Tag Archives: concussion

Raising Awareness about Mental Health

One in five Canadians suffer from mental illness; however, more than two-thirds of these individuals never seek help because of the stigma surrounding mental illness. October 10th is World Mental Health Day, a day to raise awareness and educate people about mental illness in order to help change the negative stereotypes surrounding it, and hopefully encourage people to seek help.

Physiotherapists may feel more like psychologists as patients tend to develop a positive relationship with their therapist and feel that they can be honest and open about struggles outside of their physical injury. Although it is out of the scope of physiotherapy to treat mental illness, physiotherapists play a vital role in educating patients about different avenues they can explore to seek help, as well as recognizing when someone is a danger to themselves or others around them.

Sheddon Physiotherapy and Sports Clinic treats a large number of athletes, and one would think that this population is fairly immune to mental illness. Exercise and physical activity have long been shown to help with mood disorders, depression and anxiety. Athletes are generally very driven, goal-oriented individuals, in exceptional shape physically. So it’s understandable that most people assume they are also mentally strong and healthy. However, athletes are still vulnerable to mental illness for many of the same reasons as the general population. Some common risk factors for mental health disorders in athletes include:


 Athletes devout a large amount of their time and energy to their sport. With this comes the pressure to perform and excel, which can lead to stress, anxiety and depression. The heavy training schedule of many sports, combined with school, and in some cases work, can lead to fatigue and burnout in a large number of student athletes. Unfortunately, athletes rarely seek help for their psychological problems, for fear that they will be seen as weak and possibly lose their spot on a team. Athletes who do seek help will often be diagnosed with “overtraining.” The physiological, immunological, hormonal, and metabolic changes of over-training are very similar to those associated with depression. As such, some researchers have debated whether athletes with depression are actually being misdiagnosed with overtraining.

Eating Disorders

Many athletes feel the pressure to maintain a certain weight and body composition in order to be successful in their sport. Studies show that the prevalence of eating disorders in male athletes is roughly 18%, and anywhere from 32-60% in female athletes. Eating disorders are considered to be a mental illness caused by a number of psychological and sociocultural factors. In addition, eating disorders can occur with other mental health disorders, such as anxiety, depression, OCD and other mood disorders.


An injury can bring a lot of stress and anxiety to athletes. They oftentimes feel pressure from coaches, teammates and parents to return to the game as soon as possible and in tip top shape. If athletes are playing on a scholarship or looking to get scouted to the next level, an injury can make them feel like their chances are at stake. They occasionally are unable to train/practice at the same level of their teammates and the longer the injury takes to heal, the more an athlete starts to feel they are slipping behind mentally and physically. Whether an injury is career ending or a minor sprain it will bring a host of negative emotions and can lead to further psychological issues.


Since athletes commit all of their time and energy to training, their social circle and identity becomes strongly interconnected with their sport. As such, once their career is over they have lost their outlet, friends and identity. Retirement for athletes can be a time of great psychological distress, whether it is a decision made by the athlete or they are forced to retire due to aging, competitive failure or career ending injuries. Most athletes are not prepared for this life transition of entering into a world without extensive hours of practice, strict daily schedules and the adrenaline of competition. Athletes can feel a sense of emptiness, leading to depression and other mental health issues. Furthermore, retirement also shrinks your social support network, as athletes are no longer part of a team or group to which they can turn to for help.

Whether you are an elite athlete or an average Joe, we are all susceptible to mental health disorders. Keep in mind that mental illness can be treated and that you do not have to live through it alone. If you or someone you know may be suffering from a mental illness, please seek the appropriate assistance. If you’re not sure who to turn to, talk to a family member, friend, therapist or someone you trust that can help guide you in the right direction. Acknowledging that there is an issue is the first step to recovery.

Hughes et al., (2012). Setting the bar: athletes and vulnerability to mental illness. British Journal of Psychiatry. (2) 95-96.

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Concussion baseline test 2017 Sheddon Physioyherapy Sports Clinic Oakville Mississauga

SPECIAL EVENT: Concussion Baseline Testing

We are currently offering athletes of all levels and sports who have not completed their Concussion Baseline Testing a special rate of 70$, when completed during our group sessions on Saturday Dec. 2nd, 2017 from 8am-11am. For more information or to make an appointment, please contact admin@sheddonphysio.com for available times. Please note, we require a minimum of 10 athletes to sign up to run this special event.

