Concussion is quickly becoming one of the primary areas of focus in modern sport. This is particularly true here in New Zealand, where higher risk contact sports such as Rugby are so widely played. We are only now starting to recognise the long term effects of concussion; more and more retired athletes are being diagnosed with chronic traumatic encephalopathy (CTE), which until recently was a condition onlyA seen in retired boxers and other combat sport athletes.

While as a whole, sporting bodies are starting to take the dangers around concussion more seriously, and are putting in place previsions to better protect their players, some are still lagging behind. While Rugby Union has had rules directly relating to concussion and the management of concussed players for some time, and is putting significant time and effort into better managing concussions, other sports such as Football (Soccer) are frequently found wanting in regards to their attitudes and regulations regarding the injury.

We, as healthcare professionals, are by no means free of fault in this regard either. The severity, or even the presence of a concussion, is often underestimated, and too often, management of the injury amounts to nothing more than advising the patient to avoid contact sports for several weeks. There is a great deal of misinformation regarding concussions, in both the medical and patient populations. Many people strongly associate loss of consciousness with a diagnosis of concussion, when in actual fact, this occurs in only a small minority of cases, thought to be as few as 10%. Other well recognised symptoms, such as headaches, visual and balance disturbances, confusion and amnesia, are also not going to present in all cases, and are often a sign of a more severe concussion.

The frequency of concussion is also greatly underestimated. Recent studies looking at Rugby Union put the incidence rate, at an amateur/community level of play, at ~1 moderate to severe concussion per game, with the incident rate at professional level play being as high as 2.5 per game.

Undiagnosed or poorly managed concussion can have severe consequences for players. A concussed player will perform as a lower level, is at a significantly higher risk of sustaining other injuries, and recurrent concussions are potentially life threatening. If a player or patient is suspected to have sustained a concussion, the overarching message must be to err on the side of caution and sit out from play.

The International Rugby Board (IRB) are one of the few governing bodies in sport that bar any player diagnosed with a concussion from play for a minimum period of 3 weeks. This ruling is strongly supported by the NZRU, and applies to any level of play.

Given the highly variable nature of concussions, however, simply enforcing a period of rest is not sufficient to properly manage a patient’s concussion. The recent collaborative efforts of a large number of multisector and multidisciplinary groups in Scotland have produced a graduated return to play programme known as the Scottish Concussion Guideline.

The minimum rest period is set at 14 days for patient under age 18, and 7 days for patients over 18. The patient must also be symptom free for 24 (48 hours for patients under 18) at stages 2-5.

Referring patients who present to clinic with concussion through to a physiotherapist can be a good way to ensure that the patient is properly monitored while they progress through their rehabilitation.

As a Physiotherapist muscles and what they do, or sometimes what they need to, is a fairly regular topic of conversation with our clients. This is often a very interesting conversation and allows us Physiotherapists to explain the difference between types of muscle, muscle function, and muscle building which, for progressive and effective Physiotherapy is something that at times forms the mainstay of what we do.

To begin with let me explain that within the body there are different types of muscle that have different roles to play. Namely skeletal muscle, smooth muscle and, cardiac muscle. Let me explain the difference.

Skeletal muscle or “voluntary muscle” is anchored by tendons to bone and is used to effect skeletal movement such as locomotion and in maintaining posture. Though this postural control is generally maintained as an unconscious reflex, the muscles responsible react to conscious control like non-postural muscles.

Smooth muscle or “involuntary muscle” is found within the walls of organs and structures such as the stomach, intestines, bronchi, bladder, blood vessels, and the arrector pili in the skin (in which it controls erection of body hair). Unlike skeletal muscle, smooth muscle is not under conscious control.

Cardiac muscle (myocardium), is also an “involuntary muscle” but is more akin in structure to skeletal muscle, and is found only in the heart

Of particular interest to Physiotherapists (and exercise and health professionals) is skeletal muscle which in itself can be further broken down in to type one and type two fibres.

Type one, slow twitch, or “red” muscle, is dense with capillaries and is rich in mitochondria (the power houses of muscle cells) and myoglobin (oxygen and iron carrying proteins within muscle cells), which gives type one muscle tissue its characteristic red colour. It can carry more oxygen and sustain aerobic activity using fats or carbohydrates as fuel. Slow twitch fibres contract for long periods of time but with little force.

Type two or fast twitch muscle. Fast twitch fibres contract quickly and powerfully but fatigue very rapidly, sustaining only short, anaerobic bursts of activity before muscle contraction becomes painful. They contribute most to muscle strength and have greater potential for increase in mass.

There is one further consideration and piece of knowledge that any client, patient or exerciser should know. When you commence muscle building one will not see changes in muscle mass for six weeks. This is because during this time the nervous system of the body is developing its ability to recruit muscle fibres, it is not until this has been developed that muscle fibres will begin to grow. The take home message from all this is train to your specific needs but to also hang in there, the body shape changes will come, you might just need to wait six weeks.

Ever gone to a physiotherapist and heard them say just going to try trigger point this muscle or you have a myofascial pain or you have a knot in this muscle and wonder what the hell they are going on about.

Well, the word myofascial is Latin for:
Myo = muscle tissue
Fascial = connective tissue in and around it

So myofascial pain is hyperirritable spots in the muscle or in the connective tissues surrounding skeletal muscles. These irritable spots in the medical profession are called a trigger points and in lame man terms are called ‘knots’.

