Understanding Vestibular Neuritis and BPPV: How Physiotherapy Can Help

If you’ve ever felt sudden dizziness or a spinning sensation, you’re not alone. Two of the most common causes of vertigo are Vestibular Neuritis and Benign Paroxysmal Positional Vertigo (BPPV). While they both affect balance and can be unsettling, they have different causes, symptoms, and treatments. Understanding the differences can help you seek the right care and manage your symptoms effectively.

What is Vestibular Neuritis?

Vestibular neuritis is an inner ear condition caused by inflammation of the vestibular nerve, which helps send balance signals to the brain. It is often triggered by a viral infection, like the flu or a cold.

Symptoms of Vestibular Neuritis:

• Sudden and intense dizziness (vertigo) that lasts for hours or days

• Balance problems and feeling unsteady

• Nausea and vomiting due to dizziness

• No hearing loss or ringing in the ears (unlike other ear conditions)

Vestibular neuritis can make simple tasks like walking or turning your head feel difficult. However, symptoms usually improve as your brain adjusts over time. Most people recover significantly within a few weeks, but some may experience lingering balance issues for months. Early intervention with physiotherapy can help speed up recovery and minimize long-term dizziness.

How Can Physiotherapy Help with Vestibular Neuritis?

Physiotherapists play a crucial role in diagnosing and treating vestibular neuritis. They assess your symptoms and create individualized treatment plans to improve balance, reduce dizziness, and restore normal movement. Physiotherapy interventions include:

• Vestibular Rehabilitation Therapy (VRT): A structured exercise program designed to help retrain the brain and improve balance function.

• Balance Training: Exercises that enhance coordination and stability to prevent falls.

• Gaze Stabilization Exercises: Techniques to improve visual focus and reduce dizziness when moving your head.

• Gradual Exposure Techniques: Designed to help reduce dizziness caused by motion and head movements over time.

What is BPPV?

BPPV happens when tiny calcium particles in the inner ear (called otoliths) move into the wrong area, causing brief but intense dizziness when you move your head.

Symptoms of BPPV:

• Short episodes of dizziness (usually less than a minute)

• Dizziness triggered by head movements (turning in bed, looking up, bending down)

• Nausea (but usually not severe)

• No hearing loss or ear pain

BPPV has an excellent prognosis, with most individuals experiencing full resolution of symptoms after one or two repositioning treatments. However, some may have recurrent episodes over time, requiring additional treatment.

How Can Physiotherapy Help with BPPV?

• Canalith Repositioning Maneuvers: A physiotherapist can perform maneuvers like the Epley maneuver to reposition the displaced calcium crystals, providing immediate relief.

• Vestibular Rehabilitation Therapy (VRT): A structured exercise program that helps the brain adapt to changes in balance and dizziness, improving long-term stability.

• Education and Prevention: Learning how to avoid certain movements that trigger symptoms and how to safely recover when dizziness occurs.

Many people experience significant relief after just one or two physiotherapy sessions.

Vestibular Rehabilitation

Some individuals may continue to experience imbalance or motion sensitivity following any vestibular condition. Vestibular rehabilitation therapy (VRT) can help by:

• Enhancing Balance and Stability: Improving coordination to reduce feelings of unsteadiness.

• Reducing Motion Sensitivity: Exercises designed to help the brain adapt to movement more efficiently.

• Improving Gaze Stabilization: Techniques to maintain clear vision while moving.

• Restoring Confidence in Movement: Helping individuals return to normal activities without fear of triggering dizziness.

Key Differences Between Vestibular Neuritis and BPPV

Feature

Vestibular Neuritis

BPPV

Cause

Viral inflammation of the vestibular nerve

Dislodged calcium crystals in the inner ear

Type of Dizziness

Constant, lasts for hours/days

Brief, triggered by movement

Balance Issues

Yes, often severe

Usually mild between episodes

Nausea

Common and intense

Possible, but usually mild

Physiotherapy Treatment

Rehabilitation exercises to retrain balance

Repositioning maneuvers to correct crystal displacement

Prognosis

Gradual recovery over weeks to months, may have lingering balance issues

Usually resolves quickly with treatment, but may recur

When Should You See a Physiotherapist?

If you experience ongoing dizziness, vertigo, or balance problems, a vestibular-trained physiotherapist can assess your condition and provide effective treatment. Seeking help early can speed up recovery and prevent long-term issues.

