Concussions in Kids

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What is a Concussion and What to do Next

A concussion is a Mild Traumatic Brain Injury that occurs with an impact or forceful movement to the head/body, causing a rapid motion of the brain in the skull. It can happen to children of any age as well as adults. Note: it’s not just blows to the head that can cause a concussion. Impact to the body can also transmit force to the neck and head, resulting in a concussion.

If your child has had an injury and you suspect a concussion, take them to the emergency room immediately if any of the following symptoms occur: What are the signs and symptoms of a concussion in children/teens?

Each person is different and may experience one, some or many of the below symptoms. These may vary from day to day or could be consistent. 
  •     Very Drowsy
  •      Vomiting
  •      Memory Deficits
  •      Seizure
  •      Blood from Eyes/Ears
  •      Bruising/ Black Eyes
  •      Severe Balance Issues
  •      Severe Injury
  •      Slurred Speech
  • Numbness in Arms or legs
 Emotional and Behavioural:

  • Irritability
  • Nervous/anxious/angry
  • Frustrated
  • Sadness

Physical symptoms:

  • Headache
  • Nausea/vomiting
  • Dizziness
  • Sensitivity to noise/light
  • Blurry vision
  • Decreased balance
 Mental symptoms:

  • Fogginess/tired
  • Feeling slowed down
  • Trouble remembering
  • Trouble concentrating

Sleep:

  • Trouble falling asleep
  • Trouble staying asleep
  • Sleeping too much
*Only 10% of concussions cause a loss in consciousness so this is not a reliable sign*

**Signs and symptoms of a concussion can be delayed by several hours or even several days! When it comes to kids and sports – if you’re not sure if a concussion has occurred – it’s best to rest for 48 hours after a blow to the body/head before returning to play. “When in doubt, sit them out.”

 

What are signs and symptoms of a concussion in toddlers and infants?

Infants and toddlers with a suspected concussion, or those experiencing behaviours that are abnormal/concerning for them, should seek immediate medical attention.  An infant or toddler with a concussion can present with some or all of these symptoms:

  • Crankiness/irritability that is not typical
  • Cannot be comforted or crying excessively
  • Changes in eating, sleeping or playing patterns
  • Worsened balance/walking
  • Decreased interest in toys/play
  • Increased fatigue/tiring easily
  • Decrease in skills (language, social, emotional or physical) 

What to do if your child has a concussion

Immediately:

  • Make them stop what they are doing
  • Stay with them to monitor them
  • Seek medical attention to be assessed

During the first 48 hours:

  • Allow your child to rest for a maximum of 2 days. They will need physical and cognitive rest to help their brain heal. 
  • Limit screen time and avoid activities that increase/cause symptoms. 
  • Schedule an appointment with a paediatric, concussion-trained physiotherapist to get started on a recovery plan.

After 48 hours: 

  • Limit physical exertion to activities that do not increase your child’s heart rate too high/cause them to break a sweat. 
    • Examples of things to avoid: Work outs, sports, running, biking, rough play, etc.
  • Cognitive activity should be slowly and gradually re-introduced as symptoms allow, including activities that require concentration and learning as well as exposure to loud noises. 

How long do symptoms last?

  • Most concussion symptoms resolve in 1-4 weeks. During this time we recommend that kids gradually return to school and sports with a return to play protocol, under the guidance of a trained professional.
  • Returning to full activity/sports too soon may result in more severe symptoms or long term problems. It can also put your child at risk of sustaining another concussion with more severe symptoms and a longer recovery period.

How do you treat a concussion?

Physiotherapy can help to assess and address concussion symptoms. Treatment can involve:

  • Neck dysfunction/whiplash 
  • Vestibular system – dizziness and nausea symptoms
  • Visual symptoms
  • Graded and monitored return to school and work with communication to teachers, coaches and more
  • Education on symptom management and how to successfully return to school and sports.
  • Comparing where your child is at to their Concussion Baseline Test, if they have one, and ensuring they get back fully to their baseline levels.

What’s different about Playworks Physio Concussion Treatment?

