The first concern when any athlete is suspected of concussion is to rule out the really serious that could be deadly or constitutes an emergency. Once this is done, evaluation can begin. There are several areas to evaluate: symptoms (what the patient reports), memory and ability to process information, and signs (what the healthcare provider can identify).
Symptoms: The patient is asked to describe their symptoms (which do not always begin immediately after the injury).
Memory/Cognitive: There are a variety of tests. Asking the patient to count backwards, recite well-known facts, remember items that will be asked approximately 5 minutes later are all common aspects of this portion of the exam.
Signs: This is often a major area of focus because these items cannot be altered or "faked." Many athletes are anxious to return to the game, and this portion of the exam gives a clear answer to some of the damage that may be present. There are 12 cranial nerves inside the skull as well as nerves that exit the spinal cord that can be tested for changes in their function. Changes in pupil size, ability to smell or hear, tracking of your eyes with movement, changes in sensation in particular areas or strength in certain muscles can be indicators of changes in your central nervous system.
These three areas will be tested at rest. If these areas are all normal under resting conditions, retesting under "exacerbation" or after performing challenging athletic tasks is used to further identify problems. For football, the athletes are likely asked to sprint 25-50 yards, perform jumping jacks, pushups, squats, etc to elevate the heart rate then are retested immediately.
Based on the findings at rest and/or during activity, we can determine the degree of injury. Treatment is based and later, monitored, by these tests.
Stay tuned for the next post on Treatment Options.
Concussion itself is defined as a "mild traumatic brain injury" and its symptoms typically last fewer than 24 hours. It is important to realize that the head does not have to "hit" anything and there does not have to be a large force to cause a concussion. Our bodies are designed to absorb forces front-back better than any other direction, so a hit from the side or a jarring from an angle may be enough even under low forces.
The severity of a concussion and the severity of the after-effect are determined by a number of factors including the severity and length of the symptoms, previous history of head injuries, and severity of past injuries. The big concerns aside from initial complications are Post-Concussion Syndrome and Second Impact Syndrome.1
Post-Concussion Syndrome is a condition that causes significant aftermath following a concussion. These can range from personality and emotional changes (changes in anger, temperament, etc) to reduced response time, headaches, chronic pain, fatigue and a host of other problems. In many cases post-concussion Syndrome is short-lived but it may be a permanent change. These changes can quite literally be life-altering and must be taken seriously and treated properly.
Second-Impact Syndrome is a condition that can be deadly and is still not fully understood. First described in 1984, it involves a second head injury (typically prior to complete healing of the first). The brain swells and bleeds more severely than expected. There is a large hole in the base of the skull that the brainstem travels through on its way to becoming the spinal cord; as the pressure increases around the brain from the swelling the brain can actually be deformed and pushed through this hole. This is known as herniation and can be deadly. While still controversial, growing evidence supports higher risk with concussions that are not managed fully. This is the primary reason concussions are gaining so much more attention.
Stay tuned for the next post on Concussion Evaluation....
Everywhere we look these days, you hear about concussions. As the Packers ended regular season this past week, there are prime examples! Alex Greene and Josh Sitton returned from concussion; earlier this season, it was TJ Lange, Johnny White, Jerel Worthy, and Terrel Manning. 6 players so far in the season have missed practice and many have missed games all for something that years ago didn't receive much attention. So what is the big deal? How are they evaluated? What treatment options are available? How is an athlete evaluated for return to play? Stay tuned for the next several posts to help you better understand why Concussions are such a big deal, how it is evaluated and how they are treated.
aka 5 Pet Peeves of Every Healthcare Provider
1. SPILL THE BEANS ALREADY.
Picture the last time you were in a waiting room and they were "running behind." You often blame it on "overbooking" but did you know the number one reason providers run behind is because of their patients? Have you ever noticed the first thing a doctor asks when they walk into the room is typically: "How are things going? Has anything changed?" This is on purpose. New pain, changes in pain, or new conditions require more time (and sometimes an exam) to determine their cause. Your appointment is scheduled for a specific amount of time before the next patient. Your provider plans their best of use of every time from the second they walk into that room. If you leave that new condition to the end you leave us with a variety of unpleasant choices: push our other patients back and run behind our schedule (who likes sitting in a waiting room?), rush through and possibly miss something, or put it off to the next visit (who wants to spend an extra visit and/or be sent out while still in pain?)
