Concussions are traumatic brain injuries that affect brain function. Effects from these injuries are often temporary but can include headaches, problems with concentration, memory, balance and coordination. Concussions are usually caused by a blow to the head or violent shaking of the head and upper body. Some concussions cause loss of consciousness, but most do not. And it is possible to have a concussion and not realize it. Concussions are common in contact sports, such as football. However, most people gain a full recovery after a concussion.
Can also happen due to excessive shaking of the head or acceleration/deceleration
Mild injuries (mTBI/concussions) are the most common type of brain injury
Glasgow Coma Scale
Common Causes Of Concussion
Motor vehicle collisions
Falls
Sports injuries
Assault
Accidental or intentional discharge of weapons
Impact with objects
Prevention
Prevention of concussive injuries can be paramount
Encourage Patients To Wear Helmets
Competitive sports, especially boxing, hokey, football and baseball
Horseback riding
Riding bicycles, motorcycles, ATVs, etc.
High elevation activates such as rock climbing, zip lining
Skiing, snowboarding
Encourage Patients To Wear Seatbelts
Discuss the importance of wearing seatbelts at all times in vehicles with all of your patients
Also encourage use of appropriate booster or car seats for children to ensure adequate fit and function of seat belts.
Driving Safely
Patients should never drive while under the influence of drugs, including certain medications or alcohol
Never text and drive
Make Spaces Safer For Children
Install baby gates and window latches in the home
May in areas with shock-absorbing material, such as hardwood mulch or sand
Supervise children carefully, especially when they�re near water
Prevent Falls
Clearing tripping hazards such as loose rugs, uneven flooring or walkway clutter
Using nonslip mats in the bathtub and on shower floors, and installing grab bars next to the toilet, tub and shower
Ensure appropriate footwear
Installing handrails on both sides of stairways
Improving lighting throughout the home
Balance training exercises
Balance Training
Single leg balance
Bosu ball training
Core strengthening
Brain balancing exercises
Concussion Verbiage
Concussion vs. mTBI (mild traumatic brain injury)
mTBI is the term being used more commonly in medical settings, but concussion is a more largely recognized term in the community by sports coaches, etc.
The two terms describe the same basic thing, mTBI is a better term to use in your charting
Evaluating Concussion
Remember that there does not always have to be loss of consciousness for there to be a concussion
Post-Concussion Syndrome can occur without LOC as well
Symptoms of concussion may not be immediate and could take days to develop
Monitor for 48 post head injury watching for red flags
Blurred eyesight or other vision problems, such as dilated or uneven pupils
Confusion
Dizziness
Ringing in the ears
Nausea or vomiting
Slurred speech
Delayed response to questions
Memory loss
Fatigue
Trouble concentrating
Continued or persistent memory loss
Irritability and other personality changes
Sensitivity to light and noise
Sleep problems
Mood swings, stress, anxiety or depression
Disorders of taste and smell
Mental/Behavioral Changes
Verbal outbursts
Physical outbursts
Poor judgment
Impulsive behavior
Negativity
Intolerance
Apathy
Egocentricity
Rigidity and inflexibility
Risky behavior
Lack of empathy
Lack of motivation or initiative
Depression or anxiety
Symptoms In Children
Concussions can present differently in children
Excessive crying
Loss of appetite
Loss of interest in favorite toys or activities
Sleep issues
Vomiting
Irritability
Unsteadiness while standing
Amnesia
Memory loss and failure to form new memories
Retrograde Amnesia
Inability to remember things that happened before the injury
Due to failure in recall
Anterograde Amnesia
Inability to remember things that happened after the injury
Due to failure to formulate new memories
Even short memory losses can be predictive of outcome
Amnesia may be up to 4-10 times more predictive of symptoms and cognitive deficits following concussion than is LOC (less than 1 minute)
Return To Play Progression
Baseline: No Symptoms
As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 48 hours. Keep in mind, the younger the athlete, the more conservative the treatment.
Step 1: Light Aerobic Activity
The Goal: Only to increase an athlete�s heart rate.
The Time: 5 to 10 minutes.
The Activities: Exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.
Step 2: Moderate activity
The Goal: Limited body and head movement.
The Time: Reduced from typical routine.
The Activities: Moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting
Step 3: Heavy, non-contact activity
The Goal: More intense but non-contact
The Time: Close to typical routine
The Activities: Running, high-intensity stationary biking, the player�s regular weightlifting routine, and non- contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.
Step 4: Practice & full contact
The Goal: Reintegrate in full contact practice.
Step 5: Competition
The Goal: Return to competition.
Microglial Priming
After head trauma microglial cells are primed and can become over active
To combat this, you must mediate the inflammation cascade
Prevent repeated head trauma
Due to priming of the foam cells, response to follow-up trauma may be far more severe and damaging
What Is Post-Concussion Syndrome (PCS)?
