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post concussion syndrome
By Dominick Hussey Concussion

Post Concussion Syndrome – A Comprehensive Guide

This article is the most comprehensive guide to post-concussion syndrome ever!

A Concussion is a common occurrence in daily life in Ottawa. There is a strong association between concussions and Ottawans’ favourite sports, especially ice hockey, Canadian football, rugby and soccer.

The majority of people in Ottawa who suffer a concussion do not experience any lasting health consequences.

However, for some people, the effects can be debilitating and longlasting, known as post-concussion syndrome.

Today I will discuss the physiological effects, symptoms and signs, and treatment options for a concussion and post-concussion syndrome.

Let’s jump straight in.

What is a Concussion?

A concussion is a complex pathophysiological process affecting the brain, induced by biomechanical forces. In laymen’s terms, this means that an impact to the skull causes chemical changes that affect how the mind works.

Head injuries cause a disruption in the movement of ions in and out of nerve endings. This disruption is known as an Ionic Shift. When an ionic shift occurs, the brain uses a large amount of energy in the form of glucose to correct this shift. If change continues over a long period, the demand for energy outweighs the supply leading to an Energy Crisis.

At the same time, as the ionic shift, a reduction in the blood flow to the brain occurs, further reducing the supply of energy/glucose.

A brain injury affects the visual and vestibular systems and cognitive or thinking processes.

How Do Concussions Affect the Visual System?

The brain dedicates about 70% of its energy to processing signals from the eyes. This strong connection between the brain and eyes mean that a concussion will significantly affect the visual system.

Common ways in which a concussion affects the visual system include difficulties tracking and focusing on objects. According to research, up to 90% of concussions can cause at least one visual disturbance.

How Does a Concussion Affect the Vestibular system?

Along with cognitive and other sensory processes, the vestibular system uses the remaining 30% of the brain’s sensory processing. The vestibular system is also densely connected with the visual system. As such, the vestibular system is highly susceptible to injury following a traumatic brain injury. For example, for people with a concussion, dizziness is the second most common symptom.

How Does a Concussion Affect Cognition?

According to research, an energy crisis during the acute stages of concussion can lead to cognitive difficulties such as:

  • Attention
  • Reaction time
  • Information processing
  • Working memory

What are the symptoms of Concussion?

The common symptoms of concussion include:

  • Headaches
  • Dizziness
  • Light and sound sensitivity
  • Nausea and vomiting
  • Balance problems
  • Fatigue /Sleepiness
  • Sleep issues
  • Difficulty concentrating
  • Fogginess
  • Memory issues
  • Anxiety and Depression

It is essential to realise that symptoms may be immediate, but are often delayed. Loss of consciousness occurs in less than 10% of cases and is not a marker of severity. Similarly, the degree of force of impact is always consistent with symptom severity.

How to Treat Concussion

When treating a concussion, it is essential to recognise and address the injury as early as possible. If a person experiences a head injury, even if they do not appear to have symptoms, it is essential to seek out an objective clinical evaluation. You should not diagnose a concussion on symptoms alone.

How Most Medical Doctors Treat Concussion

Most medical doctors traditionally prescribe rest for a concussion. This rest includes avoidance of time watching TV, playing video games, reading, and texting. All these restrictions are related to the eyes or visual system and do not address the vestibular and cognitive processes.

Complete rest of the visual system is critical within the first 24 to 48 hours following the injury because the eyes are a significant drain on energy. After that time, it is vital to address other systems.

Clinical recovery vs physiological recovery

The majority of well-managed concussion cases will exhibit clinical recovery in a relatively quick timeframe. Clinical improvement is a remission of symptoms. For adults, clinical recovery is usually within two weeks, while children and adolescents are generally within 30 days.

There is some evidence, however, that complete physiological from concussion recovery may take longer than clinical improvement. Physiological recovery is the normalisation of objective medical testing.

Physiological Susceptibility

A concussion renders the brain more susceptible to cellular injury. If you sustain an additional trauma before physiological recovery, more severe brain damage may result in an increase in symptoms, a more prolonged recovery timeframe, and Second Impact Syndrome.

Second Impact Syndrome

Second Impact Syndrome (SIS) happens when a second trauma occurs when the brain is still in a state of an energy crisis.

SIS results in severe neurological impairment and brain swelling, which may lead to coma and death.

SIS is a rare but devastating consequence of a premature return to sport.

Post Concussion Syndrome

Post concussion syndrome occurs when symptoms exceed expected the anticipated timeframe for recovery. According to research, 15 to 20 % of individuals with a concussion continue to experience persistent and potentially debilitating problems months after injury.

