Yudu - sportEX medicine - 1999-2010

BOLD HEAD LIGHT HEAD SPORTEX UPDATE UPDATE BY TOR DAVIES, PUBLISHER

LAUNCH OF EPALS The first thing to announce is the launch of our ePALs or electronic public advice leaflets. As a subscriber, you may already be familiar with our printed A5 format leaflets. The NHS regularly includes our range of ‘Physical Activity and Medical Conditions’ leaflets in the recommended resource sections of many of their guidelines, and the physical activity team for the Regional Public Health Group for London reviewed a wide range of advice handouts available around London and rated ours as the best out there. They went on to promote them to all public health teams within their network. We’ve also produced re-branded

versions for various occupational health departments, fitness clubs and professional member organisations and the British Heart Foundation reproduce five of our leaflets fully branded in their house-style. So it was a natural progression to turn these into a digital format ideally suited to self-employed health or fitness professionals and occupational health advisors. We have therefore created a digital magazine of single A4 leaflets, designed so that you can print as many leaflets as you want, whenever you want. There are currently

We’ve been really quite busy at sportEX over the last six months so I thought it was time to bring you up to speed with what we’ve been doing.

neck, shoulders & trunk WHY STRETCH?

Due to our increasingly inactive and deskbound lifestyles resulting from our growing use of computers and labour saving devices such as remote controls and cars, the incidence of postural problems has risen dramatically over the last 20 years. Avoiding bad postural habits while sitting at a computer or using the phone is very important. Most back and neck problems occur due to weaknesses and imbalances in the muscles used to maintain the shape of your spine. These include your neck, back, shoulder and stomach muscles.

This leaflet includes a few stretches designed to keep your muscles flexible and in good balance with each other.

It is a

good idea to do three or four stretches every hour, particularly if you spend a lot of time sitting during your day. It is also important to make sure that your chair, desk and computer are set up correctly so that you are not altering your posture to compensate for a bad working position. If you think this may be the case, speak to your occupational health department, nurse or physiotherapist at your place of work. They will help with advice and, where appropriate, equipment modifications.

the lower body

WHY WARM UP AND STRETCH Whatever your level of participation, from elite to recreational sport, formal or informal physical activity programmes, or just occasional

leisure activities, this leaflet is aimed at helping you participate safely. The main aim of a thorough warm-up and stretch is to prepare the cardiovascular system (eg. heart and blood vessels supplying the muscles), the musculo-skeletal system (eg. muscles, ligaments), and the nervous system, for physical activity.

Warming up and stretching makes the muscles more flexible and there is a growing collection of research suggesting a relationship between muscle tightness and an increased risk of muscle strains (although this is still debated between some scientists). The increase in body temperature as a result of a warm up also encourages a more efficient use of oxygen by the body as well as an increase in the sensitivity of nerves carrying messages to the muscles. Finally the warm up also helps the heart increase its output meaning more fuel products can be delivered to the muscles along with more waste products being removed.

THE IMPORTANCE OF WARMING UP AND STRETCHING While the role of, and evidence for, warming up and stretching in the prevention of injury is still widely debated, there continues to be a significant number of clinical, experimental and qualitative observations which do support a link between warm up and improved physical performance and efficiency.

WARM UP

The first aim is to increase your core body temperature which will increase the flexibility of your muscles as explained earlier.

The second aim is to increase the heart and breathing rates and therefore the supply of oxygen to the muscles. A warm up should involve a 5-10 minute period of activity such as brisk walking, slow jogging or swimming a few gentle laps. Your core body temperature should have now risen and you should feel hot and sweaty! You now need to stretch out appropriate muscle groups. Remember to repeat the stretches on both legs.

STRETCHING/FLEXIBILITY ■ Hold each stretch for between 20 seconds and repeat 5 times on both legs.

■ It is very important to maintain a good posture while carrying out every stretch.

■ Concentrate on breathing slowly and deeply, particularly concentrating on exhaling as this may help increase the relaxation of the muscles.

■ Make sure the stretches are preceded by an active warm up as outlined above as this makes the tissues more flexible. ■ The following leaflet includes stretches for all the main

Gluteal muscles (but- tocks)

Hamstring muscles (back of thigh)

Calf muscles (gastrocnemius above and soleus below)

Front view and rear view of leg muscles

muscle groups of the legs. However it may be beneficial to include additional stretches for the upper body and for specific activities or sports - a therapist, coach or trainer will be able to advise you on these stretches.

■ Each stretch should be comfortable and not cause any pain. ■ Remember to change legs on all the stretches.