At PlayWorks Physio, our therapists have up to date concussion training and we individualize each patient’s treatment to their specific concerns and symptoms. We take the time to find out what your child’s interests are and use games and play to motivate them with their exercises! From high level athletes to toddlers, each child’s plan is catered to their level. 

Have a child with a suspected concussion? Click here to book an appointment or call us to see how we can help to identify if a concussion is present and provide treatment as necessary – 604-492-3888.

 

Written by: Kate Heays & Lindsay Eriksson

 

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Pre-habilitation: Let’s Prevent Hockey Injuries!

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Can We Prevent Injuries in Hockey Players?

It’s fall, which means that school and sports are back in full swing! This often leads to some pain and injuries in athletes, as they are thrown into training, try-outs and games. In youth hockey, we see injuries such as concussions, knee pain, groin injuries and shoulder injuries. See the chart below for a breakdown of these injuries and the top 3 highest percentage of injuries.

Injury area Males Females
Head/ Neck 25.1% 28.4%
Arms/ shoulders/ wrist 45.2% 39.2%
Legs (hips/ knee/ groin/ ankle) 21.4% 23.2%

(Forward et al., 2014).

With all sports, some injuries happen because we can’t control all aspects of the sport and other players. However, we do know that improved reaction time, muscular strength, muscular endurance and joint range of motion can help us LIMIT the risk of injuries. 

For hockey players, some key areas for injury prevention are:

  • Shoulder Stability
  • Hip strength and Stability
  • Lateral Movements
  • Core Stability
  • Reaction Time

Are Breaks in Activity Beneficial?

In an article looking at the number of injuries in players who took a break mid-season, it showed that winter break caused an increase in injuries by 2.5x as compared to years with no winter break. This article highlights that long periods of rest, followed by full return to sport, causes higher risk of injuries. We want to use this time during winter break to continue to be active, to use prehab exercises to our advantage, and to spend some time doing some cross training (training in another way or with another sport) (Rees et al., 2022).

Can Physio Help?

Overall, it is extremely important to make sure that your athlete’s muscles are working efficiently, are strong enough to support the demands of the sport and that your athlete is familiar with proper warm up and cool down techniques. Physiotherapy can help with injury prevention by improving the strength and mechanics of the most common injury areas for hockey.

If your child is playing hockey this season, are they ready for activity? 

At PlayWorks Physio, we offer injury prevention group classes for hockey players! Contact us at hello@playworksphysio.com for more info.

If you would like to schedule a 1 on 1 assessment with one of our paediatric physiotherapists click here.

Written by, Darrien Cantelo, MScPT, BSc, Physiotherapist.

 

Forward, K. E., Seabrook, J. A., Lynch, T., Lim, R., Poonai, N., & Sangha, G. S. (2014). A comparison of the epidemiology of ice hockey injuries between male and female youth in Canada. Paediatrics & Child Health, 19(8), 418–422. https://doi.org/10.1093/pch/19.8.418 

Rees, H., McCarthy Persson, U., Delahunt, E., Boreham, C., & Blake, C. (2022). Winter breaks: How do they affect injuries in field hockey? Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2022.08.004 

 

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What is Developmental Coordination Disorder (DCD)?

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What is Developmental Coordination Disorder?

Developmental Coordination Disorder (DCD) is a motor skill disorder that affects roughly 5-6% of school aged kids (5 years and up), with boys being affected at a 2:1 ratio to girls. DCD is commonly described as kids who show awkward, clumsy movements in their day to day.

Often parents or teachers will notice the child having a hard time keeping up with their peers, having difficulty doing tasks that involve one or more movements and/or are delayed in gross motor skills such as jumping, skipping and ball skills. Kiddos with DCD have difficulty planning out tasks, they know what they want to achieve, but they struggle to find the map to get there.  