2. DIDN'T MOM EVER TELL YOU SECRETS AREN'T NICE?
Did you know that GI symptoms (diarrhea, gas, constipation, etc) may be related to some forms of arthritis? Did you know that changes in bowel or bladder habits with a low back injury is a sign of a very, very serious medical emergency? There are hundreds of other examples. While you may feel embarrassed about talking about your bowel movements, you shouldn't- trust me....we've heard it all! You may not think they are related, and maybe they aren't- but you are always better to tell your provider absolutely EVERYTHING and let us decide if it's relevant- that's why we went to so much school!
3. THIS IS NOT BURGER KING, YOU DON'T GET IT YOUR WAY (Sorry!)
We LOVE it when our patients want to get involved in their care and you're on board with your treatment plan. We LOVE to see patients excited about their health. That being said, it can be a struggle when a patient walks in and says: "this is what I have and this is what I need." You may be completely right, and it helps to have that input- nobody knows your body as well as you do; but keep an open mind. The entire goal of seeing a provider is to capitalize on their expertise and get back to health as quickly as possible. When a provider incorporates other techniques or options into your treatment plan, don't take it as if they weren't listening. You're provider is usually looking out for your best interest and not all techniques/options are right for all people. It's called a doctor-patient relationship for a reason....and you should absolutely be involved in your care. If you aren't comfortable with a technique or have questions- speak up!!! We'd rather answer questions and make sure you understand why we are doing what we are doing than have you go home frustrated!
4. JUST BECAUSE YOUR NEIGHBOR HAD IT DOESN'T MEAN YOU DO TOO.
We've all done it. Bob next door has a low back injury with leg pain, he says: "It's sciatica." Several days later you awake with leg pain. It must be sciatica too. Except for the fact that our leg pain is in a completely different area and doesn't involve the sciatic nerve at all. The best guideline is to seek care if you are in pain, regardless of what your neighbor has. Maybe Bob's "sciatica" got better without treatment; what if your case requires early care and you put it off? It's easy to miss something or over-diagnose just because of what is going on around us.
5. WEB MD DOES NOT ACTUALLY HAVE A MEDICAL DEGREE.
While the internet is a thriving source of information and WebMD or mayoclinic.com can have some good information about conditions, it's not exactly a replacement for professional medical advice and care. Treatments are much less effective when conditions are improperly diagnosed and many treatments may actually make the problem worse. In addition, most conditions become harder to treat and will require more treatment (either more aggressive or more frequent= more expensive!) the longer they are allowed to fester. Heaven-forbid something more serious is underlying your pain- the sooner it is diagnosed and treated, the better the outcome. Period. A proper diagnosis is the #1 battle, so don't risk losing the war!
I'm already seeing patients fighting colds and immune systems firing up. There are obvious ways to help fight off those pesky winter bugs- from washing your hands thoroughly and regularly to disinfectant sprays and hand sanitizers. But so many people forget about the most important steps! Sleep exercise, diet, and even Chiropractic Adjustments all play a role in the health of your immune system!
SLEEP- While adequate sleep is obvious, we all get caught up in busy daily life. Make sleep a priority. You should feel well-rested when you awake. Sleep allows your body to replenish immune and blood cells.
