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Showing posts with label recovery. Show all posts
Showing posts with label recovery. Show all posts

Sunday 21 July 2013

Ignore the hype: Britain's 'recovery' is a fantasy that hides our weakness


A tiny rise in GDP is nothing to celebrate while the UK economy is as dysfunctional as ever
George Osborne looking pleased
A rise in GDP will be celebrated as proof of George Osborne's wisdom – but the dysfunctions of the UK economy are still firmly in place. Photograph: Rex Features
Next Thursday we will get a further taste of what it is like living in an one-party state. The estimate for GDP growth in the second quarter will be published – predicted to rise between 0.2% and 0.3%, confirmation that a triple dip recession has been avoided and the economy is on the mend. Expect an over-the-top reaction from our centre-right media.
George Osborne's sagacity will be lauded to the skies, and scorn poured on all those who have criticised economic policy or worried about Britain's economic structures. It will be another chance to swing opinion behind the Conservative party – all the more effective because the coverage will reproduce the co-ordination of a government propaganda machine without any formal instruction being given.
Economies are like corks. They have inbuilt upward momentum driven by productivity and population growth. That momentum can be reversed for 18 months or two years in a typical recession when investment and consumption have run ahead of themselves, and of necessity fall back. But like a cork the economy will eventually bounce back to the surface – where it would have been had the recession not happened.
What we are witnessing is that natural bounce – but very weak, extraordinarily slow and no prospect of any substantive follow-through once the economy returns to 2008 levels of output some time next year. What usually takes no more than two years will have taken six – the slowest recovery for more than a century. Exports are effectively unchanged, even to faster growing non-EU countries, despite a 25% devaluation. Company investment has collapsed by 34%. Real wages are 9% below their peak – they rose in every other postwar recession – and are set to fall further. The profound dysfunctions of the British economy, despite wild claims otherwise, remain firmly in place.
What is so dismaying is that hopes that investment and exports would lead recovery have been completely dashed. Instead the British are returning to what they are best at – running down their savings and borrowing enormous mortgages, partially guaranteed by the state under the Help to Buy scheme, to force up house prices.
I did not join the chorus of criticism of Help to Buy when it was launched: it was a clever, time-limited Keynesian use of the public balance sheet to support a distressed part of the economy, and no recovery is conceivable without some rise in house prices rekindling animal spirits and lifting confidence. What was wrong was: to superimpose it upon a market that privileges buyers who want to let rather than own; the Treasury vetoing an extension to lending to business in general; and not recognising that the same Keynesian thinking is needed across the board.
What takes me aback is the determined way the national conversation is skewed towards the inadequacies of the public sector, however concerning – avoidable deaths in the NHS or extravagant pay-offs for BBC executives – without any parallel focus on the inadequacies of the private. The Coronation festival for the Queen was meant to be a celebration of British innovation. Yet there were only three large company pavilions in the Palace gardens – GSK, Bentley and Jaguar Land Rover (owned by the Indian Tata) – and a host of tiny companies dealing in niche luxury goods. The contrast with the industrial and innovative power that could have been mobilised when she began her reign 60 years ago is painful.
Moreover, back then, economic power would have been drawn more equally across the country. There were certainly regional imbalances in the 1950s but compared with today they were trivial. Outside London and the south-east there was no private sector job creation in the decade to 2008. Today these regions possess little more than what Karel Williams of the Centre for Research on Socio-Cultural Change calls a "foundation economy" – the structures that deliver the likes of electricity, food and hospital care but with virtually no private sector entrepreneurial activity. The average size of a British-owned manufacturing company in the regions, he says, is 14 – subcontracting workshops and downmarket complements to those niche luxury companies.
The problem is too few of either develop into companies of any scale. Their owners are too transactional, unsupported or plain greedy, and the financial system that supports them too fickle, disengaged and commission-hungry. Almost no new major British companies have emerged over the past 20 years while dozens that have taken decades to grow have been assimilated into global multinationals, their strategies dictated outside Britain. Some, of course, make a vital contribution to our economy. But this is no basis on which to launch anything but a fitful recovery and weak investment. Yet no fundamental questions are asked.
Instead the Conservative party, and the commentators who support it, live in Fantasy UK, in which the problem is regulation and the EU. The first initiative of David Cameron's new business team in Downing Street has been to ask British businesses to identify those EU regulations most hindering British growth. I conducted my own straw poll in London's Tech City. Brussels and the EU were simply not on the radar. Instead the list included the financial system's aversion to risk, immigration controls keeping out talented foreigners, and BT's inability to provide high-speed broadband.
The debate has to change. Companies in Britain – domestic or foreign-owned – need the prospect of a sustained growth of demand. The governor of the Bank of England, Mark Carney, hinted at establishing a target for growth and inflation combined – nominal GDP – but was beaten back by the austerity defenders. He should stick to his guns. We have to create ownership and financing structures – scaling up the proposed Business Bank fast — that permit companies to grow and stay owned, as far as possible, in Britain. We have to get fundamentally serious about infrastructure. The LSE growth commission's proposal for an interlocking system of infrastructure strategy board, infrastructure bank and independent planning commission is a good starting point. The housing market needs root and branch reform. Above all, there has to be a sense of mobilisation.
But instead we have nonsense babble about the EU being all that is holding us back; huge prizes for essays on EU exit as a focus for intellectual effort (courtesy of the Institution of Economic Affairs); and endless nostalgic festivals and celebrations about world wars one and two. Welcome to Fantasy UK.

