Thursday 25 October 2018

All about the foam roller!

Every athlete I know either has a foam roller, or wishes they did! These rollers come in many shapes and forms, from 3 foot long dense foam cylinders, to kitchen rolling pins, to fancy fabricated tubes that double as a kit carrying case. 

But does everyone really know how many uses their foam roller has? This blog is to show you the three main categories of foam roller use, and a few examples of application!

Self Massage 

I think this is the use that most people are familiar with: The 'hurts so good' rolling out of tight or bunched up muscles to get relieve without having to go to the therapist. 

Rolling 'knots' or trigger points in your muscles can be very therapeutic, and can help you feel good after a long workout, assist with your stretching routine, and sometimes speed recovery from injuries. 

The great thing about rolling as a self massage technique is that you control the pressure, duration and intensity of the session! There are a few ground rules though: 
- Rolling should not bruise your skin! If it does, talk to your therapist to make sure you're doing it right. If you need that much pressure to feel like it's working, you might need some treatment
- Start slow and increase over time! The first time you roll, don't do 10 body parts for 3 minutes each! Maybe start with 30 seconds per part, and start with 2-3 key areas. If you get a good response, increase a bit day by day.
- Never roll completely cold! Either heat up with a bit of mild exercise (10-15 minutes walking, jogging or biking), or externally with a hot shower (I like the exercise option better! Gets a deeper heat). 
- You control the pressure! If something is too intense, shift your weight off the roller and onto your supporting limb. Start by rolling out one limb at a time, and add in the partner next time! 

Here's some ideas of how to roll different parts to get you started; 

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Joint Mobilization

One major technique that therapists use in the clinic is using gentle and controlled force to mobilize a joint. The principal is to hold one part of the joint stable (i.e. the shin bone) and mobilize the other part against it (i.e. the femur). 

This principal can be applied as part of a home program, by using the foam roller to stabilize one part, and body movements to mobilize the other part. I commonly prescribe techniques for upper back or shoulder mobilization.

This is a bit more tricky to teach yourself though, and while it's a great home program exercise, it needs to be coached extensively before going solo! If you think foam roller mobilization would work well with your home program, ask your therapist at your next treatment!

Exercise Equipment 

A foam roller isn't always just used as a recovery tool, but can also often be used as a prop to intensify exercises! Check out these options and see if they fit into your routine. You can make up your own as well, as long as you are careful, ease into it, and have a spotter if you're trying something risky! 

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Where can I get my own foam roller? 

Usually you can get a foam roller at fitness, sports equipment, or running stores. What you're looking for is the right length (long if you're using it for a lot of exercises, short if you need something to travel to the field with you!), and that it is very firm! 

If you're in the Guelph area, give me a shout, and I can hook you up with a great roller at a great price! 

Monday 21 May 2018

A Personal Note About Mental Health


I don't usually write about my personal life in my business blog, but today I feel like it's important. As many of you know, in January my son was born. Today Finn is 4 months old! When he was born, my whole life changed, and not all in positive ways.

Before my son was born, I was active. I did field work in December when I was 8 months pregnant, walked our dog, had no problem with household tasks, and on occasion did some strength training. I worked on my balance and basic core and pelvic floor exercises to make sure I was strong enough for labour.

After Finn was born I was shocked with how much my abilities were reduced. My balance was so poor that I felt like I was falling when going up and down stairs. Lifting my son from the floor felt like a 1-rep max even though he was a tiny 6.5 pounds. Walking for 10 minutes felt like an hour of cardio. I didn’t know why I felt this terrible! I felt like I was doing something wrong.

I would sit on the sofa, for hours on end, unable to do simple housework, and I felt so anxious. I created scenarios in my mind where I would have to quickly jump up and get the baby, the dog and cat, and myself out of the house for some reason, and was frightened I wouldn’t have the strength to move quickly enough. I imagined that I would drop my son while carrying him to change his diaper. Looking back, I was feeling the textbook symptoms of post partum anxiety, and it was scary.    

Mental health is something that I have recognized in many of my patients, especially surrounding life changing injuries. Dealing with injury is a difficult time and can trigger feelings of anxiety and depression. I have worked with athletes who are having a crisis of identity as they are unable to participate in the sports that have become such a huge part of their lives. Eventually I started to recognize these feelings in myself. I was having a crisis of identity as I adjusted from being a busy, fierce, energetic and able entrepreneur, to being a mom, and I didn’t know how I would ever be able to combine those things together.

