Tag Archives: Sheddon Physiotherapy Oakville

concussion types treatment Sheddon Physioyherapy Sports Clinic Oakville Mississaugaconcussion types treatment Sheddon Physioyherapy Sports Clinic Oakville Mississauga

Swing into Golf without Lower Back Pain

With the warmer weather approaching, the driving ranges and golf courses will become much busier with golfers eager to start the season. Although golf is usually perceived as a fairly low impact, leisure activity, it has been estimated that every year roughly 40% of recreational golfers sustain an injury, with the most common site of injury being the lower back. Research has shown that the compression force going through the lumbar spine in amateur golfers when driving the ball, is roughly 6100 N. In comparison, cadaver studies have shown that a lumbar disc will herniate at forces around 5500 N. As such, although the golf swing appears fluid and easy, there is certainly enough force produced in the spine to lead to lower back injury. Many other factors can lead to lower back pain, including aspects of the golf swing itself, overall fitness level and regular habits on the golf course, such as how you transport your clubs, whether you warm up or not and how often you practice. 

Why do golfers get lower back pain and what can you do to prevent it?

Core strength

The core muscles play a critical role in protecting and stabilizing the lower back during the golf swing. Furthermore, using these muscles properly during the golf swing has also been shown to help increase club head speed and power. Research has shown that golfers with lower back pain have decreased core strength and don’t use their core properly during their golf swing. A golf specific core exercise program begins with learning how to isolate the key muscles to progressions on how to incorporate them into your golf swing. TIP: Next time you’re getting ready to hit the ball, reduce the amount of stress on the lower back structures by turning on your core muscles. In order to do this, think about drawing in your belly button and tightening your abdominal muscles prior to starting your backswing.


Flexibility is a key component, especially in the hips, shoulders and trunk in order to achieve a full range of motion from the back swing to the follow through. Research has shown that lack of rotation in the hips (especially the lead hip) will put increased stress through the spine. TIP: If you are lacking mobility in your hips or lower back, you may want to try turning both your feet out 25 degrees when setting up to hit the ball. This slight toe-out position will decrease the amount of rotation that needs to come from the spine.

Transporting your clubs


As nice as it would be to have a caddy carrying your clubs, the vast majority of recreational golfers have to depend on themselves to lug their clubs around the course. Research has shown that golfers who carry their clubs are significantly more likely to develop lower back pain, since the weight of the bag leads to increased compression loads on the spine. However, pull carts can also be problematic, as they require twisting of the spine, and riding in a golf cart doesn’t allow the muscles to warm up and stay loose as they would while walking. TIP: If you’re an avid golfer with lower back pain, your best bet is to splurge and get a remote controlled electronic cart that you can walk beside; second best would be a push cart.

Golf Club Fit

Off the shelf clubs are a standard length, with womens’ clubs designed for someone who is 5’4″ and mens’ clubs for someone who is 5’10″. As such, if you’re a 6’3″ male, buying a set of clubs off the shelf, you will certainly notice that you need to bend a lot more during your downswing to make contact with the ball. This will lead to increased flexion and side bending in the spine, which over a course of 18 holes will eventually lead to strain on the lower back. TIP: Spending the extra money to get your clubs properly fitted, will help your swing and your lower back.


Set-up posture plays a crucial role in how much stress will be generated in the lower back. If the lower back is slouched, then there is increased risk for injury. TIP: Make sure that when you’re addressing the ball that your knees are slightly bent and you are bending from the hips, not the back.


Want to read more tips on preventing golf injuries, click here.

At Sheddon Physiotherapy and Sports Clinic, our level 4 FITforeGOLF™ certified providers focus on innovative research on the science of golf health and performance. Therapy focuses on swing mechanics, coupled with a golfer’s specific injury to get the him/her back on the course faster and injury free.

This blog was based on the works of David Lindsay PT MSc and Dean Walker CPGA who have taught excellent courses to our therapists through the FITforeGOLF™ program. For more information you can visit the FITforeGOLF™ website at www.fitforegolf.com

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heading copy

Heading in Soccer: Is it Safe for the Brain?

Concussions make up roughly 22% of all soccer related injuries. As such, concussion prevention is a main focus, with efforts being made to help recognize how and why concussions occur, and if aspects of the sport can be changed to decrease the prevalence of head injuries. Lately, attention has been focused on whether or not heading in soccer can lead to concussion directly or if the cumulative effects of sub-concussive impacts, as seen with multiple headers in one game, can result in brain injury.

