What Is A Concussion and What Can Physiotherapy Do For You
Tuesday, October 16, 2018
Anatomy of the Brain
The brain is made up of soft fatty tissue that is well protected by layers called meninges . The brain rests inside the skull for further protection. There is however a small amount of space for the brain to move around in the skull , much like Jell-O inside a bowl. Unlike Jell-O, the brain is not uniform and is made up of billions of neurons .
What is a Concussion?
A concussion is an injury to the brain. It can be caused by a direct blow to the head, neck, or indirect force elsewhere in the body resulting in rapid movement of the brain within the skull [1-3]. This rapid movement causes brain tissue to stretch, and causes chemical changes to the neurons [1,3]. Neurons are responsible for communication and send messages from the brain to the body. These messages are responsible for everything from moving a body part to controlling emotions . With chemicals in the way, it creates a challenge for the brain to communicate and function the way it usually does . Think of trying to have a conversation with someone in a quiet room versus at a loud concert. The brain has to work harder to do what it would like to do, and it takes time for the brain to recover to normal conditions from this injury [1,3,4].
What are the Signs and Symptoms of a Concussion?
The signs and symptoms of a concussion vary between individuals. However, one may experience any of the following physical symptoms: headache, nausea, vomiting, confusion, dizziness, balance deficits, visual deficits, fatigue, light or noise sensitivity [1-4]. One may also experience cognitive changes such as difficulty with concentration, memory, and fogginess of thought [1-4]. It is possible to also experience emotional changes such as irritability, sadness, and anxiety . Sleep can also be affected by a concussion, either disturbed sleep or increasing amounts of sleep . It is important to note that an individual does not need to lose consciousness to suffer a concussion [1,2]. Signs and symptoms of a concussion do not necessarily present right away . It can take several hours to days following an incident to display signs and symptoms [1-4]. Most individuals recover in 10-14 days after obtaining a concussion . Early management is critical to a speedy recovery. If you or someone you know is suspected to have suffered a concussion, it is important to seek immediate medical attention.
Although many individuals recover quickly, it is possible for a prolonged recovery. Post-concussion syndrome (PCS) occurs when concussions symptoms persist beyond the normal course of recovery [1-3]. These symptoms can occur at rest or during increased physical or cognitive activity [2,3].
What can Physiotherapy do?
Physiotherapists use a variety of techniques to assist in your recovery for both acute and chronic concussions. This includes, but is not limited to:
Exercise therapy [1,2,5-9], such as aerobic and strengthening exercises
Vestibular therapy and oculomotor therapy [2,3,5-9], such as balance, head-eye movement, and visual tracking exercises
Cervical spine manual therapy [2,5-7,9], such as soft tissue release, neck mobilization, and acupuncture
Education [2-9], such as return to sport, return to work, and how to manage symptoms
Physiotherapists with specialized training in concussion management can perform Baseline Testing prior to a concussion, which can be used for comparison and help guide return to play after sustaining a concussion injury.
Laura Fedy, McMaster University PT Student
 Concussion legacy foundation. Team up against concussions [PowerPoint]. c2015 [cited 2018 Aug 18].
 McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2018;51:838-47.
 concussionfoundation.org [Internet]. Boston: Concussion Legacy Foundation; c2018 [cited 2018 Aug 18]. Available from: https://concussionfoundation.org/concussion-resources
 cattonline.com [Internet]. Vancouver: British Columbia Injury Research and Prevention Unit; c2018 [cited 2018 Aug 18]. Available from: https://cattonline.com/overview-what-is-a-concussion-medical-professionals/.
 Schneider KJ, Iverson GL, Emery CA, McCrory P, Herring SA, Meeuwisse WH. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47(5):304-7.
 fowlerkennedy.com. [Internet]. London: Fowler Kennedy; c2018 [cited 2018 Aug 18]. Available from: http://www.fowlerkennedy.com/wp-content/uploads/2017/02/Post-Concussion-Treatment-Guidelines.pdf.
 completeconcussions.com. [Internet]. Oakville: Complete Concussion Management Inc; c2018 [cited 2018 Aug 18]. Available from: https://completeconcussions.com/.
 Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell MR, Sparto PJ. Vestibular Rehabilitation for Dizziness and Balance Disorders After Concussion. Journal of Neurologic Physical Therapy. 2010; 4:87-93.
 Makdissi M, Schneider KJ, Feddermann-Demont N, Guskiewicz KM, Hinds S, Leddy JJ, et al. Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med. 2017;51(12):958-68.
Steph DaSilva at 3:00 PM
Concussion Baseline Testing at Back Works!
