6 Things You Have to Know about Concussion

Concussion. That word has become a hot topic as of late. Most of you have an idea of what a concussion might be. However, there are tons of misconceptions and poor information when it comes to concussion.

More importantly, there is a lot of confusion over what to do when you sustain a concussion.

So let’s try to clear up some of this information…

What is a Concussion?

An injury to the brain that affects the way the brain FUNCTIONS which is NOT the result of structural damage to the brain.  This means that the brain is not functioning normally, but nothing has been damaged within the brain tissue.

Therefore, if you performed imaging of a concussed person’s head (CT scan, MRI etc) nothing would appear.  If it did, this would be more indicative of a more serious brain bleed or stroke.  This is one of the reasons we have such difficulty objectively measuring whether someone has sustained a concussion rather than just relying on subjective symptoms.

How do you sustain a concussion?

There are many ways to sustain a concussion but the important thing to note is that direct impact to the head is not required in order to get a concussion.

Concussion can result from indirect (blow occurs elsewhere on the body and impulsive forces result in injury to the brain) or direct (blow to head, face or neck) forces.

So what is happening within the brain?

Truthfully, we still have a lot to learn.  What we believe is happening is a neuro-metabolic cascade.  In our brain (as well as everywhere else in our body) we have sodium/potassium pumps that open up to bring the metabolites in or out.  When we get a concussion, all the pumps get stretched so they all open at the same time and the axon gets clogged with sodium.  Now we have a lot more sodium then normal that we need to get out.  The only way we can get it out is by using energy (ATP).  The problem is, we get our energy from blood flow and there is actually decreased blood flow to the brain from the concussion. Therefore we have a mismatch – we need more energy and we are getting less.

How do we diagnose a concussion?

Diagnosis can only be made clinically.  It should be made by a trained professional, ideally at the sideline or later within the clinic/hospital.

There is no proven blood test or imaging that can be done to diagnose it.

There must be one or more of the following clinical domains:

  1. Symptoms that fall within 3 categories:
    A) Somatic (i.e. headache)
    B) Cognitive (i.e. feeling like in a fog)
    C) Emotional (i.e. lability)
  2. Physical signs (i.e. Loss of consciousness, amnesia)
  3. Behavioural Changes (i.e. irritability)
  4. Cognitive impairment (i.e. slowed reaction times)
  5. Sleep disturbance (i.e. insomnia)

If experiencing symptoms and/or signs in one of the above areas in combination with an appropriate mechanism to induce a concussion you likely have a concussion.

A trained professional will use outcome measures such as SCAT5 or Child SCAT5 in order to more objectively diagnose concussion. cThis can also be a tool used to monitor progress.

What to do once you suspect a concussion?

  1. The number one rule: NO SAME DAY RETURN TO PLAY. If you are in doubt if they have a concussion, sit them out.
    • If you sustain a second concussion before the first has fully healed you are at risk of developing second impact syndrome. A rare, but fatal, consequence of returning to play too soon.
  2. Monitor the concussed person every 15 min for 4 hours, then regularly for 24-48 hours.
  3. Bring the patient to the ER if any of the following is present:
    • Headache that worsens (one that keeps worsening and worsening)
    • Drowsiness or inability to be woken up
    • Inability to recognize people or places
    • Repeated vomiting
    • Worsening confusion/ irritability
    • Seizures
    • Hemiparesis/hemi-sensory loss
    • Unsteadiness
    • Slurred speech
  4. No alcohol or recreational drugs for 24-48 hours
  5. No aspirin, anti-inflammatories or pain killers for 24-48 hours. This can mask worsening headache or other symptoms.
  6. Do not drive until medically cleared

Recovery

While concussion diagnosis needs to be taken seriously the important thing to remember is that 80-90% of concussions resolve in 7-10 days.

If diagnosed with concussion, the earliest a person can return to sport is 7 days post injury. They should see a trained professional to run through a return to play protocol, and will need medical clearance before returning to sport.

If your concussion symptoms are persistent, our treatment can help.  Our physiotherapist will run through a thorough assessment to determine the main cause of your persistent symptoms and come up with an individualised treatment plan to get you back to sport, work or school sooner.

Are you ready for Golf season?