DIET- This becomes a little more detailed. Your immune system relies heavily on the nutrients you put into your system daily; deep fried chicken, fast food lunches and ice cream don't exactly pack a punch in the nutrients your body needs! To keep it very basic, your body especially needs vitamin C, vitamin A, Zinc, and Selenium. The best foods to stock up on are leafy-green veggies, and a variety of bright colored fruits and veggies. The more variety you can get from fruits and especially vegetables the better nutrient variety you get. Make it a goal, one big salad every day is a great place to start! A high-quality multivitamin to supplement what you don't get is also a big help, but don't rely fully on this. Your body will more readily absorb and use nutrients from food before a supplement. So use it as it was meant- as a supplement!
EXERCISE- Again, this is very detailed. High-intensity workouts, training for sporting competitions, or "weekend-warrior" workouts actually make your body more susceptible to infection until you have recovered. So be careful, during a competition season is the time you need to be most diligent with all of your preventative steps! Regular and moderate intensity exercise, however boost the immune systems surveillance and response to invaders. As with typical exercise recommendations, change your type of workout every 4-6 weeks. As your body adapts to your workouts, so does your immune system!
CHIROPRACTIC ADJUSTMENTS- This is often an overlooked step. While your immune system has two "sides," one side is heavily controlled by your nervous system. The nerves which carry the information to up regulate your immune response sit just in front of the spinal column and/or exit the spinal column to get into the periphery. Chiropractic manipulations influence and affect the nervous- hence being such a safe and powerful tool! This is no exception. By normalizing the nervous system information and stimulating specific areas of the nervous system we can actually increase your body's immune response.
While this article touches on the very basics of steps you can take to help prevent getting sick, catching a cold isn't always completely avoidable. Stay tuned to the best recommendations when the sniffles do hit! For more information on the details of how the immune system works, also read THE IMMUNE SYSTEM: DEMYSTIFIED.
I apologize it has been so long since I have written. I plan to begin posting more regularly again on a variety of topics- if you have anything in particular in mind, please send the request to my email at: email@example.com.
As many of you know, the past several months have been full of changes. In an effort to better serve our patients and improve our care, you will find many new features in our office and some big changes coming soon. To help keep you up-to-date, here is just a sampling:
We changed our billing procedures. All billing requiring insurance now uses a company called ChiroBill, located right here in southeast Wisconsin. This allows for more timely and accurate billing. Any services which are paid at the time of service are still managed in our office.
You'll see two new faces in the office: Cori just graduated Homestead High School and will be pursuing her college degree in the fall. Susan is a Chiropractic Technician and is continuing her education in the clinical sciences.
We've extended our office hours due to high demand. Over the past several months, we've added 5 additional hours to Mondays, Tuesdays and Thursdays!
We have a new online scheduling system. We've received great feedback from you about the ability to schedule online. This new system is easy to use and allows a realtime look at our available schedules.
We've upgraded our phone system to better assist your needs.
And the real big one.......long awaited......we have a NEW LOCATION!!! It's been in the works for a while, and as many of you know we have been searching for the perfect new home. Now we've found it. We will be moving to 3400 S. 103rd St, Suite 300, Greenfield WI 53227. We expect the move to occur in mid-August. Construction is rolling, but as we know more we will keep you up to date!
I'd like to thank all of my patients for their support and understanding as we grow, change, and improve as a company. I know change is hard, but we're trying to make it all for the better!
HOW LONG SHOULD I WAIT AFTER AN INJURY TO GET CARE?
Unless your injury is truly minor and will heal completely by itself in 2-4 days, the answer is almost always - DON'T WAIT! Evaluating an injury quickly will not only reduce the severity of the injury and speed healing, but will also typically save you money! Here's why: Inflammation. What's Really Wrong? Pain Cycles. Compensations.
INJURY AND INFLAMMATION 101
When you have any type of injury, some cells are broken open and damaged. This damage releases chemical messengers into the body and to the brain to "send reinforcements" to begin healing the area. Some of these chemical messengers are toxic and irritating- they irritate nerve endings causing pain and can irritate or damage the surrounding tissues. This is a process known as inflammation. Bruising, swelling, pain, redness and heat are all signs that inflammation is occurring.