Tuesday, May 1, 2018
With summer fast approaching and sports season gearing up, Back Works is now running concussion baseline testing for athletes of all ages. Baseline testing is a series of tests that provide an overview of healthy brain function before concussion. In the event of a concussion, a baseline test provides a point of comparison and helps health care practitioners make a better decision on return to play recommendations. We will be running baseline tests on a few Saturdays over the next few months. Athletes and their families can call the clinic (519-746-8172) or stop in to sign up.
Steph DaSilva at 8:43 PM
What is TMJ Disorder?
Monday, September 25, 2017
Temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime.1 TMD occurs as a result of problems within the joint complex that connects your jaw to your skull.1,2 The joint is composed of a capsule, articular disc, bones (mandibular and temporal) and three ligaments (temporomandibular, stylomandibular and sphenomandibular). In addition, four muscles of mastication (masseter, medial/lateral pterygoid and temporalis muscle) allow for movement of your jaw during speaking and chewing. 1, 2 Dysfunction to any part of these structures can contribute to TMD.2 Most common symptoms are localized pain to the joint or muscles of mastication and painful or painless clicking/popping of the jaw.1, 2 Further, TMD can contribute to:
Popping in ears
Stiff or sore muscles of the jaw
Pain in temple area
Locking of the jaw
What causes TMD?
Typically, TMD is caused by injury to the jaw or teeth, misalignment of the teeth/ jaw, teeth grinding, poor posture, stress, arthritis and excessive gum chewing.2 In addition, improper mechanics of the jaw during chewing can lead to TMD by loading the tissues inappropriately.2 Further, TMD may present itself alongside neck dysfunction that may be contributing to symptoms (i.e. headache and pain in temple area).2
What can physiotherapy do for TMD?
Physiotherapy can help individuals with TMD understand the underlying cause of their symptoms to help control and limit them. 1,3 In addition, physiotherapy will strive to educate you and equip you with the tools to manage tackle your symptoms on your own. 1,3 Specifically, physical therapy can help control pain; ensure proper mechanics of the TMJ, and increase strength, range and proper control of the joint. 1,3 Techniques used include but are not limited to:
Individualized therapeutic exercise (strengthening and motor control) 1,3
Friction point massage3
Dry needling 1,3
Postural retraining 1
Cervical Spine management3
Call us to see how we can help your TMJ disorder.
Evgeny Manuylov, UWO PT Student
Wright, E., & North, S. (2009). Management and treatment of temporomandibular disorders: A clinical perspective. Journal of Manual & Manipulative Therapy, 17(4), 247-254. doi:10.1179/106698109791352184
Shaffer, S. M., Brisme, J., Sizer, P. S., & Courtney, C. A. (2014). Temporomandibular disorders. part 1: Anatomy and examination/diagnosis. Journal of Manual & Manipulative Therapy, 22(1), 2-12. doi:10.1179/2042618613Y.0000000060
Shaffer, S. M., Brisme, J., Sizer, P. S., & Courtney, C. A. (2014). Temporomandibular disorders. part 2: Conservative management. Journal of Manual & Manipulative Therapy, 22(1), 13-23. doi:10.1179/2042618613Y.0000000061
Steph DaSilva at 11:04 AM
What is a Lumbar Disc Herniation?
Tuesday, August 29, 2017
Low Back Anatomy
Our spine is made up of 24 bones, called vertebrae, which are stacked on top of each other. Together, the vertebrae function to provide upright stability and create a structure called the spinal canal, which encases and protects the spinal cord (1). In between each vertebra are intervertebral discs which function to absorb shock as well as allow movement between the vertebrae (1). Each disc is made up of the nucleus pulposus, a jelly-like substance in the middle of the disc, and the annulus fibrosis which encases the nucleus (1). Entering and exiting at the back of each of the vertebrae are nerve roots which function to stimulate muscles for the production of movement as well as to detect sensations such as touch in our lower limbs (2). The majority of disc herniations occur in the low back. The low back consists of the lumbar spine, which is composed of 5 vertebrae, as well as the sacrum bone which contains 4 vertebrae.
What happens when a disc herniates?
A disc herniation occurs when the nucleus pulposus is forced (due to wear and tear or sudden movement) outside of the intervertebral disc space (3). This can damage or tear the outer portion of the disc, causing pain and inflammation (4). This inflammation can damage the nerve root exiting near the vertebra in which the injury occurred (4). Additionally, the disc may put pressure on the nerve root (3). These two mechanisms can cause pain in the low back which can radiate down the lower limbs (3). Loss of sensation and muscle weakness may also occur in the lower limbs (3)
Are symptoms always present with a disc herniation?