Symptoms following head trauma or mild traumatic brain injury, that can last weeks, months or years after injury
Symptoms persist longer than expected after initial concussion
More common in women and persons of advanced age who suffer head trauma
Severity of PCS often does not correlate to severity of head injury
PCS Symptoms
Headaches
Dizziness
Fatigue
Irritability
Anxiety
Insomnia
Loss of concentration and memory
Ringing in the ears
Blurry vision
Noise and light sensitivity
Rarely, decreases in taste and smell
Concussion Associated Risk Factors
Early symptoms of headache after injury
Mental changes such as amnesia or fogginess
Fatigue
Prior history of headaches
Evaluation Of PCS
PCS is a diagnosis of exclusion
If patient presents with symptoms after head injury, and other possible causes have been ruled out => PCS
Use appropriate testing and imaging studies to rule out other causes of symptoms
Headaches In PCS
Often �tension� type headache
Treat as you would for tension headache
Reduce stress
Improve stress coping skills
MSK treatment of the cervical and thoracic regions
Constitutional hydrotherapy
Adrenal supportive/adaptogenic herbs
Can be migraine, especially in people who had pre-existing migraine conditions prior to injury
Reduce inflammatory load
Consider management with supplements and or medications
Reduce light and sound exposure if there is sensitivity
Dizziness In PCS
After head trauma, always assess for BPPV, as this is the most common type of vertigo after trauma
Dix-Hallpike maneuver to diagnose
Epley�s maneuver for treatment
Light & Sound Sensitivity
Hypersensitivity to light and sound is common in PCS and typically exacerbates other symptoms such as headache and anxiety
Management of excess mesencephalon stimulation is crucial in such cases
Sunglasses
Other light blocking glasses
Earplugs
Cotton in ears
Treatment Of PCS
Manage each symptom individually as you otherwise would
Manage CNS inflammation
Curcumin
Boswelia
Fish oil/Omega-3s � (***after r/o bleed)
Cognitive behavioral therapy
Mindfulness & relaxation training
Acupuncture
Brain balancing physical therapy exercises
Refer for psychological evaluation/treatment
Refer to mTBI specialist
mTBI Specialists
mTBI is difficult to treat and is an entire specialty both in the allopathic and complementary medicine
Primary objective is to recognize and refer for appropriate care
Pursue training in mTBI or plan to refer to TBI specialists
Sources
�A Head for the Future.� DVBIC, 4 Apr. 2017, dvbic.dcoe.mil/aheadforthefuture.
Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004.
�Heads Up to Health Care Providers.� Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Feb. 2015, www.cdc.gov/headsup/providers/.
�Post-Concussion Syndrome.� Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 July 2017, www.mayoclinic.org/diseases-conditions/post- concussion-syndrome/symptoms-causes/syc-20353352.
Patellofemoral Syndrome: As the weather warms and spring is in full swing, more and more runners are heading outside, hitting the pavement to train for upcoming races or to just step up their game after a long winter. While there are some die hard runners who don�t let even the most brutal winter stop them, most tend to retreat indoors, waiting for warmer days and a more pleasant environment. Unfortunately, increased activity can also lead to an increased risk of injury, particularly patellofemoral pain syndrome (PFPS), also known as runner�s knee.
What Is Patellofemoral Pain Syndrome?
Runner�s knee is often used to describe PFPS, but runner�s knee is actually a broader term describing several different knee injuries or ailments. PFPS is a painful condition that is caused when the tissue that is between the femur (thigh bone) and the patella (kneecap) becomes inflamed or irritated.
Most people will notice pain in the front portion or anterior part of the knee, but pain can be experienced in other parts of the knee and even back pain may occur. Running increases the discomfort, as does sitting for long periods and going up or down stairs.
The causes of PFPS can also vary widely. Overuse is often the first thing that people think, but a problem with the way the knee is aligned is actually the most common reason.
If the patella is not properly aligned, when it moves through the groove that is at the end of the femur, it causes irritation to the surrounding tissues. This usually happens because the muscles and joints are out of balance.
For instance, if the quad muscle on one side is weaker than the other side it throws the entire system out of balance, causing the knee to become misaligned. This leads to knee pain and discomfort.
Treatment For Patellofemoral Syndrome – Runner�s Knee
When treating PFPS, rest is usually first on the list, followed by icing the area to reduce inflammation. Once the pain is under control, the next step is to determine what is causing the problem. It is important to rule out more serious conditions or injuries first in order to determine the best course of treatment.
If it is indeed PFPS, strengthening the muscles in and around the knee is generally the first step in treatment. It is important that the muscle strength is balanced so that the knee can be properly aligned. Getting a good pair of running shoes is also recommended so that future injury can be prevented.
