Concussion Series Part 2: Return to Play Protocol

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.

  1. 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.
  1. 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.
  2. 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.
  3. Participate in full practice with no contact to begin reintroduction to sport.
  1. Participate fully in practice with no restrictions.
  2. Game play.


McCrory P, Meeuwisse W, Dvorak J, et al

Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016

Br J Sports Med 2017;51:838-847



Concussion Series Part 1: What is a Concussion?

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.

Health Lessons from the 3 Little Pigs

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.

Chiropractic Care and Headaches

Headaches are a common complaint that chiropractors see in their offices on a daily basis. Headaches may be chronic and debilitating for the individuals that deal with them. There are a few different types of headaches, all of which chiropractic can have a key role in helping to relieve.

The three main types of headaches are tension, migraines, and cluster headaches. They all have their own specific symptoms, but at times can overlap. Tension headaches are one of the most common headaches and may be caused by stress and poor posture. Often times the “band” like tension headache is caused by poor positioning while performing office work and holding tightness due to stress in their upper back and neck. Cluster headaches typically come in attacks that may last every day for a few weeks. They typically are in the front of the face and may come with a runny nose and other symptoms associated with allergies. Migraine headaches have a typical pattern that usually is strong in one localized area and may come with sensitivity to light, nausea, and vomiting. Migraines may have many different triggers including foods, stress, and hormonal causes.

Chiropractic can help with all three types of headaches with adjustments of the spine. Several specific areas we look at when someone is experiencing a headache is the neck and upper back. The poor posture associated with these headaches can be improved with adjusting those areas as well as through corrective exercises to strengthen weak muscles and stretches for areas of tightness. Daily ergonomics and patterns are examined and corrected as necessary to prevent further issues down the road. Triggers for the headaches may also be caused by specific foods or hormones. Chiropractors can help alleviate those symptoms by helping the patient with their diet to try and determine what the trigger may be and how to avoid it.

If you or someone you know suffers from any of these headaches, feel free to set up an appointment with our office and Drs. Zak and Emily will look at your specific situation and give you a plan to help with your headaches.

Common vs. Normal

Just because something is COMMON does not mean it is NORMAL. Common, by definition, is something that is “occurring, found, or done often; prevalent”. Normal is “conforming to a standard; usual, typical, or expected”. In health, this holds true as many people truly have no idea how good their bodies are designed to feel. By this definition, you may find some symptoms to be “normal” for you as you expect certain things over time. However, what does human physiology say is “normal”? You don’t get to create a new normal. Normal is what our bodies were designed to do. It may be portrayed to be common nowadays for individuals to be held back by their health and not feeling they are reaching their true potential. These thoughts and feelings are confirmed by commercials that tout the countless individuals who have suffered from x and received relief from y treatment. Be it a headache, muscle and joint pain, discomfort related to pregnancy, constipation or other GI disturbance, lifestyle induced chronic disease, or a myriad of other diagnoses, you are portrayed to simply be one of many with this common issue. Rather than accepting this and finding “strength in numbers”, do something about improving your health. Seek the answer to what is going on and address the cause, rather than the symptom or effect. It may be common to hear of headaches, but it is not normal to have them and is not something you have to put up with, or routinely cover-up. You may think waking up sore is normal because your co-worker down the hall complains of the same thing every morning, or that you shouldn’t be able to get out and hike at the lake because “you’re getting old” and it’s normal to be in pain as you age. Hollywood may enjoy showing the misery of pregnancy, labor, and delivery, but I can personally attest that a truly normal physiological labor and delivery, while intense at times, is not something women should be afraid of as depicted when they have the proper preparation and support. When you seek answers for your health concerns, what are you really getting at? What will make the symptom “go away”? Or what is going on here and how can I address the CAUSE and take control of my health, truly striving to thrive in my health and life? Be it getting your body adapting and functioning better through chiropractic adjustments, regular movement, dietary modifications, other lifestyle changes, or a combination of all of the above, you deserve to live the life you want free of “common” ailments and anything else holding you back. Remember, just because it’s common does not mean it’s normal, or has to be your story. Be the one to create a new “normal” for others and inspire them to get “uncommon” by today’s standards, truly finding and feeling their optimum potential.

