Elections were held last week. One big issue that seems to come up every time an election takes place as well as has a regular spot in our newspapers and evening segments is the troubling state of healthcare in the US. Ever rising rates of chronic disease, subpar maternal and infant health, and increasing obesity (especially alarming among kiddos) are literally and figuratively crippling us as a nation. There is also the question of the rising costs spent on illness and who will pay for those rising costs. As nice as it would be for someone to take care of the problem for us, the solution to these issues will not come from Washington DC or Des Moines or your doctor’s office, but rather right in our own homes. That’s right, we hold the solution. Spending time with my 13 month old recently reminded me of how observant he is already at such a young age. Kids are like sponges and they are watching what you do. The choices you make in the kitchen, the meals you are preparing, the physical activity that you get in, how you choose to respond to a health issue or injury when it does arise, and how you spend your free time together are more important than you think. Your kids are watching, and they are taking it all in. Not to mention the fact that the better health you are personally in, the better version of you will be able to care for and play with your kids and grandkids. No matter what moves are being made upstream by legislators, there will be no greater influence on our youth, the future of our nation, than the examples they see lead by their role models at home day in and day out. We tend to blame genetics for many patterns we see running in our families. While our genetic makeup may predispose us to certain conditions, it is our common environment that nurtures our bodies as we grow. Take this opportunity to improve your child’s view of what health looks like and contribute to solving our nation’s health crisis.
Concussions can cause long lasting symptoms that have major side-effects for those that have suffered from them. Various treatments for concussions are beginning to take shape, but due to the variable nature of symptoms and gaps in the knowledge of concussions, there are no known cures for all concussion-related side-effects. However, through chiropractic adjusting, targeted exercises, and various nutritional supplements, post-concussive symptoms may be resolved quicker and with reduced chances for long term side-effects.
Chiropractic adjustments can help in the immediate aftermath of concussion due to a couple different factors. With most concussions there is an effect on the cervical spine due to the force on the head that causes many concussions. Most of the time, this is similar to a whiplash injury in a car accident. The whiplash motion causes a sprain/strain in the muscles and ligaments of the neck, especially in the upper region towards the base of the skull. Injuries to this area can cause headaches and at times dizziness. It is imperative to have these issues addressed and to begin the healing process as soon as possible so that going forward the physician is able to differentiate between symptoms that may be caused by the concussion and symptoms caused from the neck injury. Chiropractic adjustments also help after a concussion because there is a connection between the muscles that connect the first two vertebrae and the skull with a tissue called dura mater that surrounds the brain. When these muscles tighten after a whiplash injury, the muscle-dural connection can cause symptoms similar to a concussion.
Targeted exercises can begin to speed up the healing process by retraining the brain similar to how you would retrain your hamstring to function after a muscle tear. Two of the most important areas to retrain include your balance and regaining the ability to stabilize your gaze when focusing on an object. The first step in retraining your balance is to make sure that you can properly activate your core. This is done with one simple step, by standing and attempting to contract your abdominal muscles without hollowing your stomach. After achieving this seemingly simple yet very important task, balance can be improved with many different exercises. Most of the time a progression is used from the beginning of simply standing on both feet flat on the ground with your eyes open to getting more advanced with standing on one foot on an uneven surface with your eyes closed. A study performed in 2015 showed that post-concussion patients that performed 8 weeks of balance training showed structural changes in the areas of the brain that control balance and posture. Training gaze stabilization is the next step and can be done with a few easy exercises. They include actions such as holding your finger still at arm’s length in front you and moving your head in various directions while focusing your eyes on the tip of your finger. Varying the speed of head movement will increase the difficulty to further the gaze training. Towards the end of rehab, combining the gaze stabilization and balance exercises will be one of the final steps.
Nutrition is an overlooked aspect of almost all rehabilitation programs, but it can be a major difference maker in the speed and success of the program. There are numerous supplements that have shown to help post-concussion in early studies. The most highly studied supplement and one that has shown the most effectiveness is omega-3 fatty acids (fish oil). Studies have shown taking between 4-6 grams a day can help lessen the symptoms and improve the quality of brain repair. Quality of repair can be an important aspect in helping to prevent tau protein build-up, which is the main culprit in degenerative brain diseases like CTE and Alzheimer’s disease. Anti-inflammatory nutrients such as turmeric and Vitamin D can help limit the inflammation in the brain and allow healing to take place. A quality probiotic is the final piece to the post-concussion program due to the effect a concussion can have on the patient’s gut health. Gut health post-concussion is often overlooked. Many don’t associate a head injury with their gut, but there is a clear association. For example, there are many post-concussion patients that have nausea and vomiting as a symptom, exhibiting a relationship between the brain and gut. Fish oil, vitamin D, turmeric, and probiotics are not the only supplements to consider post-concussion, but they are the most important to associate.
This blog is a brief overview of what varying treatments may contribute to post-concussion recovery. In order to implement these suggestions into your post-concussion rehab, contact Eldora Family Chiropractic for individualized examination and integration of specific treatment protocols to best help you or your child.
