Concussions: More Than Just a Bump on the Head

Concussion.png

By Tara Winters  

Physical Therapist, BASI Pilates teacher

The third week of September is Balance Awareness Week! This month also marks the start of the season for America’s favorite sport...football. Therefore, I thought it would be fitting to discuss a common balance related issue among athletes - concussions.

 

Concussions are highly prevalent, especially among the athletic population. However, information on concussions and evidence about appropriate treatment options has evolved over the years, leaving many of us confused as to what to do when someone we know is affected. 

 

Fortunately, we know much more about concussions today than we did 10 years ago. Let’s review some of the background on concussions, signs and symptoms, and current treatment practices.

 

What exactly is a concussion?

A concussion is a traumatic brain injury (TBI) that can manifest into a wide array of symptoms that can last hours, days, or years.3 Symptoms can include mood swings, headaches, fatigue, brain fog, muscular tension, vertigo and memory loss.3 These symptoms can be influenced by diet, exercise, and stress.3

 

Recovery

Usually, a sports-related concussion will resolve within 2 weeks after the injury.3 Keep in mind that children take longer to recover as their brains are still developing at this age.3 Current evidence shows that the following may indicate a longer recovery time: 3,4

●       Immediate dizziness

●       Amnesia

●       Acute exertion after the injury

●       Repeated injuries

 

Treatment

If the concussion occurs during sport, the player should not return to play to avoid risking a second concussion.3 A second concussion is termed ‘second impact syndrome’ and can lead to more serious issues.3 During the initial few days following a concussion, light rest is recommended.3 Avoiding strenuous activity for one to two weeks allows for optimal healing.3 That is not to say that one must avoid activity altogether, but staying in the ‘light to moderate’ range of tolerable activity is typically appropriate. If visual stimulation is an issue, avoid bright lights or busy environments.3

 

A visit to your local physical therapist can also be helpful to address vestibular deficits and muscle tension, both of which can occur following a head injury. Vestibular impairments may include dizziness, motion sensitivity, vertigo, and headaches. Physical therapists can also assist you in creating an appropriate, graded return-to-sport exercise plan that will not lead to overexertion. Generally, mild to moderate aerobic exercise is helpful in stimulating brain-derived neurotrophic factor (BDNF).5,6 BDNF is involved in brain development, cell growth, and affects learning and memory.5,6 Another type of therapy that can be particularly effective in traumatic brain injury recovery is craniosacral therapy (CST).7 This type of therapy is performed by a physical therapist and involves gentle pressure to areas surrounding the craniosacral system of the body.7

 

Stress management should also be considered. Stress can negatively affect brain activity and exacerbate concussion symptoms as the brain is less able to handle increased energy demands following injury.2,7 Stress can mean many things for someone post-concussion. Examples include emotional stress, environmental stress, and overexertion (physically or mentally).3,7 Yoga, meditation, and breathing exercises are great stress relieving options to consider. Acupuncture is another great option for pain and headache relief.1 Many studies link acupuncture with the reduction of concussion symptoms such as headache or neck pain.1,8,9

 

If memory issues arise, try playing memory games. Lumosity is a great cell phone application that takes users through various levels of challenging memory games. SuperBetter is another app created by a woman with a TBI and is useful in setting goals and building habits.7 Journaling about gratitude can help those with a concussion ingrain positive thoughts along their healing journey.7 

 

Healthcare Professionals are Here for You

Whether you’re a professional football player or a parent concerned about your child, concussions can occur at any moment. If you notice any of these symptoms following a bump to the head, remember that it is important to get assessed by a healthcare professional as soon as possible to ensure optimal recovery.

 

Cypress Center physical therapists specialize in vestibular evaluation and treatment as well as CST. We also have skilled acupuncturists ready to assist in the treatment of any residual deficits following a head injury.

 

References

  1. Gergen D. Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report. Journal Of Chiropractic Medicine [serial online]. September 1, 2015;14:220-224. Available from: ScienceDirect, Ipswich, MA. Accessed September 6, 2017
  2. Kozlowski K. Exercise and Concussion, Part 1: Local and Systemic Alterations in Normal Function. International Journal Of Athletic Therapy & Training [serial online]. March 2014;19(2):23-27. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed September 6, 2017..
  3. Laura Morris. Mild Traumatic Brain Injury. Presented at: Elmhurst Memorial Healthcare; June 2017; Chicago, IL.
  4. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? The American journal of sports medicine. 2011;39:2311-2318.
  5. Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012;4(2):147-154. doi:10.1177/1941738111433673.
  6. Schmolesky MT, Webb DL, Hansen RA. The Effects of Aerobic Exercise Intensity and Duration on Levels of Brain-Derived Neurotrophic Factor in Healthy Men. Journal of Sports Science & Medicine. 2013;12(3):502-511.
  7. Molly Parker. Mild Traumatic Brain Injury: how to identify and treat concussions with compassion. Presented at: University of St. Augustine; November 2016; San Marcos, CA.
  8. Gergen DM. Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report. Journal of Chiropractic Medicine. 2015;14(3):220-224. doi:10.1016/j.jcm.2015.08.006.
  9. Biçer M, Bozkurt D, Aktaş İ, et al. The clinical efficiency of acupuncture in preventing migraine attacks and its effect on serotonin levels. / Akupunturun migren ataklarının önlenmesinde klinik etkinliği ve serotonin düzeylerine etkisi. Turkish Journal Of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip Ve Rehabilitasyon Dergisi [serial online]. January 2017;63(1):59-65. Available from: SPORTDiscus with Full Text, Ipswich, MA.

