physiotherapy

Depression and the Benefits of Exercise

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Exercising for depressionExercise is a useful method of managing depression but is not a stand-alone treatment. There is research based reviews that support that exercise can reduce the symptoms of depression, and now a recent article by Harvey et. al in the American Journal of Psychiatry has found exercise / activity can prevent future cases of depression.

There are several features of the researcher’s interpretations that are useful. They concluded that exercise intensity was not relevant to the prevented cases of depression. This means that any exercise is better than no exercise. Just going for a walk is one of the simplest and easiest forms of exercise to start with. If you can’t walk due to pain or injury then we would encourage water based exercise or an exercise bike. Even a short walk will release endorphins to begin to make you feel better.

The findings of an 11 year prospective study were that as little as 1 hour of physical activity per week prevented 12% of future cases of depression. So if you are not currently exercising then just being active for 1 hour a week can help with depression. The recommended 30 minutes per day remains an ideal amount of exercise for healthy living (combining physical, cardiovascular and metabolic health) and if you achieve this you are way above the 1 hour per week required for assisting with depression.

The researchers did not find that exercise was not helpful in preventing future cases of anxiety. If you have anxiety or depression use the resources such as websites such as beyond blue and black dog institute and discuss it with your GP.

Click here to read the black dog institute’s fact sheet on exercise and depression.

Harvey et.al (2017). Exercise and the Prevention of Depression: Results of the HUNT Cohort Study: AJP in advance. doi: 10.1176/appi.ajp.2017.16111223,

Strength exercise – more evidence that it is worth doing

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Strength Training

The reason for doing the recommended 2 strength based exercise sessions per week has been given another boost from a recently published study. Stamatakis et al analysed adults over 30 in the United Kingdom that were selected from a pool of 80,000 people completing an annual survey then further assessed via interview and questionnaires over a 9 year period.

Strength based exercise on its own has been shown to reduce diabetes risk and when combined with cardio exercise gave even greater benefits. This study looked at reductions in mortality that could be attributed to different types of exercise that is recommended by the world health organisation. Namely 150-300 minutes of cardiovascular exercise and 2 strength exercise sessions per week.

They found 36.2% of the sample group met only the aerobic exercise guidelines. 3.4% met only the strength exercise guidelines and 5.5% met both aerobic and strength exercises recommendations.

Participation in any form of strength exercise led to a 23% reduction in mortality from all causes and a 31% reduction in mortality from cancer. Combining the strength and aerobic exercise guidelines further reduced the rate of mortality than aerobic physical activity alone.
The definition of strength exercise included both gym and body weight exercises but they analysed whether one was better than the other. The study found bodyweight exercises gave the same benefit to gym-based activity. Previous studies have indicated that increasing muscle strength has been associated with reduced cancer mortality independent of aerobic fitness. Also higher muscle strength, as opposed to just participating in strength exercise led to reductions in mortality.

Meeting the strength exercise recommendations of twice per week was found to be as important as achieving the weekly aerobic exercise recommendations for health benefits and reducing the risk of mortality.

Summary:

  • Get into strength exercises even if it’s just body weight exercise
  • Make it challenging enough to increase your strength
  • If you are just starting out, don’t go too hard too fast or you may increase your risk of injury
  • If you are not sure what strength exercise program is suitable for you, let us know and we can help you get started on a program that is safe and effective to achieve your health goals

Stamatakis et al 2017, Does strength promoting exercise confer unique health benefits? A pooled analysis of eleven population cohorts with all-cause, cancer, and cardiovascular mortality endpoints. Am J of Epidemiology.

Lifting and stooping- the latest in lifting related research

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lifting

Should we avoid stoop lifting? There has been plenty of lifting related research in the past but none of it is conclusive. We rely on expert opinion that says the squat lift is safer than stoop lifting but recent discussion amongst clinical experts and researchers surrounds other factors being more important than the classic type of described lift when it comes to avoiding injury. The original review of van Dieen at el in 1999 highlights the very little amount of good quality research existing in the area and recent research from Dreischarf et al 2016 has provided data that challenge existing beliefs on lifting.

