Written by Aidan Lunney – APA Sports & Exercise Physiotherapist

Over the last 10 years, the spotlight has certainly shone bright on acute head injuries, or as we know it – Concussion. Prior to this, it was often brushed to the side, seen as a badge of toughness and an injury that wasn’t taken seriously because the damage wasn’t visible. Having previously worked in schoolboy level, and now semi-professional state level Rugby League, the scary reality that is a concussion, or to be specific, a Traumatic Brain Injury and it’s frequency has never been more pertinent to me. This year has seen the Australian Institute of Sport, in conjunction with the Australasian College of Sports & Exercise Physicians, Australian Physiotherapy Association and Sports Medicine Australia release the “2024 Concussion and Brain Health Position Statement”. The importance of recognition, assessment and the role of appropriate rehabilitation was highlighted, particularly with a spotlight on the effectiveness of Physiotherapy intervention in managing and assisting in the return to play and performance process. This topic is what we will look to unpack and highlight in this blog piece, a topic that is a keen interest area of mine.

What is a Concussion?

A concussion is defined by the American Association of Neurological Surgeons (2024) as “an injury to the brain that results in temporary loss of normal brain function. Medically, it is defined as a clinical syndrome characterised by immediate and transient alteration in brain function, including alteration of mental status or level of consciousness, that results from mechanical force or trauma.” Often, impairments in memory, judgement, reflexes, balance and muscle co-ordination are seen, or the individual reports a brief period fogginess or confusion, Concussions are often seen in large head collisions, however can also be more innocuous, requiring a high level of suspicion for everyone involved. Regardless of the severity or presentation, all head trauma should be taken seriously, considering current commentary and findings of Chronic Traumatic Encephalopathy (CTE) which is a degenerative brain disease resulting from recurrent head trauma.

How do we recognise a Concussion?

A concussion can be recognised by the following signs and symptoms:

• High Velocity or Direct Head Collision
• Confusion
• Headache
• Vision disturbances (double or blurry vision)
• Dizziness or imbalance
• Nausea or vomiting
• Memory loss
• Ringing ears (Tinnitus)
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste
• Trouble falling asleep

Duration of Concussion Symptoms

What a tough question to answer! Current evidence tells us that physiological healing of our brain post a concussive episode is near complete at three week point post injury. However, despite these timeframes, we often see an array of longer lasting deficits following a concussive episode. People dealing with post-concussion syndrome, or longer lasting concussive symptoms continue to deal with symptoms related to:

• Light and sound irritability
• Balance and Vestibular issues
• Short and Long Term Memory issues
• Cognitive dysfunction
• Autonomic Nervous System Dysfunction – e.g. fatigue and exercise intolerance
• Neck and upper back pain
• Headaches
• Gaze stability and visual focus – difficulty with visual focus in both simple and complex scenarios.

What is the current management of a concussive episode?

Whilst sporting governing bodies across the globe adopt slightly variable management and return to play processes, it is important to understand and be aware of the core stages in managing a concussion, and subsequently safely returning to play. Variability presents itself across sporting codes policies when it comes to timeframes for graduated return to training stages and subsequent play. Following appropriate physical, cognitive and emotional rest, a graduated return to low intensity, followed by high intensity sport-specific training occurs. This occurs in conjunction with targeted rehabilitation that as Physiotherapists, we employ to target key areas such as balance, visual and neck/upper back impairments should they arise.

How can Physiotherapy help with post-concussion symptoms?

Physiotherapy guided rehabilitation can be extremely effective in managing the spectrum of effects that are resultant of a concussion. Physiotherapist’s are well versed in concussion specific assessment, diagnosis and holistic rehabilitation. Patient and contextually specific advice and education, targeted manual therapy and deficit specific rehabilitation in a patient specific, multi-disciplinary model is our approach here at Physioactive. With assistance from our Sports Registrar, Dr. Jack Cookson, who has a keen interest in concussion rehabilitation and can assist in timelines and return to work/play processes, we aim to work collaboratively with our patients in delivering an evidenced based, contemporary and patient specific rehabilitation profile. In this, ensuring a safe, progressive and all-encompassing return to performance profile occurs, exemplified in the diagram on the right.

How can we help you at Physioactive?

Offering a full suite of Sports Medicine and Allied Health Services, we at Physioactive are best placed to assist with your concussion management. To make an appointment, or for more information, please give us a call on 3281 8876 or visit our website at www.physioactive.com.au

References & Resources

2024 Concussion and Brain Health Position Statement – https://www.concussioninsport.gov.au/__data/assets/pdf_file/0004/1133545/37382_Concussion-and-Brain-Health-Position-Statement-2024-FA.pdf

As the Christmas holidays approach, formal training, and conditioning start to wind down. As we should, we shift our focus to enjoying our time off after busy years, sporting seasons and training regimes. However, we often find the reload process post-Christmas, particularly for those with an injury history can be a common cause for physical break down, re-aggravation and the development of load related conditions.  

Whilst Physiotherapist’s and Exercise Physiologist’s here at Physioactive provide rehabilitation for sporting and musculoskeletal conditions, we work hard to emphasise the importance of injury prevention and forward planning. That doesn’t sound that exciting, does it? Think of it as “Body Insurance”, a free policy and plan you can undertake that research tells us is effective in maintaining and developing capacity, lowering the risk of injury, and keeping you primed for the season to come. Remove the need for formalities and the structured approach to exercise, these “prehab” programs are a small battery of targeted strengthening, stability or mobility-based exercises individually tailored to meet the needs of your injury history, current injury and return to activity goals.  

