More than a million hernia operations are undertaken in the UK every year and millions more choose to manage their hernias non-operatively and continue with daily life experiencing unease and discomfort. In addition to the Covid lockdowns of 2020 and the restrictions placed on elective surgeries throughout the UK, hernia operations have seen a reduction of 40%, with over six million patients still pending on waiting lists. With extended estimated lead times for non-urgent hernia repairs, it looks like waiting times could be anywhere up to 5 years. With this is mind, there is now an even higher demand for Orthosis to manage hernias in a non-operative capacity.
Hernias occur when part of your internal soft tissues protrude through a weakness in surrounding tissues and muscle walls. These weaknesses can naturally occur from a multitude of different causes. These could include muscle wastage associated with age, general wear and tear, prolonged stress or strain which forms increased intra-cavity pressure and can also occur secondary to a surgical incision.
Inguinal and Femoral Hernias
Inguinal hernias are the most prevalent hernia contributing to over 90% of hernias. They occur in men and appear when the intestine finds a weakness in the upper part of the groin and thigh. The hernia originates after passing through a natural aperture in the groin area called the inguinal canal. This canal is the pathway for the spermatic cord and associated blood vessels and nerves for the testes and lower limb. Due to its natural opening, it acts like a gateway and allows easier passage for the intestine to herniate through it. The prevalence in men is also increased due to straining or excertive exercise which can further exacerbate the issue. Lifting heavier items, heavy weightlifting or excessive toilet straining furthers the risk of developing an inguinal hernia.
Femoral hernias result in a comparable way to that of inguinal hernias. These mostly occur in women rather than men and are less prevalent than inguinal types, usually only contributing to 6-8% of hernias in the groin area. The femoral canal, like the inguinal canal, allows for easy passage for the intestine to pass through the muscle walls and herniate. The femoral canal is slightly lower in nature to the inguinal canal and is located more at hip level. Women have a naturally wider hip, and this results in the femoral canal being stretched. This therefore makes the gateway for the hernia to be larger allowing the intestine to pass much easier in this area in-comparison to than of a man.
Traditionally, groin related hernias were treated with belts and leather padding via an orthosis called a truss. These would work by means of promoting a reducible hernia by hand and then applying the belt and pad over the area to plug and filling the void.
Abdominal Hernia’s are much less prevalent than inguinal / femoral hernias. These can occur through the umbilicus at birth, via weakness in the abdomen wall, or can result due to pendulous stomachs, pregnancy, surgical incision, or from stoma care. Primary midline hernias are the most common type of abdomen hernia and will include umbilical hernia, para-umbilical, supra-umbilical, and epigastric types.
Birth related hernias usually occur around the umbilicus and result from the separation of the umbilical cord from the baby. The cord runs through the abdominal wall to provide nutrients to the baby during pregnancy. This opening will usually close naturally after birth, however, sometimes can remain open. With a newborn crying and the increased physical exertion in their abdomen, the belly button herniates. These can be massaged and supported with umbilical belts that help support and correct the protrusion, and will usually naturally disappear within the first few years of the babies life. Umbilical hernias are low in prevalence, however, 1 in 5 babies suffering from them. As mentioned earlier these can still occur in adults and are supported with similar belt like navel orthosis that support the waist and the navel area to alleviate pain and reduce any prominence.
Other abdominal hernias commonly arise in the midline where a fibrous tissue called the Linea Alba separates. Its weaker structure compared to than of its surround muscles (rectus abdominus aka the six pack muscles) means its more prone to herniation. The Linea Alba is also known to stretch and thin with larger abdomen types, so it’s also more prevalent to separating if you are overweight or pregnant.
Incisional hernias occur around the abdomen as a result of abdominal surgery. The Linea Alba plays a role in this when there is midline incision. The reason for this is that it has limited blood supply meaning it is a good insertion site for surgeons due to its lack of blood loss in theatre. However, with the incision this creates a further weakness in the abdomen muscles and can force the intestine to re-herniated around the surgical site. Even with gauzing placed subcutaneously to limit post operative displacement, the weakness through the incision can still appear elsewhere and therefore binders can be used to promoting compression and act as a second abdomen, helping to improve healing and aiding in swelling reduction and mobility post operatively.