A summary on our recent masterclass session on the topic of lifting and avoiding injury concluded the following 5 factors were valuable:

  1. Keeping the load close to the body reduces the forces on the lower back more when compared with the type of lift (stoop vs squat).
  2. Strength and conditioning to the chosen method of lifting is important. I.e. if you never stoop lift and then have to because of where the object is then you are more likely to have an injury than if you stoop lifted more often.
  3. The timing of the movement is important. This is a difficult concept to simplify but refers to when the knees and hips straighten during a lift and what the back is doing at the same time. A common observation in the clinic is that over-arching the back during a lift often leads to pain.
  4. Cumulative loading is important. If you sit and slouch through the pelvis for long periods then it will increase your risk when lifting but if you get up regularly and change posture from sitting to standing or walking then the effect of cumulative loading is reduced.
  5. Semi squat lifting places less stress on the knees than the full squat which is important if you have knee pathology. If the timing is correct and you are conditioned to lift this way it remains the optimal choice of lifting.

For those who are interested, the references referred to in this blog are:

Dreischarf et al, 2016. In vivo loads on a vertebral body replacement during different lifting techniques; Journal of Biomechanics. 49(2016):890-895

Van Dieen et al, 1999. Stoop or squat: a review of biomechanical studies on lifting technique; Clinical Biomechanics. 14(1999):685-696

 

The effect of static stretching on performance and preventing injury

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Stretching

Historically many people have used static stretching – a long hold and the end of available muscle length – as a part of a “warm up” routine before sport or exercise. But the research doesn’t back it up, and it may be detrimental.

Let’s talk about performance first. Static stretching actually decreases muscle power for a period of time – the period is debatable, but at least 5 minutes and up to 3 hours – after stretching is performed1,2. This also applies for contract-relax or proprioceptive neuromuscular facilitation (PNF) stretching. This could easily impair athletic performance, especially in sports where high force generation is required. Dynamic exercise/facilitation exercises do not seem to have this power loss effect.

What about injury prevention? Nope, no help there either. A very large study by Lauersen et al. (2014) which synthesises the best quality research surrounding injury prevention to date reported no reduction (or increase) in injury risk for people who performed static stretching3. What they did find was that proprioceptive training, strength training and a dynamic warmup did reduce the risk of acute and overuse type injuries4,5,6.

It’s hard to break old habits, but if static stretching can impair your performance and doesn’t make any difference to injury risk, it may be time to change it up. Athletes can derive a greater benefit by spending that time on a dynamic proprioceptive, agility, strength and balance training program warmup.

If you aren’t about to perform a physically demanding athletic activity and you enjoy stretching, go for it. There is no harm in stretching and if you haven’t got the mobility to perform a sport or task then both static and dynamic stretches are options to achieve this.

To read more about avoiding running injuries, click here and to read up on how to prevent injuries during pre- season click here.

  1. Marek, S. M., Cramer, J. T., Fincher, A. L., & Massey, L. L. (2005). Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. Journal of Athletic Training, 40(2), 94.
  2. Behm, D. G., Bambury, A., Cahill, F., & Power, K. (2004). Effect of acute static stretching on force, balance, reaction time, and movement time.Medicine and science in sports and exercise, 36, 1397-1402.
  3. Lauersen JB(1), Bertelsen DM, Andersen LB. Br J Sports Med. 2014 Jun;48(11):871-7. doi: 10.1136/bjsports-2013-092538. Epub 2013 Oct 7. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.
  4. Soligard, T., Nilstad, A., Steffen, K., Myklebust, G., Holme, I., Dvorak, J., … & Andersen, T. E. (2010). Compliance with a comprehensive  warm-up programme to prevent injuries in youth football. British journal of sports medicine, 44(11), 787-793.
  5. Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., … & Andersen, T. E. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj,337, a2469.
  6. Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC medicine, 10(1), 1.