As an Athletic Therapist, it is outside of my scope of practice to assess or treat mental health, but I have learned through research and experience that there are two things that I can suggest to a patient to help them through these difficult times; Exercise and Community. I could quote a dozen studies that show that even a slight increase in exercise can positively effect mood. And a dozen more that show that having a conversation with someone, especially someone who is experiencing something similar, can do the same. I often encourage my athletes to continue exercising, incorporating modifications to protect their injury, and to continue attending team practices and events to avoid isolation.

I realized that I was at a point in my recovery that I needed to start following my own advice. But I was scared! Starting something new, especially when you are feeling vulnerable and incapacitated is terrifying. Luckily for me, the midwifes at my clinic, Family Midwifery Care of Guelph are extremely aware of the difficulties with mental health that new mom’s experience. Through the magic of social media, I learned of a group called Up and Running, a program for new moms struggling with their mental health. I joined their walking with babies group, and now every Wednesday and Friday Finn and I go for a walk, and we talk and are open about how we are dealing with our new lives.

I feel so much healthier, both of mind and of body. The community and the exercise changed my life and helped my recovery. I suppose the take home message here is two fold – don’t be afraid to reach out and ask for help or join a community of others when you are hurting, and no matter what, keep moving!

Monday 21 November 2016

6 Signs that You Need to Visit Your Massage Therapist

Not sure if it’s time to go in for a massage? Unsure of how often you should book an appointment? The easiest answer is, whenever you feel like you need a massage! If you need another reason to go visit your RMT, here are a few warning signs that it could be time to book your massage treatment.
  1. Pain
This is an obvious warning sign, but sometimes we feel pain that we cannot explain. Uncertainty in the root cause of pain might be holding you back from seeking treatment.
A massage therapist might be able to help you find the source of your pain, as well as help you to manage it. Massage therapy is one of the few treatments that has been shown to reduce lower back pain, where other therapies benefits are still unclear.
Most of our clients here in Guelph, Ontario book their first appointment because of pain, but we dig a bit deeper and are able to help their pain as well as identify many other areas that we can work on.


  1. Feeling down
It might seem hokey, but a lot of people seek out massage treatment when they are feeling depressed. Massage doesn’t only help you to relax and heal your body, it can treat your mind as well.
It’s widely accepted (there are many, many studies and reviews) that massage therapy is able to reduce symptoms of depression. A couple theories for this include:
  • A hormonal response that reduces blood pressure, heart rate and stress hormones
  • A close bond forms between the therapist and client
  • Reducing pain (even imperceptibly) results in relaxation and stimulation of the parasympathetic nervous system
  • Touch stimulates oxytocin hormone (the “feel good” hormone)


  1. Injured
A lot of people hurt themselves and don’t realize that an RMT might be able to help out. Of course, immediately following an injury you should go visit a doctor, but massage might be able to help relieve the pain from an injury and even promote healing.
Muscle or joint injuries that happened as a result from work, sport, or exercise are perfect candidates for massage treatment. And if your RMT can’t help you, they can surely refer you to whomever you should see next. It’s definitely worth a shot!
At Guelph Performance Therapy we offer both Registered Massage Therapy and Certified Athletic Therapy. The combo of both disciplines will definitely help get you back to your day to day activities!
  1. DOMS
If you’re unfamiliar with the term, DOMS is an acronym for Delayed Onset Muscle Soreness. It’s essentially the fancy name for feeling sore the day (or days) after a workout. DOMS is most likely to happen when you first start working out, or get back into exercise or sport after a long break.
Many people might reach for the ibuprofen, but massage may be just as effective for relieving muscle pain. A 2012 study at McMaster University found that massage has a direct effect on reducing muscle inflammation—this means less pain and shorter recovery time.
  1. Headaches
A common reason for seeing patients in the clinic is because of an ongoing headache issue. While headaches can be a result of a number of different things like injury, dehydration, or illness, many headaches have a musculoskeletal source.
For these, a massage may be just what you need to help loosen up and shake free from a pesky headache.


  1. Stressed Out
Similar to helping alleviate depression, massage might also be able to help you deal with stress. Whether your stress comes from work, school, or family, being stressed out could mean that it’s time to pay a visit to a massage clinic.
This one has some science to back it up, as well. A study in the Journal of Neuroscience found that test subjects that had a massage showed lower activity levels in the parts of the brain that signal anxiety. The massage recipients even performed better in math tests after being treated. Very cool!