RESOURCES ■ NHS Direct (UK) - 24 hour telephone or web based help and advice service. Tel. 0845 4647 or visit www.nhsdirect.nhs.uk

■ Chartered Society of Physiotherapy - Find a physiotherapist service www.csp.org.uk

■ General Osteopathic Council - Find an osteopath service www.osteopathy.org.uk

■ British Chiropractic Association - Find a chiropractor service www.chiropractic-uk.co.uk

HIP FLEXOR STRETCH Squat down with your right leg forward and your knee at right angles. Place your left foot as far back as possible. If necessary support yourself with your hands. Lower your body towards the floor, feeling the stretch at the front of the groin.

ADDUCTOR STRETCH Sit upright with a straight back. Place the soles of your feet together. Allow your knees to fall outwards. Push knees further apart with your elbows to increase the stretch.

SETS 20

REPS 3

Hip flexors (groin area)

Adductor muscles (inside leg)

Quadricep muscles (front of thigh)

Warm up and stretching

the lower body

STRETCHING AND STRENGTHENING EXERCISES QUADRICEPS STRETCH

Quadriceps stretch (the muscles at the front of the thigh). This exercise can be done in lying (see diagram) or standing. If standing then keep your back straight, pull one foot towards your buttocks, ensuring the knee of the supporting leg is slightly bent or ‘soft and not locked straight. Tuck your bottom in and maintain this position while squeezing your heel to your buttock.

SETS 20

HAMSTRING STRETCH

Lie on your back, bring your knee towards your chest then slowly straighten your leg gently until you can feel a stretch in the back of your leg. Ensure your back is flat against the floor.

REPS 3

GASTROCNEMIUS STRETCH

Stand facing a wall resting both palms against it. Extend your left leg straight out behind you and bend the front right leg. Keep the heel of your back leg down and lean forwards to feel a stretch in the calf area.

SETS 20

REPS 3

SOLEUS STRETCH

SETS 20

REPS 3

Take the same position as above but this time bend the back leg slightly. This will change the emphasis of the stretch to the other muscle which makes up the calf muscle area. Again you should feel a stretch in the back of your calf muscle.

SETS 20

REPS 3

GLUTEALS STRETCH Lie on your back with your left knee bent. Raise your right leg with knee bent to a right angle and foot resting on your left thigh. Allow the right knee to drop out. Progress by placing your hands around the back of your left thigh and pulling it towards your chest feeling the stretch around the right hip.

SETS 20

REPS 3

Image showing some of the neck muscles RESOURCES

n NHS Direct (UK) - 24 hour telephone or web based help and advice service. Tel. 0845 4647 or visit www.nhsdirect.nhs.uk

n Chartered Society of Physiotherapy - Find a physiotherapist service www.csp.org.uk

n General Osteopathic Council - Find an osteopath service www.osteopathy.org.uk

n British Chiropractic Association - Find a chiropractor service www.chiropractic-uk.co.uk

NECK TILTING

The muscles which help in pulling the

shoulder blades together

Sit up straight and tilt your right ear towards your right shoulder without lifting your shoulder upwards to meet your ear and without rotating your head. Then repeat this stretch on the left hand side. Repeat the whole process 10 times.

SETS REPS 1

NECK FLEXION AND EXTENSION Sit up straight and drop your chin towards your chest, maintain this position for 5 seconds. Then slowly tilt your head backwards so that you are looking up at the ceiling. Again at no point should you feel any pain, if you do then stop the stretch a little earlier ie. before you feel the pain. Repeat the whole process 10 times.

CHEST AND FRONT SHOULDER STRETCH Stand up straight, clasp your hands together behind your back, push your chest forwards (make sure to keep your back straight during the stretch) and clench your shoulder blades together so that your shoulders are pulled backwards. Hold this position for 5 seconds and repeat the exercise 10 times.

UPPER BACK AND REAR SHOULDER STRETCH Stand up straight, clasp your hands together this time straight out in front of your face. Then push your arms further away from you (this will be a relatively small movement) so that you feel a stretch across your shoulder blades. Remember to keep a straight back while you do this and do not be tempted to slouch forward. Hold this position for 5 seconds and repeat the exercise 10 times.

