Latest / The STA Clinician Podcast / STA193 'Concussion: Causes, Risks & Treatment' with special guest Nicola Hunt

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STA193 'Concussion: Causes, Risks & Treatment' with special guest Nicola Hunt · The STA Clinician Podcast

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You're listening to the Sports Therapy Association podcast, putting evidence
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back into soft tissue therapy.
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Music.
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And we're live. Hey people, welcome to the Sports Therapy Association podcast,
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episode 193, entitled Concussion Causes Risk and Treatment.
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With special guest nicola hunts director of physio care rehab
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my name is matt phillips in case you're not familiar with
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this voice after 193 weeks i'm creator
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of runchatlive.com and as always this episode is being recorded
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live on a tuesday at eight o'clock on the
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sports therapy association youtube channel and facebook
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page and facebook group so if
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you are listening to the podcast thank you very much we would appreciate it
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massively if you could leave a rating and a a review just helps
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a good word of our guests get out to more people but
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if you do like the idea coming along and putting questions to the guests directly and
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just hanging out in the live lounge with other like-minded soft
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tissue therapists then all you got to do is come along to youtube
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or the facebook on a tuesday night o'clock simple
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as that anyway so concussions is what we're
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going to be talking about this episode very excited about this obviously it's
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something that a lot of listeners are familiar with and we
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have asked we've had people asking to have more information on
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it especially if you're working pitch side rugby and football and
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everything and there were some interesting questions as well in the advert which
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a few people picked up on and it caused some discussion across social media
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such as you can actually ask these if you're listening to yourself and see how
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quickly the answer comes through and our concussion is always the result of
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an intense blow to the head have a little think about that might come quickly
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it might not is loss of consciousness linked with severity of injury.
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Have a little ponder. And should someone with concussion be allowed to sleep?
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And obviously, there's lots more. And the fact is, these questions are just
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used to highlight that concussion is a topic often plagued with misinformation
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and myth, which can sadly lead to improper protocol and treatment.
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But fear not, for my guest, Nicola Hunt, Director of PhysioCare Rehab.
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Has significant expertise in delivering evidence-based
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concussion management or has been
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involved in treating that for 25 years using
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brain injury rehabilitation vestibular rehabilitation for both
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central and peripheral disorders so it's going to be
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a hugely valuable episode for all therapists and rehab
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specialists so i'm just going to check that there
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are people here in the live lounge remember if you are
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joining us live you are welcome to ask us questions directly
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nikki mansfield is through the door saying
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evening everybody this is bound to be good can't go wrong with
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a nicola oh there you go i see what you did for nikki very very good i
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was like what is she on about she's been hitting the show early but no thanks nikki
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for joining us if you do join us live then what happens basically is i can
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bring your question or comment up onto
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the screen along with your logo so it's a great networking opportunity if
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for example i bring your comment up and it says facebook user
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that basically just means that you need to click
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on a link which gives facebook permission to for.
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Me to put your information on the screen so what
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i'll do it should be in the comments for where you joined but i'll put
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this onto the screen as well so you can see it basically facebook
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user who says evening folks if that's you you
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need to go to b.live forward slash comments hyphen issue so that's b.live forward
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slash comments hyphen issue and just say yes i'm happy for matt to use facebook
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to to show my comments that's what it is so we know so we know who you are if
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not just saying the comments hey it's me that's it also Also,
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Glenn Murphy is here. Hi, Glenn, how are you doing?
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And other people coming through the door. So always good to see people who join
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us live. That's much appreciated.
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I always say I probably wouldn't do this if it wasn't live. We love the spontaneity.
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We love making our guests squirm a little bit.
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But though I saw there'd be no squirming tonight because we've got such a specialist
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in the field, we'll make sure there's a little bit of squirming.
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Anyway, this is it, people. So without further ado, allow me to bring up my
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special guest for tonight, Nicola Hunt.
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Music.
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Thank you for inviting me along this evening. An absolute pleasure.
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I appreciate you giving up your time, especially as you're such a specialist in this field.
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You're Director of Physiocare Rehab, which is based where? I like to let people
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know where you are in the country.
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I'm in Newark, Nottinghamshire.
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Newark. Why does that ring a bell, Nicky? Is that near you? I'm sure we've had
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somebody else in Newark.
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Sometimes we have guests listening, thinking, wow, this person's just round
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the corner from me. And it just makes us realize that we're in a world now where
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talking to each other since COVID is much more popular now, isn't it?
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We share time and everything.
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So if you are Newick-based, then Nicola Hunt is talking from around there today.
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So let's get straight into it, if you don't mind, Nicola. So as I mentioned in the introduction,
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you specialize in evidence-based concussion management, which kind of implies,
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with using the words evidence-based, that there is some forms of concussion
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management out there that are not evidence-based.
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So maybe that would be a nice introduction for you to chat
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about that and also in doing so give us a definition of
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what concussion is okay so let's start
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with what a concussion is so a concussion is a
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maltraumatic brain injury and the terms are interchangeable but i know sort
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of there are a lot of people favoring the term maltraumatic brain injury because
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it's harder to trivialize it whereas it's easier to trivialize and go oh it's
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just a concussion you don't hear many people people saying, oh,
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it's just a brain injury.
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So there is a little bit of pushback.
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I won't name in shame, but there was a sports coach on Sunday,
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went live in his post-game interview to say that the reason that they,
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one of the contributing reasons to why they lost was that their goalkeeper was
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playing with a concussion that he'd received 24 hours before.
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So again, you know, So change that word for brain injury and you're far less
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likely to stand there and want to say it.
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That's such a valid point. That's amazing. Yeah.
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So if we think what a concussion is, it is a concussion or mild traumatic brain injury.
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And it's caused by a biomechanical force which is transmitted to the brain,
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causing stretch and shear damage to the brain cells.
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And that damage results in inflammation, energy depletion and disruption to the brain networks.
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I do this I'll just let you keep talking I'm not
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going to jump in there with a question you've got far more interesting things to say
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than me so you keep going so I'm probably
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going to bust one of the myths right away
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is you know I think a lot of people think that a concussion has to be a hit
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to the head it doesn't because the definition of a concussion is a biomechanical
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force transmitted to the brain so that can be by a direct impact to the head
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but it can be by an impact to the body or a whiplash-type injury,
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which then transmits the forces to the head, resulting in the concussion.
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That's so important. I will jump in here because anything that I think is really
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relevant to our listeners, I mean, as we talked off air, a lot of our listeners
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are sports therapists, sports rehab specialists.
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So they may fall prey to this myth. I know I used to before I met people like
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yourself and Keith Burnett and talk with them.
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You always think you think you're being fantastic with a great subjective and
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talking about case history and listen to the patient.
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And as soon as they say, as you realize there's been no impact,
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you think, well, I can rule out concussion.
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And it's obviously not that but in fact if you
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delve deeper and has there been any impact to the body that could
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have caused a jarring or something or a whiplash kind of
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effect then you could still be dealing with a concussion then you say
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yeah absolutely and you know a lot of concussions
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particularly in sports such as rugby it's the
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speed and impact of the tackle that transmits the force to the brain rather
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than the actual impact to the head amazing that's such important this i can
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tell this episode is going to be full get you becky carol carol's just coming
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the room becky get your pen and paper out for this one and there's going to be a lot to jot down.
