Tag Archives: yoga


Last year I blogged about mindfulness and recommending this has become an integral part of our practice as we constantly see patients faced with the stress of modern living. For those that are not aware of mindfulness, which involves meditation, is defined as:-

 “the intentional, accepting and non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment”.


I was asked to proofread an  article written by Charlie Morgan, yogi and yoga teacher who promotes the slogan:-

                               ‘ Your health is your wealth, the rest is a bonus’

The article was to be published in the section on health and happiness on the blog of deliciouslyella the blogger, foodie, yogi, best-selling author, nut butter addict, Telegraph columnist, app creator & avocado enthusiast.

I was delighted to see it appear on her blog for many  people to view and subsequently read the positive comments.

Click on the link below to read the article:-

image                                     Mindfulness

Thank you Ella and Charlie for collaborating to promote mindfulness and help many people understand it’s value in today’s world.



Posted by on June 12, 2015 in Training and Advice


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This week my attention was drawn to an article on about the increase of Yoga in Sierra Leone. I had been aware of this country with long, atrocious civil war between 1991 and 2002 and a country with one of the worst records of human rights this was not the place I thought this would be happening.
I recalled years ago one of the patient’s, a Head-teacher coming into surgery having had a difficult Ofsted inspection – not an unusual when trying to manage a multicultural, challenging school in London. She certainly wasn’t the first and won’t be the last. I particularly remember her talking about a group of new children that had entered the school: they were children that had come from Sierra Leone and had been used as child soldiers. For her it finding a way to integrate them into the school was in itself a challenge as for these 8-9 year olds who had had no childhood all they knew was war and fighting. They had been deprived of a childhood and found it difficult to just play and have fun in a childlike way.
Despite peace the aftermath of this wretched war has left indelible scars and the World Health Organisation estimate that about one sixth of the almost 6 million population have mental disorders. Albeit, they only have one psychiatrist and care of these people is poor.

Tamba Fayia taking a yoga class

Tamba Fayia taking a yoga class

Tamba Fayia, once a child soldier in Sierra Leone’s civil war, who in 2012 became the country’s first qualified yoga teacher says yoga transformed his life. He set up Yoga Strength which focuses on taking yoga to the people that need it. “I work on the streets, in the slums, in the schools” says Mr Fayia. He has even held a class on a remote river island in the jungle.
He teaches at Sierra Leone’s only mental hospital in the east of Freetown, and therapists say the classes have led to clear psychological improvements in some patients. “It makes me feel light,” one patient said
He teaches at Sierra Leone’s only mental hospital in the east of Freetown, and therapists say the classes have led to clear psychological improvements in some patients. “It makes me feel light,” said one patient.


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Recently when I was choosing a book for my grandson I started to recall the many books I had read to my own children and then I stumbled on the book ‘We are going on a bear hunt’ by Helen Oxenbury’. I remember this story as one we used to tell each other around a camp fire when I was camping with the Girl Guides many years ago! We loved to build up that fear and scream out and then that that lovely feeling when all was well. Children love to feel fear when they know they are safe and can be reassured and know there will be a happy ending and I suppose that’s why so many popular children’s stories have an element of fear attached and why theme parks are so successful. It’s not just children as adults we sometimes get pleasure by experiencing a frightening experience as long as we are can somehow remain in or regain control.

Just to remind you of the emotions and feelings of fear take a look at this video of ‘We are going on a bear hunt’

How did that make you feel, how did you feel the characters feel? Did you see the fear on their faces, feel their heart thumping, their frozen fear, their legs and body shaking, breathing accelerate and become shallow and then witness their flight from the situation to find the safe haven of the bedclothes.

We have all been there whether it is before an examination, a job interview or an audition or going to experience something or someone unfamiliar. But sometimes there is feeling that flight is impossible and the safe haven does not exist.
This famous painting ‘The Scream by Edvard Munch’ (1893) portrays the sheer agony of his personal anxiety. He was taking a stroll along a path by the side of a beautiful fjord in Norway and instead of him finding it a pleasant, relaxing experience he became full of fear and indescribable anxiety.

The screamIn his diaries this is how he describes the event:-

“I was walking down the road with two friends when the sun set; suddenly, the sky turned as red as blood. I stopped and leaned against the fence, feeling unspeakably tired. Tongues of fire and blood stretched over the bluish black fjord. My friends went on walking, while I lagged behind, shivering with fear. Then I heard the enormous infinite scream of nature.”

