Concussion is a Mild Traumatic Brain Injury.

Concussions – Written by Kimberley Pilbrow (BHSc Physiotherapy)

With the start of another Winter Sports season now upon us, now is a good time for athletes, parents, coaches, officials & supporters to increase their knowledge about concussion.

Concussion is a Mild Traumatic Brain Injury which occurs when someone receives impact to the head or body causing a force to be transmitted to the brain, ie ‘shaking’ inside the skull. In a concussion injury there is no change to the macro-structure of the brain. Ie there is no permanent damage to the brain. However, there are changes at a micro level, meaning it may take some time to re-access the areas of the brain that were affected.

Historically people believed that to sustain a concussion you must be “knocked out” (loss of consciousness), this is not true- 90% of concussion occur without any loss of consciousness AND Loss of consciousness does not relate to their long-term outcomes. Ie someone who is knocked out may return safely to sport in 3-4 weeks, where as someone who is not may take 3months to recover- there is no relationship between “severity” of concussion and length of recovery.

As Concussion is a brain Injury- there is a wide range of symptoms such as:

Visible Signs:
-loss of consciousness
-slow to get up
-unsteady on feet/poor balance
-poor coordination or inappropriate playing behaviour (eg. standing out of position)
-clutching or grabbing at head
-dazed or confused
-vomiting (>once is of greater concern-take to Emergency Department)
-irritability/changes in emotions

Symptoms:
-dizziness
-headache
-nausea
-drowsiness
-“don’t feel right”
-blurred vision
-difficulty concentrating/remembering

If you (or your child) have an incident like this and have one or more of the following symptoms you should:
1) Be removed from sport immediately
2) Monitored by an adult
3) Seek Medical Attention from your GP or Concussion Trained Physiotherapist (Click here for our team)

A full list of symptoms can be found HERE– the Concussion Recognition Tool is a great resource for parents & coaches

Assessment and Treatment of Concussion:
A concussion must be diagnosed by a health professional. Examination from your Physiotherapist will include a group of tests as required including; SCAT5 or SCAT5 Child Assessment (Symptoms, Neurocognitive processing, Balance), Assessment of neck pain and movements, Neurological Exam, and Eye & Head Movements.
Treatment of each concussion is individual- REST IS NOT BEST!!
Your Physiotherapist will work with you on starting appropriate activities EARLY to aide a gradual return to daily activities (highly supported by research), followed by return to work/school and then return to sport. Your treatment plan may include; education about pacing activities, treatment of the neck joints and muscles, relearning eye tracking movements and gradual exercise progressing back to full function including work and sport specific tasks.

Key Points:
-90% of concussions occur without being knocked out
-If you suspect a concussion, remove the athlete from play IMMEDIATELY
-Seek Medical Assessment from someone trained in Concussion
-Rehabilitation is INDIVIDUALISED
-REST IS NOT BEST!
If you have had a concussion, Bureta Physiotherapy will work with you, your family and your doctor to take you through the required steps for full return to function-including sport, school or work.
Early Diagnosis is important for monitoring symptoms and guiding appropriate rehabilitation, contact us TODAY to book an appointment or discuss if our acute concussion service is right for you.

 

 

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PHYSICAL RECOVERY IS ALSO A MENTAL JOURNEY

PHYSICAL RECOVERY IS ALSO A MENTAL JOURNEY

Mariane Wray, Registered Psychologist

 Movement limitations and injuries impact not only on our physical ability to move, but also on how we think, feel and behave. Having a positive attitude towards physiotherapy and rehabilitation can improve your overall chances for physical recovery, as well as  reducing your recovery time.

 

How we respond to physical pain and injury is partially determined by how we think and what we feel. Our beliefs, values and attitudes determine how we interpret events, including those that cause injury. This interpretation drives our emotional response and resultant behaviours. For example, if I believe that physiotherapy will assist with rehabilitation, I’m more likely to seek treatment, and complete rehabilitation exercises. This belief reduces my recovery time, and creates a more positive outcome.

 

What we focus on and where we place our attention has a significant impact on the behaviours we exhibit. If we ruminate on the past, and spend time pining for our pre-injury self, we have a tendency to experience feelings of depression. If we worry about the future, and what could go wrong as a result of our injury, we tend to experience anxiety. Whilst both these emotions are within the normal realm of human experience, in worst case scenarios these may become more serious and develop into clinical issues. When we are able to focus our thoughts on our present situation and how we can make our recovery journey successful, we are more likely to have a positive outcome, as we can remain motivated to overcome our injury, and function as best as we can.

