Concussion Treatment and Prevention Part 2

Posted on January 28, 2015 by Dr. Luke Pietrantone

Concussion Prevention

Training your body for impact is as important as equipment to prevent concussions.

In my first post on concussion I wrote about how I treat patients with post-concussion syndromes and which treatments I have found the most effective. I the more I have read about concussion the more disappointed I was getting that there was minimal effort to prevent incidence of concussion from occurring in the first place. Articles on concussion prevention mostly include buying better equipment and early detection. There are finally programs being developed to prepare the body as well as possible to handle the forces of sport where concussion is a possibility.

One of my patients who was a researcher and inventor once said “We can solve any problem as long as we ask the right questions.” I think the right questions are starting being asked by researchers-who is vulnerable to concussions and why? Little can be done beyond equipment to stop a lacrosse ball form hitting a player in the head because it happens so fast. But how can coaches and trainers prepare an athletes body as much as possible to survive contact? One 2014 study, in the Journal of Primary Prevention, sought to answer the question of whether measuring neck strength could be predictive of a greater chance of concussion. For the the 2010 and 2011 season athletic trainers measured the neck strength of athletes during the preseason of 6,704 high school boys’ and girls’ soccer, basketball, and lacrosse as well as gathering concussion incidence data during those seasons. The clear conclusion was those with weaker necks suffered a higher incidence of concussion. “For every one pound increase in neck strength, odds of concussion decreased by 5 %.” The question remains how can the neck be strengthen effectively to prevent concussion?

I was pleasantly surprised to find a trainer focused on concussion prevention abut 2 miles from my East Aurora office! Coach Steve Helmicki the founder of Primordial Strength Systems has developed an Anti-Concussion program around strengthening the neck and preparing the body for contact. Coach Helmicki is a former champion power lifter and has trained an endless list of pro, collegiate high school athletes. When I went to speak with him about his Anti-Concussion program I was struck by many the letters of appreciation covering his wall.

Dr. Luke: When lead you to develop a concussion prevention program?

Coach Helmicki: I noticed about 15 years ago, neck exercise machines and neck training was dropped from the high school strengthening programs. It was mostly for liability reasons I believe. They were strengthening the rest of the body and the neck became the weak link and that happens to be connected to the head. The body is not able to dissipate the force of contact through the neck or any part of the body if it hasn’t been trained properly to receive that force.

Dr. Luke: What is your philosophy on training?

Coach Helmicki: I have developed Primodial Strength Systems based on the variable method, where I I take people through an exercise with increasing weight while I watch their form and in particular their speed of contraction. I want to increase the speed of contraction with every workout without destroying their muscle tissue. Faster speed of muscle contraction translates into more explosive power for the athlete. Its not about an amount of weight a person can push but how fast can a muscle go from a relaxed state to full contraction and then relaxation again. I have worked using this method directly with high school teams, professional teams and the Marines and reduced their incidence of injury during competition and their training while significantly improving performance.

Dr. Luke: How does the variable training method reduce the chance of injury?

Coach Helmicki: My theory is the type of muscle tissue that is developed in this way can dissipate the force of contact better than a rigid muscle. So I try to develop the body and the neck as much as possible to that end.

Dr. Luke: What is the exercise progression of your Anti-Concussion Program?

Coach Helmicki: I always assess an athlete to avoid further injury and not to overload their system. In fact I am assessing them at every exercise. I look for any degrading of their form and change their workout accordingly. I progressively strengthen the neck in all planes but take care to strengthen the rest of the body as well. Because its so individual, its difficult just to give a workout without giving some coaching but I do my best in my Anti-Concussion Manuals. I do have some examples on youtube as well.

Dr. Luke: What are some other training methods you employ in your Anti-Concussion Program?

Coach Helmicki: I teach my athletes to develop the skill, which is borrowed form martial arts training, of breathing out with contact to help dissipate the force during competition. Rigid muscles and body will retain the force and cause injury. I will get as sport specific as possible and when they are ready I have them hit a heavy bag with their body from progressively further away on and increasingly heavy bag.

Supporting Coach Helmicki’s training is a study that showed a reduced reaction time for the functional head-protective response, which is the time it takes an athlete to raise their hands from their waist to protect their head, was a strong indicate for future concussion. Post concussion, this reaction time is reduced and delayed in returning which can lead to future concussion if the athlete cannot lift their hands fast enough to protect their head.