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Okay yes so by a comfortable force it can be a direct impact to
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the head or it could be transmitted through some other impact to
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the body somewhere yeah keep going with some myths if you would let's say what
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it's not and then let's move into what it is and what we should be okay so a
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common myth is that you have to lose consciousness to have had a concussion
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when the reality is that that only around 10% of people who have a positive
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concussion lose consciousness at that point of the concussion.
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I read that. I read that. And it just looks so strange on paper again.
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I'm thinking quite a lot of these myths maybe are perpetuated by films and kind
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of the media and culture and stuff, because we always imagine you go down,
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you're unconscious, and therefore you've had a concussion.
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But you could have suffered a concussion. In fact, you said 10%.
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Does only 10% actually involve losing consciousness? Wow.
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Yeah. And only 10% of concussions will lose consciousness.
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The other 90% will have sustained a concussion, but without losing consciousness.
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That's something to take in so again when you're doing a
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case history people or even if you're pitch side and
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you're going oh well he didn't lose consciousness just keep playing mate you're fine
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you weren't out at all and i can hear sports therapists
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and anybody pitch side with their physios whatever kind of
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using that as a judgment call and that's that's a big one isn't it there must
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be so many people who don't realize that absolutely yes and i think also you
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know it's not just the therapist it's the players themselves well i didn't lose
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consciousness i'm fine so you know there's a lot to do around player education
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as well as therapist education.
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That's a big one you keep going i'm just excited about what's coming out next,
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so another myth is that you know and you know this again comes a lot from the
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hospitals and the medical team who maybe don't have the best understanding of
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concussion that you know ct scans normal mri is normal therefore you don't have
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a concussion there's nothing wrong with you go away.
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So as I described, the injury to the brain cell is a stretching and shearing.
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It changes the sort of the chemical reactions within the brain.
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It changes the energy levels in the brain.
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But what it doesn't necessarily do is destroy any brain tissue.
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So an MRI or a CT scan will show structural damage or a bleed.
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So it's not going to show a concussion because a
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concussion is a functional injury of the brain so it's
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like the software isn't working rather than the hardware's damaged and
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in your experience because MOIs we've talked
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about this with regards to lots of injuries that
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oh there's nothing on the MOI and we know that MOIs to
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start off with it can be very difficult to read and specialists can see different
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things at different times in different moments but I'm wondering how much in
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in mainstream health care there are people still still making their decision
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on whether this person is okay because their MOI looked okay?
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Is this something you think is still happening?
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I think because the NHS, as a general rule, doesn't have a concussion service,
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they are really concerned about, is there anything on that scan that we need to treat?
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Is there a bleed? Is there a clot? Is the trauma and bruising to to the brain
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tissue itself, they're less concerned about functional injury because they don't
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have a pathway to transfer that into.
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And actually, you know, from a neurosurgery point of view, the real immediate
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danger is, you know, is there something that we need to operate on or keep under
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very close observation in case we need to operate differently?
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Very soon. So, you know, for the ones that show the red flags,
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yes, they need to go to hospital and potentially be scanned.
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But for lots of people who have a concussion, a scan isn't indicated.
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I think it would be interesting. I know we had a little bit of a chat off air
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about what happens at a cellular level with concussion.
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And I think it touches nicely on what we're talking about at the moment that
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you might not see physical damage on the actual MRI.
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So without getting too deep, which I know is an insult to your 25 years of study,
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but what sort of thing are we talking about has happened in a concussion that
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wouldn't show up on the MRI?
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So the damage in a concussion is a shearing and stretch.
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So if you think about your nerves, your neurons in the brain,
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as they get stretched, simplifying it slightly,
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within that neuron, there's some little pores, and it's through those pores
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or gates that ions change from inside the nerve to outside the nerve and back again.
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And that's essentially how a nerve impulse occurs.
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It's that changing of iron from inside to outside that transmits the message
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along the nerve, because it's just an electrical impulse.
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So by stretching the nerves and opening those channels, then the ions freely move in and out.
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Now, when we think when we use our neurons,
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you know we use bits of the brain at a time generally speaking
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with an impact that by mechanical
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force you can get that change in
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the nerve in all the nerves you know right across all areas of
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the brain which is essentially what we would describe as a nerve firing so that
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sort of gives rise to some of the symptoms that somebody may get so they may
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say oh I saw stars or flashing lights that's the nerves firing in the visual
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area of the brain or they may have you know heard noises.
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That could be in the auditory, the hearing part of the brain.
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So that explains some of the symptoms that you get.
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And what happens is that those change of nerves, sorry, those change of ions,
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where they swap over, they have to be pumped back.
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And that's an active process that requires energy. Energy in the form of ATP
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is the energy that we use in the body, in cells.
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So to be able to sort of revert everything back to where it should be requires
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a huge amount of chemical energy within the brain.
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So that massively decreases the amount of energy available to the brain.
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And that continues. We're not entirely sure, you know, the sort of the average
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is somewhere between seven to 21 days that that gets back to normal with people.
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And certainly sort of, you know, with areas where you don't have the ability
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to assess clinically to that level to see sort of what, you know,
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what sort of stage of recovery the brain is at.
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Then the UK grassroots concussion
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guidelines say no competitive play within 21 days and that's to ensure that
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the energy levels in the brain has fully physiologically healed so it's not
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it's not anatomy it's not structure it's the physiology the how it works that's changed.
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So interesting then so in a nutshell and
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we're only I can't believe we're only 18 minutes into to the show but in a
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nutshell you've shown that because it is
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the physiology not the structure the more we understand that
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then that clarifies and helps us get rid of misinformation which we've used
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to to diagnose it to rehab it to to look for risk factors from it all of that
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this has to be slightly moved to the left because we now know what's actually
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causing it inside that's fascinating Yeah.
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If there are red flags, it's important that somebody gets immediate medical
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care and potentially a scam.
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And I've just noticed a question from Becky to set up there.
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Becky Carroll, I knew you'd been there very quickly. Becky Carroll says,
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are there gender differences with concussion? Yes.
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So women are much more likely to sustain a concussion. and they are more likely
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to sustain the concussion probably with less force.
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And some of the reason for that is I talked about how it being a biomechanical problem,
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force transmitted if we think about and
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if we just take as a sporting example male rugby and
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female rugby then we know that neck
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stability is greater in
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men than it is in women so neck strength and endurance strength
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is higher in men than it is
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in women therefore men have as
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a generalization a more sort of stable neck
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and therefore they are more able to stabilize at the the neck and not transmit
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the biomechanical forces to the head than the female gender who are more susceptible
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to a concussion because their neck isn't able to sort of absorb that biomechanical
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hit and therefore the forces transmit up easier.
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Fantastic so that's once again an interesting point
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to bear in mind if the athlete presented themselves in front
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of his female as opposed to a male it won't take us quite as
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much in the case history to potentially cause a concussion as it
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would do a male yes absolutely and for
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anybody involved in sort of doing the training and the
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warm-up actually doing neck stabilization regimes
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pre you know as part of training
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and pre-game can help because
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again we know that if the hit comes from the
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front where you're prepared for it you are
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less likely to sustain a concussion than if it's an absolute blinded hit
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from the back when you weren't braced and ready for
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it brilliant and that kind of reminds
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me i think we mentioned a little bit last week but
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there's this i love this word chaos at the moment which
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is we talked about at therapy expo where if you're preparing for
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rehab or if you're doing rehab or just preparing to reduce the
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risk of injury you need to recreate that chaos which is on the
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pitch so it's no point just doing strength or
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work or reactive work where you can see it happening in front of you you
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need to do reactive work where it's happening suddenly and you
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have to react quickly to prepare for those forces brilliant i
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love it when it all comes together absolutely so there.