Sunday 1 April 2012

What to do when you've done your hamstring

by Andrew Leipus in Cricinfo
 
Overwhelming feedback so far shows there are a lot of ESPNcricinfo readers out there currently suffering cricket injuries and they want some help. There are volumes of research out there but over the next few articles I will broadly discuss some guidelines on what I commonly see in practice, and provide some information that might be useful. Of course, it goes without saying that all injuries are unique and wherever possible you need to seek professional advice.

I have just read that my old captain of many years, Sourav Ganguly, has pulled a hamstring which kept him out of the Syed Mushtaq Ali Trophy quarter-final recently. Whilst this was unfortunate for Bengal, what was of interest was his comment that he will be fine by the time the IPL starts. This leaves him around two weeks in which to recover and complete his rehab. But the IPL also presents an interesting challenge to players, in that often they are coming off long seasons or a Test series. The increased intensity and speed of play during a Twenty20 is potentially a risk for the players, and where time allows, they should be gradually increasing their training intensity during the pre-camp. 

Sudden transition from standing around during Test cricket to explosive T20 is an injury waiting to happen and players need time to prepare adequately. I hope Sourav can recover in time. Unfortunately, hamstring strain injuries are a challenge for both the players and support staff, given their high incidence rate, slow healing, and a tendency to recur.

There is a continuum of muscle impairment that can occur in sport, ranging from simple muscle cramping or soreness to the worst-case scenario, of a complete rupture. We like to classify the degree of injury as a grade 1, 2, or 3, as it gives us an idea of how quickly we can get the player back to sport again. The greater the damage, the longer the rehabilitation period for restoration of full function.

Hamstring strains are quite common in cricket and can occur when overloaded eccentrically, like if the hamstring attempts to control a rapidly flexing hip/trunk or an extending leg, or both. This can happen during bowling, running between wickets or sprinting in the outfield, so every player is a potential victim. When the load applied or expected to be controlled by the muscle exceeds its capabilities, especially when on stretch, the muscle fibres tear or get damaged.

In terms of self-diagnosis, if you experience hamstring muscle soreness after a long day in the field or following training in the gym, the problem is unlikely to involve disruption of muscle fibres and will probably heal in a day or two. Many players experience this feeling after long days in the slips during a Test match. But a massage or ice bath in the evening will always help them recover by morning.
Actual muscle strains, however, always are accompanied by an acute onset of pain. A sudden, sharp "grabbing" behind the thigh is generally an indicator of a strain. Feeling pain or a swelling under your thigh when sitting is also quite indicative. The more intense the pain, generally, the higher the grade of injury.

The delineation between strong cramping and a mild strain is often difficult to diagnose, especially when the player is fatigued and dehydrated. This poses problems now that substitute runners are not allowed. Regardless, a grade 1 will probably let you continue playing, albeit with some discomfort, a grade 2 or 3 will bring you off the ground, limping. If this acute "grabbing" or "tearing" sensation isn't experienced and the hamstring pain arrives insidiously, there is a good chance the pain is being referred from surrounding areas like the lower back or pelvis. The management for this sort of injury is very different. There are many other possible sources of hamstring pain, often co-existing. This often results in a player return to sport remarkably quickly, since no muscle is actually injured at the time.

The initial management of all strains begins with protecting or offloading the muscle - applying an ice compression for 15-20 minutes every hour or two for a couple of days (commonly longer). A lot of people start to exercise too early post-injury, and in my experience sometimes it's better left alone, to allow for the natural healing processes to begin. A good rule of thumb to follow is not to do anything that hurts - it is common sense but not always followed, and leads to a premature return to sport, getting injured again, and even more time out of the game.

After a few days, when walking is easier, aim to gradually restore full range of movement, develop good alignment of scar tissue and regain optimal strength, since injured muscle becomes inhibited or weak almost immediately. Active stretching is useful in regaining movement - when sitting, use the quads to straighten the knee and provide a gentle hamstring stretch. It's much more preferable to static stretching at this stage. Soft-tissue massage is also beneficial to normalise muscle tone and soften the healing scar tissue.
 


