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.

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

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.