Having a disc herniation in the lumbar spine does not necessarily mean that one will experience the symptoms listed above. Disc herniations are commonly seen on MRI in individuals who experience no symptoms.
Physical Therapy Treatment
Patients with a herniation typically respond well to physical therapy treatment (6). When treating a herniation, Physical Therapists use techniques to reduce pain, improve mobility and decrease the chances of experiencing similar injuries in the future. Physical Therapists incorporate the use of modalities such as interferential current, acupuncture and dry needling; manual therapy including soft tissue, dural and fascial release, traction, mobilization and manipulation; as well as therapeutic exercise prescription to reduce pain and associated symptoms (4). Additionally, Physical Therapists can use techniques to re-train core stability muscles to prevent further injury. The re-training of these muscles allow for the stabilization of the spine and a greater degree of control over spinal movement (6).
Raj, P. P. (2008). Intervertebral Disc: Anatomy‐Physiology‐Pathophysiology‐Treatment. Pain Practice, 8(1), 18-44.
American Academy of Orthopedic Surgeons (2012, November). Herniated Disk in the Lower Back. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00534
Jordan, J. L., Konstantinou, K., & O'Dowd, J. (2011). Herniated lumbar disc. BMJ clinical evidence, 2011.
Shahbandar, L., & Press, J. (2005). Diagnosis and nonoperative management of lumbar disk herniation. Operative Techniques in Sports Medicine, 13(2), 114-121.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
Hahne, A. J., Ford, J. J., & McMeeken, J. M. (2010). Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine, 35(11), E488-E504.
Steph DaSilva at 2:50 PM
Monday, June 26, 2017
A big congratulations to Eoghan on setting a personal best in the Mount Tremblant half Ironman this past weekend!
Steph DaSilva at 1:14 PM
Concussion Assessment and Management
Wednesday, June 14, 2017
Concussion injuries result in rapid onset of short-lived neurological impairment that resolves usually within 7-10 days (Marshall, 2012). Concussions present with a wide range of signs and symptoms and imaging studies, such as CT scan or MRI, do not seem to show any detectable injury. This can make concussion diagnosis quite challenging. The symptoms an athlete presents with immediately following the impact gives a good indication of whether a concussion has occurred. The most commonly reported symptoms are headache, dizziness/unsteadiness, difficulty concentrating, confusion/disorientation, and visual disturbance/sensitivity to light. Loss of consciousness is reported in less than 5% of cases (Marshall, 2012) and is not considered to be indicative of a more severe injury. It is thought that the symptoms that we see following a concussion are due to a reversible functional deficit rather than actual structural damage. According to the 3rd International Conference on Concussion in Sport, if an athlete shows any signs of a concussion following an impact, they must be removed from play immediately and assessed appropriately. Although concussion is primarily a head injury, the cervical spine is often also affected. It is important that your Physiotherapist is qualified to properly assess and treat your concussion symptoms as well as any possible neck injury.
Back Works is a certified Complete Concussion Management clinic (CCM) which means we have Physiotherapists who have training through CCM in providing evidenced-based and up to date concussion management. We also provide baseline testing for athletes BEFORE a concussion has occurred. This test measures multiple areas of brain function that are commonly affected following a concussion, including memory, concentration, visual processing, balance, reaction time and motor strength. If an athlete has a concussion, we are able to compare their post-injury state to their baseline measures to help make a more accurate diagnosis and provide information on their readiness to return to sport. We use the most current evidence-based therapies to assess and treat your concussion and any other injuries resulting from the impact, and assist you with a safe and successful return to activity.
To book your baseline testing or concussion assessment please contact us at 519-746-8172.
Steph DaSilva at 3:53 PM
Friday, January 20, 2017
Back Works is so pleased to introduce the newest member of our Team, Jon Godfrey.
We first met Jon while he was completing one of his clinical placements at Back Works, and were so impressed by his skills, both clinical and professional, that we had to grab him up!
Jonathan, the youngest of four, grew up in a small southwestern Ontario town. After graduating from high school at the top of his class and being honoured with the Governor General’s Academic bronze medal, he attended the University of Windsor. He graduated with a Bachelor of Human Kinetics (honours) and also gained valuable experience as a student therapist for the varsity cross country and track and field teams. During that time, he worked part time as a personal trainer and fitness class instructor. Following his undergraduate degree, Jonathan pursued his life-long dream of becoming a Physiotherapist and attended Western University for the Master of Physical Therapy program. He prides himself in being a life-long learner and plans on working toward his certification in Dr. L.J. Lee’s ConnectTherapyTM Series through the Institute for Physiotherapy and Movement as well as his manual therapy credentials through the Orthopaedic Division of the Canadian Physiotherapy Association. In his spare-time he likes to kick back and watch the Raptors or lace up his sneakers to play some pick-up basketball. Jonathan enjoys helping his clients to become aware of and unlock their own untapped potential through physiotherapy.
