BCA Council Elections; Support Your Association and Get Involved

chiropractic-uk.co.uk Summer/Autumn 2018 • Volume 32 • Number 2

A helping hand for members of the British Chiropractic Association

Chiropractic: It’s all about the patient BCA AUTUMN CONFERENCE

BCA Council Elections; support your Association and get involved

01_Contact_Cover.indd 1 03/08/2018 10:13

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02_IFC_PheonixChiroCouch_AdvertsContact.indd 2 02/08/2018 21:31 EDITORIAL

There isno better time to be a chiropractor ongratulations to all the new University College, CMCC and WIOC as well ECCE has recently accredited the five year graduates from AECC University as authoring numerous publications and full-time (extended) Masters in Chiropractic College, MCC and WIOC who have textbooks. This prestigious title is the most Programme at McTimoney Chiropractic joined the BCA as professional senior designation bestowed by the University College (MCC). Therefore, both this and the Ccolleagues! We welcome you into the BCA in recognition of excellence in professional four year full-time programmes at MCC Family at the beginning of what will hopefully practice. Congratulations to David! are now ECCE accredited. In the future this be a rewarding and fulfilling professional career. Chiropractic education in the UK continues will be looked upon as turning point for the The opportunities for the new chiropractic to flourish. The staff, students and alumni profession in the UK as now, for the first time, graduates are now tremendous and, as Prof of WIOC must be very proud to see that the all chiropractic programmes in the UK are Greg Kawchuk reminds us, “There is no better University of South Wales recently achieved ECCE accredited. We understand that the new time to be a Chiropractor!” Dan Morgan, a number two ranking in a national league chiropractic programme at London South Bank Chair of the New Graduate Committee, has table for health professions. AECC University University (LSBU) has been oversubscribed been inspired by the words of Ralph Waldo College has launched seven new BSc courses and will be commencing as scheduled in Emerson to remind us all of what success is – in Sport, Exercise and Health Science & September. We hope to have more news from read his report in this issue. Psychology and, having achieved the ability MCC and LSBU in the next issue. Also we bring you news of two giants of to award it’s own degrees last year, is now With the BCA’s financial support the chiropractic education in the UK. Professor beginning to work towards Research Degree Chiropractic Research Council has started Jenni Bolton is retiring after nearly 40 years Awarding Powers (RDAP) enabling it to award the Programme for Early Researchers in in higher education. Her contribution to the its own PhDs. Chiropractic (PERC) which is being run in chiropractic profession has been immense Mark Langweiler has been appointed the affiliation with the Arthritis UK Research from furthering research in chiropractic Professional Lead for Chiropractic at London Centre for Sport, Exercise and Osteoarthritis. In to the development of the Bournemouth South Bank University. Having been involved this issue you can read about the projects you Questionnaire and the postgraduate in the interview process for the prospective have been financially contributing to. Advanced Professional Practice MSc degrees. students at LSBU it was interesting to note Finally, on 13th/14th October, Furthermore, she has influenced generations how many of them, or members of their we have the BCA Autumn of chiropractors at AECC University College families, had benefitted from chiropractic. It Conference building on since the 1990s giving many of them their very was also somewhat surprising to hear that the amazing events we first taste of research methodologies. some of their chiropractors were not aware have recently had. We look David Byfield, Head of Clinical Services of the programme at LSBU. The chiropractic forward to seeing you at WIOC, has been awarded a Professorship programme at LSBU is ready to welcome it’s in Birmingham! in Professional Practice by the University first cohort of students in September. I am sure of South Wales (USW). David has been under Mark’s expert guidance the programme Rishi Loatey, involved in Chiropractic education at AECC at LSBU will thrive. Editor

CONTENTS In this issue...

President’s message 5 Reports 16-17, 18, 20, 22 Special Interest 33-39 Chiropractic Research Council Lancet Low Back Pain Series – Chief Executive’s message 6 Student / New Graduate report Part 1 – Evidence-Based Call to Action News 10-13, 15 Professional Standards Committee Lancet Low Back Pain Series – Part News from your Association, 2 – Prevention & Treatment colleagues and the chiropractic Royal College of Chiropractors world in general Business & Finance 21, 40-41 Colleges 28-31 Free business advice Features 8-9, 23-26, i-iv News from UK chiropractic colleges Autumn conference Diary 42-43 Election Special Classifieds 44-47

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 3

03_Editorial_Contents1p.indd 3 09/08/2018 10:18 YEARS OF DESIGN

For chiropractors, by chiropractors.

Atlas Clinical Ltd., Northside, Eastern Avenue, Lichfield, Staffordshire, WS13 7SG Tel: +44 (0)1543 255 107 Fax: +44 (0)843 309 1832 e-mail: [email protected]

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04_Atlas40yrs_AdvertsContact.indd 4 02/08/2018 22:17 MESSAGES

Contact is produced by: President’s message Trident Print, Lagpond Lane, Sutton Mandeville, Salisbury, Wilts SP3 5ND for the British Chiropractic Association, 59 Castle Street, Reading, Berkshire RG1 7SN Tel: 0118 950 5950 [email protected] Adjusting to www.chiropractic-uk.co.uk

Views expressed in this journal do not necessarily represent the policy of the Association, nor does publication of change advertisements necessarily imply recommendation.

Contributions are welcomed. Editorial guidelines available from: hen people talk about ‘change’ and So what’s next? Thank you to the hundreds of you [email protected] ‘transformation’ it is often met with who took part in the BCA governance review. This They should be marked ‘for publication’ and addressed to: uncertainty and doubt. Whilst it can will be invaluable as we look forward and modernise British Chiropractic Association, be easy to see a problem that needs our procedures. The feedback you have given to 59 Castle Street, Reading, Wchallenging in an organisation, your life or career, Council will be reviewed and every comment taken Berkshire RG1 7SN Tel: 0118 950 5950 it is also easy to focus on all the reasons why the into account as we work on a set of proposals which [email protected] chances of success in tackling this are slim and why will see greater protection of corporate memory it is not worth trying, even though it is the right whilst opening up space to see the next generation The editorial board reserves the right to reject or edit thing to do. of members being able to contribute and serve on contributions. The past three months have seen great change Council. Contact is published by the British Chiropractic Association at the British Chiropractic Association. Council are I am passionate about providing each and and distributed free to all BCA excited at the potential that this has brought and every BCA member with the very best in day to Members, Associate Members, thank every member who has shared their thoughts day support so that I can be confident in your Provisional Members, Student Members and recognised colleges on this. Whilst I understand the concerns that some backing as Council works to deliver our strategy. Print run: 1,750 – published of you have raised I want to assure you again that We are already seeing the fruits of this and I look quarterly Council has taken a great deal of time and care in forward to welcoming all of you to the BCA Autumn Advertising: ensuring that this has been well managed and we Conference this October where I know that you will British Chiropractic Association, have had overwhelmingly positive feedback from see a vibrant atmosphere surrounding a fantastic 59 Castle Street, members on our restructuring and their experience speaker line up. Reading, Berkshire RG1 7SN Tel: 0118 950 5950 of interacting with our new teams. The specialist, [email protected] qualified support and advice that you will be Catherine receiving allows us to focus on representing your Quinn, BCA Display (four colour) Disks in correct format (details on needs, safe in the knowledge that we have secure President request) must be supplied by copy foundations. date – see below 1/4 page £250 1/2 page £312 At the start of July, I had the honour of presenting Full page £423 Back page £603 to the World Federation of Chiropractic Students Inside front cover £763 at their AGM in Johannesburg, South Africa. The Inserts from £250 by arrangement Terms: 10% discount for four Board invited me to speak to the delegates on the consecutive insertions. subject of leadership. In my first talk I spoke about the power of vision and taking responsibility. We Classified For details see classified explored the great visions of leaders in the past; advertisements page. All William Wilberforce, the Wright Brothers, Henry advertising must be confirmed in writing before copy date, Ford. It took many decades and countless failures otherwise entry cannot be and small wins but each of these people had a guaranteed. There is no VAT. focused and purposeful vision which inevitably led Future copy dates for editorial and advertising: them to their successes. A powerful vision is the Winter 2018 November 1st one that takes you out of your comfort zone and Spring 2019 February 1st gives you direction of travel. For Henry Ford it was the image of a Model T car parked on every © British Chiropractic Association driveway; for Council we had the vision of 2018. All rights reserved. No part of Contact may be reproduced, being able to provide members with the best stored in a retrieval system or possible support and services and Council transmitted in any form or by any means, electronic, mechanical, with access to specialists who will enable us photocopying or otherwise, to achieve our strategy. We remain grateful without prior written permission to the staff who have served us so well over of the British Chiropractic Association. the past two decades and are eager to see what the next two decades will bring!

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05-06_President_CEO.indd 5 08/08/2018 20:55 MESSAGES

CEO message Renewal and Growth

lsewhere in this edition you will read about the As Rishi notes in his piece, this summer brings two upcoming BCA conference and the elections more examples of renewal and growth. A new cohort to Council, the results of which will be of chiropractors join us, fresh from the combined announced at the AGM in October. relief and excitement of graduation and a whole new EThey are, of course, both key points in the BCA group of students stand ready to start their journey, year and I urge you to get involved with both. not only at AECC and WIOC, but also at the brand- They are also a re-affirmation and a renewal of the new course at London South Bank University. commitment of chiropractors to develop themselves This significant development in the capital augurs and the profession. Similarly, they reflect the BCA’s well for the future of the chiropractic profession and own commitment to develop its support of for the BCA. We already know that there is unmet members and its ability to influence the wider demand for chiropractic care across the country; a world on their behalf. growing cohort of practitioners will help service that This year has already seen some changes towards need and create a virtuous circle of increased public making the BCA more agile and responsive, with an awareness leading to increased opportunities for ability to invest more in broadening and deepening chiropractors. its services to members. That process is still in its All this, of course, is why the BCA needs to be early stages but the direction of travel is right and continually reviewing and renewing itself; to help we will see an increasing number of improvements, chiropractors and the practice of chiropractic on its products and services as the process matures and important and exciting journey. adapts. And, of course, we learn from the inevitable unintended consequences that come with the Mark Rawden, implementation of change. Chief Executive Officer

6 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

05-06_President_CEO.indd 6 08/08/2018 20:55 The specialist range...

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07_NordicOil_AdvertsContact.indd 7 02/08/2018 22:16 Getting fresh We are delighted to invite you to attend the British Chiropractic Association Autumn Conference 2018 brought to you with a fresh new look and feel.

oin us at the Hilton Birmingham Metropole on Presentations include: Saturday 13th and Sunday 14th October, as we have President’s Lecture: Alison Dantas speaker presentations and workshops focusing on Know Pain: Mike Stewart patient-centred care. Knowledge Translation: Jørgen Jevne J Empower your Patients! Phillippa & Rhiannon Oakley Playing Around: Luke Davies

“This is what the BCA is truly about and, Workshops include: as a chiropractor, I bet that’s what you are EMS DolorClast: Ian Vassey (Shockwave) passionate about too!” Empowering Your Patients/Coaching: Philippa and Rhiannon Oakley Bronwen Henley Playing Around: Luke Davies

The 2018 Annual General Meeting will also be taking place where we will be welcoming new graduate members to the association and celebrating the new Council. AGM papers and agenda will be released before the event. We anticipate the CPD hours for the conference being 7.5 hours and this is subject to GCC verification.

Would you like to be a part of conference? Then submit an abstract for a poster presentation. Submissions are invited in poster form which can be used in the future as case studies and leading light projects to inspire other healthcare professionals around the UK and beyond. Refer to the booking site for further details. http://bit.ly/BCAConf2018. The deadline for submissions is 17th August 2018.

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08-09_Conference_Feat2pp.indd 8 08/08/2018 20:44 Evening social Join us on Saturday 13 October for our social evening and awards ceremony. The night will include: • Street style food • Festival style event • Live band and DJ • BCA Awards Ceremony

So, let’s take it to the streets and celebrate!

Sponsor a student Are you passionate about getting the next generation of chiropractors involved in our association? Why not sponsor a student and help them keep their passion for patient- centred evidence-based practice alive! See how to do this on the booking site. http://bit.ly/BCAConf2018

Great Value The BCA conference team is delighted to offer a great pricing structure for this event. The combined two-day conference and evening event ticket is particularly great value. Book P.S… There will be an evening seminar before 31st August to get discounted, early-bird prices. presented by Mike Stewart MCSP SRP MSc PG Cert (Clin Ed), on Friday 12th October at the Hilton Birmingham Metropole titled A Practical Guide for Persistent Pain Book Now! Therapy. This seminar will help develop your communication and teaching skills as well as http://bit.ly/BCAConf2018 help people make sense of pain. And see you in October! Seminar cost: £40 Estimated CPD Hours: 3 To book your place, please email mike@ knowpain.co.uk or [email protected] Bronwen Henley Conference Chair

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08-09_Conference_Feat2pp.indd 9 08/08/2018 20:44 NEWS

Professor Jenni Bolton retires

rofessor Jenni Bolton, of Chiropractors, particularly during its developmental stages. internationally renowned Jenni has positions on the editorial boards of a number of researcher and educator, as professional and scientific journals and holds Honorary well as a familiar face to the Fellowships from The Royal College of Chiropractic, the Pprofession in the UK, is retiring after British Chiropractic Association and she is a Founding Fellow more than 40 years in higher education. of the European Academy of Chiropractic. Jenni retires as Vice-Principal Dr Dave Newell, Director of Research at AECC University (Postgraduate Studies and Research) College, said: “From my early encounters with Jenni way of AECC University College which she back when I first joined the College in 1988, we initiated and joined in 1983, initially on a part-time maintained a 25 year habit of intense interest in research basis, as Student Projects Co-ordinator. within the profession. Jenni has been both a mentor, trusted Jenni gained her PhD from colleague and over the years has become a close friend whose Southampton University in 1975 and impact on myself and many other individuals interested in her MA (Research and Development engaging with research and intellectual exploration has been in Higher Education) from University lasting and career changing. Her original research culminating Awarding Powers and University College College London in 2000. After three in the development and validation of the Bournemouth Title, her daily work and support at years as a Post-Doctoral Research and Questionnaire (BQ), a multi-item outcome measure and one of executive level, and for her unwavering Teaching Fellow firstly at Harvard the first to explicitly acknowledge the biopsychosocial model dedication to making the institution Medical School in Boston and then the of musculoskeletal pain which been translated into many an open and forward-thinking University of Southampton. She lived languages and is routinely used to collect data in practices higher education establishment. Her for four years in New Zealand where she all over the world. But probably most people’s lasting contributions impacted in so many worked as a Scientific Officer at Princess memories will be her personal influence on their thinking ways, both at individual student and at Margaret Hospital, Christchurch. and intellectual development through multiple supervisions profession-wide levels, nationally and It was in 1991 that Jenni joined AECC at undergraduate projects and postgraduate Masters internationally. Her legacy will live on University College (then the Anglo- and PhD level. In this she will have polished individuals’ for many years to come.” European College of Chiropractic) on a thought processes, enabled their careers and multiplied the On her retirement Professor Bolton full-time basis as Senior Lecturer. With opportunities afforded to them by the study they undertook remarked: “AECC University College has her involvement and contributions under her guidance. Her impact on the chiropractic research been a massive and hugely important expanding quickly over the years she community then is deep, historically unique and profound. part of my life for over 30 years. As you was promoted to Director of Research Jenni was one of few who first pushed those small boats out can imagine I have witnessed enormous and Postgraduate Studies in 2001 and toward the far larger horizons that contemporary chiropractic change over this period, worked with to Vice-Principal in 2012. Jenni was researchers now search and explore. Pioneer is a big word interesting and varied colleagues, many the first in the European chiropractic and its use should be limited to those truly worthy of such of whom have become close friends. community to be awarded the title of a title and in Jenni’s case it is indeed the most appropriate I have also come into contact with Professor in 2001. description of her influence.” many many students and it has been a Jenni was instrumental in the Dr Budgie Hussain, Head of the School of Medical pleasure and a privilege to teach them development of postgraduate Ultrasound said: “I had the privilege to work with Jenni in and support them in gaining their educational provision at AECC University the development of the Masters programme in medical qualifications. Throughout my time at College which included the Advanced ultrasound and a number of short courses leading to AECC University College I have been Professional Practice MSc degrees, the validation by Bournemouth University in 2007 and given many opportunities to make a innovative Postgraduate Certificate for accreditation by CASE (Consortium for the Accreditation of difference to the organisation for which new chiropractic graduates and, in 2008, Sonographic Education) in 2008. The success of the Centre I am very grateful. These opportunities postgraduate education and training in of Ultrasound Studies (CUS) and now the School of Medical have allowed me to interact with the diagnostic ultrasound. Ultrasound (SMU), can be attributed to Jenni’s unwavering chiropractic profession nationally and Jenni held a great number of external commitment to diversify postgraduate education and training internationally and, although I am not a appointments which included the at AECC. Her vision became a reality in 2008 with our first chiropractor, I have always been treated Presidency of the European Council intake of healthcare professionals from many disciplines by the profession with warmth and on Chiropractic Education (2002- such as midwives, sports physicians, rheumatologists, GPs respect. I hope to be able to contribute 2009). She was responsible for a and chiropractors. Jenni can look back with pride on her to both AECC University College and major review and publication of the contributions to the success of the SMU as a leading provider the profession in the future in some Educational Standards against which of musculoskeletal ultrasound education and training.” small ways in my new role as Professor the quality of chiropractic education Professor Haymo Thiel, Principal, said: “Jenni has helped Emeritus, conferred by the Principal on and training delivered at European and and contributed to steering the University College through my retirement-thank you Haymo. All South African educational providers is the many changes that have transformed it into the excellent that remains is for me to wish AECC assessed and judged. She also worked learning and working environment it is today. I thank her University College and the chiropractic closely together with The Royal College hugely for her efforts linked to us being granted Degree profession every success in the future.”