Unfortunately, the current Canadian healthcare system is not currently for this patient population.

What Causes Post Concussion Syndrome?

The causes of Post Concussion Syndrome are not well understood, and they are thought to be a combination of neuropathological and psychological factors. Researchers have identified some risk factors for persistent symptoms from a concussion, including:

  • A high initial symptom load
  • History of a migraine
  • History of vestibular or visual symptoms
  • History of anxiety or depression
  • History of insomnia
  • Teenage females tend to at a higher risk for a protracted recovery

Symptoms of PCS

Symptoms of PCS may include:

  • Visual and balance problems
  • Dizziness
  • Neck pain
  • Anxiety and depression
  • Headaches and migraines
  • Insomnia

The symptoms of PCS are not specific to a concussion and share clinical features of other conditions such as PTSD, depression, chronic pain and insomnia. As such, PCS requires an interdisciplinary approach to treatment.

Conclusion

Concussion results in an energy crisis that is typically resolvable, but should be appropriately managed.

During the acute stage of concussion, the brain is highly susceptible to further injury, so underscoring the importance of a delayed return to sport.

It is critical to managing the injury early and effectively, particularly in those at higher risk of symptoms.

The treatment of Post Concussion Syndrome relies upon the identification of triggers and managing them accordingly.

Have I Missed Anything?

Do you have a better understanding of concussion and post concussion syndrome?

Do you have more questions?

Either way, let me know by leaving a comment below.

4 Home Remedies For Back Pain - Capital Osteopathy
By Dominick Hussey Back Pain

4 Home Remedies For Back Pain

Do you live in Ottawa and have lower back pain?

Are you looking for home remedies for back pain?

If so you are in the right place!

Today you are going to learn about four home remedies for back pain.

And even better!

You can easily include in your daily life to relieve your symptoms.

Let’s jump strainght in.

Home Remedies For Back Pain

1. Stretching

Stretching can be very useful for your lower back as it helps to loosen tight muscles.

I highly recommend certain muscles to stretch because of their muscle attachment on the lumbar spine and pelvis such as the psoas muscles.

Read my article exercises for lower back pain for examples of stretching you can do at home.

2. Exercise

Having a regular physical activity regime is extremely important for your lower back.

A regime may include any sport.

Regular exercise will make your body stronger and will help prevent injuries. Each sport has it’s advantages.

Running

Make sure that you take advantage of the benefits of running without injuring yourself.

For example, if you like running, make sure that you use the right shoes. A high support is useful depending on which type of trail you are running on.

Depending on how often you run, you might need to change your shoes quite often (every six months for example).

Good shoes are most important for running. Any imbalance in your feet can have some side effects on your lower back.

Cycling

For cycling, a poor setting of your bike seat or handlebar can compromise good posture and then have some side effects such as back pain.

If you are not syre ask your local cycle shop for help.

Tennis

For tennis, it is important to have the right racket for you. Then, make sure to adopt the proper grip while you are playing.

Any upper body, arm, wrist discomfort/injury could affect your lower back.

After exercising, it’s highly recommended to stretch. Refer you to my article on specific stretching for your lower back.

3. Muscle Strengthening

Physiology and biomechanics of the lower back are highly related to the muscles of the core and pelvic floor.

To make your back stronger, some specific exercises can be beneficial.

I highly recommend Pilates for muscle strengthening. In Pilates you will work and strengthen core deep muscles.

If you would like more specific exercises, because you are recovering from an injury, I would highly recommend you to see an athletic therapist.

For postpartum women, even if the delivery went very well, I highly recommend to doing some pelvic floor strengthening exercise.

You will have been carrying your baby for months, so for sure your body will change and muscles will relax.

Strenghtening exercises will help to maintain the function of your back.

4. Posture

Daily postures could affect your lower back.

Sleeping

A good sleeping position is crucial.

The worst postion is to sleep on your stomach. Try to sleep on your back or your side.

Mattress and pillows quality is also a important point.

For example, if you are sleeping on your side, a medium firm mattress will be the best because your shoulder and your hip will go down, and it will allow your spine to stay straight.

If you are sleeping on your back, then a firm mattress should be okay.

Carrying

If you are carrying a lot, use a backpack instead of a bag on your shoulder.

A backpack will distribute the weight on both shoulders instead of one side.

In this way, you will prevent your spine from curving and pulling on your muscles.

When you are going to the grocery store, again, make sure to distribute the weight in both hands.