Common tasks parents notice these children may find difficulty with are as follows:

  • Bike riding: some parents may notice that they can peddle on the bike once on, but they lack the planning to stop, and get off the bike smoothly. 
  • Skipping: arguably one of the most difficult tasks for kids to learn, they have a difficult time skipping as it takes coordination of the arms and legs at the same time.
  • Shuffling: these may be seen during activities such as team sports and warm ups, a difficult. 
  • Ball skills: kids may have difficulty catching and throwing balls with accuracy.

 

How can Paediatric Physiotherapists help with DCD?

We can help by giving REPETITIVE PRACTICE! As adults, we know we get better with practice, often these kids need blocked practice to improve a skill. We can help by identifying a specific goal, give them strategies on how to get there and work on each component of that skill. We give repetitive practice to allow these kids to build that road map from point A to point B. 

We can also perform a movement screening (The Movement ABC), to help determine if your child appears to have a coordination disorder. Book your assessment here.

Things that can help at home:

  • HEAVY PLAY! Fill up a toy shopping cart and push it, pulling a sibling on a bed sheet etc, these tasks help turn on muscles that are often limited. 
  • Give them a plan: If your kid forgets to put on their socks every time before they put on their boots- put a picture of a sock by their boots so they have a visual of what they need to do.
  • Encourage your little one to remain active, whether it’s individual sports, team sports or another activity they choose. These kids can often become discouraged if sports don’t look the same for them as they do for their peers, encourage them to stay active and have fun!

 

If you have any questions, or concerns that your child may have a coordination disorder, we can help! Click here to book your assessment.

Written By: Darrien Cantelo, Physiotherapist

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Common Swimming Injuries in Kids/Teens

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A Swim-pressive Sport

Competitive swimming is a physically demanding sport that requires strength, endurance, speed, and agility.  Training includes repetitive drills to develop effective stroke techniques.  Most swimming injuries are caused by overuse and/or faulty stroke mechanics.

A Deeper Dive into Swimming Injuries

Common injuries include:

  • “Swimmer’s Shoulder”: injury to the muscles, tendons, ligaments, or cartilage in the shoulder joint
  • “Swimmer’s Knee”: injury to the muscles, tendons, ligaments, or cartilage in the knee joint
  • Neck and low back pain

Water the Causes of Swimming Injuries?

  • Overtraining
  • Poor stroke mechanics
  • Poor breathing technique
  • Poor flexibility or range of motion
  • Decreased muscle strength
  • Poor core strength or stability

How Can Physiotherapy Help Your Rehab Go Swimmingly?

At PlayWorks Physio, we can help provide education on proper warm up and cool down strategies, to improve or prevent injuries. Our physiotherapists can create a plan to improve flexibility, strength, endurance and improve stroke mechanics. Addressing all of these areas can help prevent future injuries and pain. In addition to the repetitive nature of swimming, kids are constantly growing and their bodies are changing. This makes them more prone to different types of pain and injuries! We always suggest addressing pain sooner, to have faster recovery and prevent more severe injury.

If you have a swimmer who is experiencing pain, has a current/recurring injury or you want to be preventative, you can book your Initial Assessment here.

 

Written by: Melanie Touhey, Interim Physiotherapist

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5 Tips For Choosing Shoes For Your Toddler

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5 tips for choosing shoes for your toddler

 

Choosing shoes for your toddler can be overwhelming! There are so many brands and styles to choose from. The shoes you put your toddler in can impact their foot development, arch development and overall comfort. Here are 5 important tips to consider the next time you are choosing shoes for your little one:

 

  1. A wide toe box. You want to ensure that the front part of the shoe (the toe box) is wide enough to fully allow your child’s foot to splay/spread out when they are walking. This is important for their balance and both the structural and muscular development of their feet.
  2. A flexible sole. You should be able to easily bend the shoe when you are pushing from the toe and the heel. This will allow their feet to move more naturally while they are walking and promote the development of their arches by allowing their intrinsic foot muscles to engage.
  3. Firm heel cup. The heel cup should be firm – if you pinch the heel of the shoe, it should maintain shape. This will provide adequate support for your child’s feet.
  4. The right size. It’s important to have shoes that fit your child properly, resist the urge to buy shoes that are too big!  The “flex point” of the shoe should line up with where their foot bends when walking. If a shoe is too big, then these two spots will not align. Their feet will be less supported in a larger shoe and can also lead to more tripping and ankle injuries.
  5. Secured. Having shoes with velcro or laces are ideal to make sure they fit snugly on your child’s feet. This will prevent “toe gripping” and decrease tripping. Toe gripping happens when shoes are too big or aren’t secured onto the foot well enough. It can lead to instability and over time lead to foot or leg pain.