Hamstring injury management – A breakdown of the latest research

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Sliding exercise

Athletes rejoice! For decades our understanding of hamstring (HS) injuries has been improving and evolving, yet the frequency of HS injury rates in sport have not declined. Finally, a new paradigm has been developed which consolidates our knowledge of the anatomy and the physiology of this highly prevalent injury, applies effective rehabilitation strategies, accurate return to sport testing and re-injury prevention.

We can broadly define the typical hamstring strain into a sprinting type strain which occurs at high speed running versus a stretch type strain which occurs with high kicking or other stretching movements. Each of these will typically cause an injury to a different muscle in the hamstrings group. They can generally be diagnosed in the clinic without the need for any imaging. The most common type is the sprinting type, frequently seen in football codes, soccer, hockey, athletics and other running sports. The stretch type is more common in dancers, jumpers and hurdlers, although either type can occur in any sport. Knowing the type of injury gives us a chance to apply the right exercise rehab as well as gives a guideline for the return to sport time, which varies enormously between the type, location and grade of strain.

We know that most HS injuries occur when the muscle is working hard in its lengthening phase, therefore it is essential that the rehabilitation program targets this movement at high load. A comprehensive program is undertaken, which incorporates hamstring strength, but also hip, pelvis, trunk and general lower limb strength and stability. This addresses all the factors which will lead to re-injury – that’s not new. What is new is a set of 3 specific exercises, that when applied correctly in soccer players led to a re-injury rate of only 1 in 75 players over 12 months! That’s way down from the average 1 in 4 players with conventional rehab in professional soccer.

The protocol is based on 3 specific lengthening (eccentric) strength exercises and the technique, timing and progressions of these are of critical importance, they need to be integrated and complemented with other exercises and, as a rule, should be pain free. So what can you expect to gain from completing a modern rehab program like the one we provide at NU Moves? A research study by Askling and colleagues found that their protocol of exercises led to an average return to play time of 28 days, compared with 51 days for the conventional group. Combining this with the low reinjury rate means it was proven to be a much better approach to HS rehab. The research also provided an additional return to play testing procedure (H test), which we integrate into our comprehensive existing return to play algorithm in the clinic. It assesses apprehension or feeling of insecurity as well as pain when performing a high load eccentric braking action on the leg, similar to what happens during an injury but in a safe way.

So to put it all together, we have a rehab protocol that fits well with our current understanding of hamstring strains and their risk factors. It is easy and inexpensive to perform once taught. It also reduces the time to return to play and gives better long-term outcomes. If you are ever unlucky enough to be in this position, then things are looking better now than they ever have!

NU Moves physio provides sports physio services to clubs around newcastle. For more information contact us online or give us a call and to view our current sports teams or what services we provide, click here.

Avoiding Pre-season Injury

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pre-season injuries

If you want avoid pre-season training injuries – start to plan your pre-season program now! This is good advice if you are between seasons or starting a sport again after a period of not playing. It is also good for trainers / coaches to consider when running a pre-season fitness program for a team.

A few months off regular exercise and training after winter sports is routine and often good for the body. But when pre-season training starts is when our physio clinic starts to fill up with athletes with strains. Here’s a guide to reduce your risk of injury during the next pre-season and regular season.

It starts with understanding injury risk and how we measure it. Why do some people get injured more than others? Can anything be done?

There are a lot of different reasons involved in why an injury may occur and there is no single test that provides an overall level of injury risk. Most professional sporting clubs use a complex battery of preseason testing, but it requires a huge amount of resources, and the chances are your local club doesn’t have that.

Recently a very simple, easy to understand and freely available risk indicator has been researched: The ratio of an athlete’s current exercise load compared to their historical exercise load (current week vs previous four weeks). This has been shown to predict injury risk in Cricket fast bowlers, Australian Rules football players and Rugby League football players. In order to get this ratio, you have to measure exercise load. In professional sport, players will often train with GPS and accelerometers to measure exercise load over the season – large fluctuations in load = higher risk of injury. When those devices aren’t available we have to go back to more simple measures.

