Concussion Treatment and Prevention Part 1

Posted on December 17, 2014 by Dr. Luke Pietrantone

Concussion

Chronic Headaches is a common lingering symptom from concussion.

Concussions and there lingering symptoms can often last for for months or longer. I have had patients come into the office with symptoms like daily headaches, inability to concentrate and poor sleep that have lasted over a year or more. In the medical community there does not seem to have a unified consensus on how to best heal from concussion. Most of the advice seems like common sense: rest, reduce computer and television screen time, reduce homework or work load, exercise to tolerance and return to play when you are symptom free. Concussion prevention advice is even weaker. Athletes are told to buy better equipment and and get a base line neurological assessment so that they can detect a concussion earlier. It is often pointed out that a previous concussion is predictive of future concussions. It seems to avoid concussion, the advice is don’t get one in the first place. How is that prevention? To me this is a very passive and defensive way to both prevent and heal from a concussion.

Concussion Treatment

I have treated patients with acute and chronic post concussion syndrome. The approach that gets results is usually involves cranial adjusting, leveling the head and neck and treating other injuries in the body that can affect gait.

The sutures of the skull actually move rhythmically. These joints are often become stuck with trauma.

The cranial bones of the skull move in a rhythmic fashion with the rest of the spine and pelvis and can be accentuated by your breath. These ideas were discover by William Sutherland, D.O. a century ago. The movement occurs along joints called sutures which you can see as the squiggly lines on the picture of the skull. Cranial motion moves cerebral spinal fluid around the spinal chord and even out to the ends of the nerves coming form the spinal column. Here is a cool video of CSF flow under MRI. The cerebral spinal fluid is critical to healing because it brings nutrients to the tissues of the brain and nerves as well as helps move waste out. Increased CSF fluid pressure, which can result from poor flow, can can disrupt blood flow in the brain as well. With direct trauma there is more waste to move out and a desperate need for nutrition as the brain heals. Compromised CSF flow and blood flow is a very bad thing for people are trying to heal their brain. Physicians generally do not know you skull moves and fail to consider restoring its mobility from a blow to the head. Damage and pressure on the brain of course can affect the function of any part of the body. There is no more important chiropractic adjustment that can be done to affect the brain directly than cranials. I use Applied Kinesiology to locate which bones are no moving and with gentle rhythmic pressure restore motion. The relief from symptoms is sometimes immediate and sometimes takes a month or two as we treat the body. It all depends on a person’s state of health before the concussion. I usually tell the patient that when their skull starts moving its like the first day of the healing process. When their skull is locked it is like healing has been suspended until the cerebral spinal fluid starts circulating again. Looking for a practitioner who uses cranial techniques can drastically cut the time it takes to heal form a concussion.

As a chiropractor my primary focus is to help restore function to nervous system. A nervous system that can receive information from the body, process it appropriately and send the correct output is healthy. Injuries tend to interrupt your body’s ability to communicate with itself. Concussions usually come with other trauma especially with blows to the head. A foot ball player may suffer a concussion from a helmet to helmet collision but there will be an accompanying whiplash from the head going one way and the body another.

The upper trap and SCM are visualized on the side of the neck in this illustration.

Whiplash is usually more than a sprain of the spine. There is usually strain and lingering inhibition of some of the muscles like the scalenes, upper trap or sternocleidomastoid. These traumatized muscles may not be painful after a few days but often remain dysfunctional. If for example the the SCM and upper trap are inhibited from the trauma on the right the muscle on the left will begin to pull the head to the left. This may result in pain pain the left side of the neck as those muscle become tight. What is just a significant about this example is that the eyes will not let the head tilt that far to the left during the day. It is however, exhausting for the brain to not let you fall over all day long. The brain is constantly and unconsciously trying to keep the head level by assessing combining all the information from the eyes, ears and body. When all the information is not making sense the brain cannot integrate the information well enough to give appropriate out-put. The result can be dysfunction elsewhere in the body. What if the neck wasn’t the only injury? Those injuries and even past injuries need to be to treated as well so that more effective integration of the nervous system is possible. That is a short statement but very important.