Frequently Asked Questions:

  • The season has already started, are we too late for concussion baseline tests?
    • NO! Preseason is the ideal time for testing, but anytime during the year prior to a concussion is better than no baseline.
  • WIll the cost be covered through my insurance?
    • The cost of the baseline is covered under most Extended Health Plans since it is administered by a physiotherapist.
  • My child had a baseline done over a year ago, why should we do it again?
    • As young athletes mature, their baseline scores can change greatly from one year to the next. Therefore, it is recommended that athletes get a baseline at the beginning of each season.
  • My hockey team did the impact test preseason, isn’t that good enough?
    • No! Computerized neuropsychological tests, such as the ImPACT test are only assessing one aspect of concussions, neurocognitive function. In order to properly manage concussions a baseline test must be multidimensional, assessing the full spectrum of concussion outcomes (i.e., balance, reaction time, visual processing, physical capacity AND neurocognitive function). In order to know when an athlete has fully recovered, the different areas of the brain that could potentially be affected with a concussion must be assessed prior to and after a concussion.
  •  It’s not mandatory for my childs team.
    • Concussion baseline tests are becoming widely used in many sports at all levels. Although not mandatory (yet) in all high-risk sports, it is one of the most important and effective tools for concussion management. Without a baseline test there is no way to accurately know when an athlete has fully recovered from a concussion. Research has shown that concussion symptoms improve much sooner than brain recovery, which may put athletes at risk for returning to sport too quickly, especially if sport clearance is based solely on symptoms.
  •  Those dates don’t work for my child or team?
    • If you are part of a team or an individual who would like to participate in Concussion Baseline Testing but you cannot fit these dates into your schedule, please contact us and we will try to arrange for another date and time.

Please click here to learn about Concussion Baseline Testing and why it’s so important.

concussion and neck injury physiotherapy sports clinic oakville mississauga

Concussion and Neck Injury

Most concussed patients will start to feel better within 10 to 14 days. However, roughly 10-15% of concussed athletes will go on to have prolonged symptoms that can last for weeks or years. These symptoms can effect an individuals daily life from school or work to doing basic activities like grocery shopping or going out to see a movie. Given how debilitating these symptoms can be, research has focused greatly on trying to find out “why” some people have long lasting symptoms.

Symptoms following a concussion can come from a number of different areas. For days or weeks after experiencing a concussion, there are metabolic and physiological changes in the brain, which have been shown to produce a variety of symptoms. However, the cervical spine, visual integration system, vestibular system and/or psychological factors can all be affected following a concussion and lead to a variety of similar symptoms.

The cervical spine is particularly vulnerable following a concussion, given the whiplash mechanism, which usually occurs with concussions. Studies have shown the range of linear acceleration needed to sustain a concussion is between 70-120 G’s, whereas a mild neck strain only takes 4.5 G’s. Therefore, it could be hypothesized that the majority of concussions will also have some degree of cervical spine injury, which may involve the soft tissue and/or joints of the neck. These resulting symptoms are very similar to concussions, including:

  • Headaches;
  • Dizziness;
  • Vision changes;
  • Vertigo;
  • Irritability/mood disturbances;
  • Cognitive changes (i.e., concentration/memory issues)

Current research has shown that following a concussion, physiotherapy focusing on cervical and/or vestibular rehabilitation significantly helps in the recovery of concussion symptoms. Treatment for cervical injury includes soft tissue release, mobilizations and exercises to strengthen the deep neck flexors, as well as proprioceptive exercises for the neck region. For more information regarding assessment and treatment of the visual system, click here, and for the vestibular system, click here.

At Sheddon Physiotherapy and Sports Clinic, our post-concussion assessment carefully examines the cervical spine, vestibular system and visual system, as well as a full neurological exam. Based on the patient’s findings, the appropriate therapy and exercises are given in order to reduce the symptoms. The key to a speedy recovery post-concussion is to have a thorough assessment of all the different systems in order to see which are dysfunctional and leading to symptoms. If these areas are treated early on in the injury, it may help prevent long-term symptoms.

Leddy et al., (2014). Brain or strain? Symptoms alone do not distinguish physiological concussion from cervical/vestibular injury. Clinical Journal of Sports Medicine. 0:1-6.

Marshall et al., (2015). The role of the cervical spine in post-concussion syndrome. The Physician and Sports Medicine. 1-11.


hockey injury recovery Sheddon Physioyherapy Sports Clinic Oakville Mississauga

Prevention of Ice Hockey Injuries

Ice hockey is one of the most popular sports in Canada. However, recent trends have shown that minor hockey enrollment numbers are slowly decreasing across the province. Many factors play into lower enrollment, with the most common being the steep cost of playing hockey, followed by the risk of injury. Due to this high risk of injury, research has focused largely on injury prevention initiatives such as rule modifications, equipment changes and education regarding safety.

Gender Differences

  • Male hockey players experience more injuries across all levels and ages (regardless of body checking rules);
  • Men suffered more injuries to the head and face, followed by the shoulder and knee. Whereas women were more likely to suffer injuries to the lower body, including the knee, thigh and ankle;
  • In college athletes, the most common injuries in both males and females were sprains and strains (roughly 1/3). The second most common injury in females was concussions, while males were lacerations and contusions.

Mechanism of Injury

  • Both males and females sustain twice as many injuries in games than in practices;
  • Roughly 35% of all injuries for males and females are a result of player contact;
  • 17% of injuries involve stick induced mechanisms;
  • 14% are related to puck injuries;
  • 15% are related to non-contact mechanisms, overuse, poor movement patterns and improper hockey mechanics.

Common Injuries


Shoulder injuries are more common in males than females, likely due to body checking. Shoulder injuries occur following body checking, striking the boards and contact with other players. The most common shoulder injury is an acromioclavicular (AC) joint separation.