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Professorship for Cherries Cherish David Byfield Chiropractic! he University of South Wales Our wonderful colleagues at AECC (USW) Higher Academic Awards University College are the official Committee has agreed to Performance and Rehabilitation partners recommend to Academic Board to AFC Bournemouth in the Premier Tthat the title of Professor (Professional League. The BCA was honoured to join Practice) be conferred on David Byfield, them at the End of Season awards night the current Head of Clinical Services at the to celebrate the role that chiropractic has Welsh Institute of Chiropractic. played at the club for many years. David has been involved in chiropractic professional education for the past 30 years at three institutions including Canadian Memorial Chiropractic College, Anglo-European College of Chiropractic and for the last 20 years at the University of South Wales (USW). In addition to his contribution to the literature regarding the learning and teaching of psychomotor skills and clinical education, David has been instrumental in raising chiropractic educational standards in the UK and Europe as a whole. David joined USW in 1998 where he was recruited to help develop the chiropractic degree programme and has occupied a number of senior positions since. David will be celebrating his 40th graduation anniversary from CMCC in 2019 having practised in three jurisdictions and in a number of multidisciplinary practices. A Professorship in Professional Practice is a prestigious title and is the most senior designation bestowed by the University in recognition of excellence in professional practice. As Professor in Professional Practice David has demonstrated excellence in his profession and has provided leadership at the interface of engagement News from World Spine Care between the University, industry and profession, The Yoga Project continues to expand; further training has taken place evidenced by manifest achievement in the public sphere. in Botswana to qualify more community members as Yoga teachers. This A Professor in Professional Practice, David has innovative aspect of World Spine Care empowers community members to achieved a national standing through innovative and become active and mindful on a regular basis, acting as an effective self- socially engaged practice, and has developed a reputation management tool for those with spinal pain. for effective work in the field as evidenced by his Carlos Gevers (President of the Spanish Chiropractic Association) and numerous textbooks, scientific publications, conference I represented World Spine Care at the recent European Union Conference presentations both nationally and internationally. hosted in Budapest. The booth in the delegates arena was a great chance Throughout his career, David has demonstrated to interact with European chiropractors, explaining how World Spine Care service and leadership in his outstanding contribution partners with governments and health institutions to aid their adoption of in his professional practice which has significantly evidence-based spine care principles. enhanced the reputation of the University and the I delivered a presentation on Adaptability in pursuit of optimal patient care, chiropractic profession across the globe. highlighting that often only extreme circumstances or work conditions force The title is acknowledgement for David’s us to be adaptable in our approach to patient care. However, if we adapt appointments and contribution to the development to every patient’s unique story, goals and clinical presentation we can truly of chiropractic at a statutory and professional level pursue patient-centred care. If we are willing to adapt we can put patients throughout his career, including his substantial first, collaborate with other health professionals and become integrated engagement with external professional stakeholders. advocates for those we serve. This professorial appointment is also recognition Our most recent fund-raiser was the annual Spine Ride, this year comprising of David’s ongoing commitment to the continuing 14 cyclists who rode from Bordeaux to Beziers. Look out for news on next development of these professional activities and years ride to get involved. Plans are underway for the next World Spine Care the capacity and acceptance of responsibility for conference held in India in January 2019 at the Mahatma Ghandi Institute of contributing through these activities to the external Health Science with a host of International speakers. Watch this space. promotion of the University. Nadine Harrison

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10-13,15_News_News5pp.indd 11 09/08/2018 10:19 NEWS

Cracking time in Calgary!

“Chiropractors were patient centred before it was a thing”

n April CEO, Mark Rawden and I headed to Calgary for the Canadian Chiropractic Association National Convention and Trade Show. Alison Dantas lead an inspiring workshop focused on Women in Chiropractic and I Iwas pleased to take part in this motivating session which reaffirmed to me what a fantastic choice of profession chiropractic is for women and allowed those of us present to be able to network and show our support for one another. Other highlights of the weekend included Jan Hartvigsen’s opening keynote address. This was a resounding call to action that we must take back pain seriously and ensure that we have the best care pathways available to all. As Chiropractors, this is not news to you I’m sure, but the awareness that people lose their ability to function in society due to non-communicable diseases such as MSK pain and that back pain causes the most years lived with disability is important for us to remind ourselves of. We are The BCA Supports going to see a great surge in the ways that patients engage with us and participate in the shared decision making Run Ronnie Run! regarding their care and our research. We heard from Canadian Olympic Sprinter Andre de Ronnie Leys is three years old and was diagnosed with spastic diplegia Grasse on how chiropractic has helped him to understand cerebral palsy at two. Ronnie finds it hard to walk without tripping and falling his body. He credits chiropractic over. The condition, believed to have been caused by a brain haemorrhage with encouraging him to be during a difficult birth, has left him unable to walk far without falling over more proactive and to look after or getting too tired to carry on. However there is an operation that Ronnie’s himself regarding nutrition, sleep family believe will help him but it is not available on the NHS, meaning that patterns and hydration the family have had to raise £30,000. as well as the more Celebrities including Danny Dyer, Mike Hassini, Jordon Brook, Neil ‘Razor’ practical elements of his Ruddock, George Gilbey preparation for training and many more signed up to support the Leys family and help raise this and competing. money by playing in celebrity football match! This was a great Catherine Quinn and Tim Button were on hand to provide pitch side event and we look care for the players and keep them hydrated in the heat. With their portable forward to welcoming benches in tow and a lot of tape and ice used throughout the day, they Alison to the UK this managed to see all the players leave in one piece. Autumn where, as well The match ended in a 5-4 win for Run, Ronnie, Run Celebrity FC, courtesy as delivering the inaugural of a winning penalty from Ronnie himself, after Danny Dyer was fouled in the President’s Lecture, she box in the dying seconds of the game. will again lead a Women in Ronnie’s Dad Steve Leys said: “What a day to remember and thank you to Chiropractic workshop, so I everyone involved. We are just a normal mum and dad who wanted to raise money encourage you all to join us! to help our son Ronnie who needs a little help. We worked tirelessly to make this Catherine Quinn happen and are burned out. However, would do it all again in a heartbeat.”

WIOC Graduation I was pleased to join Rob Finch of the RCC, Elisabeth Angier of the CRC and Anoushka Annan of the GCC as we celebrated the achievements of those graduating from the University of South Wales and the Welsh Institute of Chiropractic. Graduation ceremonies give us an opportunity to reflect on the hard work and dedication that each graduate has committed to in their studies and also that of their hard-working academic staff and supportive families. Congratulations WIOC! Catherine Quinn

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Development of a dementia-friendly self-assessment tool for chiropractic clinics

n the UK it was estimated that in 2015 there were 850,000

people living with dementia and this figure is anticipated

to rise to one million by 2025 and two million by 2051 (Alzheimer’s Society, 2015) reflecting one of the biggest

Iglobal health and social care challenges (Alzheimer’s An Introduction to Dementia Friendly An Introduction to Dementia Friendly Design Design Bibliography Disease International, 2015). Physical health needs are

common in people who have dementia with 72% also having other conditions, many of which are chronic or life limiting (Alzheimer’s Society, 2014) and the increasing incidence of dementia in the population means that more people who Environmental Assessment Tool: are living with dementia, cognitive problems and other co- Is your clinic dementia friendly? morbidities will be consulting chiropractors each year. Following advice from its Lay Partnership Group (LPG) in 2017 the Royal College of Chiropractor’s Council recognised the need to support chiropractors in obtaining the skills and knowledge required to provide care for patients with dementia and, in particular, the importance of the environment in which care is provided. Although dementia affects every individual differently, a large number of people will experience changes in their ability

to understand their environment. In addition, people with dementia are often, though not always, older people who may already have poorer sight and hearing, and this experience References: can be exacerbated by the distortions in perception Alzheimer’s Disease International (2015) World Alzheimer Report associated with dementias such as Alzheimer’s disease. This 2015: The Global Impact of Dementia. London: Alzheimer’s Society. Alzheimer’s Society (2014) Dementia 2014: Opportunity for Change. can lead to increased agitation, disorientation and distress London: Alzheimer’s Society. particularly in stressful situations or unfamiliar environments. Alzheimer’s Society (2015) Dementia 2015: Aiming Higher to It is therefore important that any environmental design Transform Lives, London: Alzheimer’s Society. principles developed to support people with dementia also Waller, S., Masterson, A. and Finn, H. (2013) Improving the patient incorporate best practice in design for older people. experience: developing supportive design for people with dementia: the King’s Fund’s Enhancing the Healing Environment Programme As part of its work to develop dementia-friendly 2009-2012. London: The King’s Fund. design principles The King’s Fund developed a suite of dementia friendly environmental assessment tools for care environments (Waller et al., 2013). Following the success of the ward and hospital tools, Is your health centre dementia friendly? was launched in 2014. In 2015 The King’s Fund’s MSK work on dementia-friendly design transferred to the Framework Association for Dementia Studies, University of Worcester. Musculoskeletal core capabilities framework for first point of contact Having reviewed the available tool, the RCC commissioned practitioners. NHS England, Health Education England and Skills for Health the University of Worcester to help it develop evidence-based have released a Musculoskeletal Core Capabilities Framework which is guidance, and a self- assessment tool that is applicable to aimed at practitioners who will be the first point of contact for people with the varied clinical settings in which chiropractic services are musculoskeletal (MSK) conditions. www.skillsforhealth.org.uk/services/ delivered. The resulting materials help chiropractors implement item/574-musculoskeletal-core-skills-framework supportive environmental design for people with dementia and Chiropractors have been represented in this consultation via the BCA and all chiropractors are firmly encouraged to use them. RCCs membership of the Arthritis and Musculoskeletal Alliance (ARMA). The self-assessment tool, the guidance and the associated We would encourage all members to read this document which looks at bibliography of evidence are freely available for download at the following key domains within the MSK setting: https://rcc-uk.org/dementia-friendly-assessment-tool/ A) The Person-Centred Approach Rob Finch B) Assessment, Investigation and Diagnosis CEO, Royal College of Chiropractors C) Condition Management, Interventions and Prevention, and D) Service and Professional Development. Acknowledgement: Practitioners will benefit in many ways from knowledge of this document The contents of this article were adapted from correspondence between in regards their skills development, identifying learning needs and the the RCC and Sarah Waller CBE of the Association for Dementia Studies, planning of their CPD cycle. University of Worcester, who is gratefully acknowledged.

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 13

10-13,15_News_News5pp.indd 13 09/08/2018 10:19 The newly designed HL4 Hi-Lo table offers the optimal combination of vertical lift and tilting action. It is easily adjusted to suit any height of patient and chiropractor. The perfect upgrade to your clinic’s capabilities. ◆ Controls inflammation ◆ Blocks pain ◆ Reduces swelling ◆ Stimulates tissue repair ◆ Expands the range of conditions you can treat ◆ No heat : No side effects

Atlas Clinical are British agents for the Atlas Clinical Ltd., Steens Physical brand of rehabilitation Northside, Eastern Avenue, and exercise equipment; such as Lichfield, Staffordshire, WS13 7SG Tel: +44 (0)1543 255 107 the chiropractic angle bench Fax: +44 (0)843 309 1832 and pulley systems. e-mail: [email protected]

www.atlasclinical.com

10-13,15_News_News5pp.indd 14 09/08/2018 10:19 The newly designed HL4 Hi-Lo table offers NEWS the optimal combination of vertical lift and tilting action. It is easily adjusted to suit any height of patient and chiropractor. The perfect upgrade to your ECU Convention – clinic’s capabilities. Welcome to Vas ◆ Controls inflammation fter a high-flying start to the Budapest and full of passion, the academics, researchers, speakers Convention with Falcons (top speed of 380km/h) and of course the European Leaders. Øystein Ogre stepped ◆ Blocks pain and Hawks being flown by traditional Hungarian down from the ECU Presidency after eight years and I ◆ Reduces swelling falconers over our heads in the Budapest thank him again for being a role model for those of us ACongress Centre, the European Chiropractors Union working to improve the position of chiropractic throughout ◆ Stimulates tissue repair Convention kicked off with an ultra-competitive Kahoot Europe. Your calm composure is seen by all. Vasileios ◆ quiz hosted by our own Catherine Quinn and Norway’s Gkolfinopoulos, we look forward to supporting you as you Expands the range of conditions Anne-Helene Moksness. While a number of BCA members take over the reins! you can treat were battling it out against the rest of Europe for the top It has been a pleasure to have been part of the planning spot it went right down to the wire and the winner was.... committee for this event with Thomas Lauvsnes and Anne ◆ No heat : No side effects Jonathan Field! Congratulations Helene Moksness and I can’t wait to work with each of them With Jan Hartvigsen as the first speaker the stage again on another project in the future. Thank you to Zsolt was set for yet another fantastic ECU convention. The Kalbori for being an amazing host to his beautiful city #EPIC weekend included a great equestrian show with traditional #ECU2018” Hungarian riding as well as great food, wine and dance, and Catherine Quinn was crowned by a stunning gala dinner on a river cruise on the Danube. Chiropractic band Audible Release made a comeback with faces that should be familiar to you all BCA President, Catherine Quinn said ‘It was a privilege to represent the UK at the General Council plus have News from LSBU the opportunity to present a workshop on an area of The chiropractic programme at London South Bank Chiropractic that University is ready to welcome it’s first cohort of students I get so much in September. Mark Langweiler has been appointed the enjoyment from. Professional Lead for Chiropractic for the new course. Explaining the From the next issue of Contact we will be including a integration college report from LSBU so that members will be able in to the to keep up to date with progress for this exciting new multidisciplinary course. teams you see at sports clubs and reviewing some of our procedures AGM and return to play WCCS protocols gave The World Congress of Chiropractic Students (WCCS) is an international me the chance to collaboration of chiropractic students. Membership consists of 25 chiropractic share how much institutions internationally. Since its inception in 1980, the annual conference we can learn has served as a forum for a diverse array of international student perspectives. from the sports Students and alumni come together in the spirit of unity and camaraderie to environment. discuss issues pertinent to the chiropractic profession and global health. The Thank you to WCCS endeavours to highlight the international student consensus on issues everyone who vitally important to the chiropractic profession. made this week I was honoured to be invited by the board to to present my thoughts on so inspiring Leadership and the future of Chiropractic. We discussed how to nurture a culture that inspires and motivates others while taking responsibility for planting the seed of a tree that you may never see fully grown. Leaving a legacy for a future generation to AECC Grad Breakfast reap the benefit of and develop The BBQ’s were fired up once again for the AECC into what it will later become Atlas Clinical are British agents for the University College graduation breakfast! There were a few is the gift that we are all able Atlas Clinical Ltd., Steens Physical brand of rehabilitation bags under eyes as the newly qualified final year students to give so I encourage you, as Northside, Eastern Avenue, remerged after what sounded to be a great results night I did the WCCS, to dream big and exercise equipment; such as party! It was motivating as ever to listen to Haymo Thiel and think about what you want Lichfield, Staffordshire, WS13 7SG the chiropractic angle bench and Neil Osborne as they thanked the students for their to see happening in 10 years’ Tel: +44 (0)1543 255 107 work over the past four-five years and encouraged them time that you can be a part of Fax: +44 (0)843 309 1832 and pulley systems. always to think of the patient first. Congratulations creating now. e-mail: [email protected] AECC University College! Catherine Quinn www.atlasclinical.com CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 15

10-13,15_News_News5pp.indd 15 09/08/2018 10:19 REPORTS CHIROPRACTIC RESEARCH COUNCIL

We could not do this without you! 2018 has been a busy year for the Chiropractic Research Council, with several initiatives which have been ‘in the pipeline’ for months (if not years!) finally coming to fruition. ne of our primary aims is to support research Annual Convention was made that much more magical by the and researchers, particularly those younger fact that I was given the opportunity to present my research researchers at the start of their careers. We’ve project as a final year student. Being at the Researcher’s Day, supported two WIOC students attending hearing from all the professional chiropractors and researchers Othe ECU Convention in Budapest to present their final was amazing as well as seeing the progression of this great year projects, enrolled two new graduates onto a well- profession that I will soon be a part of first hand. Completing established, research internship programme and are in the this first piece of research at an undergraduate level has really process of advertising for two chiropractors to complete opened my eyes to the opportunities that research can provide. PhDs into the delivery of chiropractic within healthcare I will endeavour to maintain an interest in this field and systems. Meanwhile, Dr Dave Newell has continued with continue to engage with research activities during my career. his activities as Senior Research Fellow, Department of This, I believe, is important for the future of the profession and Medicine, University of Southampton, creating a stable our position within the current healthcare climate. As Dr. Greg research environment for these activities to take place. All Kawchuk, who attended the Convention, said, “There is no this will help to build research capacity for the chiropractic better time to be a Chiropractor!”. Troy Magowan profession, essential if we are going to raise the profile and Manuel’s study, again supervised by Dr Pete McCarthy, credibility of the profession as it so rightly deserves. was into the incidence of intersegmental cervical joint dysfunction in patients with tinnitus and found that there is a statistically significant increase in restricted motion bilaterally in C2/3 in patients with tinnitus. Only a small study but one perhaps worthy of further investigation. Manuel enjoyed his time too and here’s what he had to say, “As a student, it was a fantastic experience to be able to attend the ECU Convention in Budapest. Thank you CRC! It was so inspirational to hear about all the current research and spotting its flaws and limitations. It was a sea of brilliant minds, all working towards one aim; moving our profession

ECU Convention, Budapest We were delighted to assist Troy Magowan and Manuel Cabrera, from the Welsh Institute of Chiropractic, University of South Wales, attend the ECU Convention in Budapest. They had their final year projects accepted for the poster presentation and were delighted to be able to attend. Troy’s study into the UK chiropractic profession’s general understanding of the terms ‘wellness care’ and ‘maintenance care’ was a fascinating read. It highlighted the somewhat emotive implications associated with the use of these terms and emphasised the need for the profession to adopt a clear consensus regarding terminology. I hope that she and her supervisor, Dr Pete McCarthy, will submit the final study for publication. Here’s what Troy had to say about her time in Budapest, “My experience attending the European Chiropractor’s Union

16 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

16-17_CRC_Report2pp.indd 16 08/08/2018 21:10 CHIROPRACTIC RESEARCH COUNCIL REPORTS

forward and upward. This will be my motto as a clinician and an aspiring researcher. Preparing my dissertation was not easy; months of data gathering, reading lots of current and updated research plus the frustrations and sleepless nights! However, to be recognised at an international poster presentation and gain recognition from such a high-calibre audience, has inspired me to come up with new research ideas!” Manuel Cabrera Jr.

