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The internet is worse than it used to be. How did we get here, and can we go back?

<p><em><a href="https://theconversation.com/profiles/marc-cheong-998488">Marc Cheong</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/wonsun-shin-1300054">Wonsun Shin</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722"><em>The University of Melbourne</em></a></em></p> <p>When it comes to our experience of the internet, “the times, <a href="https://en.wikipedia.org/wiki/The_Times_They_Are_a-Changin%27_(song)">they are a-changin’</a>”, as Bob Dylan would say. You can’t quite recall how, but the internet certainly feels different these days.</p> <p>To some, it is “<a href="https://www.npr.org/2024/01/16/1224878097/everyday-users-are-complaining-that-the-internet-is-more-chaotic-than-ever">less fun and less informative</a>” than it used to be. To others, online searches are made up of “<a href="https://www.theverge.com/c/23998379/google-search-seo-algorithm-webpage-optimization?src=longreads">cookie cutter</a>” pages that drown out useful information and are saturated with scams, spam and content generated by artificial intelligence (AI).</p> <p>Your social media feeds are full of eye-catching, provocative, hyper-targeted, or anger-inducing content, from <a href="https://theconversation.com/the-dead-internet-theory-makes-eerie-claims-about-an-ai-run-web-the-truth-is-more-sinister-229609">bizarre AI-generated imagery</a> to robot-like comments. You’re lucky if your video feeds are not solely made up of exhortations to “subscribe”.</p> <p>How did we get here? And can we claw our way back?</p> <h2>Commercial interests rule</h2> <p>One major factor contributing to the current state of the internet is its over-commercialisation: financial motives drive much of the content. This has arguably led to the prevalence of sensationalism, prioritising virality over information quality.</p> <p>Covert and deceptive advertising is widespread, blurring the line between commercial and non-commercial content to attract more attention and engagement.</p> <p>Another driving force is the dominance of tech giants like Google, Meta and Amazon. They reach billions worldwide and wield immense power over the content we consume.</p> <p>Their platforms use advanced tracking technologies and opaque algorithms to generate hyper-targeted media content, powered by extensive user data. This creates <a href="https://www.campaignasia.com/article/the-echo-chamber-effect-how-algorithms-shape-our-worldview/491762">filter bubbles</a>, where users are exposed to limited content that reinforces their existing beliefs and biases, and <a href="https://philarchive.org/archive/NGUECA">echo chambers</a> where other viewpoints are actively discredited.</p> <p>Bad actors like <a href="https://abcnews.go.com/Technology/ai-fuel-financial-scams-online-industry-experts/story?id=103732051">cyber criminals and scammers</a> have been an enduring problem online. However, evolving technology like generative AI has further empowered them, enabling them to create highly realistic fake images, deepfake videos and <a href="https://www.newyorker.com/science/annals-of-artificial-intelligence/the-terrifying-ai-scam-that-uses-your-loved-ones-voice">voice cloning</a>.</p> <p>AI’s ability to automate content creation has also flooded the internet with low-quality, misleading and harmful material at an unprecedented scale.</p> <p>In sum, the accelerated commercialisation of the internet, the dominance of media tech giants and the presence of bad actors have infiltrated content on the internet. The rise of AI further intensifies this, making the internet more chaotic than ever.</p> <h2>Some of the ‘good’ internet remains</h2> <p>So, what was the “good internet” some of us long for with nostalgia?</p> <p>At the outset, the internet was meant to be a free egalitarian space people were meant to “surf” and “browse”. Knowledge was meant to be shared: sites such as Wikipedia and The Internet Archive are continuing bastions of knowledge.</p> <p>Before the advent of filter bubbles, the internet was a creative playground where people explored different ideas, discussed varying perspectives, and collaborated with individuals from “outgroups” – those outside their social circles who may hold opposing views.</p> <p>Early social media platforms were built on the ethos of reconnecting with long-lost classmates and family members. Many of us have community groups, acquaintances and family we reach out to via the internet. The “connection” aspect of the internet remains as important as ever – as we all saw during the COVID pandemic.</p> <p>What else do we want to preserve? Privacy. A New Yorker cartoon joke in 1993 stated that “<a href="https://web.archive.org/web/20051029045942/http://www.unc.edu/depts/jomc/academics/dri/idog.html">on the internet, nobody knows you’re a dog</a>”. Now everyone – especially advertisers – wants to know who you are. To quote the <a href="https://www.oaic.gov.au/privacy/your-privacy-rights/your-personal-information/what-is-privacy">Office of the Australian Information Commissioner</a>, one of the tenets of privacy is “to be able to control who can see or use information about you”.</p> <p>At the very least, we want to control what big tech knows about us, especially if they could stand to profit from it.</p> <h2>Can we ever go back?</h2> <p>We can’t control “a changin’” times, but we can keep as much of the good parts as we can.</p> <p>For starters, we can vote with our feet. Users can enact change and bring awareness to problems on existing platforms. In recent times, we have seen this with the <a href="https://theconversation.com/thinking-of-breaking-up-with-twitter-heres-the-right-way-to-do-it-195002">exodus of users</a> from X (formerly Twitter) to other platforms, and the <a href="https://www.economist.com/the-economist-explains/2023/06/26/why-reddit-users-are-protesting-against-the-sites-leadership">platform-wide protest against Reddit</a> for changing its third-party data access policies.</p> <p>However, voting with our feet is only possible when there’s competition. In the case of X, various other platforms – from Mastodon to Threads to Bluesky – enable users to pick one that aligns with their preferences, values and social circles. Search engines have alternatives, too, such as DuckDuckGo or Ecosia.</p> <p>But competition can only be created by moving to decentralised systems and removing monopolies. This actually happened in the early days of the internet during the 1990s “<a href="https://thehistoryoftheweb.com/browser-wars/">browser wars</a>”, when Microsoft was eventually accused of illegally monopolising the web browser market in <a href="https://en.wikipedia.org/wiki/United_States_v._Microsoft_Corp.">a landmark court case</a>.</p> <p>As users of technology, all of us must remain vigilant about threats to our privacy and knowledge. With cheap and ubiquitous generative AI, misleading content and scams are more realistic as ever.</p> <p>We must exercise healthy scepticism and ensure those most at risk from online threats – such as children and older people – are educated about potential harms.</p> <p>Remember, the internet is not optimised for your best interests. It’s up to you to decide how much power you give to the tech giants who are fuelling theirs.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/marc-cheong-998488">Marc Cheong</a>, Senior Lecturer of Information Systems, School of Computing and Information Systems; and (Honorary) Senior Fellow, Melbourne Law School, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/wonsun-shin-1300054">Wonsun Shin</a>, Associate Professor in Media and Communications, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-internet-is-worse-than-it-used-to-be-how-did-we-get-here-and-can-we-go-back-236513">original article</a>.</em></p>

Technology

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MSG is back. Is the idea it’s bad for us just a myth or food science?