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Is another question there from nicky mansfield let's read
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out for podcast listeners that's a great question becky thank you dicky mansfield
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says is that nerve misfiring what causes the reflexive shoulder flexion we sometimes
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see on a rugby pitch where a player hits the deck unconscious and their arm
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shoots out above their head yes spot on that's exactly what's happened so that's
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nerve firing in the motor cortex
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and very often it's almost sort of reflex activity that is released.
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So sometimes it can be flexion activity, sometimes it's extension activity,
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but you will see those sort of gross movement patterning when you get that sudden
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firing of all the neurons or the nerves in the motor cortex.
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Fantastic. Great question, Nikki.
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Great question. Right. So there is another myth that I was thinking of.
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I don't even know how much it's a myth, but I think quite a few people are probably
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aware or have heard of that if somebody has potentially suffered from concussion,
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they must go to sleep and you've got to try and keep them awake or something
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or keep them active because that could make things worse.
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Is that boarding on the myth thing or how does that all come to play with what we know?
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It's a little bit of both so you know
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the reason for that is that if
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somebody has got more than a concussion so if they have
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got a bleed then they you know and
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they go to sleep you wouldn't recognize the deterioration so
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the the sort of the standardized advice is that
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you don't sleep for at least three hours so
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they're monitored and nobody with a concussion should be
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left at home alone they shouldn't be
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left alone they shouldn't be driving and no
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alcohol or drugs because you don't
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want anything that is going to mask any deterioration so
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again you know should stay awake for at least three
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hours and then just sort of you know check through.
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Check through the night that they are wakeable so
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that you know yes we need they need to rest because rest
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and sleep is a big part of recovery from
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a concussion but it also needs to be monitored that
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actually they're rousable so they are sleep they've
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not drifted into unconsciousness and that's
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interesting as well i think we'll dip in and out of athletic
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population and non-athletic but if someone has i'm thinking now
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i can imagine the conversation i'm sure i've said it before to my wife so i'm
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going to get into trouble here but imagine a child has had a hit to
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their head okay they've fallen over they've smacked it against something traditionally
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you would say look they didn't lose consciousness they're fine they don't need
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to go to hospital they'd be great but from what you're saying is potentially
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there could be a concussion there so you do need to monitor them go in every
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few hours see how they are and maybe even they should be spending a night in hospital.
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Yes particularly with children yes because again you know children are more
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susceptible and I think that brings us probably nicely onto something I've touched
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on a few times but not actually gone into detail of is the red flags.
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So, you know, as outlined in the Concussion Recognition Tool 6,
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some of the red flags that do need immediate medical assessment and attention
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is if there is, at the time of injury, sudden onset of neck pain or tenderness.
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If they have a seizure or fit, if there is loss of consciousness and double vision.
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Again, you know, whilst you can get loss of consciousness with a concussion,
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it would certainly be a reason to go and have a medical assessment.
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And then the others are sort of some things that maybe sort of,
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you know, may come on initially, but may come on over sort of a period of hours.
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So things like increasing confusion.
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So, you know, So if they're initially a little bit disorientated,
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but they become increasingly confused or, you know, you're seeing behavioral
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changes like agitation,
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restlessness, irritability, you know, even being a little bit sort of aggressive,
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like you would sort of picture your slightly aggressive drunk sort of behavior.
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And that's another good reason why people shouldn't have alcohol,
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because, again, alcohol and sort of that deteriorating brain function can be
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similar in its presentation.
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And it certainly masks the ability to assess well what's going on.
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So then, you know, the other things is if you've got weakness or numbness or
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tingling in more than one limb, so more than one arm or leg.
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You know so you've got one-sided symptoms or
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both legs both arms then again that is
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trip to casualty and again sometimes
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somebody will vomit and vomit once and that
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you know that's still within sort of what we would class as a concussion but
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if there's repeated vomiting again that can be a sign of raising pressure in
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the head due to a bleed therefore that's again is a trip to a and a and the
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obvious one which i think everybody would send is if there's any visual deformity of the skull,
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then they're going to A&E.
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And I think that's something we see a lot more in children because they're very
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much more commonly to sort of get that sort of big bruising with a bump.
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So this really kind of stresses the responsibility of,
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let's say, the pitch side sports therapist or physio,
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that their job really hasn't finished when the
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player is driven home by their parents or brother whoever
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it is you you should really be giving them solid advice
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on what to look out for over the next few hours and if you're that close to
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them looking after them even kind of checking in and seeing if any of the symptoms
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have come up yes yeah absolutely you know that head you know head injury advice
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around what to what to look for and you know what what are the red flags monitor
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for red flags and if any of these occur.
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999 and go to A&E is certainly the advice.
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Fantastic and you mentioned rather quickly there this was the concussion recognition
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tool six why why is it called that why why tool six I'm sorry I'm showing my
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notes here but why where's where's tool five four three two one,
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they've they've been over the years so so every
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every well normally it's every three years
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can obviously COVID came along and pushed it along then there
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is a worldwide concussion conference conference where
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all the leading experts in concussion come together and
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look at what the current evidence is
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rewrite the guidelines rewrite or
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tweak any assessment tools so yourself and
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some you know people listening may well be familiar with the scat so we're now
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on scat six as of last year so previously to that it was the scat five and again
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it's just as more evidence emerges mergers they decide what is most appropriate
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to go in the assessment tools fantastic great advice.
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Keep the questions coming people if you so wish becky and
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nikki there are great questions so far i'm sure you've got many more there please don't
25:11
hold back at all because that's one of the ideas of joining us live any questions you
25:14
may have and even if you share some experiences if anybody listening in
25:17
the live lounge has does work work pitch side
25:20
or has worked pitch side or i say pitch like pitch every single
25:23
sport has a pitch but any scenario where where potentially concussion
25:26
has happened or could happen and do let us know about your own experiences as
25:29
well let's take it back to actually being on pitch
25:32
side and rather than the kind of three hours afterwards i'll
25:36
create a scenario for you then off the top of my head let's imagine
25:39
standing on the line you'd be focusing on something else
25:42
maybe another player was kind of getting on with something you're
25:45
just watching them then suddenly there's a massive hoo-ha and you know that
25:48
somebody's gone down they're not unconscious and you've checked them unconscious
25:52
what sort of check should you be doing both with them and people around them
25:57
to work out what happened in order to rule out hopefully concussion because
26:00
that's going to have a massive effect on whether that player is allowed to continue playing.
26:03
We'll come back on later, isn't it? Yeah. What should we be looking out for?
26:07
So, you know, one of the biggest clues is mechanism of injury.
26:12
So, you know, was there a direct hit or was it witnessed that they had significant
26:19
impact from a tackle or collision that, you know, would start to give you clues
26:24
that there could be enough force there?
