Category Archives: Healthy Minds

Truth or Myth? Sports Related Concussions

Truth or Myth?  If You Sustain a Sports Related Concussion You Should Sit in a Dark and Quiet Room Until All Symptoms Subside…..MYTH!

Dr. Daniel Luczka PT, DPT, CSCS

More and more evidence is strongly supporting that an early return to physical activity, within 1 week, may reduce persistent symptoms of a concussion.   The Journal of the American Medical Association published a study that involved over 2,400 children and adolescents between the ages of 5 and 18 years old who sustained a concussion.  The findings showed that out of those who participated in early physical activity, only 28% still had persistent post-concussion symptoms compared to those who did not participate in early physical activity, over 40% of them continued to have persistent post-concussion symptoms at 28 days post injury.

The benefits of aerobic exercise on the brain have been documented for years.  Protocols such as the Balke or Buffalo Concussion Treadmill Test have been proven to be safe and effective in finding the proper dosage and intensity of physical activity post-concussion to help speed up the recovery of the athlete.

Do not fall into the out dated protocol of being told to “sit in a dark room and do nothing.” Make sure you are seeing a medical professional who is up to date on the most current research for Post-Concussion Syndrome.  Call your Physical Therapist as soon as you suspect a concussion to help ensure the best medical care is being provided!

Rehabbing the ACL, Both Physically AND Mentally

Rehabbing the ACL, both physically AND mentally
Dr. Lisa C. Clark, PT, DPT

The last time I wore the number 17, I was carried off the field. I had experienced the dreaded “pop”, the horrifying buckle, my worst fear. I had torn my ACL in double overtime, halfway through my senior lacrosse season. My college career was over and I was devastated. In the last 4 weeks of that season, I watched my teammates play the game I loved while I worked my hardest to prepare for a surgery I never wanted. The emptiness that I felt was overwhelming and lonely. I felt like my identity had been stripped from me. Being an athlete was all that I knew and, suddenly, it was just over.

Now, as a physical therapist, I treat athletes like me all the time. Luckily, many of them are young enough to return to their sports and find plenty of success, like receiving athletic awards and commit to colleges. The amount of joy that we both feel is tremendous. Many of these kids didn’t think they’d ever get back to sports, but they did and it took a lot of work to get there.

Tearing the anterior cruciate ligament (ACL) is, perhaps, the most feared diagnosis in all of sports. Physical symptoms include significant joint pain and swelling, loss of range of motion, quad weakness, difficulty walking, feelings of instability. In most cases, a reconstruction is the best option for anyone who would like to return to sports involving a change of direction. The rehabilitation process can take anywhere from 6-12 months. Many people staring this prognosis in the face are understandably overwhelmed. For athletes, though, this is an entire year of sports. Maybe 3 or 4 competitive seasons or a recruiting year that they’re missing out on. While they see their friends trying to make college decisions, they are just trying to walk, run, and squat properly.

Along with these physical symptoms comes the mental and emotional response, which is not often discussed, but is very prevalent. Perhaps even more important than rehabilitating the knee is rehabilitating the mind. Research shows that psychological responses, such as depression, anxiety, fear, and anger, are significant in cases where an athlete has suffered a severe injury. These emotions are shown to have a large effect on the rehab process. Athletes with depression, for example, are less likely to adhere to their treatment and home exercise programs. They struggle with returning to their sport, may experience a social withdrawal, and are at an increased risk for suicide. Literature suggests that athletes with depression are more likely to demonstrate poor functional and orthopedic outcomes and report a lower quality of life.

Even more significantly vulnerable for negative responses to injury are those who already have a history of depression. Athletes between the ages of 15-25 are the most at-risk group for ACL tears. This age group is also most vulnerable to suicide. Thus, depression following an injury is even more problematic in our adolescent and collegiate athletes. In general, injured athletes who gain self-worth and self-esteem from performance have been shown to be at risk for negative responses in comparison to their peers who are uninjured.