Our musculoskeletal system is made up of five different tissues; bone, muscle, ligament, tendon, nerve, with each individual tissue positively and negatively reactive to certain stressors. Expert knowledge in these areas, along with targeted programming form the crux of the “Body Insurance preventative program.” Considerations around weekly exercise load (running, jumping etc), exposure to high impact exercises (pertinent for healthy bone load and tendon capacity), sport and age specific strengthening and balance training all come together to formulate this off-season gem.  

To have a chat with one of our clinical team about these programs, feel free to contact our administration team at 3281 8876, or book online at www.physioactive.com.au 

Written by Aidan Lunney – APA Titled Sports & Exercise Physiotherapist  

When we think of Australia’s exercise recommendations of at least 2.5 hours of moderate exercise per week alongside two strength training sessions, many of us will immediately link this to helping maintain our physical and cardiovascular health, managing our weight, and preventing disease or conditions like diabetes. 

Thanks to social media and the marketing tactics of the fitness and beauty industry, the view on exercise has been skewed to be a ‘must do’ chore or a punishment for eating tasty foods – a tick-list item that is necessary to achieve an “ideal” body. But there is so much more to exercise than what we see in advertisements and viral videos – and don’t just take our word for it – this is the exact theme of this year’s national Exercise Right Week campaign, which is aiming to change the unhealthy relationship with exercise that this dialogue in the media is creating, showing you that the real additional benefits of exercise have nothing to do with the number on a scale or the amount of kilometres on a tracking app.  Read more

After sustaining an injury during sports, the first thing on many players’ agenda isn’t just recovering from that injury, but how to do so as fast as possible. While injuries sustained during sports can vary greatly in their location, severity, and how they occurred, there are five things that anyone can do to help optimise their recovery so they can get back on the sports field as fast as possible regardless of their circumstances. Read more

The new school year brings a mix of excitement and chaos. Amongst the never-ending to-do list to get the kids prepared is a key priority: buying your kids a new pair of well-fitting school shoes that you feel confident will keep their feet supported and feeling great throughout the school year.

Read more

With summer around the corner, it won’t be long until you can rejoin your teammates and fill your days with cricket, soccer, tennis and all your favourite summer sports. As a result, we’ve been fielding plenty of questions about the most effective ways to improve sports performance, and do so fast. 

Read more

We are sad to say that our loveable team members Deborah and James are leaving us after 23 and 12 years respectively.

Thank you for all your hard work and friendship over the years!

We wish you all the very best for the future!!

Menstrual related pain can quite often make it harder to engage in exercise or skip planned sessions. Menstrual associated symptoms such as abdominal cramps, increase in fatigue, bloating and reduced quality of sleep often causes a decrease in exercise or general movement during the time of menstruation. However recent research shows that engaging in appropriate exercise  can help manage common period discomforts (Demiralp and Kirmizal 2020).

Read more

Suffering from a sore lower back?

You are not alone – about 80% of the population experiences a sore back at some point in their lives, regardless of their physical and psychological health. But don’t despair – most people recover within 4-6 weeks.^[1]

Why am I experiencing low back pain?

Low back pain can affect us at any age but it most commonly occurs between the ages of 20 and 60 years. There are various factors that can contribute to a person experiencing low back pain including repetitive awkward lifting or a sudden trauma such as a fall. But there is strong evidence that non-physical factors, such as the presence of other co-morbidities (e.g., diabetes), not getting enough sleep, changes in mood, stress, smoking, can also result in a person experiencing back pain. Low back pain can be a scary experience, especially when it’s persistent and effects work performance, social responsibilities and family life.

Do I need physiotherapy to relieve my low back pain?

There are many different approaches that physios can take to help you manage low back pain – the approach taken will, amongst other things, depend on your individual presentation and your goals. But in the first instance, you might like to try these 4 gentle exercises as a starting point. If you are unable to perform any of these tips safely or easily, it’s a good sign that you will benefit from seeking advice from a physio.

If I have low back pain, should I rest?

There is good evidence that lying in bed and being still for long periods will prolong back pain symptoms. Although it can be challenging, movement is typically the best way to help you recover as fast as possible. Keep up with gentle activity and regular short walks – even if the walks are only around the house to start with.

Here are 4 gentle movement-based exercises you can try:

• Knee rocks – Performed to help relieve pain. Try performing 10-15 each direction, ensuring you keep breathing comfortably and relax your tummy muscles.
• Knees to chest – Performed to help relieve pain – i.e. try this movement and test to see whether it helps relieve your symptoms or improve your movement. Keep your tummy and back muscles relaxed whilst doing the exercise.
• Glute stretch – Hold for 30 seconds on both legs
• Avoid prolonged positions –  Aim to move at least every 20 minutes. For example, if your job involves sitting for long periods, try standing up every 20 minutes, walking around or even kneeling on something soft such as a cushion

Note: all of the above exercises are a guide only – if you’re unsure on how to do these correctly feel free to contact your physiotherapist.

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We’re here to help

If you are finding your low back pain is not settling and/or you would like further advice on how best to manage your symptoms or prevent recurrence, get in touch with one of our physiotherapists. Our highly trained physiotherapists will work with you to help you understand what’s going on and help you address the factors contributing to your back pain. We can also make a plan to be proactive about your lower back with options such as weights, Pilates, yoga and general body exercises to name a few.

References

[1] Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. European Spine Journal 2018 Jan;27(1):60-75. 2018.