Category Archives: Recovery

Vestibular Rehabilitation

By Jackie Render, PT

Balance.jpg

Vestibular Rehab is used to treat dizziness, vertigo, as well as feelings of being off-balance and unstable, blurred vision, or generally feeling “off.” A vestibular assessment at BodyTech Physiotherapy involves a detailed history, a central nervous system screen (examination of reflexes, cranial nerves, cerebellar tests), vestibular function testing, and balance testing.

What is the vestibular system?

The vestibular system is a sensory organ that lies inside your skull and connects your brain with your inner ear on each side. The vestibular system contains organs that sense gravity as well as organs that sense acceleration (turning, bending, spinning etc.). The brain uses the information from both vestibular organs to determine how the head is moving in space, for postural responses, to stabilize vision, and for balance. It shares close connections with your hearing organs and some conditions may also affect your hearing in addition to the vestibular system.

What are the symptoms of a vestibular problem?

Dizziness from the vestibular system often presents as vertigo – the illusion of movement. A person with vertigo will often feel as if the room is spinning or they are spinning within the room. Other people may describe dizziness or the room shifting or tilting. You do not need to feel dizzy to have a vestibular problem. Many people with vestibular problems will feel off-balance and unstable, or report blurred vision or generally feeling “off.”

What causes dizziness?

dizziness.jpgDizziness can come from many areas. It can be caused by medications, blood pressure changes, the brain, the neck, or from the vestibular system. Approximately 20-30% of the population experiences dizziness in their lifetime, and vestibular disorders account for a large proportion of dizziness. 

Why does it happen?

People experience vertigo due to a change in nerve signals from one or both of the vestibular organs. This change in nerve signals results in a mismatch of signals from one ear compared with the other and change can be a result of many factors.

Some common causes of Vestibular problems are:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Vestibular Neuritis or Labyrinthitis
  • Unilateral or Bilateral Vestibular Hypofunction
  • Meniere’s Disease
  • Vestibular Migraine

Vestibular problems can also be caused by structural changes to the inner ear such as structural defects, autoimmune conditions, blast injuries, as well as aging. Concussions may result in vestibular disorders either through injury to the vestibular system itself, or to the connections it has inside the brain.

It is estimated that over 35% of adults in the United States have a vestibular dysfunction that requires medical attention.

What is vestibular rehabilitation? How can it help?

Vestibular rehabilitation is a proven combination of progressive movements or exercises aimed to address the person’s areas of dysfunction. This is achieved by retraining the brain to maximize recovery or central nervous system compensation. Vestibular treatment is highly individualized and will vary depending on the condition, the presentation, and the individual’s goals.

Exercises for vestibular rehab fall into the following categories or themes:

  1. Gaze stability – working on the ability to keep your eyes focused with head movements
  2. Habituation – exercises to help make aggravating movements more tolerable
  3. Balance – either sitting, standing or while walking depending on the individual’s abilities, to help maximize postural responses
  4. Maneuvers for BPPV – a series of specific movements to help relocate crystals that may become loose in the inner ear; home exercises may also be required to settle symptoms

As the individual progresses these exercises are often combined together to increase the challenge. A combination of eye, head and body movements, mental activity, or functional tasks may also be added to help make the vestibular responses more automatic.

Why should I have treatment?

Dizziness and imbalance can have a significant influence on quality of life. They can make you feel anxious and isolated. You may feel fearful of falling or of movement bringing on symptoms. Individuals with vestibular dysfunction are often reluctant to turn their head when they are standing or moving. Those with BPPV may be fearful of looking up or lying down because of fear of symptoms. Over time this can lead to neck and upper body pain. If you feel your dizziness or imbalance makes you more cautious with movement, or interferes with your daily life you should consider a vestibular assessment. A vestibular therapist can provide you with information about your condition and appropriate treatment options to help restore your quality of life.

BodyTech Physiotherapy

Cupping Therapy

By Tim Penner, Registered Massage Therapist

Cupping therapy is a technique using cups applied to the skin to treat an array of illnesses. Used for centuries, its popularity continues to grow as people seek alternative and natural methods for treatment. Cupping stimulates healing by pulling blood to the region being treated. It promotes new blood flow to the area and removes stagnant blood which causes an anti-inflammatory effect by encouraging the body to release white blood cells, platelets, fibroblasts and other healing substances. Cupping is an effective technique to stretch fascia and muscles by helping to separate the different layers of tissue through the use of suction.

