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Chronic Back Pain

Chronic back pain is caused by a number of different contributors, and is defined as back pain that lasts longer than three months or that occurs episodically.  It can affect people of all walks of life, regardless of age or physical condition.  

The medical community doesn’t understand everything about chronic back pain yet. Questions persist on why some people have it and others don’t; or why some episodes last longer than others; and why imaging results don’t always paint the correct picture. Imaging and blood work may even show things like lumbar degeneration or disc herniation, though these findings don’t prove useful because these positive findings often don’t come with pain or other symptoms at all. On the other hand, so many people with chronic back pain will receive no positive findings from blood work or imaging at all. 

The good news is that backs are just like any other body part, and the will heal.

We do have a good understanding of some common causes of chronic back pain as well as an understanding of how pain can manifest itself.  Many people experience going to bed feeling fine and waking up with significant back pain. This can be caused by swelling of a disc as it re-hydrates during the night.  Another common trigger is doing something simple like reaching for the milk carton and the back suddenly spasms. This is the result of poor motor control and the spasm is a protective mechanism.  Sometimes it is more obvious and we experience pain during an effort of some kind like sneezing or lifting something heavy. However focusing only on the possibility of what has been “damaged” can lead us into unnecessary imaging, inappropriate treatments and much higher healthcare costs while still not solving the underlying problem. 

Pain is defined as an unpleasant physical and emotional sensation that we experience when injured OR when there is a threat of injury and no actual tissue damage present. 

It is a protective mechanism our brain uses to keep us from getting hurt.  It has biological components, psychological components and sociological components. Unfortunately, we can get stuck in a loop where we get very good at experiencing pain and our brain tells us our back is hurting even when nothing has been done to injure it. This short video does an excellent job of explaining further.

If you experience this, here are some things to consider. 

  • Your back will heal- just like an arm or an ankle. If you twist your ankle one year, and then several years later you do it again, you don’t become fearful of having a ‘bad ankle’.  The same holds true for your back.  
  • Move around as much as you can as pain allows. Moving is better than resting. If it isn’t resolving quickly, considering seeing a chiropractor or physical therapist. They are trained to help relieve your symptoms and give you the tools needed to reduce the likelihood of future episodes, and help you learn to better manage such things on your own. 

If your chronic back pain is constant and not episodic, then a multi-modal approach is best, especially if it hasn’t responded well to individual treatments. There is excellent evidence for a multidisciplinary approach as well as solid evidence for exercise therapy and spinal manipulation. You can read the full guidelines from the American Academy of Family Physicians here.

You should have a team that includes a pain management physician, a chiropractor or physical therapist and a mental health therapist that work with you to help with your symptoms. A psychologist trained in Cognitive Behavioral Therapy can be very helpful in these situations. If you’re having chronic back pain and have questions, please feel free to email me at [email protected]

Samuel S. Spillman, DC

 

Frozen Shoulder: The Culprit Causing Your Shoulder Pain

Frozen Shoulder is real, and doesn’t only occur in the winter! Generally the condition doesn’t have a definite start point, ie. patients often can’t think of an injury that started the pain. Some warning signs to look for include pain and a loss of motion in multiple directions.

Medically termed adhesive capsulitis, frozen shoulder is a condition that affects the capsule surrounding the shoulder joint. The capsule is a sheath of tissue that maintains fluid within the joint and maintains pressure, ensuring relative stability. Inflammation causes the capsule to become more fibrous and thicken. This causes limitations in range of motion and pain. If your shoulder is feeling stiff and painful, with loss of motion in multiple directions, you may be facing frozen shoulder. Identifying it early is the best

way to help effective progress.

Who gets it?

Although anyone can get this condition for a variety of different reasons, there are a few predisposing factors:

  • Most prevalent in women ages 45 to 65
  • Diabetes and Thyroid disease
  • Previous episode on opposite shoulder
  • Immobilization of the shoulder following certain surgeries
  • This condition can also develop after a minor shoulder injury

There are 3 overlapping stages of the condition called the freezing; frozen; and thawing phases. Each stage has certain treatments that may be beneficial to help speed recovery, which will be discussed below.