26:27
And then, you know, you're looking at sort of the five S's are sort of some
26:31
of the things that we're looking for. So, you know, initially,
26:34
was there initial slump in their posture? Did they fall to the floor?
26:37
Were they motionless for a moment or two? Was there any loss of consciousness?
26:42
Again, another one we're looking for is sway. Is their balance affected?
26:47
Are they slow? So are their movements delayed? Are they slower walking around
26:52
or are they swaying, staggering? staggering.
26:54
And so looking at the sort of what we say is, you know, the star,
26:59
are they confused? Is there any unusual behavior?
27:02
And what's their speech like? Are they slurring? Is their speech slower?
27:07
Are they struggling to recall words you would expect them to know?
27:11
So they would be sort of, you know, your initial clues. And then you should
27:15
be using sort of a recognized concussion screening tool.
27:18
So the SCATS, the Standardized Concussion Assessment Tool, looking at,
27:25
and that will assess some of the things that we know are instantly affected in concussion.
27:32
Again, it can sort of develop over several hours.
27:35
So it's not a case of I assess them now and they, you know, that's it, they're fine.
27:43
I think the other thing to say is certainly the concussion in
27:46
grassroots guidelines is that you know if it's
27:49
a suspected concussion and you are not
27:52
medically qualified to be able to make that assessment
27:55
to whether it was or it wasn't but you suspect it
27:58
they are off now elite sport will have people pitch side who are capable of
28:03
you know running the running the scat and deciding whether or not you know it
28:09
was a concussion but if you know if in In grassroots sports where there isn't
28:14
anybody who is able to run that,
28:17
then the guidelines are you are off.
28:21
And that they should dial 111 within sort of 24 hours and seek medical advice
28:26
as to whether it was or it wasn't a concussion.
28:29
But certainly sort of a grassroots sports, it's a concussion until it's proven otherwise.
28:34
If you have a method of injury that suspects it. Very interesting.
28:42
And this may well happen, might it? A lot of occasions, the person who's working
28:45
pitch side might not be familiar with those protocols.
28:47
Protocols they might have been pulled in the last minute or there might
28:50
just be somebody who's just in which case yeah
28:53
they have to have the confidence to say i haven't got the right
28:56
tools to do this that player's got to come off i know that how
28:58
much because managers and other team players and and
29:01
you know the spectators might want something totally
29:04
different to happen but that's where responsibility comes into it doesn't
29:07
it yeah there's a lot of pressure a lot
29:10
of pressure you definitely get paid enough either for that no
29:13
probably just a student who's not getting paid anything but given the
29:16
chance to work with a team yeah we know how that works unfortunately
29:19
all too often hey there
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30:28
Becky's got another great question, if that's okay with you.
30:30
Becky says, for those involved in sports activities that are at an increased
30:33
risk of concussion, are there any recommendations to minimise these risks?
30:37
For example, neck strengthening exercises.
30:39
We kind of touched on that with regards to recreating that chaos.
30:43
Yes. Reactive stuff. Anything else for them to mind?
30:46
Yes. You know, it would be neck stability as much as neck strengthening.
30:50
So, you know, while we want strong neck muscles, we
30:54
want that neck stability on impact so we want to
30:56
minimize the head movement with impact so it is
30:59
exercises that are building up
31:02
neck stability I know a while ago
31:05
rugby did introduce sort of a sort of quite a nice
31:08
sort of warm-up program for neck stability looking at
31:12
sort of you know depending on how strong their neck is you know it can be just
31:17
sort of you know getting here and pushing your head backwards against your hands
31:20
pushing your head forward against your hands going sideways so you're actually
31:24
doing isometric work working those deeper muscles within the neck,
31:30
and you know for some of the you know you're sort of more sort of higher level
31:33
rugby players that could be you know can they rest their head on a bench and
31:37
sort of do a sort of a bridge with their feet so that only their feet and their
31:40
head has got any contact how long can they do that and again remembering that
31:46
the ratio of extension to flexion is.
31:51
Now then what is the ratio but you you would
31:54
expect um to be able to sustain an extension for
31:58
longer than you would into flexion and again the
32:01
same for strength so working you
32:04
know working within those ratios when you're doing sustained isometrics
32:08
you want to be working the extensors longer than you are
32:11
the flexors great and i imagine if we're talking about sorry if we're talking
32:15
about stability and reaction time then we're not necessarily talking about the
32:18
person with a massive neck and the hypertrophy is going to be the best equipped
32:22
at this it's not necessarily a size thing no no because you're looking at your
32:26
deeper your deeper sort of stability muscles,
32:29
and then the other thing is you know as you've alluded to is around sort of vision training,
32:34
and vestibular training so you know making sure that their balance and their
32:38
visual function so not how well they can see but how well they can see how well
32:44
they can see in their periphery when when they're concentrating on something centrally,
32:47
how well they can react to something that they see.
32:51
So, you know, the sort of the test is what we call go, no go.
32:55
So it's like reaction time testing, but with a cognitive element.
32:59
So it's like hit it if it's red, hit it if it's green, don't hit it if it's red.
33:05
Rather than just hit it when it lights up to have that reaction,
33:09
because actually you need to be able to look at
33:12
something take in the information process what it means and
33:16
then react when you're on a sports field so it's about training up those sort
33:21
of those visual skills as well can help that's great yeah there's some like
33:25
i said we were chatting off air but at therapy expert this year that was a highlight
33:29
for me there was a few speakers like angie jackson angie jackson because you're
33:32
on jackson's been on the show who is yet pointing out vestibular training.
33:35
It really seems to be a buzz thing at the moment and rightfully so.
33:39
It's kind of the missing piece because I think Andrew Jackson was saying how
33:43
it's interesting how despite.
33:47
All the research and all the things we put into practice the
33:51
risk the biggest determinants for injury is kind of have you been
33:54
injured before so that kind of straight away suggests that
33:57
right we're missing something the jigsaw here because if everyone who's
34:00
been injured is getting injured again obviously our rehab isn't as good as we'd like.
34:03
To think we're missing something out so she was alluding to the idea that
34:05
maybe one of the chunks we're missing out is this vestibular training this
34:08
cognitive approach where you need to like you say involve the
34:12
brain in a thinking process rather than just pressing the red pressing
34:15
the green yeah and i think you know we know that
34:18
depending on what literature you read up to
34:20
around 69 of people who continue
34:24
to have symptoms post concussion those symptoms will
34:27
be either vestibular or vision very interesting
34:31
yeah and the other thing
34:34
to consider is that you know if we think about the
34:36
forces that it takes to cause a concussion and again
34:40
that depends on you know the individual but within
34:43
the literature it's somewhere between 60 and 160 g
34:47
to cause a concussion as opposed to
34:49
a whiplash which occurs at 4.5 g so again
34:53
anybody with a concussion should be having a
34:56
neck assessment and not just sort of your range
34:59
of movement and strength but actually your sensory motor so
35:03
you know are you how aware are you of neck position you
35:07
know can you come back to a a neutral position
35:10
with your eyes closed after having had your head moved
35:13
so the joint position the cervical joint position ever test to look at sort
35:18
of that sensory motor element of it and sensory motor training interesting you
35:24
mentioned whiplash a couple of times now and i think maybe that's whiplash has
35:28
been used and abused so much actually in the media.
35:31
Especially with kind of, even like in comic programs and TV with a person putting
35:35
an insurance thing on to get their, you know, their insurance paid and everything.