If you’re still not sure if it’s time for a massage, the very fact that you’re asking the question could mean you’re ready. Guelph Performance Therapy is now happy to provide massage services for whatever reason you decide deserves a treatment. Make use of your benefits and book an appointment online today!

Sources:

A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain. (2003). Annals Of Internal Medicine138(11), 898. doi:10.7326/0003-4819-138-11-200306030-00011


Hou, W., Chiang, P., Hsu, T., Chiu, S., & Yen, Y. (2010). Treatment Effects of Massage Therapy in Depressed People. The Journal Of Clinical Psychiatry71(07), 894-901. doi:10.4088/jcp.09r05009blu


Massage Therapy Reduces Anxiety and Enhances Eeg Pattern of Alertness and Math Computations: International Journal of Neuroscience: Vol 86, No 3-4. (2016). International Journal Of Neuroscience. Retrieved from http://www.tandfonline.com/doi/abs/10.3109/00207459608986710

Tuesday 12 April 2016

7 Benefits of having an Athletic Therapist at your event that you just won't believe!

Today, we are happy to announce that Guelph Performance Therapy will be providing on site Athletic Therapy coverage to the District 8 Boys and Girls Rugby teams in Waterloo Region! 


Some people ask 'why do you need an athletic therapist at an event, the coaches know the difference between hurt and injured'. Some teams think they don't need an Athletic Therapist because one of the coaches has taken a few first aid courses. Others have an off duty nurse, or paramedic, or maybe even have hired St. Johns Ambulance or similar services to be on site. 

So I wanted to share with you seven things that Athletic therapists bring to the table to help keep your athletes safe, during all sporting events, contact or non contact! 

Some of the skills that Certified Athletic Therapists bring to the table to help keep these student athletes safe include:
- Emergency First Responder certification, which means that spinal situations and other severe injuries will be recognized and cared for
- Advanced clinical decision making skills, which means that an ambulance will only be called if necessary, and that pre-ambulance care will be given
- Injury assessment, which means that only players who are fit to play return to to the field, and those who are able to return won't stay on the bench unnecessarily
- Concussion management skills, which means that concussions will be recognized, and that important return to play and referral to medical care information will be given to players, coaches and parents at time of injury
- Taping skills, which means that injuries are given the support that they are needed to be able to play
- Knowledge of the local health care system, meaning that injured players are referred to the correct medical professional for their injury
- Knowledge of sport, which allows for quick decisions, and good advice

Athletic Therapists help keep players safe, keep the game running smoothly, and keep coaches coaching! 

If you need field coverage, and all of these benefits, at one of your events, feel free to get in touch with Alana at Guelph Performance Therapy today! Call 226 - 343 - 6311 or email alana@guelphperformancetherapy.com 

Tuesday 16 February 2016

Too Many Choices! Read this for great tips on choosing YOUR health care team!

This is a topic that I have written about before, but I feel that it is so important that I'm writing about it again! It's an ongoing discussion among health care practitioners and clients alike that it is so difficult to choose which practitioner is right for you, and once you choose, if you should stick with them!

As Ontarians, we have an abundance of health care options, which sometimes is a burden. These are some simple guidelines that might help you make your decisions for your body and your health.

Recently, when speaking with patients, I heard a few disheartening statements, and unfortunately these are not isolated incidents! The first statement was from a lady I met at fitness class, who was starting to get back to her regular activities:


"I don't really like the treatment that I'm receiving from my therapist, but it's the clinic that my doctor told me to go to, so I have to keep going" 

The second statement was from a player on a team that I work with, who I was hoping I would be able to help with some exercise intensive treatment to help improve her performance in sport:
"My practitioner says that as long as I'm receiving treatment from him, I can only receive treatment from therapists at his clinic" 

With both of these individuals, I had a frank discussion about choice. Both of these people had the freedom to choose where they get treatment, weather they go where their doctor recommended or not, weather they go to multiple clinics or not. A practitioner can recommend things to patients as long as it is directly for the benefit of the patient, and even then it is only ethical to recommend a certain level or type of qualification not a specific clinic or practitioner. These referrals can certainly not be made based on financial gain or business growth of the practitioner! 

That being said, we are no closer to making a valid choice, in fact it might make it even more difficult since the entire range of practitioners including physiotherapy, athletic therapy, massage therapy, chiropractic care, osteopathy, occupational therapy... the list goes on! Here are some tips that I've gathered over the years to help choose my practitioners. 