Start recording in a diary the type (cardio, speed/sprint, power, strength etc) of exercise you do each day and some indicator of quantity (i.e. distance ran or the total time spent training). Then you need a measure of the intensity of the session which is usually relative to 100% as hard as you could go. If the session varies then record what you think is the average intensity and the amount of time spent at the maximum intensity. The goal of your workload diary is to allow you to plan your workload volume and intensity each week relative to the previous ones to make it a gradual transition during pre-season conditioning. This will avoid large spikes in workload and reduce your injury risk.

So when you get active again make sure you plan what you will do one week to the next and avoid spikes. But if do you get an injury we will be there to get you back on track.

If you want to read more on this see the articles below:

* Hulin BT, Gabbett TJ, Blanch P, et al. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Br J Sports Med 2014;48: 708–12.

* Hulin BT, Gabbett TJ, Lawson DW, et al. The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med 2016;50:231–6.

* Murray, N. B., Gabbett, T. J., Townshend, A. D., Hulin, B. T. and McLellan, C. P. (2017), Individual and combined effects of acute and chronic running loads on injury risk in elite Australian footballers. Scand J Med Sci Sports, 27: 990–998. doi:10.1111/sms.12719

Running biomechanics and muscle strength

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Running physiotherapy injury

 

Biomechanics refers to how we are built and how we move. Some of us have legs that bow out (varus alignment) and others have knock knees (valgus alignment) which relates to the shape of our bone structure. It is a combination of our bony structure and how well our muscles work that can increase the likelihood of injury with running. This blog is looking at key areas of muscle weakness that alter our biomechanics and lead to injury. Your bony structure can’t be changed but improving your strength in the right areas can be achieved within 6 weeks of an exercise program that is designed for you. Assessing the biomechanics of the body combined with a basic understanding of your running style is important if you are serious about running.

A biomechanical physiotherapy assessment considers whether you have sufficient strength and mobility in the right places for running. The muscles in the back of the leg (calf, hamstring and gluteal) are important to maintain strength for running. Weakness in these muscles often leads to pain and injury in runners.

  • Calf muscle and Achilles tendon strength – it is important to understand that both muscles and tendons can respond to the loads we put on them. A simple test and exercise for the calf and achilles is the calf raise. If you can’t do a repeated full height single leg calf raise of more than 6 reps than you probably don’t have enough strength. I encourage people to get to 15 reps and be able to repeat 3 sets as a baseline but there isn’t a magic number here because it also depends on your running style. If you are about to change your style and get further forwards on the forefoot then check your calf and achilles strength first to minimise the chance of getting achilles tendon problems.

calf raise

  • Hamstring strength is essential for fast running but a base level of strength is also important for your park runners to 10km distances. Clearly the most functional way to strengthen the hamstrings for running is to gradually increase the distance and intensity of your running sessions. If you can’t do a hamstring bridge exercise or it takes considerable effort then you need to get stronger. Caution with doing this exercise – if it causes back pain then stop and discuss with one of our physio’s.

hamstring bridge

  • Gluteal (buttock muscle) strength allows for a stable pelvis during running. If you don’t have adequate gluteal strength it puts extra load on the knees, hips and lower back. Unless you have had a biomechanical physio assessment you probably don’t know if your glut’s are working well enough. A glute bridge is similar to a hamstring bridge but the knees are bent at approximately 90°. By bending the knees it makes it harder to use the hamstrings to lift the bottom and thus challenges the gluteal muscles more. Again if you have back pain stop and get some advice.

glute bridge

  • A squat is another good exercise to get the glute muscles working for runners but it needs to be done correctly. Keeping the back straight and bending at both the knees and hips gets the gluteal muscles working. Once you have been taught to do a squat correctly the challenge is a single leg squat with letting the knee drop in valgus collapse.

Squat exercise

Hope you have enjoyed reading about good strength exercises for runners. Thanks to Pete for his stick figure art which has been enjoyed by his clients for many years.