35:39
And I know a period of time where people have said that we have,
35:46
cause other patients to catastrophize a little bit
35:49
over whiplash because if we do that with our wrist we don't
35:52
suddenly go oh my god protect the wrist put something around it and people should
35:55
be more confident in their necks and the fact we do this in a car accident or
35:59
something or something like that we shouldn't be so worried about it because
36:02
that could be what is causing people to stay stiff and not actually move and
36:05
develop more kind of pain elsewhere but i'm interested whether,
36:10
in certain cases that whiplash moment maybe the neck hasn't been injured to
36:15
the extent which some people think, but we've got to think more of what's potentially
36:18
happened with regards to concussion then.
36:20
Absolutely. So we need to think about concussion, but we also need to think
36:23
about the massive amount of sensory information that our neck gives us around
36:28
our position and our balance.
36:32
So, you know, if we think about sort of the feedback, you know,
36:35
so when we think about sensory feedback and joint position.
36:39
We can all put our thumb up, close our eyes, and we
36:42
know know whether our thumb is bent or whether our thumb is straight the
36:46
same happens with our neck we should be able to close our
36:48
eyes know and know that it's turned over there and bring.
36:51
It back to where it was when it started the amount.
36:55
Of information that we get from our neck is massively greater.
36:58
And i think it it's around about 17 19
37:01
sort of spindles in the thumb that
37:04
give us back that information and it's in the hundreds in
37:07
the muscles of the neck so although you
37:11
know we're not you know there may be an element of
37:14
catastrophizing we also have to recognize that we
37:17
get a lot of sensory information from the neck and
37:21
an interesting one to do is you know somebody who may
37:23
be coming with sort of whiplash type injuries is you
37:26
assess their balance but what's their balance like when
37:29
you put their head into rotation what's their
37:33
balance like when you put their head into extension because what
37:36
you're doing is you're then bringing in you know what what
37:39
it's happening at a sensory motor level in the
37:42
neck around position in space and
37:46
therefore your postural reflexes this is
37:48
excellent and this this definitely is a segue
37:51
just to give a shout out to paul coco who we also
37:54
mentioned off air um anybody who's done paul coco's courses recently
37:57
that are around the country i know anna maria hadn't done extra
38:00
i think nikki you've had paul coco a couple of times haven't you
38:03
i mean nikki join in if you want here but yeah paul coke
38:06
is very much on top of that and that's as you've described probably exercises
38:10
he wish he had mentioned because i think he likes to think of them as his but
38:13
yeah definitely they've been around a bit longer actually i don't think they
38:17
have been around longer than paul no one's been around longer than paul but
38:20
yeah definitely people are very excited by this it is very much um something
38:24
which we've ignored until now.
38:27
I was going to ask you something else. No, I think it's gone now.
38:30
I'm thinking of Paul Coco.
38:31
Oh, I just wanted to give a shout out as well, because I forgot Andrew McCauley's
38:35
name last week when we were doing therapy for runners, ask us anything.
38:39
And that's another person alongside Angela Jackson. So who is very much into
38:43
the idea of chaos and introducing this into a rehab.
38:46
So sorry, Andrew, personally, from my heart, I'll make this into an Instagram clip now.
38:51
Andrew McCauley, founder of ProCare
38:52
Sports Medicine. I do apologize for getting your surname last week.
38:56
I've got no excuses it was just it was just
38:59
bad of me so I'm sorry and I owe you one there we
39:03
go right back to the show so great Nikki
39:06
Mansfield has been stimulated by the call Paul Coker mentioned
39:09
Paul Coker is here in Cambridgeshire in just a couple of weeks still places left
39:12
there we go Nikki that wasn't actually just trying to
39:15
plug it it was just some feedback on Paul and what his course
39:18
offers but anyway Nick let's stay with you for a question if
39:20
that's okay Nikki says have you you had any
39:23
experience success using breath training as part of post-concussion rehab
39:26
good point jacko credits it as the missing piece of
39:29
the jigsaw and making a full recovery recovery post multiple
39:32
concussions so just to put a little bit of context into this
39:36
we probably the last time we talked about
39:39
concussion wasn't keith burnett i think it
39:41
was probably david jackson and this was
39:44
in episode 160 which was
39:47
entitled breath work for head trauma and just to
39:50
give listeners who didn't catch that episode a little bit of context david
39:53
jackson a very successful rugby player
39:56
nottingham rfc career of 13 years 316
40:00
appearances he was forced to retire basically in 2013 due to traumatic brain
40:05
injury which does like you say nicholas sounds so much more serious than forced.
40:09
To retire because of concussion a concussion but if you say brain injury then
40:14
yeah that's a good reason to retire and it was a fascinating episode with many
40:17
accounts because of the fact that he when when they.
40:21
Examined him enough they realized he'd actually probably had two or three
40:24
or more concussions previously and traumatic
40:27
brain injury and also it wasn't done in on the picture was done
40:29
in training as well the one which actually forced the retirement but
40:33
he he and we'll talk about the psychological effects
40:36
of concussion shortly in fact we'll do that after
40:39
this if that's okay with you but he was very big in in
40:42
pointing out that he felt at the time this was
40:45
back in 2013 so things might have changed but he
40:48
really felt let down by the amount of knowledge that was out out there and
40:51
especially in his circumstances where his career was
40:54
ripped away from him i mean he was like it doesn't get much more
40:56
elite in terms of competitive elite sports and he
40:59
was told you can't play anymore there's not much you can do mate just go home
41:02
and rest and uh yeah things will perk up and he
41:05
was dealing with with suicide with depression with anxiety
41:08
all the things which particularly an athlete but not only is
41:11
going to deal with and that's when he did a little investigating himself and
41:14
he found out and i'd like to talk to you a little bit about this nick if that's
41:18
okay that the the research that had been done connecting breathe breath work
41:24
particularly kind of nasal breath work with stimulating the the medulla respiratory center and in the.
41:31
Yes and and the kind of positive effect i
41:34
mean he was looking at the research and even if it was confirmation bias
41:37
he reported a fantastic change in his symptoms
41:41
and his his his way of being
41:43
his sleep and everything and it's
41:46
a great episode so do kind of have a listen to that if
41:49
you want to people episode 160 with david jacko jackson
41:52
who is an instructor with oxygen advantage and he founded probreathwork.com
41:56
nicola over to you breathwork so i think to put it into context it would be
42:02
good to look at what we would look at for concussion so we know that concussions
42:07
are multimodal and we've touched on a few of the modes that are there but we
42:11
know that concussion affects the autonomic nervous system. We know that.
42:17
Some people will go on to develop something called POTS, postural orthostatic
42:22
tachycardia syndrome, whereby you get changes to your heart rate when you are in an upright position,
42:29
abnormal changes, which affects blood pressure and therefore,
42:33
you know, ability to function.
42:36
So that's got, you know, a whole host of symptoms that are associated with that.
42:42
And one of the things that we know sort of massively increases symptoms after
42:47
a concussion is anything that affects sleep.
42:50
A concussion in itself can affect sleep, but addressing sleep after a concussion
42:55
is one of the main things that we would do in the very early days,
42:58
making sure that there is sufficient rest and making sure that it's good quality
43:02
sleep and that sleep is prioritised.