In good health,
Zak Stoulil, DC, CCSP
In part 1, we discussed how people get concussions and what goes on in the brain that causes the symptoms. In part 2, we are going to talk about the process of returning to play. The steps that are listed below should be followed by athletes that have been diagnosed with a sports-related concussion. This protocol was agreed upon at an international conference on sports-related concussion in 2016 and represents the latest consensus on the proper steps before returning to play. The link attached with the citation for the paper at the bottom of the page will take you to that consensus statement. Each step requires 24 hours of being symptom free before the athlete is allowed to move to the next step and should be managed by a qualified healthcare practitioner familiar with the current best practice guidelines.
- Reintroduction to daily activities such as school or work. 48 hours after initial injury can begin light easy aerobic exercise such as walking or riding a stationary bicycle as long as symptoms do not return.
- Observe following guidelines when returning to school:
- Begin reintroducing reading, texting, and screens (phone/TV) at increments of 15 minutes and slowly build up as symptoms allow.
- Begin homework and reading at home to increase ability and stamina of cognitive functions.
- Return to school part time or with breaks throughout the day.
- Return to school full-time.
- Observe following guidelines when returning to school:
- If symptoms free with light aerobic activity for 24 hours athlete then can increase the aerobic activity to begin raising heart rate. Light jog or more intense riding on the stationary bicycle. No resistance training. Goal is to increase heart rate and if symptoms free can move to next step.
- After the increased aerobic activity athlete can begin to participate in sport specific skill training such as shooting drills, passing, and footwork. Individual position drills in football with no contact. No full team drills.
- Participate in full practice with no contact to begin reintroduction to sport.
- Participate fully in practice with no restrictions.
- Game play.
Concussions have been a hot topic in our country the last few years, especially in sports. Most people understand that a concussion is a head injury and it has commonly been referred to in the past as a “brain bruise”. The latest research has steered the conversation away from that as a comparison because it is much different than what we understand a bruise to be when we see it on our skin. If the brain is not bruised in a concussion, then what happens after a person gets hit in the head? In order to understand what happens, first we need to understand exactly what the brain is made up of and how it is protected.
The average brain weighs about 3 pounds and has the consistency of Jell-O. It is made up of mostly fat that helps to protect the nerve cells and allow those nerve cells to communicate faster. Our brains are then suspended in a fluid inside the skull; very much like how an egg yolk is suspended inside the egg white inside of the shell. If you shake an egg, the yolk inside can be damaged even if the shell itself isn’t damaged. That also happens inside of our heads with our brain. The skull is there to protect against direct blows to the brain but the brain is still able to move around inside.
Damage to our brain happens in two phases. The first phase is the tearing of our nerve cells with the acceleration and deceleration that happens to our head when we get hit. In football, this happens in mainly two ways. First is the impact of one player striking another directly in their helmet, causing the head to accelerate backward or to the side and then stopping when it reaches the end range of motion. The brain then moves inside the head and that movement can tear the nerves and damage the supporting structure. The second phase happens after the initial tearing. Our bodies only allow certain chemicals to enter into the brain tissue itself and any other chemicals can be harmful to the cells. Thus, when the supporting structures are damaged it allows many different chemicals to cross into the brain itself and those chemicals can damage the brain tissue. The second phase happens slowly and can lead to an increase or change in symptoms over the following 2-3 days.
Concussion symptoms can be varied and that all depends on what area of the brain is damaged. Our brain is sophisticated and well organized so certain areas control our movement, balance, speech, sight, hearing, and movement. This is the reason why newer concussion testing involves many different aspects and is more than just asking the individual a few basic questions such as “Can you tell how many fingers I am holding up?” and if they know their name.
In the next two articles in this series we will go over different options for treatments and how to know when our athlete is ready to return to play.
Some of the best life lessons can come from children’s stories. I was reminded of this when recently reading my son “The 3 Little Pigs”. You may remember the plot-3 little pigs each venture off to build their own house-2 quickly go up, made of straw and sticks, respectively, and are blown down effortlessly by the Big Bad Wolf. The third pig spends a little more time and effort building his house out of bricks, but it ends up being worth it when it proves to hold strong when tested by the wolf. This parallels our health, as when we have a strong foundation of health built up, we are less likely to be “knocked down” by injuries and illnesses. Weak foundations (or no foundation at all) are built of poor dietary choices, minimal activity, and ultimately waiting until there are apparent issues (symptoms) to act and cover up the symptoms. In order to build a solid foundation, one must persist to strive towards healthy choices on a regular basis. Consume whole, REAL foods on a regular basis, maintain an active lifestyle, and keep your body moving, functioning, and ADAPTING well with regular chiropractic adjustments. This helps lead to prevention of many issues and a quicker recovery when challenged. Being sick isn’t bad; however, being sick frequently and having trouble overcoming it is a concern with your immune function. Having an occasional injury happens; however, being laid up with soreness on a regular basis or lacking energy to get out and do the things you enjoy on a regular basis is not the way to live. It is not about the challenges you face (aka the big bad wolves), but rather how you are able to prepare yourself to ADAPT and withstand or bounce back from the challenges when they arise. Build a strong foundation now before you’re forced to go seek shelter (emergency care and medications) from someone else-you will thank yourself for putting in the effort to maintain control over your health.