Over 45s with joint pain design movement to music classes to manage their condition safely

A new movement to music programme for people who have pain in their hips and knees – co-designed by participants and run by the Bristol Bones and Joints Health Integration Team – has been piloted in Bristol.

Pain commonly occurs because of musculoskeletal (MSK) conditions such as osteoarthritis, back pain and rheumatoid arthritis. They affect one in four adults and can have a huge impact on how someone lives their life. As well as pain, people can experience high levels of fatigue, stiffness and loss of movement. This affects their ability to work, to look after themselves and to do the things they enjoy. MSK conditions affect people more in deprived areas.

Research has shown that being active can reduce pain, bring back movement and improve musculoskeletal conditions. However, people are often afraid to move because they fear that movement will make their conditions worse and cause them more pain. They may feel that mainstream community activities don’t offer the right kind of help, or don’t meet their needs and physical disability.

The combination of fear of moving, loss of confidence, lack of information and fewer opportunities to be active means that people with MSK conditions often stop moving. Being inactive affects people’s mental health as well as physical health. It can make people socially isolated and can affect their wellbeing, causing low mood and depression. As a result people may find it harder to get the NHS services they need and those who already feel excluded from services become more isolated.

To address this problem, Bristol Bones and Joints HIT worked with local people over 45, who experience joint pain and who had stopped moving, to design a safe and accessible movement programme that met their needs.

The team talked to social prescribers, local charities, community groups, health and social care providers and local radio to reach participants from a diverse range of backgrounds whose musculoskeletal conditions included rheumatoid arthritis, osteoarthritis and back pain. Some had restricted movement after knee replacements whilst others were in pain waiting for joint replacements.

The group met at Bristol’s Trinity Centre over eight weeks to design and take part in a programme of music and movement sessions together.

The sessions were led by Julia Thorneycroft, an experienced dance artist and practitioner who leads Gerry’s Attic and contemporary dance company for people over 55. She said:

“The participants’ lived experience was essential in creating an activity they felt supported and safe to take part in, and able to engage all participants and their different health needs. We decided to call it a music and movement project rather than dance for this reason, so that no one felt that it wasn’t for them.”

Julia was supported by Jen Pearson, a physiotherapist with a special interest in chronic pain.  She said:

“Experiencing joint pain is not only physically limiting, but also socially isolating because it cuts you off from activities you might normally take part in. This programme was important to do because not only did it help to get people moving again safely, but it also helped them to connect with others experiencing similar challenges, and find support in each other’s progress.”

The positive response to the project from participants has encouraged the HIT to work towards offering the music and movement programme long term, in a sustainable way so that more people with musculoskeletal conditions can benefit. The HIT is currently applying for funding to continue to run the movement to music classes at the Trinity Centre.

How the programme was developed and participants’ feedback

The first two sessions of the 8-week project were two-hour development workshops. These gave participants the opportunity to get to know each other and to share their experiences. This was something they valued and helped to create an environment that felt safe emotionally.

 “I think I’ve come to the stage now where I’m fed up with explaining [my condition]. But to come to a group like this where everyone can relate without passing any judgement.”

“Really enjoyed the group this week. With the cold weather at the moment, I do struggle. But I’m not going to let it stop me…This is the first time in my life that I can express myself in a warm and friendly environment.”

Having a physiotherapist present ensured that participants were able to express and address any fears they had about their pain and moving. She was able to adapt movements so that everyone was able to take part in ways that suited them; all movement could be done sitting down or standing up and with more or less of a range of movement. She also described different types of pain so that participants knew what types of pain and stiffness they could move into without causing damage.

 “I was actually moving into my stiffness today, for the first time I was bending my knees while I walked, and it wasn’t as painful as I thought it would be but felt very alien as I haven’t done it for so long.”

Each week the sessions included relaxation and stretching, expressive movement and fun follow along routines. Participants were invited to help develop the routines by adding their own movements to them.

“[It’s] been nice to feel like you’re contributing to the movements that you’re making. There’s been something really nice about that and to begin with I was like ‘oh I don’t know I’m not very creative, I can’t think of anything’. And I’m more relaxed about that now.”

For some the project was ‘life-changing’, especially for those who felt socially isolated. Being able to share experiences with the group led participants to say that their ability to move and quality of life had improved and that they felt empowered to manage their health conditions.

“the impact it [pain] has on your mental health is really surprising, it’s shocking actually. I didn’t realise how bad I was…but having the movement and the space to share as well it’s really important.”

The project allowed the participants the time to really connect with each other and they intend to keep meeting now that it has finished.

“I was a bit unsure of coming to the group and I said to myself ‘if I’m not comfortable the first day I’m not coming back the following week’. So the first day I was totally shocked, everybody listened to everyone, everyone was really friendly, there was no negative comments, everybody was interested in what was wrong.”