Research has shown that the majority of concussions in soccer occur as a result of player to player contact or player to ground contact, with roughly 30% of concussions occurring during heading. However, the majority that occurred during heading (60-78%) were not related to ball contact; they were related to contact with another player. Furthermore, studies have looked at the acceleration forces (linear and rotational) required to sustain a concussion, and soccer headers produce a mean acceleration well below the concussion threshold. 

If heading the ball generally doesn’t produce enough force to cause a direct concussion, can the cumulative effects of repetitive heading lead to brain injury? A review of 7 high quality studies, all examining the effects of heading on cognitive functioning immediately following practices or games, found no significant effects between heading and neurocognitive functioning. However, research that has examined long term effects of soccer participation and heading is less understood. Some studies have shown that high level soccer players who have played for a number of years have cognitive deficits related to attention, memory, visual processing and concentration when compared to non-soccer athletes. However, most of these studies examining long term effects of playing soccer and heading on brain injury are not well done. For example, most studies were completed retrospectively and relied on the athletes memory of their heading and concussion history. There was usually no history taken into account for mental health issues, drug abuse, stress, education, pre-soccer baseline testing, or other factors that could have caused the cognitive deficits. As such, current research regarding the long term effects of heading in soccer is inconclusive. 

Take home message:

  • There is no evidence that heading in soccer causes permanent brain injury or neurocognitive dysfunction.
  • There is limited evidence that heading causes concussion.
  • No definitive research exists to show long term effects of heading on cognitive impairment.
  • In order to decrease the prevalence of concussion in soccer, coaches and trainers should focus on teaching safe and proper heading techniques, with a reduction of athlete-to-athlete contact.

Maher et al., Concussion and heading in soccer: A review of the evidence of incidence, mechanisms, biomarkers and neurocognitive outcomes. (2014). Brain Injury; 28(3): 271-285.

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Baseline Testing: The Key to Effective Concussion Management

Concussion management programs have become a major focus in sports medicine clinics due to the increased public awareness and recognition of concussions. One of the biggest concerns following a concussion is the possibility that an athlete returns to sport before the brain has fully healed and sustains a second concussion, which has the potential to cause irreversible brain damage. Unfortunately, there is no single clinical test that can be done to know when an athlete has fully recovered from a concussion. Furthermore, 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;
  • and visual processing.

These different test results need 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 Mississauga and Oakville area.

Why choose us for baseline testing?

Most clinics will tell you that they provide concussion baseline testing, but that doesn’t mean they do it properly. Traditional baseline programs focus solely on computerized neuropsychological tests, such as the ImPACT test. Although vital for assessing neurocognitive function, research has shown that neuropsychological tests should not be used in isolation, since they only address one aspect of concussion. 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). 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.

How often should an athlete undergo baseline testing?

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. Also, if an athlete sustains a concussion during the season, a new baseline will be done following full recovery from the concussion, in case a second concussion occurs during the year.

We are one of the top private clinics in Canada in volume of concussion baseline testing through Complete Concussion Management. In addition, we have successfully treated hundreds of sports-related concussions and have an extensive network of specialists, including a sports medicine physician, vestibular physiotherapists, chiropractors and athletic therapists. We offer the highest quality of concussion testing and management in the Mississauga and Oakville area. If you are interested in learning more about our baseline testing for individual athletes or teams, please contact us at 905-849-4576

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Pain and Bad Weather Sheddon Physio Sports Clinic Oakville Mississauga

Predicting the Stormy Weather Through our Pain

We probably all know at least one person who is considered to be a human barometer as they can predict upcoming weather changes due to headaches or achy joints. How and why is pain/stiffness weather sensitive? Is it actually backed by scientific findings, or is it purely psychological?

Unfortunately, the majority of studies have found no significant relationship between different weather conditions and pain. Furthermore, findings were strictly subjective pain ratings without objective medical findings. Does this mean it is purely psychological? It is highly unlikely that so many people are wrong. As you can imagine, it is hard to control for weather in a study, as so many weather variables would have to be taken into consideration, that it makes it very difficult to find relationships between any one specific variable. For example, at least 50% of headache sufferers believe that weather changes trigger their migraines/headaches. However, wind speed, temperature, humidity, barometric pressure and sunlight have all been reported as triggers. In addition, some individuals have headaches triggered by falling barometric pressure, while others report headaches with rising barometric pressure. These individual differences make it hard to see specific correlations with any one weather variable.

Overall, the studies that showed specific relationships between pain and weather generally found that cold and damp weather conditions influenced reports of pain in subjects with arthritis, headache, fibromyalgia, gout, low back pain and chronic pain.

Interestingly, one study that took place over a two-year period, examining the effects of weather on active individuals with osteoarthritis, found no relationship between weather and joint pain or stiffness. The authors concluded that exercising regularly, may have diminished the effects of weather on pain (Wilder et al., 2003).