Cupping therapy uses cups, made of soft silicone and hard plastic, to suction soft tissue.  It is this vacuum effect, or negative pressure that provides a therapeutic result when applied to the skin. Many types of cupping therapy have been developed over the years. At BodyTech Physiotherapy our massage therapist uses 2 different types of cupping techniques: massage cupping and dry cupping. Massage cupping is usually done in a massage therapy treatment in which the cups are applied to the skin and moved around. Dry cupping is slightly different as the cups are applied to the skin and the affected body part is moved around to create a stretching effect.

Is cupping for me?                          

Massage or dry cupping can be used for many different conditions. The effects on the body include helping decrease stress, encourage relaxation and improve circulation. It can also be used to decrease swelling in certain areas and can help improve respiration when applied to the ribs and chest.  When it is used in conjuntion with massage and in specific areas, it helps reduce tension in muscles, and fascial tissue restrictions. The combination of massage and cupping leads to improved range of motion and posture. It can reduce tone in the muscles, help to improve flexibility and aid in reducing fascial adhesions left behind by old injuries. Cupping can help with many conditions such as low back pain, fibromyalgia, whiplash and tendonitis.

Some conditions that can be treated with cupping

  • Tendonitis
  • Fibromyalgia
  • Frozen shoulder
  • Low back pain
  • Whiplash
  • Tension headaches
  • Carpal tunnel syndrome
  • Plantar fasciitis
  • Sprain/strain
  • Golfer/tennis elbow
  • IT band friction syndrome

cupping1                cupping2

Low back pain                                      Iliotibial Band Friction Syndrome

Along with the conditions listed above, cupping also can be beneficial to the people suffering from the effects of Parkinson’s and Multiple Sclerosis, as well as using it to aid in rehabilitation after a major injury or surgery.

The most common side effect of cupping therapy is the bruised appearance that you see after the treatment is completed. The discolouration of the skin is only on the surface of the skin and does not generally cause pain after the massage. The bruised appearance can last for a few days or even up to a week. If significant bruising occurs your therapist will promptly remove the cups and discuss the effects with you.

Overall, cupping therapy can be beneficial to almost everyone. Just like massage, every treatment is specific and individualized to each client and their needs.

Concussion Management Part 2: How Long Does Recovery Take?

By Cassandra Kroner, PT

In part 1 of the concussion management blog series we covered how the brain is affected following a concussion, common symptoms, why early intervention is critical, and how physiotherapy can help optimize recovery. One of the most frequent questions people have following a concussion is about recovery time – ‘when can I go back to work full time?’ or ‘when can my son/daughter play soccer again?’. It can be helpful to understand the general stages of injury and potential progression of symptoms:

concussion blog image_jan2019

The initial days following a concussion are considered the acute stage of injury, and cognitive and physical rest is critical at this time. After 7-10 days of adequate rest the chemical balance and blood flow in the brain has been restored, and symptoms that continue are known as post-concussion syndrome. Some symptoms can last upwards of 6 months or years post injury. It is important to keep in mind that not everyone will progress through all three stages, and the length of time symptoms last will vary between individuals.

Why Recovery Can Take Longer

There are a number of factors that can complicate and prolong recovery, and these can help us predict if symptoms are likely to persist longer than the usual 6 weeks. A history of migraines, mental health conditions such as depression or anxiety, or learning disabilities, have been found to increase recovery times. Additionally, visual or vestibular dysfunction or a high number of initial symptoms following a concussion usually indicate prolonged recovery.

History of Concussion

People who have had a previous concussion are more susceptible to have another one due to a lower threshold for injury after each concussion – meaning the next concussion can happen from a lower severity injury than the first time. Additionally, there is often an increased number of symptoms and a longer recovery time after each subsequent concussion. A concussion at a young age risks disruption of brain circuits yet to be developed, and also creates a wider window for repeated future concussions.

Repetitive hits that are common in sports such as hockey or football, which do not cause a concussion, are known as sub concussive trauma. Research has shown this repetitive trauma can result in increased reaction and processing time, memory impairments and increased chance of making mistakes. These effects can place an athlete at an increased risk for a concussion during sport. If the athlete does sustain a concussion at this point, the brain has a diminished reserve capacity to manage injury, and the effects of subsequent concussions are cumulative and result in increased impairment in function with each concussion.

Additional Injuries

Another complicating factor is the presence of other injuries, such as whiplash or neck sprain/strains, that can occur with falls or car accidents. These neck injuries alone can cause similar symptoms to a concussion including headaches and dizziness, and in combination with a concussion can result in more severe and prolonged symptoms. Having an assessment by a physiotherapist can determine which symptoms are from the neck injury and which are from the concussion – resulting in individualized treatment strategies to target the cause of each symptom.