 

Proper footwear is so important, especially in the early years! If you have any questions please reach out, we are always happy to help! 

 

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The Top 4 Figure Skating Injuries

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Figure Skating and Common Injuries

Figure skating is a demanding sport that requires flexibility, balance, strength, and artistry. It is a skill-based sport that requires many repetitions of complex movement patterns across all disciplines. With the demands of on-ice, off-ice, flexibility, and dance training, overlooked injuries can grow to more complex injuries.

The Top 4 Figure Skating Injuries:

  1. Ankle Sprains
  2. Knee Pain
  3. Back Injuries, from extreme positions or the impact on landings with a rigid boot
  4. Concussions, can be from falls with or without a direct hit to the head

How physiotherapy can help:

  1. Addressing an injury early can prevent the progression from an acute to a chronic injury. By identifying injuries early on, skaters are able to return to their regular training earlier without pain, allowing the skater to focus on their coach’s feedback.
  2. Pre-habilitation and injury prevention can decrease a skater’s risk of an injury during the season.
  3. Concussions happen in the sport. Recovering from a concussion can be tricky and your physiotherapist can guide your return to sport in a safe manner.

To book an assessment with National Figure Skater and Physiotherapist, Kai-Jing Leong, click here.

Written by: Kai-Jing Leong

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Heel Pain/Sever’s Disease – What is it?

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Severs- what it is, what is happening, how physio can help

What is Sever’s Disease? 

Sever’s Disease occurs when the C shaped growth plate at the back of your heel gets inflamed from stress from the achilles tendon. Growth plates are areas of cartilage located near the ends of the bones, and this is where bone growth occurs. Since it is the last part of a child’s bone to harden, growth plates are particularly vulnerable to injury. Adults don’t have open growth plates anymore, so this condition is found only in kids. Sever’s Disease is also 2-3 times more likely to occur in boys than girls, and it is associated with big growth spurts!

What my child may complain of?

  • No pain in the morning, but usually is worse with increased load during the day
  • Pain worsens with repetitive activities (example: running or jumping)
  • Tenderness on both the inside and outside of the heel
  • No swelling, redness or skin changes noted with this condition
  • Calf tightness

Things that may make Sever’s worse:

  • Worn out shoes
  • Hard surfaces
  • High amounts of physical activity
  • Big growth spurts
  • Back to activity after a long break

How can physio help?!

At Playworks Physio we specialize only in kiddos! We see kids with this type of heel pain VERY often, especially with the start of sports seasons. Your Physio will take a good look at what is happening and what might be causing it, and give lots of tools to help. Some things include stretching and strengthening activities, suggestions for activity modifications, shoe recommendations, and of course, this will all be FUN for your kiddo.

Our main goal is to help reduce your kiddos pain, solve the source of the issue to prevent it from returning, and improve their ability to participate in their activities again, pain free!

– Darrien Cantelo, Physiotherapist

 

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Toe Walking – Can You Treat It?

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Did you know that toe walking is something that can be treated at a paediatric physio clinic? 