 

Often we are unaware of where we place our mental focus and attention, or if we have a tendency to ruminate or worry. Our typical thought patterns sit within our sub-conscious, so although they are constantly there, they are often not noticeable. These thought patterns are our ‘self-talk’; the stuff that we say to ourselves repeatedly, but we never really hear. If we have a tendency to notice negative aspects of a situation, our self-talk is likely to be harsh, critical and negative. If we focus on the ‘good stuff’, or the positive aspects, our self-talk is likely to be helpful, supportive and encouraging.  Self-talk is very powerful, and it contributes to our beliefs, thoughts, emotions and behaviours.

 

If you have identified that your beliefs and thoughts may be hindering your recovery, there are mental strategies that that you can use to develop a more helpful attitude towards your physical rehabilitation.

 

Practice Mindfulness:

 

Mindfulness is the psychological process of bringing one’s attention to the present moment, and is a skill developed largely through the practice of meditation. Mindfulness assists with reducing the effect of negative thought patterns and those associated with depression and anxiety. Mindfulness can assist with creating an internal state of calmness and peace, and this produces a physiological state that is more responsive to rehabilitation and physiotherapy. If you have not tried Mindfulness before, but are interested, a good place to start is;

 

https://www.headspace.com

 

Be Optimistic:

 

Having positive emotions and thoughts is referred to as optimism, and is associated with better health. As well as reporting more positive emotions, optimists report better overall health, and may even live longer than pessimists. When dealing with setbacks, such as a physical injury, optimists tend to deal with problems head-on. Instead of being in denial about their injury or the effectiveness of physiotherapy, they plan a course of action, seek advice from others, and stay focused on solutions and positive outcomes. Optimists tend to expect a good outcome, and even when they don’t get it, they find ways to learn and grow from the negative experience.

 

To be more of an optimist, choose positive language. When you notice negative thoughts, reframe these into positive statements. For example, if you catch yourself thinking ‘physio doesn’t help’, re-frame this into a positive statement such as ‘physio will help as long as I do my exercises consistently’. These sorts of statements can help to reframe your thoughts and assist with maintaining your motivation towards rehabilitation.

 

One strategy to try is to ask yourself these three questions each day;

  • What did I do to promote my rehabilitation today?
  • What progress did I notice?
  • What did I learn from this experience that I can use tomorrow to assist my rehabilitation even further?

 

Choose How You Use Your Mental Energy:

 

We all have choices in where we direct our mental energy. Choosing to place the majority of your mental energy on things that are within your control can improve your sense of self-efficacy. This is the belief that you have control over what happens to you. A good sense of self-efficacy helps to create and maintain the belief that you have a significant influence over your own recovery from physical injury.

 

Imagine a mental circle, and place within this all of the things that are within your control in relation to physiotherapy and rehabilitation. This may include things like  ‘choosing my physiotherapist’, ‘choosing my appointment time’, ‘attending my appointments’, and ’completing my physiotherapy exercises’. Any time that you notice yourself worrying or thinking about things outside of this circle, let them go and return to the things within your mental circle.

 

Having a positive attitude towards physiotherapy and rehabilitation supports a healthy recovery from injury. Practicing the strategies above within your recovery journey may  have positive outcomes in other areas of your life, as these mental skills are not specific just to rehabilitation. Although utilising your mental capacity to assist with physical recovery may require some effort, it is a smart thing to do and you may notice surprising outcomes as a result

Contact details:

Mariane Wray
Warrior Fitness
Mariane@warriornz.co.nz
021629620
First session: $120.00 / students $80.00
Thereafter: $150.00 / students $120.00

REFERENCES:

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191.

Bedard, M., Felteau, M., Mazmanian, D., Fedyk, K., Klein, R., Richardson, J., & Minthorn-Biggs, M. B. (2003). Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries. Disability and Rehabilitation, 25(13), 722-731.

Britton W. Brewer (1994) Review and critique of models of psychological adjustment to athletic injury, Journal of Applied Sport Psychology, 6:1, 87-100, DOI: 10.1080/10413209408406467

Cullen, M. Mindfulness (2011) 2: 186. https://doi.org/10.1007/s12671-011-0058-1

Sullivan, M. J., & Adams, H. (2010). Psychosocial treatment techniques to augment the impact of physiotherapy interventions for low back pain. Physiotherapy Canada, 62(3), 180-189.

Victorson, D., Farmer, L., Burnett, K., Ouellette, A., & Barocas, J. (2005). Maladaptive Coping Strategies and Injury-Related Distress Following Traumatic Physical Injury. Rehabilitation Psychology, 50(4), 408-415.
http://dx.doi.org/10.1037/0090-5550.50.4.408

Abnormalities found on scans in asymptomatic people.

