research

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,

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

 

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.