<p><em><a href="https://theconversation.com/profiles/evangeline-mantzioris-153250">Evangeline Mantzioris</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>MSG is making a comeback. The internet’s favourite cucumber salad recipe includes fish sauce, cucumber, garlic and – as the video’s creator Logan tells us with a generous sprinkle from the bag – “MSG, obviously”.</p> <p>But for many of us, it’s not obvious. Do you have a vague sense MSG is unhealthy but you’re not sure why? Here is the science behind monosodium glutamate, how it got a bad rap, and whether you should add it to your cooking.</p> <h2>What is MSG?</h2> <p>Monosodium glutamate (MSG) is a sodium salt of glutamic acid, one of the amino acids that make up proteins.</p> <p>It occurs naturally in <a href="https://www.tandfonline.com/doi/full/10.1080/10942912.2017.1295260#d1e167">foods</a> such as mature cheeses, fish, beef, mushrooms, tomatoes, onion and garlic. It provides their savoury and “meaty” flavour, known as <a href="https://www.sciencedirect.com/science/article/pii/S0022316622140186">umami</a>.</p> <p>MSG has been used to season food for <a href="https://wjpsonline.com/index.php/wjps/article/view/effects-monosodium-glutamate-human-health-review">more than 100 years</a>. Traditionally it <a href="https://pubs.acs.org/doi/epdf/10.1021/ed081p347?ref=article_openPDF">was extracted</a> from seaweed broth, but now it’s made by fermenting starch in sugar beets, sugar cane and molasses.</p> <p>Today it’s widely used as a flavour enhancer in many dishes and pre-packaged goods, including soups, condiments and processed meats.</p> <p>There is no chemical difference between the MSG found in food and the additive.</p> <h2>Is it safe?</h2> <p>For most people, yes. MSG is a safe and authorised additive, according to the Australian agency that regulates food. This corresponds with food standards in the <a href="https://www.fda.gov/food/food-additives-petitions/questions-and-answers-monosodium-glutamate-msg">United States</a>, <a href="https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A02008R1333-20201223#tocId3">European Union and United Kingdom</a>.</p> <p>Two major <a href="https://www.foodstandards.gov.au/sites/default/files/consumer/additives/msg/Documents/MSG%20Technical%20Report.pdf">safety reviews</a> have been conducted: one in 1987 by a United Nations expert committee and another 1995 by the Federation of American Societies for Experimental Biology. Both concluded MSG was safe for the general population.</p> <p>In 2017 the <a href="https://www.efsa.europa.eu/en/efsajournal/pub/4910">European Food Safety Authority</a> updated its stance and set a recommended limit based on body weight, aimed to prevent headaches and increased blood pressure.</p> <p>That limit is still higher than most people consume. The authority says an 80kg person should not have more than 2.4g of added MSG per day. <a href="https://www.nature.com/articles/1602526">For reference</a>, Europeans average less than a gram per day (0.3-1 gram), while in Asia intake is somewhere between 1.2-1.7 grams a day.</p> <p>Food Standards Australia New Zealand says the European update does not raise any new safety concerns not already assessed.</p> <h2>Isn’t it bad for me?</h2> <p>Despite the evidence, the idea MSG is dangerous persists.</p> <p>Its notorious reputation can be traced back to a <a href="https://news.colgate.edu/magazine/2019/02/06/the-strange-case-of-dr-ho-man-kwok/">hoax letter</a> published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJM196805162782014">New England Journal of Medicine</a> in 1968. A doctor claiming to have experienced palpitations, numbness and fatigue after eating at a Chinese restaurant suggested MSG could be to blame.</p> <p>With a follow-up article in the <a href="https://www.nytimes.com/1968/05/19/archives/-chinese-restaurant-syndrome-puzzles-doctors.html">New York Times</a>, the idea of “Chinese Restaurant Syndrome” took off. Eating MSG was associated with a range of symptoms, including headache, hives, throat swelling, itching and belly pain.</p> <p>However an <a href="https://www.sciencedirect.com/science/article/pii/027869159390012N?via%3Dihub">early randomised control trial</a> showed no difference in these symptoms between people who were given MSG versus a placebo. This has since been confirmed in a <a href="https://ift.onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12448">review of many studies</a>.</p> <h2>Can MSG cause reactions?</h2> <p>A very small percentage of people may have hypersensitivities to MSG. The reported reaction is now known as MSG symptom complex, rather than so-called Chinese restaurant syndrome, with its <a href="https://www.jandonline.org/article/S2212-2672(21)00068-X/abstract#:%7E:text=A%20New%20York%20Times%20piece,connecting%20MSG%20to%20health%20outcomes.">problematic</a> racial connotations. Symptoms are usually mild, short-term and don’t need treatment.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S0091674999703714">One study</a> looked at 100 people with asthma, 30 of whom believed they had hypersensitivities to MSG. However when participants were blinded to whether they were consuming MSG, not one reported a reaction.</p> <p>If you believe you do react to added MSG, it’s relatively easy to avoid. In Australia, it is <a href="https://www.foodstandards.gov.au/consumer/additives/msg">listed</a> in ingredients as either monosodium glutamate or flavour enhancer 621.</p> <h2>Is it better than table salt?</h2> <p>Using MSG instead of regular salt may help <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893472/">reduce</a> your overall sodium intake, as MSG <a href="https://www.medicalnewstoday.com/articles/msg-what-the-science-says-about-its-safety#Uses-of-MSG">contains</a> about one third the amount of sodium.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/21372742/">One study</a> found people who ate soup seasoned with MSG rather than salt actually liked it more. They still found it salty to taste, but their sodium intake was reduced by 18%.</p> <p>MSG still contains sodium, so high use is associated with increased <a href="https://pubmed.ncbi.nlm.nih.gov/21372742/">blood pressure</a>. If you’re using MSG as a substitute and you have high blood pressure, you should closely monitor it (just as you would with other salt products).</p> <h2>Should I use MSG in my cooking?</h2> <p>If you want to – yes. Unless you are one of the rare people with hypersensitivities, enhancing the flavour of your dish with a sprinkle of MSG will not cause any health problems. It could even help reduce how much salt you use.</p> <p>If you’re <a href="https://www.tandfonline.com/doi/full/10.1080/25765299.2020.1807084#d1e199">vegetarian or vegan</a>, cooking with MSG could help add the umami flavour you may miss from animal products such as meat, fish sauce and cheese.</p> <p>But buying foods with added MSG? Be aware, many of them will also be <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/un-decade-of-nutrition-the-nova-food-classification-and-the-trouble-with-ultraprocessing/2A9776922A28F8F757BDA32C3266AC2A">ultra-processed</a> and it’s that – not the MSG – that’s associated with poor physical and mental <a href="https://www.mdpi.com/2072-6643/14/1/174">health outcomes</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237871/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/evangeline-mantzioris-153250">Evangeline Mantzioris</a>, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/msg-is-back-is-the-idea-its-bad-for-us-just-a-myth-or-food-science-237871">original article</a>.</em></p>

Food & Wine

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

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

Body

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"We should give back": Bill Gates' ex-wife on giving away her $16bn fortune

<p>Melinda French Gates has opened up on her decision to give away her fortune after leaving the Bill &amp; Melinda Gates Foundation in June. </p> <p>Melinda, who is reportedly worth $16.8 billion, said that she will stick with her decision to give away her fortune on <em>The Late Show with Stephen Colbert, </em> as it's "the right thing to do for society". </p> <p>"If we grew up in the United States, anybody who has grown up in this country has been really lucky and I don't care who you are," she explained.</p> <p>"To be able to go to a decent school, grow up and pursue your career, and if so you are a billionaire, my gosh, you have benefited from this country, right?</p> <p>"So we should give back."</p> <p>She also feels there is "a responsibility and to do it in a way that's incredibly thoughtful".</p> <p>Melinda, who divorced the Microsoft founder Bill Gates back in 2021, has announced her plans to focus on her organisation Pivotal Ventures, which she founded in 2015.</p> <p>The organisation's aim is to "advance social progress by removing barriers that hold people back."</p> <p>She said that she is  determined to ensure that "women's rights are not only on the agenda, but that women are setting the agenda" – especially after watching women's rights be rolled back internationally over the last few years."</p> <p>"What I saw, part of why our women's rights got rolled back in the United States is that those organisations were starved for funding, and they were playing defense," she explained. </p> <p>Melinda has pledged to donate $1 billion to this end over the next two years. </p> <p><em>Image: Julien De Rosa/EPA/ Shutterstock Editorial</em></p>