How does weather affect symptoms?

Some studies have tried to explain the physiological effects that weather has on the body, but there haven’t been any conclusive results.

  • Some studies have shown that low vitamin D (less sunshine and less light) may play a role in increasing arthritis symptoms;
  • Some researchers suggest that mood may play a role. Damp and cold conditons are associated with a more negative mood, which in turn has been associated with higher pain levels. One study found that individuals reported the least number of symptoms on warm sunny days, due to more exercise, better sleep and a more positive mood;
  • Colder temperatures may increase joint stiffness and pain, due to an increase in viscosity of synovial fluid;
  • A decrease in barometric pressure will allow tissue to expand, therefore putting more strain on joints;
  • Increased humidity can cause increased joint swelling/stiffness.

Take home message:

There’s not much you can do to change the weather, studies have looked at different climates around the world, and they have yet to find the ideal location. As such, you need to focus on what you can control to help keep your headaches and achy joints happy.

  • Regular exercise may help prevent flare-ups of pain during poor weather conditions;
  • Add layers over your achy joints in order to keep them warm during cold and damp days;
  • Try to remain positive even if the weather is gloomy.


Aikman (1997). The association between arthritis and the weather. International Journal of biometeorology.

Wilder et al., (2003). Osteoarthritis pain and weather. Rheumatology. 955-95

Consussions and suicide Sheddon Physio Sports Clinic Oakville Mississauga

Concussion and Risk of Suicide: Beware of Misleading Information

Concussions are a hot topic, especially regarding the potential for long term health issues. The recent Hollywood movie “Concussion” is based around some current research that has looked at concussions and its association with long term depression and suicide in NFL athletes. With the growing media coverage around concussions, and numerous professional athletes stating long term debilitating effects due to concussions, parents are starting to doubt putting their kids in high-risk sports such as football and hockey. A recent poll in the States found that roughly 40-45% of parents are considering pulling their kids out of contact sports such as football, hockey and wrestling, due to the higher risk of sustaining a concussion. Fortunately, there is lots of research and public awareness surrounding concussions, which is educating parents, coaches and athletes. Unfortunately, along with this increase in concussion knowledge comes potentially misleading information, which is either not fully supported by research or in the early stages of development.

Last month a group of researchers out of the University of Toronto published a study on the risk of suicide post concussion (Fralick et al., 2016). Their results were not very optimistic, as they found that adults with a diagnosis of concussion had an increased long term risk of suicide 3 times the population norm. These results quickly got picked up by the media, adding more fuel to the concussion crisis and putting fear into the public. Although the article was only recently published, there has been some criticism that the results of the study may not be accurate due to methodological flaws. Their results showed an astonishingly high association between concussions and suicide compared to past studies; therefore, criticism has addressed a number of factors which may have biased the sample group, thus causing these high numbers. If you are interested in the detailed critical analysis, you can read more here.

Another major flaw of the study is not fully excluding individuals with a history of mental illness (depression, substance abuse, etc), which is one of the known leading causes of suicide. With the current study, in order to exclude concussed patients with prior mental conditions, physician notes from the year prior to injury were examined. Unfortunately, this method has its limitations, since roughly 45% of people with mental issues, such as depression or anxiety disorders, are either non-diagnosed or have not yet sought treatment. Including concussed patients with a prior mental disorder will skew the results, since the cause of the suicide may have had nothing to do with the concussion.

Unfortunately, anyone in the general public coming across the results of this study in the news will not likely seek out the article and read through the methods section in order to look for flaws. They will quickly look at the results and likely jump to the conclusion that anyone with a concussion is doomed. The overall goal of the present study was to gather some longitudinal data and answer a question in which many are interested. Please use caution when coming across such articles, and until further research emerges, there still is no definitive answer as to whether or not a concussion directly leads to an increased in suicide risk.

Take home message:

What do we know about concussions and long term health issues?

  • Long term complications following concussion are still not fully understood;
  • Determining who will have long-standing concussion symptoms is also not fully understood;
  • The causes of suicide involve many factors and likely cannot be directly related to a single specific cause;
  • Pre-existing mental health issues is one of the strongest predictors of post concussion depression and anxiety (Yang et al., 2015);
  • Depression scores will increase post concussion; however research shows that even mild musculoskeletal injuries will increase depression scores post injury. Mainwaring et al., (2010) showed that athletes with ACL injuries reported higher emotional disturbances, such as depression and anxiety, and for a longer period of time, compared to the concussed athletes;
  • Football players are likely not doomed. Many studies have examined the risk of depression and suicide in former NFL players and the risk is either similar to that of the general population or even lower;
  • Proper management of concussion is key for full recovery;