Programme for Early Researchers in Chiropractic (PERC) It’s important to build research capacity from the ‘grass roots’, encouraging chiropractors at the start of their careers to engage in research activities. So we were delighted to be able to select two new graduates to participate in this summer’s eight-week CRC-funded Programme for Early Researchers in Chiropractic (PERC) Internship Initiative. WIOC graduates, James Oldham and Anna Maria Fjærestad Holmberg, were selected from a number of applicants by the CRC’s independent Scientific Committee and started the programme in early July. James and Anna Maria have joined in with the research activities at WIOC and AECC University College, conducting Lancet Low Back Series emphasised the huge burden that their own research studies which will be written up for is back pain and explained how existing management of publication and submitted for presentation at professional LBP within mainstream healthcare simply isn’t working. conferences and seminars over the next year. The Series urged exploration of alternatives, in line with the The PERC programme is run in affiliation with a very well- clinical guidelines and recommendations. These guidelines established internship scheme at the prestigious Arthritis repeatedly advise the non-invasive, non-surgical, non- Research UK Centre for Sport, Exercise and Osteoarthritis pharmacological “multimodal package of care” (patient and a network of six UK institutions (Universities of advice, reassurance and education, manual therapy, exercise Nottingham, Oxford, Southampton, Bath, Loughborough and and general activity) that we chiropractors are so proficient Leeds) all with an excellent reputation for MSK research. at delivering and that patients are so satisfied with. In addition to conducting their own studies, James and So to explore exactly HOW we might deliver chiropractic Anna Maria will attend a weekly research training day at care within established NHS MSK systems, integrate within each of the affiliated institutions, meeting up with other a multidisciplinary team and assess the clinical outcomes interns and researchers on the scheme. This provides (efficacy, cost, patient satisfaction etc) is just what is needed. a unique opportunity for the new graduates to work alongside some of the world’s leading MSK researchers in Moving forward and a BIG thank you…!!! a multidisciplinary, collaborative setting. They will develop All of this work is designed to build UK chiropractic research networks with graduates and researchers from other capacity. We are involving early career researchers who will healthcare professions including medicine, orthopaedics, hopefully continue to pursue research activities for many rheumatology, physiotherapy, occupational therapy, years to come, generating the research and publications epidemiology and physiology; networks that they will that our profession so desperately needs. We are constantly continue to build upon in years to come. looking at ways to develop research capacity further and It is a fantastic opportunity for James and Anna Maria to support researchers in their activities. enhance their research skills so early in their chiropractic However, all of this is costly and none of it would be career. It is a first for the UK chiropractic profession to be possible without you and the generous levy that you all give involved in such an established, multidisciplinary setting in a to the CRC as BCA members. For just a £1 a week from each number of very credible, research institutions. Well done and of you all of this has been possible! So, a HUGE thank you! good luck to James and Anna Maria, we look forward to seeing We need to continue to support research for our them present their work at Researchers’ Days in the future! profession to develop and gain the cultural authority and credibility it so rightly deserves. If all of the 3000 or so PhDs – Delivery of Chiropractic Care in MSK practising UK chiropractors gave a £1 a week to the CRC Healthcare Systems we’d generate over £150,000 each year! What is more, if there Recruitment is underway for two PhD positions exploring was a contribution of just 10p from each patient visit and, delivery of chiropractic care in existing MSK healthcare working on a conservative 60 patients a week for 48 weeks, pathways; a ‘triage and treat’ model in North Hampshire and we’d easily generate well over £1million! In the meantime a North East Essex. These two studies are part of the University very big thank you for all that you do. of Southampton research initiative and are funded by the We really couldn’t do it without you! CRC. They can be completed on either a full or part-time basis so are ideal for a practising chiropractic clinician. Elisabeth Angier These studies are very timely, the recently published Chair, Chiropractic Research Council

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 17

16-17_CRC_Report2pp.indd 17 08/08/2018 21:10 REPORTS STUDENT/NEW GRADUATE REPORT

Be the best you can be Congratulations and welcome to all new members and all new graduates!

o its that time of year again; caps, gowns, black for the profession, recently represented the Association at tie events, celebratory fizz and beaming smiles. It the World Congress of Chiropractic Students AGM, been can only mean one thing, exam results and, more interviewed on Channel 5 news, organised two conferences, importantly, Graduation! all whilst running a clinic in London. Many other members SGraduation signifies a transition from student to of the association continue to work non-stop to promote professional life. Every single one of you should be extremely chiropractic to the public through countless radio proud of yourselves for your achievements over the last interviews, newspaper articles and Facebook. four to five years. If your story was anything like mine the Whilst we’re on the topic of social media the Association journey was certainly a rollercoaster. There were countless has also provided its own specific Facebook page for recent times I would have arrived home for the weekend and told and new graduates to discuss queries or concerns regarding my parents, “that’s it! I’ve had enough, I QUIT!”. Thankfully everything from clinical advice to advice on the management I was always persuaded that the hard work and sacrifices of cases, all whilst being done in a safe, non-judgmental and would be worth it! And speaking now, four years into clinical friendly environment. Thus far, it has been an invaluable tool practice, the hard work was certainly worth it. for open discussions and even for CPD opportunities. However your journey is just beginning. You have decided www.facebook.com/groups/142928966447293/ to join an amazing profession, one which continues to With all of this in mind you have chosen well by joining grow in size, strength and reputation. The opportunities are the Chiropractic profession and the BCA in particular. endless and, as some of you may have already found out, the I would like to be the first to welcome you all to the satisfaction you can receive from treating people knows no profession and the association and I look forward to end. We have the ability to change peoples lives, decrease pain, meeting all our new colleagues at the next conference. increase functionality and do it with a humble attitude and a However, before I sign off, I’d like to leave you with this, a smile on our faces. Some of you may have decided to specialise little message written in 1840 by a poet named Ralph Waldo in a particular area of chiropractic such as chronic pain Emerson. The poem is titled What is success?. management, sports, paediatrics or obstetrics, all of which present their own unique and specific challenges. My advice What is Success? would be to embrace those challenges, enjoy the difficult cases, To laugh often and much; continue to learn from peers, open your arms to competition To win the respect of intelligent people and continue to improve your knowledge base year-on-year. and the affection of children; You can never know too much! Be the best you can be! To earn the appreciation of honest critics I truly believe that the current BCA regime is a living and endure the betrayal of false friends; representation of this attitude. I know how hard BCA To appreciate beauty; Council is working to provide support for all of its members To find the best in others; and, by joining the BCA, you are a valuable member of To leave the world a bit better, whether by this association. As a BCA member you are entitled to a healthy child, a garden patch access our fantastic BCA Plus offering which includes BCA or a redeemed social condition; Privilege and which Treasurer, Tim Button, continues to To know even one life has breathed work wonders with. Tim continues to bring unrivalled easier because you have lived; deals for members on a regular basis throughout the year. How is it possible to mention the ongoing hard work of This is to have succeeded the association without including our President, Catherine Quinn, a natural leader who continues to work tirelessly Daniel Morgan Chair, Student and New Graduate Committee [email protected]

18 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

18_Student_Report1p.indd 18 08/08/2018 22:09

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19_PheonixShockwave_AdvertsContact.indd 19 02/08/2018 22:20 REPORTS BCA PROFESSIONAL STANDARDS COMMITTEE

Professional Standards Committee

he BCA Professional media), conduct of Council and Standards Committee committee members during (PSC) was asked by BCA and after office; Council to review the • develop a Quality Agenda TTerms of Engagement and the BCA promoting highest ethical Code of Conduct and Disciplinary standards and provide advice Procedure as well as being to members via Council on encouraged to pursue development clinical governance; of a Quality Agenda. • refer breaches of conduct to The PSC is instructed to: the Disciplinary Committee; • advise BCA Council on • report to Council quarterly. professional standards and The committee has met regularly ethical issues; via Skype and liaised with BCA at current BCA advice, Quality or suggestions regarding • advise members on proactive Head Office, Council, President and Standards of the Royal College of professional standards. risk management; Executive as necessary. Chiropractors and, of course, the [email protected] • maintain and develop codes The PSC has reviewed and GCC Code. We will be making of conduct and disciplinary revised the BCA Code of Conduct this information available to Jeff Shurr procedure; and Disciplinary Procedure and members after the next Council Chair PSC • maintain guidelines on begun the development of the meeting in August. Please contact Warren Dickinson & professional behaviour Quality Agenda in respect of the me or any of the committee John Williamson (including conduct on social Terms of Engagement, looking members with any concerns Committee Members

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20 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

20_ProfStandards_Report1p.indd 20 08/08/2018 21:18 BUSINESS & FINANCE

Phew: Hot weather and the workplace

irstly, it is important to note Look at the environment your employees work in and more comfortable and less likely to that there is no maximum potential contributing factors to the overall temperature take time off work. Taking time to workplace temperature. It of the office. Are there windows which can be opened? provide your employees with perks can is a common myth that this Are there any machines that generate a lot of heat? Expert also really help boost morale and keep Fexists and entitles employees to be guidance can also be used to advise on this. Speaking to people engaged such as providing cold sent home from work if it gets too staff to gain a majority view of a comfortable working food and drinks. hot. There is a legal requirement temperature may also be useful. for employers to provide a base Managing Absences temperature when it is cold but the Listening to Your Staff Employees have no legal grounds inverse is not true. The ‘ideal’ temperature is different for everyone; you cannot to take a day off due to workplace Health and Safety Regulations ensure everyone has their idea of a perfect temperature, but temperature unless they have a simply require workplace you can listen to the overall consensus of your employees. If legitimate medical condition that is temperatures to be ‘reasonable’ lots of members of staff are complaining that it is too hot this directly impacted by the heat (or the and this is applicable all year round. is likely to be the case. Instead of ignoring their grumbles take cold). As an employer you have a legal Just because there isn’t a legal steps to address these before they result in formal grievances. obligation to provide a reasonable requirement does not mean that Easy but effective steps can include using portable desk fans temperature and look after the general complaints about the temperature or utilising air conditioning units. Employers may also have a wellbeing of your employees. So, while from staff should be disregarded legal obligation to make workplace adjustments if a disabled there is no legal obligation to provide though. employee has a medical condition that is directly affected your employees with a particular by the heat (or the cold when air conditioning is turned up temperature, the benefits of doing Working Out a Reasonable to reduce the effects of warmer temperatures). Speak to this so are significant and the pitfalls of Temperature employee to better understand their needs. ignoring your employees is great. Just Dependant on the nature of the work because employees cannot legally being done and the type of workplace, Relaxing Dress Codes take a day off because of the heat a ‘reasonable’ temperature fluctuates Higher temperatures can have a detrimental effect on your doesn’t mean they won’t try. Avoid this so you should take all your workplace employee’s engagement and productivity. Relaxing the dress scenario by being fair, listening to your factors into account when performing code slightly (something as simple as stating ties are not a employees and making adjustments a risk assessment. requirement when it is hot) will help make your employees when necessary.

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 21

21_HotOffice_Business1pp.indd 21 09/08/2018 10:17 REPORTS

Royal College of Chiropractors

RCC activities in the year ahead will, perhaps more than ever, highlight how RCC membership complements membership of your Professional Association.

Call for PPQM/CMQM applications Promotion & Wellbeing Society, the inaugural meeting of which will Calls for applications for both awards for the 2019-2021 period are now take place in Manchester on Saturday 8th September. This meeting open. The application form and conditions of award can be accessed is suitable for any chiropractor interested in developing their public at https://rcc-uk.org/rcc-quality-marks. The deadlines for receipt of health role, particularly in terms of improving the impact of their public applications are Friday 28th September 2018 (PPQM) and Friday 2nd health interactions with patients and is a must for any RCC member November 2018 (CMQM). who would be interested in joining a steering group to help develop the role and activities of the Society (N.B. steering group members will Dementia awareness receive funded membership of the Royal Society for Public Health). The RCC has now launched its evidence-based guidance and self- Registration is available at https://rcc-uk.org/rcc-events assessment tool to help chiropractors ensure their clinics provide a dementia-friendly environment. Please see the accompanying article in Rob Finch this issue of Contact. Chief Executive e [email protected] New Public Health Promotion & Wellbeing Society t +44 (0)118 946 9727 Following discussions with the Royal Society for Public Health and w www.rcc-uk.org Public Health England, the RCC is launching a new Public Health fb.com/royalcollegeofchiropractors

Forthcoming RCC CPD events Register online at https://rcc-uk.org/rcc-events/ or contact [email protected] | 0118 946 9727

Managing Recent Toddlers, Teenagers and FICS/RCC ICSSP Upper Assessment and Onset Cervical the Challenged Child Extremity Seminar Management of Radiculopathy: 22 September 2018 • 09:30 19 October 2018 • 08:00 Hypermobility Improving Standards Venue: Copthorne Hotel, Venue: Holiday Inn Oxford, 10 November 2018 • 09:30 and Quality of Care The Close, Quayside, Peartree Roundabout, Venue: Holiday Inn Express 22 August 2018 • 18:30 Newcastle Upon Tyne NE1 3RT Woodstock Road, Birmingham NEC, Bickenhill Venue: Apollo Hotel, College Member Fee: £145.00 Oxford OX2 8JD Parkway, Birmingham B40 1QA Aldermaston Roundabout, Northern Member Fee: £135.00 Holders of the ICCSP College Member Fee: £99.00 Basingstoke RG24 9NU Non-College-Member Fee: £185.00 qualification may qualify for Trent & Midlands Member Fee: College Member Fee: £35.00 a discount, please enquire. £89.00 Non-College-Member Fee: £50.00 Radiation Protection Student rate applies to final year Non-College-Member Fee: £145.00 Supervisor (RPS) students and 1st year graduates. Developing the Refresher Training College Member Fee: £695.00 Public Health Role of in association with Sports & Exercise Faculty Chiropractors: Imaging Innovated (RCCSEF) Member Fee: £599.00 Inaugural Meeting of 29 September 2018 • 09:00 Student Member Fee: £450.00 the New RCC Public Venue: Holiday Inn Oxford, Health Promotion & Peartree Roundabout, Chiropractic Approach Wellbeing Society Woodstock Road, to Supporting the 08 September 2018 • 10:30 Oxford OX2 8JD Mother-Baby Dyad Venue: Manchester Airport College Member Fee: £195.00 20 October 2018 • 09:30 Marriott Hotel, Hale Road, Hale Non-College-Member Fee: £245.00 Venue: Holiday Inn Leeds Barns, Manchester WA15 8XW Wakefield, Queens Drive, College Member Fee: £35.00 Ossett, Wakefield WF5 9BE Non-College-Member Fee: £55.00 College Member Fee: £99.00 Yorkshire Member Fee: £89.00 Non-College-Member Fee: £145.00

22 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

22_RCC_Report1p.indd 22 08/08/2018 22:11 BCA Council Elections Support your Association and get involved

23-24,i-iv,25-26_Elections_Feat8pp.indd 23 08/08/2018 21:58 BCA Council Elections

It is that time of the year when I write to invite you to participate in the BCA’s democratic process to elect members of its Council.

strongly urge you to engage in this exercise as decisions The timetable for the election process is as by Council affect all members. Existing Council members follows: have given excellent service to the BCA; however, as a • Nominations must be received by 5pm on 29th August progressive organisation, we welcome new ideas. If elected 2018 Iyou will have an opportunity with your colleagues to shape • Should a ballot be required, this will open by the future of the BCA. Given that it is the UK’s and Europe’s 14th September 2018 leading chiropractic membership body you will, as the BCA’s • Voting will close at 5pm on 28th September 2018 leaders, influence the direction of the profession in our • Results declared at the AGM on Saturday 13th country and beyond. October 2018

For 2018, the following roles are up for If you would like to stand for election for any of these posts election: you should complete a Nomination Form together with the • Vice-President Declaration of Interest and Manifesto Statement all available • Secretary in this section and return to the BCA at the address below to • Treasurer arrive no later than 5.00pm on 29th August, 2018. • Five general Council members The envelope should be addressed to: Mark Rawden, British Chiropractic Association, Overviews of these roles are found later in this section. 59 Castle Street, Reading, Berkshire RG1 7SN The role of President is elected for a two-year term and and marked: STRICTLY CONFIDENTIAL - ADDRESSEE the current President, Catherine Quinn, started her term in ONLY October 2017. The rules governing this election are included in this The posts up for election are open to full and semi- section along with the Nolan Principles of Public Life to active members only. which BCA Council members are expected to adhere. Please note that, with the exception of the President (who All this information plus the forms are available on the is elected for a two year term) these posts are for a one year BCA Members’ Area at: www.chiropractic-uk.co.uk/ period. council-elections-2018 Council membership attracts an honorarium (see later in this section) and Council members will be required Regards to attend six meetings annually. Nominations must be Mark Rawden proposed and seconded by Full and/or Semi-Active Chief Executive members only. Should the nominations outnumber the posts available, there will be a ballot.

24 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

23-24,i-iv,25-26_Elections_Feat8pp.indd 24 08/08/2018 21:58 COUNCIL NOMINATION FORM

agree to put my name forward for election to the post of

SIGNATURE OF NOMINEE* Date

SIGNATURE OF PROPOSER*

Name in Capitals

SIGNATURE OF SECONDER*

Name in Capitals

Note: * The nominee, proposer and seconder must be Full or Semi-Active members of the BCA. You may wish to attach a photograph which will be visible to voting members.

The form, along with the Declaration of Interest and Manifesto, MUST REACH the BCA (BY RECORDED DELIVERY) BY 5.00PM ON 29th AUGUST 2018. THE ENVELOPE SHOULD BE ADDRESSED TO Mark Rawden, BCA, 59 Castle Street, Reading, Berkshire RG1 7SN and marked: STRICTLY CONFIDENTIAL – ADDRESSEE ONLY

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 i

23-24,i-iv,25-26_Elections_Feat8pp.indd 1 08/08/2018 21:58 DECLARATION OF INTEREST

declare that I am currently working as a clinic owner/employee at

1. Please list below any association (with chiropractic organisations), you have had during the past five years, that could potentially give rise to a conflict of interest in your role as a Council Member. Name of organisation Nature of association/involvement

2. Please list below any association you have had (with non-chiropractic organisations) during the past five years, that could potentially give rise to a conflict of interest in your role as a Council Member. Name of organisation Nature of association/involvement

3. Please list below any association (with chiropractic and/or non-chiropractic organisations), that your immediate family (defined as your parents, siblings, spouse and children) have that could potentially give rise to a conflict of interest in your role as a Council Member. Name of organisation Family member involved Nature of association/involvement

SIGNED Date

This Declaration of Interest needs to be completed by the person being nominated to stand for election to the BCA Council. Any information withheld or found to be inaccurate may result in disciplinary action and disqualification from serving on Council

ii CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

23-24,i-iv,25-26_Elections_Feat8pp.indd 2 08/08/2018 21:58 Manifesto Statement (maximum five hundred words): Please explain your motivation to stand for election and what you would bring to the role.

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 iii

23-24,i-iv,25-26_Elections_Feat8pp.indd 3 08/08/2018 21:58 RULES FOR THE ELECTION OF COUNCIL MEMBERS

Should the number of candidates for any role exceed the number of positions available, there will be a ballot. The ballot will be undertaken electronically and overseen by the Electoral Reform Society.

In these cases the following rules will apply: • Only full members (i.e. Ordinary and Semi-Active members) are eligible to vote. • Eligible members will be issued with a link a not later than 28 days before the date of the Annual General Meeting. Eligible members may only vote by using the login details supplied to them. • The voting page will list all nominations for contested posts, together with the names of proposers and seconders and the number of vacancies to be filled. Each candidate’s manifesto will also be available. • The voting page shall contain instructions on how to vote. • The voting will close on 28th September at 5pm.

The Nolan Principles of Conduct Underpinning Public Life Selflessness Holders of public office should take decisions solely in terms of the public interest. They should not do so in order to gain financial or other materials benefits for themselves, their family, or other friends.

Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might influence them in the performance of their official duties.

Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

Accountability Holders of public office are accountable for their decisions and actions to the public and must submit to whatever scrutiny is appropriate to their office.

Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

Leadership Holders of public office should promote and support these principles by leadership and example.

All this information and plus the forms are available on the BCA Members’ Area at: www.chiropractic-uk.co.uk/council-elections-2018

iv CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

23-24,i-iv,25-26_Elections_Feat8pp.indd 4 08/08/2018 21:58 Job Descriptions

VICE PRESIDENT SECRETARY The Vice President is elected by BCA members on The Secretary is elected by BCA members on an annual basis. In acting an annual basis and has responsibility for assisting on behalf of their peers, the Secretary should be objective in his/her in developing the strategic direction of the BCA in recommendation of individuals for reward or benefit. consultation with the President and Council members. The Secretary is accountable to the membership for his/her decisions In acting on behalf of his/her peers the Vice President and actions and should be as open as possible about the reasons for his/her should be objective in his/her recommendation of decision. The Secretary should promote and support the aims and objectives individuals for reward or benefit. of the British Chiropractic Association by leadership and example. The Vice President is accountable to the membership The Secretary is expected to observe confidentiality on issues, which are for his/her decisions and actions and he/she should discussed either at Council meetings or within the Council framework. The be as open as possible about the reasons for his/her Secretary may claim an honorarium and travelling expenses as agreed by decision making. The Vice President should promote Council from time to time. and support the aims and objectives of the British Chiropractic Association by leadership and example. LIST OF DUTIES The Vice President is expected to observe 1. The Secretary will ensure compliance with the Association Memorandum confidentiality on issues which are discussed either at and Articles and will assist the Chief Executive in any review of Council meetings or within the Council framework. He/ Memorandum and Articles, which may be required. she may claim an honorarium and travelling expenses as 2. The Secretary will, in conjunction with Council members and the Chief agreed by Council from time to time. Executive liaise with the Chiropractic Colleges and Student Bodies. 3. To attend BCA Council Meetings and any other meetings, as required. LIST OF DUTIES 4. To review Council paperwork permitting adequate preparation to allow full 1. The Vice President will deputise for the President in participation at BCA Council and other meetings. his/her absence. 5. To respond to requests for comments, information and consultation in a 2. To attend BCA Council Meetings and any other timely manner. meetings as required. 6. To undertake specific tasks, as agreed and designated by the Council from 3. To review Council papers permitting adequate time to time. preparation to allow full participation at BCA Council 7. To liaise with BCA members and act as a conduit for information to and and other meetings. from BCA Council. 4. To respond to requests for comments, information and consultation in a timely manner. 5. To undertake specific tasks, as agreed and designated by the Council from time to time. 6. To liaise with BCA members and act as a conduit for information to and from BCA Council.

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23-24,i-iv,25-26_Elections_Feat8pp.indd 25 08/08/2018 21:58 TREASURER GENERAL COUNCIL MEMBER The Treasurer is elected on an annual basis by the BCA membership. In Members of BCA Council are elected on an annual acting on behalf of their peers the Treasurer should be objective in his/her basis by the BCA membership. In acting on behalf recommendation of individuals for reward or benefit. of their peers members should be objective in their The Treasurer is accountable to the membership for his/her decisions recommendation of individuals for reward or benefit. and actions and should be as open as possible about the reasons for his/her Members of Council are accountable to the decision. The Treasurer should promote and support the aims and objectives membership for their decisions and actions and should of the British Chiropractic Association by leadership and example. be as open as possible about the reasons for their decision The Treasurer is expected to observe confidentiality on issues, which are making. Members of BCA Council should promote and discussed either at Council meetings or within the Council framework. The support the aims and objectives of the British Chiropractic Treasurer may claim an honorarium and travelling expenses as agreed by Association by leadership and example. Council from time to time. Members of Council are expected to observe confidentiality on issues, which are discussed either LIST OF DUTIES at Council meetings or within the Council framework. 1. The Treasurer will, in conjunction with the Chief Executive and Accountant, Members of Council may claim an honorarium and ensure that the requirements of the Companies Act are undertaken and that travelling expenses as agreed by Council from time to full books of accounts are kept of all money received and expended by the time. Association. 2. The Treasurer will, in consultation with the Chief Executive and Accountant, LIST OF DUTIES present timely financial reports to BCA Council and will oversee the 1. Attendance at BCA Council Meetings and any other preparation of the annual budget and production of the annual accounts. meetings as required. 3. To attend BCA Council Meetings and any other meetings, as required 2. To review Council papers and to permit preparation 4. To review Council paperwork and to permit adequate preparation to allow to allow full participation at BCA Council and other full participation at BCA Council and other meetings. meetings. 5. To respond to requests for comments, information and consultation in a 3. Responding to requests for comments, information timely manner. and consultation in a timely manner. 6. To undertake specific tasks, as agreed and designated by the Council from 4. To undertake specific tasks as agreed and designated time to time. by the Council from time to time. 7. To liaise with BCA members and act as a conduit for information to and 5. To liaise with BCA members and act as a conduit for from BCA Council. information to and from BCA Council.

Council Honorarium

• Council members will be paid £2,000 annually. This will include attendance at six meetings; four Council meetings plus two other meetings e.g. the strategy meetings. • For meetings, over and above the six, Council members will be paid £350 per full day of meetings. Attendance at meetings lasting up to 3.5 hours (excluding travelling time) will attract half day’s honoraria. Such meetings must be authorised in advance by the Chief Executive. • For any non- Council members who are asked to undertake work on behalf of the BCA, the same rates will apply i.e. £350/full day. Such work must also be pre-authorised by the Chief Executive. • Meetings in the evenings or at weekends will not attract honoraria.

26 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

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27_LightforceLasers_AdvertsContact.indd 27 03/08/2018 10:23 COLLEGES

News from UniversityAECC College

t has been nine months since we launched seven new BSc courses in Sport, Exercise and his teaching became AECC University College. Health Science and Psychology. To facilitate this we have experience and The name, the logo, updated adapted our management structure into three distinct the understanding institutional responsibilities and schools to allow us to focus on these specialisms; The of the UK Higher Iprocesses have all had time to bed-in School of Chiropractic, The School of Psychology, Sport and Education sector. and it now feels like a natural moment Physical Activity and The School of Medical Ultrasound. We wish Phil all to take stock of where we are and This is an important moment for the University College the best and look where we plan to go. and reflects all the hard work from our academic and forward to seeing What may seem like cosmetic professional services staff. In particular I would like to thank the chiropractic changes to the external eye have had Dr Stewart Cotterill, Head of The School of Psychology, Sport reputation of a profound impact on our institution. and Physical Activity. the University Our vision remains as pertinent as Following this change in institutional structure we College soar to ever; to be a leading higher education had the privilege of appointing a new Head of School of new heights. institution in the university sector Chiropractic and I am pleased to announce the appointment In April we welcomed a number specialising in chiropractic and of Phil Dewhurst. He has proved to be a real asset to of UK and European chiropractic other healthcare disciplines and the institution through his knowledge of chiropractic, associations and stakeholder to be recognised both nationally organisations onto campus for our first and internationally for our quality Chiropractic Stakeholders Forum. It and excellence. At this stage of our was a real pleasure to have the group development it is about demonstrating on-site and to discuss educational and our distinction through our actions. professional issues as well as future Cultivating and maintaining plans for growth. long-lasting relationships and May continued to be a busy time as communicating our excellence and our academic staff members attended expertise to increase visibility within this year’s European Chiropractic the associations and organisations to Union Convention in Budapest, which we belong. Hungary. Three members of staff Underpinning this renewed vitality presented at the ECU Researchers’ is our expansion into the specialist Meeting and Dr Dave Newell, field of health sciences. We officially Director of Research, took part in a plenary session on the topic of basic mechanisms of pain, function, and manual treatment. Two PhD students also highlighted the work they have Joyxxxx been undertaking. Michelle Holmes,

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Research from AECC University College

Research within the university sector is a Taught Degree near universal expectation of both the public, Awarding students and funders. Over the years at AECC Powers (TDAP) University College we have been fortunate The to have key people on faculty who have University been pioneers in early research pertinent to College will the chiropractic profession and who have begin to move toward contributed substantive and impactful a positon where we will be eligible to take activity on the international stage. For me, part in REF and work toward gaining RDAP three individuals stand out. powers. The first goal is arriving soon and Lecturer in Research Methods, Professor Jenni Bolton the author of the we hope to be ready to take part in REF for presented her PhD project on the Bournemouth Questionnaire (BQ) one of the first time as an institution in 2021. The use of patient-reported outcome the first patient reported outcomes for low gaining of RDAP will take rather longer but measures (PROMs) for individuals with back and neck pain to fully embrace the plans are already under way to take the steps back pain. AECC University College biopsychosocial model; Professor Alan Breen necessary to put us on that path. graduate and Bournemouth University who has been influential in early clinical We have formed three new research PhD student, Amy Miller, presented studies exploring the efficacy of chiropractic centres in addition to our existing one in two posters, a platform presentation at care, translational research and latterly biomechanics. These will be focused on Researchers’ Day and a workshop. imaging technology; Associate Professor clinical services and provision, educational To better reflect our breadth Joyce Miller, who has been a stalwart research and psychology/sport/physical of alumni and to provide more of research pertaining to the paediatric activity. collaborative learning opportunities, population and more recently important We have been involved with the we have revitalised our annual Alumni public health issues such as breast-feeding Welsh Institute of Chiropractic (a close Reunion. Now titled AECC Summit, the and how the profession can positively collaborative partner) and the Chiropractic ‘bigger and better’ event takes place influence such behaviour. They have all Research Council (funded by BCA members) on Saturday 15th September and is a supported multiple individuals at Masters to successfully engage with an Arthritis chance for alumni to reconnect, learn and PhD level as well. Research UK initiative that provides an something new and make memories. However with the growing realisation opportunity for two chiropractic graduates Consisting of panel talks, research that research is truly the currency of a to attend an eight-week research taster presentations, demonstrations, tours health profession and the advent of our with other health orientated profession and the ever popular evening dinner University College status, the need for a graduates before their first clinical job. This and dance, AECC Summit 2018 is set more comprehensive and strategic approach involves universities such as Nottingham, to be one to remember. to research capacity building and output Southampton, Bath, Oxford, Loughborough Many of you will have received our is called for. We have begun to roll out a and Leeds, where the multidisciplinary new alumni bulletin, Tide. The bulletin University College-wide research strategy group of students will spend one day in each, provides alumni with a range of that aims to embed a research culture interacting with high-level researchers during graduate stories including memories, across our institution. This will enable us to their eight-week project. We have already achievements and guest articles, structure teams and processes to facilitate been successful in appointing two candidates updates from staff and important focused research activity which encourages for this initiative for 2018 and intend to University College news. Our focus will and facilitates budding chiropractic continue this activity over the next few years. always be to help you maintain links researchers. Our goals are ambitious and we have had with your alma mater and to create In the Higher Education (HE) sector most some notable successes already; we are new connections within our alumni Universities possess two key activities that excited to be beginning this journey. The community. drive research. The first is eligibility to take ongoing and deeper professionalisation of As we progress through the second part in the Research Excellence Framework the chiropractic profession will require a half of the year we celebrate the (REF) exercise, a process where institutions robust and active research culture and clear continuing drive and ambition which submit their research output associated with academic routes for career progression. High runs throughout the University College research active staff for a UK wide exercise reputational individuals and strong research via our staff, students, partners and of quality assessment that brings with it open doors offer inclusion and influence like communities. All of this activity the possibility of securing part of a pot of no other activity. reinforces our pioneering spirit and HE funding for research. The second is the Whilst in the past the pioneers blazed a embeds us as a specialist provider in awarding of PhDs which requires institutions trail, we now have to build a city. health sciences. to have Research Degree Awarding Powers (RDAP). This institutional power is similar to Dr Dave Newell Haymo Thiel our recently successful application in 2017 for Director of Research Principal, AECC University College

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28-31_AECC+WIOC_Colleges4pp.indd 29 08/08/2018 22:07 COLLEGES News from WIOC ollowing a busy couple of months of exams, marking You may have seen on our WIOC Facebook (Welsh and meetings there have been a number of changes Institute of Chiropractic) and Instagram (welsh_institute_ within the Chiropractic team and across the Faculty. chiropractic) feeds that our new student clinicians took part Dr James Gravelle has been appointed as Head of in the annual simulation sessions at USW, accompanied FSchool for Sport Health and Professional Practice and Dr by our own Chiropractic members of staff and visiting Linda Evans as Deputy Dean of the Faculty of Life Sciences. fellow, Dr Lloyd Evans (GP). During these sessions students We wish them the best of luck in their new roles and look were placed in contextual situations designed to enhance forward to working with them. We would also like to process-based learning and the development of transferrable congratulate David Byfield for his substantial contribution competencies. Once again, our students did the course and to both the MChiro programme at USW and the the institute proud during these sessions, setting the bar chiropractic profession in general; he has been recognised by even higher for the next cohort! being awarded the title of Professor. I would like to welcome Bianca Zietsman as a full-time As mentioned in a previous report one of the main things lecturer on the chiropractic programme consolidating the keeping us busy has been preparing for University Validation years of effort she has put into helping secure and develop and GCC re-accreditation. I am delighted to say that we undergraduate student-based research. We look forward to were successful on both counts and that the programme the opportunities this will bring to research development continues to flourish. Indeed, the University recently at WIOC. Brian Gleberzon, a longstanding member of achieved a number two ranking in the Guardian league table academic staff at CMCC, has enrolled through WIOC as for health professions 2019! a new PhD student. He will be looking at the delivery of In keeping with tradition during the graduation period, jurisprudence by chiropractic courses worldwide and his Year 4 students are awarded prizes in recognition of their supervision team includes both Peter McCarthy and Alister academic and clinical achievements. We are extremely Du Rose (for his first PhD supervision). proud of the performance of the graduating cohort as a In terms of research activity Mark Langweiler and Peter whole but would like to give special recognition to the McCarthy are working on a second book about developing following students (now colleagues), who have performed research in CAM as a follow up to their successful first exceptionally well in the respective categories. edition. This has also been a busy period in terms of research activity at chiropractic meetings around Europe. Prize Recipient Sponsor At the ECU meeting in Budapest there was a significant WIOC presence with four staff members and three final year Academic Excellence Freya Roberts Bolton Dr B. Hammond students contributing. Staff participation kicked off the day before the main meeting on Researchers Day where some of Freya Roberts Bolton & British Chiropractic Best Research Project Ana Santos Association our research was shared with European colleagues.

Maria Laoudikou & Royal College Best Research Project Fatma Bosina Chiropractors

Robin Sagbakken & Clinical Excellence Atlas Clinical Limited James Oldham

Excellence in Radiology Fatma Bosina PLH Medical Limited

European Graduate of the Year Jonathan Shurr Chiropractors’ Union

Aatharsan Sellathurai & British Chiropractic Leadership Jonathan Shurr Association

Personal & Professional Rhiannon West & British Chiropractic development Reuben Bilton Association

Graham Harding Diego Casati WIOC Memorial Award

Mark Davies Memorial Didrik Winsnes & Dr M. Williams Award Jussi Jarvinen

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WIOC students present at the meeting included Manuel journal and participated in the annual editors meeting Cabrera, Troy Magowan, and Maria Laoudikou, all of whom over the two days prior to the RCC summer meeting (other presented elements of their undergraduate research. WIOC editors present were Bruce Walker, Simon French and Jeff staff also made strong contributions. Bianca Zietsman Hebert with Editorial Board members Jan Hartvigsen and presented as a keynote speaker describing her motivation Dave Newell). All those present gave a lecture covering for research and the development of her cervical spine/ various aspects of the future of the chiropractic profession concussion/disc injuries research. Bianca also presented and the importance of developing a research capacity. a sport injury workshop with Catherine Quinn and On the horizon is WFC Education Conference in London Ulrik Sandstrøm. A workshop on Acute Onset Cervical and members of WIOC will be presenting. David Byfield sits Radiculopathy was also co-presented by David Byfield under on the planning committee and will be moderating the end the banner of the Clinical Chiropractic Special Interest of conference consensus exercise. One thing to look out for Group. Both received wide acclaim by their respective at the Education Conference will be an initiative by WIOC’s audiences, the latter workshop format being considered as tech guru, Danny Clegg, considering the development and a standard for future Special Interest Group activity. Bianca integration of a classroom and 24-7 video feedback system Zietsman, Danny Clegg, Alister Du Rose and David Byfield for psychomotor skills training. This uses Video Enhanced also presented research including a platform presentation Observations (VEO) and will include a report on some collaboration with Dave Newell of AECC University College, positive outcomes from an associated quantitative study, looking at the challenges of introducing contextual factors as well as a VEO workshop. Danny has also had an abstract in an undergraduate curriculum. In total seven research accepted for his development of ‘Hydrapractic’, a process- posters were presented and I am pleased to say that, of the based learning exercise using a simulated patient encounter, undergraduate presenters, one is currently considering and physical technologies usually associated with the extending their undergraduate study and another is training of police and emergency services. considering enrolling on a PhD. The Royal College of Chiropractors summer meeting Alister Du Rose in Birmingham was based around the Editors of the David Byfield Chiropractic and Manual Therapies journal (of which the Peter McCarthy RCC is a co-sponsor). Peter McCarthy is an editor on the Rhys Breckon

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 31

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32_LloydWhyte_AdvertsContact.indd 32 03/08/2018 10:23 SPECIAL INTEREST

Research at your fingertips BCA members have exclusive access to the Research Review Service (RRS), where latest research papers are reviewed by a team of top class reviewers. These are published weekly and details posted in InTouch and on the BCA Member Twitter feed. In each edition, Contact selects recent reviews to highlight. You can access RRS via the Members’ Area of the BCA Website: select Services tab and then Research Review Service.