Money & Banking

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Susan Sarandon's daughter claps back at wedding dress critics

<p>Susan Sarandon's daughter has spoken out against body-shaming trolls who were criticising her wedding dress. </p> <p>Eva Amurri, who like her mum is also an actress, became the subject of online criticism after she shared photos from her wedding day online. </p> <p>Writing on her blog <em>Happily Eva After </em>the 39-year-old admitted that the comments left her in tears, "in a way that brought me right back to Middle School".</p> <p>"Here were people I didn't even know and who didn't know me, spending time and energy typing something that they hoped would bring me one thing and one thing only: Shame," she recalled the moment she came across the "hundreds of cruel comments". </p> <p>"It wasn't what they were saying per se, I've had much more horrible things directed at me on the internet, but it was the yucky feeling of knowing that there are people out there (and lots of them!) whose immediate reaction upon witnessing my little family's joy was to try to hurt us."</p> <p>She continued to explain that she was shocked that her wedding photos had gone viral due to something beyond her control. </p> <p>"I was so taken aback by the fact that it was already viral... and for two reasons completely out of my control: My Breasts," she wrote.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/C82pK8juxqM/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C82pK8juxqM/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by People Magazine (@people)</a></p> </div> </blockquote> <p>"I've always been naturally very large-chested, and my breast size fluctuates with my weight (as real breasts often do)," she wrote, adding that she is a mother of three and she had breastfed all of her children. </p> <p>"Are my breasts the same perkiness they were at 20 years old before they sustained human life three times over? Definitely not. Do I care? Some days more than others. But my body isn't something I'm ashamed of."</p> <p>She then said that she chose the dress because she wanted to feel "sexy and elegant" on her special day. </p> <p>"I had purposefully gone into my wedding dress shopping wanting to show my figure and really celebrate myself as a woman - body parts included," she shared.</p> <p>"It had never occurred to me that people I don't even know would find my body so offensive, and especially that they would care so much about what I would choose to wear on my own wedding day."</p> <p>She then criticised the online trolls for their "embarrassing" behaviour and how unfortunate it was that women still experience this kind of criticism. </p> <p>"You don't need anybody's permission to make the choices you make for yourself," she wrote.</p> <p>"And when people feel something about those choices? Well, that's none of your business."</p> <p><em>Images: Instagram</em></p> <p> </p>

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Walking can prevent low back pain, a new study shows

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

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Terminal lucidity: why do loved ones with dementia sometimes ‘come back’ before death?

<p><em><a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”.</p> <p>Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members.</p> <p>Since as early as the <a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">19th century</a>, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals.</p> <p>It is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/20010032/">43% of people</a> who experience this brief lucidity die within 24 hours, and 84% within a week.</p> <p>Why does this happen?</p> <h2>Terminal lucidity or paradoxical lucidity?</h2> <p>In 2009, researchers Michael Nahm and Bruce Greyson coined the term “<a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">terminal lucidity</a>”, since these lucid episodes often occurred shortly before death.</p> <p>But not all lucid episodes indicate death is imminent. <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13667">One study</a> found many people with advanced dementia will show brief glimmers of their old selves more than six months before death.</p> <p>Lucidity has also been <a href="https://www.sciencedirect.com/science/article/pii/S0167494311001865?via%3Dihub">reported</a> in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury.</p> <p>Moments of lucidity that do not necessarily indicate death are sometimes called <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12579">paradoxical lucidity</a>. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia.</p> <p>But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease.</p> <h2>Why does terminal lucidity happen?</h2> <p>Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that <a href="https://psywb.springeropen.com/articles/10.1186/s13612-014-0024-5">music can sometimes improve lucidity</a>. But many episodes of lucidity do not have a distinct trigger.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S0300957223002162">A research team from New York University</a> speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost.</p> <p>Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger.</p> <p>And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred.</p> <p>Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife.</p> <h2>Why is it important to know about terminal lucidity?</h2> <p>People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person.</p> <p>Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person.</p> <p>For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/202342/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/yen-ying-lim-355185"><em>Yen Ying Lim</em></a><em>, Associate Professor, Turner Institute for Brain and Mental Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/terminal-lucidity-why-do-loved-ones-with-dementia-sometimes-come-back-before-death-202342">original article</a>.</em></p>

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Surgery won’t fix my chronic back pain, so what will?

<p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a></em></p> <p>This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.</p> <p>The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.</p> <p><a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs.</p> <p>The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?</p> <h2>Opioids and invasive procedures</h2> <p>Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.</p> <p><a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.</p> <h2>Addressing the contributors to pain</h2> <p>Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:</p> <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> <p>Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.</p> <p>The interventions have minimal side effects and are cost-effective.</p> <p>In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.</p> <p>In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.</p> <h2>Why isn’t everyone with chronic pain getting this care?</h2> <p>While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150.</p> <p>In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.</p> <p>Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.</p> <p>Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.</p> <p>Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.</p> <h2>So what can we do about it?</h2> <p>We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.</p> <p>Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.</p> <p>Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/christine-lin-346821"><em>Christine Lin</em></a><em>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.</em></p>

Body

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Legendary Star Wars and James Bond actor passes away

<p>The galaxy far, far away has dimmed a little with the passing of Michael Culver, a distinguished British actor whose name became etched in the annals of cinematic history, particularly for his role in the iconic 1980 film <em>Star Wars: Episode V - The Empire Strikes Back</em>.</p> <p>Culver, who portrayed Captain Needa, the unfortunate Imperial officer, met his demise in one of the franchise's most memorable scenes at the hands of Darth Vader. However, his legacy extends far beyond the realms of science fiction, encompassing a career spanning over five decades of stage, screen and political activism.</p> <p>Born in 1938 in Hempstead, North London, to esteemed parents within the theatre industry, Culver was destined for a life under the spotlight. His father, Roland Culver, was a notable West End stage actor, while his mother, Daphne Rye, served as a casting director in London-based theatre. Following in their footsteps, Culver honed his craft at the London Academy of Music and Dramatic Art, laying the foundation for a prolific acting career.</p> <p>Culver's journey in the performing arts began in the late 1950s, with appearances on Broadway in Shakespearean classics such as <em>King Henry V</em>, <em>Hamlet</em>, and <em>Twelfth Night</em>. His talent soon graced the West End stage in 1962, marking the start of a distinguished theatrical career. Transitioning to the small screen, Culver made his onscreen debut in 1961, captivating audiences with his versatile performances in British television series and movies.</p> <p>However, it was Culver's portrayal of Captain Needa in <em>The Empire Strikes Back</em> that solidified his status as a cultural icon. Despite his character's brief appearance, Culver left an indelible mark on audiences worldwide, immortalised in one of cinema's most unforgettable moments. His confrontation with Vader, culminating in a chilling demise, remains etched in the memories of countless fans, a testament to Culver's ability to captivate audiences with his presence.</p> <p>Beyond his intergalactic exploits, Culver's talents graced a multitude of productions, including notable roles in <em>Sherlock Holmes, A Passage to India</em>, <em>Secret Army, </em>and even appearing in two James Bond movies – <em>From Russia With Love </em>and <em>Thunderball</em> – in uncredited roles. His versatility and dedication to his craft earned him admiration and respect from peers and audiences alike. Yet, Culver's contributions extended beyond the realms of entertainment; in the early 2000s, he shifted his focus to political activism, leveraging his platform to advocate for causes close to his heart.</p> <p>Despite bidding farewell to the limelight, Culver's legacy endures through the countless lives he touched and the memories he forged on stage and screen.</p> <p>An extended message on the Alliance Agents Facebook page, who represented Culver, read as follows:</p> <p>"We are very sad to confirm the passing of our friend and client Michael Culver. A career spanning over 50 years with notable roles in Sherlock Holmes, A Passage to India, Secret Army and of course one of the most memorable death scenes in the Star Wars franchise. Michael largely gave up acting in the early 2000's to concentrate his efforts into his political activism. It's been an honor to have represented Michael for for the last decade and to have taken him to some of the best Star Wars events in the UK and Europe.  A real highlight was taking Michael to Celebration in Chicago in 2019.  He was lost for words when he saw his queue line with nearly 200 people waiting to see him. We worked with Michael just 3 weeks ago at his last home signing with our friends at Elite Signatures. Michel died on Tuesday 27th February at the age of 85."  </p> <p>"We miss him."</p> <p>His passing leaves a void in the hearts of fans and colleagues, a reminder of the fleeting nature of life's curtain call. As we reflect on his remarkable journey, let us celebrate the life and legacy of Michael Culver, an actor whose talents transcended galaxies and whose spirit will continue to inspire generations to come.</p> <p>In his memory, let us heed the timeless words of Captain Needa himself: "We shall double our efforts."</p> <p>Rest in peace, Michael Culver. The force will always be with you.</p> <p><em>Images: IMDB / Wookiepedia</em></p>