43:05
So it's not sort of staying up late, getting up early.
43:08
It is prioritising sleep because that's when the brain recovers.
43:12
So the role of breathwork is around sort of looking at autonomic regulation,
43:17
bringing sort of, you know, calming down the nervous system.
43:21
Breathwork works through vagal nerve stimulation amongst other methods.
43:25
So it calms down the nervous system. It reduces sympathetic nervous system activity,
43:31
which is then sort of promoting rest, relaxation,
43:35
autonomic parasympathetic, which is your rest and digest nervous system.
43:40
So promoting better sleep.
43:42
So it links in with how we would manage sleep.
43:46
The autonomic nervous system affects as
43:49
well so autonomic is
43:53
one of the things that we would assess and that is why
43:56
the return to play starts off with steady state exercise so what you know it
44:02
starts off with rest for the first 48 hours then you would go on to sort of
44:06
light daily activity when you go back into exercise then it's steady state exercise
44:11
so you want a steady state heart heart rate, no peaks and troughs,
44:15
and you want to see if the athlete will tolerate increasing the heart rate and
44:19
maintaining an increased heart rate without an increase in symptoms.
44:25
Because, as I said earlier, it's energy depletion within the brain and changes
44:30
in blood flow in the brain.
44:31
When you increase the demand through exercise,
44:35
is the brain and body able to meet that, that or
44:38
does it create a deficit i.e experienced
44:41
in symptoms so if somebody is reporting headaches
44:44
confusion feeling more dizzy when they're
44:48
exercising then that shows that there is some
44:50
autonomic involvement excellent there
44:53
we go and so that would probably be
44:56
where breathwork i would i would say breathwork fits
44:59
in so is it possible
45:02
that 10 11 years ago
45:05
now that wouldn't have been been suggested by a consultant
45:08
and now these days depending who you go and see it might be something that
45:11
might be introduced as part of rehab or and
45:15
i think it will probably sit more with therapists than consultants and i think
45:20
consultants diagnose more than treat there are there are very few that will
45:25
be involved in in the treating as well but for the majority certainly if you
45:29
go to your local a&e hospital then no they're they're very unlikely to come up with.
45:35
You know a recommendation for a treatment plan okay
45:38
and then we've got the other modalities so
45:41
you know we know that vision can be affected one
45:45
of the things that is very noticeable after concussion is
45:48
your what's called your convergence so your ability when you look at something
45:51
out here and you bring it closer for both eyes to come in and look at it and
45:57
that you know particularly in children that translates they can't explain that
46:01
to you they don't have the words and what What is often seen is,
46:04
you know, their behavior at school deteriorates.
46:06
They start messing around instead of paying attention to lessons.
46:10
And it is because, you know, all of a sudden the words aren't clear on the page.
46:14
They're not able to bring their focal point into where the words are.
46:19
So everything looks a bit blurred. They're not concentrating properly.
46:23
And so that's an important factor, you know, assessing convergence, their ability to track.
46:29
So their ability to sort of follow a moving object and look between one point and another.
46:35
So that would that you know vision is really important
46:38
to assess your vestibular system we know
46:41
that a lot of people after a concussion get a condition called
46:44
bppv benign postural positional vertigo which
46:48
basically means you move your head and you go very dizzy for a
46:50
few seconds and then it settles down but
46:54
obviously you know if you're trying to run around and look for a ball
46:56
every time you move your head you go very dizzy for a few seconds that's not
47:00
great to be experiencing on a football pitch or rugby
47:03
pitch and and we know
47:06
also there's something called the vestibular ocular reflex
47:09
so a link between the vestibular system which controls balance and the eyes
47:13
so again you may not go dizzy but what might happen is when you turn your head
47:17
the world takes a fraction of a second to sort of come back into focus again
47:21
and these are all reasons why people People shouldn't return to play too early because if they're,
47:28
you know, sometimes people just say, oh, I'm off my game.
47:32
But they're off their game because their vision timing is just a fraction out.
47:36
So instead of being able to very quickly pick up where the ball is,
47:39
they are a fraction of a second behind where they were before they had their concussion.
47:44
And that's enough to make them off their game, as people sort of say.
47:49
So theory then you've mentioned quite a few tests which with with training.
47:56
Whilst people are still working in their scope finger tests
47:59
and seeing if how people react and and like you said
48:02
convergence and stuff that's something which therapists could
48:05
be doing just as a quick check just to
48:08
help somebody who comes back and said oh yeah i had a concussion it was
48:11
diagnosed now you want to get back if you did something like that just let me
48:14
just try something a second with you because you reported you're still a little
48:17
bit dizzy stuff and it comes up as a negative that would be a red flag to say
48:20
you know what i'm not quite sure you're ready yet but but who would you tell
48:24
them to then go and see if they do test positive in some of these tests,
48:28
thanks to listening to this podcast, for example?
48:30
So if it's looking at vision and vestibular, then because the two are quite
48:36
intrinsically linked, then it would probably be a vestibular physio to start
48:40
with to look at further in-depth vestibular testing.
48:45
It may be that they need to go to ophthalmology or optometry,
48:49
but the vestibular physio should
48:52
be able to do that screening and see whether it is anything specific to
48:56
the eyes or whether it's all linked with the
48:59
sort of the neck the vestibular and vision or so
49:02
is that something that a physio has done
49:05
on top of their original studies or right
49:08
yeah yeah it's not it's
49:11
not it's not part of the undergraduate syllabus okay fine that's very interesting
49:15
so again kind of that multidisciplinary approach and having a good network and
49:18
be having someone that would be very interesting yes and in order to do some
49:23
of these tests looking at the time that brings us on to some courses that you've put together,
49:29
carefully arranged for people who at entry level might be interested because
49:33
they know they're working with people who potentially have had concussions so
49:36
can you tell us a little bit about that so i had i there is a company called
49:41
your brain health which is very big in australia and it's led by two Australian physiotherapists.
49:47
They have, they are bringing the model sort of over to the UK world and then
49:53
sort of going worldwide.
49:54
So we are, I have, I am the educational lead for the UK for your brain health.
50:01
And we have three different levels of courses. The first level is around about 60 minutes online.
50:09
And that will give you the introduction to to concussion
50:12
what a concussion is how to recognize it
50:15
what are the red flags in concussion and that
50:18
very sort of initial management of what you should
50:21
be doing and a little bit of sort of insight into the rehab as i've gone over
50:26
tonight and two level for that for listeners are thinking oh that's i think
50:30
because my my listener my listener that made me feel very important suddenly
50:34
um our listeners and and not just sta members but there's quite a lot of imposter
50:39
syndrome we've We've talked about a lot.
50:40
And I naturally presume that if it's a physio, especially one of your experiences,
50:44
oh, yeah, I'm doing a course. I think, well, obviously, I'm not going to be
50:47
allowed through the door.
50:48
But what do you think would be a level of knowledge or entry requirement in
50:51
order to be able to attend that level one course? Zero. Zero.
50:54
There you go. So, you know, the level one course, we, you know,
50:59
we are aiming it out at anybody who is near a sports pitch.
51:03
They don't even have to, you know, they don't have to be a therapist.
51:06
They could be the coach. They could be a parent volunteer.
