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Category Archives: Physiotherapy

Concussion and Physiotherapy

Definition: ” A traumatic brain injury (TBI) induced by biomechanical forces” (McCrory et al., 2017)

EVIDENCE FOR PHYSIOTHERAPY REHABILITATION FOR CONCUSSION

Systematic Review – Schneider et.al. 2017:

“A brief period (24-48 hrs) of cognitive rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored sub-symptom threshold, submaximal exercise may be of benefit.”

In 2010, researchers first showed that specialised exercise regimens can relieve prolonged concussion symptoms.

A concussion is a mini- traumatic brain injury

WHAT IS THE ROLE OF PHYSIOTHERAPY

  • On field assessment (side-line)- identification and emergency response
  • Initial assessment in the clinic:
    • Cervical spine range of motion
    • Upper and lower limb neurological testing
    • Gait and balance
    • Mental status
    • Sleep pattern/disturbances
    • Occular/vestibular function

TREATMENT AND REHABILITATION

Physiotherapy for concussion is patient specific and includes the following:

  • Education and reassurance
    • Concussion explanation
    • Moderate rest and early activation- encourage light exercise. Insufficient evidence for complete rest
    • Signs and symptoms to look out for
    • Importance of rehabilitation
    • Potential psychological effects of concussion (anxiety, withdrawal)
  • Manual therapy
    • Massage
    • Joint mobilisation
  • Rehabilitation and guidance
    • Research supports early psychological, vestibular, cervical interventions as well as closely monitored active rehabilitation programs
    • Individualised rehabilitation
    • Cervical spine ROM exercises
    • Breathing exercises
    • Balance training
    • Exercise programs that are tailored around the patients social sporting activities
    • Vestibular therapy: BPPV, Nystagmus
    • Vision therapy: Convergence/divergence
  • Nutritional advice and education
  • Referral to multi-disciplinary specialists as required
motor-occular exercises
Deep neck flexor training, with motor-ocular exercises

Outcome measures used for concussion to help diagnose and assess improvements in physical and cognitive function

  • Maddock’s questions
  • SCAT 5
  • Cogsport
  • HeadSmart

RETURN TO LEARN, WORK AND PLAY

  • Full recovery is classified as “a resolution of post cuncussion symptoms and return to normal balance and cognitive function”
  • Limited evidence to support medication use

Want to learn more about concussion management contact our team today or book in an appointment online.

References:

  • Leddy, J.L., Sandhu, H., Sodhi, V., Baker, J.G., & Willer, B. (2012). Rehabilitation of concussion and post-concussion syndrome. Sports Health, 2(4), 147-154. doi:10.1177/1941738111433637
  • McCrory, P., et al. (2017). Consensus statement on concussion in sport: the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 0:1–10. doi:10.1136/bjsports-2017-097699
  • Schneider, K.J., Leddy, J.J., Guskiewicz, K.M., Seifert, T., McCrea, M., Silverberg, N.D., Feddermann-Demont, N., Iverson, G., Hayden, A., & Makdissi, M. (2017). Rest & treatment/rehabilitation

Hypermobility

Hypermobility is a common condition that affects 1 in 20 people. Research has shown that 10-25% of children have hypermobility. The symptoms will usually be most obvious between the ages of 13 and 19 years old with the majority of patients presenting at age 15. Girls have been found to be more affected than boys.… Continue Reading

Vertigo

What is vertigo? Vertigo is an abnormal sensation of motion; Disequilibrium is a sensation of impending fall or of the need to obtain external assistance for proper locomotion. Positional vertigo or Benign paroxysmal positional vertigo (BPPV) is the most common. It is the sensation of spinning that occurs after the patient’s head has moved to… Continue Reading

POSTERIOR BUTTOCK PAIN

Getting to the ‘bottom’ of buttock pain can sometimes prove a diagnostic dilemma, due to the number of potential local sources of nociception and relative complexity in anatomical relationships within the posterior hip region. This is compounded by pelvic structures and more remote sources within the lumbar spine. Perhaps this conundrum sometimes leads health and… Continue Reading

Adhesive Capsulitis the “Frozen Shoulder”

What is a frozen shoulder? A frozen shoulder (ADHESIVE CAPSULITIS) is a common condition affecting 3% of the population. It usually affects people over the age of 40 years and is more common in women than in men. It is a primary idiopathic condition where the inflammatory pathological process of excessive scar tissue (arthrofibrosis) is formed across… Continue Reading

HAMSTRING INJURIES

Hamstring Injuries; a common injury Hamstring injuries are the most common non-contact muscle injury seen in a variety of different sporting activities. We might hear in someone’s history, “I took off sprinting to get the ball and felt a pull in the back of my thigh” or “I went for a high kick and something… Continue Reading

LUMBAR DISC INJURIES AND PHYSIO

What are lumbar disc injuries? The area between the lumbar vertebral bodies and sacral vertebral bodies is a transition zone. It is at increased risk of injury due to the change in biomechanics that occurs between these regions. Separating each vertebral body of the spine are pads of fibrocartilage based structures that provide support, flexibility, and… Continue Reading

Achilles Tendinopathy

What is it? Achilles tendinopathy is an overuse injury that involves dysfunction and local tendon pain with excessive loading (Malliaras et al., 2013). The tendon structure can be altered resulting in a tendon that is less capable of sustaining repeated load. An injury to the Achilles Tendon can severely impact a patient’s daily activities as… Continue Reading

What is Telehealth Online Physiotherapy?

In light of the recent COVID-19 pandemic, there has been a push for the provision of online telehealth physiotherapy services. Mediphysio has answered the call and has developed a strategy to provide online physiotherapy to its existing patients. Is online telehealth any good? How does it work? A virtual consultation can be just as beneficial… Continue Reading

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