Chiropractic For Runner�s Knee
Runner�s knee, or PFPS, responds very well to chiropractic treatment. The chiropractor is able to do a complete exam and find the cause of the problem, then tailor the treatment accordingly. This is typically done on a case by case basis with treatment that is based on the individual�s unique needs. The chiropractor may do various chiropractic alignments and manipulations on the spine, hip, ankle, and knee in order to bring the body back into proper balance.
The chiropractor may also recommend other complimentary treatments including special supplements, dietary adjustments, and an exercise plan. The chiropractor may also recommend certain stretching exercises to aid in healing. Kinesio taping is another common treatment that may be used in conjunction with chiropractic care. It is particularly beneficial when there is a muscular strength imbalance. The tape can help support the weaker muscle group.
Chiropractic care is a very effective treatment for patellofemoral syndrome and the associated knee pain. It works to correct the problem by bringing the body back into proper alignment, allowing it to function as it should.
Knee Injuries: Alex Jimenez was a wrestler for 15 years when he suffered an ACL tear. Once diagnosis confirmed his knee injury, Alex Jimenez began an extensive care regimen, consisting of chiropractic care with Dr. Alex Jimenez and crossfit rehabilitation, in order to help him recover. Now that Alex Jimenez dedicates himself to health and fitness, he’s always mindful of engaging in the proper exercises to avoid suffering another sports injury. With a positive mentality, Alex Jimenez was able to find his life plan when his ACL tear healed completely.
Chiropractic Care For Knee Injuries
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. The prevalence of ACL injury is higher in athletes who take part in sports, such as basketball, soccer, skiing, and football. Roughly half of ACL injuries occur together with injury to the meniscus, articular cartilage, or other ligaments. Furthermore, patients may have lumps of the bone beneath the cartilage surface. These might be seen on a magnetic resonance imaging (MRI) scan and might indicate injury to the overlying articular cartilage.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Skateboarding: Javier Mata has entrusted Dr. Alex Jimenez for many years now, receiving trustworthy chiropractic care after experiencing several low back pain injuries throughout his life. Javier Mata first considered the non-surgical treatment choice following his own father’s recommendation to seek chiropractic care after he himself received treatment with Dr. Alex Jimenez. Javier Mata has found tremendous relief through spinal adjustments and manual manipulations and he highly recommends chiropractic care with Dr. Alex Jimenez.
Skateboarding Injury Treatment
Skateboarding is a popular recreational activity among children and teenagers. Although it is an enjoyable and exciting activity, skateboarding carries with it a serious risk for injury. Roughly 70,000 injuries requiring a trip to the emergency department occur each year. There are many things that parents and children can do to help prevent skateboarding injuries, such as carefully selecting safe places to ride and wearing protective gear, especially helmets. Many accidents happen when a child loses balance, falls off the skateboard and lands on an outstretched arm. Skateboarding accidents often involve the wrist, ankle, or face and sprains or strains may occur.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
ACL Sports Injury: Alexander Jimenez, champion wrestler, trained hard at Push-as-Rx, Crossfit & Athlete Rehabilitation, to gradually become the athlete he is today. When he suffered an ACL tear, Alexander Jimenez had to undergo surgery, where he then started his rehabilitation process at Push-as-Rx. With a clear focus in mind, Alexander Jimenez was able to overcome his difficulties and he became a champion wrestler. For Alexander Jimenez, Push-as-Rx provided him with the mental and physical edge he needed in order to become the best athlete he can be. Alexander Jimenez recommends Push-as-Rx to younger athletes and athletes who are looking to achieve their fitness goals.
ACL Sports Injury Therapy
Anterior cruciate ligament injury is when the anterior cruciate ligament (ACL) is either stretched, partially torn, or totally torn. The most common injury is a tear that is complete. Symptoms include pain, a popping sound during trauma, instability of the knee, and joint swelling. Swelling generally appears within a couple hours. In approximately 50 percent of cases, other structures of the knee, for example surrounding cartilage, ligaments, or the meniscus, are damaged. The underlying mechanism frequently involves a rapid change in direction, abrupt stop, landing after a jump, or direct contact into the knee. ACL tears are most common in athletes.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
IT Iliotibial band syndrome is a very common injury among runners. If it is diagnosed early and treatment commences immediately the chances of it becoming a chronic condition are reduced. It responds very well to chiropractic since it involves the pelvis and related muscles. When pelvic mechanics are not functioning properly the muscle don�t work efficiently which hinders flexibility and mobility. This can lead to tight muscles which may inhibit motion and cause pain. Chiropractic adjustments have been proven to help with the condition.
What Is The Iliotibial Band?