Takeaway

Physiotherapy plays a crucial role in treating both vestibular neuritis and BPPV. If your dizziness is constant and severe, vestibular rehabilitation therapy can help. If your vertigo happens in short bursts with movement, repositioning maneuvers can offer quick relief. Seeing a physiotherapist for assessment and treatment can help restore your balance and improve your quality of life.

Written by Matthew Long, Physiotherapist

Understanding Corticosteroid Injections: Benefits, Risks, and What You Need to Know

Corticosteroid injections (CSIs) are a widely used treatment option for a variety of musculoskeletal conditions, particularly when inflammation and pain are involved. These injections provide relief in cases where other treatments have been less effective, but they come with a set of potential risks and side effects that patients should be aware of before opting for this intervention. In this blog post, we’ll break down what corticosteroid injections are, how they work, their uses, risks, and the guidelines for their safe application. 

What Are Corticosteroid Injections? 

Corticosteroids are synthetic drugs that resemble cortisol, a hormone produced by the adrenal glands. Cortisol is crucial in regulating the body’s response to stress and inflammation, which is why corticosteroids are effective in reducing pain and swelling in conditions like arthritis, tendonitis, and bursitis. 

Typically, corticosteroids are injected directly into the affected area, and they may be combined with a local anesthetic to enhance pain relief. The idea is to reduce inflammation at the site and provide significant, albeit short-term, pain relief. 

Who Benefits from Corticosteroid Injections? 

Corticosteroid injections can be a game-changer for people dealing with joint pain, particularly in conditions where other treatments have failed. Some common conditions treated with CSIs include: 

• Osteoarthritis (OA): In OA, corticosteroid injections can provide significant pain relief, particularly in the knee, hip, and shoulder joints. However, long-term use is generally discouraged because repeated injections can accelerate joint deterioration. 

• Frozen Shoulder: For people with shoulder pain, especially those with frozen shoulder, corticosteroid injections can help reduce inflammation and improve range of motion. 

• Tendon issues and Bursitis: CSIs are often used in cases of tendonitis and bursitis, where inflammation is present around the tendons and joints. 

• Carpal Tunnel Syndrome: For some individuals with carpal tunnel syndrome, CSIs can help reduce the inflammation around the median nerve, relieving pain and numbness. 

• Trigger Fingers: Corticosteroid injections are often the first-line treatment for trigger finger, offering relief in a large percentage of cases. 

Risks and Side Effects 

While corticosteroid injections can be effective, they come with several risks. It's important for patients to weigh the benefits against potential side effects: 

Local Side Effects: 

• Joint Arthropathy: Long-term use may weaken the joint structure. 

• Tendon Weakening: Corticosteroids can weaken tendons and increase the risk of ruptures, particularly in places like the Achilles tendon. 

• Skin Changes: Some people experience skin depigmentation or thinning of the skin around the injection site. 

• Fat Atrophy: Repeated injections can cause the fat pad around the joint to shrink, potentially affecting joint function. 

• Post-Injection Flare: A small percentage of people experience a temporary flare-up of pain or swelling after an injection. 

Systemic Side Effects: 

• Impaired Blood Sugar Control: Corticosteroids can worsen blood sugar levels, particularly in people with diabetes. 

• Increased Blood Pressure: They may cause a rise in systolic blood pressure. 

• Facial Flushing: Some people experience redness or flushing of the skin, particularly on the face. 

• Mental Health Effects: In some cases, corticosteroids have been linked to mood swings or even psychosis. 

• Immunosuppression: Corticosteroids can suppress the immune system, making the body more susceptible to infections. 

When Should You Consider Corticosteroid Injections? 

Corticosteroid injections are typically considered when other conservative treatments, such as physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), or rest, haven’t provided adequate relief. In many cases, injections are recommended when pain limits the ability to engage in rehabilitation exercises or when surgery is not an immediate option. 

It’s important to understand that CSIs are meant to be a short-term solution. Long-term or frequent use is not recommended due to the risk of joint and tissue damage. Patients should always discuss their treatment options with their healthcare provider and consider the risks versus benefits. 

Written by Caitlyn Alexander derived from Nick Lavadas’ masterclass on physio network. 

Myth vs. Fact of Lower Back Pain + My Story of Recovery

Last month, we celebrated World Physiotherapy Day, a global event that emphasizes the importance of physiotherapy in managing common conditions such as lower back pain (LBP). LBP affects millions worldwide, impacting physical health, mental well-being, and quality of life.

