Tag Archives: concussions



The topic of concussion has been in the media quite frequently in the last several years. Top athletes, like Sidney Crosby, have definitely put concussion in the spotlight.

Crosby was unable to return to his game for almost a whole year because of persistent symptoms related to concussion. Furthermore, research has shown that 96% of deceased ex-NFL players have a form of brain damage called Chronic Traumatic Encephelaphathy (CTE), which may be related to repeated head traumas like concussions.

Safety Of Athletes Involved In Contact Sports


This calls into question the safety of athletes involved in contact sports. In contact sports, there seems to be a higher incidence of these injuries.

However, concussions do not just happen to the famous pro-athlete. They can happen to athletes playing at any level or any age. They can do more than take away playing time.

Rowan Stringer, a high school rugby player, sadly made headlines in the media in 2013 after she lost her life to Second Impact Syndrome (SIS). This occurs when multiple concussions occur in rapid succession. SIS specifically affects the peadiatric and adolescent populations.

Concussions can also happen to anyone who is involved in an accident involving some form of head trauma. This includes falls and motor vehicle accidents. It is important to understand, that concussion is a serious injury.

If not managed appropriately, it can lead to persistent symptoms. Concussion can prevent you from returning to your beloved sport and/or regular life activities including work and family.

What Exactly Is Concussion?

So, what exactly is concussion and why does it have such a major impact? The changes that happen with concussion happen at a deep cellular level of the brain.

The injury starts with some form of trauma to the head, which creates stretching of the cells in the brain. These changes are microscopic and most often not picked up on imaging exams. As a result, concussion is often labelled as an invisible injury process.

Symptoms of Concussion

These chemical processes produce symptoms such as headache, nausea, dizziness and fogginess that are classic to concussion injuries.

Another major hallmark symptom of concussion is fatigue. This feeling of persistent tiredness is due to the energy crisis in the brain that results from the initial cellular stretching. These symptoms can wreak havoc on a person’s life and take them out of their sport or work.

How long do Concussion symptoms last?

Although the chemical reactions from the initial trauma take about 7 to 10 days to stabilize, the symptoms that are experienced by the patient can last for several weeks and months or even years. The lasting symptoms happen as a result of the changes that have been made to the different processing systems of the brain.

These changes produce an inability to make sense of either the visual or vestibular information in our environment. This overwhelms the brain and further aggravates the symptoms. It is vitally important, that appropriate management strategies have to be in place to treat these symptoms in an effective and timely manner so that an individual can return to their life.

How Do You Treat Concussion?

So how do you treat concussion if it is an invisible injury? The mechanism may be invisible but the symptoms are definitely not. Therefore, it is important to do a thorough assessment. This helps to understand what the exact symptoms are and which brain systems are at fault.

imPACT Testing

During the initial assessment, the patient will most likely be starting the appointment with a computerized test called imPACT, which is a heavily researched and validated neurocognitive test. This test looks at a variety of categories including verbal memory, visual memory, speed and reaction time. At completion it provides important information on a patient’s performance.

The test can be repeated over time and it can be used to check if there has been any meaningful change in performance. Once the imPACT test is completed, the patient will be assessed by the physiotherapist.

The Physiotherapist will go through a detailed history of the injury and symptoms to get an understanding of what the patient is going through and which brain systems are affected. The Physiotherapist will then go through a series of physical tests that test the visual and vestibular systems.

The therapist will be looking at how the patient is performing on the test and what symptoms are produced with the tests. If there are any other injuries present, such as neck pain, the physiotherapist will assess these issues as well.

Concussion Treatment

With the information gained from the assessment, the therapist will start providing the appropriate treatment to start reducing the symptoms of concussion. The treatment provided will vary from person to person because each case of concussion is unique.

Therefore, there cannot be a cookie-cutter approach to treating this complex injury. A large component of the initial treatment plan will involve education to rest and reset the brain and modify work/home/sport activities to allow for appropriate healing.


On follow up visits, the therapist will prescribe specific exercises to start healing the affected systems in the brain. These exercises are important to be continued at home. Consistent and regular practice of these exercises will ensure improvement in the symptoms. It is important to understand that these exercises will produce some of the symptoms of concussion but they are meant to do so.

It is in this manner, that the visual and/or vestibular systems are retrained. Once the exercises are mastered at one level, the physiotherapist will continue to progress them to be more and more challenging until the patient is able to perform them without any symptoms. It is through these progressions that the therapist will be able to help the patient return to work and/or play and just life in general.


Concussion symptoms can be very debilitating and can go on for a long time. It is important to seek out a qualified Physiotherapist trained in concussion management as soon as possible so that these symptoms are not affecting a person’s quality of life and taking them away from the things that they love.

At PhysioNow, we have highly trained Registered Physiotherapists ready to assess and treat Concussions.  Call today to get started on your recovery!


Benign paroxysmal positional vertigo(BPPV)


Vestibular Systems
• Comprises five sensory organs that provide your brain with information about head position and movements including head rotation, linear movements and static positions of the head relative to gravity
• Five sensory organs including 3 semicircular canals and 2 otoliths


BPPV is a mechanical problem in the inner ear. It occurs when some of the  crystals that are normally embaded in gel in the ear become dislodged.  They then can move into one or more of the 3-fluid filled semicircular canals.