Products to assist with Common Hernias.
Orthotix are a UK based NHS supplier of class 1 medical devices and the off the shelf range of modern and discrete hernia supports are now available to the NHS and the public and cover a wide array of hernia conditions as mentioned above. Manufactured by both of our partners, Pavis and Orliman, the range encompasses a selection of machine washable hernia supports with innovative materials and cotton-based products to cover a wide array of hernia presentations.
A new innovative way to treat groin related hernias such as inguinal and femoral types is via Hernia Underwear. Used as an alternative to the traditional leather truss type belts, these highly compressive briefs, boxer shorts, and Y front type slips provide uniformed compression around the pelvis and groin and can also provide mild abdominal compression when chosen in the deeper variants. Designed by Healthcare Professionals to effectively reduce pain and discomfort, the low profile, discrete hernia underwear improves cosmetic appearance, offers unparalleled comfort, and are unrestrictive to allow for uninhibited mobility, making them ideal for prolonged daily use.
In addition to this innovative hernia underwear range, Orthotix also offer a selection of other hernia supports including traditional truss’s, elasticated abdominal binders, Stoma care supports, and a selection of genito-hernia supports such as jock straps, bag truss’s and prolapse truss’s.
Mark Harris, Hayley Huntley (Managing Director of Orthotix), Kieffer Moore (pre-transfer), Tom Cooper (Managing Director of Ace Feet in Motion), Joe Ralls, Matthew May (Head of Medical) at the CCFC training facility.
The agreement sees Cardiff City Football Club remain amongst an impressive roster of elite sporting brands. All of which have partnered with Orthotix to benefit from their market leading products and clinical services offered.
Orthotix are delighted to announce that they have formally renewed their partnership agreement with Cardiff City Football Club which will see them continue as the Official Supplier of sports medicine bracing and orthopaedic supports to the first team squad until 2024.
Hayley Huntley, Managing Director of Orthotix said;
“We are thrilled to continue our professional affiliation with Cardiff City Football Club. The Bluebirds’ stadium is just a stone throw away from our headquarters in Canton so it’s fantastic to see such a high-profile professional sports team working with our local business.”
Throughout the course of a typical season the medical staff at CCFC will typically utilise a selection of Orthotix products to assist them with player injuries, rehabilitation and recovery. Common injuries associated with professional football include; fractured metatarsals, ankle inversions, calf strains, pulled hamstrings as well as knee sprains and ligament damage.
The medical team at CCFC will also be able to refer any players requiring specialist orthotic bracing to the new Orthotix clinical facility, run by Consultant Orthotist & Clinical Director – Chris Law. The recently launched clinic which is now open to the public has been setup to enable improved access to much needed class 1 medical devices. It will enable patients to be measured, fitted and supplied with medically approved product for various orthopaedic conditions and injuries. The clinic offers the public daily walk-in slots (Mon-Friday) and diarised appointments for more technical product requirements.
The agreement sees Cardiff City Football Club remain amongst an impressive roster of elite sporting brands. All of which have partnered with Orthotix to benefit from their market leading products and clinical services offered.
The question being, is it safe to lengthen the screening process for women when the worry of cervical cancer is already prevalent?
With Public Health.Gov recently announcing changes to their cervical cancer screening, thousands of women have been left with concerns over their personal health as the government announced screening will now be routinely completed every 5 years rather than 3.
Brought to my attention earlier in the month by a social media post from a work colleague and numerous friends feeds and stories about this, I’ve come to work to find discussions between staff over this matter. The question being, is it safe to lengthen the screening process for women when the worry of cervical cancer is already prevalent?