Please contact us to book an appointment with Jon!
Steph DaSilva at 2:46 PM
Welcome Back Steph!
Friday, January 20, 2017
Back Works is happy to announce that Steph DaSilva has returned from maternity leave and is now accepting new patients. Please contact us to book your appointment!
Steph DaSilva at 2:38 PM
What is a "pinched nerve"?
Thursday, August 11, 2016
A "pinched nerve" in the neck can cause radiating pain into the shoulder, down the arm and into the hand. The technical term for this is called "cervical radiculopathy" and is a common neurological disorder of the neck that results from problems with exiting nerve roots. Nerve roots are commonly altered by mechanical compression or chemical irritation (e.g. inflammation). Cervical radiculopathy often presents itself as neck, shoulder and arm pain, and may include symptoms such as numbness, pins and needles, weakness, and altered sensation in the neck and upper extremity1,2. Certain movements of the neck can increase or decrease the symptoms in the arm.
Cervical radiculopathy affects people of all ages, with men affected slightly more than women. The onset can be both gradual or sudden and often occurs with no specific trauma or physical exertion1,2.
What causes Cervical Radiculopathy?
Cervical radiculopathy is caused by anything that impacts nerve roots exiting from the spine. This includes, but is not limited to factors such as spondylosis (degeneration of the spinal segment) and compression from tight musculature in the neck which narrows the opening where the nerve passes through, pinching exiting nerve roots. Herniated discs and inflammation can also impact exiting nerve roots1,2.
What can physiotherapy do for cervical radiculopathy?
Physiotherapy can help individuals with cervical radiculopathy to manage their symptoms and increase range of motion of the neck and arm by decreasing the compression at the spinal level as well as along the course of the nerve, improve mobility of the nerve, reduce pain and inflammation and correct the underlying factors that lead to the onset of the radiculopathy. Techniques used to achieve these goals include but are not limited to:
Therapeutic exercise (strengthening, stretching and range of motion) 1,3,4,5
Postural education and exercise 3
Functional exercise 3,5
Manual therapy 1,3,4 (mobilization, manipulation and soft tissue release)
Massage therapy 2,3,4
Inferential current 2,3
Heat applications 2,3
Acupuncture and Intramuscular Stimulation (IMS)
A comprehensive assessment is essential in determining the cause of the radiculopathy and to determine the best course of treatment for each individual. Please contact us for more information on what physiotherapy can do for your neck and arm pain!
Henry Chan, UWO PT Student
Woods, Barrett I. and Alan S. Hilibrand. "Cervical Radiculopathy". Journal of Spinal Disorders & Techniques 28.5 (2015): E251-E259. Web.
Eubanks, Jason David. "Cervical Radiculopathy: Nonoperative Management Of Neck Pain And Radicular Symptoms". Am Fam Physician 81.1 (2010): 33-40. Web.
Hoving, Jan Lucas. "Manual Therapy, Physical Therapy, Or Continued Care By A General Practitioner For Patients With Neck Pain". Annals of Internal Medicine 136.10 (2002): 713. Web.
Boyles, Robert et al. "Effectiveness Of Manual Physical Therapy In The Treatment Of Cervical Radiculopathy: A Systematic Review". Journal of Manual & Manipulative Therapy 19.3 (2011): 135-142. Web.
Cheng, Chih-Hsiu et al. "Exercise Training For Non-Operative And Post-Operative Patient With Cervical Radiculopathy: A Literature Review". J Phys Ther Sci 27.9 (2015): 3011-3018. Web.
Steph DaSilva at 7:20 PM
Back Works Own, Rabi Guha, Teaching Abroad!
Thursday, July 21, 2016
Congratulations Rabi on your first International teaching experience! Rabi spent the month of June in England assisting on Linda Joy Lee's (LJLI) Connect TherapyTM Series and the Thoracic Ring ApproachTM. Rabi is a Certified LJLI practitioner - part of the first group of 10 ever to receive this designation. Back Works is very proud and extremely lucky to have such a skilled and accomplished therapist on our team! We also have two other therapists, Lisa and Nicola, that have completed the series. For more information on Connect TherapyTM and the Thoracic Ring ApproachTM please contact the clinic.