With winter sport starting up again, it seems a perfect time to talk about concussion. Concussion seems to be the hot topic over the past few years: Sports commentators are talking about it far more than ever before and even Hollywood has shown the impact of concussion on people’s lives.
In this article we will cover:
-
- What is Concussion?
- Signs and symptoms
- What do the latest guidelines say about assessment and treatment?
- When can a player return to sport?
- Post Concussion Syndrome and how physio plays an integral role in rehabilitation
What is concussion?
Concussion is a head injury caused by traumatic forces to the brain. This can happen either by a direct hit to the head or a ricochet effect from a big impact.
What does concussion look like?
There are obvious and subtle signs that someone has sustained a concussion……
Obvious
-
- Loss of consciousness
- Slow to get up
- Confusion/disorientation
- Blank look
- Balance, walking and coordination problems
- Memory Loss – you can ask them some simple questions like “What venue are we at today? What half is it?
Subtle
-
- Drowsiness
- Dizziness
- Light and noise sensitivity
- More emotional than normal
- Feeling foggy
- Headache
What do the latest 2021 guidelines say about concussion?
A player who has a suspected concussion must be removed from the game immediately and must not return under any circumstances. There are a few important initial things to do with a player suffering a suspected concussion:
1) Monitor symptoms, particularly for any serious symptoms. You should call in ambulance immediately if player has any of the following signs or symptoms:
-
- Neck pain or tenderness
- Double vision
- Weakness or tingling/burning in arms or legs
- Severe or increasing headache
- Seizure or convulsion
- Loss of consciousness
- Deteriorating conscious state
- Vomiting
- Increasingly restless, agitated or combative
2) Player must not be left alone for 1-2 hours
3) The player must avoid alcohol
4) The affected player must not drive home, a responsible adult must drive them home.
5) You can conduct a memory test.
Within 72 hours of the initial injury:
The player must be referred to an emergency department or see a medical professional who is experienced in concussion management.
Once the player has returned home, they need 24 hours of total rest from mental and physical activity. This includes minimal screen time, no school/work and no physical activity.
The total minimum time for complete and relative rest (until symptoms have stopped with no medication) is 7 days for 19 years and over &14 days for 18 years and under.
When can the player return to sport?
This time will vary from player to player however the minimum times are as follows:
-
- Under 18 years cannot return for at least 19 days after all symptoms have disappeared
- Over 18 years cannot return for at least 12 days after all symptoms have disappeared
Does headgear reduce the risk of concussion?
There is a strongly held idea that wearing headgear will reduce the risk of concussion. Significant research has been conducted in the area and unfortunately has not found that wearing headgear will reduce concussion risk. Does this mean you shouldn’t wear headgear…no! Headgear is particularly useful at reducing the risk of cut to the head, as well as the dreaded cauliflower ears.
How can physio help in concussion?
While most people will recover without problem from concussion, some players will develop post concussion syndrome (PCS) which can limit players from return to sport for extended periods of time. Physiotherapy plays a key role in PCS and can help players to return to sport up 4 times quicker as neck pain, stiffness, weakness and reduced joint position sense (JPE) all contribute to PCS and can be addressed with specific exercises and manual therapy.
If there is 1 key thing to remember with regards to concussion, it is this… “If in doubt, sit it out!”
If you have any questions regarding concussion or post concussion syndrome, please do not hesitate to get in touch with us at by calling 8319 3642 or email info@clinicalphysio.com.au
How to Treat and Manage Stiff Ankles
If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.
- Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.
Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:
- Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.
Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!
Hip Range of Motion
How Much Flexibility Do I Need and How Do I Test It?
For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:
- Lie down on your back with your legs extended.
- Place the inclinometer length-ways on your thigh,
- Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.
How to Treat and Manage Stiff Hips
The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.
For the rest of the population, here are some effective strategies for improving hip mobility:
- Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
- Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
- Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.
Conclusion
Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.
By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!
