Concussion: If in doubt sit it out



With the winter sport season approaching many young and mature athletes will participate in a sport that involves physical contact.

As a coach, manager, team member or family member, it is important that you are aware of the signs, symptoms and management of a player suspected with concussion. In this blog, we aim to inform you on what a concussion is and what you need to know.


What is a concussion?

It is a subtype of mild traumatic brain injury in which complex pathophysiological processes affect the brain induced by traumatic forces. It may be caused by a direct blow to the head and typically results in a rapid onset of short-term impairment of neurological function that does resolve spontaneously. Recovery may vary from minutes to hours.

The most at risk sports include Taekwondo, Rugby and Ice hockey. Rates have risen since 2012 from one concussion every 3 matches to once concussion every match in the 2015 season of Australian Rugby Union. The increase concussion rates are partly explained by new guidelines that allow players, referees, coaches and medical practitioners to identify concussions.


What are the signs and symptoms to look out for?

  • Headache
  • Dizziness
  • Blurred vision
  • Nausea
  • Reduced reaction time
  • Confusion
  • Ringing in ears
  • Slurred speech
  • Impaired conscious state
  • Poor coordination or balance
  • Unsteadiness when walking
  • Slow to answer questions or follow directions
  • Poor concentration
  • Vacant stare
  • Light sensitivity


What do you do if you suspect a player has a concussion?

On field management is to rule out structural injury. Immediately, perform basic first aid and remove from play.

The Scat5 (standardized concussion assessment tool- 5th edition) is clinically proven to be both reliable and valid and is for health professionals only.

Taken from the Scat 5 concussion assessment, the Maddocks Questions are a quick indicator to determine if a player has a concussion and should therefore not return to play. An important and well established assessment for concussion on the sideline under the most recent concussion guidelines, is to assess an athlete’s orientation to time and place. This does not have to be done by a health professional.

The following questions are asked which should be preceded with the preface: “I am going to ask you a few questions, please listen carefully and give your best effort. First, tell me what happened?”

  1. What venue are we at today?
  2. Which half is it now?
  3. Who scored last in this match?
  4. What team did you play last week?
  5. Did your team win the last game?

Any player with a suspected concussion should be REMOVED from play, medically assessed and monitored for deterioration.

Ensure that the player:

  • Does not drive
  • Does not drink alcohol
  • Must be in the care of a responsible adult.

Concussion signs and symptoms evolve overtime and so it is important to re-evaluate the assessment of concussion. Rest and restricting activity is essential to allow the brain to recover. Reduce time spent on sports, video games and television.

Rugby Australia’s current concussion care guide outlines the best practice of concussion management for community levels of play.   

Should the player show any signs and symptoms of a concussion they must be referred to a medical centre.


Growing pains… Can they be treated or are they just a part of growing up??

For anyone who’s had kids you probably know that they tend to complain of aches and pains pretty often but they’re usually a one off and you probably don’t think twice about it. But what about when this complaining becomes a bit more frequent and they tell you about the same type of pain a little more often?
I’m sure you’ve heard the term ‘growing pains’ or maybe ‘Osgood Schlatter’s or Severs Disease … so when is it time to get those so-called ‘growing pains’ checked out? Is there really anything we can do to treat them? Or is it just a part of growing up?

Today’s blog is going to give you a bit more detail into these types of conditions and help to guide you on how to best manage them at home. Lastly, we will help you decide when they might need to get in to see the physio!


So what’s actually going on here..?
This type of pain falls into a condition known as Traction Apophysitis and can affect a number of different areas of the body. The most common conditions you may have heard of are on the back of the heel and the front of the knee. These are known as Sever’s Disease and Osgood Schlatter’s Disease respectively. Here is a list of some of the other areas where traction apophysitis’ can occur:

Severs Disease = Heel (Calcaneus) – Achilles Tendon
Osgood Schlatter’s = Knee (Tibial Tuberosity) – Patella Tendon
Sinding Larrsen-Yohansson = Knee (Patella) – Patella Tendon
Little League Elbow = Elbow (Medial Epicondyle)
Hip Joint Anterior = superior iliac spine OR
Ischial Tuberosity OR
Anterior inferior iliac spine

This condition occurs in children and adolescents typically secondary to a growth spurt as the bones tend to grow faster than the muscles causing tension through the attachment site of these muscles. As the bodies’ larger muscles contract repetitively, particularly in very active children, the constant pulling on the immature bone causes local irritation, inflammation and microtrauma.