When you bring your child in for an initial assessment at PlayWorks Physio, this is typically what you can expect:

  • Your physiotherapist will go over a detailed history of your child’s development (including pregnancy history, early development, toe walking habits as well as other medical history)
    • Why is a history important ?
      • If you know the root cause of the issue, then you’ll have more success in the treatment outcome. There are a few different reasons kids walk on their tip-toes:
      • 1) Neurological cause 
      • 2) Genetic cause 
      • 3) Sensory cause 
      • 4) Muscular cause  
      • Knowing the cause of the toe walking will help the physiotherapist create the most specific, and successful treatment approach for your child.
  • Watching your child move (and play)! It’s one of our best-kept, “not-so-secret” secrets. Kids are smart, when they hear “the physio is going to watch you walk,” they’ll change their pattern to walk to what they think is better. Your physio will encourage them to play around the treatment room, getting them to walk, run, skip, jump, squat, crawl, spin and bend. This will allow your physio to watch and analyze your child’s usual movement patterns.
  • Next, your physiotherapist will discuss the recommendations to fit your child’s (and family’s) individualized needs. This may include:
    • a plan for future physio sessions (if needed) 
    • exercises to work on at home 
    • orthotics (some kids need extra support to help your child achieve an appropriate walking pattern. Not all kids need this support, and the goal of these is typically a short-term solution to help achieve a normal walking pattern).
    • referral to any specialists if needed

Scroll down to see some examples of kids who are working on toe walking and some before/after pictures. Our goal is to get their heels to “strike” the floor when they take a step. In the examples below, you can see the progress made with coming to physio and following a home program!

Example A:

  • This kiddo has been coming to physio since January 2020 (even virtually through the pandemic!) and his treatment plan includes weekly physio, custom orthotics, and a gait-retraining program. He’s very close to being completely discharged from physio. This family was extremely dedicated and were gold star patients in following the plan. As a result he’s had a change of 16 degrees of ankle range, and we’re not stopping yet!

Before

After

Example B:

  • Kiddo B has been intermittently coming to physio, and her physio plan includes exercises to do at home, and shoe recommendations. The before/after picture was taken in the same session! 

Before

After

Example C:

  • Kiddo C has been coming to physio once a month to work on her goals. Her plan also includes home exercises and custom orthotics. 

Before

After

If you’re interested in what we can do for your kiddo’s toe-walking habits, email us at: hello@playworksphysio.com or book your assessment here.

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A to Z what about Pee?!

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A to Z but what about Pee !?

Summer holidays – one of the most awaited times of the year! Perhaps it involves a camping trip, or a summer slumber party. Whatever it is; it’s time for kids, and parents to relax, reset, and be stress free from the school year! 

That is the case, unless you’re a kiddo (or a parent of a kiddo) with urinary incontinence. Summer holidays and fun, social plans can be absolutely terrifying. 

How can I go on a camping trip if I pee my pants sometimes?

How will my child go to the birthday sleepover if they wet the bed some nights? 

The most important thing to know is that wetting the bed, or clothing is not your fault, nor your kiddo’s fault. There are many things out there (including Paediatric Physio!) that can help kids decrease these occurrences, so keep smiling … we can help! 

A second crucial thing to know, is that this is more common than you might imagine. The number of children and teens who struggle with continence is astounding, so it’s not just you and your kiddo. And want to know something else? It’s especially common in athletes! So you’re not alone! Helping your child realize that several kids in their class or on their sports teams also live with this can help them appreciate this more. Urinary leakage typically comes with a bunch of shame, guilt and fear. So try to let it go, and again…it’s not your fault!

There are a few definitions I’m going to go over so you can start to understand what may be going on with your situation:

Continuous incontinence – this is for kiddos who constantly leak in non-discrete amounts. This is something that you should see a doctor about, and is usually more of a “hardware” issue, than a “software” issue.

Intermittent Incontinence – this applies to kiddos who have specific, urinary leakage incidents. This can be daytime only, nighttime, only, or both. It can be for kiddos who are over the age of 5 who never achieved continence (primary), but also for kiddos who have previously attained bladder control (secondary). More specific categories include:

    • Urge Incontinence: when a kiddo has a sudden or unexpected need to pee and can’t make it to the toilet in time.  
    • Stress Incontinence: when a kiddo has leakage with a specific activity such as coughing, sneezing, or laughing BUT ALSO during sports when you kick, run, or hop!
    • Nighttime Incontinence: when a kiddo wets the bed at night 

Who are the culprits ?!