Ace Sports Clinic presents an interactive evening event where we will show you how to prepare your body, prevent injury and maximize your golf performance.  You will learn about the best mobilization and stretching exercises to take your game to the next level.  You will walk away with an understanding of optimal golf bio-mechanics and the best exercises to prevent pain.
Time & Date:  Tuesday June 13th 6.30 – 8pm
Price: $55 per person  Presented by: Victoria Chambers
Location: Ace Sports Clinic, 1 St Clair Ave W, Suite 302, Toronto, ON M4V 1K6
Important information: This golf event will be limited to the first 15 participants to register
To book your spot in Toronto, please call Ace Sports Clinic on (416) 792 4223.

Yoga Therapy at Ace Sports Clinic

Yoga is a tradition that originated in India and dates back thousands of years.  Within the past century, it has made it’s way to the west and is now a popular physical activity for people who want to get some exercise but who also want to connect to their deeper selves via the union of mind, body and spirit.  Yoga therapy is a fairly new term that refers to the application of traditional yogic techniques such as asana (physical postures), pranayama (breath work) and meditation to improve specific health ailments in a particular person.  Because everyone is unique in terms of physical body, ability and health condition, yoga therapy is usually done one-on-one to holistically address one’s particular goals or health issues.  It is a more gentle approach than what one would typically experience in a ‘regular’ yoga class because the goal is less about exercise and more about health maintenance and healing.

In addition to treating physical ailments, yoga therapy is extremely successful in addressing issues that exist in the energetic plane such as anxiety, depression and insomnia.  It has been proven to help reduce risk factors for high blood pressure and cardiovascular disease through simple techniques using the breath, and can also alleviate side effects from harsh medical treatments such as chemotherapy/radiation. Although it is not a cure, a successful yoga therapy course can lead to lower drug dosages for individuals living with conditions such as type II diabetes or asthma.

Performed on a daily basis, yoga therapy will help maintain and enhance existing good health, prevent future ailments and speed up recuperation and/or complete eradication of specific health issues.  Considered to be a ‘complimentary system’, yoga therapy can be beneficial on it’s own but it can also be applied in addition to other types of medical treatments and physical therapies for maximum results.

If you or anyone you know could benefit from this kind of holistic, non-invasive, therapeutic approach to better health please contact Ace Sports Clinic to book a consultation.

Suffering from elbow pain when serving or throwing?

Pain on the medial side (inside) of the elbow often plagues the overhead athlete.

If this pain persists it is usually an indication of either:

1. Medial epicondylitis (golfer’s elbow)

2. Ulnar collateral ligament (UCL) sprain

3. A combination of both of the above

What’s medial epicondylitis?

Medial epicondylitis, commonly referred to as “golfer’s elbow”, involves injury and irritation to a complex of tendons that converge to become the common wrist flexor tendon. This common wrist flexor tendon is mainly responsible for flexing the wrist and fingers, and attaches onto a bone at the inside of the elbow called the medial epicondyle. With injury, movements that generate force through the common wrist flexor tendon produce pain at the medial epicondyle. Most commonly, these movements involve stretching the common flexor tendon by extending the wrist/fingers or contracting the tendon by actively flexing the wrist/fingers. For tennis players, this will likely mean pain with serving and forehands as both these strokes involve aggressive wrist flexion and extension actions.

Just a quick note – the suffix “itis” in “epicondylitis” refers to inflammation and assumes that there is an inflammatory process associated with tendon injury as opposed to a degenerative process. Controversy in the research on this topic has spawned the term “epicondylosis”. So if you’ve ever come across both “epicondylitis” and “epicondylosis” with confusion it’s totally understandable. For the purposes of this post and for simplicity’s sake, we will stick with using “epicondylitis”.

What’s an ulnar collateral ligament (UCL) sprain?

The ulnar collateral ligament (or UCL for short) is a ligament that is responsible for providing support to the inside of the elbow. Similar to the common wrist flexor tendon, the UCL attaches to the medial epicondyle of the elbow and will thus produce pain here when injured. As with any sprain, a UCL sprain will cause pain when force is applied through the ligament. A force termed “valgus stress” puts the most stress on the UCL and will typically produce pain at the medial epicondyle when the UCL is sprained. A great example of valgus stress can be seen in the late cocking/acceleration phases of a baseball pitch or tennis serve (seen in the image below). It is during these actions that pain from a UCL sprain will be most pronounced in the overhead athlete.