Top of the

erector spinae muscle which runs down the length of the back

Levator scapulae helps extend the neck and lift the shoulder blade

stretching neck, shoulders & trunk the NECK, SHOULDERS AND ARM EXERCISES

NECK ROTATION Sit up straight and keeping your shoulders and body in position, turn your head slowly to look to your right and then slowly to your left. Try and increase your range of movement but you should at no time stretch to a point of pain. Repeat this exercise 10 times

SETS REPS 1

10 BACK AND STOMACH STRETCHES

FORWARD KNEELING STRETCH Bend down with your weight spread equally through your knees and hands. Bend your knees and sit back on your heels leaving your hands out in front as in the diagram. Drop your

shoulders and relax. Repeat this stretch 10 times.

SETS REPS 1

SUPINE KNEES-TO-CHEST LOWER BACK STRETCH Lie on your back so you are looking up at the ceiling. Slowly hug one, or preferably both knee(s) into your chest and hold it there for 10 seconds. You can try rocking forwards/backwards or side-to-side keeping your head on floor and generating a gentle rhythm if you feel comfortable. Stretch out flat again and repeat this process 5 times.

SETS REPS 1

STOMACH MUSCLE STRETCH 1 Lie face down. Prop yourself up onto your elbows and gently straighten them until you feel a stretch in your stomach. Hold that position for 10 seconds. Repeat this stretch 10 times.

SETS REPS 1

STOMACH MUSCLE STRETCH 2 Turn over to lie on your back. Bend your knees so that your feet are flat on the floor. Keeping your

SETS SETS REPS

REPS 3

knees bent, lower them gently to your right hand side (so that they are

resting on the floor if comfortable). Then place your arms on the

SETS REPS 10

opposite side so you are almost in a Z shape. Hold this position for 10 seconds and repeat the exercise on the other side so that your knees are now on your left and your arms on your right. Hold for 10 seconds and repeat the whole process 5 times on each side.

SETS REPS 1

SETS 20

REPS 3

36 leaflets in the booklet with another 18 being added over the next two months.

A subscription gives you access to all the leaflets within the booklet as well as new leaflets which will be added as we go along. There are two types of subscription: n ePALs single practitioner - a single login with access from 3 individual computers (eg. work, home, laptop) = £50 per year n ePALs multi-practitioner - a group

15 individual computers = £150 per year We have created a Lite version of the booklet with 10 of our most popular leaflets which is available free at http://bit.ly/sportEXePALsLite To subscribe to the full booklet please visit http://bit.ly/sportEXePALsBuy

SPORTEX WEBSITE Publishing is going through an interesting and for me a very exciting time at the moment. Being an amateur technology fan, I am constantly experimenting with the new opportunities offered by technology, to add value and bring our sportEX content to life. But rest assured that I don't believe in any way that print is dead!

Our subscriptions to the printed publications continue to increase and most people agree that you just can't beat printed magazines for physical presence. However

www.sportEX.net

we will be continuing to expand our online offering and will be launching in October, a new improved way of accessing our articles. We will also be launching some online content channels which allow you to get more content around specific interest areas. At the same time we will upgrade our shopping and ecommerce area. If you haven't yet been online and seen the online versions of our magazines, then please do. You can see samples without having to login by visiting our sportEX brochure which we also launched recently. We have nicknamed this brochure A Guide to

What We Do and How We Do It! There are lots of fun links and animations. For more info visit http://www.bit.ly/sportex

Physical activity and

HOW DOES PHYSICAL ACTIVITY HELP IF YOU HAVE ASTHMA? n Many people have misconceptions about the effect of physical activity on asthma. Research has shown that physical activity can help prevent the airways from tightening up when triggered and lead to fewer asthma attacks.

n As you get fitter this can help reduce exercise induced asthma. n Physical activity is particularly important for children with asthma, it boosts self-esteem and confidence, and enables them to do more and cope better with their asthma.

n Physical activity also helps reduce many other forms of ill-health such as high blood pressure, high blood cholesterol and being overweight.

n In addition physical activity and a healthy diet, helps reduce stress and improves your overall feeling of well-being.

STAYING SAFE When you are active you breathe more rapidly and this cools and dries the lining of the airways. This can irritate them and bring on an asthma attack. The following can help prevent this from happening: n Use a fast-acting blue inhaler 15-20 minutes before starting to exercise. This can significantly reduce and even eliminate exercise-induced asthma for up to four hours..

n Before starting to exercise, do a gentle warm-up alternating between some stretches and a few 30 second sessions of jogging on the spot. This helps reduce the risk of

WHAT TYPE OF ACTIVITY IS BEST?

While stamina-based activity is particularly important for health benefits, you also need to include some strength and flexibility- based activity to get the best he

While stamina-based activity is particularly important for health nclude some strength and flexibility-

based activity to get the best health gains.