To conclude, although concussions can be an invisible injury, they need to be properly managed and rehabilitated just like any other injury. This management includes assessment to determine the cause of symptoms, specific treatments to address each impairment, and strategies to manage recovery at home. Visiting a physiotherapist trained in concussion rehabilitation will ensure that both concussion symptoms and neck injuries are addressed. The goals of treatment are to restore physical and cognitive function while facilitating a safe return to work and sport. Awareness and education about concussions and treatment options are important to ensure that people don’t suffer unnecessarily from prolonged symptoms – this is where a trained Physiotherapist can help!

BodyTech Physiotherapy

Concussion Management Part 1: The Role of Physiotherapy

By Cassandra Kroner, PT

What is a Concussion?

Concussions are a type of mild traumatic brain injury. Common causes include car accidents, sports, falls, or workplace accidents. Concussions can result from direct impact to the head, or from forces elsewhere in the body such as sudden acceleration or deceleration that cause an  injury to the brain and brain-stem.  The result is damage to cells and chemical imbalances that disrupt normal brain function.

Concussion Head imageImmediately following injury a sequence of chemical processes occur as the brain attempts to restore its normal balanced state. This increased activity in the brain is happening at a time when blood flow is decreased to the site of injury, creating an increased demand for energy. The resulting impairments in neurological function can cause a variety of signs and symptoms:

Physical Behavioural/Emotional Cognitive
Headache Drowsiness or fatigue Feeling foggy
Nausea Irritability Trouble thinking clearly
Vomiting Depression Feeling slowed down
Blurred or double vision Anxiety Difficulty concentrating
Balance problems Sleeping more than usual Difficulty remembering
Dizziness Difficulty falling asleep Trouble finding words
Sensitivity to light or noise Sadness Confusion

 

First Steps Following Injury

Concussions are often under-reported and misdiagnosed, and it is important to note that loss of consciousness is not necessary for a diagnosis. Contributing to the difficulty in identifying concussions is the lack of imaging or other tests to aid in diagnosis. Unless there is bleeding or swelling in the brain, the changes that occur with a concussion are not visible on a CT or MRI. If a concussion is suspected, an evaluation by a physician is recommended, and unless symptoms are severe or quickly worsening it is usually not necessary to visit the emergency room. Once the diagnosis is established and conditions requiring further medical treatment are ruled out, treatment should begin immediately.

Early Management

HeadacheTimely intervention following a concussion is essential to ensure optimal management and recovery. An outdated approach to concussion treatment is to stay in a quiet dark room until symptoms are resolved. With a growing demand for evidence-based treatment strategies, there is a wealth of new research that refutes this old-fashioned ‘dark room’ approach. Although complete rest is recommended for the first 48-72 hours after injury, research supports a more active approach to recovery following the initial rest period. Prolonged physical rest can lead to de-conditioning, depression and fatigue, making it more difficult to return to the previous level of physical activity.

Complete physical and cognitive rest immediately following a concussion is critical to ensure adequate energy supplies for the brain as it attempts to heal. Excess physical or cognitive exertion at this time will use precious energy that the brain needs and can result in exacerbation of symptoms and prolonged recovery. Physical rest means no exercising and caution with exertion around the house. Cognitive rest should focus on refraining from activities that require concentration (schoolwork, reading), as well as visual attention (television, video games, computer or phone use). Alternative options are listening to music or audio books.

Importance of Physiotherapy

A visit to a physiotherapist with advanced concussion management training is recommended for a detailed assessment following a concussion. Your physiotherapist will take a thorough history and can assess visual and vestibular symptoms, balance, cognitive function, and any additional injuries sustained at the time of concussion. Recommendations for the initial rest period as described above will be tailored to each individual, and further suggestions for management of symptoms will be provided.

Treatment plans involve a carefully monitored graded program of exertion to assist with a safe return to work/school and then sport. Every individual will experience a different set of symptoms following concussion, and as a result there is not a ‘one size fits all’ approach to treatment. This is why having a professional guide you through recovery is valuable. Specific and progressive exercises will be provided to target deficiencies in the vestibular and visual systems. To facilitate a gradual return to school or work, suggested accommodations would be provided to minimize symptoms and maximize participation. Additionally, manual therapy to address complaints such as neck pain or headaches can be part of treatment. Once the individual has returned to school or work, physical exertion testing is the last step before being cleared for sport.