The Iliotibial Band, or fasciae latae, is the outer casing of muscle that extends along the outer thigh, from the top of the hip to the outside of the knee. IT Iliotibial band syndrome occurs when that casing becomes thickened. It is flexed or tight when you stand; it is what keeps your let straight, allowing the larger thigh muscle to rest.
There are two primary muscles that are involved in iliotibial band syndrome, the buttock muscle, or gluteus maximus, and the tensor fasciae latae muscles. Sometimes Iliotibial Band Syndrome is referred to Tensor Fasciae Latae Syndrome and the two terms can be used interchangeably.
IT Iliotibial Band Syndrome Defined
As the iliotibial band thickens it pulls in the area where it connects to the knee. This results in knee pain due to the application of too much pressure on the bursa. The bursa then becomes swollen, inflamed, and painful. During activity, such as running on an incline, the glutes are heavily involved.
The other end of the iliotibial band is inserted at the glutes so as the band tightens from this activity, it can trigger iliotibial band syndrome pain. Repeated activity further aggravates it, as does running on tight indoor tracks or uneven roads as well as having collapsed arches or running it inferior or worn out running shoes.
Symptoms Of Iliotibial Band Syndrome
There are several symptoms that can be used to diagnose iliotibial band syndrome. Lateral knee pain (pain on the outside of the knee) is a primary symptom and often used as a key diagnostic tool. Few conditions involve lateral knee pain. Other symptoms include:
Pain that worsens after running, particularly after running on an incline, climbing stairs, or climbing hills
There may not be any pain until you do something that aggravates it like climbing a hill.
The pain may not begin until you are mid-way through a run.
The pain can be intense and debilitating.
It can accompany a snapping hip, which occurs when the muscles that cross the outer hip may click or snap while running or walking.
The pain may be present along the lateral thigh without incorporating the knee, but it is only in very rare instances that it is concentrated on the gluteal or hip muscles.
Iliotibial band syndrome is often attributed to over training. This can mean suddenly increasing hill repeats or doubling your mileage.
Treatments For IT Iliotibial Band Syndrome
If your iliotibial band syndrome is caused by a problem with pelvic function, relieving the pain from the condition can be difficult. Stretching is not likely to bring relief � and if it does it won�t last long. If the pain from iliotibial band syndrome lasts for more than two weeks even if you are only stretching, your regular exercise routine, and ice and you don�t see much improvement, a chiropractor can help.
Even if the pain is located in the knee, the problem could originate in the pelvis. A chiropractor can assess your condition, check to see that your pelvis is functioning properly. If it isn�t, spinal adjustments and other chiropractic treatments can bring the body back into alignment and make the pelvis more functional.
Chiropractic Clinic Extra: Sport Injury Treatments
Feeling back pain, being unable to perform daily tasks, workout and play sports can be frustrating for anyone. The debilitating symptoms can drive individuals to seek fast relief. But, while a person�s only concern maybe only to fix the day�s pain, fixing the root/cause of the problem is far better in the long run and�can be easily achieved from chiropractic treatment. After receiving a single adjustment, many people especially athletes can expect an increase in their range of motion and less pain. Regardless of the reasons for seeking chiropractic treatment, one question always crosses people�s minds, how often should one see a chiropractor?
The answer to that question depends on the individual�s goals. Generally, spinal complications are not the result of a single day�s activities but tend to occur gradually over a period of time. Many spine conditions and injuries result in symptoms that may intermittently increase and decrease over several years, causing constant, nagging pain or sharp, extreme pain due to wear and tear type of injuries that the body is no longer able to heal on its own.
Chiropractic Treatment Sports Injury
Healing requires time and patience, a person also needs to be aware of what caused the complications in the first place. Suddenly stopping strict exercise routines or gaining weight in a certain amount of time can create an accelerated aging process on the joints.
If an individual�s goals are solely focused on alleviating the pain resulting from one time, then it won�t take much time to heal. Generally, receiving adjustments 2-3 times per week for several weeks can ease pain and decrease other symptoms. But, if a person is seeking to relieve the symptoms associated with an underlying condition or injury, or if a person is seeking to correct an improper posture or a mechanical dysfunction, the process could be much longer. This healing process often may require about 2-3 months of regular adjustments.
Despite completing treatment and successfully alleviating any symptoms, it is recommended to continue chiropractic adjustments on a regular basis. What is considered a regular basis for adjustments? Getting adjusted at least once a week by a chiropractor can help maintain a person�s overall health and can prevent small problems from becoming greater issues. For a greater majority of individuals, especially those who sit most of the day, it�s recommended to maintain an adjustment schedule every week or two. A chiropractor will explain what is the right schedule.
By Dr. Alex Jimenez
Chiropractic Clinic Extra: Sport Injury Treatments
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
Symptoms Of Iliotibial Band Syndrome
