Tag Archives: return to sport

How to Recognize a Concussion?

Concussion Symptoms

Concussions make up roughly 22% of all soccer related injuries. Despite public awareness and athlete education surrounding concussions, roughly 50% of athletes do NOT report their concussions and return to sport while still symptomatic. These athletes either see no harm in playing with a concussion, believe it will make them look weak, or truly do not realize that they have sustained a concussion. In reality, a concussion should be taken seriously. Playing any sport with a concussion will prolong recovery, and if the athlete were to sustain a second impact, there is the potential for additional and more complicated injuries to the brain, which could even be fatal. This article is meant to educate coaches, athletes, trainers, and parents on how to recognize and manage concussions more effectively.

Concussion Recognition

Recognizing a concussion is the most important step in the management of the injury. Concussions are extremely difficult to recognize because you must rely heavily on athletes reporting their symptoms, and no two people will experience a concussion in the same way. If an athlete sustained a significant hit to the head OR body, you should suspect a concussion. REMOVE THEM FROM PLAY, and assess for symptoms. There are a number of different symptoms that people will experience, including physical symptoms (i.e., headaches, fatigue, dizziness, blurry vision, neck pain, balance issues, nausea), cognitive issues (i.e., poor concentration, memory issues, confusion) and/or emotional disturbances (i.e., irritability, sadness, emotional). If an athlete denies any symptoms, there are still some signs you need to look for:

  • Does the athlete appear to be disoriented, slow, or uncoordinated?
  • Does the athlete seem to be starring into space or appear dazed and confused?
  • Is the athlete sick and vomiting?
  • Is the athlete acting odd or out of character?
  • Did the athlete lose consciousness?
  • Is the athlete unable to respond to simple questions? Is their speech slurred?

If the athlete has any of the above signs or symptoms it is best to err on the side of caution and have a medical practitioner assess and diagnose properly. Early concussion recognition and intervention has been shown to significantly decrease recovery time and improve long-term outcomes. At Sheddon Physiotherapy and Sports Medicine all of our therapists are trained in concussion management and we strive to assess athletes with suspected concussions as quickly as possible.

Importance of a Concussion Baseline Test

A concussion impacts how the brain functions; therefore an MRI and other brain scans will NOT detect a concussion. Furthermore, there is no single clinical test that can be done to know when an athlete has sustained or fully recovered from a concussion. Occasionally, athletes sustain a hit and have a vague concussion presentation, whereby they deny symptoms, but parents feel that something seems off. In unclear cases like these, a preseason concussion baseline test comes in handy since it tests different areas of the brain that could potentially be affected by a concussion. Post injury test results need to be compared to pre-injury values in order to know if/when an athlete is at their normal pre-concussion baseline values. If an athlete does not achieve their pre-concussion baseline value in one or more components of the test, then a concussion is diagnosed. The baseline test is also essential for return to play decision-making. Research has shown that if sport clearance is based solely on symptom resolution, which occurs much sooner than brain recovery, athletes may be at risk for returning to sport too quickly. 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.

Concussion baseline testing is currently recommended in the National Concussion Guidelines for all athletes. This guideline was developed by chief medical experts of the Canadian Paraylmpic Committee, Own the Podium, and the network of high performance sport institute across the country. At Sheddon Phyiotherapy and Sports Medicine, we offer the most comprehensive and research proven concussion baseline testing of any sports medicine clinic in the Mississauga and Oakville area. Teams and athletes across the GTA have trusted in our baseline testing for many years. To date, we have completed over a thousand baseline tests and successfully treated well over 800 concussions.

All of the therapists at Sheddon Physiotherapy and Sports Clinic have undergone extensive training with the Complete Concussion Management program in order to be educated with the most recent research-proven concussion management strategies. CASM and the Canadian Concussion Collaborative strongly promote a multidisciplinary approach to concussion management, which extends beyond the family doctor to include health care professionals with developed skills and expertise in concussions. If you have experienced a concussion and are still suffering from symptoms, contact one of the therapists at SPSC in order to assess and treat them immediately. If you have not suffered a concussion, but play a high-risk sport, contact SPSC regarding our baseline testing at 905-849-4576.

We are located only 6 min East of Oakville Place and 7 min from Oakville Go Station.

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ACL Rehabilitation: What you Knee’d to know.

ACL injuries continue to be one of the most common and devastating sports injuries. Despite the long and extensive rehabilitation process, rates of re-injury range from 3-22% for an operated ACL and 3-24% for the contralateral ACL in the first 5 years after surgery. Due to these numbers, many athletes never return to their sport. A recent systematic review was published by a group of ACL experts in order to help develop evidence-based guidelines for rehabilitation following ACL reconstruction. Topics they examined included:

  1. Preoperative factors that can effect recovery;
  2. Effectiveness of physical therapy;
  3. Benefits of specific exercises;
  4. Return to play guidelines;
  5. Risk for re-injury.