With contact sports there is no way to completely reduce your risk to zero. Making sure your neck is strong and that you train for contact in your specific sport can at least help prevent concussion.

Over Hydrating or Hyponatremia in Endurance Sports

Posted on October 18, 2014 by Dr. Luke Pietrantone

I just was finally able to read and finish a book, Challenging Beliefs, by Dr. Tim Noakes that was sitting on my desk for over a year. Sometimes you only get to books like that when the time is right. It is a memoir of Dr. Noakes research, running, and writing career. He is most famous for writing the Lore of Running, the definitive text on running, which is sold in almost any bookstore I have ever been. In Challenging Beliefs, Dr. Noakes talks about the different topics he has studied over the years and one in particular really caught my attention. The idea that you can be over hydrated causing a state in the body called exercise-associated hyponatremia (EAH). This can not only affect your performance but can possibly lead to death if all the conditions are right. Symptoms of EAH are nausea, vomiting cramps and the water sloshing around in your belly as you run.

It seems to be universally know the dehydration has the potential to damage your performance in endurance sports. It makes sense. Not enough water in the body and chemical process in the body will not work the way that they should. As you lose water the sodium level in your blood begins to rise which triggers your to become thirsty. That thirst disappears after you have drank enough water and the sodium concentration returns to normal. When this potential problem was recognized there was massive education of the athletes to avoid dehydration. There was also money to be made by sports drink companies and the advice turned into the dogma that athletes should be constantly drinking to avoid zero percent dehydration or drink before you are thirsty.

Think About Passing That Aid Station If You Are Not Feeling Thirsty

EAH occurs when an athletes drinks water in such large quantities that it dilutes the amount of sodium in the blood. Water then moves into the cells increasing their volume. Normally this water would come out in the athletes urine but in some individuals they still secrete hormones that make the body retain the water. The increasing cell volume can put pressure on the brain as it expands making the whole situation worse and even lead to death in extreme cases. The treatment for these people is to add sodium to their system so the water can begin to move out.

Dr. Noakes first study on the idea of over hydrating in in durance events was in 1985 but it would take until 2003 for USA Track & Field and 2007 for the American College of Sports Medicine to accept his recommendations. More studies through out the years showed consistently that over drinking can lead to EAH and negative effects on performance and the dehydration should not necessarily be so feared. In fact, another study of the 1997 New Zealand Ironman Triathlon, showed those athletes who perform best often are dehydrated to some degree at the end of a long race. Some races even reduced the number of aid stations on longer races noticing a reduction in need for drastic medical attention for the athletes. Challenging Beliefs is fascinating and worth the time to read if you are interested in athletics of any kind.

It still happens that a relatively healthy athlete dies during a marathon from over drinking. At the very least over-hydrating can negatively affect your performance. I wonder how often a person is very disciplined in their training, is in shape for a marathon, only to be sabotaged by drinking large amounts of water days before and then during the race. I have had so many patients well train, fit and ready for a marathon only make it half way through a race and have to pull out. Maybe I should have told them to avoid over hydrating and it might have made a difference. I also think about the people who have over-trained and stressed there adrenal glands. One of the functions of the adrenal glands is to help regulate electrolyte balance through a hormone called aldosterone. Are these over-trained individuals more susceptible to EAH? It might be one more reason to be mindful over over-training.

Here are Dr. Noakes recommendations on hydration:

Be trained and fit enough to race the distance you have signed up for.
Drink when your are thirsty which tends to be between 400mls, and no more than 800mls per hour, of water. This could vary with fitness level and conditions.

Pretty simple but some many of the best ideas are.