While this information is intimidating, it is worth mentioning that research indicates that most athletes return to their sports with minimal complications following proper rehabilitation. Therefore, as a clinician, I do all that I can to help ensure my patients that I thoroughly believe they will return to their pre-injury status. The hardest part is convincing them of the same thing, which can be an uphill battle. I always discuss the mental portion of ACL tears, like fear, discomfort, frustration, and grief. I let them know that these feelings are normal and encourage them to talk with teammates, coaches, family, friends, or even me. Sometimes just acknowledging these emotions and talking about them can take away their power. We also set goals and try to accomplish them one-by-one. I also try to schedule my ACL patients together so that they form a comradery with each other. That is sometimes more helpful than anything – strength in numbers and emotional support. If that isn’t enough, though, I encourage my patients to utilize the many resources we have to ensure our athletes are making a complete physical and mental recovery: primary care or mental health practitioner, sports psychologist, cognitive behavioral therapy, counselors or wellness professionals (to name a few).

If you are a PT/ATC/MD or any clinician reading this: please take the time to educate your ACL patients about how much mental health affects their outcomes and their return to athletics. Understand that depression can make it difficult for patients to be consistent with visits and remain compliant with home exercises, especially with time spans of 6-9 months. Instead of being frustrated, be encouraging. Show that you care and use what you know to help to motivate them. Increase their number of visits as they get closer to their return-to-sport to make sure they are sticking to their programs. Rehab compliance can help to improve their physical and mental ability. Prove to them why that is the case.

If you are an athlete who has suffered an ACL tear and are in any stage of recovery: your mental health is a HUGE factor in your return to what you love. Your PTs and the people working around you want what is best for you. These are some symptoms of depression: sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite or sleep, and poor concentration.

If you experience any of them, please talk to someone about it. These feelings are perfectly normal and can be dealt with in whichever way is most appropriate. If any of these symptoms are interfering with your rehab process, it must be taken care of. As I mentioned above, remember that depression will make it difficult for you to stick with your exercises, but the more effort you put in, the better you will be both on and off the field. Stay involved in team activities. Go to practices and games and team functions. Do whatever fundamental drills you can participate in (stickwork, ball handling, hand-eye reaction drills, etc). You are still part of a team, even if you’re not putting on the uniform every day.

Treating patients with ACL injuries is my passion, not just because I’ve been down that road, but because I love getting to know and understanding the whole person. Not just their knee, but their emotions, their goals, their passions, and their motivations. It would be a mistake for me and all of my colleagues to not address the most important part of ACL rehabilitation: the mental recovery.

Soccer and the Concussion Dilemma: Are They Preventable?

Over the past decade, there has been a 60% increase in the number of sports and recreation-related emergency room visits due to concussions and traumatic brain injury.1  As a result, concussions are at the forefront of media coverage, prompting investigations into management of concussions at multiple levels of play.  This has also prompted a surge of research into Concussionconcussion management and prevention, including the well-known Heads Up campaign.  Concussions are highest in football and girls soccer with females between the ages of 10-19 being most at risk for soccer-related concussions.  There is minimal research to support that concussions are preventable however, there are ways to modify the factors involved in the mechanism of concussions.  Thus far, the majority of the focus has been on modifying helmets and other headgear versus within the players themselves.  The goal of this article is to educate coaches, parents, and athletes about the signs and symptoms of a concussion as well as to explain potential injury prevention strategies.

A concussion is defined as “…a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”2  What does this actually mean? A concussion can occur as a result of a direct blow to the head, face, neck, or any other part of the body where the force is transmitted to the head. This usually occurs during sports or as a result of a fall or car accident.  This trauma usually results in short-lived neurological symptoms (headache, dizziness, tingling, numbness, vision changes) that typically resolve quickly on their own.  These symptoms reflect a change in function of the brain but usually do not cause an injury evident on imaging.  Basically, a decrease in blood flow to the brain causes an energy crisis.  With exercise, blood is pulled away from the brain to support the lungs and muscles that work to sustain activity.  Therefore, if an athlete attempts to return to sport before their brain heals, too much stress is placed on the brain.  This can cause continued symptoms and place the brain at risk for further damage including Second Impact Syndrome.

