Getting around muscle ageing

Muscle can regenerate through a process that involves multiple steps and players, including the immune system. As our organism ages, the muscles lose the capacity to regenerate. Now, a new study led by Joana Neves and Pedro Sousa-Victor, group leaders at the Instituto de Medicina Molecular João Lobo Antunes (iMM,Portugal), and published now in the scientific journal Nature Aging*, discovered that it is possible to modulate the function of the immune cells to recover the ability to regenerate muscle in aged mice.

The researchers found a protein that regulates the function of a subset of immune cells, macrophages, by promoting their ability to clear residues in the regenerating muscle. “We found that the behavior of macrophages is altered in aged mice. Macrophages are a type of immune cells that are capable of phagocytosis, the process of ingestion and elimination of particles inside cells”, says Joana Neves, group leader at iMM and co-leader of the study.“During regeneration the macrophages are responsible for clearing the dead cells from the muscle after injury, which is a normal step of the process of muscle regeneration.
Macrophages act like a cellular vacuum cleaner, cleaning the “dirt” from the muscle”, adds Joana Neves. The researchers found that macrophages in aged mice have reduced levels of a protein, called MANF, that is crucial for this process. “In fact, this protein is so important in this process that if we decrease MANF levels in the macrophages in younger mice, their ability to regenerate muscle is also impaired”, adds Neuza Sousa, student at iMM and first author of the study. “On the other hand, increasing the levels of the protein MANF in aged muscle is sufficient to recover muscle’s regenerative capacity”, continues Neuza Sousa. 

On the implications of the study for regenerative medicine and aging, Pedro Sousa-Victor, co-leader and group leader at iMM, says: “A central promise of regenerative medicine is the ability to repair aged or diseased organs using stem cells. This approach will likely become an effective organ rejuvenation strategy, potentially increasing human health span by delaying age-related diseases. Our study shows that immune ageing is an important obstacle to the regenerative capacity of aged muscle”.

The clinical success of the current stem-cell based therapies is limited by the capacity of aged and diseased organs to regenerate. In this study, the researchers discovered an immune modulator that can be used to improve the function of the immune system in the aged muscle. “We believe that MANF could be used in the future as a supplement to improve the efficiency of current muscle regenerative therapies”, concludes Pedro Sousa-Victor. 

“Promising evidence” that osteopathy may relieve musculoskeletal pain

New App Designed to help hairdressers Tackle Musculoskeletal Disorders

There’s “promising evidence” that osteopathy, the physical manipulation of the body’s tissues and bones, may relieve the pain associated with musculoskeletal conditions, finds a review of the available clinical evidence, published in the open access journal BMJ Open.

But there’s little or only inconclusive evidence to back its use in children, and for the treatment of migraine or irritable bowel syndrome (IBS), the findings show.

Osteopathy, which was first developed in the late 1800s in the USA, is based on the principle that the structure (anatomy) and function (physiology) of a person’s body are intertwined. It aims to repair imbalances in this relationship.

In common with other forms of complementary medicine, osteopathy has grown in popularity over the past decade, particularly for the treatment of musculoskeletal disorders. The researchers therefore wanted to assess its safety and effectiveness for different conditions. 

They trawled research databases for systematic reviews and pooled data analyses (meta analyses) of relevant randomised controlled clinical trials, published up to November 2021. 

Only trials carried out by doctors with osteopathic training or osteopaths were included.

The search uncovered nine systematic reviews or meta analyses conducted between 2013 and 2020, involving 55 primary trials and 3740 participants. 

The systematic reviews reported on the use of osteopathy in a wide range of conditions, including acute and chronic non-specific low back pain, chronic non-specific neck pain, chronic non-cancer pain, primary headache, and IBS.

The pooled data analyses reported that osteopathy is more effective than other approaches in reducing pain and improving physical function in acute/chronic non-specific lower back and neck pain and in chronic pain not associated with cancer. 

The other comparative approaches included dummy treatment (placebo), sham osteopathy, light touch therapy, no treatment, waiting list, conventional treatment, physiotherapy or other forms of complementary medicine.

But small sample size, contradictory findings, and wide variations in study design meant that the evidence on the effectiveness of osteopathy for use in children with various conditions, ranging from attention deficit hyperactivity disorder to asthma and infantile colic, and the treatment of migraine and IBS, was limited or inconclusive.

No serious side effects associated with the therapy were reported in the 7 systematic reviews that evaluated them, although only two defined how these were measured.

“This overview suggests that [osteopathy] could be effective in the management of musculoskeletal disorders, specifically with regard to [chronic non-specific low back pain] and [low back pain ] in pregnant women or [those who have just had a baby],” write the researchers. 

“In contrast, inconclusive evidence was derived from [systematic reviews] analysing osteopathy efficacy on paediatric conditions, primary headache, and IBS,” they add. 