Driving

If you are driving a lot, make sure you pay attention to your sitting posture.

For example, make sure that your back is straight and your arms relaxed.

If you feel the need to use armrests, then use both.

When talking about daily postures, your psoas muscles are usually a significant cause of lower back pain.

To avoid misbalance in these muscles, make sure you bend your knees and keep your back straight when you need to pick something up.

Sitting

If you have a desk job, pay attention to your sittingposture.

See below for an example of the right position for sitting at a desk while using a computer:

4 Home Remedies For Back PainYou should sit at about 75% in the back of your chair (leave a small space between your back and the back of the chair). Top of the screen should be at the same level as your eyes (so you don’t have to flex or extend your neck). The keypad should be in front of you. Ideally, your elbows should rest on the armrests or the muscular part of your forearms should rest on the desk. Have your knees going inward, which will avoid your gluteal muscles becoming tight and then pinching your sciatic nerve.

If you have to answer the phone, make sure that your head and back stay straight. Don’t bend your head on one side.

Have I Missed Anything

Which home remedie are you going to try firsy?

Or did I miss one of your favourites?

Either way let me know by leaving a comment.

Visceral Osteopathy Helps Man With Back Pain - Capital Osteopathy
By Dominick Hussey Back Pain, Case Study

Visceral Osteopathy Helps Man With Back Pain

“The intensity of the pain increased to a level in which I could barely walk – let alone carry anything.” That’s how Michael began when he spoke to me at my office.

He suffered from lower back pain for few months, never had that before and didn’t make any wrong movements to create this pain. He woke up one morning and felt this little pinch on his lower back.

At 42, Michael has a stressful job, and family activities are also intense and to think about this pain until a morning he cannot wake up.

He tried massage therapist, physiotherapist and chiropractic ( the conventional treatment to release a lower back pain ) that was helpful! But only for few days. The same intensity of pain came back.

His family doctor referred to a specialist who did a scan on his back. He said it showed wear and tear at L3/4 and 4 or 5, but Michael didn’t understand what this meant. He thought apparently there is something seriously wrong and worried about it even more. The specialist said he could have injections, but they probably wouldn’t work.

During this time he could not participate in any of his regular like jogging or gym session. He would be too stiff and also afraid to damage his back.

A friend told him about osteopathy and how this therapy helped another friend. So, he thought, why not try another manual therapy before an injection.

During the first consultation, we talked about his back history to obtain information useful in formulating a diagnosis and providing an osteopathic care to the patient.

For him, I concluded it was some organs restrictions, especially the large intestine that may be affecting his back. This area had not been explored with other therapists so maybe to focusing on this area would be helpful. Osteopathy considers a body as a whole.

Osteopathy considers a body as a whole.

“Any structure that crosses a joint can restrict that joint.  It is certainly true for muscles.  This also holds true for organs. “

Michael had a scar tissue formed after surgery a year ago. Nobody told him that a restriction would pull the surrounding tissue towards it.  

After an hour treatment using different visceral osteopathy techniques, we re-tested his mobility, and he was surprised how his range of motion was better and how his pain was less intense.

His fear of pain has gone as he now knows how to manage it using self-massage around the scar tissue for example and has since participated in several activities including a vigorous game of three on three basketball.

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What is the best exercise for lower back pain - Capital Osteopathy - Ottawa
By Dominick Hussey Back Pain ,

What is the Best Exercise for Lower Back Pain?

As an Osteopath, my clients often ask me what the best exercise for lower back pain is.

Should I do yoga? What about swimming? I have heard Pilates is the best exercise for lower back pain.

When talking to individuals about exercise for lower back pain, my answer will always depend on their presenting symptoms. However, there is an exercise I recommend to all my clients with lower back pain.

What is the best exercise for lower back pain?

Before I tell you what I consider what the best let’s discuss the pros and cons of the different choices.

 Yoga

I am a huge fan of yoga. It has been shown to have many health benefits. Yoga helps to strengthen core muscles and increases flexibility which is key to preventing lower back pain.

In my opinion, yoga is one of the most physically demanding exercises I have tried. It seems to work every muscle in your body. It appears that if you have a physical weakness, then yoga will expose it.

On this note, I have observed that a number of my yoga teachers have lower back issues. Because of this observation, I do not think yoga causes lower back pain. Rather I believe that yoga highlights that somebody has an underlying reason why they developed lower back pain. For one of my instructors who I am treating the cause of lower back pain was her irritable bowel syndrome (IBS). Once we started to help her IBS, her owner back pain improved.