Caring

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Bold idea sees hotel offer thousands in cash back if it rains

<p>In a move that's making waves in the travel industry, a posh hotel in the heart of Singapore has rolled out a revolutionary offer: rain insurance. Yes, you heard it right – rain insurance!</p> <p>InterContinental Singapore, a sanctuary for jet-setters seeking respite from both the humidity and the occasional tropical deluge, has unleashed a game-changer for travellers. Dubbed the "Rain Resist Bliss Package", this offer promises to keep your spirits high even when the rain gods decide to throw a dampener on your plans.</p> <p>Picture this: you've booked your suite at this 5-star haven, eagerly anticipating your Singapore escapade. But lo and behold, the forecast takes a turn for the soggy, threatening to rain on your parade – quite literally. Fear not, dear traveller, for with the Rain Resist Bliss Package, you can breathe easy knowing that if your plans get drenched, your wallet won't.</p> <p>Now, you might be wondering, how does this rain insurance work? Well, it's as simple as Singapore Sling on a sunny day. If the heavens decide to open up and rain on your parade for a cumulative 120 minutes within any four-hour block of daylight hours (that's 8am to 7pm for those not on island time), you're entitled to a refund equivalent to your single-night room rate. The package is available exclusively for suite room bookings starting from $SGD850 per night – so that’s around $965 rain-soaked dollars back in your pocket, no questions asked. No need to jump through hoops or perform a rain dance – just sit back, relax, and let the rain do its thing.</p> <p>And fret not about having to keep an eye on the sky – the clever folks at InterContinental Singapore have got you covered. They're tapping into the data from the National Environmental Agency Weather Station to automatically trigger those rain refunds. It's like having your own personal meteorologist ensuring that your plans stay as dry as your martini.</p> <p>But hey, if the rain does decide to crash your party, fear not! The hotel has an array of dining options to keep your tastebuds entertained while you wait for the clouds to part. And let's not forget, Singapore isn't just about sunshine and rainbows – there are plenty of indoor activities to keep you occupied, from feasting at Lau Pa Sat for an authentic hawker experience to retail therapy at Takashimaya.</p> <p>And here's a silver lining to those rain clouds: fewer tourists! That's right, while others might be scrambling for cover, you could be enjoying shorter lines, less crowded attractions, and even snagging better deals on accommodations. Plus, let's not overlook the fact that the rain brings a welcome respite from the tropical heat, making outdoor adventures all the more enjoyable once the showers subside.</p> <p>So, pack your umbrella and leave your worries behind. With InterContinental Singapore's Rain Resist Bliss Package, you can embrace the unpredictable and turn even the rainiest of days into a memorable adventure. After all, as they say, when life gives you lemons, make Singapore Slings and dance in the rain!</p> <p><em>Images: InterContinental Singapore / Getty Images</em></p>

International Travel

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

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

Body

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He's back! Charles and Camilla's secret "son" drops DNA bombshell

<p>The Australian man who has long claimed to be the secret child of King Charles and Queen Camilla has shared the details of a wild plot to extract his DNA. </p> <p>The 57-year-old man from Queensland revealed he was tracked down by an American woman, who claimed she was the illegitimate child of the late Prince Philip, and attempted to get a DNA sample from the man. </p> <p>Simon Dorante-Day has made headline around the world with his claims that he is the son of Charles and Camilla, which he says are the results of decades worth of research. </p> <p>“My grandmother, who had worked for the Queen, told me outright that I was Camilla and Charles’ son many times,” he said.</p> <p>Now, in an interview with <a href="https://7news.com.au/lifestyle/aussie-man-who-claims-to-be-charles-and-camillas-son-drops-biggest-ever-dna-bombshell-c-12788618" target="_blank" rel="noopener"><em>7News</em></a>, Dorante-Day shared the story of how he was tracked down by the American woman, who knocked on his door in the early hours of the morning on December 2nd. </p> <p>The 57-year-old and his wife Elvianna were immediately skeptical of the woman, who said she used a private investigator to track him down. </p> <p>“This woman claimed that she was the secret illegitimate daughter of Prince Philip who lived in San Francisco,” Dorante-Day said.</p> <p>“She explained that she had travelled from the US after hiring an investigator to track me down in Queensland. The whole purpose of her visit was to ask me for a sample of my DNA."</p> <p>“She wanted to compare it to hers, to basically prove that we were both related to the royal family.”</p> <p>After humouring the woman and letting her share her evidence along with her elaborate story, Simon concluded that the whole thing was a scam, along with an illegal attempt to extract his DNA.</p> <p>“This woman had a lot of so-called proof to back up her claims, but the whole thing just seemed really fishy,” he said.</p> <p>He recalled how the woman shared her own adoption story, which resulted in her turning to the FBI for help, who allegedly handed her her original birth certificate, which listed Prince Philip as her father. </p> <p>“Of course my bulls*** meter is flying off the handle at this point. I know how hard it is to get any government authority to address these sorts of issues — I hardly think the Federal Bereau of Investigation would just offer up the fact that she was the daughter of the Queen’s late husband," Simon said. </p> <p>“It was all just wild.”</p> <p>The Queensland father and grandfather said it wasn’t long until the woman gave away her real reason for wanting his DNA: money.</p> <p>“She said that she’s already been given a large payout from the royal family after she proved she was the daughter of Prince Philip,” he said.</p> <p>“And she felt that if she was able to compare my DNA to her DNA, and prove we were both descendants of the royal family, then we could ask them for even more money."</p> <p>“Elvianna and I told her what we’ve said to everyone from day one — this isn’t about money for us, at all. This is about us finding out who my birth parents are and protecting my family. We have never wanted money.”</p> <p>After saying goodbye to the pair, Dorante-Day said he and his wife were left reeling.</p> <div> <p>“At the end of the day, this was an illegal attempt to procure my DNA,” he said. </p> <p>Despite the whole experience leaving Dorante-Day and his wife rattled, he said his stance on proving that he is Charles and Camilla's son has not changed. </p> <p>“It takes a lot of work, money and time to build a case like this, but I am confident I will get there,” he said.</p> <p>“I know Charles and Camilla are my parents and I’m ready to prove it.”</p> <p><em>Image credits: Supplied</em></p> </div>