Overall inflammation is a good thing. It causes nutrients, oxygen, blood and building blocks for new tissue to be sent to the area. The problem is controlling this inflammation.
The body goes into hyper drive! As all of these new products are sent to the area, the lymphatic system (the structures that work like sewers to drain away the "waste" and damaged tissue) can't keep up. You get one huge traffic jam. As congestion builds, pressure builds up and begins causing damage to the surrounding tissue (this is combined with irritation and damage still occurring from those previously released chemicals). As this damage occurs, more chemical messengers are released. Snowball!!!
REASON #1: Stop the inflammation and prevent Secondary Damage.
This is the premise behind RICE: Rest, Ice, Compress, and Elevate. These are very important to quickly control the inflammation and reduce the secondary damage!
There are also many additional treatment options to reduce inflammation quickly. Kinesiotape, electrical stimulation, lymphatic massage, ART....the list could go on and on. The sooner we are able to address a problem, the less inflammation is allowed to persist. Decreasing inflammation means decreasing secondary damage. Decreasing secondary damage means actually reducing how severe the injury could have been.
REASON #2: WHAT'S REALLY WRONG?
This one seems obvious, but many serious injuries are often overlooked thinking the injury is something else. Some of those more serious injuries may require special treatments, or may actually get worse with some treatments that are otherwise recommended. The longer the big injury goes untreated, the higher the risk of long-term problems and even disability over time.
For example....Did you know there are 5 common sites of ankle fractures connected with simple ankle sprains? And one isn't even in the ankle- it's in the knee! So if you aren't looking for it, it's likely to be missed. And contrary to popular belief, most people can walk on several of these fractures! There are also 6 commonly sprained ligaments in any ankle sprain. Treatment is very, very different depending on the location and severity of fracture or sprain. Three of these common injuries, if left untreated will result in needed surgery- when they could have been corrected simply with early treatment!
Needless to say: A quick exam to rule out the scary stuff is well worth your time and money!
REASON #3: PAIN CYCLES
Your body is much smarter than most of us give it credit. It actually learns patterns and forms habits. Two of these patterns are pain cycles and compensation patterns.
As your nerve endings are irritated with chemical messengers, or have been damaged themselves the obvious occurs- you experience pain. Like any information carried through your nervous system, the signal is transported up the nerve and "synapses" with the next nerve. It continues "leap frogging" or "synapsing" with each new nerve until it reaches the brain.
Every time a synapse is used to transport information, that connection becomes reinforced. That connection becomes stronger every time a signal is relayed. What happens when that signal is relayed constantly for 3 weeks, 3 months, 3 years, before you decide to do something about it? It becomes infinitely stronger and more difficult to break. This is known as a pain cycle.
This is one reason why we may be able to treat an injury completely in one visit immediately after the injury occurs, but the same injury may take weeks or months of treatment to respond if the condition has been there a long time. Needless to say, again, a quick evaluation and treatment early on will save you time....and money......in the long run!
REASON #4: COMPENSATIONS
As I said above, the body is smart! The second type of learning it does with an injury is learning compensations.
How many times have you sprained an ankle only to find your other leg begins to hurt, or your knee, or your back? Your body doesn't like pain and will do anything to get away from it- even without you knowing. Your gait with change, you will use your arm differently, etc.
These changes, known as compensations increase the amount of strain on other tissues, joints and ligaments. Similar to pain cycles, every time you use the new pattern- that pattern is strengthened. Overtime, the body forgets how to use "normal" patterns. Overtime those tissues are not designed to withstand the types of forces they are being subject to. Overtime they break down, stop working or cause pain themselves.
Controlling pain quickly and treating an injury appropriately and completely discourage compensations from occurring. The last thing you want to do is spend time, energy, pain and money addressing a second, third or fourth problem all because you didn't take care of a simple injury to begin with!
