Category: Physiotherapy

A concussion is a mild traumatic brain injury caused by a biomechanical force.  It is sometimes called an invisible injury since we often can’t see the symptoms and they can also be very subtle.  Only one symptom needs to be present to be considered a concussion and you do not have to lose consciousness.  Although awareness and education has increased, concussions are still under reported and diagnosed.

A concussion is a functional disturbance of the brain rather than a structural one, so no abnormalities are seen on standard imaging like CT scans and x-rays.  Damage to the brain can occur when it hits the skull – from a force to the head or to any other body part that causes the brain to move and come into contact the skull.  This is why a helmet does not prevent all concussions; it does not stop the brain from moving within the skull.

Concussions should not be treated like other physical injuries – you cannot play through a concussion.  Not only should physical activities be limited, but so should activities that require concentration and attention (school work, video games, text messaging, etc) since they may exacerbate symptoms and possibly delay recovery.

If you get a concussion and return to play before you’ve fully recovered, and then get another blow to the head, it can be very dangerous.  The second hit can be much less intense, but symptoms can be more severe, recovery takes longer and full recovery is less likely.  It’s much smarter to take time off and miss a game or two, than to return too early, get a second concussion and then miss a whole season.

Research shows that the effects of concussions which are not managed properly are cumulative and can still be measured months or years following the injury. The soonest that you should return to play is about a week from the time of the concussion, but it could be a month or a year, depending on the individual.  Luckily, 80-90% of concussions fully recover.

The return to play decision can be a difficult one to make.  A rule of thumb is that one is symptom free and back to their “baseline” or normal level.  Baseline tests are recommended prior to the start of a season to establish the player’s normal physical and mental state.

Sue Underhill is a Registered Physiotherapist at Maximum Physiotherapy. She does concussion baseline testing, retesting and management.  Sue is also available to do a group/team presentation about concussion management.

If you would like more information or to book an appointment call 705-444-3600 or go to www.maximumphysiotherapy.com

Shockwave Therapy (SWT) is a relatively new and innovative treatment for musculoskeletal conditions.  SWT is a series of high-energy percussions or radial pressure waves to the affected area using a transmitter head on the skin.

The mechanical pressure of the shockwaves provokes a response in the tissue that stimulates the formation of new blood vessels.  This increase in blood supply/circulation accelerates the healing process.  The radial pressure waves also stimulate the body’s natural self-healing processes by promoting a positive inflammatory response at the site, then assisting with regeneration and repair. SWT appears to be able to jump start the healing process especially in stubborn chronic  injuries where other modalities have not been successful.

The evidence for the use of SWT is overwhelming!

In the last 10 years, over 300 articles and abstracts have been published regarding the efficacy of SWT. Of special note, many randomized controlled trials showed that SWT is safe and effective for treating plantar fasciitis (Gerdesmeyer et al. 2008) hamstring tendinitis (Cacchio et al. 2010), Achilles tendinopathy and jumper’s knee (Rompe et al. 2007), and calcific shoulder tendinitis (Bannuru et al, 2014). There has also been exponential growth in SWT use for trigger point therapy.

The most striking aspect of SWT is that it has a 75-85 percent success rate when combined with exercise.

For many injuries, SWT is an alternative to surgical procedures. For best results it is recommended that treatment be performed at one week intervals for a minimum of three treatments.

Sue Underhill is a Registered Physiotherapist at Maximum Physiotherapy. Maximums’s therapists are trained in administering Shockwave therapy. Give us a call (705)444-3600 to find how Shockwave Therapy can help you. 

For over 40 years we have all been routinely treating injuries with ice. Yet, surprisingly, there is no scientific evidence to support the use of ice for tissue healing and recovery. In fact, recent scientific research and clinical studies show that, not only is the application of ice ineffective in some cases, but it can also delay the healing of an injury.

A 2013 Journal of Strength and Conditioning Research article concludes that “these data suggest that topical cooling (icing), a commonly used clinical intervention, appears to not improve but rather delay recovery from eccentric exercise-induced muscle damage”.

Gabe Mirkin, the doctor who came up with the popular treatment acronym RICE in the late 1970s (rest, ice, compression, elevation) is backtracking and admits RICE was widely accepted without scientific validity.

According to Gary Reinl, the author of “Iced! The Illusionary Treatment Option”, icing does not reduce swelling or inflammation. The lymphatic system is responsible for eliminating the “waste” in the tissues caused by inflammation. It does this predominantly by muscle movement putting pressure on the one-way valves. Ice inhibits this muscle pump and therefore does not reduce swelling.

When tissues are damaged, more blood arrives at the injury site and with it, inflammatory cells such as leukocytes and macrophages. These cells rush to the damaged tissue to release proteins which clean up and heal the injured site. This build up of fluid, or swelling at the site should be considered a positive reaction. It allows the inflammatory process to progress, and prevents further injury (by increasing sensitivity to pain and restricting movement). Healing is delayed by anything that temporarily blocks blood flow to the injury site – like certain medications and ICE.
We should not stand in the way of our body’s natural inflammatory response, which consists of a universally recognized 3 phase healing process. Inflammation is the first phase followed by the tissue repair and tissue remodeling phases. So if we stop inflammation, we are stopping the healing process. Essentially there cannot be healing without inflammation.

Ice can still be used for temporary pain reduction and local numbness – just be aware of its role in inflammation and swelling. Do your due diligence and then get on board with the huge industry-wide movement!
Sue Underhill is a physiotherapist who believes in keeping up to date in the latest and most effective treatment strategies. Call her and the other therapists at Maximum for the most current treatment for your injury.