There have been many studies that have explored the abnormalities within our bodies through using different imaging techniques. The key take home message that research has brought to us is we are not all perfect, even if we are walking around pain free performing all our daily activities without issues.
However when injury does occur we may get x-rays, an ultrasound or refer you to a specialist who can get an MRI which can come back with findings such as a disc bulge. As demonstrated in the infographic above, it shows us that at least 37-96% of individuals can have this problem in their lower back, and up to 87% in their neck.
It is also reported that for men aged between 40 and 70 years old, up to 96% of individuals have shoulder abnormalities . Although these individuals can carry out their daily routine symptom free.
There are many findings on imaging from head to toe that are part of the normal ageing process and yet do not affect any part of our social or work life or our physical activity. What we don’t know is that we may have already been living with them for many years in our lives. This goes to show that even if we have an ‘abnormality’ within our body on imaging, it doesn’t necessarily mean that we are ‘injured’ or that our injuries are as bad as they present.

Image: Leedarrenh

Lateral ankle sprains – How should they be managed?

Diagnosis, Treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline – vuurberg et al., 2018.
Lateral ankle sprains, how should they be managed

Lateral (outside) ankle sprains are the most common ankle injury. Approximately 40% of all traumatic ankle injuries occur during sport, and only 50% of individuals seek medical attention.
Due to the poor attention to injury, a large population develop chronic ankle instability. 1-4 years following initial injury, 5-46% of individuals with chronic ankle instability still experience pain, 3-34% has recurrent sprains, and 33-55% report instability.
Risk Factors
Predisposing factors that increase the risk of sustaining a lateral ankle sprain compose of Intrinsic factors (patient-related), and Extrinsic factors (sport, environment).
Intrinsic risk factors
Modifiable risk factors include:
• Reduced strength around the ankle and calf
• Limited ankle mobility and range
• Poor proprioception (“the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement”)
• Low cardiorespiratory endurance
• Increased BMI (Body mass index)
• Preseason deficiencies in postural control/balance e.g single leg stand
Non-modifiable risk factors include:
• Anatomical abnormalities in the ankle, knee alignment, and multiple clinical defects
Extrinsic risk factors
• Sport dependent – Highest incidence of lateral ankle sprains were found in: Basketball, indoor volleyball (landing following jumping), field sports, climbing.
• Playing surface – Natural grass vs artificial turf vs court
• Position played in sport – e.g within soccer, defenders obtain 42.3% of lateral ankle sprains in the sport.
Treatment
Below is some of the latest evidence for the best treatment options, and how we can get you back running around with the kids, or back onto the sports field.

 R.I.C.E (Rest, Ice, Compression, Elevation)
Purpose: to reduce pain and swelling, improve patient function
RICE alone as a treatment is not enough, the best evidence is to apply the RICE principles alongside with exercise therapy.

 Non-steroidal anti-inflammatory drugs (NSAID’S) – E.g Ibuprofen, naproxen, diclofenac
Purpose: to reduce pain and swelling for acute injuries
If you have any concerns in regards to medication please discuss with your doctor.
Adverse effects may include: stomach discomfort, allergic reactions, heart burn, nausea, vomiting, diarrhea and/or constipation and more.

Immobilisation
A minimum of 4 weeks in a low leg cast following an acute lateral ankle sprain results in less optimal outcomes when compared with functional support (brace, tape, tubigrip/bandage) and exercise strategies with duration of 4-6 weeks.
However recent evidence showed a short period (less than 10 days) of immobilisation with plaster cast or rigid support (brace) can be of added value in the treatment of acute lateral ligament injuries as it helps reduce pain and oedema (swelling), and improves functional outcomes

Functional support i.e ankle brace/ tape/ tubigrip
Tubigrip/compression stocking following the acute phase of treatment begins to become unhelpful as it doesn’t provide sufficient support. Therefore using a lace up brace or semi-rigid brace will provide enough ankle support
Ankle braces results in better outcome compared to rigid or K-tape
K-tape is unlikely to provide sufficient mechanical support to unstable ankles

 Exercise
Consist of neuromuscular and proprioceptive exercises
Reduce the risk of recurrent injuries by reducing ankle instability, and associated with quicker time to recovery and enhanced outcomes

 Manual mobilisations
Manual mobilisations provide short term increase in ankle range of movement and can reduce pain in lateral ankle sprains
However manual therapy in combination with exercise therapy results in better outcomes than exercises alone

 Surgical therapy
60-70% of individuals who sustain lateral ankle sprains respond well to non-surgical treatment programmes
Surgery is mainly reserved for patients who have chronic ankle instability and who have not responded to comprehensive exercise-based physio programme.