Stamina-type activities: Walking, swimming, cycling, dancing, tennis and housework (washing floors or windows) Strength-type activities: Walking uphill, carrying shopping, climbing stairs, gardening (digging or Flexibility-type activities: Dancing, y gardening

wimming, cycling

climbing stairs, gardening (digging or mowing) and housework Dancing, yoga, Pilates, T’ai Chi and

Tips on increasing your activity level Perhaps take a dog for a walk to mak

use a pedometer to count your steps. y n Look for opportunities to be active during y n Try using the stairs instead of the escalator

example park at the far end of the car park, or walk one stop further to catch the bus, and take 10 minutes out of your lunch break to go for a walk.

during your whole day. For car park, or w e 1

escalator start by walking part of the way up and progress to walking up the whole way.

of the escalator. If you do use the y up

n Choose activities that you enjoy doing. Involve your friends and family to make your activities fun, sociable and enjoyable.

activities fun, sociable and enjo

Remember Set yourself realistic goals and don’t worry if you miss one day. Just make sure that the next day you pick up where you left off.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. To the extent permissible by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negligence) as a consequence, whether directly or indirectly, of the use by any person of the contents of this article.

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n Walking is an ideal activity as it’s free and easy to do anywhere. k to make it more interesting or

s free and ea

asthma getting asthma symptoms during the exercise.

n Try to minimise your exposure to asthma triggers such as pollen and cold weather while you are exercising. For example wear a scarf or cycle mask over your mouth. Alternatively exercise indoors when it is cold or go swimming as the air is warmer and more moist.

n If you have, or have recently had, a respiratory infection, cut down on the amount of physical activity you do until you are well.

n Avoid activity if you have significant asthma symptoms before you start the exercise.

n Activities with intermittent periods of exertion such as golf and tennis or team sports such as football, netball and volleyball are less likely to cause asthma symptoms.

n Activities like yoga can also be particularly beneficial as it teaches proper breathing techniques.

n Make sure you spend 10 minutes cooling down at the end of each exercise session as this will help reduce the risk of getting asthma symptoms.

n If you are playing sport at a competitive level, find out from the relevant sporting governing body which asthma medications are permitted as some are classed as performance-enhancing drugs and prohibited.

ody which asthma medications are lassed as performance-enhancing

n Physical activity – as well as viral infections, cold weather, pollens and animal dander, are common triggers of asthma, but symptoms can be prevented by appropriate management.

ell as viral infections, cold w , are common trigger HOW MUCH AND HOW OFTEN?

Frequency Your main aim is to build up to 30 minutes of moderate intensity activity on 5 or more days of the week. If this seems too much to start with, try starting with 3 x 10 minute walks spread throughout the day and work towards 2 x 15 minute walks and then 30 continuous minutes. One goal is to try and increase your activity by 2 minutes each day.

Intensity

Moderate intensity means breathing harder and getting warmer than normal. It does not need to be hard. You should be able to talk and be active at the same time.

Advice Whatever your chosen activity, it should be performed at a gentle intensity which gradually increases until after about 10 minutes you have reached the level you can maintain for your chosen period of activity. This gets the blood flowing to your muscles and allows your heart rate to increase gradually. When you are nearing the end of your activity you should also slowly decrease the level of activity over 5-10 minutes to allow your heart rate to slow down gradually.

Exercising and

concussion CONCUSSION IN SPORTCONC fluid replacement

WHY GOOD HYDRATION IS IMPORTANT DURING EXERCISE Good hydration at any level of exercise participation is important in preventing unnecessary stress to the cardiovascular system as well as many of the other side effects of dehydration such as nausea, vomiting, headaches and sluggishness. It is particularly important in hot and humid weather when sweat loss is much greater.

Guidance n The overall aim during exercise is to consume fluids at a rate sufficient to

replace all the water lost through sweating and breathing

n If conditions are hot and/or humid and/or you are already dehydrated, it is important to increase fluid uptake

n These are only general guidelines and do not take account of individual characteristics and physiology – drink as much as is comfortable, it is difficult to ‘hyperhydrate’ as excess fluid is excreted through urine

n It is recommended that to improve the palatability and desire to drink fluid during exercise, it is preferable for the drink to be cool (15-22o

C).