Physiotherapists used that day to raise awareness about effective treatments and encourage early intervention and preventive strategies. Research shows that up to 70% of people who experience back pain will face a recurrence within a year, adding to personal, economic, and healthcare burdens. However, with proper management, this cycle can be disrupted, improving both function and long-term health.

Definition

There are different definitions of low back pain (LBP) depending on the source. 

o   According to the European Guidelines for prevention of LBP, LBP is defined as “pain and discomfort, localised below the costal margin and above the inferior gluteal folds, with or without leg pain”.

o   According to S.Kinkade, which resembles the European guidelines is that LBP is “pain that occurs posteriorly in the region between the lower rib margin and the proximal thighs”.

o   The most common form of LBP is the one that is called “non-specific LBP” and is defined as “LBP not attributed to recognisable, known specific pathology”. 


Myth vs. Fact of Lower Back Pain

Myth: “I need a scan or X-ray to know what’s wrong with my back.”

Fact: Imaging scans rarely identify the exact cause of lower back pain. Disc degeneration, bulges, and arthritis are common findings in people without pain and are often part of natural aging.


Myth: “Resting in bed is the best way to recover.”

Fact: While avoiding aggravating activities is helpful initially, extended rest can slow down recovery. Gentle movement and gradually resuming regular activities are key to promoting healing.

Myth: “If moving hurts, it must be causing damage.”

Fact: Pain during movement doesn’t always mean harm. Staying active helps keep your spine healthy and strong. Inactivity often leads to stiffness, muscle weakness, and fear of movement, which can prolong recovery.

Physiotherapy helps manage LBP through evidence-based strategies, such as:

            1.         Assessment and Diagnosis: Identifying the root cause of pain and tailoring treatment plans.
            2.         Manual Therapy: Techniques like mobilization and manipulation improve mobility and reduce discomfort.
            3.         Exercise Therapy: Strengthening core and back muscles to support the spine and prevent future injuries.
            4.         Patient Education: Teaching body mechanics, posture, and lifestyle modifications to reduce pain recurrence.
            5.         Pain Management: Offering non-invasive methods to control pain without heavy reliance on medications.

My Recovery Story

As a physiotherapist, I guide patients through their recovery journeys. But when I faced lower back pain myself, I truly understood the emotional and physical challenges they experience.

The pain began during a move to a new unit, where lifting boxes and cleaning caused significant strain on my back. At first, I assumed the pain would go away, but it lingered and began affecting my ability to work and stay active. Even simple tasks felt difficult, and I found myself needing frequent breaks throughout the day.

Realizing I couldn’t manage it alone, I sought help from my colleagues. Their advice and manual therapy sessions were invaluable, reinforcing the importance of asking for help even when you’re knowledgeable about the condition.

Although I initially hesitated to start exercising due to pain, I knew movement was essential for my recovery. Given my experience as a Pilates instructor, Pilates was a natural choice for me. However, it’s important to note that recovery doesn’t need to involve Pilates. Any form of movement therapy whether walking, swimming, yoga, or strength training can be effective, as long as it’s something your body can tolerate.
For me, Pilates provided a way to rebuild my strength through controlled exercises targeting my core and back muscles. But more importantly, it helped me regain trust in my body. I started with gentle movements and progressed gradually, listening to my body’s signals along the way.

Over time, I noticed significant improvements. My pain reduced, my mobility returned, and I felt stronger and more stable. Pilates also deepened my understanding of proper body mechanics, which I now incorporate into my practice when advising patients.

My recovery journey reminded me that the key to overcoming back pain is movement any type of movement that suits your preferences and abilities. Whether it’s yoga, swimming, strength training, or even daily walks, the most important thing is to stay active and avoid fear of movement. The body thrives on motion, and progress comes from small, consistent efforts.

Lower back pain is a challenge, but it doesn’t have to be a life sentence. Through professional guidance, movement, and a patient mindset, recovery is achievable. My personal journey reinforced the importance of staying active, listening to your body, and seeking help when needed. Rehabilitation is a process, but with persistence and the right approach, it can lead to both physical and mental transformation.

The message I now share with my patients and with anyone dealing with back pain is simple: keep moving in a way that feels right for you, and trust that your body can heal.

Dealing with Lower Back Pain? We’re Here to Help!