I recall many patients who have attended surgery where fear has been so overwhelming that they feel frozen, unable to carry on, unable to face going to work or school even unable to get out of bed. One such patient came to me following a panic attack ( an extreme feeling of fear ) which occurred just before she about to sing a second Aria on Christmas Eve at the Chapel Royal. She had sung the first Aria beautifully then she became so overcome with anxiety she was unable to sing the second Aria.
She had graduated from Cambridge with a double First in Music and was about to launch on a career of being an Opera singer. She was devastated and felt her whole life had crumbled. Thankfully with treatment she overcame this anxiety and was a wonderful moment when I went to hear her sing in an Opera at St.Brides, Fleet Street. I think I was more anxious than she was! She then literally went off into the World to sing.
Other patients never make to the surgery but languish in there beds or at home too fearful to seek help.
These are the sort of patients that cannot wait in the waiting room and pace up and down the corridor or outside, desperate, on edge,trembling, asking for a glass of water or may simply walk out. Having talked to them I have shared their feelings, felt their anxiety and fears and now we try to arrange a time when they can come to be seen with a minimal waiting time, and we hopefully give them time to express how they feel because I know that if they are seen we can help treat this condition and they will ‘go off into the world and sing’
Ways we can signpost you to get help:-

    • We have an in-house counsellor Tony who sees patient on a relatively quiet time in the surgery and a chance to give space to talk.
    • a referral or self referral to IAPT
      You can phone or email as below
      Telephone 020 3313 5660
    • we recommend self help books such as:-
      A sequel to Danny Penman’s other book ‘ Finding peace in a Frantic World’
      These can be obtained from Amazon as a book or downloaded onto a kindle

‘Want a happier, more content life? I highly recommend the down-to-earth methods you’ll find in Mindfulness. Professor Mark Williams and Dr. Danny Penman have teamed up to give us scientifically grounded techniques we can apply in the midst of our everyday challenges and catastrophes,’ Daniel Goleman, author of Emotional Intelligence
Many patients have been grateful to having this book recommended to them. – this can be easily printed This has a useful podcast from someone suffering anxiety and how it was overcome and a booklet with information and ways to help anxiety

  • join a Yoga class or follow a class on YouTube or try the following 10 poses
    which I have re blogged to follow this blog.
  • finally if you are feeling too desperate to leave your home, phone a friend or seek help outside there will always be anytime day or night a sympathetic listening ear at the end of the phone from the Samaritans. Hence, everyone reading this I suggest that as Dr Livingston and myself have done make sure the number is on your mobile or near your phone as none of us know when we may need to phone that number.

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Back pain can impact on many things we want to do on a daily basis. Fortunately there are a number of things you can do to lower the chances of developing disabling back pain and reduce the impact back pain may have on your life.

Back pain

The first part of my career in my surgery consultations I saw many patients with lower back pain but this was as a result of heavy manual work by miners, steelworkers, labourers and farmers. Working conditions were hard and there was little attention paid to prevent chronic back problems. We only had limited ways of investigating and simply relied on our clinical skills to diagnose a problem and tended to air on the side of caution as we were unaware of what was occurring in the body . After years of carrying out sophisticated CT scans and MRI scans and following up patients we now realise we were being over cautious and pain did not necessarily mean serious damage and most cases of back pain could be treated by encouraging movement and over the counter painkillers. Physiotherapy and other treatments were not widely available and at that time the advise was bed-rest in every case! Many patients took to their beds for many weeks and as a consequence became long term invalids often never to work again. We now know that this bad advise and that 60% of acute back pain will have resolve after 2 weeks and most will resolve in 12 weeks. Also, by having regular exercise a recurrence can be prevented as well as advising manual workers at their place of employment how to lift and to encourage the use of equipment to assist lifting to avoid unnecessary trauma.

During the second half of my career the patients who I see with back pain are sedentary workers who develop it as a result of prolonged sitting.
Back pain
It is actually more about how the body has to adapt to all the sitting, standing, and lifting than the activity itself.
Musculoskeletal problems today affect more women than in men for all age groups. For both genders, prevalence is noted higher in the 75 years and above age group. Nationally evidence suggests that MSK pain prevalence is higher in ethnic groups 63%-89% than White subjects (53%) at 45-64 age groups. 11.2 million working days per year are lost through MSK problems. Patients with MSK conditions account for the second largest group of patients in receipt of incapacity benefits after mental health. Back pain occurs in 4 out of 5 people at some time in their life.

In Ealing this accounts for 16% of incapacity claims, which is higher than the London average (15%). Increasing longevity, obesity and lack of weight bearing exercise will increase the number of patients with MSK conditions. The Chartered Society of Physiotherapy found that nationally 36 per cent of employees worked through their lunch break and 31 per cent experienced pain at work at least once a week. The economic and personal costs could be greatly reduced by encouraging better working habits and recommending appropriate exercises and providing early access to services, such as physiotherapy, for people who develop ongoing musculoskeletal conditions.