Recovery time frames vary between individuals, but for many people, symptoms resolve in a month or less. However, there are a number of factors that can delay or prolong recovery. Stay tuned for part 2 of the concussion management blog series to learn more.

BodyTech Physiotherapy

Update: Continue reading on part two of our Concussion Management blog series.

Physiotherapy after a Fracture

By Courtney Lacey, PT

fractureIf you have recently broken a bone, you may be wondering when you will be able to return to all of your normal activities. While it typically takes 4-8 weeks for a bone to heal, you will likely require physiotherapy to help get you back to full function.

How do fractures happen?

A broken bone, also known as a fracture, can occur in many ways. Most often, broken bones are the result of a traumatic mechanism of injury such as a fall, motor vehicle accident or contact during a sporting event. Fractures can also occur from repetitive motions which place stress on the muscles and bones. A common example of this is stress fractures in the legs from running. Finally, fractures can more easily occur in people with osteoporosis – a disease which weakens bones and makes them more likely to break.

How do you know if you have a fracture?

These are some signs and symptoms which may indicate that you have a fracture:

  • Immediate and severe pain following a fall or accident
  • A “pop” or “click” heard or felt during the incident
  • Swelling in the area
  • A bump or deformity
  • Unable to weight-bear through the injured limb

If you suspect you have a fracture, you will need to see a doctor who will order an X-ray to confirm the diagnosis. Often, those who experience an injury causing a fracture will go to the hospital to be evaluated.

Does a fracture heal?

While bone healing takes approximately 4-8 weeks, the timeline depends on both the person and the type of fracture.  In order for a bone to heal properly, it has to first be set in the proper position, which is called reduction. The doctor may be able to reposition the bones without surgery, which is called a closed reduction. Sometimes, surgery may be required to bring the ends of the bone close together, which is called an open reduction. Pins, plates or screws may also be used to keep the bones in place. If the fracture did not cause any part of the bone to shift out of place, no reduction is needed. Once the doctor has determined the bones are in a good position to allow for healing, the area will be immobilized in a cast or a splint.

When can the cast come off?

To determine if you are ready to have the cast removed, you will have an X-ray done with the cast or splint in place. The doctor will look for the formation of a callus, which demonstrates that healing has taken place. The doctor will then remove the cast and may recommend that you have physiotherapy. Physiotherapists play a key role in returning you to your full function as quickly as possible after a fracture.

Why do I need physiotherapy?

There are several reasons why physiotherapy is needed after fracture. Depending on the amount of healing that has occurred, your doctor may have special instructions (how much weight to put through the limb, certain activities to avoid, etc.) that your physiotherapist can help you understand. Once the cast is removed, you may still have some swelling and pain around the fracture site. Physiotherapists may use modalities (such as ultrasound or TENS) to help decrease pain and swelling and improve your mobility and tolerance for using the injured limb in daily activities. If you had surgery, you may also have a scar which creates scar tissue and can disrupt movement. At BodyTech Physiotherapy your therapist will use manual therapy techniques to help mobilize the scar tissue and the areas around the injury as needed to  restore normal movement around the surgical site.

Physiotherapy is crucial to improve your functional mobility that you may have lost during your time in the splint or cast. Immobilization over 6-8 weeks will cause loss of range of motion and strength, which will make daily tasks difficult to do. Your physiotherapist will help restore your proper range of motion using manual therapy techniques. While the fracture site will be stiff and sore, you may also lose range of motion at surrounding joints that were moving differently during the healing process. For example, if you have broken your elbow, it is also necessary to  assess your shoulder, wrist and hand to ensure that these joints are moving properly. Not correcting the mobility around the fracture site can prolong your healing process and lead to future injuries as well.

Once your range of motion has been restored, you will need to regain strength in order to return to your pre-injury activities. Your physiotherapist will work with you to create a proper strengthening program to re-introduce your bones to loads and stresses that you encounter in your daily activities. Lack of strength or going back to activity too soon puts you at risk of re-injury or prolonging the healing process. Physiotherapy will help you understand the correct exercises to do and will tailor your program to the activities you plan to return to, whether it be high level sport or recreational activity.

How long until I am back to my regular activities?

Your rehab program will vary in length depending on the type of fracture, if there was surgical intervention, and the type of activity you plan to return to. Depending on the nature of the injury, physiotherapy can take anywhere from 8 weeks to one year for more complex fractures. Your physiotherapist will guide you through your rehab program, ensuring you are progressing at an appropriate rate and prevent complications or future injury.

BodyTech Physiotherapy