Tag Archives: Physiotherapy Oakville

Oakville Soccer Club 2017 Concussion Baseline Testing Invite

Dear OSC Parents, Players, Staff,

Concussions make up roughly 22% of all soccer-related injuries. One of the biggest concerns following a concussion is the possibility that an athlete returns to sport before the brain has fully healed; sustaining a second compounding concussion has the potential to significantly delay healing and/or cause irreversible brain damage.

Research has shown that symptom resolution occurs 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.

How are health practitioners, coaches, and parents supposed to know when an athlete is ready to return to sport? 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, including:

  • Balance;
  • Strength;
  • Reaction time;
  • Neurocognitive performance;
  • Visual processing.

These different test results need to be compared to pre-injury values in order to know when an athlete has returned to their normal pre-concussion baseline values. As such, the best way to ensure that you return to sport safely following a concussion is to get baseline tested before a concussion even occurs.

At Sheddon Physiotherapy and Sports Clinic we offer the most comprehensive concussion baseline testing of any sports medicine clinic in the Oakville and Mississauga area.

If you have further questions regarding concussions, concussion baseline testing, or would like to book an individual or team baseline, please call us at (905) 849-7856.

Frequently Asked Questions

Q: The season has already started, are we too late for concussion baseline tests?A: NO! Preseason is ideal, but anytime during the year is better than no baseline.

Q: Will the cost be covered through my insurance?
A: The cost of the baseline is covered under most Extended Health Plans since it’s administered by a physiotherapist.

Q: My child had a baseline done over a year ago, why should we do it again?
A: 
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.

Q: Isn’t the ImPACT test enough?
A: 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.

If you have further questions regarding concussions, concussion baseline testing, or would like you book an individual or team baseline, please call us at (905) 849-7856.

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Achilles tendon injury recovery 2016 Sheddon Physioyherapy Sports Clinic Oakville Mississauga

Growing Pains

Osgood Schlatters, Severs and Sinding Larsen Johansson diseases are common adolescent conditions that people think of when they hear of injuries affecting young rapidly growing athletes. However, traumatic injuries, such as ACL tears and overuse injuries, such as stress fractures, are also more prevelant during the adolescent growth spurt. Many adolescent athletes are specializing in sport earlier and are engaging in year round training. How can you make sure that your young athletes can continue to train during this vulnerable stage of development without suffering from injury?

Physiological changes during the Adolescent Growth Spurt

  • Hormonal changes, such as an increase in estrogen in girls, has been shown to potentially lead to increases in ligament laxity, and therefore decrease joint stability;
  • The bones are growing faster than the muscles can adapt in terms of flexibility and strength, which puts a lot of stress on the muscle-tendon junctions, bone-tendon junctions, ligaments and growth cartilage;
  • Increased risk of growth plate injury due to decreased physeal strength during this time;
  • Increases in height lead to a higher center of mass, which makes muscular control of the body and balance more challenging;
  • Bone mineralization lags behind bone linear growth, which makes the bone more fragile to injury;
  •  “Adolescent Awkardness”, whereby growth is occurring at different rates and there is now an imbalance in strength, flexibility and coordination;
  • Altered landing biomechanics in response to growth and development (i.e., increased knee valgus);
  • Sensorimotor function is not fully mature by the time children reach adolescence.

Injury Prevention Strategies

  1. Stay flexible by keeping the muscles at an optimal length as the bones grow, with particular focus on the hamstrings, quadriceps and lower back (which have all been shown to be excessively tight during the adolescent growth spurt).
  2. Strengthening key muscles (i.e., core/hips, etc.) to prevent imbalance.
  3. Focus on exercises that develop neuromuscular control, proprioception and postural stability, especially for young female athletes.
  4. Proper technique in landing and jumping, since this is one of the main mechanisms of injury in this age group.
  5. Careful monitoring of training workload during this vulnerable period, especially if the athlete is showing early signs of an injury.