Lower back pain can be frustrating and disruptive, but you don’t have to manage it alone. Our team of expert physiotherapists is here to guide you toward the right treatment plan tailored to your needs. If you’re experiencing discomfort or stiffness, we encourage you to make an appointment with us to explore effective solutions and get back to doing what you love.

Don’t let pain hold you back—book your session today and take the first step towards recovery!

Written by Christine Alano, Physiotherapist

Endometriosis + Physiotherapy

Straight off the back of Women’s health week is the perfect time to discuss endometriosis. What is it? What are the common symptoms? And what can a Pelvic Health Physiotherapist do to help?

What is Endometriosis (or Endo)?

§  According to the World Health Organization (WHO) endometriosis is defined as a disease in which tissues similar to the lining of the uterus grows outside the uterus. It is thought to affect roughly 10% of women and girls of reproductive age globally.

§  There is no known cure for endometriosis and management is usually aimed at Symptom management

§  Endometriosis can only be diagnosed with Laporscopic surgery but researchers are currently working to create less invasive, bed side techniques of diagnosis.

Symptoms

Symptoms of endometriosis can vary quite a bit from person to person because the emerging evidence is suggesting that Endo and Endo symptoms are more systemic in nature, so it can affect much more than just the pelvic region.

But common symptoms can include (but are not limited to) (WHO 2023):

§  Irregular and or heavy periods

§  Pelvic pain including pain with sexual intercourse, bowel movements and/or urination.

§  Abdominal bloating

§  Nausea

§  Fatigue

§  Issues with conception

§  Depression/anxiety

Endometriosis related pain

-        Endometriosis-associated pain (EAP) syndrome is defined by the 2023 European Association of Urology Guidelines on Chronic Pelvic Pain as ‘chronic or recurrent pelvic pain in patients with laparoscopically confirmed endometriosis’ the term is used when the symptoms persist despite adequate endometriosis treatment. (APA 2024)

-        While endometriosis is thought to initially arise due to local inflammation, lesions and hormonal effects (Zondervan et al 2020), the persistent nature of EAP is due to a more widespread response in the body and it is proposed that endometriosis is a systemic disease (Taylor et al 2021)

Management

-        When people hear Pelvic/Women’s health physiotherapy they tend to picture them treating ante or postnatal women or women with incontinence issues. However, Physiotherapy can play a large role in endometriosis management. EAP can be of a result of musculoskeletal and nervous system response to pain, which leads to ongoing or persistent pain even after the endometrial tissue has been removed.  (APA 2024)

-        Physiotherapy can address pain related to nervous system dysregulation and secondary musculoskeletal pain as a result of increased “danger” messaging from the area.

-        Women who suffer with endometriosis benefit from a multidisciplinary or team approach to management. The team will obviously include a good GP, a Gynecologist and may also include a naturopath or dietician and/or a psychologist depending on symptoms.

So please make an appointment with one of our Women’s Health Physiotherapists to discuss a personalized, endometriosis management plan.

Written by Caitlyn Smith, Physiotherapist

Myofascial Cupping- what are those funny marks?

With the Olympics having been back in full swing again you might start to see a lot of athletes with the odd-looking circular marks on their backs, shoulders or legs. This is from a treatment called Myofascial cupping.

Fascia is a layer of connective tissue below the skin. It surrounds every part of your body and provides shape and support. It is multi-layered and plays an active role in the body. It supports tissues and organs, lessens friction, eases muscle tension, and tightens up reflexively. It also helps your bloodstream, bone tissue, and skeletal muscles.‌

When it’s healthy, your fascia is slippery and smooth, and it stretches with you as you move. If it’s not doing well, it can get thicker, stickier, drier, and tighter.

Between layers of body fascia, a substance called hyaluronan helps the layers work smoothly with each other. When the hyaluronan dries up, your body fascia can seize up around muscles, make it harder to move, or get uncomfortable knots. Dried-out fascia, called fascia adhesions, can happen because of:

• A lifestyle without enough physical activity

• Activity that uses the same part of your body over and over

• Surgery or injury that causes damage to one part of your body

That is where Myofascial cupping can be a great treatment method for these particular adhesions. Using a squeeze pump, it creates a negative pressure treatment within the cup, which we can lift the tissue to create space and movement within the underlaying layers and intercellular fluid.