Other therapies
Other treatment options are can also be used during treatment, although please discussed with your physio if these are beneficial for you.
These including: Acupuncture, Vibration therapy, laser therapy, electrotherapy, shockwave therapy, ultrasound.

Here at Bureta Physio we can properly assess your injury and give you the appropriate recommendations to get you back into what you love doing. Call 07 576 1860 to arrange an appointment time or click here to book online

 

Strain and sprain is not OK!

“The perfect movers, without strain and pain are under 5 year olds”

Stiffness and strain for many is part of life, indeed a modus operandi for many. But imagine if stiffness and strain equates to dysfunction, pain and harm, this forms much of our function and day. I recently attended a Integrated Movement Patterns Course to upskill on the Milicich Method where the emphasis was on non – specific neck and back pain. These methods were derived from analysing the perfect movers of this world; the few uninjured high performing individuals, who work within gravity, pain free. A small percentage are in the adult population and a high percentage are the 5 years old’s and under, the perfect movers of this world; the young who display natural movement synergies. The ability to move their centre of mass with perfect balance is part of our natural physical development, which sets the foundation for future movement.

The Milicich Method aims to facilitate these fundamental movement patterns that are still within our central nervous system and awaken them to treat strain and sprain. Diaphragm function underpins strength and function within these movement synergies undoing habits, utilising language to facilitate existing pathways. These are key to the learning process. Many people have unlearned the pro-gravity system and reprogrammed the anti-gravity system in their brain, working against gravity instead of with gravity.

One aspect of our daily lives that contributes to neck and back strain is lifting and the Milicich Method addresses this concern looking at the way 5 year old’s squat and how power lifters perform. This was instrumental in re-establishing the pro-gravity movement pattern. The natural flat foot squat (FFS) position is a movement that much of the western society has lost. The FFS that every child performs, moves the centre of mass through a vertical range of motion, and this is a very specific sequence of movement incorporating diaphragmatic breathing to engage the power chain, which gains a successful lift without strain within gravity.
If this concept of eliminating strain and sprain, re-establishing fundamental principles of movement and working within gravity is something that you would like to explore then I look forward to facilitating this learning process.

Marcel Gyde
Senior Physiotherapist

Keeping you safe on the slopes

With the snow season commencing the excitement can be as intense as the chill; but there should be some things to take into consideration before strapping on our boots and hitting the slopes. Snow sports have a high risk for serious injuries. Although most injuries are caused from unexpected and uncontrollable factors such as weather conditions, falls and collisions; these can be minimised with good preparation and safety practices.

Falls and collisions on the mountain can be traumatic and could be caused by many factors;

  • Fatigue
  • Lack of instruction
  • Using slopes unsuitable for skill level
  • Faulty or ill-fitting equipment
  • Altitude sickness
  • Dehydration
  • Being off pieste
  • Back country without knowledge and/or experience
  • Failure to observe warning/ safety signs

Here are the National Ski Areas Association Responsibility Code for Reducing Risk

  • Always stay in control
  • People ahead of you have the right of way
  • Stop in a safe place for you and others
  • Whenever starting downhill or merging, look uphill and yield
  • Use devices to help prevent runaway equipment
  • Observe signs and warnings, and keep off closed trails
  • Know how to use the lifts safely

 

Equipment Essentials

  • Wear a helmet- it can save your life!
  • Good quality goggles; essential for seeing the contouring of the ground especially in low light conditions

Recommended for beginners and those who spend significant time on the mountain

  • Knee pads
  • Elbow pads
  • Wrist guards

Vital tip! Make sure your equipment is serviced and personally fitted to your experience level, weight and height. This ensures the safety features will work as they are designed to.

 

Stay within your skill level .
Familiarise yourself with which colour slopes match with which difficulty to avoid being in a slope that is too difficult.

Before considering going off pieste ask yourself; do I have the knowledge and experience? Are the conditions safe? Am I sure where the section will end up? Do I have the knowledge and gear in case of an avalanche?

If the weather changes suddenly make sure to; keep close to the slope markers and look out for warning signs and abide by them.

Most importantly make sure you feel confident to stop and/or change direction safely and quickly in case of an emergency.

Additional tips:
Parents supervise your children ensuring they are hydrated and fed, skiing appropriate slopes for their skill level and that they are abiding by the ski code.