51:09
They could be the referee. It's anybody who wants to upskill in their knowledge
51:14
of what a concussion is, recognising a concussion and knowing what to do in
51:19
that initial management.
51:21
And that in itself because you're involved
51:23
in it we know this is going to be evidence-based and
51:27
then it's informed and so it may well be an idea for
51:30
anybody who thinks they've already got a concussion certificate of some form or
51:33
done a course to do this to see how much
51:35
has changed and what does need updating maybe yes yeah
51:39
that makes sense i'm just going to bring this big on the screen so people can see if this
51:42
is the podcast you can't see this on the screen but those of.
51:44
You who actually are in the live lounge and there's the website that
51:47
you need to have a a little look at as nicholas
51:51
said the website itself is yourbrainhealth.io
51:57
so it's yourbrainhealth.io and
52:01
if you go to that website then you will click on courses
52:03
and you'll see it very nicely labeled there you just got concussion level
52:07
one level two and level three so there's the information that we
52:10
are talking about there and if you stay tuned sta
52:13
members then there is an sta
52:17
discount count of 20% which we will mention shortly a
52:20
little bit of a hook there so you don't just sign off now but yeah so that's
52:23
the level one course which as Nicola said is for anybody if
52:26
you are working near a pitch and you would like
52:29
to up your game in terms of knowledge about concussion that would
52:32
be one for you right level one what about level two then
52:35
what happens there so level one and level
52:38
two are both online and they were both recorded by James
52:41
over in Australia and level two
52:44
is we have cut it down slightly
52:47
I think it's 14 hours it
52:50
might be slightly under but it's around 14 hours it's
52:53
all modular it's all online and it goes through all the goes through sort of
52:59
again a little bit more detail about what a concussion is and then looks at
53:04
the multimodal assessment so how you would assess autonomic vestibular vision
53:09
in cervical Michael touches a little bit on mood, anxiety.
53:14
Depression, and then things that sort of go associated with a concussion,
53:19
such as migraine, headaches.
53:22
So it gives you sort of the skills to go through in theory and demonstrates
53:27
videos of the assessments.
53:30
Fantastic. So both level one and level two, just to repeat, online.
53:33
So you guys can do it in your own time. The first one's like,
53:36
I think, 60 minutes or 45 minutes long.
53:39
And then the second one is longer, just under 14 hours of content,
53:43
which again, you can do in your own time.
53:45
And obviously, it'd be worth doing level one before you went on to level two,
53:49
just you've got the right foundation, I guess.
53:50
Information knowledge or not necessarily you
53:53
know if if you've if if you're wanting to get involved
53:56
in the rehab side of it then you know
53:59
you could start into level two you wouldn't have to do level one first fantastic
54:03
now that takes us level three which is the face-to-face one which i believe
54:07
you have to have done what both the previous courses or at least the level two
54:11
no you have to have done level two or another concussion course at a similar
54:16
level so to do the level level three,
54:18
you need to be coming into it with a good understanding of,
54:22
you know, the theory and,
54:24
you know, the theoretical how to assess.
54:26
And then the level three is all about putting it into practice,
54:29
getting, you know, getting sort of supervised practice of how to do all the
54:33
techniques, practicing on
54:35
each other, getting some feedback and working through some case studies.
54:39
Fantastic. And that's in person with yourself and Professor James?
54:44
James McLaughlin. Yes. I'm not going to try and say that. Yeah. Yeah.
54:48
The first one is I and it will be me and some other tutor leading them because
54:55
he's not going to fly out from Australia for every course.
54:57
That makes sense. That would not be good. And we've got some dates already for
55:01
these in May and July, haven't we, I think? Yes.
55:05
So it's the 11th of May in Leeds.
55:10
And then I think you're probably on the website and I'm not.
55:13
I think it's the 13th of July in Doncaster and we are looking for a venue down south.
55:20
Oh right okay down south where's south for you is that south of London then?
55:25
We are trying to be geographic so sort of we are we haven't secured a venue
55:30
yet but probably sort of London or sort of slightly to the west of London.
55:38
Right okay you're gonna have people writing in
55:41
non-stop now we need a training venue with lots of beds fantastic we'll make
55:47
sure that that gets mentioned in the show notes people know and then we will
55:50
be taking it up to Scotland as well so we the plan is to have to sort of cover
55:55
the country with the face-to-face courses do you have hosts up in Scotland,
55:59
No, not yet. Oh, we've got some contacts there as well. That's fine. Okay.
56:04
Wonderful. Great. So that's Leeds on the 11th of May and Doncaster on the 13th
56:08
of July, if you want the face-to-face.
56:09
But bear in mind, again, if you're listening and getting all excited,
56:11
you need to have done either the Level 2 Comprehensive Concussion Management
56:15
online via the website or something of a similar level.
56:20
And I guess if people aren't sure if their training is of that level,
56:24
then they can contact you personally or is there something on the website?
56:27
How would they find out? Yes. If you make contact through the website,
56:30
then one of us will get in touch with you and just have a chat through as to what level you've done.
56:36
Very exciting. We do have one last unanswered question if we've still time.
56:40
We do. I'm saving that now. I'm just making her wait a little bit.
56:43
Very demanding, our Nikki.
56:44
Okay. Yeah, I can't think of anything else. Yeah, go on then.
56:46
Let's bring it up. Nikki Mansfield, you can have the last question of the night. Let's bring this up.
56:51
Nikki Mansfield says, on the ANS angle, as we're monitoring the steady increase in output,
56:55
might we be looking out for chronic fatigue type symptoms say
56:58
hours later or next day suggesting poor exertion recovery
57:02
short answer is
57:05
yes the longer answer is that one of
57:08
the main things that we're screening for with the you know
57:11
the increasing steady state exercise is whether
57:14
it triggers symptoms so the way we
57:17
would do a full exercise assessment is the buffalo concussion
57:20
treadmill test or the bike equivalents if
57:23
somebody wasn't able to do a treadmill but what
57:26
we're looking for is does activity increase their
57:30
symptoms and generally speaking it's straight away but yes absolutely sometimes
57:35
it can be a delayed reaction and if that's a delayed reaction then you would
57:41
be prescribing aerobic steady state exercise at a roundabout sort of at a lower
57:47
level what we call a sub-symptom level.
57:49
So you need to know what heart rate they started to get symptoms at,
57:53
and then they need to exercise at a percentage lower than that at steady state to improve.
58:01
There we go, Nicky. Short and long answer. It was interesting when I was reading
58:05
about that Buffalo concussion treadmill test.
58:08
I think I saw that it pointed out that in recent,
58:11
I don't know how or when the studies came about that showed it,
58:14
but the idea that just as we know that total rest physically often isn't the
58:18
best way to reach recovery, you need to be putting some optimal load through
58:22
a limb or something or muscle tendon.
58:24
It's similar with this, isn't it? We know now that brain rest isn't as effective
58:28
as once was preached, that we do need to get people actually moving.
58:33
Tell us a little bit about that, if you're OK time-wise.
58:35
Yes. So, you know, the advice for concussion used to be rest till you get better.
58:39
But, you know, I can't think of any injury that you rest till you get better.
58:44
You've got to do something active to speed up recovery.
58:48
So rest, certainly for the brain, is really important in the first 48 hours.