Family & Pets

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Couple misses their own wedding after cruise ship forced to turn back

<p>A couple has missed their own dream destination wedding after their cruise ship was denied entry into New Zealand. </p> <p>Janine Sherriff and Kyle Risk dreamed of exchanging rings at the popular Lord of the Rings filming location, Hobbiton, located on the north island of New Zealand. </p> <p>The couple were meant to meet up with some close friends and family in New Zealand, as they travelled across from Australia on a P&amp;O cruise ship, but were turned back from docking over an unclean hull. </p> <p>The “Kiwi Adventure” cruise, which was meant to be a 13-day journey, turned into more of a Tasmanian adventure after the ship was told to head to Australia’s southernmost state instead.</p> <p>New Zealand’s biosecurity laws were triggered over just three juvenile mussels and one single hydroid (AKA: lace coral), which needed to be removed from the ship's hull. </p> <p>“We took the time off from work, we had our nearest and dearest friends and family all co-ordinate to be in New Zealand at this exact time,” Janine told the <em><a href="https://www.abc.net.au/news/2023-11-25/cruise-ship-turned-away-from-nz/103151078">ABC</a></em>.</p> <p>“The plan was to get off the boat, go straight to Hobbiton, have our wedding, then head straight back to the boat for the rest of the honeymoon.”</p> <p>“Now we have to figure out what to do about our wedding, we have all this money down the drain. I am heartbroken this day has been taken away from me."</p> <p>Kyle added, “First off, I was furious.” </p> <p>“I saw Janine’s face when we got the news. I was ready to explode.</p> <p>“I got a selfie from our family and friends at the site in Hobbiton we should have been on about 20 minutes before we had to turn around.”</p> <p>“It would have meant a lot as it was a beautiful setting. As long as we have each other,” he added.</p> <p>The cruise operator in charge of the vessel, P&amp;O, has offered customers $300 in on-board credit and a 50 per cent credit on a future cruise.</p> <p>“We apologise for the change in itinerary and thank our guests for their patience and understanding,” a spokesperson for the company’s Australian division said per the <em><a href="https://www.dailymail.co.uk/news/article-12791331/Engaged-couple-P-O-cruise-forced-turn-New-Zealand-fume-dream-Lord-Rings-wedding-ruined.html">Daily Mail</a></em>.</p> <p><em>Image credits: Facebook / Shutterstock</em></p>

Travel Trouble

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How to get rid of sciatica pain: solutions from back experts

