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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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

What is Rehabilitation

Have you ever wondered how exercise works? Watch this video!

This video shows mechanotherapy at work. Mechanotherapy is the science behind how exercise works and why your physiotherapist prescribes your particular exercises. When you put a controlled load through the body’s tissues, like a muscle contracting against resistance, this will cause the cells in that muscle to respond. The cells recognise that muscle is working against resistance and a cascade of reactions begin that eventually lead to muscle fibres increasing in size. How your physiotherapist manipulates the exercise will determine what sort of reaction the cells will have. For example, exercises to build muscle are different to exercises that encourage weight loss. A detailed understanding of how this works is required by your physiotherapist to get the outcome you desire. The physiotherapists at Bureta are well trained in rehabilitation and exercise prescription so are able to tailor a treatment plan specifically for each individual!

Core stability for Dancers – try our Dance Pilates

Are you a dancer who wants to improve your technique, flexibility or just prevent those niggly injuries that can keep you from training?

Here at Bureta physio we have a dedicated physiotherapist who can help you with this.

As a dancer you will be aware of the importance of core stability to improve turns, control arabesque and prevent many back issues.  You may already being lots of training for it but are you really doing what you need to do to get the most out of it.

Core stability is not about doing hundreds of sit ups, getting a ‘six-pack’ or being able to hold a plank position for 3 minutes (although these do still have their purposes!)

True Core Stability IS…

  • The ability to control the spine dynamically, that is, with movement.
  • Fine co-ordination of all of the muscles that control your trunk, not just the abdominals.
  • The ability to adjust the level of control needed, depending on the situation.
  • Creating a stable base off which to work the limbs.
  • Stabilizing the mid-section to allow smooth and effective transfer of force through the body.

While everyone needs some level of core stability, some people need more than others. For a dancer, core stability needs to be fantastic fine coordination of all of the muscles to allow controlled mobility of the pelvis and spine with movement, rather than bracing in one spot.

So How Do We Do That?
True core stability exercises are extremely hard to do properly and very easy to do wrong. The purpose of our specific dance pilates courses are to ensure you understand the finer details required to gain true core stability and a progressive system of exercises the train your muscles in the best possible way.

Flexibility
Our dance pilates classes also provide ways to improve your flexibility in a safe but effective manner.  Unfortunately we often see injuries that are caused by over-stretching, especially on young bodies that are still developing.  Its not that as a physiotherapists we are against improving flexibility but this can be achieved through controlled and safe methods not putting joints or muscles through undue stress.

Lucy Poole, one of our physiotherapists here at Bureta is experienced with working with dancers both from a amateur level through to professional so you can get the most from your dancing.  This can be through a one to one physiotherapy session, one to one pilates classes or in our group dance pilates classes.

The goal of the classes is to improve dance technique and reduce dance related injuries that we see a lot in the clinic.  Simple postural and muscle balance adjustments can make a huge difference to current performance and prevent time off due to injury.

They will run for 6 consecutive weeks at a cost of $80 for 6 consecutive sessions.

Heading to the slopes to ski or snowboard? – you have got to read this first!

Ok so the last couple of days in the bay have been super cold for our standards

Winter is here and many people will head to the snow for a well earned break. While skiing/boarding comes naturally to some, others spend most of their time unsuccessfully negotiating the equipment and terrain. Whatever your level of experience, skiing/ boarding can be hazardous and contribute to injury. The physiotherapists in our practice can help. We can ensure that you are prepared for the slopes by minimising your injury risk through specific exercise programmes, fitness regimes, strengthening and warm up, stretching and cool down techniques.

To avoid injury this snow season, the physiotherapists in our practice recommend you:

Be fit to ski/snowboard

Begin to incorporate ski-specific exercises into your regular exercise routine at least eight weeks prior to your holiday. This will promote use of the muscles and joints required for skiing. Strengthen the muscles specific to snow sports (thighs, butts, core stabilisers and triceps) to reduce the risk of injury and increase your enjoyment and endurance on the slopes. We can outline ski-specific or board-specific exercises whilst prescribing a conditioning programme to improve your core stability and muscle strength. Ultimately, your performance on the slopes relies on your fitness, so talk to us about how to achieve an optimal fitness level. We have access to a number of gyms around Tauranga and can write you a ski or board specific program and you won’t be tied into a long term membership!! Talk to us about Bureta Physio’s corporate gym rates 

Look after your back

When travelling distances to reach the mountain, rest every two hours and stretch. See one of our physiotherapists for effective stretching advice, and if you have had problems with your back come into the clinic and pick up a Lumbar roll for the trip which means when you unfold yourself after the trip you are ready to go

Warm up, stretch and cool down

Before hitting the slopes, warm up like you would with any other sporting activity. Stretch your thigh, calf and arm muscles check out or blog on dynamic stretches. Start your day with easy runs to loosen up (make sure you also do this after each rest break.) Once you have finished skiing for the day, remembers to cool down. These activities will better prepare your body to avoid injury. We can show you warm up, stretching and cool down techniques.

Ski within your capabilities

Beginners should take advantage of a ski lesson and not succumb to the pressure of keeping up with experienced skiers. Don’t be afraid to rest when you find yourself getting tired. Fatigue can increase your injury risk. And remember, the more unfit you are, the more tired you will become. Injuries often happen on that last run of the day!

To avoid injury on the snowfields this winter, consult one of our physiotherapists on how to best prepare your body.