Symptoms of a concussion may include: loss of consciousness, confusion, headache, dizziness, nausea, vomiting, loss of memory from before or after the injury, mumbling, drowsiness, blank stares, personality change, irritability, mood swings, exaggerated emotions, seizures, poor performance on the field, unsteady gait, poor balance, slow speech, poor coordination, difficulty concentrating, ringing in the ears, double or blurred vision, sensitivity to light or sound, feeling mentally foggy, and numbness or tingling.  If any of these signs or symptoms are present in an athlete after a blow to the body or head, the athlete should be removed from play until cleared by a medical professional specializing in concussion management.  Never return an athlete to play on the same day.

Recovery from a concussion varies.  The metabolic dysfunction (change in blood flow) that occurs in the brain after a concussion is commonly present for up to two weeks.3  About 80% of high school athletes recover within 3 weeks which means the remaining 20% of these athletes have continued symptoms lasting longer than 3 weeks (protracted recovery).Recovery may be longer in athletes with: memory loss, confusion, loss of consciousness, dizziness, and vomiting after the concussion as well as those athletes with a pre-existing learning disability, prior concussions, migraines, younger age, and athletes who tend to over-exert themselves.3

Many important factors may increase the likelihood of suffering a concussion in soccer and therefore, prevention programs should aim to modify these factors.  Females are more likely to sustain a concussion due to differences in head-neck strength as compared to males.  However, this being said, females are also more likely to report their symptoms.2,3  There is an increased risk of concussion in the 10-19 year old female soccer athlete since they start to compete at a higher level but have not yet developed the strength and awareness to control their body.1  Core strength is vital to head control and far too often, developing the correct kind of core strength is overlooked in modern day training regimens.  The core must have good strength as well as endurance to help stabilize the hips, shoulders, and head during contact, especially in soccer.  Many athletes attempt to complete exercises that are too difficult, resulting in loss of form and control. Often these athletes must go back to the basics of core strengthening prior to completing more advanced exercises.   It is vital to maintain a neutral spine at all times during exercise.  The chin should be tucked, pelvis should be in neutral, core should be drawn up and in, and shoulder blades should be lightly pinched.   The deep cervical spine neck flexors are the most important component in neck stabilization during head contact, and unfortunately, one of the most poorly recruited muscle groups.  Strategies to correct this are listed in the exercise table.  By improving core muscle timing, strength, endurance, and recruitment patterns, decreased strain is placed on the head and neck, and therefore the brain during repeated contact in sports such as soccer.

Another important factor in concussion prevention is visual tracking and postural awareness.  Soccer athletes must be able to dribble and kick a ball while accelerating, decelerating, changing direction, cutting, and heading a ball.  They must be able to follow the ball effectively with their Postureeyes and head while paying attention to their surroundings.  Often times when young athletes attempt to head a ball, they are somewhat hesitant, forgetting to protect their head by putting their elbows up.  Occasionally, they will even close their eyes prior to the time of contact.  This loss of visual control and awareness may increase the likelihood of head contact with another player.  Improved education about correct heading mechanics as well as practice to improve visual tracking will only make for a better soccer player.  Some strategies to improve visual tracking are listed in the exercise table as well.  Improved visual tracking may decrease the likelihood of concussions in youth soccer by improving an athlete’s body awareness, heads-up play, and ability to brace their body with contact.

Although many other strategies exist for potential concussion prevention, the main focus should be on improving core strength and control as well as visual tracking.  As young athletes grow, their ability to stabilize their body rapidly decreases, placing them at risk for a multitude of injuries.  A few simple changes to strength and conditioning regimens may be enough to decrease the risk for concussions.  A number of additional strategies for decreasing the likelihood of concussions are listed below.