If you are the parent, coach or trainer of a young growing athlete, be proactive and chat with one of the therapists at Sheddon Physiotherapy and Sports Medicine on injury prevention strategies. If your child is already showing signs of injury, book them in for an assessment to help alleviate pain and return to sport healthy.

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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.

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Prevention of Ankle Injuries in Soccer Players

Soccer requires a lot of sudden stops, cutting, jumping and landing movements, which have all been shown to increase the risk of lower extremity injuries, especially to the ankle. Roughly 35% of all soccer injuries occur in the ankle, with an average time lost from play of about 48 days. With the high prevalence and long recovery time associated with ankle injuries, identifying modifiable risk factors and prevention strategies is key to keeping athletes healthy on the field.

Mechanism of Injury

Roughly 50% of soccer related ankle injuries occur during contact with another player. Other common mechanisms include:

  • Overuse;
  • Tripping on grass;
  • Jumping, twisting and landing;
  • Tackling;
  • Shooting/kicking.

Common Ankle Injuries

The most common ankle injuries experienced by soccer athletes are ligament sprains (80%), followed by overuse impingement syndromes, tendonitis (achilles, peroneals, posterior tibial tendon), and though rarely, soccer players will experience fractures or osteochondral lesions.

Ligament Sprains

Ankle sprains account for 80% of all soccer athlete injuries, and these athletes are 5x more likely to sustain a recurrent ankle injury upon return to soccer. Initial treatment following a sprain will involve modalities, manual therapy and rest. However, functional treatment is key for long term success, focusing on strengthening, balance, and proprioception required for return to sport.

Anterior Impingement Syndrome

Anterior impingement syndrome, better known as “Soccer Ankle”, has been shown to occur in roughly 60% of professional soccer players. Athletes generally feel pain in the front of the ankle, with feelings of giving way and catching, as well as pain with dorsiflexion movements (moving your foot up), squatting, sprinting and stair climbing. It has been proposed that recurrent ball impact results in microtrauma to the anterior joint, causing extra bony growth, which can become impinged with movement. Physical therapy treatment can be successful; however some athletes will require surgical intervention, which does have a high success rate.

Tendon and Muscle Strains

Tendon and muscle strains are another common overuse injury experienced in soccer players, with the achilles being the most common site of injury. To read a more comprehensive review on achilles tendon injuries and prevention strategies, click here.

Risk Factors

Several risk factors have been shown to predict who will sustain an ankle injury:

  • Previous injuries increased the risk for an ankle injury by up to 7x – especially if previous injuries were poorly rehabilitated. Symptoms that become chronic can be an indicator that the previous injury has not been properly rehabilitated, and overuse will eventually lead to future injury.
  • Muscle tightness or strength imbalance 
  • Slower reaction time 
  • Overuse
  • Joint instability (Mechanical instability due to ligament laxity or functional instability due to poor proprioception, coordination and weakness).
  • Poor balance and lower limb power (vertical jump)
  • Insufficient training
  • Inadequate warm up
  • Increased age:  Adolescent studies showed a high rate of injury in 12-15 year olds.
  • Playing on artificial turf has been associated with a greater risk for ankle sprains
  • Increased likelihood during competitions vs. training

Although there are several risk factors for ankle injuries, it is predicted that 30% of them are caused by a chance event that cannot be avoided.