Now you’re likely not going to believe this (as did I when I first heard it), but one of the main suspects of urinary incontinence is constipation! Let me explain…

When your rectum is full (even more so in little bodies), it pushes on the bladder and doesn’t allow it to fully fill. Furthermore, all that build up in the abdomen puts extra pressure on the “sensors” making it difficult to tell when it’s really time to go. Even pooping daily can mean constipation, so, everyone is assumed to be constipated until proven innocent! 

Next on the suspect list are those sneaky pelvic floor muscles. These muscles sit in your pelvis and control the flow of pee and poop out of your body. Sometimes they can be weak, however they can also be tight and gripping, trying to hold everything in. When these muscles can’t contract properly, it causes constipation, poo stains in undies, itchy bums, pee dribbles and even those bigger leaks. 

Other culprits can include things such as family history, life events (new sibling, divorce, illness/injury, etc), frequent urinary tract infections, early toilet training and sensory involvement. 

Ta-Da! The solution:

  1. Say it, repeat it, believe it: It is not your fault. You are not alone 🙂 
  2. Get yourself to a qualified physio who has extra training to treat the pelvic floor, but also who has experience working with kids. They will be able to assess the muscles (in a non-invasive way!!) as well as determine other culprits at play. Based on what they find, your paediatric physio can help you come up with a fun plan to becoming continent! CLICK HERE to book an appointment.
  3. It’s important to have a proactive health care team that is up to date with what’s going on. Knowledge is power and having a supportive team will help make the journey even easier! 

For more information check out this cool video made by SickKids in Toronto for a great summary!

https://www.youtube.com/watch?v=E8Khck8lWak

If you want to schedule an appointment with our paediatric physio and pelvic floor trained physio CLICK HERE.

Written by: Karly Dagys, Physiotherapist

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Are Flat Feet Normal in Kids?

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Did you know that almost everyone is born with flat and flexible feet? In their first year, babies’ feet grow extremely fast – about 2.5cm! As children get older and start walking, their feet are still flat because the bones, muscles and ligaments are not yet fully developed.

 

Foot development

The main arch of the foot, the medial longitudinal arch, begins to form at 3-4 years of age. This arch continues to develop throughout the first 10 years of life and many studies state that the mature foot posture is not obtained until 7-10 years of age (Uden et al., 2017). This means that we should expect our children’s feet to be flat during their first 3-4 years and to then start developing an arch over the next 7 or so years.

 

Factors that can affect foot development

  • Poor fitting shoes: too small, too big, too rigid
  • Not enough barefoot time at home

 

What about those Flat Feet?

Flat feet aren’t always problematic. As you can see from above, younger kids tend to have naturally flatter feet and therefore treatment is not always necessary. If your child goes up on their tiptoes you should be able to see their arch form. This is considered “flexible flat feet”. These should not be painful. Ultimately painful flat feet in kids are a problem and non-painful, flat feet in children (or adults!) are not a problem and do not need to be treated unless they are accompanied by any of the points listed below.

 

Here are some reasons why we see kids at PlayWorks Physio for flat feet:

  • Their walking pattern is different. For example, if they do not push off from their big toe, instead they use the inside of the foot
  • Complaints of foot, ankle or knee pain
  • Bunion development on the inside of the foot
  • Frequent rolling of their ankles
  • Complaints of their feet getting tired or sore after activity
  • Excessive pronation (collapsing inwards) of feet

 

Things you can do to encourage proper foot development in your kids

  • Find properly fitting shoes. Look for shoes with a supportive heel cup and flexible sole. CLICK HERE  to learn how to pick the best shoes for your child.
  • Have your child barefoot when safe/appropriate. This helps develop the muscles, ligaments and tendons of their feet and will contribute to arch development.
  • Play around with walking on different types of surfaces. For example: grass, hills, trails, gravel, sand etc.

 

If you have any questions about your child’s foot development, email us at hello@playworksphysio.com

 

Written by: The PlayWorks Team

 

References: Uden et al. Journal of Foot and Ankle Research (2017) 10:37

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