“Nevertheless, based on the low number of studies, some of which are of moderate quality, our overview highlights the need to perform further well-conducted [systematic reviews] as well as clinical trials (which have to follow the specific guidelines for non-pharmacological treatments) to confirm and extend the possible use of [osteopathy] in some conditions as well as its safety,” they conclude.

Experience of arm pain needed to help shape new research

Alarming numbers of doctors experiencing mental health issues as a result of work pressures
Alarming numbers of doctors experiencing mental health issues as a result of work pressures

People living with painful hand and arm conditions are invited to take part in research and help create a new online support platform for patients. 

The research is open to people with a range of complaints including hand and thumb osteoarthritis, tendonitis, tennis and golfers’ elbow, carpal tunnel syndrome and non-specific arm pain – previously termed repetitive strain injury. 

Musculoskeletal diseases such as these conditions affect an estimated 10 million people across the UK, causing more disability than either heart disease or cancer. 

Researchers at the University of Leeds’ Faculty of Medicine and Health, Keele University’s School of Medicine and Impact Accelerator Unit, University of Southampton and the University of Aberdeen will work in collaboration with people living with these conditions to design, develop and test a new online programme. It will feature support, information, and a tailored, progressive exercise plan, to guide people in managing their condition.

Lead researcher Philip Conaghan, Professor of Musculoskeletal Medicine in the University of Leeds’s Institute of Rheumatic and Musculoskeletal Medicine, said: “Musculoskeletal diseases are common, chronic and disabling. Not only do they affect people physically, causing significant pain and disability, they also have a major impact on mental health and well-being. The symptoms and wider-reaching consequences can also impact upon people’s ability to function in their work, family and social lives. 

“There are currently few treatment options, with little evidence for long-term benefit. The best approach to managing these conditions, therefore, remains uncertain.

“The design of our new resource will be guided by expertise through lived experience, ensuring that the diverse supportive needs of people living with this range of conditions are met.” 

The six-year research project, titled Digital – My Arm Pain Programme (D-MAPP), is funded by the National Institute for Health Research (NIHR), the research partner of the NHS, public health and social care, and the charity Versus Arthritis. 

Dr Neha Issar Brown, Director of Research at Versus Arthritis, said: “Pain is complex and impacts every aspect of your life. People with musculoskeletal (MSK) conditions like arthritis often need more than just medication. They need support with mental health, sleep, mobility, exercise, self-management tools and much more. However, finding the right information and support you need can be difficult.  

“Being guided by the lived experience of people with MSK conditions means the platform will be much better placed in enabling people to manage their pain in a way that works for them, by giving access to expert advice and support from the comfort of home.” 

Both people with a musculoskeletal condition of the hand or arm, and healthcare professionals with experience in treating these conditions, are invited to take part in co-creating and testing the D-MAPP website. 

They will be invited to take part in a survey study, small group discussions and interviews. They can then support the researchers to design the final online programme, which will be tested out on a larger scale. 

Further information, and an initial questionnaire, is available online or by contacting the research team at D-MAPP@leeds.ac.uk. Much of the research will take place online so participants do not need to travel. 

Further information 

Contact University of Leeds press officer Lauren Ballinger via l.ballinger@leeds.ac.uk with media enquiries. 

SIX IN TEN YOUNG ADULTS NOW HAVE ‘COVID BACK’ – SO WHAT SHOULD YOU BE DOING?

Mind Your Back I
Mind Your Back

Longer working hours coupled with poor hybrid  working posture have led to an explosion in back problems amongst younger working adults

 The ‘Covid stone’ – the average weight gain during pandemic has been an issue for many Brits, but hybrid working is now taking a toll on our backs. A new national survey[1] and report commissioned by www.mindyourbackuk.com – backed by Mentholatum[2]makers of a range of evidence-backed topical muscle and joint products and the brains behind a public health initiative – reveals that 64 per cent of 18–29-year-olds have back problems.

 With back pain already costing the UK £10 billion per year and accounting for four in ten sick days,[3] it’s clear we need to take action to stop back issues spiralling out of control.

 GP and advisor to www.mindyourbackuk.com, Dr Gill Jenkins, says: “For the six in ten Brits who have been mostly or always working from home during the pandemic and are now hybrid working, almost half don’t have constant access to a table and supportive chair during their working day. And unfortunately, 20 per cent have to work while sitting on a sofa or bed. This plays absolute havoc with posture and spine health”.

 The www.mindyourbackuk.com survey also found that some workers working from home or hybrid working have been forced to buy their own specialist chairs (17%) as only 11% received work station equipment from their employers.

While the average working day has increased by 48 minutes worldwide[4], many Brits are doing less exercise to compensate for this. A fifth of those polled admitted to doing no exercise at all in a typical working week and just 7 per cent got up to walk around and stretch every hour – which is recommended for desk work.