I need a community to motivate me to exercise. I am not a big fan of doing exercise on your own. I never give tasks to people because they rarely find the time or motivation to do them. Yoga classes have a double benefit of exercise and the healing properties of a community.

Swimming

I have never been a strong swimmer, so I have never enjoyed it as an exercise. In fact, whether you enjoy doing an exercise is an important factor to consider when choosing the best one you if you have lower back pain. You are more likely to do it if you like it!

Just like yoga, it is an all body exercise which could represent a problem. However, at the same time it is non-weight bearing so is less physically demanding.

Swimming lacks the benefits of community. A good compromise might be aquaerobics that a group setting.

My biggest reservation about swimming is to do with pool water. Unless you have a nearby lake or fresh water pool most people are restricted to using chlorinated public pools. We use Chlorine for its antibacterial properties. However, although it helps to kill bacteria in the pool, it is harmful to our bacteria or microbiome.

Cycling

A large proportion of my Ottawa clients enjoys cycling. In the summer some cycle to work.

For somebody who has lower back pain cycling is an excellent form of exercise because it is non-weight bearing.

Like swimming most people cycle on their own so motivation can be an issue.

Cycling is also dependent on the weather. And in the winter only a few brave Ottawans are seen on their bike.

Walking

Walking is probably the oldest form of exercise known to man. It requires no special equipment or facilities. You can do it virtually anywhere and at any time of the year.

It requires no special equipment or facilities. You can do it almost anywhere and at any time of the year.

You can do it almost anywhere and at any time of the year.

Living in the country, I do less walking than I did in town because I have to drive everywhere. Hence for myself, there is a motivation issue.

Owning a dog would be motivation. However, I am not sure my five cats would appreciate the gesture.

If you do live in town then walking is the perfect exercise. Especially if you live close enough to walk to work.

The best exercise for lower back pain

The above four forms of exercise are the ones I consider the most for people with lower back pain.  Is there a best exercise for lower back pain for you? The answer is yes, but it is dependent on a few key factors including enjoyment, motivation and community. The most popular exercise I prescribe for people with lower back pain is walking but would not recommend it to myself because it does not fit with me.

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hip-pain
By Dominick Hussey Osteopathy

How Osteopathy Can Help Hip Pain

Hip pain is a common condition treated by osteopathic manual practitioners. It may occur because of problems with your muscles, hip joints, menstrual cycle and the nerves. In this blog, I will outline the symptoms and causes of hip pain, tips on to avoid hip pain and how an osteopath may help.

Symptoms of Hip Pain

  • Groin, buttock or inner thigh pain
  • A painful clicking in the groin
  • Increased pain on going upstairs, vacuuming, and or walking
  • A tightness behind your hip joints when stretching
  • Pain in any of the areas above during or since pregnancy

Causes of Hip Pain

There are a number reasons for hip pain some of which can be helped by visiting an osteopathic manual practitioner.

Muscular problems

Pain can come from a tight, strained or overused muscle in the hip or from the joint itself.

Joints Issues

Pain from osteoarthritis or wear and tear in the hip joint is also common. You need to know that osteopathic manual practitioners can’t cure arthritis and it depends on the severity of the wear and tear. An osteopath can help by easing the symptoms of an arthritic hip joint.

Injuries

Pain in the hip can sometimes be the result of an injury; it can be referred from the back or related to the way you move, stand and use your hip.

Pregnancy and Hormonal issues

Pregnancy releases a hormone (relaxin) in the body to soften the pelvic ligaments so that baby can pass through more quickly in birth. However, relaxin softens all ligaments including those of the pelvis which can sometimes destabilise the hip.

Five Tips to Avoid Hip Pain

  1. Avoid staying in the same position for too long
  2. Check your posture, especially when sitting at a desk
  3. Do not sit at your desk for longer than two hours
  4. At home, stretch on your yoga mat for 10-15 minutes a day
  5. Walk for half an hour or more a day

How Osteopathy can help hip pain

Osteopathy can have a significant result in the treatment and management of your hip pain, although this does depend on the cause of pain and the damage already done.

An osteopath will view the patient as a whole rather than just the symptoms to determine the most appropriate course of action.

The key to treatment is to gently move the hip joint to stretch the soft tissues and spread the synovial fluid (the joints’ natural lubricant) over all the surface of the joint. In this situation, your osteopath can use trigger point, fascia, visceral and craniosacral therapy.

X-rays, scans and other tests are sometimes required to make a proper diagnosis. In such cases, an osteopath will refer you to your family physician.

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