Once the cranial bones have been freed up and function has started to be restored to the rest of the body. You have to move the body to help connect the brain back to the injured areas and the rest of the body. I have used simple cross crawl exercises in the past to activate the whole body and synchronize the brain until I found something that I liked better. Power Kinetics developed by Dr. Eugene Charles is like cross-crawl for Superman! This is a challenging workout but I really like the way he integrates movement of the entire body and brain while reducing the risk of injury.

Spark by John Ratey, MD

With a functioning body and normally moving skull additional aerobic exercise can be added at low intensities at first. Aerobic exercise delivers much needed blood flow to the brain for bringing healing nutrients which also removes metabolic wastes. If you are running or even walking you get the benefit of moving your body in a cross crawl pattern that helps integrate your nervous system. In the book, Spark: The Revolutionary New Science of Exercise and the Brain, John Ratey, MD convincingly lays out study after study showing that shows exercise is better than medication for depression, ADHD/ADD, managing stress, addiction and for anti-aging. Aerobic exercise builds neural connections so your brain can literally rewire itself and levels out neurotransmitters which can be responsible for a persons sense of well-being. This is a massive topic but for now this is just more proof that exercise is good for your brain especially when healing form concussion.

Concussion Prevention

Stay tuned for Part 2 of this post where I will cover some strategies for concussion prevention.

The Sacroiliac Joint and Low Back Pain

Posted on December 6, 2014 by Dr. Luke Pietrantone

The morning after the first storm! My car is in there somewhere.

When we set up our practice in East Aurora and decided to live in Elma we knew there would be snow but these last couple days have been crazy! An entire years worth of snow (71 inches) in 2 days! As I was shoveling for hours on end, I was constantly thinking about my form taking care not to lift the heavy snow with my lower back. Snow events like these usually lead to an increase of patients with back injuries and the most common injury tends to be a sprain of the sacroiliac joint. The sacroiliac (SI) joint is located just below the base of the spine on the left and right and can be considered part of the pelvis. The SI becomes over-stretched spraining the ligament in the joint space. It makes sense that this can happen because of the heavy snow and repetitive nature of shoveling. More commonly the patient is set up for this injury because the muscle surrounding and supporting the sacroiliac joint are not working properly. Now when the person goes to shovel the SI joint is more likely to sprain because the forces of lifting and turning are going through the joint instead the muscles. This is the case throughout the body. Inhibited or poorly function muscles cannot move the joints correctly and then the joint itself begins to break down. Muscle inhibition is often painless and the first symptom you feel is inflammation in whatever joint those muscles are supposed to support.

What to do about a sprained sacroiliac joint beyond ice and rest.

His hand is on the top part of the sacroliac pain. The SI joint may extend 1-2 inches below his finger tips.
Correct the source of of inhibited muscles. The major muscle that helps stabilize the sacroiliac joint are the sartorius, gracilis, rectus femoris and abdominals in the front and glut max and piriformis on the back. This is where applied kinesiology shines by letting the body tell us what the major source of stress in the body that is causing the inhibition. The most common causes for the sacroiliac joint are blood sugar handling issues, chronic stress and joint fixation. These types of stressors often go unnoticed and when you go to do some strenuous physical activity the joint is no longer supported by the right muscles and becomes sprained. I would say this is more often the case, but it is possible to over do an activity like shoveling and sprain the sacroiliac joint out right. Even then the supporting muscles will be inhibited and need direct attention.

See a chiropractor for adjustments! Muscles move bones which is why I tend to address muscle inhibition first. However, fixations of the joints associated with the sacrum, pelvis, low back and even as far away as the neck can cause pain and muscle inhibition throughout the body. Freeing these joints allows the nervous system to properly communicate with the muscles and the rest of the body. The result is less pain and improved function. The right adjustment, in the right place and at the right time can be one of the most powerful tools for restoring normal tone on the nervous system. It makes sense that a joint should be able to move freely and be in the correct position for optimal healing.