58:52
However beyond 48 hours
58:55
then you know lying in a darkened room resting which
58:59
is how some people interpret best is actually detrimental
59:02
because you're going into sensory deprivation you're not using your vestibular
59:07
system you're not using sort of vision you're not getting that stimulation you're
59:12
not getting the changes to the autonomic nervous system with your sort of you
59:16
know increasing heart rate on demand for functional activity.
59:20
So all of that is important.
59:22
And, you know, low level exercise, we're not, you know, nobody's going running,
59:27
you know, straight after concussion, but get, you know, going for a gentle walk
59:31
and, you know, doing some sort of pottering around the home activities is important
59:37
to get on the road to recovery.
59:39
It's not around just lie in a darkened room and rest.
59:42
However, with any sort of activity, if you start got to feel an increase in
59:46
symptoms, then you do go and rest until those symptoms subside.
59:52
So we usually say, if you're thinking of a VAS scale, 0 to 10,
59:56
if your symptoms are increasing sort of above seven or by three points,
1:00:01
then, you know, you stop and you go and have a rest.
1:00:05
Fascinating great advice it's 904
1:00:08
i'm already kept you i apologize nicola i will keep you for very
1:00:11
shortly for a few minutes more i think there's so much there once again
1:00:14
and it's something i harp on about and i
1:00:17
hope people don't get bored of it but even if
1:00:20
not even that sounds terrible if you're a massage therapist
1:00:23
i don't like saying even because it makes it sound like there's a sliding scale
1:00:26
but and that's not true at all because massage therapist you
1:00:29
may be the person who somebody who has suffered from concussion
1:00:32
comes to visit because they want to lie down and get get away from the
1:00:35
stress for an hour and they're going to be receptive to
1:00:38
you because they're taking their clothes in front of you and they like you
1:00:41
and they know you and that's where you could be
1:00:44
educating that person and just having a little chat maybe after
1:00:47
before and identifying some of these potential
1:00:50
masqueraders where they think oh i'm just dizzy or this is happening because
1:00:53
of this this and this and it could be if you know through
1:00:57
their medical park you or something that they've coming back from
1:00:59
concussion if you ask the right questions and listen and
1:01:02
you you see thanks to information from people like Nicola
1:01:05
that they might be missing some of the proper rehabilitation
1:01:09
recovery from concussion then you could change that person's life massively
1:01:12
and avoid the chances of re-concussion if they're going back to sport by just
1:01:17
by just listening to these points so again it's so important I think for everybody
1:01:21
involved in the health process to to know about these things so thank you Nicola
1:01:25
so much for and there has been so many tonight that you've shared so it's amazing
1:01:28
definitely an area that needs cleaning up so thank Thank you for that.
1:01:32
Go on. I was just going to say, thank you very much for inviting me on.
1:01:36
I think, you know, I think it's such an important topic to share knowledge on.
1:01:40
You know, none of us can do it in isolation and, you know, no one person can be everywhere.
1:01:47
So the more people that know about how to recognise a concussion,
1:01:52
how to manage it well, will improve the brain health of our population.
1:01:58
Definitely. Amazing. Right. I do not want to keep you for much longer,
1:02:01
but I do just need to quickly let our listeners know about what's coming up
1:02:06
in the next couple of weeks.
1:02:07
Very excited, always excited. But we've got a special two-part shoulder series
1:02:12
coming up with two absolute giants from the industry.
1:02:16
I'm even I'm just trying to create a bit of dramatic effect now by not saying the name straight away.
1:02:19
But you probably don't even appreciate and hopefully a lot of you don't appreciate
1:02:23
what we've got lined up for you because you want to hear these people.
1:02:25
I always pray that you haven't heard of them. You haven't seen them,
1:02:27
even though as famous as they are and as well known and respected as they are
1:02:30
in the literature and across the board.
1:02:34
We have got next week in our part one is going to be called Treating the Shoulder Steps to Success.
1:02:39
And we've got special guest joe gibson who anybody who
1:02:42
is familiar with joe hugely respected both nationally.
1:02:45
Internationally for her shoulder rehab lectures and courses she's
1:02:48
a clinical physio specialist at the upper limb unit at the royal liverpool hospital
1:02:51
of the uk absolute massive educator shoulder geek
1:02:54
on twitter that's her name not her just a
1:02:57
personality but yeah an absolute gem of a
1:03:00
guest i'm so happy that we have got you or got her to
1:03:03
talk about um the shoulder in part
1:03:06
part one that's next week if you listen to podcasts and it's not april
1:03:09
the 16th yet then i really would suggest that you try and join us
1:03:12
for that eight o'clock on youtube or on facebook
1:03:15
whatever your poison is whatever you prefer and then
1:03:18
the week after in part two as if joe gibson wasn't enough
1:03:21
on april the 23rd i'll be talking live with special
1:03:24
guest ian horsley who will be talking shoulder assessment
1:03:27
qualitative versus quantitative and again
1:03:30
if you work with the shoulder and you've
1:03:34
have done any education then then the names don't get much bigger
1:03:36
than Ian Horsley he's currently lead physio and technical lead for
1:03:39
the Northwest for the English Institute of Sport he was physio
1:03:42
for England Rugby Union for 14 years including six years working with
1:03:45
the elite playing squad PhD in 2013 examined
1:03:49
issues around shoulder injuries and professional rugby several articles published
1:03:53
in peer-reviewed journals and chapters in in endless sports injury management
1:03:57
books and he's currently consultant physio to England football so again I don't
1:04:02
like to say that I'm I'm giving you too much because I'm not.
1:04:04
Because you deserve everything I can give you.
1:04:06
But two massive names if you're interested in shoulder injuries.
1:04:09
Next week and the week after. So do please join us for that.
1:04:13
However, tonight has been all about Nicola Hunter concussion.
1:04:16
So thank you once again, Nicola, for joining us. Really appreciate it.
1:04:19
And like I say, if you're interested in concussion courses, then go along to
1:04:23
the website. All the links will be in the show notes.
1:04:27
And also, yes, the discount, which you've hung around for to know what the discount
1:04:31
code is. That's why people haven't signed off yet. Yeah.
1:04:33
So, yeah, for Sports Therapy Association members, there is a 20 percent discount for these courses.
1:04:39
And all you have to do is enter the code. No, I'm not that stupid.
1:04:43
What you have to do is you have to go along to the members area for the Sports
1:04:46
Therapy Association website, go along to the members area and the code will be given to you.
1:04:51
Then it's just one of its reason 136B for being a member of the Sports Therapy
1:04:57
Association. Association.
1:04:58
Yeah, you'll find the code there along with all the codes which our guests graciously
1:05:02
offer us for the great education they're doing. So there you go. Find out.
1:05:06
If you're not sure how to go to the members area, then just email Matt at the
1:05:08
SDA.co.uk or Jake at the SDA.co.uk or Gary at the SDA.co.uk and we'll help you out.
1:05:14
Right, Nicola, once again, thank you so much for your information. Absolutely brilliant.
1:05:18
And you've got such a wonderful way of talking about it and educating people about it as well.
1:05:23
So I wish you luck in the courses and hope they go really well.
1:05:26
Thank you and thank you everybody for who was listening and for the questions
1:05:30
because some really great questions tonight certainly have well done people
1:05:33
done me proud right take care everybody look after each other hopefully we'll
1:05:38
see a few of you live next week bye.
1:05:42
Music.