How do you tell the difference between medial epicondylitis and a UCL sprain?

Although the location of pain in both conditions will be similar, a UCL sprain will typically be unaffected by wrist and finger movements as it has no direct attachment points there. Instead, a UCL sprain will be affected when valgus stress is applied through the elbow, manifesting in pain, and decreased accuracy and speed during a baseball pitch or tennis serve. Conversely, medial epicondylitis will be most affected by wrist and finger movements but not valgus stress through the elbow. It is also possible that a UCL sprain and medial epicondylitis can simultaneously co-exist. In this case, wrist movements, finger movements, and elbow valgus will all produce symptoms at the medial epicondyle.

Treatment

At Ace Sports Clinic, treatment of both medial epicondylitis and UCL sprain will typically involve soft tissue work and specific rehabilitation drills in order to guide tissue healing and regain tissue resilience.

It is also important to consider the surrounding joints such as the shoulder, wrist, and even the hips and spine. Because of the complex interconnectivity of the human body, limitations in one joint may contribute to overloading and subsequent injury elsewhere. Thus assessment and treatment of areas other than the area in question may be required for effective intervention and long-term resolution of injury. And if you’re a tennis player, it may be important to have your stroke technique analyzed by our team of experts at Ace Sports Clinic to identify areas that may be contributing to injury.

Come visit us and experience the Ace difference!

Dr. Keenan O’Young is a Canadian trained Chiropractor, former national- and international- level tennis player, and tennis coach. As a chiropractor, Keenan’s mission is to provide the highest caliber of evidence-based manual therapy and rehabilitation in order to help his patients optimize movement, prevent injury, and relieve pain. His intention is to set a new standard of Chiropractic that is at the cutting edge of musculoskeletal health and sports injuries. Keenan’s treatment style is based on a combination of soft tissue work, exercise prescription, joint mobilization and manipulation, and acupuncture. He takes a holistic approach to healthcare and is passionate about positively influencing others.

Types of Injuries we treat at Ace Sports Clinic

 We are often asked: “What types of injuries do you treat at Ace Sports Clinic?”

While back pain, neck and shoulder pain, tendonitis and muscle strains are common, we also assist with the rehabilitation of traumatic sporting injuries.

Like the one sustained by one of our clients Neil, while Heli-skiing off-piste recently in British Columbia.

Neil sustained a fractured clavicle that required surgical repair and stabilization.

 

2 days later – Neil visited Ace Sports Clinic to start some gentle massage which helped him cease pain medication

3 days later – Neil commenced some gentle restorative Yoga aimed at keeping other regions of his body moving

6 days later – Neil returned to his regular spin class using only his right arm for support

16 days later – Neil started singles squash lessons with a pro

A positive mindset, good treatment and advice has allowed Neil to resume his active lifestyle with some modifications.  He will review with his surgeon soon and is already planning his next Heli-skiing trip once his clavicle is 100% healed.  He works daily on his exercises prescribed by our Physiotherapist.

Neil has inspired us all at Ace Sports Clinic and shown the resilience of the human body.  We are honored to have played a part in Neil’s recovery.

Come visit us today and let one of our experts help you ‘live well and keep playing’, whatever your sport may be.

www.acesportsclinic.com

 

 

Common Causes of Lower Back Pain

..and some quick, easy things to try at home to help settle it down

Low back pain is one of the most common injuries we see at Ace Sports Clinic. Often it’s of gradual onset, creeping in slowly, starting as occasional discomfort and eventually being a consistent uncomfortable or painful niggle. Sometimes it’s a full-blown crisis where we can barely move without intense pain.

In all of its forms, low back pain is often multi-faceted in its origins and while it’s rare to identify only one cause, there are common culprits that we see. Often when one area is functioning poorly, we find that the body compensates and shifts the blame elsewhere; meaning the source of the pain and the problem area may not be the same. This is why we can’t just look at the back when it comes to low back pain.

Below are three of the most common things we see which contribute to low back pain and some gentle exercises you can perform to try to help settle down the pain.