Lancet Low Back Pain Series – Part 1 – Evidence-Based Call to Action

Background Information: very small percentage of LBP cases. LBP Papers Reviewed: These seminal articles, published by patients are also prone to suffer from 1. Buchbinder R, van Tulder M, Oberg B et al. Low back The Lancet, one of the world’s most- additional psychosocial comorbidities pain: a call for action. Lancet 2018 Mar 20. pii: S0140- read medical journals, are a literal ‘call such as depression and/or anxiety and 6736(18)30488-4. doi: 10.1016/S0140-6736(18)30488-4. to action’ to change the way low back complain of pain in multiple sites of [Epub ahead of print]. pain (LBP) is perceived, assessed and the body. Concomitant maladaptive 2. Hartvigsen J, Hancock MJ, Kongsted A et al. What low treated worldwide. The global point changes in pain processing can also back pain is and why we need to pay attention. Lancet prevalence of activity-limiting LBP is occur, which may contribute to one’s 2018 Mar 20. pii: S0140-6736(18)30488-4. doi: 10.1016/ approximately 7.3%, indicating that pain experience. As such, LBP is S0140-6736(18)30480-x. [Epub ahead of print]. approximately 540 million people are known to be a truly bio-psycho-social affected by LBP at any time. As such, and layered phenomenon, requiring Author Affiliations: LBP has now become the number one different treatments at different times. Cabrini-Monash Department of Clinical Epidemiology, 1 cause of disability worldwide . Cabrini Institute and Monash University, Malvern Victoria, The authors describe a global challenge Etiology and Pathophysiology Australia; Department of Health Sciences, Faculty of of preventing potentially harmful and of Low Back Pain Science, Vrije Universiteit Amsterdam, The Netherlands; wasteful practices for the assessment Imaging findings are commonly used Department of Sports Science and Clinical Biomechanics, and treatment of LBP, while ensuring by healthcare providers to explain University of Southern Denmark, Odense, Denmark; equitable, effective and affordable the possible etiological source of LBP. Nordic Institute of Chiropractic and Clinical Biomechanics, healthcare for those who need it. However, the diagnostic importance Odense, Denmark; Department of Health Professions, The first article (#1 above) sets the of imaging findings are largely Faculty of Medicine and Health Sciences, Macquarie stage by identifying and describing the questionable, as multiple findings University, Sydney Australia; Arthritis Research UK Primary worldwide calamity surrounding low identified in LBP sufferers are also Care Centre, Research Institute for Primary Care and 2 back pain. The second article (#2 above) common in those without LBP . Health Sciences, Keele University, Staffordshire, UK; progresses to define low back pain and Some imaging findings, such as type 1 Department of Public and Occupational Health Research its causes, as well as biopsychosocial Modic changes (odds ratio [OR]: 4.0), Institute, VU University Medical Centres, Amsterdam, correlates that contribute to the variable disc extrusion (OR: 4.4), disc bulge The Netherlands; Kaiser Permanente Washington Health clinical presentations and treatment (OR: 7.5) and spondylolisthesis (OR: Research Institute, Seattle, USA. effects seen in LBP patients. The third 5.1), have some association with LBP. paper in the series (summarized in However, these associations require Research Review by Dr. Demetry Assimakopoulos© a separate Review) discusses the further investigation. Unfortunately, no various evidence-based treatment and evidence exists that imaging improves screen for red flags. Interestingly, prevention strategies for LBP. clinical outcomes. Therefore, existing approximately 80% of individuals clinical guidelines recommend against with acute LBP have at least one red Summary: routine use of imaging for back pain3, 4. flag5, despite less than 1% having a Despite its incredible prevalence, the The utilization of imaging in cases serious disorder. Nearly all red flags exact cause or nociceptive source of of radiculopathy and spinal stenosis are uninformative when reported in LBP remains elusive for most patients. is also debatable. Disc herniations isolation and do not change post-test Urgent assessment and treatment are and stenosis are commonly found on probabilities of serious abnormalities. required in serious causes of low back MRI in those with and without LBP. As pain, such as neoplasm, infection, such, these imaging findings must also The Burden of Low Back Pain fracture and inflammatory conditions. be clinically correlated. The median 1-year period global Luckily, these severe causes make-up a Imaging is often considered to prevalence of LBP is approximately

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37%. LBP peaks in mid-life and is more which contributes to the cycle of autoimmune diseases. Replacement common in women than men (despite poverty in poorer world regions. wages account for 80-90% of the total gender reporting being variable Interestingly, in higher-income costs. However, different figures may around the world). Activity limitations countries, differences in social be quoted based on differences in presenting alongside LBP increase compensation systems are largely national legislation and healthcare with age. Low back pain prevalence responsible for national differences practices. Estimates of direct medical is greater in higher-income countries in the rate and extent of LBP-related costs from LBP are largely calculated compared to middle- or lower-income workplace disability. In high-income from high-income countries, with the countries. There is no difference countries, disabling LBP is associated USA having the highest costs. These between rural and urban areas. with socioeconomic status, job high costs are attributed to a more In 2015, LBP accounted for satisfaction and the potential for medically intensive approach and approximately 60.1 million years lived monetary compensation. higher rates of surgery, compared with with disability, making it the number The disability associated with other high-income countries. In many one cause of disability worldwide; an LBP not only affects one’s ability nations, the most common reason for increase of 54% since 19901! The rise to work, but also one’s ability to medical visits is LBP! in this global burden is almost entirely function independently and engage Approximately half of people seeking secondary to population increase in social activities. Chronic LBP is care from primary care practitioners and aging in both high-income, low- often associated with hopelessness, suffer constant or fluctuating, low-to- income and middle-income countries, family strain, social withdrawal, job moderate intensity pain. Unfortunately, as opposed to increased prevalence. loss, disappointment with healthcare while many individuals improve, Importantly, LBP-related disability encounters, pain acceptance, learning approximately ⅔ of people continue to is highest in working populations self-management strategies and report some pain at 3 and 12-month worldwide. This is especially wealth at retirement age. LBP truly has post-injury time intervals. The best concerning in middle- and low-income multifaceted, biopsychosocial effects evidence suggests that approximately nations, where job modifications are on many patients. 33% of people with LBP will have a almost completely impossible. This is The economic impact of LBP recurrence of LBP within 1 year of problematic, as many sufferers modify is comparable to cardiovascular recovering from a previous episode. their activity without compensation, disease, cancer, mental health and It is now understood that LBP is a

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long-lasting condition with a variable disability. The fear avoidance model encoding of high threshold (noxious/ course, rather than episodes of unrelated has been expanded to include the dangerous) stimuli from the environment occurrences. influence of maladaptive learning into an electrical signal which is Multiple risk-factors and triggers processes and disabling beliefs on pain transmitted to the CNS. Nociception for episodes of LBP exist. The most perception and behaviour, suggesting is NOT synonymous with ‘pain’. These commonly cited risk factor of a new that pain cognitions have a central role episode of LBP is a previous episode. in the development and maintenance Individuals with other chronic of disability and pain itself11. Pain Societal factors are also correlated conditions, such as asthma, headache self-efficacy has been consistently with LBP. Interestingly, chronic, and diabetes, are also more likely to associated with impairment, disability, disabling LBP disproportionately report LBP than those with otherwise affective distress and pain severity12. good health (OR: 1.6-4.2). Individuals As such, many clinicians have moved affects low income and low with mental health comorbidities such away from aiming to directly alleviate education populations. as psychological distress (OR: 2.526) and pain, to aiming to change beliefs depression (OR: 2.97) also have a greater and behaviours13. (REVIEWER’S risk of future LBP. Lifestyle factors NOTE: this does not mean that we as inputs are normally processed such as smoking, obesity, physical providers should take the ‘bio’ out of in multiple areas throughout the inactivity and other factors that are ‘biopsychosocial pain management’. nervous system. In the context of correlated with poor general health are Many times, fears can be confronted chronic pain, the actual processing also associated with LBP and CLBP. during treatment or with exercise. While of nociceptive inputs changes. It has Genetics are believed to account for a thorough biopsychosocial framework been demonstrated that patients approximately 21-67% of the future risk for chronic LBP exists, we should not with chronic LBP show structural of LBP; this association is stronger in unnecessarily dismiss patients and brain changes in different cortical chronic and disabling LBP cases8. Heavy simply refer them to psych when faced and subcortical areas and altered workloads (OR: 1.08-4.19), awkward with the challenge of kinesiophobia functional activity in pain-related areas postures (OR: 8.0), heavy manual tasks (for example). Rather, treatment of following painful stimulation15. (OR: 5.0), feeling tired (OR: 3.7) and kinesiophobia can be performed via Processing of nociception is distraction during activity (OR: 25.010) educating your patient on the relationship contingent upon the nociceptive drive, have all been associated with LBP. Still, between fear-avoidance and pain/ context, cognition and emotion. If the nature or even existence of causal disability and gradual confrontation any of these factors are altered, the pathways linking these risk factors and using imagined movements, mirror same nociceptive input can produce the development of back pain remains therapy and a gradual exposure a different cerebral signature in the unclear. to painful/fearful movements. Of same patient. While these findings are course, success is incumbent upon certainly attractive and impressive, The Biopsychosocial the patient being ready to confront their clinical implications still require Framework for LBP their kinesiophobia. This can often be further clarification and study. The relationship between disabling facilitated through co-management with LBP and biophysical impairment(s) is a psychologist, if necessary.) Clinical Application & not fully understood. However, some Societal factors are also correlated Conclusions: physical impairments are demonstrated with LBP. Interestingly, chronic, Low back pain is now the number in at least some individuals with LBP, disabling LBP disproportionally one cause of disability worldwide. such as muscle size and composition affects low income and low education The burden of LBP is ever increasing, alteration, and poor coordination (or populations. One study14 predicted particularly in low- and middle- motor control). It is uncertain, however, disability to any pain condition income nations. This worldwide whether these changes are causes, or in older age based upon life-time issue is adding additional strain to consequences, of LBP. socioeconomic status. Interestingly, already overburdened healthcare Several psychological factors, such as these findings were independent of and social systems. Generally, a depression, anxiety, catastrophization comorbid conditions, psychological specific nociceptive source for LBP and pain-self-efficacy (one’s belief in indicators and BMI (OR: 2.04). The cannot be identified. Recurrences their ability to influence events of one’s suggested mechanisms for the effect are unfortunately common. While life), have been investigated for their of low education on LBP include only a smaller percentage of patients relationship with LBP. The presence environmental/lifestyle exposures end-up with chronic and disabling of these factors in LBP sufferers is in low socioeconomic groups, lower low back pain, the costs associated associated with a heightened risk of health literacy and unavailable with healthcare and work disability disability. The mechanisms of this healthcare. Routine and increased attributed to low back pain are relationship are unfortunately not physical workloads are also associated strikingly large. The exact costs vary fully understood. The fear-avoidance with disabling LBP. between nations, and are related to model of chronic pain has been social norms, healthcare approaches well investigated, demonstrating Central Pain Processing and and legislation. While several global an association between fear of pain Modulation initiatives exist to address this burden, and avoidance of activity, leading to Nociceptive inputs are defined as the there is a need to find cost-effective and

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context-specific strategies for long-term A similar argument can be stated for conscious of finding a balance between management of low back pain. all professions, including interventional continents, gender, and professions REVIEWER’S NOTE: I believe these medicine, surgery and mental health. while still maintaining the highest Lancet articles are an important call Our unified mantra should be: “right scientific standards. to action for all healthcare professions. patient, right treatment, right time”… All invited authors then met in We all, in some way, shape or form, with all egos aside! Buxton, UK in the summer of 2014 attempt to help our patients manage to discuss the papers that were chronic forms of pain. As a clinician Study Strengths / Weaknesses: now in progress. The author teams who practices in two inter-disciplinary, These were exceptionally well-written subsequently worked on individual academic, chronic pain management and referenced articles. The authors papers and the steering group gave settings, I must congratulate the authors drew on expertise from a multitude feedback on drafts and finally in the of these articles for their contribution. of professional backgrounds and fall of 2015 we submitted 5 papers. 6 The subtext of these papers is that every synthesized this information incredibly months later we were notified that chronic low back pain patient has well. The limitations of these papers they had all been rejected, and the different needs. Biological, psychological pertain to the data itself. Much of the message was to reduce the 5 papers and social circumstances have variable evidence pertaining to LBP comes to 3. The main problem was that the contributions to pain presentation. Every from high-income countries, and as papers did not have a truly global patient is an n=1 and should be treated such, it is uncertain how well these perspective. The mood in the steering as such. We need to identify what a data generalize to low- and middle- group was not good! However, after patient’s real-time needs are and adjust income countries. Additionally, research several (long) teleconferences, we our delivery of healthcare practices as regarding the burden of LBP is not decided to give it one more go. We their needs change. We as clinicians and often a priority in low-income nations. rearranged the author teams and rehab providers need to step outside our Unfortunately, the exact consequences over the next year we produced the 3 proverbial comfort zones and identify of LBP in these countries remain papers. These then went through peer- patients that we can and cannot treat. largely unknown, although this is review and revisions but were finally changing. Broader aspects of life, such accepted in December of 2017. as participation, well-being, social The papers were published online Additional References: identity, career burden, health resource in March 2018, and the reception 1. Global Burden of Disease, Injury Incidence, Prevalence Collaborators. utilization and work-disability costs has been overwhelmingly good. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis were likely not accounted for in the There seems to be agreement that for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1545–602. GBD 2015 study. Subsequent inclusion the current model of care for LBP is 2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature and consideration of these factors not sustainable and that the papers review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol 2015; 36: 811–16. may change interpretation of the data. convincingly have shown the evidence- 3. Jarvik JG, Gold LS, Comstock BA, et al . Association of early imaging for Additionally, studies evaluating cost practice gap, while also showing a way back pain with clinical outcomes in older adults. JAMA 2015; 313: 1143–53. 4. Wong JJ, Cote P, Sutton DA, et al. Clinical practice guidelines for the of assessments and treatments may forward. I think it is too early to say noninvasive management of low back pain: A systematic review not capture all cost aspects from the just how influential these papers will by the Ontario Protocol for Traffic Injury Management (OPTIMa) individual patient’s point of view. be, time will tell. But I am convinced Collaboration. Eur J Pain 2016; 21: 201–16. 5. Maas ET, Juch JN, Ostelo RW, et al. Systematic review of patient that they will stand as a monument history and physical examination to diagnose chronic low back pain Commentary on Lancet Series for some years and that we will see originating from the facet joints. Eur J Pain 2017; 21: 403–14. . from Dr. Jan Hartvigsen: significant changes in the way we 6. Power C, Frank J, Hertzman C, Schierhout G, Li L. Predictors of low back pain onset in a prospective British study. Am J Public Health 2001; The idea of writing a series of papers manage LBP in the coming decade. 91: 1671–78. on LBP for The Lancet was conceived I am very humbled and pleased 7. Currie SR, Wang J. More data on major depression as an antecedent risk factor for first onset of chronic back pain. Psychol Med 2005; 35: 1275-82. at a meeting in the Forum for Research to have been part of this project. 8. Ferreira PH, Beckenkamp P, Maher CG, Hopper JL, Ferreira ML. Nature on Back and Neck Pain in Primary Interestingly, we have not received or nurture in low back pain? Results of a systematic review of studies Care that was held in Brazil in 2012. any funding for these papers. People based on twin samples. Eur J Pain 2013; 17: 957–71. 9. Heneweer H, Staes F, Aufdemkampe G, van Rijn M, Vanhees L. Physical Together with Rachelle Buchbinder have done all this work on their own activity and low back pain: a systematic review of recent literature. Eur from Melbourne, Australia, I wrote an time and at their own expense. I have Spine J 2011; 20: 826–45. outline of 10 papers that we shared learned so much from working with 10. Steffens D, Ferreira ML, Latimer J, et al. What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care Res 2015; with a small group of people: Maurits these extremely dedicated, intelligent 67: 403–10. van Tulder, Nadine Foster, Martin and talented people. 11. Crombez G, Eccleston C, Van Damme S, Vlaeyen JW, Karoly P. Fear- Underwood, Dan Cherkin and Chris Sometimes you just happen to be at avoidance model of chronic pain: the next generation. Clin J Pain 2012; 28: 475–83. Maher. Lancet really liked the idea of the right place at the right time. 12. Jackson T, Wang Y, Wang Y, Fan H. Self-efficacy and chronic pain a series of papers on LBP (in fact the outcomes: a meta-analytic review. J Pain 2014; 15: 800–14. 13. Frost H, Klaber Moffett JA, Moser JS, Fairbank JC. Randomised editor-in-chief replied back after 30 Jan Hartvigsen (June 17, 2018) – controlled trial for evaluation of fitness programme for patients with minutes) but thought that 5 papers Professor and Head of Research at the chronic low back pain. BMJ 1995; 310: 151–54. would be better than 10. This group, Institute for Sports Science and Clinical 14. Lacey RJ, Belcher J, Croft PR. Does life course socio-economic position influence chronic disabling pain in older adults? A general population that was now the steering group, Biomechanics at the University of study. Eur J Public Health 2013; 23: 534–40. then met over 3 days in Amsterdam Southern Denmark (SDU) and Senior 15. Kregel J, Meeus M, Malfliet A, et al. Structural and functional brain in Maurits’ office in November 2013 Researcher at the Nordic Institute of abnormalities in chronic low back pain: A systematic review. Semin Arthritis Rheum 2015; 45: 229–37. to outline 5 papers and put together Chiropractic and Clinical Biomechanics suitable author teams. We were very (NIKKB)

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Lancet Low Back Pain Series – Part 2 – Prevention & Treatment