Who is at risk?
Traction apophysitis’ are more common in boys than girls and usually around the ages of 9-14, typically around the time of a growth spurt. It is more common in active children who are playing high levels of weekly sport, particularly running, jumping and kicking sports. Thus it is an overuse type of injury. It can affect one side of the body but also affects both sides in up to 30% of children.



How do we diagnose a traction apophysitis?
Pain is often a gradual onset but can be aggravated by a single event e.g sudden increase in activity. The pain increases with activity and will usually settle with rest although as the condition progresses it can also be painful during rest! The area of pain is tender to touch, for example the back of the heel or front of the knee, and can result in local swelling and inflammation. This inflammation and repetitive trauma can result in the formation of a lump on the heel or knee.

In some cases the pain may cause the child to limp and in extreme cases an avulsion fracture can occur. This is when the tendon pulls a piece of bone off secondary to a strong muscular contraction. There may be associated tightness of the surrounding muscles and often some biomechanical predisposition to the condition.




So can we treat this condition?
You may have been told that these ‘growing pains’ will eventually go away… and yes that’s true, it is a self-limiting condition which means as they reach skeletal maturity the pain will eventually subside… But that doesn’t mean that treatment isn’t effective!

As Physio’s we can help to manage symptoms and allow the child to continue playing sport (as they usually want to to!) and most children will respond well to this conservative management.

The first step involves reducing local symptoms by the use of rest and ice post activity. Anti-inflammatories may also be effective in the early stages. From here treatment will focus on gradually loading the surrounding muscles to better support the painful area, addressing abnormal biomechanics and movement patterns and some stretching (being mindful not to aggravate the painful area).
Isometric muscle activation can be effective early on and exercises will progress from non-weight bearing positions into weight bearing. The use of taping to help offload the tendon is also very effective particularly in the heel and knee. Heel raises can also be used for the same effect when treating Severs.

Often in the early stages the child can continue playing sport but as it progresses and becomes more painful there may need to be a discussion between parents, coaches and the physio about modifying their activity levels. Although the evidence doesn’t suggest an acceleration of the healing process it will contribute to a reduction in pain and is therefore important to consider for your child.


How long do symptoms normally last?
This will vary between children depending on body type, level of activity as well as a number of other factors. It is important to know that symptoms may be present for up to 2 years!


Do I need to get my child an x-ray?
These conditions are clinically diagnosed and radiographs are usually not required. Imaging may only be indicated if an avulsion injury is suspected. Your physio will be able to tell you if they are concerned about this. 



Stay tuned for some examples of how to tape your child to help reduce symptoms!

Find this information helpful? Share it with your friends!

Do you think your child could be suffering from one of these conditions? Bring them in and see one of our friendly physios for an assessment.

5 Common mistakes when starting a running program

So for those of you who decided your New Year’s Resolution was going to be ‘Get fitter’ or ‘Start some regular exercise’ or maybe to ‘Run a half marathon’, then this blog is for you! By this stage you’ve probably got a few runs under your belt and maybe you’re starting to realise it’s not as easy as you had hoped!

This blog is going to run you through the 5 biggest mistakes people make when trying to start a new running program and hopefully give you a few tips to help you make it to your 2018 goal, whatever that might be! There’s a good chance that by this stage in the year you’re getting a bit of an idea of what I’m talking about here.




 Number 1: You’ve started with too much too early!

So here you are in February, you’ve done a few runs a week and you’re starting to feel tired…. The body is feeling tight and rundown,  you’ve got a couple of small niggles which are starting to prevent you from running as far or maybe you just can’t be bothered anymore.

The biggest mistake people make when starting a run program is too many km’s too early and instead of getting fitter, you’re getting an injury! Most running injuries occur through training error e.g building up quicker than your body can tolerate or running too much with poor biomechanics!

Everybody is different and your run schedule depends on a few things… most importantly how much exercise you were doing beforehand! If you were doing next to nothing then you’ve gotta take it slow. This might mean 2 short runs in the first week around the 2-3km mark. Even if you feel good at this stage, stick to the schedule and wait until the next week to build on this. Don’t get over excited and belt out 4 runs in the first week close to your max distance.

Did you know a regular marathon training schedule is around 16 weeks? That’s 16 weeks of regular running on top of a BASELINE fitness of regular 10km runs prior to even starting this schedule. If this seems like a lot, that’s because it is and is a reflection on the time you should be giving to hitting a goal such as a half marathon or marathon to avoid giving up after 6 weeks because you’ve got an overuse injury!