AVOID DRINKING ALCOHOL- this can cause loss of judgement/ balance and control which could lead to injuries to yourself and/or others.

 

How physiotherapy can help?
To enjoy the ski season to its full potential prevention of injuries is more effective than treatment. The stronger, fitter and more flexible you are, the less likely you are to injure yourself in an accident and this is how physiotherapy can help! Physiotherapy can provide you with an individualised exercise program to increase your body’s capacity to cope with the physical demands of snow sports.  The program can be tailored to your personal weaknesses /tightness whilst also taking into account any previous and/or current injuries; chronic or acute. We can take you through the appropriate warm up and cool down techniques / exercises/stretches targeting your individual needs. Furthermore we can give pointers on your technique designed for injury management and prevention. By addressing these factors we can help improve your performance on the slopes and reduce your risk of injuries.

Enjoy your time on the slopes !

Improve your sleep

Strategies to Improve quality and/or quantity of sleep

Inadequate sleep and/or poor- quality sleep affects the non-athletic and athletic population. Consequently, adequate sleep is a critical component for post exercise recovery thus effecting performance. Therefore, below we have listed strategies you can implement to enhance your sleep quality to optimise your health, work/sport performance and recovery.

Nutrition do’s and don’ts
Do’s

Consume tryptophan containing foods such as milk, meat, fish, chicken, eggs, beans, peanuts, cheese and leafy green vegetables in the evening meal to increase melatonin production.

Try including carbohydrate foods at dinner to assist with Serotonin production, e.g. potatoes, rice, pasta… this may not be ideal if overweight or working on losing fat.

Try consuming 30ml tart cherry juice in the evening to increase exogenous melatonin intake (also decreases DOMS -Delayed Onset Muscle soreness). Use in a periodised way, e.g. around high volume training or to get sleep sorted initially if in a rut or during competition.

Consume a balanced, healthy diet, including adequate wholegrains, low fat dairy foods, fruits and vegetables for magnesium and B vitamins.

Try 300-400mg Magnesium supplement prior to bed.
Don’ts

Alcohol intake prior to bedtime (fragments sleep later in the night)

Caffeine and nicotine stimulants intake prior to bedtime (individual tolerances do exist). This includes coffee, tea, energy drinks, cola, chocolate.

To be cautious of
Be conscious of food portions before bed (eating large portions of food can raise core body temperature and make it difficult to fall asleep) and fluid intake prior to bed (to minimise need to go to the bathroom).

Consume fluids with evening meal to increase absorption, then taper off;
i.e. individual fluid prescriptions may be necessary following late- night training/competition to ensure rehydration.

Aim for no more than one visit to the bathroom during the night to minimise sleep fragmentation.

Combating Stress
Use a journal to write down worries/thoughts before bed

Write a ‘to do’ list for the next day to help clear the mind

Body Temperature
Lowering core body temperature in the evening to induce drowsiness and sleep:

Skin-warming (for cool environmental conditions) – achieved through warm baths/shower/spa, hot foot baths, warm blankets or dressing gowns, wearing warm socks and woollen boots/slippers

Skin cooling (for warm environmental conditions) –achieved through cool showers, cold water immersion, appropriate use of air conditioning, light bed covers

Keep a Routine
It is critical to maintain a pre- bed routine to prime the body for sleep. This is crucial for proper sleep hygiene.

Allow 1 hour ‘the de-power hour’ to unwind before bed

Maintain a regular bed and waking time each day (entrains our internal body rhythm -circadian rhythm)

Avoid computer screens, texting, bright lights for 1-2 hours before bed (stimulates the eye). Some people may find a dimmer TV screen from a distance helps them relax.

Creating a sleep friendly environment
Keep the TV out of the bedroom.

Keep the bedroom for sleep activities only, and ensure it is quiet, dark and comfortable.

If you cannot sleep within 15 minutes of going to bed, get up again and try a different strategy. Eliminate the bedroom clock (avoids stress of ‘losing valuable sleep time/clock watching’).
Napping
Napping can be a valuable way of increasing total sleep hours. Experimenting with a 90 minute nap mid-afternoon (one full sleep cycle). Recommended for individuals during heavy training prior to competition or who are having short nights.

If insomnia is a problem, do not nap in the day. Otherwise time naps for 8 hours after rising time (2-3pm) and keep these no longer than 30 minutes.

Naps times between 30-90 minutes or longer than 90 minutes may result in temporary sleep inertia and performance impairments.

Napping 10-12 hours after morning waking time will likely disturb nocturnal sleep. Set an alarm to wake at the right time post nap.