SUMMARY: Evaluating and treating an injury quickly and completely will save a lot of pain and hassle in the long run. If you are even unsure if an injury needs to be treated, assume that it does. At the very least, you will avoid future injuries and potentially costly treatments and learn something about your body in the process!
Have you ever wanted to network with other companies, meet new people, spread the word about your business? Try this FREE EVENT! (& free coffee!)
If you RSVP on this link by March 16th. Guest speaker Gail Olsen will be discussing the Health Care Reform and how it could and will affect you! Click on this link to learn more and sign up today!http://www.intouchprofessionals.com/opennetworking.html
How do you feel about the five finger Vibram shoes? Good idea? Waste of money? Do you own a pair? Have you thought about it? Leave a comment and let us know how you feel about them!
Tell us what you really think - you can even be anonymous if you'd like!Then take a look at this website (click HERE) and see why the U.S. Military has banned them.
There's two sides to every story though. There's also the "If it isn't broken, don't fix it" attitude as the Running Jackalope
says! Or look HERE
to see Vibrams in the news and who's wearing them!Whatever you decide,
As a wedding gift, my husband took me to get my first pair of (affectionately termed) frog shoes; aka Vibram Five Fingers. He had read about them and had a good friend who had recommended them; he knew I would be intrigued and he was right. I threw myself head first into evaluating every aspect of this new "biomechanical wonder."
I was skeptical, to say the least. I had heard all about the barefoot movement and minimalist shoe design. I had read articles both for and against this concept; and I still debated whether this was a fad or something that would change biomechanics forever. I had new reason to objectively re-evaluate the literature and have lengthy discussions regarding the underlying biomechanics with my mentor and good friend.
I had already been doing my foot fitness from years of previous injury and my own biomechanical deficiencies. I thought I was ahead of the game, and wore them immediately. I was shocked how different they were and how far I still had to go! Over the next several weeks, I attacked my foot fitness with a new energy and very gradually increased my use of the shoes in my workouts and daily life.
By the time of our wedding, I had strengthened myself to wearing Vibrams all day, every day without complaint; in fact they were starting to become more comfortable than regular shoes. While on our honeymoon, we went for a very rigorous canyon hike, on very uneven and difficult terrain. After ten hours of difficult hiking, I finished strong and felt as if I could do it all over again- right away. I was shocked that for the first time of long duration, strenuous activity I had no joint aches or pains and my feet didn't even feel tired!
I was beginning to believe that maybe there was something to this new movement. When we returned home, I scoured for information from reputable sources. I realized there was overwhelming evidence that those who are good candidates, should convert to a "minimalist" or "barefoot" style of training. Not only for running, but fitness as well.
For thousands of years we roamed the forests and our feet were forced to grip and bend with every step. Most of us have been in shoes since we began walking. Our feet only grip a flat, solid surface and rarely if ever bend because of the rigid soles. Many people know they "overpronate" and therefore are told they need a specific shoe to correct it. We rely on "arch support" or on stabilizers to prevent our ankles from rolling. The result is weakness, stiffness, and often injury.
Over the past few decades the choices in footwear and athletic footware have skyrocketed. Yet, there has been a consistent increase in foot and ankle injuries from ankle sprains, metatarsalgia, plantars fasciitis and even stress fractures. Current research is now suggesting it is because we have outsmarted ourselves and need to go back to the basis. This is the foundation of "minimalist" shoes. They are designed to allow foot movement and encourage gripping and proper foot musculature, just as our feet have done for ages.
There are many factors which determine whether barefoot training is the best option for you. For most people minimalist shoewear is the best option, but you must first do your homework. Jumping into a minimalist shoe without properly training your feet first is a recipe for disaster. Gradually increasing your use, and combing the appropriate foot strengthening will help reduce your risk of injuries associated with minimalist shoes. A complete evaluation is needed to help determine your foot movement, foot strength, natural biomechanical tendencies, and any residual problems from previous injuries.
Hopefully you found this series interesting. Next week, stay tuned for a new series: Its All Connected!