Concussion Part 3: Treatment Overview

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


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.

When something is “getting on your nerves”…

As chiropractors, a common phrase we hear in the office is that someone believes they have “pinched a nerve”. Usually, they believe this because when they move in a certain direction they feel a pinching sensation in a localized area and that leads to pain. The patient usually experiences a loss in their range of motion and cannot function at 100% in their daily life. What that person has described is most likely not a pinched nerve by the true definition. A pinched nerve typically has very different symptoms than the one described. The condition that was described above is typically inflammation in the spinal joints that leads to a loss of movement. Chiropractic adjustments can help restore the normal movement for that joint and promote resolution of the inflammation.
In order to have a truly “pinched nerve”, the patient would be suffering from an impingement of the nerve. That means that much like stepping on a water hose and preventing the water from reaching the opening; your nerve flow has been interrupted. The symptoms that come with this are typically numbness/tingling, radiating pain and/or weakness of either the arm or leg muscles. If the nerve is getting pinched in your neck, that will typically affect the arm and if the nerve is in your low back, that will typically affect your legs. The nerve can be impinged by a variety of causes. Several common causes are disc herniation, arthritis that has narrowed the opening for the nerve, or tight muscles that affect the nerve. Each of these causes will present differently and the treatment may vary. The severity of the impingement will also change what the patient experiences. The order of progression typically goes from first a vague numbness or tingling sensation that will eventually progress to more of a true painful feeling. The last step in the progression is typically to have loss of strength. Depending on where the nerve is getting impinged and at what level in the spine, different areas will go numb and different muscles will lose their strength.
Each of these differences will help the chiropractor decide what form of treatment is best and where to apply the treatment. It may be determined that a lighter force adjustment with more traction applied will help in order to take the pressure off of a herniated disc or that a more traditional manual adjustment will be best to reintroduce proper movement and adaptability to the joint, allowing it to move freely and take the pressure off of the nerve. If it is tight muscles that are impinging on the nerve, which may happen, for example, in the elbow, frequently soft tissue techniques (varying from massage type of pressure to instrument assisted techniques) work well to help loosen up the muscle and eliminate scar tissue that may be causing problems. Soft tissue techniques often work well in the wrist as well for issues such as carpal tunnel syndrome.
Hopefully this helps you learn a little more on what exactly a “pinched nerve” is and how chiropractors can help.

Little Choices, Big Results

Our health is within our power to take charge of through the little choices we make every day“.  What better time to be reminded of this than at the start of a new year? Just as we like to sit down around this time each year and figure out trips that will be taken throughout the year and evaluate our current financial situation and goals, take a moment to sit down and evaluate the state of your own health. Don’t just think about what procedures you may or may not have had to have done in the past year or what medications you are or aren’t currently taking, but how are you really doing?

Physically, how do you feel when you wake up in the morning? Do you feel well rested and ready for the day? Do you have the energy to go to work and give it your best and come home and enjoy playing with your kids? Are you able to get some regular activity in and enjoy the sweat, or do you drag yourself through a tired half effort? Do you have enough energy to brighten someone else’s day through volunteering, whether it be donating your time or a friendly, sincere smile?

Mentally, how do you feel when you wake up in the morning? Do you feel clarity in your mind and a clear focus on the tasks that lie ahead of you? Are you able to complete tasks on hand with a sharp mind, or do you feel you spend much of the day in a fog? Does a new challenge have you looking forward to the opportunity, or do you dread the obligation to put forth a greater effort?

Emotionally, how do you feel when you awake each day? Are you excited to take on the challenges of a new day, or are you dreading “another Monday” or “another week”? Do you enjoy each encounter during the day and week, giving it your present focus, or are you frequently looking ahead to the weekend/next paycheck/next vacation/next big event?

How did you do? Are you happy with where you are, or do you have work to do? If you are happy with your answers that is fantastic. Keep up the great work! If you have one or more areas that need some further attention, please don’t let it slip by. We often have no idea how good we are supposed to feel-physically, mentally, or emotionally. We often have some areas of our lives that need work, but rather choose to ignore them as other things take importance.

Remember, the better you take care of yourself, the better you can take care of those you love and care for. Whether it be a significant other, children, parents, siblings, good friends, employees, coworkers, or customers, those counting on you will be better served by you at your best. When you fly on an airplane and they give the pre-flight instructions on what to do in an emergency, they always tell you to put oxygen on yourself first prior to helping anyone else. This is the reason. You are much better equipped to care for others when you have remembered to first take care of yourself.

Take action steps today to put your health first this year-not only for you, but for those counting on youThe path to a healthier you begins with little choices that you can get started on now. Small, positive changes will add up over the course of a year to have big results on you and your overall quality of life, as well as those who interact with you.

Wishing you a healthy and happy new year from all of us at Eldora Family Chiropractic & Wellness Center!