Concussion injury prevention strategies:

  • Know the signs and symptoms of a concussion: The sooner an athlete is removed from play, the more likely they are to recover. Remember, just because they didn’t get “knocked out”, doesn’t mean they don’t have a concussion.
  • Play heads up soccer: Always watch the play happening around you, even when you aren’t involved. Concussions occur when an athlete is unable to effectively brace their head and neck.
  • Posture: Keep your head in a neutral position especially when heading the ball.
  • No blindsiding: Don’t hit people who can’t see you as this is dangerous to both athletes. Promote fair play and clean body contact from your teammates and opponents.
  • Avoid excessive contact at practice: This decreases the unnecessary force through the brain because as few as 50-60 blows to the head per week may lead to a change in brain function.
  • Heading the ball: Maintain good posture (chin tucked) while heading the ball.
  • Complete an injury prevention program: Improving your posture, awareness, core strength, and visual tracking may decrease your likelihood of concussion.
  • Improve your visual tracking: Just like any other muscle in the body, the eye muscles require use and exercise to get stronger. There are many exercises to improve your visual tracking.  An easy way is to start tracking the ball with your eyes every time you receive a pass, kick the ball, during throw-ins, or if you go up for a header.  Writing a different number on each of your practice balls and having the player call out the number as the ball is being passed to them is one unique way to train this.
  • Develop core strength: A strong core (including hips, shoulders, neck, and abs) helps to stabilize your head during contact, thus decreasing the strain through your neck and brain with contact.
  • Improve your conditioning: The better your conditioning, the less likely you are to place your body into poor situations. You must be able to stabilize your body during all athletic activities.  As fatigue increases, body control decreases, increasing your likelihood for injuries such as ACL tears and concussions.  Cardiovascular fitness, flexibility, strength, agility, power, balance, and control are all important to injury prevention.
  • Correct your asymmetries: Have a medical professional assess side-to-side differences with strength, flexibility, and posture to prevent injury.
  • Cross-train: Find an activity or sport outside of soccer that you enjoy and do it! Playing soccer all year without a break or change in training leaves certain muscle groups weaker.
  • Growth and development: If the athlete is smaller (especially pre-pubescent females with longer necks) but plays against larger athletes, consider activity modifications until adequate strength develops.
  • Nutrition and hydration: The better your nutrition and hydration, the more likely your brain can prevent and recover from a trauma (including smaller, repeated traumas).
  • Skip the head gear: Understand that headgear may or may not prevent concussions (the research is mixed). Often athletes feel invincible with more protective equipment, which may leave them more vulnerable.
  • Advocate for rule changes: Children are not “little adults” and therefore should not play with the same rules as adults.
  • ImPACT testing: Remember ImPACT tests are of little value without baseline testing. Consultation of a skilled professional is also needed to interpret the results.

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Figure 1 credit to: http://news.discovery.com/tech/brain-scan-detects-effects-concussion-120611.htm

Figure 2 credit to: http://health.thehupps.com/straighten-your-health-how-posture-affects-your-health/

  1. Concussion in Sports and Play: Get the Facts. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.  2011.  http://www.cdc.gov/concussion/sports/facts.html.  Accessed 2/20/2014.
  2. McCrory P, Meeuwisse W, Johnston K, et al. Consensus Statement on Concussion in Sport- the Third International Conference on Concussion in Sport Held in Zurich, November 2008. Br J Sports Med.  2009; 43 (suppl 1): i76-i90.
  3. Sabini RC, Reddy CC. Concussion Management and Treatment Considerations in the Adolescent Population.  Phys Sportsmed.  2010; 38 (1): 139-146.

Written by Michelle Feairheller

Cardiovascular Deficits After a Concussion and What That Means for Return to Play

 

If you ask someone what the signs and symptoms of a concussion are they may say they have complaints of a headache, nausea, dizziness, blurry vision, balance difficulties or short term memory issues. Did you know, it is common for someone with post-concussion syndrome to have deficits with their cardiovascular system, which causes poor activity tolerance? Some of these deficits include altered CO2 sensitivity, low heart rate variability, and altered blood flow to the brain. When they try to participate in physical activity that increases their heart rate it may lead to increased reports of headache, difficulty concentrating, fogginess, and nausea. Someone with poor activity tolerance has an increase in symptoms due to their altered cardiovascular system.