 
A lot of people start to exercise too early post-injury, and in my experience sometimes it's better left alone, to allow for the natural healing processes to begin. A good rule of thumb to follow is not to do anything that hurts
 





A good sports physio will address these issues and examine for any other contributing or driving factors that may be modifiable, such as muscle imbalances, weakness, poor flexibility or dysfunctional movement patterns. In other words, they will look for reasons, biomechanical or otherwise, why the injury possibly occurred and try to correct or improve them.

After this, a progressive amount of training load is needed to strengthen the injured and weakened muscle without injuring it again. Some of the better traditional exercises prescribed early in rehabilitation don't require any equipment and include hip bridging off of a bench, squats, lunges, deadlifts and single-leg standing windmills.

Hamstring curl machines found in gyms certainly have their place in rehab but are a luxury not a necessity. Stationary cycling is also beneficial for maintaining cardio fitness and initially provides a low load to the hamstring. Access to a spin bike is useful if it has a weighted fly-wheel, since this will introduce an eccentric load to the hamstring. Eccentric loading has been shown to be a critical component to full hamstring rehabilitation.

Jogging can be reintroduced gradually, initially as sideways movements, which places less stress on the hamstrings. As pain-free contraction and full range of motion are regained, drills such as 80-metre run-throughs are common, like 20m of gradual acceleration leading into 40m of steady pace, followed by a deceleration over the next 20m. The distances and intensities of the acceleration and steady pace are gradually increased from session to session as the injured muscle adapts to increasing loads. Progression is based on the ability to complete each session successfully and wake up the next day without pain or stiffness. The ultimate goal is rapid acceleration into a full sprint, and for cricket, rapid changes of direction.

At some stage during this programme, cricketing skills will be reintroduced. For example, once lunging is comfortable it is quite reasonable to begin easy net sessions. Similarly, bowlers coming off hamstring strains need to begin "walking through" their actions, progressing to controlled medicine-ball throws and gradually bowling off a short run.

As mentioned at the start, there is no recipe. What you need instead is a structured and flexible progression of loading the injured muscle and the reintroduction of the necessary skills to avoid the development of altered movement patterns associated with the injury. The loads can be increased as the muscle becomes stronger, as can the progression of the gym programme to include more dynamic functional training and plyometrics/power training.

In terms of returning to play, don't be one of the many people who equate a lack of pain or stiffness with being fit. Prevention of re-injury starts with thorough rehabilitation of the current injury. Incorporating a dynamic warm-up before playing is the norm nowadays and static stretching is uncommon (although there still is a place for it). Bowling actions need to be reviewed carefully by the coach to ensure there is no altered movement - bowlers often don't finish their actions completely when recovering from a hamstring strain, and avoid short or full deliveries as they require a slightly longer delivery stride.

Ultimately, the best functional testing is seen under match conditions. Muscles tend to tighten when weak or fatigued and the best practice for this is to play a match, often at a lower grade than usual, in order to better control the efforts.

As you can see, there is a lot to cover in management of the "simple" hamstring strain and this has just been an introduction. But the best piece of advice I can give for prevention of hamstring strains is to be physically well conditioned. The more functionally strong the muscle, the less likely it is to fail.

Wednesday 9 November 2011

A Eurosceptic hero alongside sainted Maggie? It's got to be Gordon Brown

The judgments for which Gordon Brown was mocked look rather different now we've seen David Cameron in action
  • Gordon Brown
    Gordon Brown and his wife Sarah say farewell to the German chancellor, Angela Merkel, at a meeting at No 10 on the eve of the 2009 G20 summit. Photograph: Dan Kitwood/Getty Images

    Few arguments are more unfashionable than the one I am about to make: the case for Gordon Brown. Unfashionable because, 18 months after he left office having led Labour to its second worst result since 1918, Brown still arouses intense loathing. At the Conservative party conference I saw otherwise calm Tories foam with anger at the mention of the former prime minister, furiously tearing away at his every trait, personal and political. That hatred is outdone in some corners of the Labour forest by diehard Blairites still seething at the memory of how Brown thwarted their hero in Downing Street before chasing him out of it.
    belle mellor Illustration by Belle Mellor
    With enemies on both sides, that leaves few defenders in the press, a fact compounded by the ex-PM's near-total invisibility, his appearances in the Commons rare. The torrent of memoirs from colleagues, Alistair Darling's the latest, have only damaged his reputation still further.

    Not many would attempt to push aside the mountain of anecdotes detailing Brown's impossible behaviour as both colleague and boss. Even his most ardent admirers now accept that Gordon Brown was temperamentally unsuited to the job of prime minister.