1. Tight hip flexors / Too much sitting

Your hip flexor, or your iliopsoas, is an incredible and powerful muscle. Made of two muscles which share a common insertion, the psoas major originates in a spinal attachment in your mid-low back. Psoas major makes its way forwards through your abdomen where it picks up the iliacus muscle at the front of your pelvis and together they descend into a shared attachment on your femur.

The massive iliopsoas has many attachments, including those at the lumbar spine, the hip and pelvis.
The massive iliopsoas has many attachments, including those at the lumbar spine, the hip and pelvis.

Since we spend so much of our time sitting, the hip flexor is often in a contracted or shortened position, which means, it can become tight without you even realizing. Due to its attachments, when your hip flexor is tight, it can have ramifications not just at the hip, but also in your lower back. Tight hip flexors often manifest in an excessively arched lower back, or flexion through the hips. Over time these postures put stress on the joints and muscles of your lower back and result in pain.

This can be common for those who participate in exercises or sports which cause us to lean forward such as hockey, cycling, tennis or squash as these activities tend to shorten our hip flexors

Hip Flexor Stretch

We often find that a correctly performed hip flexor stretch, is one of the most effective ways to settle low back pain contributed to by a tight hip flexor.

  • Begin by comfortably kneeling on one leg on the floor – place a towel/mat under your knee
  • Ensure you are straight and not twisted through your hips. Tuck your tailbone under to flatten your low back
  • The purpose of this stretch is to lengthen your hip flexor. If you have any excessive arching in your low back, you are effectively shortening your hip flexor because of its attachments to your spine.
  • Hold for 30 seconds. The sensation you feel should be a gentle stretch and not discomfort.

2. Lazy glutes

Your gluteal muscles are collectively one of the most powerful muscle groups in your body… when they work. A common finding in low back pain is overactive and tight quads, hip flexors and/or hamstrings and poorly functioning gluteal muscles. This can put strain on the joints and muscles of your lower back and alter your mechanics resulting in pain. If your quads are on fire after a leg workout and you feel nothing in your buttocks, this one is probably for you!

Why are the glutes lazy? As with all questions regarding the body, it can be for various reasons. Sitting is a huge contributor because it shortens the structures at the front, which re-positions your pelvis and inhibits the proper functioning of your glutes. Over time this results in the glutes becoming lazy and turning off.

Often poor workout technique or imbalance in your workout routine can be to blame. You should ensure that you balance exercises which target the front of your body with those which target the back 1:1.

In terms of technique, if you are finding exercises that are supposed to target your glutes aren’t making you ‘feel the burn’, come and speak to one of our exercise specialists and get some advice on how to make your exercises more targeted.
Some general advice is to avoid over-arching your back and to make sure your weight is in your heels rather than your toes.

Hip Bridge

The hip bridge is an excellent exercise to both open up your hips and also target your glutes and hamstrings. This is one of the most commonly prescribed exercises for low back pain where the gluteal muscles are one of the culprits

  • Start by lying on your back with your knees bent up and feet hip distance apart
  • Breathing in to prepare, on your exhale, press through your heels to evenly lift your buttocks off the ground to make a straight line with your body
  • Ensure that you do not over-arch your lower back to lift your buttocks higher.
    Slowly lower your body and repeat.
    Start with 2 sets of 10 repetitions

3. Poor Mobility

Mobility is an essential component of any healthy spine. When one area of your back is tight, it will impact other areas. It’s very common for anyone who spends a lot of time sitting to have poor mobility in their upper and mid-back, which can put excess pressure on the muscles and joints of your lower back, causing pain.

Poor seated posture is a huge contributor to poor spinal mobility. We recommend that desk workers or anyone who spends a lot of time in their car, have an ergonomic assessment done every 12 months at a minimum.

A major predictor of poor spinal mobility is previous low back injury. If you have a history of low back pain, you may be habitually protecting your low back by avoiding movement in that region, which could in fact be contributing to your pain. A lack of movement may be causing over-activity in the muscles of your back (and elsewhere), which can cause them to be tight and sore. It can also cause compensation patterns which can result in problems elsewhere.

Mobility is one of the most important things for a healthy body and we should all be including it as a regular part of our exercise routine. Including a weekly Pilates or yoga session as a regular part of your routine is a wonderful way to get some movement in your body.

