Tag Archives: sports injury

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 An outdated approach to concussion treatment is to stay in a quiet dark room until symptoms are resolved.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

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It’s all in the shoulder blade

Shoulder Diagram

Shoulder injuries are among some of the most common injuries that occur; luckily, the shoulder joint is an area that we have extensive knowledge in treating at BodyTech Physiotherapy. The shoulder is one of the most complex joints in the body because of its unique anatomy, structure and function. Due to the complexity of the joint, there are multiple factors that contribute to and influence the function of the shoulder. In most cases the rotator cuff muscles are the source of pain, but they are not always the cause of the problem.

The key to treating this difficult joint is a comprehensive assessment and thorough understanding of how the shoulder functions. An essential concept in treating the shoulder is building a good foundation for the shoulder muscles to work. This requires focusing on the shoulder blade because it provides a stable base for the shoulder joint. The rotator cuff muscles attach to the shoulder blade, therefore it is important for the shoulder blade to function properly in order to prevent injury to the rotator cuff. Posture and strengthening for both mobility and stability of the shoulder and shoulder blade are key concepts in rehabilitation.

At BodyTech Physiotherapy we use a comprehensive approach for both the assessment and treatment of a shoulder problem. Our assessment will focus on identifying the cause of the shoulder injury as well as the contributing factors that led to the injury. Our clinical experience and advanced physiotherapy training ensures that the entire shoulder problem is treated, not just the symptoms. In addition to correcting posture and increasing strength, we work on normalizing the pattern and coordinating the muscles involved in shoulder mobility, thus helping to prevent a re-occurrence of the shoulder injury.

BodyTech Physiotherapy