A physical therapist is someone who can diagnose and treat a concussed athlete with poor activity tolerance from these cardiovascular deficits. By using the Balke Treadmill test and tracking symptoms and vital signs, a physical therapist is able to appropriately prescribe an aerobic conditioning program to help get an athlete back to the field quicker.

Make sure after a concussion a physical therapist is ensuring the cardiovascular system is ready for return to play. We are the movement specialists!

5 Ways To Change The Way You Move (& to make you a better athlete)

If you’ve ever watched a child learn to crawl,  walk or develop a new skill, it’s amazing how persistent they are until they have achieved their goal.  It’s even more incredible how quickly they can master these skills and how smoothly they move in the process. As athletes, our rapid growth interferes with this innate ability to move.  Here are some suggestions on skills to practice to regain  what we lost in adolescence or to maintain it while we still have it.

1. Deep squat every day.  If you’ve ever watched a child play, they are able to hold a deep squat for ten minutes at a time.  We quickly lose this as we grow due to tight calf muscles, stiff ankles and hips,and decreased body awareness.  Start by holding onto something such as a couch or Hold deep squatchair if needed.  Gradually increase your hold time until you’re able to text, scroll through your social media feed, do homework, or make it through a whole commercial break in this position.
2. Get outside and “play”.  Kids love to be outside and practice free play.  Too often this is the part that we cut out of our lives when it gets hectic. Free play allows for improved creativity and mental/physical growth.  Every day, no matter the weather, get outside.  Take a walk as a family, swing on the monkey bars, sit and read a good book, or just enjoy mother nature’s beauty.  This helps us to reset our internal clocks and our minds as well as to help develop stability on uneven surfaces.
3.  Get enough sleep.  Children usually get 12-16 hours of sleep per day to fuel their rapid growth and development.  Obviously athletes can’t expect to get that much sleep, however 8-10 hours is recommended for adequate recovery between workouts and especially when injured. If our body and mind works hard during the day, there may not be enough blood flow to the body parts that need it for recovery.  Easier said than done? Try to avoid procrastination for a week and I bet you’ll be able to get to sleep earlier than usual.  Even 30 minutes extra per night can be helpful.
4. Spend some time barefoot.  Help to develop arch control and strength in your foot.  Shoving your foot in shoes, especially non-supportive shoes helps to undo the practice we got as kids.  Being barefoot also helps to develop the body’s natural ability to balance.
 Deep squat
5. Practice mindfulness. Kids have naps to rejuvenate  but you might not have that luxury.  Find at least 10 minutes a day to practice meditation, mental imagery, or to just let your mind wander. If you need help, search for apps that help guide this such as Headspace.
If you start to forget these things, just spend some time watching a small child.  You’ll quickly realize how fast we lose those little things which make us strong yet mobile and stable.  This is often part of what leads us down the path of injury and pain.
**Deep squat picture compliments of Robwolff.com**

Concussion Signs and Symptoms

As we discussed in a previous post, the mechanism of a concussion is not always immediately observable by a coach, parent, or athletic trainer.  Often the only way to diagnose a concussion on the field is from an athlete self-reporting his or her symptoms.  To ensure that an athlete is reporting a possible concussion he or she must have a full understanding of how those symptoms may present.

 

So what should the athlete report?

  • Headache
  • Dizziness
  • Nausea
  • Balance Issues
  • Sensitivity to light or noise
  • Feeling foggy
  • Confusion or memory issues
  • Not feeling “right”

 

What should parents and coaches be looking for?

  • Appears dazed or stunned
  • Is confused about assignment, position
  • Forgets plays/responsibilities
  • Is unsure of the score or opponent
  • Moves clumsily
  • Loss of consciousness
  • Shows behavior or personality changes
  • Cannot recall events prior to the hit or fall
  • Cannot recall events after the hit or fall

 

It is very important that the athlete, parent, and coach recognize the above signs and symptoms of concussion and immediately seek medical attention by a medical provider who specializes in the management of sport-related concussion.  If an athlete is returned to play with concussion-like symptoms he or she is at risk of suffering a second trauma that could complicate the recovery process.  Parents and coaches need be playing an active role in keeping athletes safe, and knowing what to look for after a suspected head injury is a step in the right direction.