As a male some might feel this may be a strange or a taboo subject to pass comment on, but as a Health Care Professional working in offices which are occupied heavily by women, am I not compelled to investigate this and help to support their concerns, whilst educating them and myself, and raising some awareness for those who feel strongly against these changes?
With a national ‘re-think’ petition campaign via change.org gaining over 1.2million signatures, women have fought back against the changes, expressing concerns that the extra 2 years left unattended between screenings can potentially open their risk of being misdiagnosed.
Cancer Research UK has commented saying that if diagnosed that 99.8% of cases are preventable. So, the initial thought is, why are women not screened yearly? Surely increasing the length of time un-screened will put women’s lives at risk!
What is Cervical Cancer?
The 4th most common type of cancer in females, and the highest of prevalence in under 35’s, cervical cancer is a type of cancer where uncontrolled abnormal cell division occurs in the cervix area, affecting the uterus/womb. Strongly linked to a virus called Human Papillomavirus (HPV), cervical cancer is the most common cancer caused by this virus, with total infection rates contributing to 5% of the worlds cancer diagnosis and 7.5% of all cancer deaths.
Cervical cancer risks can be lowered by routinely testing for cell changes in the cervix and via a vaccine that helps prevent cell abnormalities caused by the virus. Almost all cases of cervical cancer are linked to HPV.
What is HPV?
HPV is a common group of virus’s associated with skin-to-skin contact in the genital area. HPV is a sexually transmitted disease, however, penetrative sex is not required for transmission. Reported to be over 20,000 total cases in the UK and over 500,000 globally each year, the virus has no real symptoms and as well as its risk of cancer cell development, can also cause skin concerns such as common warts, verruca’s and genital warts. HPV is mostly linked to cancer cell development in the genital area due to its sexual transmission orientation and contributes to 99% of cervical cancer cases, as well as associations to cancer in the rectum, anus, throat and mouth.
Women are most at risk of HPV associated cell changes and thus are at a higher risk of cancer cell development. An average of over 3000 cervical cancer cases are diagnosed each year in the UK, contributing to almost 1000 deaths between 2016-2018. Despite these figures, cell changes develop slowly when in contact with HPV, and can take on average of 10 years before showing signs of abnormalities in a healthy population.
How does the NHS routinely test for cervical cancer in women?
Cervical screening started back in the 1960’s via means of the Papanicolaou Test (PAP Smear Test), identifying pre-cancerous cells in the cervix and helped identify women who were at higher risk of cancer development. PAP testing was later stopped when it was realised the method resulted in large quantity of false negatives and misdiagnosis.
In the 1980s it was found that HPV was a key factor in cancer development and the government launched a nationwide campaign introducing a new method looking for specific markers which increased risk. Cytology methods and computerised inputting were introduced, however, despite the government’s best attempts and the strategies becoming much more embedded into routine public health practice, the 1980’s – 1990’s saw numerous failings of the system and almost 100,000 women needing re-examination due to cases being missed.
From 2000 onwards the processes improved and rates have since significantly dropped. Screening was standardised to a 3-year procedure for women between the ages of 25-49, and 5 years for ages above 50+. Cytology screening process replaced its predecessors, via means of a liquid-based cytology (LBC), which subsequently ran alongside the HPV vaccination program which was introduced in 2008. This method continued until 2019 where it was replaced with Hr-HPV DNA testing, where specific high-risk strains of the virus are identified with almost 100% accuracy. Due to this and combined with the already successful vaccine, Hr-HPV screening is now the primary protocol for cervical cancer testing nationwide.
What is the vaccine?
HPV vaccine helps to protect against cancer by stopping viral infection from High-risk HPV strains. The vaccine is given in two doses and has been available to girls aged 12 and above born after 1st Sept 2006, or to women born after 1991 until the age of 25. Over 10 million vaccinations have been administered since 2008 and has reduced pre-cancerous cell changes by over 87%. Due to its success, public health and the NHS decided from 2019 that the vaccine was to be offered to boys to further limit the risk of HPV transmission between sexes.