Recovery from the condition generally takes anywhere from 6 months to 2 years, and has the following stages and interventions that can help at each stage:

 

The Start (months 0-3)

What to expect:

  1. Pain begins with no initial injury, can be sharp and/or dull in nature
  2. This is when inflammation occurs, but adhesions haven’t formed
  3. Pain most notable at endrange movements, but can be present at rest
  4. Trouble sleeping is common

In this stage, you should see a physical therapist for a few visits to learn exercises to maintain range and slow the loss of motion. You will also be educated on the condition and general progression through the stages.

 

 

 

A few tips:

  1. Use the shoulder as normally as possible without exacerbating symptoms.
  2. Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain.
  3. Listen to your body, if your causing a significant increase in pain you’re doing too much 
  4. Keep contact with your PT during this stage; activity or exercise modifications are often needed

 

Freezing (months 3-9)

What to expect:

  1. Loss of motion in all directions, with external rotation and raising the arm to the side are usually most affected
  2. Range of motion becomes progressively worse
  3. Daily activities (reaching, dressing, bathing, workouts) can become more uncomfortable
  4. Increased inflammation and blood flow present within tissue

Physical therapy continues to be beneficial in this stage to maintain ROM and function. PT interventions will be tuned to the amount of tissue irritability the patient is experiencing. 

A few tips:

  1. Continue using the shoulder as normally as possible
  2. Performing range of motion exercises will be helpful in maintaining range
  3. Listen to your body, if there is an increase in pain with activities and exercising, there may also be an increase in inflammation
  4. Keep contact with your PT during this stage; activity or exercise modifications are often needed

 

Frozen (months 9-15)

What to expect:

  1. Increased fibrosis = increased loss of motion
  2. Your joint will be much more stiff, but pain will begin subsiding
  3. Your shoulder is likely to have large range of motion deficits in this stage

 

You will likely be working with a home program for care at this point. Let your PT know if you have any changes that you have questions during this stage.

 

 

 

 

A few tips:

  1. Once again, continue using that shoulder as normally as possible
  2. Try to avoid movements that are too uncomfortable to complete

 

Thawing (months 15-24)

What to expect:

  1. Pain will begin improving, and eventually resolve
  2. Significant stiffness will remain, but will improve slowly
  3. Minor range of motion loss may persist after resolution
  4. Fibrosis of joint capsule, but decreased inflammation

The shoulder will begin During this stage you should begin appointments with your PT for more intensive stretching and manual therapy. Functional strengthening exercises will be used to begin returning the shoulder to normal. 

A few tips:

  1. Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain
  2. Begin a strengthening program that challenges your range of motion as well
  3. Be sure to work with your PT to develop a comprehensive program to return your shoulder to normal

 

Treatment of frozen shoulder can be long and arduous, but arming yourself with information can be one of the most effective tools. Make an appointment with your physical therapist or chiropractor to learn more about the condition and how you can manage it effectively. Remember, early intervention and education is essential for recovery. 

Bryan Esherick PT, DPT Have questions? Email me at [email protected]

 

Information adapted from the clinical practice guidelines Shoulder Pain and Mobility Deficits: Adhesive Capsulitis from the JOSPT.

CBD Oil: Newest Tool for Chronic Pain

CBD oil is gaining in popularity and is showing up everywhere – across the web and on store shelves everywhere. But, many of us are just hearing about it and have some questions – so let’s take a closer look.

CBD stands for cannabidiol – and it is a compound found in both cannabis and cannabis sativa (better known as hemp).  

While both plants have hundreds of compounds that may be pharmacologically active, the best known is THC, which has a psychoactive component. However, both plants also contain CBD which also has pharmacological effects but NO psychoactive component.  The CBD products at health food stores, grocery stores, and doctor’s offices are sourced from hemp and have no psychoactive properties.

OK, but why is it suddenly all over the place?

There are a number of reasons. It has been found to help with certain seizure disorders and recently the Virginia board of medicine has added it to the legal formula and it can now be prescribed for this purpose.  But it is also available over the counter. The recent Farm Bill in 2018 among other things, designated CBD products to be “generally recognized as safe” or GRAS, which means it can be added to food stuffs and sold.  For the time being the FDA and DEA have not taken any steps to change that, although they could at any time. Common side effects may include tiredness, diarrhea and changes of appetite/weight.  