Ankle Sprains: More Than Just a Minor Injury

Posted on September 16, 2014 by Dr. Luke Pietrantone

Ankle Sprain Can Cause Distant Problems

People tend to not think much of a sprained ankle, even if it is relatively severe. After a couple of weeks they may be able to walk without much pain and swelling, so they think their ankle is all healed up. Often, they return to sports and exercise without giving it much thought. I have seen old ankle sprains lead to distant problems that in no way seem connected to the sprain. Here is a recent case example:

A 71-year male came to the office complaining of mild right shoulder pain for the past six months and intermittent left hip pain for years. When he raised his arm to the side, he felt pain that was sometimes sharp enough to prevent him from raising his hand over his head. He says he never had an injury that he could remember, “it just came on slow.” When the patient walked, his left shoulder was completely immobile neither moving forward nor back. Muscle testing showed almost none of his shoulder muscles worked when they were supposed to. The same was true when his right hip was tested. When I got down to his right ankle there was a significant weakness in his tibialis posterior muscle. This muscle is critical for optimal function of the ankle and foot. I asked if he had sprained it. 3 years prior he had badly sprained his ankle while reaching for a golf ball on a hill. It took 3 months for him to walk normally. As a demonstration, I taped his ankle and had him walk around for about 5 minutes. With the tape was still on, I retested all those muscles and most of them had turned on! We would direct most of our therapies and rehab at his ankle. Within a week and 2 visits he was 90% improved. Imagine if we would have tried to treat the shoulder first. No matter what we would have tried, it would have always come back.

Injuries Can Disrupt The Alternating Arms and Legs of Normal Gait

As a person walks their gait is a complex series of muscle turning on and off in a specific sequence. If a person does this flawlessly, it is relaxing to the nervous system. If there is disruption in the gait pattern, even if it is small, it can become a major stressor. This stress can manifest in any other joint in the body. Most likely the ones involved in gait.

The body will compensate and display many layers of dysfunction to survive and keep us moving. Think about it. Every step, (and there are thousands everyday), sends a little irritation into the nervous system and your body has to accommodate to that noxious stimuli.

If you injure your ankle, get a thorough evaluation that involves muscle testing and applied kinesiology. Be sure to rehabilitate your ankle so it is functional and strong so you do not end up with unexplained dysfunction elsewhere in your body.

Overlooked Dysfunction of the Wrist

Posted on February 5, 2013 by Dr. Luke Pietrantone

As always with Applied Kinesiology we are looking to find what is not functioning in the body and through directed therapy get it working again. In the wrist the most overlooked dysfunction occurs with the pronator quadratus muscle. This is a little muscle that connects the radius and ulna (the two long bones of the wrist) right before the base of the hand. The motion the pronator quadratus helps with is pronation of the wrist and hand. To feel this motion put your hand on the desk facing the ceiling and then turn it so that the palm is facing the desk top. The motion of putting your palm down on the desk is pronation. Another major function of the pronator quadratus is Continue reading →

Knee pain from nowhere: Mini case study

Posted on November 15, 2012 by Dr. Luke Pietrantone

A patient came in recently having been treated for neck pain that was resolving after 3-4 visits. She said, “My neck is feeling much better but yesterday I started having pain in the right knee with every step I take. It just started from nowhere.”

When joint pain starts for no particular reason the cause is often some internal stress. In Applied Kinesiology when there is an internal stress on a particular organ there is often a weakening or dysfunction in associated muscle. This is not usually painful but, when a joint starts to be used with dysfunctioning muscles, joint pain is not far behind.

When I tested the muscles around the patient’s knee and found the only weakness to be in the quadriceps. This is the big muscle on the front of the thigh that connects to the kneecap. The quadriceps is also associated with the small intestines in Applied Kinesiology. When testing the quad against various reflexes for the small intestines it functioned much better. I asked the patient about any changes in the diet, intestinal distress, travel…all of which she denied. After asking about increased fiber, more raw vegetables, nuts…she admitted to eating loads of trail mix in the past week. A rapid increase in fiber can be stressful for the intestines. I call this “over-nuting-yourself.” I treated the reflexes, acupuncture points, and spine associated with the small intestines without ever touching her knee. I had her walk afterward and the pain that was there was reduced by 90%! At he follow up visit for her neck the patient said the knee did much better and the remaining pain resolved over the next couple of days. This was the little bit of tendonitis that had built up in the short time she had been stressing her small intestines.

Not all knee pain is this simple but it illustrates the idea that pain that comes from nowhere it usually has a cause. Without using the tool of muscle testing and Applied Kinesiology we would never known where the pain was coming from. Likely, the simple therapy of “less fiber” would never have been used and she would have only gotten better by accident when her diet happened to have less fiber.