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

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/

Hip tendinopathy problems and solutions

Aggravating movement Why does it aggravate Solution
Lying on painful side

 

Direct compression from the mattress Add a soft mattress cover eg use a spare duvet
Lying on the non-painful side Upper leg adducts, causing compression Place pillows between your knees and ankles to reduce hip adduction
‘Hip hanging” standing position Increases tension of the ITB, increases compression and may lead to abductor weakness Don’t hip hang
Sitting with legs crossed Compression from the ITB with adduction Don’t cross your legs
Sitting in low chairs Hip rests in flexed position which increases tension on your TFL muscle and your ITB increasing compression. Can cause pain on rising from sitting. Sit on a tall chair so hips are above the level of your knees
Standing on painful leg Pelvis drops on non-weightbearing side leadign to hip adduction Use some support for single leg activities – eg dressing or do in sitting
Walking (especially climbing hills or over striding) If pelvic control is poor the hip can adduct during gait causing compression and pain Stay active but stick to what you can comfortably do, avoid large hills and over- striding
Climbing stairs Pelvis drops on non-weightbearing side leading to hip adduction Hold onto hand rail for support. If servere do 1 step at a time leading with the good leg.