Background Information: not be routinely used as part of early Paper Reviewed: The burden of low back pain (LBP) and management and should be reserved Foster NE, Anema JR, Chou R et al. Prevention and back-related disability have increased, only for patients in which these Treatment of Low Back Pain: Evidence, Challenges, and in spite of the large investment of assessment strategies may change pain Promising Directions. Lancet. Published online March 21, healthcare resources into its treatment management (i.e. those with suspected 2018 http://dx.doi.org/10.1016/S0140-6736(18)30489-6 (1, 2). The additional two papers in cancer, inflammatory conditions, etc.). this important Lancet series (reviewed LBP management guidelines are Author Affiliations: separately) described the global burden now placing greater emphasis on self- Arthritis Research UK Primary Care Centre, Research of LBP and examined its potential management, physical/psychological Institute for Primary Care and Health Sciences, Keele etiology and clinical course. This therapies, and some forms of University, Staffordshire, UK; Department of Public third paper in the series endeavoured complementary medicine, with less and Occupational Health and Amsterdam Public to summarize the multitude of LBP emphasis on pharmacological and Health Research Institute, VU University Medical practice guidelines, and the evidence surgical treatments. Various guidelines Centre, Amsterdam, Netherlands; Kaiser Permanente for prevention and treatment of recommend that non-pharmacological Washington Health Research Institute, Seattle WA, USA. LBP. The authors also attempted treatments such as massage, acupuncture, to highlight examples of effective, SMT, Tai Chi and yoga be utilized as Research Review by Dr. Demetry Assimakopoulos© promising or emerging solutions to the first line therapies. Multiple guidelines global burden of LBP. also consistently recommend that [CBT], relaxation, mindfulness) patients should be thoroughly educated or a combination of physical and Summary: about the nature of LBP, reassured psychological therapies for individuals Prevention of Low Back Pain (LBP): that symptoms will improve over time, that have failed to respond to previous There is unfortunately very little encouraged to avoid bed rest, and to stay treatments5-7. Multi-disciplinary published about LBP prevention. active and working. They additionally programs providing a variable Multiple potentially preventive recommend that pharmacological combination of supervised exercise, interventions are recommended, such interventions be reserved for patients CBT and pharmacotherapies are more as work-place education, no-lift policies, who fail conservative care. Early, effective than standard treatments for ergonomic furniture, mattresses, back supervised exercise therapy is typically complex chronic cases. belts and lifting devices, despite a lack not necessary, but can be considered if Pharmacological treatments are of robust evidence in their favour. One recovery is slow or if individual patients reserved for those who fail to respond large systematic review3 concluded carry risk factors for persistent disability to first-line treatments. Paracetamol that exercise alone, or in combination and pain. The recommendations are the was previously recommended as a with education, is effective for same for cases of acute radiculopathy, as first-line pharmacotherapy for LBP. prevention (pooled relative risk [RR] data are insufficient to suggest whether However, more recent evidence has = 0.55). Unfortunately, the included initial management should differ. shown Paracetamol is ineffective and studies in that particular systematic Graded activity/exercise targeting it carries a potential for harm6-8. As review3 took place within secondary functional prevention of disability are such, a short-course of NSAIDs should prevention settings and are thus poorly recommended for patients suffering be trialed rather than Paracetamol7. generalizable to primary care. from chronic LBP (> 12 weeks). Routine use of opioids should only be Overall, there is poor to very-poor Exercise should be prescribed based carefully utilized in select patients, quality evidence suggesting a lack on the patient’s individual needs, for a short duration with appropriate of effectiveness of education, back preferences and capabilities, as studies monitoring, and otherwise not trialed belts, shoe insoles and ergonomic have failed to experimentally identify since benefits are small and substantial programs4,3 for the prevention (or one superior form of exercise. risks exist. The use of Gabapentinoid treatment) of LBP. Further, very little Some guidelines suggest against drugs like pregabalin are now being evidence exists for or against any LBP the use of passive therapies such reconsidered, after a 2017 trial prevention strategy in children. as SMT, mobilization, massage and showed pregabalin to be ineffective acupuncture, while others advise a trial in the management of radiculopathy9. Treatment of LBP: of passive care in individual patients. Guidelines also suggest consideration Guidelines on the assessment and Modalities such as ultrasound, of short-term use of muscle relaxants, management of non-specific LBP TENS, IFC, short-wave diathermy although more research is needed. recommend the use of a biopsychosocial and back supports are consistently Recent guidelines do not paradigm to inform decision making3,5-7. not recommended5-7. Guidelines also recommend use of epidural or facet The guidelines also stipulate that recommend psychological therapies joint injections for back pain5,7, laboratory testing and imaging should (i.e. cognitive-behavioral therapy but do endorse the use of epidural

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injections for severe radicular pain7 to non-surgical treatments has been three guideline-appropriate indications These recommendations are based advocated by some7, but not others12. led to a 36.8% reduction in lumbar spine on the evidence demonstrating that The benefits of spinal fusion surgeries imaging. Also, the addition of short epidural injections only provide small for discogenic, degenerative, non- educational messages to all outgoing short-term pain relief (< 4 weeks, radicular LBP are similar to intensive lumbar spine MRI reports significantly typically), and fail to provide long-term multi-disciplinary rehabilitation; reduced imaging rates by 22.5%. benefit or reduce the risk of surgery5,10. and perform only slightly better than Implementation strategies require Although rare, epidural injections are standard non-surgical management. The repetition to effectively enable change also associated with potentially serious risks, cost and number of adverse events in clinical practice. adverse events, including loss of vision, of fusion surgery are also far greater than Improved and better-integrated stroke, paralysis and death11. Use of those for non-surgical management. education of healthcare professionals radiofrequency denervation for chronic As such, spinal decompression surgery could support implementation of low back pain that is unresponsive should be reserved for those with severe best practice for LBP, break down or progressive neurological deficit, professional barriers, develop a common or when non-surgical treatments for language and create innovative Additional References: radicular pain have failed. strategies for practice13. Examples of this 1. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of include integrated education of medical chronic low back pain. Arch Intern Med 2009; 169: 251−58. 2. Hoy D, March L, Brooks P, et al. Measuring the global burden of low The Global Gap Between and chiropractic students in Denmark, back pain. Best Pract Res Clin Rheumatol 2010; 24: 155−65. Evidence and Practice: and the successful training of Swedish 3. Michaleff ZA, Kamper SJ, Maher CG, Evans R, Broderick C, Henschke A large gap exists between evidence and physiotherapists in identifying and N. Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative practice in low-, middle- and high-income addressing psychosocial obstacles to interventions. Eur Spine J 2014; 23: 2046−58. countries. Data from Australia and recovery in patients with LBP14. 4. Steffens D, Maher CG, Pereira LS, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med 2016; 176: Qatar have shown that advice to keep More radical solutions are needed to 199−208. patients active and at work are provided change the clinical-care model for LBP. 5. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National clinical in only very few consultations. Further, An example includes the development guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J 2018; 27: 60–75. a multitude of American studies have of stratified primary care for non- 6. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines shown that only half of those with CLBP specific LBP – known as the STarT Committee of the American College of Physicians. Noninvasive are prescribed exercise. Another glaring Back Tool. This tool is comprised of treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann and potentially fatal example guideline- two components: Intern Med 2017; 166: 514−30. discordant practice are data showing that 1. A brief self-completed questionnaire 7. UK National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. November opioids are prescribed in approximately to identify an individual patient’s 2016. https://www.nice.org.uk/guidance/ng59 (accessed Nov 7, 2017) . 60% of LBP cases presenting to American risk of developing persistent pain; 8. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of emergency departments! These and and paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015; 350: other examples are ongoing symptoms 2. Treatment(s) matched to each risk h1225. of the continued waste of healthcare sub-group. 9. Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for dollars and high patient costs in terms of This type of stratified care is more acute and chronic sciatica. N Engl J Med 2017; 376: 1111−20. 10. Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections radiation exposure, work absence, opioid- effective than a base care comparison for radiculopathy and spinal stenosis: a systematic review and meta- related deaths, wound complications, group15 and more cost-effective than analysis. Ann Intern Med 2015; 163: 373−81. cardiopulmonary complications, usual primary care16. The UK guidelines 11. US Food and Drug Administration. Drug safety communication: FDA requires label changes to warn of rare but serious neurologic problems mortality and a lack of positive clinical now recommend risk-stratification. after epidural corticosteroid injections for pain. 2014. https://www.fda. outcomes. The world is finally starting Another potential health-care gov/downloads/Drugs/DrugSafety/UCM394286.pdf (accessed Nov 7, 2017) . to realize the mess we have created via solution may be to reconfigure the 12. Juch JNS, Maas ET, Ostelo R, et al. Effect of radiofrequency denervation mainstream management strategies for whole clinical pathway of care from on pain intensity among patients with chronic low back pain: the Mint LBP! first contact in the primary setting to randomized clinical trials. JAMA 2017; 318: 68−81. 13. Myburgh C, Mouton J. The development of contemporary chiropractic specialized care. An example of this is education in Denmark: an exploratory study. J Manipulative Physiol Implementation of Best Canada’s Saskatchewan Spine Pathway, Ther 2008; 31: 583−92. Evidence: which aims to use multi-disciplinary 14. Overmeer T, Boersma K, Main CJ, Linton SJ. Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a Implementation strategies need to be care to reduce MRI requests and spinal biopsychosocially orientated university course? J Eval Clin Pract 2009; tailored to overcome specific barriers surgery referrals17. A major barrier 15: 724−32. 15. Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified to change. These strategies must to this relates to current models of primary care management for low back pain with current best include education and training, social healthcare reimbursement, which practice (STarT Back): a randomised controlled trial. Lancet 2011; 378: interaction, clinical decision support reward volume over care quality18. 1560−71. 16. Foster NE, Mullis R, Hill JC, et al. Effect of stratified care for low back systems and targeted reminders. Another emerging direction could pain in family practice (IMPaCT Back): a prospective population-based Challenges to implementing best be to target both healthcare and public sequential comparison. Ann Fam Med 2014; 12: 102−11. practices include: short consultation health through integrated healthcare 17. Kindrachuk DR, Fourney DR. Spine surgery referrals redirected through a multidisciplinary care pathway: effects of nonsurgeon triage times, lack of clinical knowledge, fear of and occupational interventions. While including MRI utilization. J Neurosurg Spine 2014; 20: 87−92. litigation and desire to appease patients. it is expected patients to return to work 18. Fuhrmans V. Withdrawal treatment: a novel plan helps hospital wean Fortunately, successful examples of once pain improves, the association itself off pricey tests. The Wall Street Journal (New York). Jan 12, 2007. 19. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients guideline implementation do exist. In between pain, function and return to with recent onset low back pain in Australian primary care: inception the UK and USA, special radiograph work is weak. It is well-established that cohort study. BMJ 2008; 337: a171. requisition forms that only allowed people can improve in function and

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return to work even if pain remains, from patients, policy makers, clinicians provide focused implementation of and that return to work occurs before and researchers alike. best practice, redesigning of clinical symptom recovery19. This implies that pathways, integration of health and healthcare and occupational health Below are the key messages that occupational care, make changes to interventions should be intertwined. readers should take away from payment systems and legislation, Data from the Netherlands show that this article: and to enact large public health participatory return-to-work programs 1. The majority of clinical guidelines prevention strategies. Unfortunately, have doubled total return to work rates recommend self-management, the evidence underpinning these and enabled earlier return to work physical and psychological solutions is inadequate. compared to usual care. therapies and some CAM therapies 6. Further testing of these promising Public health approaches offer for LBP – this is great news for solutions and development of new a possible solution. Mass-media chiropractors, physiotherapists solutions is needed, especially in campaigns have shown success in and other conservative clinicians! middle- and low-income countries. four high-income countries. These They also now place less emphasis campaigns are more successful when on pharmacological and surgical Study Methods: they have a clear focus on behaviours treatments. Routine use of imaging The authors identified pertinent studies rather than beliefs alone and and advanced investigations are not using broad search terms in PubMed incorporate new ways to disseminate recommended. and Scopus, and through asking experts information (i.e. personalized marketing, 2. Very little prevention research practicing or performing research social networks and customized digital exists. The only known secondary within middle- or low-income nations. communications). We certainly have a prevention intervention is regular No statistical analyses were performed. lot of work left to do in terms of how we exercise +/- education. More educate the public about LBP! research is needed in this area. Study Strengths / Weaknesses: 3. The evidence on treatment and These authors essentially provided Clinical Application & prevention is mainly from adult a proverbial “State of the Union” by Conclusions: populations in high-income discussing the evidence for the entire The authors of this paper countries. Whether these spectrum of low back pain treatments. sought to synthesize the various recommendations are appropriate They advocated that different recommendations for the management for children or patients in middle-to- treatments may be best at different of low back pain. Recommendations low-income countries is unknown. times for individual patients, without spanned from conservative-care to 4. The use of non-evidence-based bias towards a specific profession interventional and surgical care. They practice methods continues, (what a concept!). It is amazing also discussed examples of effective, regardless of income setting. The to see such a collaborative effort promising and emerging solutions to the most common problems relating between international institutions worldwide LBP crisis, and to improve to LBP include: presentations to and professions. Unfortunately, in knowledge transfer of guidelines to emergency departments, liberal many ways, specific recommendations clinical practice. They concluded that use of imaging, opioid prescription, could not be made in middle- and no single specific proposed solution will spinal injections and surgery. low-income nations, as more evidence be effective without collaborative efforts 5. Solutions for these issues could be to needs to be collected in these regions.

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business advice FREEClaire Moore, Senior Consultant from Croner’s Business Support Helpline, takes a look at recent issues that BCA members have faced and gives guidance on how to deal with them. For free help with tax, VAT, employment, payroll, health & safety and commercial legal issues contact the helpline on 08445 618116 quoting scheme number 25742 (24 hr service for employment queries, normal office hours for other topics). Members can also use the online Business Essentials portal accessed via the Members’ website.

I read about the recent case regarding employment status, can you give us an update? Summary (EAT) upheld the decision of the employment tribunal on On the issue of whether the Where the dominant feature of the basis of the obligations on the claimant to provide the company was a client or customer a contract was that of personal work personally. of the claimant, it was necessary to performance, a limited right to look at the wording of the written substitute another person may not be Decision: Court of Appeal contractual documents to determine inconsistent with the existence of an The Court of Appeal dismissed the company’s appeal on the whether the company was a client or obligation to provide services personally basis that a conditional right to substitute another person customer of the claimant. On the one so as to be a worker for the purposes may not be inconsistent with the existence of an obligation hand, the claimant was free to reject of Employment Rights Act 1996 s.230(3) to provide services personally. a particular offer of work and was free (b) and Working Time Regulations 1998 to accept outside work if no work was Regulation 2, and so as to be within the Decision: Supreme Court offered by any of the company’s clients. wider definition of “employment” in The Supreme Court dismissed the company’s appeal. The However, there were also features of Equality Act 2010 s.83(2). Supreme Court held that the findings of the tribunal were the contract which strongly militated founded upon a conclusion that the claimant was a “worker” against recognition of the company as The facts within the meaning of s.230(3)(b) of the Employment a client or customer of the claimant. The claimant worked as a plumber for Rights Act 1996 (otherwise known as a “limb (b) worker”). These included the company’s tight Pimlico Plumbers Ltd, a plumbing and Regulation 2(1) of the Working Time Regulations 1998 defines control over the claimant’s attire and maintenance company. The claimant a “worker” in identical terms to s.230(3)(b), and case law has the administrative aspects of any brought various employment tribunal suggested that the meaning of “employment” in s.83(2) of the job, the severe terms as to when and claims including claims of disability Equality Act 2010 is also essentially the same. how much it was obliged to pay him, discrimination, unfair dismissal, If the claimant was to qualify as a “limb (b) worker” under and the various covenants restricting holiday pay and arrears of pay. The s.230(3)(b) then it was necessary for him to have undertaken his working activities following company sought to rely on written personally to perform his work for the company, and that termination. Accordingly, the Supreme terms in the contractual documents the company be neither his client nor his customer. Court concluded that the tribunal that the claimant was an independent When considering whether the claimant had undertaken had been entitled to conclude that contractor of the company. to provide a personal service, it was relevant that he had a the company cannot be regarded as a limited facility (not found in his written contracts) to appoint client or customer of the claimant. Decision: Employment Tribunal another Pimlico Plumbers operative to do a job he had The employment tribunal decided previously quoted for but no longer wished to undertake. Comment that the claimant had not been However, it was helpful to assess the significance of this “right The decision effectively puts a an employee under a contract of to substitute” by considering whether the dominant feature spotlight on a business model under employment, and therefore that he of the contract remained personal performance on his part. which operatives are intended to was not entitled to complain of unfair In this case the terms of the contract (with reference to “your appear to clients of the business as dismissal, but he was (1) a “worker” skills” and such like) were clearly directed to performance working for the business, but at the within the meaning of s.230(3)(b) of by the claimant personally, and any right to substitute was same time the business itself seeks to the Employment Rights Act 1996. significantly limited by the fact that the substitute had to maintain that, as between itself and its come from the ranks of those bound to the company in operatives, there is a legal relationship Decision: Employment similar terms. Consequently, the tribunal had been entitled of client or customer and independent Appeal Tribunal to hold that the dominant feature of the claimant’s contract contractor rather than employer and The Employment Appeal Tribunal with the company was an obligation of personal performance. employee or worker.

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What if a grievance is raised during a disciplinary hearing? In the course of a disciplinary process, an employee might raise a grievance that is related to the case. The statutory Advisory, Conciliation and Arbitration Service (ACAS) Code of Practice on Disciplinary and Grievance Procedures, which should be followed by the employer, recommends that if this happens the employer should consider suspending the disciplinary procedure for a short period while the grievance is dealt with. Depending on the nature of the grievance, the employer may need to consider bringing in another manager to deal with the disciplinary process. In small organisations this may not be possible and the existing manager should deal with the case as impartially as possible. If the employee was simply mistaken in the claim of a grievance or over how the disciplinary procedure works, then Acas advises the employer to carry on with the disciplinary hearing.

The business is to be sold and transferred to a new employer in three months’ time. The transferee (the new employer) has asked me to make redundant some of the employees who are to be transferred before the time of the transfer. How should I respond? The effect of the TUPE Regulations 2006 is that employees transfer automatically to the transferee employer whether or not that employer needs them or wants to keep them on. If the sole or principal reason for a dismissal is the transfer, it will be automatically unfair under the Regulations unless the employer can show an economic, technical or organisational (ETO) reason for the dismissal entailing changes in the workforce. Redundancy qualifies as an ETO. However if you dismiss staff on grounds of redundancy before the transfer at the request of the transferee, the How long do we keep employee records for once they have dismissals are still likely to be automatically unfair — left our employment? because the ETO reason must relate to the dismissing There is no minimum or maximum legal requirement to retain employee employer. The reason for the dismissals does not apply details on a broad scale. Some details will need to be kept for HMRC, TAX to you and you would not be able to rely on the fact that or other legal reasons. Under the GDPR, which came into force on 25th May the new employer does not require those employees after 2018, you should only retain data for no longer than is necessary to fulfil the the transfer. purposes for which it was collected. The new employer can consult with you about collective redundancies (that is, where at least 20 staff are at risk of dismissal) prior to the transfer, but only if I run a small business. I only employ five staff. One of these you agree. employees is facing a charge of gross misconduct. As the owner of the business and sole manager can I run the disciplinary hearing and then hear the appeal? A common failing for the employer in tribunal proceedings is that the same Members of the BCA have individual oversees the disciplinary process from start to finish. Ideally, different people should carry out the investigation, disciplinary hearing and appeal stage. access to the Croner However it is recognised that this will not always be practicable, particularly for Business Support Helpline small employers such as you. You could consider employing an HR consultant and Croner-i Business to conduct the necessary investigation or chair the disciplinary meeting or hear Essentials as part of their the appeal. Employment tribunals take the general view that this is acceptable, membership package. provided it is made clear who makes the final decision to dismiss.