Trigger points are often caused by muscle injury or repetitive strain. They often cause pain, tightness/ stiffness and limited range of movement which can lead to loss of normal function. Trigger points often secondary pain to other types of pain caused by injury.

These shortening muscle fibers can cause pain when pressed on. Trigger points also have special properties in that they can refer pain. This means that the pain people feel is often in different area of the body compared with the location of the trigger point.

A common trigger point people can relate to the most, is the one found in the trapezius muscle (muscle located in the upper shoulder). This trigger point can refer pain up the side of the neck up the posterior part of the neck and across the eyebrow making you feel like you have a headache.
Trigger points can either be active or latent. When they are active they cause this constant aching or evening burning pain. This is usually when people seek treatment. Lantent trigger point usually only cause pain when you press over them. Both active and lantent trigger points can cause the muscle to be weak due to it being taut and not as flexible.

When treating trigger points physiotherapist use numerus techniques. One of the most is to apply pressure to over the trigger point and allow the short fibers to relax under there pressure given. Once these muscles been triggered off we need to prevent them from shortening again by stretching them through full range and treating the cause of them triggering in the first place.

People often feel instant relief after a muscle has been triggered or after a few treatment sessions.

Do you have knots you want released? Why not make a booking now to see one of our physiotherapists.

The anterior cruciate ligament (ACL) is a common injury in active individuals. Statistically females are up to five times more likely to suffer injury and ACL tears are also particularly prevalent in sports that require any pivoting or twisting such as football, netball, rugby or rugby league.

Although ACL injuries are multi-factorial and cannot be linked with any one specific cause there is recent research into preventative actions that can limit your risk of injury.

As we are heading into a new winter season of sport I thought that it would be a good time to review a few of these areas.

Learn to land well

When watching sports that require a high frequency of jumping and landing it is evident that most ACL injuries occur during the landing phase. When we land our joints are required to distribute load effectively. If our movement patterns are less than adequate then tensile forces are increased inside the knee joint which places stress on the ACL.

Improving your movement patterns, learning how to appropriately stack your joints and both load and land efficiently reduces these large tension forces inside the knee.

Improve core strength

A lot of the time a lack of strength higher up the kinetic chain can lead to poor control at the knee. A lack of trunk and pelvic control has been strongly linked with ACL injury. We frequently find that with inadequate core control the knee rotates inwards and forwards which again increases the forces distributed through the knee.

Taking the time to build up dynamic core strength and load effectively through the pelvis can mean that the knee holds better patterns when pushed on the sports field/court.

Mobilise

Possibly most important factor is the need to check your joint mobility above and below the knee. More specifically a lack of ankle dorsiflexion or full range of hip movement has been linked to knee instability, poor loading patterns and increased risk of ACL injury.

This doesn’t always mean stretching and quite often routine static stretching will miss the specificity needed to improve range at these joints. Joint mobility conditioning emphasises an understanding of what is required from individual joints when performing particular movements or actions.

In short the best thing that you can do for your prevention of ACL injures or any lower limb injury for that matter is check whether your body is prepared adequately for what you are asking it to perform.

If you would like any assistance in assessing or conditioning in any of these areas do get in touch with our team at North City Physiotherapy. We are experts in movement assessment and joint conditioning and would love the opportunity to prepare you for your upcoming season.

Shoulder injuries are some of the most common injuries seen in the clinic. Your shoulder blade or Scapula (to use the anatomical term) plays an important role in allowing the shoulder to move. Leading shoulder experts are in agreement that abnormal scapula position and movement has some association with shoulder impingement, rotator cuff dysfunction and shoulder instability. As a result of this association, exercises that target scapular and shoulder stability are common in physiotherapy shoulder rehab protocols. In this newsletter, we are going to take a closer look at the Scapula and how it can help get your shoulder back performing at 100%.

The scapula provides a stable base to allow your arm to move in almost any direction. It is therefore logical to expect abnormalities to scapular position and movement to subsequently interfere with your shoulders movement patterns as you lift your arm, potentially predisposing the shoulder to a variety of pathologies that are commonly encountered in physiotherapy practice.

EMG studies have found that patients with shoulder injuries commonly have soft tissue imbalances following muscles; Serratus Anterior, Upper Trapezius, Lower Trapezius, Pectorial and Rhomboid Muscles.

 

To put it simply, physio rehabilitation of the scapula generally involves correcting the muscle imbalances through stretches and strengthening, here are some of the basic exercises I prescribe:

The Push up plus: Used to strengthen the Serratus Anterior

The Pec Minor Wall Stretch

These exercises are all designed to make sure your shoulder blade is held in the correct position and prevent abnormal movement patterns. Even if you are not currently experiencing shoulder pain, the exercises can be great for making sure the shoulder is stable and strong decreasing the chance of a shoulder injury occurring. If you have a shoulder injury or simply would like to find out more about strengthening the scapula the skilled team at North City Physiotherapy can get you started today!

BY JACK WALLER – STAFF PHYSIOTHERAPIST

Jack Waller is a physiotherapist at our Porirua clinic and runs a clinic also at Aotea College.

If you want to see Jack you can ring us on 0800 627 497 or book online at:
http://nzappts.gensolve.com/ncp/clinician/details/jack_waller