 Number 2: You’ve given no thought to your Shoes!

Now I’m sure you’ve heard it before, your shoes can make a huge difference! Does that mean you need to go out and buy a new pair just to go running in..? Not necessarily. Does that mean you need to go and get your foot assessed and placed in the perfect shoe for your foot..? Not really. Everyone has their own style. Chances are you have heard of the term ‘overpronator’ or maybe you’ve been told your ‘feet are flat’ or maybe that you run on your toes. The question is do these things really matter, and the answer is no. You might have the flattest feet in the world but your biomechanics allow for this and for whatever reason you don’t get any injuries.

These are the three things I recommend when looking for shoes prior to starting a running program (if you’re looking to buy newbies) or if your shoes already fit this category then keep what you’ve got.   

  1. Make sure they’re comfortable
    • You’re going to be spending a bit of time in these shoes so make sure when you put them on, they feel right. Don’t be sucked in to going for a shoe which tells you it has ‘good arch support’ or ‘cushioned sole’ if it doesn’t feel right on your foot.
  2. Aim for a lighter shoe
    • Keep it simple. You obviously don’t want extra weight on your feet. Opt for something on the lighter side which still feels like it’s giving you adequate support.
  3. Don’t make big changes from your usual shoe
    • The body likes what it’s used to! Don’t make huge changes. If you’ve used runners which have worked in the past then stick to what you know and what your body knows!

In saying all this, your choice of shoe is important and can have huge effects on your running. So don’t just get into a program without giving them any thought at all!


 Number 3: You’re not changing up the variables…

What variables? If I want to get better at running then I just go out and run right?

Wrong. Do you know why it’s so hard to break habit? Because the body hates change. And when it comes to running, doing what your body hates is the best way to get better! Don’t go out and do the same thing over and over because your body will love this and won’t adapt and will struggle to improve. Change it up!

Change up your pace/load/intensity: try a short quick run and a long slow run during your weekly program

Change up your routes: road running, trail running, hill runs, flat runs, suburban runs, country runs… the options are endless

Change up the type of training: introduce some cross training, the best thing you can do is add in some strength/circuit training into your program. The best runners in the world will be strength training at least 2 x a week.



Here is an example of a program you could possibly try for one of your training weeks.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Strength and Conditioning (Circuit) Short quick run/speed work Rest Long, slow run Strength and conditioning (gym work focused on lower limb muscles) Rest Middle distance run


  Number 4: You haven’t got a rest schedule

This is probably the least thought about part of your running program and also one of the most important. One of the biggest errors you can make is not allowing the body to rest and recuperate post training. Without adequate rest your runs will become harder, your performance will diminish and it will become mentally harder to get out and train… all signs of overtraining.

So what to do? How much rest do I need? The best thing you can do is plan your weekly runs (and further) to ensure this is achieved and make sure you stick to it! This may involve a recovery week every 4-6 weeks which involves NO running. Ensure you’re incorporating adequate cool down and stretch time post training runs and most importantly adequate sleep.

When your program first begins, your first couple of weeks might look like this…


Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Short quick run/speed work Rest Rest Strength and Conditioning Rest Middle distance run Rest


It’s also important to consider the other components of your life… your social, work and family life should also be factored into your program. If Monday is usually a long day at work for you, then this might be one of your rest days.

Don’t underestimate how important good rest and sleep is and look for the signs of overtraining. These can include:

  • Decreased performance
  • Excessive fatigue
  • Loss of appetite
  • Insomnia
  • Extended muscle soreness
  • Personality changes, loss of concentration




Number 5: You’ve got niggles and you’re not getting them looked at

Last but not least tip number 5. Niggles. Otherwise known as something that is a persistent annoyance or discomfort and these are precursors to INJURIES.  As physiotherapists we always recommend an assessment prior to starting any significant change in training program to ensure your body is ready to handle this change. For running this might involve looking at your gait, assessing your stabilising muscles and talking about your program, your shoes and your goals.

Whether it’s some slight low back pain, shin pain, knee pain or foot pain the best thing you can do prior to starting a running program is to get these niggles looked at, because as your mileage increases chances are they’re only going to get worse!