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6th – 7th October 2018 20th – 21st October 2018 BCA Council Members Integrative protocols for the Dr Leonard Faye's Motion Palpation & cervicogenic patient Adjusting Masterclass – Upper Body President Holiday Inn, Farnborough • 15 hours CPD The Tuning Room Chiropractic, Ice Arena Catherine Quinn e [email protected] e [email protected] Wales, Cardiff, CF11 0JS Vice-President w goo.gl/2zG6qj w the-tuning-room.co.uk/bookonline Stephen Williams Immediate Past President 11th – 13th October 2018 27th October 2018 Matthew Bennett Evidence Based Clinical Practice The Art of Communication Treasurer J Bolton, A Jones-Harris • 16 hours CPD • AECC Jo Blakeley • 6 hours CPD • AECC Tim Button t 01202 436237 e [email protected] t 01202 436237 e [email protected] w www.aecc.ac.uk/cpd w www.aecc.ac.uk/cpd Secretary Ulrik SandstrØm 12th October 2018 27th – 28th October 2018 Jatinder Benepal Dr Leonard Faye's Motion Palpation & BCA Autumn Conference pre- Adjusting Masterclass – Lower Body Prab Chandhok seminar: A Practical Guide for The Tuning Room Chiropractic, Ice Arena Matthew Clifton-Hadley Persistent Pain Therapy Wales, Cardiff, CF11 0JS Nick Rowe (Lay Member) Mike Stewart • 3 hours CPD • Hilton w the-tuning-room.co.uk/bookonline Arif Soomro Birmingham Metropole 2nd – 4th November 2018 Victoria Wheeldon e [email protected] Dynamic Neuromuscular Stabilisation Updated contact details for council members can be 13th – 14th October 2018 Course B found at www.chiropractic-uk.co.uk/whos-who Zuzana Suzan • 19 hours CPD • AECC BCA Autumn Conference t 01202 436237 e [email protected] Editorial Board Chiropractic: it’s all about the w www.aecc.ac.uk/cpd patient 10th November 2018 Rishi Loatey (Editor) Estimated 7.5 hours CPD • e [email protected] Assessment and Management of Hilton Birmingham Metropole Hypermobility Anne Barlow (Sub-editor) t 01865 522861 w http://bit.ly/autconf18 Holiday Express, Birmingham NEC e [email protected] t 0118 946 9727 e [email protected] Mark Rawden t 0118 950 5950 13th – 14th October 2018 w rcc-uk.org/rcc-events/ e [email protected] Evidence based understanding of clinical anatomy, diagnostics & treatment of the 10th – 11th November 2018 pelvis The Shoulder and Thorax in Sports and Andry Vleeming • 13 hours CPD • AECC Performance 8th September 2018 t 01202 436237 e [email protected] Evan Osar • 16 hours CPD • AECC Developing the Public Health Role of w www.aecc.ac.uk/cpd t 01202 436237 e [email protected] Chiropractors: Inaugural Meeting of the w www.aecc.ac.uk/cpd New RCC Public Health Promotion & 17th October 2018 Wellbeing Society Clinical Audit 17th – 18th November 2018 Manchester Airport Marriott Hotel Jennifer Bolton • 6 hours CPD • AECC Motion Palpation Institute – Spine t 0118 946 9727 e [email protected] t 01202 436237 e [email protected] Corey Campbell • 14 hours CPD • AECC w rcc-uk.org/rcc-events/ w www.aecc.ac.uk/cpd t 01202 436237 e [email protected] w www.aecc.ac.uk/cpd 22nd September 2018 18th – 20th October 2018 24th November 2018 Toddlers, Teenagers and the Challenged Research Methods Child J Bolton, A Jones-Harris & P Miller • HePAG Foundation Courses Copthorne Hotel, Newcastle Upon Tyne 20 hours CPD • AECC Manchester t 0118 946 9727 e [email protected] t 01202 436237 e [email protected] w www.hepag.org.uk/events/foundation w rcc-uk.org/rcc-events/ w www.aecc.ac.uk/cpd 24th – 25th November 2018 19th October 2018 29th September 2018 MSK Issues in the Breastfeeding Neonate FICS/RCC ICSSP Upper Extremity Seminar I Lopez-Bassols, A Marchand, A Miller • Radiation Protection Supervisor (RPS) Holiday Inn, Oxford 11 hours CPD • AECC Refresher Training t 0118 946 9727 e [email protected] t 01202 436237 e [email protected] Holiday Inn, Oxford w rcc-uk.org/rcc-events/ w www.aecc.ac.uk/cpd t 0118 946 9727 e [email protected] w rcc-uk.org/rcc-events/ 20th October 1st – 2nd December 2018

29th – 30th September 2018 Chiropractic Approach to Supporting Assessing & Building Load Tolerance for the Mother-Baby Dyad Sustainable Activity & Athleticism Care of the Pregnant Pelvis Holiday Inn, Leeds Wakefield Craig Liebenson • 14 hours CPD • AECC WIOC, Treforst Campus t 0118 946 9727 e [email protected] t 01202 436237 e [email protected] w www.uswcommercial.co.uk/ w rcc-uk.org/rcc-events/ w www.aecc.ac.uk/cpd short-courses/chiropractic-cpd/ 20th – 21st October 2018 26th – 27th January 2019 6th October 2018 Introduction to Dry Needling Whiplash & Mild Traumatic Brain Injury HePAG Foundation Courses John Reynolds • 11 hours CPD • AECC Nicole Oliver • 11 hours CPD • AECC London t 01202 436237 e [email protected] t 01202 436237 e [email protected] w www.hepag.org.uk/events/foundation w www.aecc.ac.uk/cpd w www.aecc.ac.uk/cpd

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16th February 2019 4th May 2019 Benign Paroxysmal Positional Vertigo Lumbar Spine Stenosis Workshop Who & Where Richard O’Hara • 7 hours CPD • AECC Carlo Ammendolia • 7 hours CPD • AECC AECC University College t 01202 436237 e [email protected] t 01202 436237 e [email protected] Parkwood Campus, Parkwood Road, Boscombe, w www.aecc.ac.uk/cpd w www.aecc.ac.uk/cpd Bournemouth, Dorset BH5 2DF t 01202 436200 f 01202 436312 w www.aecc.ac.uk 2nd – 3rd March 2019 11th – 12th May 2019 Motion Palpation Institute – Extremities Extremity Adjusting Workshop British Chiropractic Association (BCA) Mark King • 12 hours CPD • AECC Mohsen Kazemi • 7 hours CPD • AECC 59 Castle Street, Reading, Berkshire, RG1 7SN t 01202 436237 e [email protected] t 01202 436237 e [email protected] t 0118 950 5950 f 0118 958 8946 w www.aecc.ac.uk/cpd w www.aecc.ac.uk/cpd e [email protected] w www.chiropractic-uk.co.uk

9th – 10th March 2019 18th – 19th May 2019 Chiropractic Patients Association (CPA) Dynamic Neuromuscular Stabilisation Rehabilitation of Temporomandibular Twingley Centre, The Portway, Salisbury, Wiltshire SP4 6JL Exercise 1 and Cervicothoracic Disorders t 01980 610218 w www.chiropatients.org.uk Veronika Nasslerova • 13 hours CPD • AECC James George • 11 hours CPD • AECC t 01202 436237 e [email protected] t 01202 436237 e [email protected] European Chiropractors’ Union (ECU) w www.aecc.ac.uk/cpd w www.aecc.ac.uk/cpd The Glasshouse, 5A Hampton Hill, Middlesex, TW12 1JN t 020 8977 2206 w www.ecunion.eu 23rd March 2019 General Chiropractic Council (GCC) Stable Function of the Neck and • These diary dates can also be found on the Shoulder Girdle members’ area of the BCA website: Park House, 186 Kennington Park Road, London, SE11 4BT Jonathan Cook • 7 hours CPD • AECC www.chiropractic-uk.co.uk t 020 7713 5155 t 01202 436237 e [email protected] • Contact endeavours to make sure diary e [email protected] w www.gcc-uk.org date entries are accurate, but we strongly w www.aecc.ac.uk/cpd advise you always check the details with the The Royal College of Chiropractors (RCC) training provider before booking. Chiltern Chambers, St. Peters Avenue, Reading RG4 7DH 27th – 28th April 2019 • The GCC mandatory CPD cycle for 2017/18 runs t 0118 946 9727 e [email protected] w www.rcc-uk.org Chronic Myofascial Pain and Central from 1st September 2017 to 31st August 2018. • Don’t forget the BCA has a CPD guide for Sensitisation Welsh Institute of Chiropractic (WIOC) Jay Shah • 15 hours CPD • AECC members and this can be found on the Members’ Area of the website or by calling University of South Wales, Treforest, Pontypridd, CF37 1DL t 01202 436237 e [email protected] the BCA office t 01443 480480 f 01443 482285 w www.southwales.ac.uk/chiro/ w www.aecc.ac.uk/cpd

International Academy of Plain lm x-rays InternatIonal academy of VVeterinaryeterInary cChiropractichIropractIc

or digital imaging EssentialEssential Veterinary Veterinary ChiropracticChiropractic forfor Equine Equine and and CompanionCompanion AnimalsAnimals Young Radiology Kenneth J. Young Practice-orientedPractice-oriented intensive intensive training training presented presented in 5 modules in D.C., D.A.C.B.R, M.App.Sc. (Medical Imaging) over 5a periodmodules of 6 overmonths a withperiod (210 of contact 6 month hours with of practical (210 and theoreticalcontact hours instruction), of practical with experiencedand theoretical international Doesn’t it just make facultyinstruction from Canada,), withEngland, experienced Denmark and Germanyinternational faculty from Canada, England, Denmark and GermanyUpcoming Course Start Dates: sense to have a UpcomingSittensen/Northern Course Start Germany Dates: DACBR report all your Sittensen/Northern» October 24th, Germany 2018 diagnostic images? » April 3rd, 2019  October 24th, 2018 Address to send lms or discs ONLY:  Bournemouth,April 3rd, 2019 UK, AECC University College Young Radiology, c/o MXD Ltd, Bournemouth, UK, Quill House, Charnham Lane, AECC» April University 10th, College2019 Hungerford, Berkshire, RG17 0EY Further informationApril and 10 moduleth, 2019 dates: www.i-a-v-c.com All other correspondence, please: InternatIonal academy of VeterInary chIropractIc Further information and module dates: www.i-a-v-c.com [email protected] Dr. Donald Moffatt (MRCVS), Dorfstr. 17, 27419 Freetz, Germany. www.youngradiology.com International Academy of Veterinary Chiropractic Dr. DonaldTel: +49 Moff 4282att ( MRCVS)590099 •, Dorfstr. E-mail: 17, [email protected] 27419 Freetz, Germany. Tel: +49 4282 590099 , E-mail: [email protected]

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CLASSIFIEDS

CHIROPRACTIC JOBS CHIROPRACTIC POSITION IN CENTRAL CHIROPRACTOR NEEDED IN SWINDON – LONDON BE YOUR OWN BOSS FULL OR PART TIME ASSOCIATE Employed position with GCC, BCA, and CPD Elixir Chiropractic is looking for an enthusiastic, REQUIRED FOR S.E. LONDON fees paid. Position also includes holiday pay and self-motivated, diversified Chiropractor to take over pension. Starting salary £2-4K PCM plus bonus and maintain an existing patient base in Swindon. Associate required to join busy clinic by Crystal scheme. Please send CV and covering letter to The clinic is a relatively new – but already well Palace, S.E. London. [email protected] reputed – independent treatment room based in Established 22 years. Predominantly musculo 02074904042 www.clerkenwellislingtonclinics.co.uk a sports centre. The hours are fully flexible, but a skeletal practice using Diversified, A.K. & S.O.T. minimum of three days a week would be required Knowledge of Nutrition and N.E.T. (Neuro to maintain the existing patients – the option ASSOCIATE WANTED emotional technique) would be beneficial. Full to do more is available if needed/wanted. With support and mentoring provided. Self-motivated, experienced associate required for excellent percentage incentives, this job would be Contact: Daniel Cheung 020 8771 2070 multidisciplinary practice(s) in Southwest England, an excellent opportunity for a chiropractor who [email protected] full-time or part time (27-39 hours pw). has a few years clinical experience and is ready to www.target-health.co.uk The successful applicant will be required to take take control of their own career, manage their own over and develop a well-established patient base in a patients' and wants to be their own boss! CHIROPRACTIC ASSOCIATE OPPORTUNITY traditional Market Town. A background in Diversified For more information or to apply please send your CV to [email protected] A rare opportunity has opened to join a result and SOT/AK techniques would be useful, Dry driven, busy, vibrant and supporting clinic in leafy, Needling Technique useful but not essential. www.elixirchiropractic.co.uk highly sort after, Fulham, South West London. Please send CV and introductory letter to the practice manager: [email protected] Fulham, despite being in vibrant London, is unique ASSOCIATE CHIROPRACTOR in that it is has a village ‘feel’ to it thus enjoying the benefits of both city and village life. JOIN ONE OF THE UK'S LEADING Chiropractor wanted to join our well established South East London Practice. The perfect candidate must be full of life, enthusiastic, CHIROPRACTIC CLINICS – LINCOLNSHIRE willing to learn and happy to teach what you can offer The position will benefit from an established patient When deciding to open Chirohealth we had a vision us. Delivering exceptional care and an excellent service base, as well as most weekly new patients. where our patients not only got outstanding care but to the community is considered the norm. Our practice focuses on our diversity of adjustment they also loved visiting the clinic because it was a fun methods, as well as a high level of ethic. Will take over a busy patient base from the outgoing place to be. So we visited Chiropractic clinics around associate who is leaving to travel around the World the globe, we attended worldwide seminars and EMG Scanners are used on each new patient, and (lucky fella). Start date is beginning of September conferences, had coaching by customer service gurus we are a maintenance based practice. 2018 however finding the right candidate is most and the leaders in the Chiropractic community…we Training will be provided and contribution towards important. then took the best bits and created The Chirohealth seminars. Coaching, support and being part of the bigger Way! We can’t tell you how proud we are that our Position can suit a new graduate with ambition and Team is part of this package. The Clinic has been in clinic has now become a “must go” for chiropractors; determination. operation for over 20 years. showcasing quality Chiropractic and natural CV to be sent to [email protected] New graduates or experienced chiropractors are healthcare, super systems for a smooth running clinic, www.chiropractichealthcentres.co.uk welcome. and we’ve seen well in excess of 10,000 patients! Preferably email your CV to: Our commitment to you includes: [email protected] • One to one in-house ‘essentials’ coaching CHIROPRACTOR REQUIRED FOR BUSY Or call our CA Team on 020 7731 3737. (intensive and ongoing) CLINIC IN SUTTON, SURREY We look forward to meeting you soon. • Interactive automated media coaching (yours to Sutton Chiropractic Clinic, part of The Chiltern www.fulhambackcare.co.uk keep forever, delivered to your inbox) Health Centre group, which is on the London/ • One to one proven external Chiropractic coach Surrey border has a vacancy for a Chiropractor. CHIROPRACTOR NEEDED IN CHECK OUT our recruitment page to find out more This very busy, multi-disciplinary poly clinic was ST MARGARETS, TWICKENHAM www.chirohealth.co.uk/join-our-team established in 1975 by Brian Hammond. The clinic Exciting opportunity for a patient-focused, self- If you want to work in one of the UK’s leading has an on-site dexa scanner, digital x-ray facilities motivated Chiropractor to join our established Chiropractic clinics, email [email protected] and on-site diagnostic ultrasound. We have 4 male and expanding clinic. Strong diversified adjusting or call 01724 871222 for more details. therapist’s and our female therapist will be leaving. skills required with an interest in patient education Because of the nature of the clinic, certain patients through rehab/lifestyle. The area has a strong sporty will only see a female therapist. Start date can CHIROPRACTOR NEEDED IN EDINBURGH! background but we see all ages, including babies, so be negotiated. The vacancy is four days a week, an interest in these areas is favourable. An exciting opportunity awaits an enthusiastic, Tuesday, Wednesday, Friday and Saturday. The clinic is located in the centre of St Margarets, motivated and confident associate in the Knight For further details please email a great location near Richmond Upon Thames chiropractic clinic, 20 minutes from the beautiful [email protected] or call 020 8661 1613. and a short train ride to central London. We have city of Edinburgh. As the capital of Scotland, it www.thechilterncentre.co.uk a thriving patient base and are highly thought of offers great arts, culture, cuisine and scenery. within the community. The clinic is expanding Strong diversified adjusting skills required with ASSOCIATE REQUIRED FOR SOUTH EAST further with our investments into marketing an interest in patient education through rehab/ LONDON CLINIC and up-to-date clinic facilities. Full support and lifestyle. Clinic was established 14 years ago and mentoring provided if required. has a strong patient base. Owner is going part-time Long established expanding practice in southeast Do you see yourself as more than just an associate? so fortunate opportunity to take over current London requires new associate. Experienced There will be an opportunity for the right person clientele. Support and mentoring available with this practitioner preferred, but new graduates will be who wants more, to develop their role from multidisciplinary team. considered (PRT trainer at practice). Days and associate to partner. hours are negotiable. Diversified technique with If you would like the opportunity to join our clinic good adjusting skills desirable. We look forward to showing you around! or would like more information then Contact name: Daniel Harvey Ruth Elphick [email protected] contact Dr Gordon Knight by email on 07718482976 [email protected] Location: South East London www.elphickclinic.com Look forward to hearing from you. Contact email: [email protected]