What can CBD oil do and why would anyone take it? Well in addition to the above mentioned anti seizure properties, there is some limited research that suggests that CBD oil can help people with chronic pain, as well as with sleep, and anxiety.  Now the research is far from conclusive and there are many more double blind random control trials that need to be performed before the science and medical communities are going to get behind this being a new cure-all. However, as it has been generally recognized as safe and there are anecdotal reports popping up everywhere with people touting its benefits, people are flocking in droves to try it. We began carrying these products after a few patients requested them and they’ve proven to be very popular with patients for pain relief.

Samuel S. Spillman, DC

Not All Tendons are Created Equal

Have you ever experienced knee pain when beginning a new activity or increasing training volume? Does this pain go away after the warm-up, but come back the day after or when stopping the activity? You may have been of the lucky ones if these symptoms were short lived and went away within a few days. For many, this pain can become a chronic issue and affect everyday activities like sitting, stair climbing, and walking. This chronic condition is characterized by pain in the patellar tendon.

Jumper’s knee, runner’s knee, or patellar tendinopathy are all synonyms for this common condition. It generally affects the adult population ranging from 16-40 year olds, but can affect anyone if a training schedule is not properly developed. The tendinopathy is generally due to overstressing a poorly conditioned tissue, which can eventually lead to tendon dysrepair. Just like your muscles, bones, tendons, and ligaments also have to be trained to meet the demands you are putting on them. The reasons for pain with this condition is poorly understood, but it is believed that the brain and central nervous system play a big role in sensitization of the tissue. Once this process begins it is hard to reverse, which is likely why symptoms can last anywhere from a few weeks up to 2 years.  

No matter the activity, whether you are increasing your training volume, load, surface, or equipment the degenerative process may begin. The importance of ramping-up training or allowing appropriate time for tissue adaptation can not be overstated. This is why this injury is more prevalent at the beginning of a sporting season or training regimen. Have you ever wondered why marathon runners are very calculated in their training regimens in terms of increasing mileage? This condition is one of the reasons, as all tissues take time to adapt. Remember, the preseason is what prepares your body, and may be the most important part of the season to reduce injury risk.. Check out our upcoming blog in the spring on how to prevent training injuries.

As always, better outcomes are seen with more timely interventions versus the wait and see method. Treatment is generally aimed at reducing pain, reconditioning the tissue, and improving proprioception in the joint and surrounding tissues. Eccentric and heavy slow resistance exercises have been shown to be the most beneficial in treating this condition, and certain protocols have been established. Since everyone’s tendon quality and pain levels may be different, it’s essential to ensure you are starting at the right level for your state; if the tendon is stressed too much during recovery, the tendinopathy cycle will repeat itself and may become worse. Remember, there is no established timeframe for recovery, so being patient with recovery is important. The good news is that you can usually continue training, but it is best to consult your physical therapist about possible changes in impact training, training load, or training volume. Cookie cutter approaches to treatment won’t work, so be sure treatment is properly adjusted to meet your needs.

Bryan Esherick PT, DPT

Cardio Health for a Longer Life

As heart health awareness month comes to an end, we want to highlight the wonders of cardiovascular exercise – help clarify exactly what it is – and remind you to keep your heart healthy all year long. 

Cardiovascular exercise – or cardio – is defined as any activity that gets your heart rate up. Now, that’s a pretty wide definition which is great because that means you can choose from a ton of different activities – some that you might enjoy more than others, and that means you’ll be more apt to get your body moving more. You could choose anything from: running; dancing; using the elliptical; rock climbing; swinging a kettlebell; playing tennis, basketball, soccer, football; practicing martial arts; taking classes like zumba, kickboxing, or jazzercise… and the list goes on and on – even sex can count! The idea is to choose activities you enjoy, and shift your mind from thinking it needs to be something you don’t like doing.

The benefits are cardio are huge. Most people immediately associate cardio as a weight loss tool, and it’s true that it is a big benefit. But there are so many other wonderful benefits to highlight as well.

Here is a list of health benefits you may have not have associated with cardio:

  • MENTAL HEALTH:
    • improves mood
    • fights depression
    • relieves anxiety
    • improves cognitive function
    • stimulates nerve creation
    • boost self esteem
    • builds social relationships
  • PHYSICAL HEALTH:
    • improves cardiovascular health
    • lowers risk of all causes of mortality
    • decreases risk of heart disease
    • improves blood pressure
    • lowers cholesterol
    • relieves pain as exercise increases pain tolerance

There is also some evidence to suggest that regular exercise effectively slows how quickly our bodies age by helping to repair the little proteins at the end of our DNA strands – called telomeres – which can help to keep us younger and fitter longer. Perhaps we have found the Fountain of Youth after-all!

