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!

Yoga’s Effect on the Lymphatic System and Stress

Posted on September 26, 2014 by Dr. Luke Pietrantone

I had the chance to do my first yoga session in years this past Sunday at JoyWheel Yoga, which is in the same building as my office. It was BRO-ga, which is yoga for dudes! Mostly BRO-ga is just fun to say. Adam and Erin Schifferli taught a great class that focused on on basic yoga postures, breath and bringing awareness to your body as you move it. It was basically an antidote for sitting at your desk all day under stress. This class was timely for me as I have been sitting at my in front of my computer for much longer periods than I am used to as we set things up at the office. Afterward, I was able to feel more upright and a little soreness in the muscles that hold my shoulders back. In the next couple of days I was able to reflect on some of the major benefits of these yoga poses and and the way they worked the upper body. The positive impact on the immune system was the thing stood out above all others.

The lymphatic system drains into the subclavian vein in front and under the shoulders.

The lymphatic drainage system is often taken for granted and only noticed when you have a cold or flu. As your immune system fights the foreign invaders the lymphatic system drains away wastes and toxins, which tends to create inflammation and swelling at the lymph nodes along the way. These inflamed nodes are most often felt under the jaw and the sides of the neck. There are lymph nodes and ducts through the rest of your body although you may never feel them get inflamed. On a daily basis the lymph recycles blood plasma, transports fatty acids and proteins much of which has come from you digestive tract. Many times while testing a patient they showed tremendous need for nutrients which completely goes away when we get their lymphatic system flowing. The nutrients were there the whole time they were just unable to access it!

The flow of the lymphatic system is from the arms and legs toward the body and up to the subclavian veins where the lymph enters the circulatory system. All the lymph eventually drains in front under the chest muscles and under the shoulders. The primary way the lymph moves throughout the body is by muscles squeezing the lymph along the channels and ducts which requires movement. What if you don’t move all day? The posture of sitting at a desk inevitably leads to rounded shoulder with tight chest muscles and ever weakening back muscles. Tightness in the chest muscles in the front can restrict the flow of lymph in a significant way. By sitting at a desk, day in and day out, with poor posture compounds the the problem. Little movement means less lymph flow and tight chest muscles means reduced possibility for lymph flow. This is a recipe for a poorly functioning immune system and weird and distant problems like backache worse in the morning, inability to get over a cold, swelling in the arms and legs and symptoms of nutritional deficiencies despite a good clean diet.

The postures and exercise portion of yoga has the benefit of moving and strengthening the muscles not to mention circulating your lymph. This truthfully could be accomplished by many forms of exercise if done consciously with good form. Most others types of exercise however, don’t have the ability to break the cycle of stress quit so effectively. During the class Adam continually tried to tune the class into being aware of what their body was doing and feeling. Over the course of an hour, I found I wasn’t thinking of anything other than how my body was doing and my breath. It was a peaceful place to be.

Stress can be so destructive that taking the time to break the cycle with something we enjoy, and is positive for our health, is critical. Left unchecked, stress suppresses the immune system making sitting at the desk with a congested lymphatic system a health time-bomb. My experience after class of feeling at peace is nicely backed up by a Harvard Medical School article that says yoga can reduce heart rate, blood pressure, perception of pain, anxiety and even positive impacts on depression. Other proven ways of breaking the stress cycle are meditation, walks in nature (one of my favorites), low intensity exercise or even a chiropractic adjustment. You will know what works for you when you find it. For me, I will keep doing yoga and taking walks in places like this forest. Sorry, no pics of Dr. Luke doing yoga, the web is not ready for that!

No Stress in These Woods!

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.

What Makes People Like Tennis Star Novak Djokovic Gluten Intolerant

Posted on August 23, 2014 by Dr. Luke Pietrantone

The US open of Tennis is about to start. As world number 1, Novak Djokovic, takes the court one of the great stories in sports will be told again and again. If you are unfamiliar with his story, here it is. Up to 2011 Djokovic was an excellent player, yet he was not considered to be one of the elite tennis stars. Why was this? After all, he won the Australian Open in 2008. Although he was obviously very skilled in every aspect of the game, he had a habit of collapsing in the heat and during long extended matches. Djokovic would blame it on asthma and seasonal allergies. He appeared out of shape to most of his opponents and even television announcers. This accusation was despite Djokovic’s regimented training schedule, which consumed most of his waking hours. Then in 2011 he won 3 Grand Slam tournaments, 10 Titles, and 43 consecutive matches on his way to becoming the world’s number 1 tennis player. He was so dominant that year there are few achievements in the history of sports that can even compare. What does he credit this dramatic turn around to? Are you ready for this? It’s so simple yet so epic. He changed his diet! He simply stopped eating gluten, dairy and reduced his sugar significantly. How did he know what dietary changes he needed to make? Someone used muscle testing on him to figure it out! When his body no longer had to fight through the inflammation created by consuming these foods, he was able to maintain his skills even during the longest matches. The tennis world did not see him coming.