The reasons for this include a lack of motivation – cited by 46 per cent – and being pushed for time (37 per cent) or lacking energy (26 per cent) – all very bad news for our backs.

Of the people who had experienced new back pain, more than half (56 per cent) said they have lower back pain compared with 23 per cent who have pain in the neck or shoulder blades. Lower back and neck pain are common complaints when screens are not at eye level, or chairs fail to support the back, allowing desk workers to slump.

Dr Jenkins comments: “Caring for our backs can reduce stress and boost energy so we can live our lives to the full, without pains and aches holding us back. We can’t hurry the lockdown easing but we can do things at home to care for our backs. The Mind Your Back 5 S.T.E.P.S. programme[5] keeps your back mobile, flexible and active, and is easy to incorporate into daily life”.

Mind Your Back 5 S.T.E.P.S. programme

Five simple S.T.E.P.S. for home working back care:

  • STRETCH – Gentle stretching, even for a few minutes a day, increases mobility and helps loosen tight muscles. Check out 5 stretches at https://www.mindyourbackuk.com/stretch 
  • THERAPY – hot, cold (or preferably both, alternated) or anti-inflammatory topical therapies (rubs, sprays, patches), such as Deep Heat, Deep Freeze and Deep Relief which help kick-start the healing process.
  • EXERCISE – walking, cycling and swimming are all gentle, low impact, exercises that help to mobilise your muscles and joints.
  • POSTURE – check your posture, especially while doing desk work or watching TV, to ease non-specific lower back pain and enhance healing
  • STRENGTHEN – core and back exercises strengthen back muscles and prevent localised stiffness and pain. See 5 examples at https://www.mindyourbackuk.com/strengthen

 What kind of home worker are you?

#1. Sofa Slumper

You are comfier on the sofa than sat at a table and often find yourself craning over a small screen. Hours can pass as you slide further down the sofa and although you might feel zen, your back is crying out for a posture reset. What’s more, after taking a break to go and eat, you’re back on the sofa to watch TV. Will your spine ever be upright?

Dr Jenkins tip: Place a cushion under your bottom and behind your back to correct your posture.

#2. Desk Roller

You are replicating the office environment: a desk, a chair and you’re (hopefully) sat upright. However, it can be tricky to avoid hunching over a laptop screen unless you’re set up with a big at-eye-level monitor. Tense shoulders and posture that slumps as the day goes on can wreak havoc with your poor back.

Dr Jenkins tip: Make sure your screen is at eye level by placing your laptop on a stack of books.

#3. Kitchen Cruncher

A lack of space means standing at your kitchen worktop squeezed in between the blender and kettle. Naturally, a worktop doesn’t offer the comfiest work stations and your spine soon finds itself curled over a keyboard for hours on end. You might even start placing all your weight on one leg, causing an imbalance in your spine.

Dr Jenkins tip: Ensure that both feet are flat on the floor at any given time and that you focus on standing up straight.

#4. The Pacer

Whether through choice, or lack of space, classic traits of a Pacer involve wandering from room to room, carrying the laptop in one arm and often, a phone in the other. It’s a case of working wherever there’s space, even if it’s crossed legged on the floor which has a tendency to put your back into a slumped position.

Dr Jenkins tip: Walking around is better than sitting but make sure you use a couple of cushions when you sit on the floor and try to keep your screen as close as possible to eye level.

Check out www.mindyourbackuk.com for more tips on caring for your back.

Does COVID-19 vaccination affect rheumatic and musculoskeletal disease flares?

Does COVID-19 vaccination affect rheumatic and musculoskeletal disease flares?
Does COVID-19 vaccination affect rheumatic and musculoskeletal disease flares?


In a study of 1,377 patients with rheumatic and musculoskeletal diseases—such as inflammatory arthritis and lupus—flares of their conditions were uncommon following two-dose COVID-19 mRNA vaccination. In a study of 1,377 patients with rheumatic and musculoskeletal diseases—such as inflammatory arthritis and lupus—flares of their conditions were uncommon following two-dose COVID-19 mRNA vaccination.

In the Arthritis & Rheumatology study, 11% of patients reported flares after vaccination that required treatment, and there were no reports of severe flares. Flares were associated with prior SARS-CoV-2 infection, flares in the six months preceding vaccination, and use of combination immunomodulatory therapy.

“’Our findings demonstrate that the vaccines are safe and should alleviate the safety concerns of any hesitant patients,” said first author Caoilfhionn Connolly, MD, MSc, of Johns Hopkins University School of Medicine. “This study highlights that most of our rheumatic patients tolerated the vaccine well with mostly having local reactions such as injection site pain, which was quite reassuring, but most importantly, we did not observe any severe flares of their underlying autoimmune disease,” added co–senior author Julie J. Paik, MD, MHS, also of Johns Hopkins University School of Medicine.