The secret is to find something you enjoy and like doing, and stick with it. For me, it is martial arts. I’ve trained in it my whole life and get my cardio from Brazilian Jiujitsu and running. Bryan plays hockey and likes to use the rowing machine, while Dongjin plays soccer and Megan opts for aerobic dance. Think about what gets you moving – and of you’re not moving, give us a call and let us help you get started. Who knows, you just might find a new passion or hobby that will help keep you fit for life.

–Sam Spillman, DC

Tennis Elbow: What You Need to Know

If you’ve ever noticed an ache around the outside of your elbow that just doesn’t seem to go away, you might be experiencing a condition commonly known as tennis elbow. Once it starts, this type of injury can affect your strength and function in your arm. So, if you’re feeling that ache and haven’t done anything about it, now might be the time. 

Despite its name, this condition rarely affects tennis players.

It’s most common in sports and occupations that require repetitive movements – think computer work, climbing, heavy labor jobs, etc.  Tennis elbow is a form of a tendinopathy – affecting the tendons of the forearm muscles – classically called tendonitis.  The tendons undergo a degenerative process as a result of highly repetitive stresses. This process causes: increased blood to flow to the area; collagen creating cells; and ground substance. This cascade of changes can lead to pain and discomfort in the area – as well as poorly formed tendon structure which is then vulnerable to further injury.

Due to the nature of the injury, and the general inability to stop activities that aggravate the condition, it can take from a few months to up to two years for the tendon to fully recover and for pain to subside. It is possible for the condition to subside on its own, but there are steps you can take to decrease the duration of the symptoms.

Treatments for this condition vary greatly from surgery at the most extreme end, and to wait-and-see on the other, with everything in between. At Balanced we focus on rehabilitating the tendon through gradual loading of the tissue to reorganize collagen; and soft tissue work to relax overactive muscles; and education to empower our patients to heal quicker. We generally recommend avoiding bracing, cortisone shots, and surgery. By optimizing the environment for the tissue to heal, our patients often obtain quicker results and are able to return to normal activity and reach their goals within a more predictable time frame.  

Bryan Esherick PT,DPT

Skiing: How to Prepare and Avoid Injury

The knee joint is the most vulnerable and most common snow sport related injury. The good news is there are steps you can take to condition and prepare your body for winter sports such as skiing.

Things to do in preparation for your ski trip:
  • Core and lower extremity exercises (listed below)
  • Training your cardiovascular fitness- many injuries occur as a result of fatigue
  • Proper equipment that is appropriate for your height and skill level
  • Take a skiing technique class before hitting the slopes
Preventing Injury on the slopes:
  • First off warm up your body before hitting the slopes each day
  • Proper technique: Hands and weight forward, legs parallel and hips, knees and ankles flexed equally
  • Stay on trails that are marked for skiing safely

The following are exercises should be preformed several weeks before you plan to ski. All of the exercises should be attempted for 1 minute and increase the time as you improve.

Balance

Standing on one leg reach the other leg toward an imaginary clock face. Repeat on other side.

Lateral Jumps

With both feet close together bend your knees and jump side to side while maintaining a straight spine and a flat back as well as even weight in both feet.

Rotational Jumps

Start from a squat position with feet close together jump from diagonal to diagonal landing on the balls of the feet.

Side to side skaters

Stand on one leg and take a large step to the with the other leg and then take another large step back to where you were. Make sure your pelvis stays level and your knee does not buckle inward.

Check out the full video for these fun and helpful exercises!

Rotator Cuff: Repairs and Road to Recovery

Rotator cuff is a term that many people fear when mentioned by a healthcare provider. This fear is usually warranted but, if a partial tear, can usually be treated conservatively if caught early. This fear may come from not knowing about conservative measures that can help. On the other hand, when conservative management fails or the tear is more significant, surgery is generally indicated. The goal of this blog is to help answer many of the questions you may have when a healthcare provider mentions that your rotator cuff may be the cause of your shoulder or arm pain. A brief description of the function of the cuff and the pathology will be followed by a look at the road to recovery and what to expect as you go through the weeks of rehabilitation. 