Public Health England have suggested the vaccine will now prevent over 64,000 cervical related deaths, and 10,000 anal cancer deaths by 2058. Despite these figures and a well-established national vaccination programme against HPV, the vaccine does not protect against all types of Hr-HPV and there is no guarantee it will fully stop cancer development. There is always a risk of virus mutation, cell infection and cancer development despite being vaccinated or not.
My passing professional thoughts…
From reading online, comments seem to be based around the age of which screening starts (25) and the gap of which screening intervals occur (3 or 5 years). Not only is the lengthening of the screening duration from 3 to 5 years concerning, but it seems many feel that the age of which screening can start should be dropped from 25 to the age of 18.
With these comments in mind and the science suggesting that the combined protocols are sufficiently managing cervical cancer diagnosis, public health have subsequently suggested screening does not need to occur as often. The fact that HPV is slow acting on cells, taking up to 10 years to development and that under 25s are extremely unlikely to have any developmental changes, they suggest by inviting women to screening early could result in unnecessary investigations and treatment, with higher NHS costs.
The most recent Hr-HPV screening test is reported to be 98% reliable. This then shows that when HPV testing is completed, if the result is negative there is likely no Hr-HPV in the cervix and therefore minimal risk of cancer. If the first screen was completed and clear, even if the day after HPV was transmitted, the virus could then take up to 10 years to become harmful in cells. Therefore, if testing started at 12 alongside the vaccination programme, this would essentially mean you are safe from HPV related cell changes until the age of 22.
Saying that, there is still margin for error in the testing. HPV is usually contracted at a sexually mature age, and the fact the vaccine is offered at an age where teenagers are sexually active, wouldn’t it seem more sensible to screen at a slightly earlier age? With the average UK woman being sexually active by the age of 15, the current method leaves a gap of 10 years from vaccine to screening! This is the same 10 year period that scientists reports cells being able to change in cancerous ways. So, should we screen for Hr-HPV 10 years after the vaccine?
The Government nonetheless backs its rationale explaining that cervical cancer risk is rare in women under the age of 25 even though Hr-HPV is common in these age groups. The International Agency for Research on Cancer support this explaining these types of cells are usually dealt with via our own immune systems within a young age group, and subsequently they advise that with vaccination that screening doesn’t need to occur before the age of 25, explaining it can cause more damage than benefit.
This all seems ok for the younger age groups. Vaccines successfully prevent the virus and associated cell changes, however, has anyone considered the women who are over 25, but still under the age of 49, and who were born before 1991. Wouldn’t this group of women be exempt from the vaccine? And therefore, the associated potential risks for women aged 32 onwards be higher?
Public Health and the NHS look at stats and listen to health advisors who say research the science, and they feel the science is right. HPV is prevalent in teenage years but the risk of the virus causing irreversible damage is low thanks to the vaccine and more reliable laboratory testing but this isn’t the case with the later age groups. There are hundreds of comments from women raising concerns from being undiagnosed/misdiagnosed due to this rationale.
I might not be a mathematician but as previously mentioned, anyone born before 1991 wasn’t entitled to the vaccine, meaning someone born in 1990 would be 32 years old, and the age group for the new proposed screening spans till the age of 49. Researchers have mentioned risks of HPV are lower in women aged below 25, and this would then otherwise indicate that risks rise after 25. Therefore, there is 17-year age gap/ range of women that are at higher risk and have not had the vaccinations, who are now expected to have the longer screening intervals.
It’s ok to say that the science says otherwise but if cases are still apparent, then shouldn’t this age range for women in their 30s onwards be screened on a different pathway regardless of how successful the newer Hr-HPV screening is! Considering this, and the fact that we all know the NHS system has been put through excessive stress due to Covid-19, resulting in the likeliness of cases being missed, are the risks not even more of a concern currently?
Granted this is a very tricky subject to comment on and to try and balance out an argument from a neutral perspective. In my opinion I think the vaccination should still occur at the age of 12, and considering the 10-year viral development window, that screening should then commence at the age of 22, or 10 years after the time of being sexual active. Teenagers and women should be able to consent to the screening at their own accord, with the first review interval being at 3 years, and monitoring thereafter at 5-year intervals as long as the test is clear.