<p><strong>The scoop on sciatica pain</strong></p> <p>Fun fact: The sciatic nerve is the largest nerve in the human body. It runs from the lower back down each side of your body, along the back of the hips, butt cheeks, and knees, down the back of the calf, and into the foot. It provides both sensory and motor nerve function to the legs and feet.</p> <p>Not-so-fun fact: Sometimes this nerve can get compressed in the spine at one of the roots – where it branches off the spinal cord – and cause pain that radiates down the length of the nerve. This is a dreaded condition known as sciatica. It is estimated that between 10 and 40 percent of people will experience sciatica in their lifetime.</p> <p>“Sciatica is the body telling you the sciatic nerve is unhappy,” says E. Quinn Regan, MD, an orthopaedic surgeon. “When the nerve is compressed at the root, it becomes inflamed, causing symptoms,” Dr Regan says. These symptoms can range from mild to debilitating.</p> <p>While sciatica can often resolve on its own, easing symptoms and feeling better usually requires some attention and careful behaviour modifications. Rarely, you may need more medical intervention to recover fully.</p> <p>Here’s everything you need to know about sciatica, including symptoms, how it’s diagnosed, how it’s treated, and what you can do to prevent it from recurring.</p> <p><strong>Symptoms of sciatica</strong></p> <p>Sciatica is quite literally a pain in the butt. The telltale symptom of sciatica is pain that radiates along the nerve, usually on the outside of the butt cheek and down the back of the leg. It usually only happens on one side of the body at a time. Sciatica doesn’t necessarily cause lower back pain, though it can.</p> <p>Dr Regan says that people with sciatica describe the pain as electric, burning, or stabbing, and in more severe cases, it can also be associated with numbness or weakness in the leg. If sciatica causes significant muscle weakness, to the point of losing function, and/or the pain is so bad you can’t function, it’s time to get immediate help, Dr Regan says.</p> <p>Another symptom that warrants a trip to the ER and immediate medical intervention: bowel or bladder incontinence. “That means there’s a massive compression, and the pressure is so severe it’s harming the nerves that go to the bowel and bladder,” says orthopaedic surgeon Dr Brian A. Cole. This is rare, but when it happens, it’s imperative to decompress the nerve immediately, he says.</p> <p><strong>The main causes of sciatica</strong></p> <p>The most common cause of sciatica is a herniated or slipped disc. A herniated or slipped disc happens when pressure forces one of the discs that cushion each vertebra in the spine to move out of place or rupture. Usually it’s caused when you lift something heavy and hurt your back, or after repetitive bending or twisting of the lower back from a sport or a physically demanding job.</p> <p>Sciatica also can be caused by:</p> <ul> <li>a bone spur (osteophyte), which can form as a result of osteoarthritis</li> <li>narrowing of the spinal canal (spinal stenosis), which happens with normal wear-and-tear of the spine and is more common in people over 60</li> <li>spondylolisthesis, a condition where one of your vertebrae slips out of place</li> <li>a lower back or pelvic muscle spasm or any sort of inflammation that presses on the nerve root</li> </ul> <p>Some people are born with back problems that lead to spinal stenosis at an earlier age. Other potential, yet rare, causes of sciatic nerve compression include tumours and abscesses.</p> <p><strong>Could it be piriformis syndrome?</strong></p> <p>Something known as piriformis syndrome can also cause sciatica-like symptoms, though it is not considered true sciatica. The piriformis is a muscle that runs along the outside of the hip and butt and plays an important role in hip extension and leg rotation.</p> <p>Piriformis syndrome is an overuse injury that’s common in runners, who repetitively strain this muscle, leading to inflammation and irritation. Because the muscle is so close to the sciatic nerve, piriformis syndrome can compress the nerve and cause a similar tingling, radiating pain as sciatica. The difference is that this pain is not caused by compression at the nerve root, but rather, irritation or pressure at some point along the length of the nerve.</p> <p><strong>Sciatica risk factors </strong></p> <p>Anyone can end up with a herniated disc and ultimately sciatica, but some people are more at risk than others. The biggest risk factor is age. “The discs begin to age at about age 30, and when this happens they can develop defects,” Dr Regan says. These defects slowly increase the risk of a disc slipping or rupturing.</p> <p>Men are three times more likely than women to have a herniated disc, Dr Regan says. Being overweight or obese also increases your chance of injuring a disc. A physically demanding job, regular strenuous exercise, osteoarthritis in the spine, and a history of back injury can also increase your risk. Sitting all day doesn’t help either, Dr Cole says. “You put more stress on your back biomechanically sitting than anything else you do.”</p> <p>Certain muscle weaknesses and imbalances can also make you more prone to disc injury and, consequently, sciatica. “People with weak core muscles and instability around the spine might be more prone to this since the muscles need to stabilise the joints of the vertebrae in which the nerves exit,” says Theresa Marko, an orthopaedic physical therapist.</p> <p><strong>How sciatica is diagnosed</strong></p> <p>If your symptoms suggest sciatica, your doctor will do a physical exam to check your strength, reflexes and sensation. A test called a straight leg raise can also test for sciatica, Dr Regan says. How it’s done: Patients lie face up on the floor, legs extended, and the clinician slowly lifts one leg up. At a certain point, it may trigger sciatica symptoms. (The test can also be done sitting down.)</p> <p>Depending on how severe the pain is and how long you’ve had symptoms, doctors may also do some scans (MRI or CT) on your spine to figure out what’s causing the sciatica and how many nerve roots are impacted.</p> <p>Scans can also confirm there isn’t something else mimicking the symptoms of sciatica. Muscle spasms, abscesses, hematomas (a collection of blood outside a blood vessel), tumours and Potts disease (spinal tuberculosis) can all cause similar symptoms.</p> <p><strong>Managing mild to moderate sciatica </strong></p> <p>Resting, avoiding anything that strains your back, icing the area that hurts, and taking nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen, are the first-line treatment options for sciatica, Dr Regan says. If you have a physically demanding job that requires you to lift heavy things, taking some time off, if at all possible, will help.</p> <p>While it’s important to avoid activities that might make things worse, you do want to keep moving, says Marko. “Research now advises against bed rest. You want to move without overdoing it.”</p> <p>A physical therapist can help you figure out what movements are safe and beneficial to do. For example, certain motions – squatting, performing a deadlift, or doing anything that involves bending forward at the waist – can be really aggravating. Light spine and hamstring stretching, low-impact activities like biking and swimming, and core work can help. “In general, we need the nerve to calm down a bit and to strengthen the muscles of your spine, pelvis and hips,” Marko says.</p> <p>“Within a week to 10 days, about 80 percent of patients with mild to moderate sciatica are going to be doing much better,” Dr Regan says. Within four to six weeks, you should be able to return to your regular activities – with the caveat that you’ll need to be careful about straining your back to avoid triggering sciatica again.</p> <p><strong>Treating severe sciatica</strong></p> <p>If you’re trying the treatment options for mild to moderate sciatica and your symptoms worsen or just don’t get better, you may need a higher level of treatment.</p> <p>If OTC pain relievers aren’t cutting it, your doctor may prescribe a muscle relaxant like cyclobenzaprine (Flexeril).</p> <p>An epidural steroid injection near the nerve root can reduce inflammation and provide a huge relief for some people with sciatica. The results are varied, and some people may need more than one injection to really feel relief.</p> <p>Surgery is usually a last resort, only considered once all of the conservative and minimally invasive options have been exhausted. Dr Regan notes that a small percentage of people with sciatica end up needing surgery – these are usually patients who have severe enough sciatica that their primary care doctors have referred them to spinal specialists. And only about a third of patients who see spinal specialists may end up having surgery, he says.</p> <p>Surgeries to relieve disc compression are typically quick and done on an outpatient basis, according to Dr Cole.</p> <p><strong>Preventing sciatica in the future</strong></p> <p>“Once you have a back issue, you have a higher chance of having a back issue in the future,” Dr Regan says. Which means that your first bout of sciatica isn’t likely to be your last. It’s important to adopt a healthy lifestyle to reduce the risk of sciatica striking again.</p> <p>Building core strength is key. “Think of your midsection as a box, and you need to target all sides,” Marko says. “By this, I mean abdominals, obliques, diaphragm, pelvic floor, glutes and lateral hip muscles.” These muscles all support the spine, so the stronger they are, the better the spine can handle whatever is thrown its way.</p> <p>If there’s an activity you enjoy that aggravates your back, ditch it for an alternative. For example, running can trigger back pain and sciatica in some people, Dr Regan says. If you’re prone to it, try a new form of cardio that’s gentler on your back, like swimming, biking, or using the elliptical. Even just logging fewer kilometres per week can help reduce your risk.</p> <p>Dr Regan also recommends making sure you learn how to weight train properly. Lifting with the best form possible, learning your limits, and reducing weight when you need to will help keep your back safe from disc injuries.</p> <p>Making small changes to your daily life and workouts can help keep your back healthy and minimise the time you have to waste dealing with sciatica in the future.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.com.au/backtips-advice/how-to-get-rid-of-sciatica-pain-solutions-from-back-experts" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Body

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Cruise ship forced to turn back after 100 passengers injured in storm

<p>The Spirit of Discovery cruise ship was forced to turn back after around 100 passengers were injured during a massive storm. </p> <p>Cruise company Saga have said that most of the injuries were minor, but five people had to be taken to hospital when the ship returned to England on Tuesday local time. </p> <p>One passenger told<em> BBC News</em> that a few passengers  "feared for their lives", when the storm hit the ship in the Bay of Biscay, off the French coast. </p> <p>"People were writing texts to their loved ones in case we capsized," they added. </p> <p>"The tone of voice in our captain... he was physically scared. We had crew crying. We had many passengers in awful states of fear." </p> <p>The passenger also claimed that that injuries included broken bones and cuts, with reports of furniture flying around and  people  being knocked off their feet, as the ship stopped moving and veered dramatically to one side as part of its safety manoeuvre. </p> <p>Another passenger, 75-year-old Jan Bendall, told the BBC that she and her husband were "holding on for dear life", and that it was overall a frightening experience. </p> <p>"It was quite frightening, I'm not somebody who frightens easily," Bendall said.</p> <p>"We were lucky - we're quite able-bodied, but I think some of the older people and people in their own cabins were quite worried," she added.</p> <p>The ship itself holds almost 1000 passengers and holds cruises for people over 50. </p> <p>Saga told the <em>BBC </em>that there had been "very limited" damage and the ship had "remained safe at all times." </p> <p>"While the weather is clearly beyond our control, we want to offer our sincere apologies to all those affected who are now safely on their way home in calmer seas," the spokesperson said.</p> <p><em>Images: Nine News/ Facebook</em></p>

Travel Trouble

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Meg Ryan is back after a "giant break"

<p>Meg Ryan is back and she has spilled it all, ahead of her first rom-com release in nearly 15 years. </p> <p>In an interview with <em>People Magazine,</em> the <em>When Harry Met Sally </em>star revealed the reason why she took a step back from her career. </p> <p>"I took a giant break because I felt like there's just so many other parts of my experience as a human being I wanted to develop," she told the outlet. </p> <p>"It's nice to think of it as a job and not a lifestyle. And that is a great way of navigating it for me."</p> <p>The 61-year-old also shared the inspiration behind her first rom-com <em>What Happens Later, </em>which she directed, wrote and starred in. </p> <p>"It came to me during lockdown," she gushed. </p> <p>"The essence of it is these two people who are stuck together. I just love that idea that we're held in a space, even if it feels conflicted, maybe for reasons that heal them."</p> <p>This is the first rom-com that she has acted in for over a decade, with her last film in that genre being <em>Serious Moonlight</em> back in 2009.</p> <p>In another another conversation with <em>Interview</em> <em>magazine's</em> Carol Burnett, she opened up about the process of making her film. </p> <p>"Truly, the easiest part was acting in it," she told the publication. </p> <p>"I want to direct again just so I can sit in the chair, because I’m sure there’s a lot of things I missed."</p> <p>"I hadn’t done a role in a really long time, but it was fun with David," she added, referring to co-star David Duchovny, known for his role as Fox Mulder in <em>The X Files</em>.</p> <p>"A lot of it was done in two shots. I’m proud of that. I set up everything beforehand so that once we were there, it was just David and I trying to tell the truth."</p> <p>She revealed that the film was assembled together with a very "deliberate" process and a budget of only $3 million. </p> <p>"We had to do it really quickly. A lot of those extras weren’t even ours, they were real people," she said. </p> <p>"We went back in post and made everybody the same palette. There’s a lot of stuff you can do digitally now, thank god." </p> <p>The actress first shot to fame in 1980 for her girl-next-door image, after playing the love interest in iconic films like the original <em>Top Gun </em>and <em>When Harry Met Sally. </em></p> <p><em>Images: Getty Images/ Edward Berthelot/WireImage</em></p>