The most common knee injury sustained during hockey is a MCL sprain/tear, usually resulting from an on-ice collision or from a player catching a skate on the ice.


Groin pain is common in hockey players and accounts for 9% of all hockey related injuries. The most common hip/groin injury is adductor muscle strains, usually resulting from overuse. In hockey players who have had a long history of groin pain, injuries such as   sports hernias, labral tears and femoroacetabular impingement are common due to skating and hockey mechanics. For a great review on groin injuries and hockey players click here.

Foot and Ankle

Lateral ankle sprains can occur while playing hockey. However, a high ankle sprain is more common with hockey players, due to the rigidity of the ankle in the skate protecting the outside ankle ligaments, but putting the anterior ligaments at risk with twisting and rapid changes in direction. A high ankle sprain involves the ligaments at the front/bottom of the leg that connect the tibia and fibula.

Head and Neck

Facial injuries have decreased dramatically with the use of a helmet with a cage, as well as mouth guards. However, neither have been shown to prevent concussions, which are still common in hockey due to many factors, such as the high speed of the game, an unforgiving surface, bigger and faster players and high rates of collision.

Prevention Strategies

In order for youths to have fun and enjoy playing Canada’s Sport injury free there needs to be education, prevention strategies and management programs that lower the overall injury rates in ice hockey players.

  • Overuse injuries are common and can be prevented with proper off ice conditioning. For example, restoring balance between the hip and core muscles during dry-land strength training can prevent groin injuries.
  •  Proper, well-fitted equipment is essential
  • Injuries should be assessed and treated ASAP!!
  • The majority of injuries occur during player contact; therefore, players need to be encouraged to play fair and safe. While PeeWee hockey has eliminated body checking as a way to decrease the number of concussions, it is unclear whether it will have an effect. Recent research shows that female ice hockey players are more likely to suffer concussions than their male counterparts. This highlights the fact that even though body checking is prohibited in female hockey, it is still a very physical sport;
  • Players, coaches and trainers need to be educated and aware of the rules of the sport, as well as the dangers of hits to the head and body checking another player from behind. Although education programs regarding concussions are effective at increasing education and awareness, most studies show that athletes don’t follow through with what they’ve learned and the effect is usually lost by the 2 month follow-up. While these education programs are essential, more work needs to be done in order to further increase athlete follow through and retention.

MacCormick et al., (2014). Are there differences in Ice Hockey injuries between sexes? The Orthopaedic Journal of Sports Medicine. 2 (1).

Popkin et al., (2016). Evaluation, management and prevention of lower extremity youth ice hockey injuries. Journal of Sports Medicine. 7:167-176.

off balance post concussion physiotherapy sports clinic oakville mississauga

Feeling “Off Balance” Post Concussion

Assessment and treatment of concussions involves a multi-faceted approach in which many systems are examined and treated. An important area to address post concussion is  the vestibular system, which plays an essential role in balance, coordinating movement and spatial orientation. However, it doesn’t work entirely alone. It interacts with the visual system and proprioceptive receptors in muscles and joints, which together send messages to the brain to help achieve and maintain balance and stability as we move through daily activities. Following a concussion there can be direct/indirect damage to any of the systems, which may result in the person feeling off balance, dizzy, nausea, spinning, lightheaded or disorientated. Research has suggested that anywhere from 23-81% of patients will experience one or more of the above symptoms post concussion. Furthermore, these symptoms may be a risk factor for prolonged recovery and can persist in 10-30% of patients. The most common complaint related to dizziness following a concussion is feeling “off balance.” These symptoms are perfectly normal post concussion and can be treated with vestibular rehabilitation.

Vestibular rehabilitation is a key management technique for getting concussed patients back to feeling normal. At Sheddon Physiotherapy and Sports Clinic (SPSC), concussed patients suffering from dizziness and imbalance are thoroughly assessed in order to determine which aspect of the vestibular system is affected. Due to the complexity of the balance system, assessment also includes the visual system (read our past blog here regarding visual rehabilitation), proprioceptive receptors, as well as the integration of all three systems.

From the assessment, patients will be given a treatment approach and exercise program tailored to their individual needs. Exercises may include simple eye-head coordination exercises, visual rehab, static and dynamic balance, ambulation tasks and symptom habituation exercises. A key feature with these exercises is that patients may often feel worse before they feel better, which is counter-intuitive to why they are seeking your help. In most cases, the brain has to learn to compensate in order for your symptoms to improve. Therefore, if you avoid the activities that make you dizzy, you generally will not get better. Having said that, more isn’t better either. Your assessment findings will help your therapist determine how much and how often you should be doing your exercises. Everyone is different and your program will progress as your symptoms improve. 

If you have suffered a concussion and can’t shake the feeling of dizziness and feeling off balance, contact one of the therapists at SPSC in order to assess and treat these symptoms. If you haven’t suffered a concussion, but have any of the above symptoms, vestibular rehabiliation can also work for you (it’s not just for concussed patients). Read our past blog here on living with dizziness.