Preoperative factors

Many athletes will start doing physiotherapy prior to surgery in order to strengthen the knee. The above researchers found that quadriceps weakness, as well as extension deficit (not being able to reach 0 degrees of extension or more) prior to surgery, will have a negative consequence on the rehabilitation process post-surgery. Don’t tell yourself these issues will get “fixed” with surgery, prehab is essential to guarantee a successful post-surgery outcome.

Strength and Neuromuscular training

There are many exercise programs designed for ACL injuries. What exactly should you be focusing on? Strengthening, proprioception and neuromuscular training are vital, especially for return to sport. For some ideas on where you should be focusing, please read our earlier blog, here.

Modalities

Most physiotherapy clinics use a variety of different modalities with their patients, but which ones are most useful post ACL?

Muscle stimulation has been shown to be effective when combined with exercise. The muscle stimulation will help activate the muscles, which are either too weak to engage, or are inhibited due to pain and/or swelling. The machine helps turn on the muscle during exercise, and the patient is encouraged to work with it to help regain strength. In addition, cryotherapy has been shown to help with acute pain and swelling.

Return to Play

Return to sport rehabilitation should focus on plyometrics and agility, as well as take off and landing mechanics. A series of different tests need to be performed in order to determine readiness to return to sport. These tests should assess strength, balance, and proprioception, as well as functional sport patterns. It is essential that both the injured and uninjured knees be tested, due to the high rate of injury to the opposite knee with return to sport.

Risk of Re-injury

Rates of re-injury range from 3-24% for either the surgical or non-surgical knee, with some researchers claiming that the opposite knee is twice as likely to get injured upon return to sport.  Other studies have shown that age is a major predictor of recurrent ACL injuries, with young athletes (under 20) having a rate of 20-40% re-injury. Other risk factors include:

  • Poor neuromuscular function and biomechanics;
  • Higher activity level;
  • Allographs vs. autographs.

Whether you have just been diagnosed with an ACL tear and you’re waiting for surgery, or you’ve undergone the surgery and are working on rehabilitation, the staff at SPSC can help guide you along the way to ensure a full and successful return to sport.

Van Melick et al., (2016). Evidence-based clinical practice update: Practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. BJOSM.

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Sheddon

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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Friends in Need are Friends Indeed

Physical therapy plays a significant role in the healing process for all types of injuries, but there are also psychosocial factors that can influence how long it takes an individual to recover. Research has shown that one of the most significant psychosocial factors during the injury recovery process is “social support.” Social support has been defined as having caring people around for guidance, encouragement and assistance. Ones social support network can consist of a number of different people, including family, friends, co-workers, teammates, coaches and therapists.

Although ANY social support is beneficial, research has shown that it is important that key people are part of the social support team. For instance, in terms of return to work following injury, research has discovered that workers who felt they had good social support at work, such as getting along with co-workers/supervisors and having a caring work environment, were less likely to develop chronic pain, recovered sooner and returned to work sooner. Along the same lines, the majority of injured athletes reported family and friends as their primary sources of support. However, social support from therapists, coaches and teammates had a more positive effect on the rehabilitation process. More specifically, social support from therapists and medical staff has a strong influence on the athletes well-being and recovery during rehabilitation, while support from coaches and teammates was necessary for a successful return to sport and competitive readiness.

As a friend, spouse, parent, coach, employer, coworker, etc., don’t take for granted the power of supportive relationships by letting others know that you care. Social support helps decrease stress, enhances positive beliefs, promotes overall well-being and improves coping skills during recovery from injury.

Take home message:

  • Coaches and teammates should stay in touch with injured athletes and keep them involved in team practices and functions;
  • Athletes have a more positive rehabilitaion and return to sport if coaches are sensitive to the injury, supportive and reassure the athlete that they will return to pre-injury status;
  • As an employer, workers returned to work sooner and recovered quicker if they perceived a caring work environment. Check in on them and let them know that you are looking forward to their healthy return.

Fernandes et al., (2014). Social support and sport injury recovery: An overview of empirical findings and practical implications. Revista de Psicologia del Deporte.

Steenstra et al., (2011). Systematic review of prognostic factors for workers’ time away from work due to acute low back pain: An update of a systematic review. Technical Report.

Melloh et al., (2013). Who is likely to develop persistent low back pain? A longitudinal analysis of prognostic occupational factors. Work. 297-311.

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