Benefits of myofascial cupping-

• Stimulates the local nervous system and can also have a relaxing affect

• Helps to stimulate lymph system removing congestion and toxins- improving our immune system

• Moves and drains excess fluids

• Stretches and unwinds fascia and releases soft tissue

• Moves blood stagnation

• Draws an increase blood supply to tissues- stimulating skin health, increasing oxygen supply

• Removes micro and small adhesions- allowing for more ROM

• Relieves inflammation after the acute stage

• Provides deep tissue work without discomfort

• Improving circulation

• Relaxes superficial connective tissue, allowing for deeper hands-on work

The suction created by cupping pulls stagnant intercellular fluid to the surface, removes toxic debris and replaces it with fresh oxygenated, nutrient rich fluid. Encouraging our bodies natural healing ability.

Because cupping is using a suction method it can leave marks on the skin, these are not bruises. Although sometimes referred to and can look like bruises, there has been no trauma happen to the skin or underlaying structure, if performed properly. These marks are due to the underlaying stagnant fluid and increase in circulation being drawn to our bodies surface where our lymph system and natural healing structures are able to disperse it.

Myofascial cupping performed by a qualified therapist is a safe treatment for a lot of people not just athletes and can even be performed during pregnancy.

Written by Nicole Clark, Myotherapist

Thigh Freedom: Exploring the Reformer Thigh Stretch

-Are you looking for a unique workout on the reformer to strengthen, tone your thighs and improved thigh flexibility?

-Thigh stretch on the Reformer is a great exercise to enhance flexibility and range of motion and promote better posture and overall lower body strength.

By incorporating Thigh Stretches on the reformer into your fitness regimen, you can unlock the transformative power of this exercise, promoting better posture, increases flexibility, and overall lower body strength.

Whether you spend your days seated at a desk or pushing your limits in the gym, tight thighs can hinder your performance and comfort. The reformer, with its dynamic resistance and support, offers an ideal platform to achieve a deep, effective stretch that promotes both flexibility and strength.

In this blog post, we'll delve into the step-by-step process of performing the thigh stretch on the reformer, ensuring you do it with precision and control.

We'll also share tips; safety considerations and benefits of thigh stretches. Get ready to experience true thigh freedom and elevate your fitness journey!

Thigh Stretch on the Reformer

1. Starting Position

- Adjust the reformer so it has a light to medium spring tension

- Kneel on the carriage with your knees up against the shoulder blocks.

- Hold onto your straps at the studs or just above on leather straps.

2. Performing the Thigh Stretch

- Engage your core and keep your spine neutral

- Slowly press your legs into the carriage and lean back as far as you can continue to reach down in your legs.

- Then press your shins into the carriage and reach your arms forward to close the spring.

3. Return to Start

- Slowly and with control, bring your hips back to the starting position

What are the benefits of Thigh Stretch on the Reformer?

1.        Increased flexibility

Reformer based thigh stretches target the major muscles of the thighs, including the quadriceps, hamstrings, and hip flexors. Consistent practice can lead to improved flexibility in these areas, allowing you to perform daily activities with ease and grace.

2.        Improved range of motion

This workout helps to elongate the muscles and mobilize the joints, leading to an increased range of motion.

Enhanced flexibility and range of motion contribute to better performance in other exercises and activities, reducing the risk of injuries.

3.        Enhanced posture

 Tightness in the thigh muscles can contribute to poor posture. Incorporating thigh stretches into your routine can help alleviate muscles imbalances and promote a more upright and aligned posture 

4.        Strengthening and toning

While primary focusing on stretching, thigh exercises on the reformer also engage the inner muscles, leading to toning and strengthening of the thighs.

Building thigh strength improves overall stability and helps in everyday movements and physical activities.

Safety Considerations!

1. Consult with healthcare professionals:

- It is important for individuals with specific conditions to consult with healthcare professionals or certified Pilates instructor before starting any new exercise regimen.

- They can provide personalized guidance and ensure exercise is appropriate for individual needs and capabilities.

2. Knee Alignment:

 Ensure your knees are cushioned and aligned properly to avoid strain.

3. Controlled Movement:

Always move slowly and with control to avoid injury.

4. Listen to Your Body:

- Remember to always listen to your body, start slowly and gradually increase the intensity of your workouts over time.

-If you feel any sharp pain, ease out of the stretch immediately

Tips!!

-If you're new to this exercise, you might want to use a lighter spring setting to ensure you don't overstretch or strain your muscles.