Because of the amount of time spent sitting, the body must gradually adapt itself to that position. This happens in a number of ways. The first thing it must adapt to is how the weight goes through the hips and pelvis. Then, there is the sitting position – upright, slouching, or something in-between.
This position could be termed the Office Worker’s Slump. In the Office Worker’s Slump, the back curves forward, which means the abdominals are not engaged, while the lower back muscles (erector spinae) are constantly shortened. The result is stress on the lumber vertebrae and subsequent intervertebral discs.
Back -sitting
The Office Worker’s Slump puts the spine under unnecessary daily stress, and throws its surrounding supportive muscles into a state of imbalance. These muscles help prevent injury to the back; harm their effectiveness, and there is an increase risk of suffering back problems.
Then people with already susceptible backs attend training sessions at the gym and put their backs under undue strain. Simply moving heavy equipment around can cause damage – and that’s before making a start on those heavy weight bearing moves.
The results vary from mild to crippling back pain – but both can be easily avoided. It is therefore important to follow gym work in the correct fashion and far from amplifying back issues, it can help to lower the risk of spinal injury.

Back pain is not generally caused by a serious condition but if not treated promptly by exercise and painkillers a pain cycle can easily evolve.
Pain cycle

The back is a complex structure made up of bones, muscles, nerves and joints. This can often make it difficult to pinpoint the exact cause of the pain.

Back- anatomy
Causes of lower back pain
Most cases of back pain are not caused by serious damage or disease but by sprains, minor strains, minor injuries or a pinched or irritated nerve. In most cases, the pain gets better within 2 weeks and completely recovers in 4-6 weeks. As stated earlier it can usually be successfully treated by taking over the counter painkillers, keeping mobile and carrying out suggested back exercises for at least 6-8 weeks after recovery to prevent a relapse.
Back pain can be triggered by everyday activities at home or at work, or it can develop gradually over time as a result of prolonged sitting or standing or lifting badly. Other causes of back pain include:

  • bending awkwardly or for long periods
  • lifting, carrying, pushing or pulling incorrectly
  • slouching in chairs
  • twisting
  • over-stretching
  • driving in a hunched position or driving for long periods without taking a break
  • overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury)
  • Sometimes back pain develops suddenly for no apparent reason. Some people just wake up one morning with back pain and have no idea what has caused it.

Red flagYou should seek immediate medical help if your back pain is accompanied by:

  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain that doesn’t ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • loss of bladder or bowel control
  • inability to pass urine
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night

How to prevent back pain

Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help.
If you have recurring bouts of back pain, the following advice may be useful:

  • lose weight – too much upper body weight can strain the lower back; you can use the healthy weight calculator to find out whether you need to lose weight.
  • wear flat shoes with cushioned soles as they can help reduce the pressure on your back
  • avoid sudden movements which can cause muscle strain
  • try to reduce any stress, anxiety and tension, which can all cause or worsen back pain – consider Yoga, Pilates and/or meditation.
  • stay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain.

Read more on:-

        • examine your posture at the working desk

Back posture

  • using pillows when lying down to support the back
    Back pain
  • regular exercises whilst at the desk
    imageIn view of the fact that the majority of cases of back pain are not related to serious damage or disease your GP will encourage you to take the above advice and carry out the exercises illustrated below or as instructed on the video below showing a demonstration from our physiotherapists at Ealing Hospital.

Recommended back exercises

Edited by Dr Ian Bernstein

Edited by Dr Ian Bernstein

In Ealing we are fortunate enough to have an excellent community based facility for assessing and treating musculoskeletal problems started by an enthusiastic GP who has pioneered assessment and treatment of MSK problems in the community and by passing on his expert knowledge this has empowered other GP’s in Ealing to select the appropriate patients to be referred for more specialist care. This is not only beneficial economically but has reduced waiting lists for secondary care Orthopaedic opinions and investigations such MRI scans. The service is constantly being expanded and along with specialised physiotherapists and now Orthopaedic surgeons there is a comprehensive team of therapists who are able treat a wide range of musculoskeletal conditions including back problems in Clayponds Hospital. Hence, in Ealing patients are now initially treating themselves and then if they demonstrate no significant improvement after 6 weeks can be referred for specialist assessment, investigation and treatment by this service.
If a very serious cause is considered the case can be fast tracked and the patient can be seen immediately or within 2 weeks.
For further information for those living with back pain:-

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Posted by on February 14, 2014 in Training and Advice


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An idea for Mindful Meditation!


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