Prevention Strategies

  • Warm up:
    • An improper or lack of warm-up is one of the easiest ways to injure yourself. Take 5-10 minutes before games to warm up properly. Check out the FIFA11 warm-up program here.
  • Stay in shape:
    • Preseason training should focus on muscle imbalances and weaknesses, with particular attention placed on proprioceptive exercises, especially in young adolescent soccer players.
  • Follow the rules of the sport:
    • Unfair player contact accounts for 25% of soccer related ankle injuries
  • Adequately rehab your injuries with sufficient rest time
  • Protective equipment:
    • Shin guards have been shown to reduce the impact forces to the leg, reducing the occurrence of soft tissue and fracture injuries to the lower extremity. In addition, ankle braces have been shown to provide mechanical stability to the ankle joint, as well as increase proprioception in previously injured ankle joints.
  • Focus on neuromuscular, balance and proprioceptive training:
    • Proprioceptive mechanoreceptors are found in the ligaments in the ankle. As such, injury to the ankle will likely damage these mechanoreceptors, resulting in a proprioceptive deficit and instability in the joint. If proper rehabilitation exercises are not completed prior to return to sport, then the athlete is at an increased risk for re-injury.
    • Proprioceptive exercises should include balance training in a static position progressing to dynamic movements, including equipment such as the bosu, wobble disc and balance boards. Furthermore, plyometric exercises that enhance joint stabilization and reaction time exercises should be part of the return to sport training program.

With cooler weather coming, this marks the start of the indoor soccer season. Ensure your current injuries are well rehabilitated and spend some time working on your weaknesses (strength, proprioception, balance, etc.). Research has shown that indoor soccer is associated with twice as many injuries than outdoor soccer. Possible factors include high-speed movements, smaller size field, and surface changes. Focus on yourself now and don’t get stuck on the bench resting your injuries this indoor season.

Henry et al., (2015). Risk factors for noncontact ankle injuries in amateur male soccer players: A prospective cohort study. Clinical journal of sport medicine. 26:251-258.

Nery et al., (2016). Foot and ankle injuries in professional soccer players. Diagnosis, treatment and expectations. Foot and ankle clinic N. Am. 391-403.

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Strong Feet = Less Injuries

You probably don’t see a whole lot of athletes spending time in the gym focusing on strengthening their feet. However, research has shown that exercises targeted at strengthening the feet can help prevent and treat a number of different foot conditions, such as plantar fasciitis, metatarsalgia, tibialis posterior tendinopathy and hallux valgus (bunions).

Why is a strong foot so important?

The intrinsic muscles of the feet help with stability, shock absorption, balance, arch support and foot mechanics. If there is a weakness in these deep muscles, then other structures will take the extra load, which subsequently lead to injuries not only in the feet, but also up the lower extremity, as biomechanics of the whole leg are altered. For example, weak intrinsic foot muscles can lead to over-pronation of the feet, which results in the leg rotating inwards, putting strain on structures of the hip and knee, potentially causing injuries to these areas.

Luckily, you don’t have to devote a whole training workout just to your feet. Research has evaluated EMG muscle activation of the intrinsic foot muscles during a number of different foot exercises in order  to determine which exercise is the most beneficial. The key exercise across a number of different studies is the “short-foot exercise.”This exercise has been widely studied and has been supported in the research for the following conditions:

  • Preventing foot/lower extremity injuries in runners;
  • Decreasing pain and disability due to bunions;
  • Prevention and treatment of plantar fasciitis;
  • Decreasing the risk of falls in the elderly

Instructions:

  • With even weight on both feet, place a business card under the first metatarsal head and slide the card back towards your heel as you lift the inside of the foot (in order to raise your arch)
  • Be sure to keep the weight on the metatarsal heads where the business card is placed – not through the toes; you should be able to lift the big toe up and down.
  • Hold the position for 10 seconds, relax and repeat for 10 repetitions and 2 sets.

Click here for a visual

The short-foot exercise is initially done in a seated position and can be progressed to more challenging positions, such as standing, balancing on 1 leg and eventually while doing functional activities such as squatting. Research has shown that doing this exercise daily for 4 weeks improves postural control of the foot, specifically preventing over-pronation, as well as improving balance and proprioception. 

If you have been suffering from foot pain that won’t go away, contact Sheddon Physiotherapy and Sports Clinic and a therapist can help get you back on your feet.

Fourchet and Gojanovic (2016). Foot core strengthening: relevance n injury prevention and rehabilitation for runners. Swiss Sports and Exercise Medicine. 64,26-30.

Jung et al., (2011). A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Physical Therapy in Sport. 30-35.

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