I like to use the Serola Belt to help stabilized the sacroiliac joint after it has been sprained. Think of a sacroiliac sprain as a sprained ankle but in your back. With any sprained joint you need to rest and support the joint as it heals. In general, I am not a fan of supporting joints all the time because it tends to promote weakness around those joints because the muscles become dependent on the brace and start to not do their job. While a joint is healing a brace can be very useful with the idea that you will use it less and less over the course of 3-4 weeks.

Avoid re-injuring the sacroiliac joint. Get up from a sitting position every 20-30 minutes and walk around. Watch shearing forces through the pelvis like getting in a car. Instead of putting one leg in at a time instead try sitting your behind in the car first and then bring both legs into the car at the same time. When bending over to pick things up of the floor bend your knee slightly and bend toward the ground at your hips while keeping your low back straight. This engages the big muscles in your low back and the stress is taken off the sacroiliac joints. If an activity feels like its straining your injured area-Do Not Do It!

Look for Part II of this post where I will cover stabilizing the sacroiliac joint with exercise.

Bonus Owen and Claire Pics!

Open House

Posted on October 20, 2014 by Dr. Luke Pietrantone

Pietrantone Chiropractic Entrance

The Pietrantone Chiropractic Open House will be this Friday, October 24th from 6-8pm! The Dr. Luke and Dr. Michelle will be available for consultation throughout the evening or we can sip wine and talk about how we love the Pegulas. This would be a good oopportunityto ask any questions you may have about how we practice.

Karen Rosolowski, from Infinite Wellness Reflexology will be holding an Open House at the same time. JoyWheel Yoga will be open as well so you can see the space and speak with an instructor.

We will have light food for those coming right from work, refreshments and wine.

RSVPs to 655-1421 or drlpietranotne@aol.com are appreciated so we know how much food to prepare.

Location: 411 Main Street, East Aurora, NY 14052

Happy National Midwifery Week!

Posted on October 8, 2014 by Michelle Pietrantone

Having delivered both of our babies at home, I have a special place in my heart for midwives. We were so blessed to be served by Marilee Pinkleton of TLC Birth while we lived in Northern Virginia. What a beautiful gift it is to have a midwife at your side during such a defining moment in your life. October 5th-11th is National Midwifery Week. Created by ACNM to celebrate and recognize midwives and midwife-led care. I believe everyone needs to know how much #MidwivesMakeaDifference to women and families! Our midwife came to our home for each prenatal visit, bringing with her a simple bag of tools to check on both me and the baby. Each visit was such a relaxing hour where the trust I would need in myself and in her grew every time we met. When I think of standard prenatal care it saddens me to know this same kind of trust isn’t always being built. The mother is faced with many tests, some invasive and all stress inducing. The World Health Organization ranks the United States as 24th (last) among all industrialized nations in infant mortality and low birth weight. The medical system in the United States is considered to be the most highly advanced in the world. We spend more on birth than any other country in the world. We expect this technology to improve our lives and solve our problems. We are led to believe this technology alone leads to improved outcomes. This is not always the case. In countries with the healthiest, happiest and best supported mothers it is midwives managing normal births. Obstetricians only take care of high-risk mothers.

Midwives are the experts in normal physiologic birth. Midwifery is based on the idea that most pregnancies, labors, and births are normal biological processes resulting in healthy outcomes for both mothers and babies. Midwifery concentrates on optimizing the health and wellness of a woman and her baby, identifying and managing medical problems early on, and attending to the emotional, social, and spiritual needs of both pregnancy and birth. They understand a woman needs to move around during labor. Walking, squatting, and swaying allow the mother to choose the best position to manage pain for herself. Guiding her along, never forcing. Eating and drinking during labor provide critical energy for the final stage. Most importantly treating each woman as an individual rather than a statistic. Due dates are not stuck to rigidly. Starting, stopping, and slowing down during labor are all allowed as part of the natural process. Midwives are trained to be vigilant in identifying women with serious complications. Medical expertise and interventions are sought when necessary.