1) If someone is pushing you towards a certain choice, then think critically about their motives. If they have a financial interest in you attending that clinic, then they may not have your interests at heart!

2) You should be given opportunity to ask questions either from the person giving you a referral, or from the practitioner themselves about why this course of action is the best for your health.

3) Once you are in the clinical or treatment environment, you should feel comfortable and at ease. If you don't 'mesh' with a practitioner, that's OK. You should always feel free to seek different treatment if your therapist doesn't make you feel comfortable. 

4) Your therapist should spend time talking to you face to face, discussing your treatment, adjusting to meet your needs and your goals, and shouldn't seem rushed. This is your time! If you are being treated in tandem with several other patients, and that doesn't feel right, then feel free to discuss it with your therapist. 

5) You should start to feel better after a few treatments. This doesn't mean you'll be magically cured, but if you've been to a few appointments and don't notice any change, then something needs to be adjusted. This goes hand in hand with not making a commitment to continue treatment for a certain amount of time, or commit to a long term 'maintenance program'. There is no way to know how your body will respond to treatment! 

If you are unsure if your practitioner is correct for you, or you're thinking of starting treatment and think that Athletic Therapy might be the right choice, then give us a call at Guelph Performance Therapy and we'd be happy to help! 







Thursday 28 January 2016

How to Maintain and Prevent Dance Injuries


Hello!

My name is Imogen; I'm a Certified Athletic Therapist in Cambridge, ON and owner of Hespeler Village Athletic Therapy. My area of expertise is with dancers and their injuries. During my childhood and teenage years, I was a competitive dancer which has given me the insight and experience to better help my dance clients. I'm so excited to talk about dance injuries because it allows me to bring my two passions—dance and Athletic Therapy--together into one topic! I hope you enjoy reading it as much as I enjoyed writing it!  But, please be aware that it's kind of a long one.

When you think of athletes, dancers probably don't pop into your mind. This is unfortunate, because dancers are athletes who pour their mind, body, and soul into a passion for their sport, not unlike football, hockey, or rugby players. If young dancers are at a high level, they can be at the studio upwards of 4 hours per day, and professional dancers spend even more time in the studio!

For young dancers, their time spent dancing is outside of the hours spent in school and on homework, they may even have a part time job to work around. Can you imagine the physical and mental toll this can put on their body? For this reason, a major factor in dance injuries is fatigue. These athletes are so passionate about perfecting their jumps, turnout, or pirouettes that they don't take the needed time off for recovery. In the grand scheme of things, this is not the best way to improve your performance. But we'll come back to this in a few minutes.

Now, we all know that dancers are known for being extremely flexible and graceful, but a common misconception is that they aren't "real athletes". Dance takes an incredible amount of strength, control, agility, and balance, which often brings along the typical types of injuries you'd see in sports. The most common injuries seen in dancers include:

  • Muscle spasm
  • Strains/sprains in the lower extremity and back
  • Overuse injuries such as tendonosis
  • Chronic fatigue

Typically, when dancers sustain these injuries, they tend to “dance through the pain” rather than going to their local Athletic Therapist for an appropriate dance specific rehab program—shameless self promotion! In some instances, the dancers seek help from a therapist who doesn't specialize in dance. This can lead to frustration and a non-committal attitude to their rehab program because they feel misunderstood and don't see the relevance in the exercises or advice given--I'm speaking from first hand experience here. For this reason, it is my opinion that the most important step in treating and maintaining your dance injuries is to seek help from an appropriate medical professional that knows and understands the demands of dance.

The second most important piece of injury prevention advice I can give is for every dancer to ensure that he/she has a very strong core. I don't mean the “hey, check out my six pack” type of “core” that you may be thinking of. I mean the deep deep muscles that stabilize your spine and keep everything in control, so all of your other muscles can do their jobs.

Do you know what I'm talking about? If not, don't worry, I'm going to tell you!

Your core is comprised of some very deep muscles that attach to your spine and are within your abdominal cavity. See how this can be confused with that awesome six pack you've got going on?

If you were to look even deeper, under that six pack, you'd find a broad flat muscle that wraps around you like a weight lifter's belt, called transverse abdominus. This is what most people are talking about when they say “core.” 

But wait! There's more to it than that! You also have to consider the small group of muscles that run up and down each side of your spine on the back side, called multifidus. They control the rotational stability between individual vertebrae and assist in extension of the spine. Then there is the pelvic floor and diaphragm which create the “floor” and “roof” of the entire functional unit we like to call your core. If you picture these muscles contracting together, they theoretically create a small, dense cylindrical shape within your abdominal cavity which is your “core.”