Djokovic’s story is like many others I know. Maybe they do not become the world number one in tennis, but their lives are changed for the better in major ways when they give up foods their bodies are reacting to. Often their chronic symptoms go away and other problems go away as well-the ones they don’t tell me about. Patients often ask why and how did this happen? They say, “I used to be able to eat those foods without any trouble. Why can’t I now?” The answer can often be found in their patient history. I ask, “What was happening in your life around the time that this started?” It usually takes a moment or two of reflection before they say something like, ”I was going through a divorce,” “I was taking care of my terminally ill father,” “My child was in the hospital,” “I was working long hours at a job I hated,” or “I had just had my 3rd baby in 3 years.” You get the idea. A significant life event generally precedes the onset of their chronic symptoms. There is almost always a timeline that fits.

Stress is insidious and it destroys your body slowly. People think they are thriving on stress, but that is never the case. When they think they are ”thriving” they are really adapting. The body will eventually run out of reserves and can no longer adapt. When it does, the person has a health crisis that was sometimes years in the making. Hans Selye, in his classic book The Stress of Life, found that stress causes intestinal ulcers, suppresses the immune system, and increases the size of the adrenal glands (reason you can adapt to stress at all). We know that the cells that line the intestine are connected with something called tight junctions. Tight junctions function to keep out undigested food particles, toxins and microorganisms that naturally live in our gut. Under stress the tight junctions can start to break down allowing food, toxins and microorganisms to cross the intestinal lining. This can happen even before the classic ulcer is present. These cracks in the intestinal linings make the immune system go crazy. The immune system begins to fight this steady stream of invaders. When you have a cold or flu some of the symptoms of fatigue, headache, achiness are simply due to your body’s immune system working so hard. Mobilizing the immune system requires tremendous energy. This is some of why when you are sick you feel so bad. Symptoms are reasonable for the 1-2 weeks a cold might last, but what if you felt like that all the time. Many people do feel like that all the time, and it often it comes from their immune system battling their leaky gut.

Whole books are devoted to the subject of leaky gut, but here are some of the basics that answer our question of “How did this start?” Something causes a disturbance in the gut such as prolonged stress, poor diet, excessive alcohol, antibiotics, toxic chemical exposure, or pathogenic organisms like bacteria or yeasts. The lining of the intestines becomes compromised affecting the immune system as well as the cells that line your intestine directly. These cells called enterocytes, and their finger like projections called microvilli, are where digestion and absorption occurs. Depending on the level of damage to the intestinal lining different enzymes will no longer be produced or work effectively. It could be enzymes specific to lactose (a type of sugar many people cannot digest), dairy protein, gluten, other wheat proteins or starches to name a few. If this goes on for long periods of time the immune system begins to attack more and more strongly. If it goes on long enough, the body can even begin to attack itself. You are one of these people if you have an auto immune disorder, joint pain, thyroid problem, skin problem or any other body issue that goes away when you take specific foods out of your diet. I have seen it time and again as I work with patients to try and reverse this damage to the gut.

Why did the detrimental affects of intestinal damage start with tennis star Novak Djokovic? I am going to speculate wildly here. A patient of mine gave me a book that Djokovic wrote, Serve to Win, where he tells his tennis story and talks about how important diet is to athletic performance. There is a chapter early in the book that talks about a part of his childhood that was horrific. No child should have to endure such trauma. Djokovic grew up in Belgrade, Serbia during the War of Kosovo. He recounts a time when he was running to a bomb shelter when he tripped and was separated from his family in the darkness. When he was on the ground he looked up to see 2 laser-guided bombs blow up a building in front of him. For 78 nights at 8pm, the siren would blow and they would head for the bomb shelter as the city was bombed. “The feeling of helplessness dominated our lives,” he said. One of the worst forms of stress is feeling like you will not be able to control the situation you are in. Imagine that level of stress on a child. Not knowing day to day if he would see his family again. I think this stressful time period in his life may have started the cascade of events that led eventually to his inability to digest gluten and dairy. Of course, there easily could have been other factors involved over the years as well. There could have been compounding events such as the stress of being bombed and taking a round of antibiotics, which could create an imbalance of bacteria in the intestines; both acting together to result in intestinal damage. I do not know for sure, but I bet the start of Djokovic’s problems could be linked to the time after living through airstikes.

If you have chronic health issues think back to when it all started. What was happening in your life before the symptoms began? Using applied kinesiology and muscle testing we can quickly determine if the health problems you may be experiencing are related to your intestines. Knowing if you have to avoid a certain food makes your life easier and healthier. Using targeted herbs, supplements and lifestyle modification we often restore intestinal balance, which reduces he number of foods one needs to avoid. It is worth the effort of changing your diet because often it is the only way you will recover your health.