    And yet posterity's judgment of leaders does not rest solely in their hands. The conduct of their successors matters too: Clinton looked better after George W. History may yet have similar second thoughts about Brown, reviewing his record in the light of what has followed.

    Take last week's fiasco of a G20 meeting in Cannes, which did little to solve the crises in Greece and Italy, and whose most enduring legacy may prove to be off-mic comments made by the host, Nicolas Sarkozy. Contrast that with the meeting of the same group chaired by Brown in London in April 2009, which agreed a $5tn stimulus to the world economy and was duly hailed for preventing a global recession tipping over into a global depression. A year later the highly respected Brookings Institution predicted "that in coming years, the London G20 summit will be seen as the most successful summit in history".

    Part of that was good fortune on Brown's part: in 2009 the US and Germany were in broad agreement on what needed to be done. But much of it was down to Brown's own actions as chair. The very attributes that infuriated his domestic colleagues were put to their best use: he worked around the clock preparing for that summit, hectoring, manoeuvring and bullying his fellow world leaders until they had buckled to his will. These were the same behind-the-scenes methods he had used a decade earlier as he pushed fellow finance ministers to relieve developing countries' debts. It wasn't pretty, it wasn't telegenic, but it was effective.

    How very different it is today. It was ironic to hear George Osborne castigate his European counterparts for simply "waiting on developments", since that's exactly what he and David Cameron do at these international powwows. One veteran of the summit circuit says that the two Brits regularly turn up with no agenda of their own, so unlike Brown and, to be fair, Tony Blair, who almost always arrived with a plan, ensuring, in the tired phrase, that Britain punched above its weight. (I'm told that, rather poignantly, Brown is still the man with a plan: he was ready with detailed proposals on jobs and global finance had Osborne not blocked him for the top post at the IMF.)

    What is even harder for the Tories to stomach is that it was Brown who delivered what they themselves long insisted was the critical policy goal of the past two decades: keeping Britain out of the euro. It was Brown and his legendary five, impossible-to-meet tests that restrained the gung-ho Blair and ensured Britain stayed out of the single currency. Absurdly, Osborne has tried to give the credit for that to William Hague and his save the pound campaign, which rather forgets that both Hague and his campaign were crushed in 2001. If Eurosceptics want to have a hero whose picture they can put on the wall alongside the sainted Margaret, I'm afraid that it's got to be Gordon. That they can't is testament to a visceral hatred not only of Brown but of his chief lieutenant at the time, whose opposition to the euro was total and decisive: Ed Balls.

    Least fashionable of all is the case that Brown was right on the deficit. The coalition's entire programme is predicated on the notion that Brown was incontinent with the nation's money, running up colossal debts. But the rise in borrowing from some £40bn to £170bn was not the result of a crazed spending spree. It was the consequence of the crash of 2008 and the subsequent collapse in economic activity, consisting mostly of increased welfare payments – including the dole for those thrown out of work – and declining tax revenues caused by fewer people earning wages. This was a deficit created by crisis, not by profligacy.

    If Brown was not the source of the disease, what about his remedy? His preferred approach – over which he fought with, and lost to, Darling among others – was to secure the recovery first, get the economy ticking over nicely, and only then start attacking the deficit. If the economy were growing, shrinking the deficit would be less painful; tackling it too early risked sucking out demand, choking off the recovery and so, paradoxically, increasing the deficit.

    Well, guess who called it right. The last quarter with Brown in charge saw growth of just over 1.1%, surpassing all expectations, with unemployment coming down. The economy appeared to be getting back on its feet. But then the deficit fetishists of the coalition took over and the economy stalled, with more growth in that last Brown quarter than in the next four Cameron quarters combined. Suddenly Brown's insistence that growth had to come first looks prescient and wise.

    Indeed, there are judgments big and small for which Brown was mocked at the time but which look rather different now. As PM, he overruled Darling, preferring to increase national insurance rather than VAT. Now, thanks to Osborne, we've seen the calamitous impact of a VAT rise on both inflation and demand. More crucially, Brown realised at the start that the economy had to be central, refusing to be diverted to other projects, however worthy, including promised constitutional reform. Barack Obama may well wish he had made the same call, putting healthcare to one side and focusing exclusively on jobs.

    Of course, there was much that Brown got badly wrong. Hailing the end of boom and bust was absurd; relying on City and house price bubbles to raise cash was fatal; failing to run a surplus during the good times foolhardy.

    But what's intriguing is that these were mistakes made as chancellor, on which Brown's standing remains high. Perhaps a revision is in order, downgrading his record in No 11 but upgrading his performance in No 10. The Conservatives won't ever undertake such an act of revision, the historians might not do it for decades to come. But Labour, whose future prospects partly depend on knowing what to say about its recent past, should do it much sooner.