Cases are always going to slip through the net, and can be missed due to laboratory error. There is also an element of genetic or family history to be considered where quicker cell deformation can occur and these should be considered on individual bases in these cases.
Considering all this, I see the governments rationale, and it seems from my perspective a largely debatable subject. I think the key closing point here should be science says there isn’t a risk and as a medical professional I believe in science! Yet if there is concern raised by women then shouldn’t we re-consider these protocols? The fact that Change.org has a huge petition campaign behind this already, shows me there is some proof in the comments.
I hope this HotTopix doesn’t cause any controversy, but I hope it does raise some knowledge and awareness. I know I have learnt and become more knowledgable by writing this and hope it can be as useful and informative to the readers.
If you would like to support this cause, then please click on the link below to sign up for the ‘re-think’ campaign.
Core instability and poor back care can destabilise our building block and can cause postural issues and malalignment of our body, resulting in direct back pains which can be assisted with back braces and supports…
What is Back Care Awareness Week?
Back Care Awareness was established for people to pay more attention to our general back care and maintenance. It may seem obvious that our backs are a vital part of the human body but do we actually know how to care for it the right way? Orthotix Clinical Director, Chris Law has shared his knowledge and insight into the importance of taking care of our backs.
Why is it essential to look after our backs?
The human skeleton makes up about 20% of a person’s body weight and contains 206 bones, of which the spine/back is made up of 26. Our spine is divided into three spinal groups: Cervical vertebrae (7 bones found in the head and neck area), Thoracic Vertebrae (12 bones found in the upper back and are linked to our ribs.) and the Lumbar Vertebrae (5 bones found in the lower back.
Our skeletal system’s main function is to provide support for the body. For example, our spinal column provides support and alignment for the head and structure for our torso, as well as protection and accommodation of our central nervous system. It also gives protection to our internal organs from injury. For example, the thoracic spine and inclusion of its cage protects the heart and lungs.
The spine, allows for a multitude of movement. Muscles throughout our back connect to bones through tendons. These connections allow the spine to move in many ways. It’s therefore important to ensure we look after our spines, and it’s associated soft tissues. Core instability, and poor back care can destabilise our building block and can cause postural issues and malalignment of our body, resulting is direct back pains, referred pains in our shoulders and neck, lower limb nerve pains and discomforts, including impingement pains and sciatica, plus issues with digestion, circulation, and breathing.
Common back conditions and symptoms?
Trauma and injury results in a majority of ‘Red Flag’ back pains. These can include such things as fractures, slipped or herniated disks, tumours (metastasis) and instability from cancer treatments. It can also be attributed to conditions including scoliosis, postural lordosis/kyphosis, and pathologies such as spina bifida. Degenerative problems and conditions such as degenerative disc diseases, osteoporosis and inflammatory arthropathies are also key contributors to back pain and postural stance alignment. These can all cause skeletal deformities, and nerve related problems as a result from high-risk spinal cord compression.
Outside of ‘Red Flag’ diagnosis which require specific treatments, general back pain and back discomforts are often diagnosed as non-specific.
Non-specific back pain
This usually means back pain comes from a non-identifying reason and is usually attributed to being mechanical. Back pains manifest from pour posture, pour lifting technique, and result in sprains and strains to our muscles and connective tissues. Factors such as genetics, age, wear and tear, general fitness levels and body weight are also influencing.
Most non-specific back pain is reported to be in the lumbar (lower back), however can also manifest in the mid back, between the shoulder blades, and up into the base of neck. Symptoms usually are pain, which worsens with movement and activity. Altered posture, muscle spasms, numbness and tingling pains that commonly reported as symptoms. Pains can be referred, usually coming into your legs, and can include stiffness with difficulty to move freely. Sometimes it can feel like your legs are giving way despite the issue coming from your back.