THE SPORTS DRINK COMPOSITION Research has shown that ingestion of certain concentrations of carbohydrate and sodium can aid rehydration. However the percentage concentrations are relatively precise if they are to achieve their goals of rehydration. The optimal drink should contain: n no more than 4-8% of carbohydrate (40- 80g/l or 4-8g/100ml). For example eg. sucrose, glucose polymers or starch. Amounts exceeding this concentration will slow digestion which may lead to stomach discomfort, nausea and vomiting. In many popular drinks additional water is required in order to dilute the carbohydrate concentration to the level for absorption – too much carbohydrate may actually increase the risk of dehydration and reduce performance. Coca-Cola and Pepsi contain carbohydrates at a concentration of 10-11%, and ready diluted bottles of Ribena contain concentrations of 14%

EXERCISE SITUATION 1 hour – low to

moderate intensity PRE EXERCISE

Drink around 500ml of water 2 hours before

exercise and another 125- 250ml just prior to beginning exercise

> 1 hour – moderate intensity

As above – although a sports drink may be

beneficial in place of water – particularly if you are

already dehydrated or have failed to eat sufficiently

> 1 hour high intensity and for multiple exercise sessions per day

particularly where a high level of performance is required ie. back to back tennis matches

As above – substituting water for a sports drink to provide sufficient fuel and fluid to optimise longer duration performance

DURING EXERCISE

Drink small amounts of water frequently – a few sips every 15 minutes should be sufficient. The aim is to match intake of fluid with the amount of fluid lost during the activity. The key is to start drinking early and frequently. Drink as much as possible

Guidelines recommend 125-250ml every 15 minutes. The more intense or

prolonged the activity, the more important this becomes. Water is sufficient but a sports drink may help sustainperformance and replace lost fluid more quickly

For intense exercise it is recommended that you consume around 30-60g of carbohydrates an hour. This can be achieved by drinking 600-1200ml per hour (150-300ml every 15 mins) of a solution containing 4-8% carbohydrates (ie. suitable sports drinks)

Concussion can happen in most sports although it is most frequently

associated with contact sports like boxing and rugby. However it can

happen during

n a small amount of sodium (0.5-0.7g/litre of water – this promotes fluid retention and prevents the premature ‘switch off’ of the thirst mechanism

n NO caffeine – newer, trendy energy drinks such as Red Bull and Red Devil contain caffeine which acts as a stimulant giving a sudden boost to energy levels – however while caffeine has been shown to improve athletic performance it is also a diuretic promoting excretion of fluid (thereby hastening dehydration). People taking part in high level sport who might be subject to drug testing should note that caffeine is a restricted substance. Contract the sport’s governing body medical officer for further information

most sports at any level, either during competition or practice. This leaflet gives advice on identifying people who may be suffering from concussion and stresses the importance of getting medical advice at both the time of the event and also during the lead up to returning to participation. This leaflet is not a substitute to seeking individual medical advice.

A concussion is any direct or indirect impact to the head that can cause a change in behaviour, awareness, and/or physical feeling. It may occur due to a direct blow to the head or more indirectly by very sudden stops or changes of direction. It is important to note that you don’t have to be knocked out to have a concussion, more than 90% of concussions do not involve loss of consciousness.

n no carbonation (fizz) – this can cause stomach discomfort and result in you feeling bloated.

The table will help guide you on the amount of fluid you should consume before, during and after activity at various intensities

TOP TIPS n Pale to very pale yellow urine indicates being within 1% of optimal hydration

If you experience any of the common features and indicators of concussion shown in the box below, particularly after some sort of impact event, it could be a sign that you have concussion. It is very important that you stop playing and sit down immediately and get medical advice from a doctor.

n There is unlikely to be a decrease in performance if at least 80% of sweat loss can be replaced during exercise

n o calculate the percentage of contents in a drink divide the amount in grams in one serving (in this case 4g) by the amount of fluid in millilitres in one serving (100ml) and multiply by 100 to give a percentage ie. 4g/100ml x 100 = 4%.

POST EXERCISE

It is important to understand that you don’t necessarily need to hit your head against something or get hit by an object to suffer concussion. A quickly moving player that hits another player and causes a sudden change in direction may cause a jarring movement of the head and neck that can cause a concussive event. Sometimes you may get knocked out but most of the time the main problems are headaches, dizziness, fatigue and memory problems. These are called post-concussion symptoms.