Maintaining Your Health

Similarly to maintaining your car’s health with regular oil changes by an auto mechanic and keeping up your oral health with visits to the dentist on a regular basis, it is wise to keep your spine and nervous system in good working order with regular trips to the chiropractor for an examination and adjustment.
A quote in a recent article featured in Women’s Health Magazine summed it up best. “To focus only on your back health when you are in pain is like only exercising when you gain 10 lbs or only eating healthy when your cholesterol is high, and then going back to your old habits shorty thereafter.” Back pain leads to a significantly high amount of days of work missed, money spent on various treatments (including surgeries and injections), and general reduction in our daily functioning and well-being. Our suggestion? Be proactive, such as we are in the situations listed above. By having regular oil changes and check-ups on our cars we are able to avoid major issues while on the road, as well as maximize the lifespan of our vehicles and their important parts, like the engine, that are required to be in good working order for its function. By having our teeth regularly checked on and cleaned, we are able to have any issues such as decay noticed and addressed early on, extending the health and function of our teeth as long as we possibly can. Our spine is literally our “backbone”, forming the main structure for all of our movement, as well as housing our spinal cord, which carries information from our brain out to literally every part and function of our body through the nerves branching off of it. With such an important job, it is absolutely vital that we take good care of our spines.
How often should regular adjustments occur? Everyone is different based on their age, history of stressors (accidents, pre-existing conditions) and lifestyle and their time between adjustments may vary. On average, every 3-4 weeks is ideal to keep up regular maintenance, with more frequent visits as necessary. Aside from avoiding pesky aches and pains, being proactive in regularly caring for our spines can aid in maximizing our body’s functioning directly by removing any restrictions getting in the way of our nervous system functioning, and indirectly by allowing us to stay active as well as aid in getting adequate sleep at night that we need to allow our bodies to rest and replenish as needed.
In addition to being adjusted on a regular basis by a chiropractor, aim to drink plenty of water (all cells, organs, and tissues depend on being adequately hydrated for proper function), work on eating an anti-inflammatory diet (cut back on processed foods and added sugars as you’re able, getting in lots of fresh produce), and get regular movement into your daily routine (both actively with walking or jogging, as well as relaxation such as yoga or stretching routines).
By taking care of your most important asset, your health, you can not only minimize the risks of having larger flare-ups and issues down the road, but you can focus on getting the most out of life.

“Health is like money; We never have a true idea of its value until we lose it.” -Josh Billings

Give us a call today to get working on how you can take charge of your health!

Eldora Family Chiropractic & Wellness Center

Taking Charge of Your Pregnancy

Pregnancy is such an exciting time! Nothing can quite compare to the wonder and miracle of growing and nurturing a tiny baby who relies on you solely to develop into a human being who will eventually thrive on the outside, breathing and functioning on their own. While it is an amazingly exciting time, it is also a big responsibility to take on. This is pressed upon new parents in terms of the financial responsibility and “settling down” to be good role models for their child, but what seems to be forgotten or under-emphasized at times is the importance of mom’s health prior to conceiving her child and throughout her pregnancy.  This goes beyond the well-known avoidance of toxic substances such as alcohol and tobacco products (though it is imperative that this advice is followed). What are you nourishing your body with on a regular basis, and therefore nourishing your growing baby with? What movement are you getting in on a regular basis both to promote a healthy functioning body for yourself as well as getting your body into shape to withstand the trials of your upcoming labor, delivery, and subsequent motherhood to your child? How are you preparing yourself and learning all about what you’re about to undertake, both during your pregnancy and during labor and delivery, as well as making good decisions that you are confident in throughout?

Women need to take charge of their birth process and become informed, evaluate the data, and make authentic decisions regarding all aspects of pregnancy and the birth process. Women also need to invest at least as much time (and, preferably, more) in this endeavor as they spend evaluating and choosing the furnishings for the baby’s room, the best developmental toys, the highest quality stroller, and even maternity clothes. Now more than ever, it is essential that women use the information age to their advantage and arm themselves with the knowledge they need to make an authentically informed decision that will affect their lives and that of their babies.

In order to make an authentic decision related to birth, women need to speak candidly with their practitioners while simultaneously taking the initiative to develop an evidence-based fund of information about pregnancy and birthing that is available and accessible through a variety of educational resources. It is critically important to seek out the information that is available about birth versus solely relying on practitioner opinion. The concept of taking charge of your own health by actively learning about health maintenance and illness and disease prevention is encouraged in various aspects of healthcare today; it is often absent in maternity care.” -Alyssa Benedict (Pathways Magazine Issue 39)

As stated above, it is so important for women who are pregnant or even considering having children to know their options throughout pregnancy, labor, and delivery. “If you don’t know your options, you don’t have any.” (Diana Korte, co-author of “A Good Birth, A Safe Birth”) How do you “know your options”? Research. Ask questions. You can start with talking to a trusted friend or healthcare professional for guidance on where to begin, or by looking into reading materials. Search scholarly journal articles online. Arm yourself with data from multiple sources, as to avoid biases. Take birth classes. These extend beyond the hospital as well. Find a class that provides good information on prenatal nutrition and exercises, newborn care, breastfeeding, and general education on what happens during your pregnancy, labor and delivery, as well as options you have throughout the process. Many classes are out there, covering all sorts of trains of thought and wishes for expectant mothers. Ask around, do some research, and find the best fit for you. Also, be sure to choose a birth care provider who is on the same page with you. Choose someone with whom you can form a mutual patient-doctor relationship of respect and openness. Form a solid support team to back you up and help you along the way, whether it consists of a significant other, chiropractor, doula, family members, or trusted friends.

What are your goals with your pregnancy and delivery, as well as with raising your baby and giving them the best start you can in life? The choices you make for yourself and your baby are a big deal, as one of the most important things after securing the physical health of your baby and yourself is your emotional well-being and readiness to take on motherhood with confidence, feeling in charge of your choices and health as you move forward in this exciting new adventure.