Movies

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"Devastating blow": Back to the Future star's tragic family news

<p><em>Back to the Future </em>star Lea Thompson, renowned for her role as Lorraine, the endearing mother of Michael J. Fox's iconic character, Marty McFly, has recently shared some deeply saddening family news.</p> <p>The 62-year-old actress opened up about her personal struggle, revealing that both of her older brothers have been diagnosed with Parkinson's disease within a few months of each other.</p> <p>This announcement resonated profoundly with her fans and followers, especially given Michael J. Fox's well-known battle with the condition since his diagnosis in 1991 at the tender age of 29.</p> <p>In an emotionally charged Instagram post, Thompson shared her family's ordeal, writing, "Both of my beloved exceptional big brothers have been diagnosed with Parkinson’s within a few months of each other. It was such a devastating blow."</p> <p>She went on to describe how the disease had stealthily crept into their lives, noting that her brothers had been displaying signs of slowing down, but the true nature of their condition hadn't been immediately apparent.</p> <p>Fortunately, their early diagnosis, made possible by the diligent efforts of researchers supported by the Michael J. Fox Foundation, has offered them access to medications and tools that have significantly improved their quality of life.</p> <p>Accompanying her heartfelt message, Thompson posted pictures of herself with her two brothers during a day of golf, capturing a precious family moment. Another poignant photo showed her brothers with their arms wrapped around each other.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cyz8bCxO9GF/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cyz8bCxO9GF/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Lea Thompson (@lea_thompson)</a></p> </div> </blockquote> <p>Thompson's dedication to raising awareness and support for Parkinson's research was evident when she expressed feeling "honoured" to be part of a "public service announcement" for the Michael J. Fox Foundation's gala, sharing a behind-the-scenes photo from the campaign. She also expressed gratitude for the support of scientists, philanthropists, and her "movie son", Michael J. Fox, who has been an unwavering advocate for Parkinson's research.</p> <p>The response from Thompson's fans and followers was heartwarming, as they flocked to the comments section to express their solidarity. Messages of love, hope and empathy poured in from all corners, with many sharing personal connections to Parkinson's disease and the advances in treatment and therapies they have witnessed.</p> <p>Parkinson's disease is a debilitating neurodegenerative condition, and it is the second most common neurological disorder in Australia, with over 100,000 Australians grappling with its impact. Common symptoms include tremors, slowness of movement, and rigidity.</p> <p>Michael J. Fox's diagnosis at the astonishingly young age of 29 stands as a stark reminder of the disease's unpredictable reach, as the average age of diagnosis hovers around 65.</p> <p>Parkinson's disease results from the brain's inability to produce sufficient dopamine, a neurotransmitter vital for controlling movement. Diagnosing Parkinson's is not straightforward; it often relies on clinical evaluation by specialists such as neurologists, who meticulously assess clinical signs and symptoms, as there are no definitive laboratory tests like blood work or brain scans available for diagnosis.</p> <p>Lea Thompson's open acknowledgment of her family's struggle with Parkinson's disease not only shines a light on the challenges faced by those living with the condition but also underscores the importance of continued research and support for those affected. </p> <p><em>Images: Instagram</em></p>

Caring

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Dawn French hits back at "shameful" weight loss comments

<p>Dawn French has hit back at hurtful comments about her drastic weight loss almost a decade ago, admitting she "never rejected" the size she was. </p> <p>In 2014, the British comedian and actress dropped over 45kg after undergoing a hysterectomy following a terrifying cancer scare. </p> <p>The dramatic weight loss came after French's surgeon said she would heal better from the procedure if she lost weight. </p> <p>At the time, dozens of articles were written about French's transformation, praising her weight loss. </p> <p>Now, the 65-year-old has taken umbrage with the comments, telling <a href="https://www.thetimes.co.uk/article/id-never-felt-so-ugly-how-dawn-french-learnt-to-love-her-flaws-3z95kc823" target="_blank" rel="noopener"><em>The Times</em></a> how unfair it is that women are in the public eye are often “reduced” to descriptions of their appearance.</p> <p>“I have never rejected the bigger woman I have been. Lots of people do it and say, ‘Oh, you look so much better – now you look well.’ And I think, ‘F*** off! Don’t judge that other person who I loved,’” she said.</p> <p>“[British singer] Alison Moyet is a very good friend and so often she has been reduced to descriptions of her physicality.”</p> <p>“She’s this giant talent, why reduce her to that? I’m not taking any s*** from anyone about any of it,” she said.</p> <p>French went on to reflect on the early days of her career, which began in the late 1980s alongside Jennifer Saunders. </p> <p>Despite the success of their BBC show <em>French and Saunders</em>, they were often described by how they looked, something she says “never” happened to their male colleagues.</p> <p>“For many years Jennifer [Saunders] and I were always described by how we looked, especially me, because I was the bigger one.”</p> <p>“It was always about ‘running to fat’ or ‘plump’, and they never said that about any of the male comedians.”</p> <p>“I absolutely own whatever my size is and I will call myself whatever I want. But if I feel like the intent is to shame me, I will not have it,” French said.</p> <p><em>Image credits: Getty Images</em></p>

Body

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What is cognitive functional therapy? How can it reduce low back pain and get you moving?