Choosing a pregnancy and birth provider is in your hands. Do all the research you can about a group or individual to fully understand how they practice. If their ideas don’t match up with yours, or you have a bad gut feeling when meeting them, move on. If you have suffered a traumatic birth consider changing to a new provider. VBAC can be a healing experience for many who have had an unplanned C-Section. Most areas don’t promote midwifery despite evidence in numerous studies. A 2013 Cochrane systematic review comparing midwife-led to physician-led models of care found that women attended by midwives were less likely to have an episiotomy or instrumental birth, less likely to have a preterm birth or loss of the fetus before 24 weeks gestation, and more likely to have a spontaneous vaginal birth. The review concluded, “Midwife-led continuity of care was associated with several benefits for mothers and babies, and had no identified adverse effects compared with models of medical-led care and shared care.”

Midwife means “with-woman.” You take the time to plan so many aspects of your babies future. Plan for the birth of your dreams- choose a midwife.

Chiropractic and Pregnancy

Posted on October 4, 2014 by Michelle Pietrantone

Chiropractic and Pregnancy

In thinking what to write about in my first blog post, I couldn’t imagine any other topic! I have had the joy of working exclusively with pregnant patients (and their babies of course) for the last seven years. I have explained many times why working with the female pelvis makes such a profound difference to the mother during pregnancy from a comfort standpoint but most importantly how it helps during labor and delivery.

Just yesterday standing outside my sons preschool another students grandpa was asking why we moved from Virginia to Buffalo, assuming it was because of my husbands job. I explained we moved to be near our families, and that we were both Chiropractors. He shared his Chiropractic success story with me and asked for a card. When he saw I treat pregnant woman he had so many questions! He said he had never thought of that before…. but looking back recalled how much his two daughters complained about their pregnancy aches and pains.

I explained to him that the position of the unborn baby is critical during pregnancy. The function of the mother’s pelvis has everything to do with this success. A pelvis that can adapt to the changes the body undergoes during pregnancy creates a comfortable pregnancy and uncomplicated birth for both mother and baby. It can significantly reduce the need for interventions such as drugs, forceps, vacuum extraction, and c-section, which may result in birth trauma. Chiropractic care during pregnancy is the best way to achieve a functional pelvis and give the baby the most room to get into that optimal birth position.

Importance of Uterine Ligaments

Chiropractic eases the discomfort of pregnancy and prepares the low back and pelvis for birth.

There are four major ligaments that support the uterus during pregnancy. These ligaments have attachments at various points of the lumbar spine, sacrum, tailbone and pubic bone. Two of these ligaments have smooth muscle fibers in them, allowing them to contract and also spasm. As the belly expands these ligaments balance and stabilize the uterus from front to back. The joints and muscles of the pelvis must work in harmony. If one or more joints become less mobile than optimal, the ligaments may spasm in response. Symptoms will include: groin pain, cramping, shooting leg pain, rib pain, hip pain, back pain, and pubic pain, just to name a few. Have you ever noticed a pregnant woman constantly rubbing her lower belly? She is experiencing the discomfort of the round ligament as it works to stabilize the uterus.

Uterine Constraint

If the mom is suffering with pelvic dysfunction, the baby is under strain as well. The amount of room within the uterus decreases as the torsion of the uterus increases. The analogy I share with moms is sort of corny, but seems to help people understand. Imagine the uterus is a fully inflated hot air balloon tethered to the ground by a rope on either side. If one rope is tighter than the other, the balloon can tilt a bit to that side. The ligaments of the uterus can create a similar dysfunction. The result may be improper position of the baby, delayed labor, slow labor, and sometimes facial deformity and torticollis at birth.

Chiropractic during pregnancy identifies and removes mechanical strain in the spine and pelvis. Soft tissue massage, ligament release, and gentle adjusting allow the body to respond and adapt to the postural and mechanical strain of pregnancy. The most well known Chiropractic technique addressing pregnancy and Chiropractic is the Webster Technique. Think of the difference in quality of life Chiropractic during pregnancy could make! Enjoying your pregnancy and achieving the birth you have imagined for yourself and your baby is the ultimate goal.