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.

 

 

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

Do you suffer from dizziness, vertigo or loss of balance?

Vestibular rehabilitation is an effective treatment for these symptoms caused by an inner ear dysfunction.  The vestibular system sits deep in your inner ear and is made up of three semi-circular canals and the utricle and saccule.  The semi-circular canals detect rotational head movement and the utricle and saccule detects linear and vertical head movement.

The brain receives information from both vestibular systems, your eyes, receptors in your joints and muscles to maintain balance/equilibrium.   When the system is damaged then the information sent to the brain is altered and results in symptoms such as dizziness.

 

Common causes of vestibular dysfunction are:

  • Labrynthitis
  • Vestibular neuritis
  • BPPV (Benign paroxysmal positional vertigo)
  • Menieres disease
  • Acoustic neuroma
  • Oxotoxicity – damage to the system from the use of some medications

Other causes of vestibular dysfunction can also benefit from vestibular rehabilitation including:

  • Post stroke
  • Post head injury: Positional vertigo and particularly BPPV is the most common cause of severe dizziness – it is also common post head injury and can be recognised by the pattern of dizziness which is reproduced when the head is placed in a certain position.

There can be other serious causes of dizziness which need to be evaluated by your doctor or specialist to determine whether vestibular rehabilitation is appropriate for you.

 

How this is treated is dependent on the cause and can include:

  • Specific head, body and eye exercise:
  • Gaze Stabilisation
  • Balance
  • Gait and Strengthening exercises

(These exercises will be performed in the clinic and at home.  These exercises are designed to retrain the brain to recognize and process signals from the vestibular system and coordinate them with information from your eyes and muscles and joints.)

  • Canal repositioning techniques (for BPPV).  When you suffer from BPPV the dizziness is a result of otoconia (small crystals) moving into the semi-circular canals most commonly the posterior canal.  With specific techniques and different head positions the crystals can be shifted back out of the canals reducing dizziness.

 

If you have been suffering from dizziness vestibular rehabilitation can be an effective treatment option for you so contact us now on 075761860 to book an initial vestibular contact (one hour appointment) or contact me directly for further information donna@buretaphysio.co.nz.

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.

Deep Neck Flexors- Small exercises for big neck pain.

Most people have heard of “the core” when talking about low back pain and strengthening, but not many have heard of the deep neck flexors (DNF) which are a group of muscles that are “the core” for neck. These small muscles are buried deep in your neck and are responsible for the stabilisation of the neck.

Neck trauma, poor posture, whiplash, muscle imbalance, and overuse can cause dysfunction in these muscles which may lead to ongoing and recurrent neck/ upper back / shoulder pain, headaches and on occasion other symptoms of dizziness, nausea, and visual disturbances

Most people with neck pain do not experience a complete resolution of symptoms, resulting in a persistent and recurrent condition. Between 50% and 85% of those who experience neck pain at some initial point report having it again 1 to 5 years later. Training of the neck stabilisation muscles has been shown to be crucial in the complete resolution of recurrent and chronic neck pain. It has also been shown to beneficial for athletes in contact sports in the head such as rugby and soccer for prevention of injury.

Training the DNF’s requires the participant to lye on their back with the neck supported with a rolled up towel under the head. The physiotherapists at Bureta use the pressure biofeedback cuff under the neck to help you train these muscles. To activate the DNF we ask you to perform a small head nod without activating the larger muscles around the neck. We grade the strength of your neck flexors which can be anywhere between 22mmhg and 30mmhg on the pressure cuff. Once you have the correct technique you will be asked to perform the exercises daily and we will review your progress on the next appointment.

Depending on your symptoms and what your goal is, we have a progressive strengthening program with specific exercises for the DNF’s to reach their optimum function. You should notice an improvement in symptoms within the first few weeks but it may take up to 12 weeks to build the strength you require depending on your goal. The physiotherapist at Bureta can guide you through the process, contact us for an appointment.

Your Injury, Our Challenge, Your future

An example of deep neck flexor training is seen in this video link https://youtu.be/6Of_10gUelI

Using a pressure cuff to train neck muscles

Using a pressure cuff to train neck muscles