Back to School, Back to Better Posture

By Tara Winters- physical therapist and BASI Pilates teacher

Let’s talk about posture. And by posture, I don’t mean the outdated notion of standing up straight, with your shoulders back and your chin down. I am talking about the way we carry ourselves as we move through our everyday activities.

Poor posture is prevalent within our society, especially among adolescents. Since adolescence is a vital time for bone and muscle development, it is important to understand the impact that posture has on our body. Cell phone and computer usage are becoming quite ubiquitous, and we seem to be spending more time hunched forward. This puts undue stress on the joints and nervous system, contributing to muscle imbalances and other possible issues down the road (arthritis, anyone?). 7,8 These static sitting postures build habits which can also translate into movements performed throughout the day, from picking something up off of the floor to throwing a baseball. Not to mention the fact that young adults also spend many hours of the day sitting at a desk and lugging around backpacks full of textbooks. Adding any load to abnormal posture stresses the system even more...and here we go again!

It’s not all bad, though. Posture is a result of habit, and habit can be changed. As we head back into the school year, it is worth our time to explore small changes we can make to improve posture and adapt to our current environment.

Backpacks matter:

One study found that backpacks positioned in the middle of the back, with shorter straps, rather than lower on the back produced better standing posture.2 Be sure to observe your child’s standing posture when wearing his or her backpack to ensure they are not leaning forward or backward. Wearing both straps, rather than one, will distribute forces more evenly along the spine. And finally, check with the school to assess how reasonable it is for students to leave books at school. This way, they won’t have to carry more than necessary to and from school. Many studies show that carrying a backpack greater than 10 to 15 percent of your body weight can have significant effects on walking, going up and down stairs, and overall load on the body.1,2,5

Ergonomics:

Children sit for 45-60 minutes per class, and they may have 6-7 classes per day (hopefully, one of these is physical education). Although it’s hard to influence adolescent sitting posture in class, we can ingrain good postural habits at home. So, let’s focus on a work station that you can control- the desk or area that your child does homework at. Ensuring that the desk is ergonomically sound can do wonders for your child during long study hours. This can also include purchasing a book stand or holding your phone at eye level, rather than in your lap, to keep the neck in a more neutral position.

Get some sleep:

Fatigue from lack of sleep, or lack of quality sleep, can manifest in our daily postures and movement.3,4 Ensuring that your teen gets some quality shut eye by turning off devices (laptop, cell phone) an hour or two before bedtime can help the natural production of melatonin, a hormone that regulates sleep.3,4 Blackout curtains or an eye mask can also be beneficial in keeping any artificial light out of the room.

Get moving:

In the end, it all comes down to movement. Changing positions frequently can help us avoid sustained pressures and stresses on our body. Enrolling in sports, taking your daughter to a yoga or pilates class with you, or walking by the beach (summer isn’t over yet!) are all great options for increasing frequency of movement throughout your child’s day. They are also great bonding opportunities.

Making small changes throughout the day makes improving posture manageable. It also sets our body up to move in the most efficient way, leading to less energy expenditure and less risk for injury. Sounds like a win-win to me.

Finally, if you have deeper concerns about your child’s posture, consider setting up a physical therapy appointment here at The Cypress Center. Cypress therapists are experts in movement analysis, postural syndromes, and injury prevention. They can provide you with further insight on posture and implement an individualized exercise plan to fit your needs.

References

1.    Song Q, Yu B, Zhang C, Sun W, Mao D. Effects of Backpack Weight on Posture, Gait Patterns and Ground Reaction Forces of Male Children with Obesity during Stair Descent. Research In Sports Medicine[serial online]. April 2014;22(2):172-184.

2.    ABDELRAOUF O, HAMADA H, SELIM A, SHENDY W, ZAKARIA H. Effect of backpack shoulder straps length on cervical posture and upper trapezius pressure pain threshold. Journal Of Physical Therapy Science [serial online]. September 2016;28(9):2437-2440.

3. Kayaba M, Iwayama K, Tokuyama K, et al. The effect of nocturnal blue light exposure from light-emitting diodes on wakefulness and energy metabolism the following morning. Environmental Health & Preventive Medicine [serial online]. September 2014;19(5):354-361.

4. Tosini G, Ferguson I, Tsubota K. Effects of blue light on the circadian system and eye physiology. Molecular Vision. 2016;22:61-72.

5. Minghelli B, Oliveira R, Nunes C. Postural habits and weight of backpacks of Portuguese adolescents: Are they associated with scoliosis and low back pain?. Work [serial online]. May 2016;54(1):197-208.

6. Ingraham P. Posture Correction: Does it matter? www.PainScience.com. https://www.painscience.com/articles/posture.php. Accessed August 23, 2017.

7. Norris C. Osteoarthritis of the Knee: A Practical Treatment Approach. Co-Kinetic Journal [serial online]. April 2017;(72):14-21.

8. Levinger P, Menz H, Fotoohabadi M, Feller J, Bartlett J, Bergman N. Foot posture in people with medial compartment knee osteoarthritis. Journal Of Foot And Ankle Research [serial online]. 2010;Available from: Academic OneFile, Ipswich, MA.