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EXCELLENT OPPORTUNITY IN BEAUTIFUL ASSOCIATE REQUIRED IN WELL FANTASTIC ASSOCIATE OPPORTUNITY ANGLESEY! ESTABLISHED MULTI-DISCIPLINARY CLINIC HERE AT STOKECHIRO Excellent opportunity for an associate to join Benefit from being on the Essex coast as well as only We offer... practice and/or to purchase. a 50-minute train journey into central London, and Outstanding clinic facilities here in Stoke-on-Trent Fancy a change of scene? Want the opportunity to with excellent links to Europe with London Southend including bright, modern treatment rooms, Atlas work in a thriving clinic and have a fantastic quality Airport only 5 minutes away from the clinic. We are couches, onsite x-ray suite with digital processing of life? Breath-taking beaches, stunning views and also only 10 minutes away from the lovely town of and a yoga and pilates studio spectacular mountains? ‘Work hard, play hard’, surf Leigh on Sea (rated one of the best places to live in the UK by “THE TIMES” newspaper). A brilliant team environment – our team of 5 before breakfast, kayak after supper? AND make the chiropractors, an osteopath, 4 massage therapists Our clinic, located in Southend-on-Sea, has been most of a unique clinical opportunity? and 5 chiropractic assistants work closely together established for over 20 years, and 2 years ago expanded We are looking for an enthusiastic, committed and with regular coaching sessions within the clinic and its services with the addition of sports massage, shortly motivated chiropractor with a patient-centred, social events outside of clinic after completing a major refurbishment. evidence-based approach to join our team. This A full-time position with flexible start date, We aim to provide an integrated approach to is a fantastic opportunity to take over an existing competitive salary and low cost of living, your Fees chiropractic and healthcare, maintaining excellent patient base, learn the ropes and in due course (including GCC and BCA/UCA) and insurance paid purchase the practice. Individual mentoring, relationships with local GPs, local sports teams and coaching and support will be provided until the other healthcare professionals. This is a great opportunity for a chiropractor wanting to join a clinical team and develop candidate is in a position to buy the clinic. There are We are primarily a diversified clinic, also using themselves in a fun and supportive environment. several buy-out/associate options depending on the activator, blocks, and soft tissue modalities as well candidate’s circumstances. A direct purchase would as rehabilitation. We are not a high-volume clinic. Please see our flyer to see what our team say be considered. Mentoring and support can be provided if needed about working here, and find us on Facebook @ Established in 2007 and growing steadily since, the (with our principal chiropractor a PRT trainer). stokechiroteam to read our 5 star patient reviews clinic has easily supported 2 clinicians working Percentage based. Hours to be discussed. and see what we’ve been up to. 4.5 days/week and a massage therapist. Excellent Contact: Jon Hicks http://backpainsouthend.co.uk/ If this position sounds interesting to you please reputation, high rates of patient-satisfaction, [email protected] contact [email protected] and we will word-of-mouth recommendations and referrals Location: Essex arrange a visit to our clinic to observe our team and from local health-care community. Town-centre discuss the role in more detail location with access to local amenities and WANT TO BE HAPPY WHERE YOU WORK? Location: Staffordshire transport-links to ease patient access. Recently Do you want great mentors to talk to and help you Contact: Hannah Knibbs 01782 660744 refurbished throughout; reception, 2 treatment www.stokechiro.co.uk [email protected] rooms, kitchen and WC, friendly efficient develop your skills, and take over a patient base? reception staff and long-term lease. ‘Turn-key’ If so, call Shellie, our practice manager on 07400 clinic with reliable, diverse patient-base, and 989910 or email [email protected] WEST NORFOLK: KEEN, COMMITTED regular influx of new patients and waiting-list for to arrange a Skype call with the directors, Claudia CHIROPRACTOR REQUIRED FOR appointments. Reluctantly clinic owner has to D’Aloia and Kerrie Fleming. PERMANENT, FULL-TIME POSITION move on due to family relocation but is happy to Check out our website www.sheffield-chiropractors.com Keen, committed chiropractor required for work with successful candidate to ease transition. We have 2 clinics based in Sheffield which have permanent, full-time position to take over a well- Anglesey is a stunningly beautiful place – wide been established for over 20 years. established patient list this summer. We’re looking open sandy beaches, busy market towns and The successful associate must be motivated, for a skilled and enthusiastic practitioner for our quaint villages and the wilds of the Snowdonia enthusiastic, a team player and willing to develop small, friendly team, able to develop good patient National Park just a stone’s throw away. It is ideal their own patient base too. We work in mainly relationships and provide top quality care to them. for someone who enjoys the outdoor life – surfing, diversified and SOT technique and have massage In return we’ll support you, value your skills, windsurfing, kayaking, mountain biking, trail therapists at both clinics and good connections encourage your ambition and give you the running, horse-riding – but might not suit someone with local Pilates studios and gyms. professional freedom to work in a way that suits you. who needs their hectic urban life! The current full time permanent post available We welcome either an experienced chiropractor or Contact Elisabeth [email protected] has an established patient base and would suit a new graduate: principal will act as trainer and pay 01248 751177 www.llangefnichiropractic.com an experienced chiropractor looking for new PRT fees. opportunities or a newly qualified chiropractor who The King’s Lynn Chiropractic Clinic has been would rise to the challenge of a demanding post. PART TIME ASSOCIATE REQUIRED IN established for many years. The local medical ANDOVER, HAMPSHIRE Arrange a Skype call so we can have a chat and talk more community have asked us to provide chiropractic about the post. What’s the worst that could happen? YMYB Health & Wellness Centre is a chiropractic care on the NHS, and we work hard to maintain led clinic focusing on core chiropractic disciplines, Contact name: Shellie Fleming their trust in this. primarily diversified manipulation. We are a small, Location: Sheffield King’s Lynn is a short drive from Thetford forest, ambitious clinic based in Andover, Hampshire. Phone: 07400 989910 Royal Sandringham and the nature reserves of the Webpage: www.sheffield-chiropractors.com North Norfolk coast, but within an hour of Norwich The clinic has a welcoming reception area and 3 Contact email: [email protected] comfortable treatment rooms fully equipped with and Cambridge. Accommodation in this attractive everything required for great quality chiropractic CENTRAL LONDON MULTI-DISCIPLINARY area is easy to find and inexpensive! treatment. CLINIC – GRADUATE OR RECENT This is an ideal opportunity for someone who: We are offering a self-employed part-time position QUALIFIED CHIROPRACTOR • wants the professional freedom to work in a way for 2 days per week with an expected income of Central London Chiropractor (Charlotte St). We are suitable to them £12-30k, aiming for a full time, prominent position currently recruiting for an experienced Chiropractor • welcomes the challenge of providing care to NHS in our clinic. We will offer support in developing to join a leading Multi-Disciplinary Private patients. practical and clinical skills and the skills required to Healthcare Clinic in Central London. You will work Contact name: A J Norman build and manage your own client base. alongside Physiotherapist, Osteopaths, Sports Location: West Norfolk The ideal candidate would be energetic, enthusiastic Therapist and Acupuncturist. Webpage: www.lynnchiropractic.co.uk/ and have a passion for healthy, active living. Chris 0207 526 4925 keen-committed-chiropractor-required/ Contact: Jon Booth, 07724 742041 http://holistichealthcareclinics.com Contact email: [email protected] www.ymyb.co.uk [email protected] [email protected]

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EXCITING CHIROPRACTIC MENTORSHIP PATIENT BASE, GUARANTEED RETAINER Terms – EXISTING PATIENT BASE TO TAKE OVER £2-4KPCM + COMMISSION + EXPERIENCED £60 minimum for up to 400 characters. £75 for 401-800 AND AVAILABLE TO START NOW! MENTORING & HAPPY TEAM :-) characters. £15 for every additional 400 characters after 800. Are you looking for somewhere that you can • Highly successful, busy clinic in Eastbourne, East Sussex Charges for non-BCA members will attract an uplift grow to be the very best you can be, surrounded • Patient base of 25%. by a fun and supportive team, helping your busy • Full OR P/T-time available • Payment must be received by copy date list of patients get out of pain and stay well with Chiropractic care? • £2,000 to £4,000pcm guaranteed minimum • Payment by card, BACS, or cheque (made payable to BCA) retainer PLUS commission If so, we are the team for you! • There is no VAT Lushington Chiropractic is a highly successful, • To advertise or reply to a box no. contact: Ann Goble, Alba is located in Warrington, 25 mins Manchester VERY busy clinic in Eastbourne, East Sussex. We’re British Chiropractic Association, 59 Castle Street, and Liverpool with Snowdonia, the Peaks and Lake looking for a chiropractor to join our lovely, caring Reading, Berkshire RG1 7SN. T: 0118 950 5950 District are all an hour’s drive away. and highly-successful clinic. We offer experienced, F: 0118 958 8946 E: [email protected] What can you expect? dedicated mentoring, a patient base and minimum • Confirmation of booking: all advertising must be retainer of £2-4,000 pcm depending on experience. confirmed in writing and paid for before copy date, • A place where patients feel part of the family otherwise entry cannot be guaranteed • Amazing support and coaching from an inspired and On top of that you'll also earn a % commission. • Tell us if you also want to place your advert in the In award-winning owner and her exceptional team ABOUT US Touch Newsletter or online • A full-time position, with excellent work/life balance We’re a Nice Clinic • If you would like a box no. please enquire • A guarantee of 5 NPs per week, so you know you • Multi award-winning, including PPQM, CMQM • Most patients recommended by word of mouth – • Contact’s acceptance of classified advertisements does will be busy not imply that advertisers are members of the BCA • A great salary – you can expect to earn between No Groupon Deals • Multi-disciplinary team • The BCA reminds all advertisers that they must £35 and £40k in your 1st year with us – with great comply with Advertising Standards Authority rules room for progression beyond this as well • Support from on-site Principal and that recruitment classifieds must also comply • Great team dynamic, lots of fun, team socials and • Well-trained, award-winning, enthusiastic CAs with laws on discrimination. The BCA will make best CPD done together – fully paid for! • Seaside town, with great schools and outdoor life efforts to point out where adverts may fall short of • GCC fees paid Great Reputation & Genuinely Caring legislation, but ultimately, the responsibility must • Large clinic rest with the person placing the ad. If you are interested in being a part of what we are doing, please email me: [email protected] • Excellent reputation locally and within with your CV and a paragraph about what inspires chiropractic profession and excites you. • Our highly experienced and happy chiropractic AMAZING OPPORTUNITY FOR 2 team will all be happy to help you settle in ASSOCIATES TO JOIN OUR EXPANDING Contact name: Jemma Firth Supportive and Experienced Mentoring NATURAL HEALTH CENTRE Location: Warrington Phone: 07984 533304 • Weekly chiro meetings, PRTS Mentor and When we decided to serve Chinese tea we were Webpage: www.albaclinic.co.uk dedicated 121 weekly coaching if needed shocked by how much patients loved it…our • Earn well (£60-80K+) connect with your passion practice became more of a community. for chiropractic, and develop a work/life balance AWESOME CHIROPRACTORS Chinese tea reduces your risk of death from to match REQUIRED FOR EXPANDING GROUP OF cardiovascular disease by 30-42%* helping more SOUNDS INTERESTING? MULTIDISCIPLINARY CLINICS IN ESSEX than our patients spines…..GABA in the tea reduces Contact James Revell DC on 07830 107558 stress and it is much easier to adjust a relaxed Associate positions available in busy and or [email protected] patient! expanding group of clinics in east Essex. Advanced More info www.chirocare.co.uk/join-the-team.php Established 25 years ago we have so many patients Chiropractic are looking for motivated, enthusiastic, CHIROPRACTOR REQUIRED IN DERBY we are expanding into an even larger practice…to confident and energetic associates to join our do this we need YOUR HELP… currently there is a 3 award winning multidisciplinary team. A successful & thriving dental practice in Derbyshire week wait for an appointment! Due to patient demand we are expanding our reach with a very large & long established (dental) patient base is looking for a chiropractor to provide chiropractic What are the benefits? and we need more fantastic Chiropractors to join our team. The successful applicant would be taking over a services to its patients. Following the recent expansion of • Individually tailored coaching and mentoring current patient base and joining our Witham, Maldon Cosmetic White Smiles & the Oakwood Dental Centre, programme so you can focus on mastering your or Chelmsford clinic as a full-time, self-employed a fantastic opportunity has arisen for an enthusiastic, Chiropractic skills or learn how to run a business associate. Our vibrant, fun and successful team are highly motivated chiropractor to join our team. or both! proud to have been awarded "Best Customer Service Skills & Attributes • Digital X-ray machine • Good communicator, confident with people • Experienced support team in Essex" and all our clinics have been awarded both • Positive outlook and passionate about health and • Work alongside a natural medical doctor PPQM and CMQM quality marks. Both Chiropractic wellbeing • Flexible employment terms, an attractive pay and business mentoring, self-improvement and • Commercially confident & motivated to grow percentage PRT training is available with our clinic directors your practice • Amazing local sports, a wide range of local teams and external speakers. Our Chiropractors use • Team player and clubs mainly diversified techniques, activator technique, • Organised • GCC fees paid dry needling, exercise, FMS and rehabilitative care. • Well-presented • A relocation package Patients range from professional athletes to weekend- gardeners and everything in-between. Massage • Can manage high volume of clients Live in one of the top 7 places in the UK. therapists work alongside the Chiropractors to provide Mandatories www.thebackpaincentre.me all round care to our patients. • BSc/Master of Chiropractic or equivalent qualification instagram @thebackpaincentre The right candidate must have great • GCC registration Apply now e-mail [email protected] communication skills, be a confident adjustor Other Detail *Ref Tea consumption and risk of cardiovascular and a team player. Join a professional, fun, lively • Flexible hours with a view to grow with patient base outcomes and total mortality community and get the most out of your job. Please contact us for further details on Zhang C et al. Eur J Epidemiol 2015 Location: Chelmsford, Essex [email protected] Location: Poynton Phone: 01245 200369 Lisa Eaton • Derby • 01332 280557 Phone: 01625 850300 Webpage: www.advancedchiropractic.co.uk www.cosmeticwhitesmiles.co.uk Webpage: www.thebackpaincentre.me Contact email: [email protected] [email protected]

46 CONTACT Summer/Autumn 2018 • Volume 32 Issue 2

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ASSOCIATE REQUIRED IN SURREY AND annum, exact placement within the band will be associate if required HAMPSHIRE dependent upon qualifications and experience. • Average weekly visits 215 (over 8 years) on 25 hour Applicants must be able to demonstrate their working week for each Chiropractor Durham House is looking for a dynamic motivated • New patient full waiting list approximately new associate to become part of our team. We eligibility to work in the UK in accordance with the Immigration, Asylum & Nationality Act 2006. 6 weeks (currently) are an established community based company, • Digital capable x-ray across two locations and offer a large number of For an informal discussion please contact Arvid • Omni, Zenith and Hy-lo tables services including studio classes and workshops. Thorkeldsen via email [email protected] • Athrostim, activator, SOT equipment and some Experienced and/or new graduates welcome, help To apply, please download an application form and CBP equipment and support will be given. job description from our website www.aecc.ac.uk/ • Very loyal maintenance patients PVA 65-70 For more information please forward your CV to: about/join-the-team/ • Turnkey practice, variable technique package [email protected] Completed application forms should be emailed to: using mostly manual adjusting Webpage: www.durhamhousechiropractic.co.uk [email protected] • 2 fully trained exceptional CA’s who go above and beyond • >80% word of mouth recommendation ASSOCIATE CHIROPRACTOR, READING FOR SALE – CLINICS Region: Multi-disciplinary clinic requires an associate This is the beautiful central hub of North Cornwall, Chiropractor to join their team. The position would suit CLINIC FOR SALE HEBDEN BRIDGE close to beautiful beaches including Polzeath, a self-motivated Chiropractor with 1-2 years’ experience. Daymer Bay, Rock and Padstow, home of Rick Stein Would you like to run your own clinic? Would you to name a few. Cornwall is growing exponentially, An interest or experience in SOT and Dry needling like this to be in the “4th funkiest town in the world” infrastructure can’t keep up, demand is high for is preferable. with a “delightfully relaxed vibe” and “the town with Chiropractic. Population explosion of 40-55% in A graduate would be considered. most local identity”? Summer! The cathedral city of Truro is only 30 1-2 days a week required. Hebden Bridge Chiropractic was established fifteen minutes away, Plymouth 45 minutes and Exeter years ago and has an excellent reputation in the 60 minutes. Newquay has the counties only Contact Rachel Ackroyd, 01189 311 444 local community and further afield. It is a calm International airport and this is 20 minutes away. Email: [email protected] and relaxing place to work. Most new patients are http://21stcenturyclinic.co.uk/ We feel very attached to this practice and have through word of mouth. Excellent relationship with given our hearts and souls but it is time to move local GP’s and health care professionals. on. Please don’t enquire if you’re not genuinely ASSOCIATE CHIROPRACTOR NEEDED The clinic has two treatment rooms, the second interested in a family centred lifestyle practice. currently being used by three massage therapists, a Enthusiastic chiropractor required to take over For enquiries please email your interest to reflexologist and a counsellor. It is leasehold, on the existing full time patient base (initially some [email protected] including ground floor with a shop front. maternity cover). your contact details. Please DO NOT call the clinic. The current chiropractor works 3.5 days per week The successful candidate will be part of busy, Contact Kylie, [email protected] and wishes to retire but is happy to stay on for a friendly, energetic clinic in Cheshire which has wadebridge-chiropractor.co.uk time to ensure a smooth transition. debbiedinc@ been established 20 plus years. Ideally BUPA/PPP hotmail.com registered but not essential. Please call Sue on AMAZING OPPORTUNITY TO OWN A 01606 47776 or email CV to [email protected] BUSY WEST LONDON CLINIC CLINIC FOR SALE, HAMPSHIRE Perfect for someone who wants to walk into a modern JOBS – FACULTY Are You An Associate Chiropractor Reaching Your and beautifully designed clinic with a busy client list to Potential in Practice? Do You Aspire to run and own take over, as well as operating systems in place. LECTURER CLINICAL SCIENCES your own practice? • Established in 2010 As the chiropractor/proprietor is looking to relocate • Turnover 160k with great growth potential AECC University College to another country, we’re looking for the right person • Reception area, adjusting area and two private rooms The AECC University College is a distinctive to come in, to work as an associated chiropractor • Fully systematised and specialist Higher Education Institution, with the option to buy at a later date or to buy • Majority of NP’s from referrals internationally recognised for providing the practice outright. Surrounded by the beautiful • Atlas Chiropractic Software undergraduate and postgraduate education and countryside of the South Downs National Park, yet • Excellent location in the heart of West London on clinical training in chiropractic, rehabilitation and close to Portsmouth and the south coast and only 10 a main road with easy access to Central London exercise science, and diagnostic ultrasound. minutes drive to the market town of Petersfield. and Motorways This is an exciting opportunity to join the University Low risk as it a busy and thriving clinic with Genuine Reasons for a quick sale College at a key stage in its development. Reporting great internal and external referral and with low Serious offers invited to the Vice Principal Undergraduate Studies and overhead. Contact: Beatrice Cathcart, 0208 8111896 Quality, the successful candidate will contribute to Email: [email protected] the development and delivery of clinical sciences If this sounds like a potential fit for you, contact us and engage actively and enthusiastically with at 07432003242 or [email protected] the academic administration and management Contact Felisa, 07432 003242 ITEMS FOR SALE processes at the University College. Duties will www.clanfieldchiropractic.com also include engagement in relevant research and USED TRIUMPH CHIROPRACTIC COUCH scholarship activity as well as the supervision of FOR SALE clinical students in the outpatient clinic. REPUTABLE, ESTABLISHED NORTH CORNWALL CLINIC FOR SALE This table has been recently reupholstered, The successful candidate for this role should have a refurbished and works perfectly. Drop down head chiropractic degree or equivalent and appropriate Rare and unlikely opportunity re-presents itself. piece with breakaway, foot pad expansion. Thoracic clinical experience. Relevant academic and/ Reluctant sale but lifestyle change is calling. and lumber drop, variable lumbar flexion. or teaching experience at the undergraduate or Clinic: Great value for a great price! postgraduate level will be an asset. The individual • 140m2 leasehold– reception, 4 adjusting rooms, Price £2,000 should stay abreast of developments in pedagogy office, x-ray/consult room, therapy room, free and technology enhanced learning and possess parking and conservatory Sloane Square, London. Marianne Potgieter, 020 excellent interpersonal skills. • Established 2000, 2 Principal Chiropractors – 7881 4962, [email protected], The salary for this post is £37,925 – £43,562 per one willing to stay for transition period as www.sloanesquarechiropractors.com

CONTACT Summer/Autumn 2018 • Volume 32 Issue 2 47

44-47_Classified_4pp.indd 47 08/08/2018 22:42 Chiro-advert-2018.qxp_Layout 1 15/05/2018 14:36 Page 1

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48_OBC_TheTensCompany_AdvertsContact.indd 48 03/08/2018 10:23