The cuff’s main purpose is to improve shoulder stability by actively pulling the arm bone into the shoulder socket with arm motion. It does this through a concert of contractions of the 4 muscles that make up the structure. Each muscle works intricately with the other to provide the most stability possible: Even when one muscle is not working properly, it can lead to issues. Without the rotator cuff, the shoulder generally becomes unstable which can lead to further tearing or other injuries affecting the shoulder joint.

Tears are fairly common and can affect people of all ages. They occur most commonly in patients in their 50’s and above, likely due to tissue deconditioning and other age related changes. Tears also occur frequently in overhead throwing athletes. Cuff injuries generally occur gradually over a period of time where symptoms begin to evolve and worsen. Warning signs of tears include deep, dull shoulder pain, trouble sleeping, and an inability to move the shoulder through its full range of motion. Labral tears and biceps tendinopathy are common concurrent injuries that may also be addressed.

Surgery vs. conservative management will generally be decided on a case by case basis and based on failure to conservative treatment, imaging results, signs and symptoms, and quality of life reported by the patient.

Here is what to expect when surgical repair is indicated.

Day 1- week 2: Surgery is generally performed at an outpatient surgical center. Most repairs are done arthroscopically meaning a small camera will be inserted with tools on the end to complete the repair. A local nerve block as well as general anesthesia is used during the procedure so you will be asleep the entire time. The nerve block will also help to ease pain for the hours following surgery and likely into the next day. This usually only requires 2-3 small incisions in your skin. You will return home the same day following the surgery. Pain killers are generally prescribed to help ease pain, and they should be taken to make you more comfortable.

The next 2 weeks are used to allow the repair to heal properly and is the maximal protection phase. During this time your arm will be in a sling and you will likely sleep in a recliner to protect the repair. Moderate pain is a normal experience during this time so be sure to ice and take any medication as prescribed.

Week 2-4 Post-op: This is generally when physical therapy is initiated, but some surgeons will wait for 6 weeks before therapy is initiated. During this period in therapy, the therapist will move your arm for you to begin regaining normal motion. You will also begin working on activating the muscles around your shoulder blades. Gentle activation of your shoulder muscles will also start.

Weeks 5-10 Post-op: The goal of this phase is to obtain good range of motion and to be able to stabilize your shoulder throughout the range with your muscles. Range motion will continue to be progressed and active motion will be progressed gradually within relatively pain-free ranges to hopefully reach full range by week 7-8. Range of motion progresses differently in different patients so don’t be discouraged if it takes longer than normal. Strengthening exercises will also progress gradually to gain strength for normal activities.

Weeks 10-20 Post-op: The goal of this phase is to continue progressing strength and stability to prepare your shoulder for return to all prior activities. You will also be expected to become more independent with exercises. Challenging functional movements will be performed later in this stage. Complex movements like throwing will be broken down into parts to practice before performing the actual movement to ensure proper shoulder function. You will likely be weaned from PT and may be discharged to continue with comprehensive home program to continue toward the end of this period. Athletes that need more intense treatment will continue with therapy into the return to sport phase.

Be sure not to perform activities that are too taxing for your shoulder at this point. Your shoulder will be feeling much better, which makes this a common time for re-injury to occur. Although your shoulder is feeling better, that does not mean it is fully healed and ready for full return to all of your normal activities.

Weeks 20+: Typically the safe return to sport phase. You will progress back into your sport or other activities. Continue with your home exercises to continue building strength and stability throughout your shoulder complex.

You can expect to be checking in with your surgeon throughout this process to insure that everything is going as planned. Your therapist should be in contact with the surgeon throughout the process to ensure you are progressing as expected as well.

I hope this blog can ease any anxiety about your upcoming procedure and give you a brief guide for what to expect following a RTC repair. Surgery can be intimidating, but the more you know going into it, the better the outcomes!

We will be following one of our patients through rehab and will post exercise videos and updates throughout his recovery. Be sure to check them out!

Bryan Esherick, DPT

Treating Pain without a Pill

Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.  

As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas. 

Joint Manipulation and Mobilization

Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are  powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.

Massage

Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction. 

Therapeutic Exercise

Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.  

Education

Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.

As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives. 

Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of  your best self!

Bryan Esherick PT, DPT

 

Concussions and a Safe Return to Sport

Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.

Here some tips to help you recognize concussions:

  1. Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
  2. They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
  3. Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
  4. Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
  5. IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.

One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.

When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.

By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.

Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.