Low Spine Twist & Arm Openers

Below are two gentle, easy mobility exercises which target your upper and lower back respectively. They can both be done in bed or on the floor and are an excellent way to start or end your day. We often encourage people to use these as a warm up exercise for sport as a way to gently get your body moving before launching into higher energy movements.

Low Spine Twist

  • Lying on your back, cross one knee over the other.
  • Take a deep breath in and as you exhale, drop your knees towards the side which is crossed over i.e. if you have crossed your left knee over your right, drop to the left hand side.
  • Keep your head, neck and upper body and hands flat to the floor to feel a stretch through your lower back and side.
  • As you inhale, bring your knees back to the starting position.
  • Repeat for 10 repetitions before swapping your legs over and performing 10 on the other side.

Arm Openers

  • Begin by lying on your side with your head supported by a pillow. Your knees are bent and your hands are stretched out at shoulder height with hands stacked one on top of the other
  • Ensure your shoulders are relaxed
  • Take a deep breath and as you exhale, float your top arm up and keeping the elbow straight, rotate through your rib cage to reach out to the opposite side
  • Allow your eyes to follow your hand to feel a gentle stretch through your rib cage and upper-mid back.
  • Remain in the stretch for a breath, before returning on the following inhalation. Repeat for 10 repetitions before swapping sides and starting again.

Conclusion

Any back pain is often a multi-faceted and complicated issue. Rarely is there one single cause and every person will have a different cause and different needs, however, we do know that mobility in your spine and equality in your movements are two of the things which reduce the re-occurrence and incidence of low back pain.

* If you feel any pain while performing these exercises, you should stop immediately and seek the opinion of a medical professional.

Victoria Chambers is an Australian trained osteopathic manual practitioner who is currently completing her certification in applied functional science and has previous dry needling qualifications. Victoria believes in empowering her clients to take their health in their own hands by giving them the tools to manage and prevent injury through effective education, hands on treatment and rehabilitation.

Osteopathy is a holistic, hands-on approach to healthcare which addresses the whole body’s needs to aid in pain, injury management and prevention. Osteopathy recognizes the important link between the structure of the body and the way in which it functions.
Your Osteopathic practitioner will utilize a variety of hands on techniques, alongside exercise prescription and education to work with you to achieve your health goals.
At Ace Sports Clinic we also collaborate as a team with our other expert health professionals towards the optimal well-being of our clients.
Call us today on 416 792 4223 to experience “The Ace Difference”

Federer does it again!

Tennis champion Roger Federer has defied the odds and recently become the first player to reach 18 grand slam wins.

After about 6 months out of the game, recovering from a knee injury, he came back to win the Australian Open.

Ace Sports Clinic’s Luke Fuller was down under at the Australian open series treating the male players.

Luke’s family caught up with Rafael Nadal

Follow our new blog to receive tips on health, wellness and injury management.

If you play tennis, golf, soccer or have children who play sports, the Ace Sports Clinic team has the expertise and experience to elevate your game.

Our therapists have multiple skill sets – our Chiropractor is also a high level player and tennis coach; our Registered Massage Therapist is studying Osteopathy; and our Physiotherapist was a key member of the Toronto Pan Am games.  Come in today to experience ‘the Ace Difference’.

COMMON TENNIS INJURIES

Tennis is a game of skill, speed and strategy.  It involves a player possessing strength, endurance and good hand-eye coordination.  The effectiveness and efficiency of a player’s court movement and tennis strokes is an important component of successful tennis play.

Ace Sports Clinic’s practitioners have years of experience treating and rehabilitating tennis injuries in tennis players of all ages.

Tennis injuries can affect the entire body due to the multi-directional nature of the sport.  Common injuries include :

  • Spinal injuries such as facet joint sprains and lumbar disc bulges
  • Muscle strains particularly of the thigh, abdomen and shoulder
  • Joint sprains like ankle ligament sprains, and knee ligament injuries (particularly on hard courts)
  • Labral tears of the hip and shoulder
  • Tendinopathies including rotator cuff and tennis elbow

As you can see from the above list, our bodies need to be well prepared to withstand the physical demands of tennis.

Visit our clinic today, for expert advice on rehabilitation, injury management and preventing injuries so you can stay on the court and enjoy all the positive health benefits of tennis.