The general aim is to replace 150% of the fluid lost. At this level of exercise aim to consume one litre of water for every 1,000 kcal burnt. Or weigh yourself before and after the exercise and aim to replace every pound lost with 500-750 millilitres of water

Follow the same principles as above. Any weight lost during exercise will be due to loss of water which then needs to be replaced. Water is adequate as the type of fluid replacement as long as enough is consumed

As above it is important to try and replace 150% of the fluid lost. It is advisable to rehydrate using a fluid containing a small amount of sodium per litre. This encourages you to keep

drinking when water may have ‘switched off’ your thirst prematurely

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SECOND IMPACT SYNDROME People who have suffered one concussion impact and still have post concussion symptoms, are prone to second impact syndrome. This results in sudden swelling in the brain which may lead to coma and death and can occur with a relatively minor second impact.

The only way to prevent this happening is better education of people to identify concussion and clear advice that nobody should ever return to play before all the symptoms are completely gone and the individual has been given a clean bill of health by a suitably qualified doctor.

as a substitute for specialist medical advice in each individual case REDUC A CONC

EDUCING THE RISK OF SUFFERING CONCUSSIVE EVENT

a) Training - improving baseline neck strength and the ability to tense the neck muscles. Both help in the absorption and dissipation of forces

ving baseline neck strength

and the ability to tense the neck muscles. Both help in the absorption and dissipation of forces thereby reducing the risk of injury

b) Good techniques – learning how to block and tackle properly in contact sports and heading the ball properly in soccer.

CONCUSSED w to block

5 STEPS ON HOW TO RECOGNISE IF SOMEONE ELSE IS CONCUSSED 1 Are they staring vacantly or do they have a confused expression

2 Are they playing appropriately – ie. running in the correct direction, shooting at the correct

ying appropriately – ie

the correct direction, shooting at the correct goal

3 Is their memory altered – ask questions such as’, ‘what ground are you playing at’, ‘which half of the game are you in’, ‘which ying’, ‘when was your last

ying at’,

‘which half of the game are y team are you playing’, ‘when w e pla

as good discriminators of memory in concussion)

did we win?’ (these have all been identified as good discriminators of memory in

goal’, ‘which team did we play last week and e all been identified

in sport

4 Keep your eye out for post-traumatic amnesia (the length of time after the impact event during which a person is unable to memorise ongoing events). Ask questions like ‘how did you get injured’, ‘what is the first thing you remember’ and ‘the last thing you remember after you got hit?’

5 Check for any post-concussion symptoms (see box on common features)

IMPORTANT If you detect any of these symptoms in someone, stop them playing immediately and do not let them return to play until they have been properly assessed by a medical doctor. Equally they must not be allowed to return to play after a concussion, however minor, until these symptoms have completely disappeared and this has been confirmed by a doctor.

If you suspect that someone has experienced a concussion it is very important that they are continually observed and not left alone until they have been assessed by a medical doctor who should also monitor their gradual progression to returning to play.

Remember if you return to play too early you are likely you may have to sit out even longer next time and more importantly you are at serious risk of second impact syndrome which may result in coma or death.

FACTS AND FIGURES n 1 million people in Britain attend hospital each year as a result of a head injury. Sport and recreation accounts for 15% of these injuries (source Headway - The Brain Injury Association)

n 7.8% of alpine ski injuries and 9.4% of snowboard injuries (1999-2001) in Scotland occured to the head (source Scottish Ski and Snowboard Injury database)

COMMON FEATURES AND INDICATORS OF CONCUSSION n Vacant stare, confused expression

CON

n Being confused, easily distracted and/or unable to do normal activities n Walking or running in the wrong direction, maybe even shooting at your n Being unaware of time, place, date n Having slurred or incoherent speech n Being suddenly very uncoordinated and/ n Having emotions that are out of reason

n Being slow to answer questions or follo alking or running in the wrong direction, ma ving slurred or incoherent speech

, place

ving emotions that are out of proportion to circumstances eg. n Changes in mood eg. anxiety, depression, sleep disturbance, irritability n Feeling ill eg. headaches, ringing in the ears, blurred vision, feeling and/

, depression, sleep disturbance n Any period of loss of consciousness Feeling ill eg. headaches, ringing in the ears, blurred vision, feeling and/or being sick

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or general guidance and information only and should not be relied upon as a basis for planning individual medical care or ase. To the extent permissible by law, the publisher, editors and contributors accept no liability for any loss,

injury or damage howsoever incurred (including negligence) as a consequence, whether directly or indirectlys a consequence, whether directly or indirectly, of the use by any person of the contents of this article.

, editors and contributors accept no liability for any loss, y any person of the contents of this articl

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ery uncoordinated and/or dizzy, eg. stumbling or walking in a wobbly line proportion to circumstances eg. crying for no apparent

alk or unable to do normal activities our own goal er questions or follow instructions