<p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p>If you haven’t had lower back pain, it’s likely you know someone who has. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/22231424/">around 40% of adults</a> in any year, ranging from adolescents to those in later life. While most people recover, <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">around 20%</a> go on to develop chronic low back pain (lasting more than three months).</p> <p>There is a <a href="https://bjsm.bmj.com/content/54/12/698">common view</a> that chronic low back pain is caused by permanent tissue damage including “wear and tear”, disc degeneration, disc bulges and arthritis of the spine. This “damage” is often described as resulting from injury and loading of the spine (such as bending and lifting), ageing, poor posture and weak “core” muscles.</p> <p>We’re often told to “protect” our back by sitting tall, bracing the core, keeping a straight back when bending and lifting, and avoiding movement and activities that are painful. Health practitioners often <a href="https://theconversation.com/having-good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it-183732">promote and reinforce these messages</a>.</p> <p>But this is <a href="https://bjsm.bmj.com/content/54/12/698">not based on evidence</a>. An emerging treatment known as <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">cognitive functional therapy</a> aims to help patients undo some of these unhelpful and restrictive practices, and learn to trust and move their body again.</p> <h2>People are often given the wrong advice</h2> <p>People with chronic back pain are often referred for imaging scans to detect things like disc degeneration, disc bulges and arthritis.</p> <p>But these findings are very common in people <em>without</em> low back pain and research shows they <a href="https://pubmed.ncbi.nlm.nih.gov/24276945/">don’t accurately predict</a> a person’s current or future experience of pain.</p> <p>Once serious causes of back pain have been ruled out (such as cancer, infection, fracture and nerve compression), there is <a href="https://pubmed.ncbi.nlm.nih.gov/27745712/">little evidence</a> scan findings help guide or improve the care for people with chronic low back pain.</p> <p>In fact, scanning people and telling them they have arthritis and disc degeneration can <a href="https://pubmed.ncbi.nlm.nih.gov/33748882/">frighten them</a>, resulting in them avoiding activity, worsening their pain and distress.</p> <p>It can also lead to potentially harmful treatments such as <a href="https://pubmed.ncbi.nlm.nih.gov/27213267/">opioid</a> pain medications, and invasive treatments such as spine <a href="https://pubmed.ncbi.nlm.nih.gov/19127161/">injections</a>, spine <a href="https://pubmed.ncbi.nlm.nih.gov/12709856/">surgery</a> and battery-powered electrical stimulation of spinal nerves.</p> <h2>So how should low back pain be treated?</h2> <p>A complex range of factors <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">typically contribute</a> to a person developing chronic low back pain. This includes over-protecting the back by avoiding movement and activity, the belief that pain is related to damage, and negative emotions such as pain-related fear and anxiety.</p> <p>Addressing these factors in an individualised way is <a href="https://pubmed.ncbi.nlm.nih.gov/29573871/">now considered</a> best practice.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/15936976/">Best practice care</a> also needs to be person-centred. People suffering from chronic low back pain want to be heard and validated. They <a href="https://pubmed.ncbi.nlm.nih.gov/35384928/">want</a> to understand why they have pain in simple language.</p> <p>They want care that considers their preferences and gives a safe and affordable pathway to pain relief, restoring function and getting back to their usual physical, social and work-related activities.</p> <p>An example of this type of care is cognitive functional therapy.</p> <h2>What is cognitive functional therapy?</h2> <p><a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">Cognitive functional therapy</a> is about putting the person in the drivers’ seat of their back care, while the clinician takes the time to guide them to develop the skills needed to do this. It’s led by physiotherapists and can be used once serious causes of back pain have been ruled out.</p> <p>The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it.</p> <p>It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the <a href="https://www.restorebackpain.com/patient-journey">person’s preferences</a>.</p> <p>Cognitive functional therapy usually involves longer physiotherapy sessions than usual (60 minutes initially and 30-45 minute follow-ups) with up to seven to eight sessions over three months and booster sessions when required.</p> <h2>What’s the evidence for this type of therapy?</h2> <p>Our recent clinical trial of cognitive functional therapy, published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext">The Lancet</a>, included 492 people with chronic low back pain. The participants had pain for an average of four years and had tried many other treatments.</p> <p>We first trained 18 physiotherapists to competently deliver cognitive functional therapy across Perth and Sydney over six months. We compared the therapy to the patient’s “usual care”.</p> <p>We found large and sustained improvements in function and reductions in pain intensity levels for people who underwent the therapy, compared with those receiving usual care.</p> <p>The effects remained at 12 months, which is unusual in low back pain trials. The effects of most recommended interventions such as exercise or psychological therapies are <a href="https://pubmed.ncbi.nlm.nih.gov/34580864/">modest in size</a> and tend to be of <a href="https://pubmed.ncbi.nlm.nih.gov/32794606/">short duration</a>.</p> <p>People who underwent cognitive functional therapy were also more confident, less fearful and had a more positive mindset about their back pain at 12 months. They also liked it, with 80% of participants satisfied or highly satisfied with the treatment, compared with 19% in the usual care group.</p> <p>The treatment was as safe as usual care and was also cost-effective. It saved more than A$5,000 per person over a year, largely due to increased participation at work.</p> <h2>What does this mean for you?</h2> <p>This trial shows there are safe, relatively cheap and effective treatments options for people living with chronic pain, even if you’ve tried other treatments without success.</p> <p><a href="https://www.restorebackpain.com/cft-clinicians">Access to clinicians</a> trained in cognitive functional therapy is currently limited but will expand as training is scaled up.</p> <p>The costs depend on how many sessions you have. Our studies show some people improve a lot within two to three sessions, but most people had seven to eight sessions, which would cost around A$1,000 (aside from any Medicare or private health insurance rebates). <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, Professor of Musculoskeletal Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, Research Fellow in physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, Adjunct Associate Professor of Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">original article</a>.</em></p>

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Loch Ness monster back in headlines after "most exciting" photo in decades

<p>A recent potential Loch Ness monster sighting has generated immense excitement among monster enthusiasts, who claim these photographs are the most captivating seen in decades.</p> <p>The incident unfolded when Chie Kelly, 51, inadvertently captured images of an unidentified, sizeable creature gliding across the surface of Loch Ness five years ago in August.</p> <p>At the time, she hesitated to release the images, fearing public ridicule. However, her decision changed after the largest 'Nessie' search in over half a century took place last month – called The Quest Weekend.</p> <p>Kelly, accompanied by her family, was enjoying a meal at an inn nestled on the shores of the Scottish loch when she began snapping photos.</p> <p>According to the <a href="https://lochness.com/findings-revealed-from-the-quest-weekend/" target="_blank" rel="noopener">Lochness.com website</a>, Chie Kelly "had lunch in the Dores Inn and then started walking around. I was just taking pictures with my Canon camera of Scott and our daughter Alisa, who was then five, when about 200 metres from the shore, moving right to left at a steady speed was this creature.</p> <p>"It was spinning and rolling at times. We never saw a head or neck. After a couple of minutes, it just disappeared and we never saw it again.</p> <p>"At first I wondered if it was an otter or a pair of otters or a seal, but we never saw a head and it never came up again for air.</p> <p>"It was making this strange movement on the surface. We did not hear any sound. There were these strange shapes below the surface. I could not make out any colours – the water was dark. I could not accurately assess its length, but the two parts that were visible were less than two metres long together.</p> <p>"I don’t know what it was, but it was definitely a creature – an animal. At the time I did not want to face public ridicule by making the photographs public. But I met Steve Feltham at the weekend and showed him the images, and he said immediately that they were ‘very interesting’.”</p> <p>Feltham has dedicated more than 30 years to the search for Nessie since abandoning his job and selling his house in 1991. After looking at the images, he said, “These are the most exciting surface pictures I have seen. They are exactly the type of pictures I have been wanting to take for three decades.</p> <p>"It is rare to see something so clear on the surface. They are vindication for all the people who believe there is something unexplained in Loch Ness. They are remarkable. I have studied them and still do not know what it is. I persuaded them that these pictures were so important they should make them public. They warrant further investigation. It is not driftwood – it is a moving creature and totally unexplained.”</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CrRewR8txip/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CrRewR8txip/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Chie Tchié Kelly-Kano (@kelly.chie)</a></p> </div> </blockquote> <p>Reports of the Loch Ness monster have spanned ancient history, with stories dating back to an Irish missionary allegedly rescuing a swimmer from a creature in the loch during the 7th century.</p> <p>The completion of a road adjacent to the loch in 1933 led to a surge in monster sightings. Despite numerous searches over the years, a DNA survey conducted in 2018 failed to provide any evidence of a plesiosaur or other large animals residing in the lake.</p> <p><em>Images: Instagram / Chie Kelly</em></p> <p> </p>

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