Now, consider this example: dancers require excellent strength in their hip flexors and surrounding muscles to lift their nice straight leg, with a beautifully pointed foot, high up in front of them and gracefully hold it there for what seems like an eternity. But let's pretend this particular dancer has a weak core and is struggling to hold her leg for a few seconds at an eye-soring level of just above 90 degrees—oh my!

Part of the struggle here is because her core muscles are not working with her in this position to stabilize her spine so her hip flexors can do their job. In a lot of cases, the hip flexor (specifically psoas major in this case) is left to split it's task between stabilizing the lumbar spine that it's attached to and lifting the leg into forward flexion. Since this muscle's main job is to bring the leg into hip flexion, it really struggles when you ask it to do both.

Maintaining a strong core is so so SO important for dancers to be able to do the movements required of them. I've also been reading up about how a weak core can cause chronic neck tightness in dancers (and other athletes), so check out my website for a blog on this soon!

If you want a more in depth explanation of how important your core is, read my blog post about it!

Another important aspect of maintenance for dancers is ensuring proper breaks from dance. See? I told you we'd come back to this. You probably thought I forgot, didn't you?

“Take breaks from dance” is meant in two ways, full out rest OR do something else for a while. Yes, you should schedule down time into your busy schedule! Everyone should, it's good for your mental health and gives your body some time to recover from the demands you place on it.

Taking a break from dance doesn't always have to mean complete rest and doesn't mean it needs to be for an extended time! Cross training is an important aspect for any athlete and is equally important for dancers. 

In the studio, a dancer works a lot on technique, plyometrics, and agility but there isn't much strength or cardiovascular training. For this reason, it is very important that dancers build in time for cross training, which also gives them a little break from too much dancing—yeah right, there's no such thing, right? Wrong! Build “dance breaks” into your schedule, it will help you to stay fresh, strong, and avoid over training.

There have been many research articles suggesting that strength training is quite helpful with injury prevention for dancers, and if it's done properly there will be no major muscle bulking, which is what every dancer is trying to avoid. In fact, it helps to ensure that every muscle is working to it's full capacity, therefore you can jump higher, lift higher, dance longer, and look great while you're doing it! 

I've also been reading that the Fartlek Interval Training method is the most highly recommended method for dancers looking to work on their cardio endurance—you should all want to do this, it will help your performance immensely! Think about it. Try and schedule some cross training into your life and you'll see the positive effects on your performance both in class and on stage. Maybe you'll even finally get that solo you've been working so hard for!

Also, please consider your ankles when strengthening! If you're planning on starting pointe or already are en pointe, keep working on that ankle strength! And I don't mean just sitting on the floor with a theraband pointing and dorsiflexing your ankle. You need weight bearing, functional, ballet specific movements to be strong enough to be successful! Ask your teacher for advice, or you could ask your local, friendly, Athletic Therapist--there it is again ;)--for some dance specific training exercises to get you started.

The last thing I'll mention is that you NEED to take care of your feet! Just like musicians have to take care of their hands, dancers need to care for their feet! This means:

  • Keep your toe nails short and cut straight across—a curved cut can leave you prone to ingrown nails and nobody wants that
  • Don't wear coloured nail polish on your toes all of the time—you won't be able to easily see if you're having any of the typical dancers foot problems
  • Look after your calluses, they aren't all bad—don't file them off unless they are becoming too big and cumbersome/painful and interfering with your dancing. They protect you from unnecessary blisters and abrasions
  • Be sure to keep your blisters clean and covered—there are products and methods that can help reduce friction on a blister or blister prone area. Ask your dance teachers for advice, they know what you're going through!
  • If you find that you are getting blisters often, even after your shoes are broken in, consider going back to the store and being refitted. Chances are, your shoes aren't right for you. Maybe you need a different shape/size/style


I know I've thrown a lot of information at you in this post but here is a recap of the main take-home messages:
  1. Seek professional medical advice from a therapist who has got a lot of experience with dancers and preferably has first hand experience dancing at a high level
  2. CORE STRENGTH—I can't stress this enough. It will improve your dancing noticeably and help you to be less prone to injury.
  3. Schedule “dance breaks” into your week and try cross training sometimes too. It will help your performance immensely!
  4. Strength training is important. You should all be doing it, no exceptions.
  5. Take care of your instruments—YOUR FEET!
  6. Most importantly, HAVE FUN!  Dance is meant to be a fun, educating, and worthwhile experience.  Don't try so hard that it becomes less fun for you.  Take advice from your teachers, appreciate what they're telling you, and try to apply it to your own dancing.
 