-Pay attention to your body alignment and posture throughout the exercise to avoid injury and maximize effectiveness.

- Perform exercise with control.

Start today and discover the transformative power of thigh stretch on the reformer.

Your body will thank you for the care and dedication you invest in its well-being.

Written by Christine Alano, Physiotherapist

Choosing a new pair of sneakers?

There are many different things that influence the kind of shoe that will suit your needs - from what you’re planning on doing in them, width, or level of support.

First some common words that might pop up in search for the right shoe:

Pronation: When the ankle rolls in excessively Supination: When the ankle rolls out excessively Neutral: where the ankle neither rolls in or out excessively

Gait: walking

Stability shoe: Has arch support / technology that prevents excessive pronation
Neutral shoe: Has no arch support for those who supinate or have a neutral gait

Heel drop: difference in height between the heel and toes in millimetres

Width:
2A - Narrow
B - Womens standard
D - Women’s wide / Men’s standard 2E - Womens extra wide / Mens wide 4E - Men’s Extra wide

Walking shoes:
Walking shoes are shoes specifically designed for walking - unlike traditional sneakers which are designed for the purpose of running. Walking shoes are often a little bit heavier and/or may have a leather upper for some added durability.

Running shoes:
Running shoes will have a mesh upper and have a variety of different features depending on the brand and model. They are typically light in weight and are designed specifically for running, although can be used as a walking shoe as well.

Most brands will offer a stability option and a neutral option, some common models will include (but not limited to!)

Stability running shoes:

Asics:
Kayano: Asics most supportive running shoe GT-2000: Asics mid range support option
// Offers both cushioning and support

Brooks:
Adrenaline: Brooks mid range supportive running shoe
// offer both cushioning and support, it has a higher heel drop which can potentially benefit those who may get tight calves or achilles pain.

New balance
860: New balance’s supportive running shoe
// Offers both cushioning and arch support, and tends to be a bit more generous in width for those more comfortable in a wider fit.

Hoka:
Gaviota: Hoka’s most supportive running shoe
Arahi: Mid range supportive running shoe
// Hoka also uses rocker sole technology to propel the foot forward during the gait cycle - potentially helpful for anyone with plantar fascia pain or arthritis in the foot

Neutral running shoes: (No arch support for those who roll out or have a neutral gait) Neutral shoes are also perfect for those with orthotics!

Asics:
GT-1000: a base range option with minimal support and good cushioning. Gel nimbus: Maximum cushioning, lightweight and best for running

Brooks:
Ghost: Brooks cushioned neutral shoe option, has a slightly higher heel drop
Ghost max: Brooks maximum cushioned shoe - designed with a rocker sole to help propel the foot forward during gait.

New balance:
880: Offers cushioning and a more generous width for those who need it

The main takeaway - Different runners will all have slightly different features and options to suit a variety of different people. It is always best to go and try a pair for yourself to find out which is most comfortable and most appropriate for you!

Written by Bridgette Keath, Physiotherapist

Concussion- “If in doubt, sit them out!”

The Australian Institute of Sport, Sports Medicine Australia, Australian Physiotherapy Association and the Australasian College of Sport and Exercise Physicians have come together to release a new position statement on concussion. The position statement aims to provide up to date evidence-based information on concussion to help minimize the lasting impacts of recurrent concussion. With recent passings of former AFL and AFLW players due to recurrent concussions (referred to as chronic traumatic encephalopathy or CTE), this position statement has come at a very important time. 

What is concussion?  

Concussion occurs when a biomechanical force from an object or another person causes the brain to rattle inside the hard casing of the skull. This can sometimes occur from minor knocks where consciousness is maintained or larger knocks where a person loses consciousness. It is important to note that symptoms can vary from person to person. The position statement outlines below the signs and symptoms that everyone should be aware of:  

Mandatory signs of concussion (immediate removal and no further play)  

• Loss of consciousness 

• Lying motionless for > 5 s  

• No protective action was taken by the athlete in a fall to the ground, directly observed or on video  

• Impact seizure or tonic posturing  

• Confusion, disorientation  

• Inability to respond appropriately to questions  

• Memory impairment/amnesia  

• Balance disturbance or motor incoordination (e.g., ataxia) 

• Athlete reports significant, new, or progressive concussion symptoms  

• Dazed, blank/vacant stare or not their normal selves  

• Behaviour changes atypical of the athlete 
   

Discretionary signs of concussion (immediate removal for further assessment) 

