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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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

Warm up, protecting our kids

Warmup prior to sport is one of the most under utilised tools in the fight against sporting injuries. Many of us grew up in a world where sport was primarily for fun, we played numerous sports all lasting a few months of the year and the majority of us never did this with the consideration of higher goals or a professional career in the future. We were strong, active, healthy, largely injury free kids.

The sporting landscape has changed and not necessarily for the better.  In a society with a growing obesity epidemic our sporting participation rates for children, adolescents and young adults are lower than ever and continuing to drop. Alongside this the number of moderate to severe injuries in our children and adolescents is at an all time high and continuing to rise.

Across the ditch in Australia they are suffering from what could be considered an ACL rupture “epidemic”. New research has revealed that Australia has the highest rates of ACL reconstructions in the world (200,000 reconstructions at a cost of >$140 million) and they are being reported at younger ages with some as young as seven or eight. It is not clear yet what is causing these growing rates of ACL rupture but there is spectulation that a combination of a lack of “free play”and early sports specialisation could be to blame.

Rules and restrictions on climbing trees, playing everyday lunchtime school games and too much time spent on devices is ensuring our children are functionally weaker than ever before. We see this on a daily basis with an increase in sporting injuries and on the other end of the spectrum an increase in back and neck pain as a result of a largely sedentary lifestyle from younger and younger ages.

Sports are now often year round, multiple levels of a sport are played by athletes concurrently with the load of training and competing often being higher in a week than many of our professional and semi professional adults. YET all of this is occuring on a growing skeleton. This along with the reduction in movement control and strength is creating the “perfect storm” when it comes to injuries in adolescence.

Having an impact in this landscape is challenging and at times frustrating but is a hugely rewarding area if changes can be made. We can not have the next generation of children having “40 year old knees” by the time they are 10 and we can not afford to have a generation of children ceasing to play sport as a result of injury as this has significantly detrimental greater health consequences.

 

Warmups prior to sport are almost always completed especially in team sports. Yet historically these largely consist of a jog and some static stretching which is what we completed 30 years ago. Research and time has moved on but education to the public still lacks in this area. Static stretching is not effective in the reduction of injuries and can potentially be detrimental prior to to sport due to reducing power production of the involved muscle after being stretched. It has NO place in a warmup prior to sport.

Warmups MUST be multifactorial, sport specific and include strengthening, balance and agility exercises. These will not only help prepare our children for the sport they are about to play but reduce their risk of injury and assist in enhancing their performance. Faster, stronger players who are not injured regularly will always be an asset to a team.

 

Effective warmups have been shown in research to prevent major injuries by up to 50% and all injuries by up to 30%. Research also shows us that teams that have the least injuries win the most and athletes that can complete the majority of their planned training will have a much higher chance of achieving their performance goals. IT IS TIME FOR CHANGE!  We must implement appropriate warmups across all sports from pre puberty – some would say it is negligent of us if we don’t!

 

See links below for examples of sport specific warmups for netball, rugby & football or contact us at Bureta Physio buretaphysio@xtra.co.nzor 5761860 for further information

 

http://netballnz.co.nz/useful-info/netball-smart

https://www.rugbysmart.co.nz/sportsmart-warm-up

http://fit4football.co.nz/the-11plus/11plus/

http://fit4football.co.nz/the-11plus/11plus-kids/

Kids school bags

On a daily basis, your child may lug more than five kilograms to and from school in their backpack. This concerns our practice as there is a connection between loads carried and reports of unhealthy spinal symptoms including lower back, shoulder and neck pain. By getting your child to see one of our physiotherapists for a check up, we can determine whether your child’s spine is not at risk of injury and suggest actions such as flexibility and muscle control to help maximise their spine’s health. To keep your child’s spine in good health use the following tips in addition to speaking to one of our physiotherapists. Tip 1 Choose the right backpack that … Fits the body comfortably Doesn’t extend above the shoulders when seated Has shoulder straps that are broad, well padded and adjustable Has straps attached to the top of the pack at separate points Has a waist strap to keep the load in place when moving Has separate compartments to allow heavy items to be packed close to the body Is padded where it touches the back and made of firm material to prevent the load from sagging backwards. Tip 2 Pack smart Lighten loads – don’t let your child carry too many heavy books on the same day Plan ahead – to avoid your child carrying lots of equipment at the same time, like sports gear, musical instruments or art materials Pack the heaviest items – such as a lap top – closest to the body and the lighter, softer items further out. Tip 3 Carry smart When packed, make sure the backpack doesn’t sag or pull backwards Insist your child uses both shoulder straps when wearing the backpack Ensure the backpack’s waist strap is used to keep the load in place when your child is walking or cycling Don’t let your child carry the backpack for too long – advise them to take breaks and put it down.

Knock knees, flat feet, fallen arches – Should I be concerned about these with my child?

As children grow from babies through toddlers, young children, the dreaded teens and finally to adults they go through many growth stages. During different stages of growth their body is placed under varying stresses. There are a number of factors or biomechanical issues that are good to have checked out by a physio to help ensure your children stay pain and injury free.

Babies-toddlers: during this stage there are a number of milestones which are most often the largest concern. These include the recommended time to sit, crawl, walk and develop higher functions likes socialising and language. It is important to realise that all children develop at differing rates, and some may bottom shuffle instead of crawling or skip it altogether and go straight to walking. If you have concerns at this stage speak with your GP/paediatric nurse or physio. Odds are your child just has quite reached that stage yet.

Toddler-young children: during this stage changes in the alignment of the lower limb and growth spurts can result in a variety of problems. Many children will often suffer ‘growing pains’, flat feet, knock or bowed knees and clumsiness with sport and running. If you notice any of these it is important to have them checked to ensure that growing pains are not muscle/tendon injuries and that foot issues are within normal limits. Unchecked these can go on to generate further problems.

Teens: Once again an important area due to massive growth spurts and changes to the general structure of their body as puberty takes hold. It is also at this stage that we often see dramatic increases in the duration and intensity of activity.

Common problems during this stage for girls include frontal knee pain, ankle sprains, calf tears and shin splints.

For boys common issues include shoulder instabilities, sprained ankles and knees, tendon attachment inflammation (Osgood-schlatters etc) and shin splints.

During the school term between work, sports and after school events it can be hard to find time to get these niggling injuries or pains checked but it is important that these issues are sorted out SOONER rather than later and that the appropriate treatment and rehab programmes can be started.

For a Free assessment voucher or quick chat to see if your child is appropriate for a full assessment give us a call on 5761860 or email buretaphysio@xtra.co.nz for more information.