana Christante/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Thalidomide narratives focus mostly on the “tragedy” of the drug’s effects. But soceity’s reactions to thalidomiders’ bodies and needs significantly contributed – and continue to contribute – to their negative well-being and worsening health.</p>
<h2>Society’s reaction</h2>
<p>Although improving today, public perception of thalidomiders has been extremely negative since they were born. This quote, from the 2001 book <a href="http://www.amazon.com/Dark-Remedy-Thalidomide-Revival-Medicine/dp/0738205907">Dark Remedy: the impact of thalidomide and its revival as a vital medicine</a>, paints a good picture of societal reactions to thalidomiders’ unique appearance:</p>
<blockquote>
<p>How did parents endure the shock of the birth of a thalidomide baby? The few who made it through without enormous collateral damage to their lives had to summon up the same enormous reserves of courage and devotion that are necessary to all parents of children with special needs and disabilities; then, perhaps, they needed still more courage, because of the special, peculiar horror that the sight of their children produced in even the most compassionate.</p>
</blockquote>
<p>People were shocked by the emergence of thalidomiders. Some researchers argue their appearance made abortion more acceptable.
<a href="http://shm.oxfordjournals.org/content/25/4/863.abstract">One study</a>, for instance, stated that the number of thalidomide babies born in the late 1960s in South Australia “greatly assisted the prominence given to the issue” of abortion reform. </p>
<p>Euthanasia was also on the cards for dealing with thalidomide “babies”. Some parents engaged in so-called <a href="https://news.google.com/newspapers?nid=950&dat=19621106&id=aUdQAAAAIBAJ&sjid=-lYDAAAAIBAJ&pg=6582,682458&hl=en">“mercy killings”</a> by giving their child barbiturates (heavy sedatives), for instance.</p>
<p>But other parents were able <a href="http://prism.ucalgary.ca/bitstream/1880/49886/1/parentswithout%20prejudice.pdf">to resist the negative reactions</a> to thalidomiders and become advocates for their child. They set their children up for a better future. Having loving and accepting parents meant the child would more likely end up in a regular school, for instance, and be supported to develop coping mechanisms to deal with their future challenges. </p>
<h2>Thalidomiders’ struggles</h2>
<p>There is a basic understanding about how humans should perform everyday tasks using their arms and legs. So it remains difficult for people to accept individuals who eat with their feet and get around by crawling, rather than walking.</p>
<p>When thalidomiders reached school age, the negative attitudes towards them manifested in schoolyard bullying. Many <a href="https://www.qld.gov.au/disability/children-young-people/bullying-disability-mental-health/">disabled children experience bullying</a> and some researchers argue the problem is <a href="http://www.anti-bullyingalliance.org.uk/media/2242/bullying-and-disability.pdf">growing</a>.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102597/original/image-20151120-10438-rs5pji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many thalidomiders overcame barriers, such as British comedian Mat Fraser.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/slipperroomnyc/13771676354">slipperroom/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>As thalidomiders grew up, many exhibited <a href="http://poi.sagepub.com/content/31/2/147.full">low self-esteem</a> and a <a href="http://poi.sagepub.com/content/31/2/147.full">lack of confidence</a>. Because of missing limbs, many struggled to gain independence, especially when their physical environment – such as homes, stairs and public transport – were not tailored to their difference.</p>
<p>Thalidomiders’ unique ways affected <a href="http://poi.sagepub.com/content/31/2/147.full">employment</a> prospects and work relationships. Many had to develop <a href="http://poi.sagepub.com/content/31/2/147.full">more coping mechanisms</a> as adults to deal with negative reactions at work.</p>
<p>Of course, there are those who made it in the system the despite barriers and some reached great heights in their professions, such as German Opera singer <a href="http://www.thomas-quasthoff.com/">Thomas Quasthoff</a> and British comedian <a href="http://matfraser.co.uk/">Mat Fraser</a>.</p>
<h2>Worsening health</h2>
<p>Thalidomiders today have rapidly worsening health issues. Because some body parts were <a href="http://poi.sagepub.com/content/31/2/147.full">overused</a> to compensate for missing limbs and to compensate, in part, for the lack of social accommodations (including adaptations of the physical environment), the body’s natural degradation occurred faster than in the general ageing population. This was particularly acute for the musculoskeletal system.</p>
<p>One <a href="https://www.conterganstiftung.de/fileadmin/de.conterganstiftung/content.de/Downloads/Aufgaben/Projektfoerderung/Contergan_Endbericht_Universitaet_Heidelberg.pdf">study from Germany</a> – that surveyed thalidomiders between 2010 and 2012 who were between 50 and 55 years old – showed the percentage of those who couldn’t work had increased from 7% in 1985 to more than 30% in 2011.</p>
<p>The study <a href="https://www.conterganstiftung.de/fileadmin/de.conterganstiftung/content.de/Downloads/Aufgaben/Projektfoerderung/Contergan_Endbericht_Universitaet_Heidelberg.pdf">also showed</a> the quality of life of these thalidomiders in their 50s was comparable to that of an 80-year-old; mostly due to health issues and pain. </p>
<p>This study triggered a response by the German parliament that led to an <a href="http://www.reuters.com/article/2013/04/26/germany-thalidomide-idUSL6N0C55SD20130426">increase in financial support</a> for thalidomiders in Germany. </p>
<p>Another <a href="http://www.thalidomide.ca/filesNVIAdmin/File/TVACs%20Study.pdf">2013 study from Canada</a> showed 64.1% of respondents were employed in 2013, compared to <a href="http://www.thalidomide.ca/thalidomide-survivors-survey/">73.3%</a> in 1999. </p>
<p>The study also found that the fear of needing to permanently quit their jobs due to deteriorating health played on the minds of 31% of respondents. And 17% said they were no longer able to hold down a job due to their thalidomide-related health problems. This is concerning, as most rely on their income to meet their unique needs.</p>
<p>The Canadian studies, as with the German study, were part of lobbying efforts to obtain adequate support from the Canadian government. The campaign was a success and this year, the Canadian government <a href="http://www.theglobeandmail.com/news/national/understanding-canadas-thalidomide-compensation-deal/article24578777/">increased support substantially</a> by offering, for the first time, a monthly payment for Canadian thalidomiders.</p>
<p>Although the physical difference of thalidomiders is the product of thalidomide, how society treated, treats and continues to treat thalidomiders also has a significant impact on their quality of life.</p>
<p><em>Stay tuned for other instalments in the <a href="https://theconversation.com/au/topics/thalidomide">thalidomide series</a> this week.</em></p><img src="https://counter.theconversation.com/content/47562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregor Wolbring is a thalidomider and is Vice President of the Thalidomide Victim Association of Canada. </span></em></p>Reactions to the thalidomiders’ difference contributed – and continue to contribute – to their negative well-being and deteriorating health.Gregor Wolbring, Associate Professor, Cumming School of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.