"Great dancers are not great because of their technique.  They are great because of their passion" --Martha Graham

Thursday 7 January 2016

Watching "Concussion" (the 2015 movie) as an Athletic Therapist

Like dozens of other Athletic Therapists and sports medicine professionals, I was counting down until the new Will Smith movie 'Concussion' was released in December 2015. I was a mix of anxious and excited to see it, wondering if it would be scientifically accurate, or if the facts would get caught up in the drama (also excited to see if Will Smith could pull off the accent... I think he did a good job.



I was most anxious that parents would have a knee-jerk reaction to pull their kids from collision sports and take the information about Chronic Traumatic Encephalopathy out of context. I expressed this fear to a therapist friend and she reminded me that some fear is a good thing. Parents and children need to fear the consequences of repeat head trauma, the same way we need to fear the consequences of inactivity, and the consequences of poor nutrition. 

CTE is a chronic condition. It results from numerous blows to the head, including concussive events and blows that are being called sub-concussive events. What's scary is that these sub-concussive events don't always produce symptoms, but they can contribute to the damage. It takes YEARS of these blows to produce CTE, starting from a young age. 

I like to think of it as a point system. We all start out with a certain number of points. Every time you have a concussive or sub-concussive event, you loose some. When you properly manage your concussion (take time off, get evaluated, step-wise return to play etc) you get some points back. Taking time off from contact sport gets you some points back too. Problem is that we have no idea how many points everyone starts out with, how many points a concussion is worth, or how many points you have to loose to be at risk for CTE. There's a lot of uncertainty around how the brain works, or doesn't work, but if you loose enough of these unknown points, then it's game over for you. 

So what do you do in youth sport to prevent CTE? Unfortunately we have not figured out how to prevent a concussion. Helmets prevent skull and face injuries, but don't actually protect the brain that well. Even abstaining from contact sport doesn't prevent concussions, there's an increasing number of reported head and brain injuries resulting from activities of daily living! But we can maximize the chances of the brain healing, and minimize the chances of other conditions such as CTE or Second Impact Syndrome. Here's some advise that I would give to any youth contact or high risk sport participant.

1) Always report to a coach or athletic therapist if you have symptoms. 
You can check out the list of possible symptoms in the Consensus Statement for Concussions, but it includes feeling foggy, ringing in the ears, headaches, dizziness, and a general feeling of unrest or not feeling right. The symptoms are very broad because the brain is very complex. One symptom counts though, you don't need to have multiples to suspect a concussive event. 

2) Report major hits to a coach or athletic therapist, even if you don't have symptoms! 
Sometimes if an impact is big enough, its a smart idea to to take a break for a day (or seven), just in case the symptoms develop within the next 24-48 hours. The hit may also have produced a sub-concussive event which they're saying is just as dangerous. 

3) Report if you were hit in a different sport or activity! 
The slate isn't wiped clean between sports. If you sustained a blow to the head in Lacrosse practice, and were removed from play, you probably shouldn't be playing in a football game the next day. 

4) Consider only participating in one risky activity at a time.
Most coaches have been trained on how much hitting is too much (to the best of our knowledge right now). For instance, most football teams will only have full contact practices 1-2 times per week. If you participated in more then one sport (i.e. ice hockey and wrestling) at the same time, then you may be experiencing too many blows to the head, and using up too many 'points'. It's also difficult to monitor injuries unless your coaches and therapists are talking to each other! 

5) Seek the advise of a trained professional.
Having a baseline on file is very helpful, but only if it's used! It's also only helpful if the person discussing your return-to-play decision with you is knowledgeable about concussions in sport. Even if you have not been formally diagnosed with a concussion, you can still participate in a step wise return to sport protocol, and undergo concussion rule-out testing to ensure that your brain is fully healed (and you've earned back your 'points') before returning to your activity. 

This list of course isn't exhaustive, but it's a good place to start for active teens and their parents. It is a good thing to be aware of the consequences of contact sport and have a small amount of fear of blows to the head and concussions.

If you have any questions at all about concussion management and risk mitigation surrounding contact sport, get in touch with your Athletic Therapist. They can help point you towards valid literature and help weed through the information available on the internet.