• Clutching their head 

• Being slow to get up 

• Suspected facial fracture  

• Possible balance disturbance or ataxia  

• Behaviour changes atypical of the athlete  

• Other clinical suspicions 
   

Red flag signs of concussion (immediate referral to emergency department) 

• Neck pain  

• Increasing confusion, agitation, or irritability  

• Repeated vomiting  

• Seizure or convulsion  

• Weakness or tingling/burning in the arms or legs  

• Deteriorating conscious state  

• Severe or increasing headache  

• Loss of vision  

• Visible deformity of the skull  

• Loss of consciousness  

• Unusual behavioural change  

• Double vision 

Physiotherapy Involvement in Concussion Management   

Physiotherapist are becoming more involved in the assessment and management of concussion with increasing evidence supporting physiotherapist’s role in the rehabilitation from concussion. At the current time it is still required for people with concussion to get medical clearance from a medical practitioner, however, physiotherapists play a key role in guidance through a graded return to sport framework (see link below). Physiotherapists also work with people who suffer from more complex prolonged symptoms and don’t meet the checkpoints of the graded return to sport framework. This includes treatment centred around vestibular oculomotor and neck-based rehabilitation which helps with faster symptom resolution.  

So, next time you or someone you know has a head knock, make sure you are aware of the signs and symptoms of concussion and follow a graded return to work framework so that we as a community can reduce the impacts of recurrent concussions! 

 Written by Matthew Long, Physiotherapist

Headache + Migraine: a pain in the neck?

Physiotherapy is often overlooked in the treatment of headache and migraine. It is the most common non-pharmacological treatment for headache and migraine. Physiotherapists can treat headache and migraine by treating the upper cervical segments to desensitise the lower brain stem which often contributes to these conditions. You don’t have to have neck pain or stiffness associated with your headache or migraine to benefit from this treatment. Physiotherapy has been shown to be effective in headache + migraine sufferers even without neck pain or stiffness as these patients will still be experiencing an over-sensitised lower brain stem which is enclosed by the upper cervical vertebrae.

Research has shown the following conditions can have successful outcomes with Physiotherapy treatment:

-        Cervicogenic Headache

-        Cluster Headaches

-        Tension-Type Headaches

-        Migraines

-        Abdominal Migraines

-        Menstrual Migraines

-        Migraines with Auras

-        Post Concussion Syndrome

-        Cyclic Vomiting Syndrome

-        Hemiplegic Migraines

-        Trigeminal Neuralgia

-        Vestibular Migraines

The course was based on the Watson Headache® Approach, a protocol for the skilled assessment and management of the upper cervical (neck) spine in Cervicogenic and Primary Headache, and related conditions in which the underlying dysfunction is sensitisation of the lower brainstem. The Watson Headache® Approach is recognised as a scientifically researched method of examination as well as a comprehensive clinical management system. For further information, go to: www.WatsonHeadacheApproach.com

Written by Caitlyn Smith, Physiotherapist

What is an AHA and what do they do?

Allied Health Assistants (AHAs) work with allied health practitioners (such as Physiotherapists, Occupational Therapists and Exercise Physiologists), in a supportive and collaborative role. AHAs assist in implementing therapies following an initial assessment completed by an allied health practitioner. We work together to ensure that continuity and quality of care is achieved between patients and their treating allied health professional.  

AHAs play an integral role in supporting patients to participate in their individualised treatment plans, whilst ensuring that plans are manageable and enjoyable. We endeavor to maintain effective communication between patients and their treating allied health practitioner, as well as assist with administration tasks and reporting.  

We work with all ages and abilities, ranging from children to more experienced adults. You will find us in the clinic, the pool, a local gym, playgrounds, parks, kindergartens, schools, homes and more. Some therapies that we assist with are:  

• Pilates (Reformer & Mat-based) 

• Strength building 

• Balance 

• Neurological Rehabilition 

• Hydrotherapy 

• Early Intervention & play based therapy 

• Passive stretching 

Using an AHA can assist in stretching your therapy budget and allows for regular flexible interactions with a trained assistant to aid you in reaching your therapy goals. Maintaining a fun, comfortable and supportive environment is what we aim for to ensure that the best outcomes are achieved, and we are motivated to provide a positive experience and build strong relationships with our clients. 

Written by Lauren & Kylie, Allied Health Assistants