Symptoms can come on quickly and can be very acute and painful, or could come on after an event, and a period of rest. Non-specific back pains do however generally settle down with time and rest. Rehabilitation via back supports or back bracing to improve core stability, and to help improve posture, allows for our connective tissues to have a break, and back pains to further reduce. Include the use of back supports/bracing with back focused exercise, you can support and strengthen the weakness, and improve back alignment and improve poor posture.
Recommendations Non-specific back pain
Non-specific back pain usually gets better on its own over time. Recurring back pain usually results from continued improper body mechanics and can be prevented by avoiding movements that jolt or strain the back, and by maintaining better posture, and lifting techniques. Many work-related injuries are caused by repetitive lifting, improper technique, and awkward posture.
Recommendations for keeping the back/spine healthy is to regularly exercise and keep fitness levels up. Keep the exercise low-impact, and age-appropriate. Try to specifically target and strengthening lower back muscles and abdominal muscles. Maintaining a healthy weight and keeping a low BMI is advised as this will lessen mechanical stress coming through the back, by naturally decreasing its load.
Key considerations for assistive supports include:
Use ergonomically designed seats and cushions at home and at work
If you are office based, try to walk around periodically, gently stretching to relieve tension
Use a rolled-up pillow behind the small of your back to support your lumbar
If you are a manual worker, ensuring correct footwear is being used.
Ensure you get a heavier duty back brace when lifting heavier objects, helping reduce repetitive strain and to help protect the back from injury.
Lift from the knees, and squat down to pick up items. Don’t bend through your spine
If you suffer from knee pains, consider bracing your knees for extra support
For general day to day assistance, brace your back with items that are flexible and still allow movement, however, can provide stability to you core and abdomen. By doing this you get a more solid base of support for your lumbar spine, which will improve posture, better aligning your spine and facet joints, and will allow back pain to reduce but giving additional support to our soft connective tissues, letting any acute aggravations to settle down.
Over the week, our Clinical Director Chris will be showing you some back supports from Orthotix, and from our partners Orlimen and Pavis, which are clinically approved, and have been proven to be reliable, comfortable supports for the NHS, helping patients across the UK to reduce back pains and improve their back care.
Further Bracing Recommendations
Most braces to treat non-specific back pain can be purchased online, however knowing which brace to purchase can sometimes be confusing and difficult, and knowing if the brace is approved and suitable for your condition can also be concerning.
At Orthotix, we can suggest a range of products not only to help with back pains, but with pains and instabilities through the body. Being a supplier to the NHS, you can rest assured the products we prescribe are clinically approved and are of medical grade. You can access our web shop and utilise our categorised limb sections to navigate to the spine for a variety of back supports, and also navigate a whole array of other medical approved braces and supports.
The latest chapter in the Orthotix success story will see the business move into it’s third premise in under a decade. Originally set up in the Merthyr Tydfil Industrial park, the business soon outgrew its surroundings before moving to its existing facility within the Dacey Ltd building in Canton, Cardiff.
The continued expansion has left Orthotix bursting at the seams of its current home and with demand from new markets emerging, future growth has become inhibited. With this in mind, the Company Directors enquired about purchasing the adjoining property. This had remained derelict for a number of years and after a protracted period of negotiations with the owners, a deal was successfully negotiated.
In Early 2018, work began on the renovation of the new Orthotix 25,000 SqFt premise, which requires a complete overhaul, including roofing, plumbing, electrics and asbestos removal. The new building when finished will create increased warehousing, modern offices, design suites and a product showroom complete with fitting clinics.
Executive Director, Paul Cooper said;
“This move is much needed for our business as it will enable us to significantly upscale our operations to meet existing and future demand for our products across our trade, retail and export platforms. The project will also give us the opportunity to enhance our corporate branding, with a modern facility befitting of the leading sports and orthopaedic bracing distributor in the country”
Renovation works are set to be complete by the summer of 2018 and the expansion of Orthotix is anticipated to create a number of employment opportunities.