What is a Concussion?

What is a Concussion?

                Concussions have become a hot button topic not only on the playing fields across the country but in the media as well.  While the extra attention can certainly increase awareness, misinformation can lead to an incomplete picture and the inability to separate fact from fiction.  This post will be dedicated to describing and how the injury most commonly occurs.

First a definition; a concussion is most often referred to as a mild traumatic brain injury.  However, there is not currently a consensus definition for this injury.  An athlete with a concussion who is subjected to an MRI or CT scan does not usually present with “brain damage,” or any visible signs of bruising or bleeding.  Our inability to accurately see the “damage” can sometimes lead to an incorrect and incomplete diagnosis.  This does not change the fact that even though an injury is not visible a concussion can lead to impairment in one or more areas of the brain which can affect balance, coordination, speech, memory, and visual system.

A concussion can be caused in a number of different ways, but ultimately occurs when the brain rapidly moves back and forth, subsequently striking the inside of the skull.   The most common mechanism is a direct blow to the head from another player, a piece of equipment like a soccer ball or lacrosse stick, or contact between the player’s head and the ground.  A less common way is from an indirect blow.  This could be caused by a blow to the body which forces the head to violently snap back or rotate.  It is very important to note that a concussion DOES NOT always come from a direct blow to the head.

If an athlete is suspected of suffering a concussion during competition she should be removed from play immediately and not allowed to return until she has been evaluated by an appropriate medical professional.  We will be presenting the most common signs and symptoms to look for in an upcoming post.  Stay tuned…

 

ASMP Blog

Welcome to our new weekly blog series!

Kinetic Physical Therapy’s Adolescent Sports Medicine Program was founded to address the rehabilitation unique to the adolescent athlete.  Understanding that athletes require a different approach, the Adolescent Sports Medicine Program applies the best evidence when designing sport-specific rehabilitation and injury prevention programs.  These programs aim to educate athletes on his or her injury, the importance of a dynamic warm-up prior to participation, implement exercises to combat injuries, and discuss other strategies to keep the athlete healthy and on the field.  In addition to this, Kinetic Physical Therapy has a host of other services available to the athlete including: sports nutrition, Functional Movement Screens, and ImPACT concussion testing.

The goal of these posts is to keep the athlete, parent, and coach informed on important topics in sports.  We will address sports performance, nutrition, the mental aspect of sport, when to seek out a physical therapist for a consultation or evaluation, provide injury prevention strategies that the athlete can implement immediately, and dive in to specific injuries and our approach to managing them.  All of this information drives us towards our ultimate goal, to keep athletes pain-free and on the field.

Coach.me

app-iconHaving trouble starting positive habits, or breaking bad ones?  Coach.me uses competition and community support to help individuals create and break habits. It is as simple as stating the habit you would like to create; yoga, meditation, drink more water, or exercise; and then check off daily as you complete the task. It has a streak system that calculates how many days in a row the task has been completed. As that number grows, the likelihood of an individual continuing to complete it also increases, therefore creating that positive habit. A section is available to ask questions and learn new strategies from other people who are attempting to create or break the same habits. This is a free app that is definitely worth trying out.

Sleep Cycle App

sleep-cycleSleep Cycle – The goal of sleep cycle is self-explanatory; track an individual’s quality of sleep. The user’s sleep cycle is determined by tracking the amount of motion throughout the night, revealing the quality and quantity of sleep.  This is accomplished by placing a phone under the pillow with the app active for the entire night.  Results; including time in deep sleep, time awake, quality of sleep, and number of hours slept; are available upon waking and also stored for future reference.  It is debatable whether the app is able to accurately measure the different phases of sleep.  However, if nothing else it can benefit the user by keeping him or her interested in sleep habits. This app costs a one-time fee of $2.99.