Benign paroxysmal positional vertigo(BPPV) is  one  of the most common causes of vertigo. It creates a false sensation of spinning.
• Benign: it is not life threatening
• Paroxysmal: it comes in sudden, brief spells
• Positional: it gets triggered by certain head positions or movements
• Vertigo: a false sensation of rotational movement


a)      Dizziness
b)      Vertigo (sensation of spinning)
c)       Nausea
d)      Sense of imbalance or unsteadiness
e)      Poor gaze stability
f)       Vision disturbance

Visual Coordination screening



• The relationship between the inner ears and the eye muscles are what normally allows us to stay focused on our environment while the head is moving.  The dislodged crystals make the brain think you are moving when  you are not. This mistakenly causes the eyes to move, which makes it look like the room is spinning. This is called Nystagmus.

• The Nystagmus will have different characteristics that allow the practitioner to identify which ear the displaced crystals are in and which canal is involved.
• The most common tests are DIX hall pike and Roll test.
• There are two types of  BBPV.  One type, where the loose crystals can move freely in the fluid of the canal(canalithiasis). The more rare type is one where the crystals are thought to be hung up on the bundle of nerves that sense the fluid movement(cupulolithiasis).

Physiotherapy Treatment
• One maneuver that is used for the most common location and type of BPPV is called the Epley maneuver. However , that will not work for all people . Often people have tried the Epley maneuver themselves or had it performed on them without success.
• In the vast majority cases, BPPV can be corrected mechanically by a Registered Physiotherapist. Once your  provider knows which canal is involved and what type it is , we can take you through the appropriate treatment maneuver.

Check out this video for an example of the  Epley Maneuver.  Please do not attempt this yourself until you have been properly assessed and screened by one of our Registered Physiotherapists to see if this maneuver will be appropriate for your condition!

If you have any further questions, please call PhysioNow today! Our experienced Vestibular Physiotherapists would be happy to help you.

Baseline Testing Concussions

Baseline Testing

Why is baseline testing Concussions important?

There are no  special tests to diagnose and gauge the severity of concussions.  Athletes are recommended to undergo baseline testing before the beginning of the sports season. Baseline test results are helpful  for most healthcare professionals  involved in an athlete’s concussion care. This includes Physiotherapists, Physicians, Concussion Specialists, and Vision Therapists.  Baseline tests let the Physiotherapist compare the before injury  function to the results of post concussion baseline testing. It’s a great tool  to measure the severity of concussions.  It helps therapists to make  treatment goals.  Safe return to sports following concussions can be determined with this tool.


Components of Baseline testing  Concussions


  • Impact Test, This is the gold standard test.  It  looks at different functions of your brain before and after concussion. It is a computer based test. It usually takes about 30 minutes. The test assesses your ability to process information, and remember things.  It also tests how quickly you can follow  instructions/tasks. It’s the most scientifically validated test and recently got approved by the FDA.


  • Visual Coordination screening 
    Visual Coordination screening
     Following concussion, functioning of the visual system  is greatly affected. This involves the eyes and part of the brain that processes visual information.   Correct vision and clarity of  vision is not affected. However, the ability of your eyes to move together is affected. This usually leads to symptoms like dizziness, difficulty focussing,  and headaches. Testing the visual system before the sports season provides valuable information about the function of the visual system.  It allows for treatment of any problems.


  • Balance and Postural stability– With Post-concussive injury, both static and dynamic balance is affected. You can feel dizzy with standing, change in position or with certain movements. Most sports require an intact balance system to improve performance.


Registered Physiotherapists at PhysioNow are trained to conduct baseline testing before the beginning of  the sports season and following concussive injury. Registered Physiotherapists at Mississauga are skilled to assess any deficits in your baseline testing and treat them. Visual coordination exercises  will be done to help you  return to sports faster .

Please call today to get your baseline testing done or to treat your concussion.

Concussion- how do you know if you have one?

Determining if you have a concussion

Concussions have been a hot topic in medicine for a few years, but many people still have questions regarding what exactly concussions are and how they should be treated.


Simply, concussions are a bruise to the brain that occurs when the brain hits the inner side of the skull. This usually occurs when the brain has a sudden stop. Studies suggest that you are more likely to get a concussion with a sudden stop if there is rotation, or turning, of the head during the fall or hit. Diagnosing a concussion can be complex as there are no clear tests that can show the damage including MRI or CT Scan. Scientists are working on solving this problem, but there are no clear answers yet. Even the story of how the injury happened can be quite different. You do not have be go unconscious (or be knocked out) to shows signs of a concussion. In fact, you don’t even have to hit your head. Often the sudden forward and back or side to side motion of a quick and jarring stop can be enough.
Doctors and Sport therapists will look at many factors to decide if you have a concussion. They will look at your symptoms such as a headache or dizziness. Even feeling sad or angry more than normal can be a sign of a concussion. They will also assess your balance, ability to concentrate and remember facts to see how your brain is working. Baseline testing for people at higher risk, such as athletes, can be helpful. Then the medical practitioner can compare these results to what was normal for you before you were injured. If you have not had baseline testing, they will compare it to what is average for someone your age. If it has been decided that you do have a concussion, this medical professional can guide you through the proper treatment and process to return to activity.
For more information on this topic please watch “Concussion 101 – Primer for Parents and Kids”, by Dr. Mike Evans.