Consider this… 1km = roughly 1,300 steps when walking so maybe reduce this a bit for running steps… lets say 1,100 steps. If you run 10km, that’s 11,000 steps. A half marathon is 23,210 steps and a marathon is 46,420 steps! So, for example, your hip muscles are compensating for your foot which rolls in every time it lands and are having to work extra hard to control this. For a marathon that is over 46,000 times that this muscle is doing a job it doesn’t want to do. Chances are you’re going to end up with a sore hip. The fact of the matter is that running is a repetitive sport and is thus prone to repetitive strain injuries. Get the little niggles looked at early and prevent them from becoming full blown injuries which keep you sidelined for weeks instead of days.




If you have any questions about your running program or want an assessment prior to starting a program then book in a session with one of our physiotherapists today!

Shin Splints? The secrets to reducing your pain!

Chances are you’ve heard the term shin splints before… Over the past few weeks I have noticed a spike in the number of patients coming in to the clinic with what is most commonly known as ‘shin splints’. This could be due to the fact that we are coming to the end of the winter sport season or maybe because we are sitting in the middle of the running season!
In the physio world ‘shin splints’ is actually a broad term used for a number of conditions which fall under medial tibial stress syndrome (MTSS) and is any pain experienced in the front of the lower leg.
In this post I am going to give you a guide on how to identify this condition and give you 3 simple exercises to help reduce your symptoms and get you back on the track!

So what are they…?
Medial tibial stress syndrome could be caused by a number of tibial injuries including tendinopathy, inflammation of the periosteum (connective tissue surrounding bone), stress reaction of the bone and remodelling of the periosteum.
The most common complaint we hear in the clinic from someone suffering this condition is a general, dull ache in the mid-lower part of the shin bone and is most commonly associated with increasing activity. The diagram to the right displays the usual area of pain for this condition.

The condition commonly presents in both legs at the same time but the pain may be greater on one side. At first it may only present at the beginning of exercise and once the body is ‘warm’ the symptoms disappear but then return as the body ‘cools’ down. As the condition progresses, the pain tends to stay throughout the whole event, including afterwards. Like the name suggests, shin splints are a stress reaction to chronic, repetitive loads going through the tibial bone.



What increases my risk of getting shin splints?

  • Females 2-3x more likely than males
  • Sudden increases in training (frequency, duration, intensity)
  • Running or playing sport on hard surfaces
  • Recent change in footwear
  • Fat fleet (Pes planus)
  • Weak or inactive core muscles
  • Biomechanical abnormalities and training errors

I think I’ve got shin splints… What can I do??

Most people will probably tell you to stretch or foam roll your calves if you’re suffering from shin splints… but this is only part of the answer.

Here we’ll look at 3 simple exercises which can help manage pain coming from the shin bone region. Remember this is a complex condition and ideally requires a physiotherapy assessment which is directly tailored to you and the causes of your tibial stress! If your symptoms aren’t improving or are getting worse, make an appointment with your trusted physio!


  1. Attack the source

Calf raises with eccentric focus

Studies show that weak calf muscles are more prone to muscle fatigue, leading to altered running mechanics and in turn extra strain on the tibia. This exercise is to start as soon as the acute painful stage has subsided and the exercise is tolerable.


  1. Attack contributing factors

Glute med

Crab Walks

The glutes are extremely important muscles which sit on the side/back of the hip and contribute to lower limb stability and alignment. Although this muscle is higher up the chain, weakness of the glute medius will result in torsion of the tibia and in turn greater stress on the bone!

It also allows you to start the rehab process early as these exercises do not cause excessive stress on the painful area of the shins.


  1. Attack poor foot biomechanics

Toe Swapping

When it comes to the lower limb, the inner foot muscles are extremely important in keeping the foot, in particular the arch, placed in an optimal position. These muscles often become weak or underactive leading to collapse or poor stability through the arch.

This exercise can be made easier and harder by performing in standing or on unstable surfaces.



What else could my pain be coming from…?

Stress Fracture: thought to be caused by similar processes to MTSS this is a more progressed condition in which small fractures start to appear in the tibial bone.

Chronic Exertional Compartment Syndrome: also occurs from repetitive loading or exertional activities. Can present with symptoms that indicate nerve involvement such as weakness or numbness in the lower leg. More commonly affects the outer region of the lower leg.


Galbraith, R. et al. (2009) Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine. Sep; 2(3) 127-133.


Gym Ball Exercises

Did you know your gym ball is for more than just sitting on?

There are a whole range of exercises you can try to get the most out of your gym ball with little to no extra equipment needed. We have put together 3 videos to help start you off with some exercises. Each video will focus on a separate body area – lower body, upper body and abdominals.

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