Concussions are a commonly seen condition, especially in sports care. Chances are if you have played a significant amount of competitive sports, regardless of the level, you or one of your teammates has experienced a concussion. Concussion management has taken some large steps forward over the last decade in sports medicine to help provide better assessment, diagnosis, and return to play guidelines for the concussed athlete. This approach assures that a player is safely evaluated and removed from competition in the event of a concussion and then able to safely return to play without risk of further insult.
Along with this approach to management of concussions, many colleges and professional organizations have also realized the benefits of co-managing concussions across multiple healthcare disciplines, including chiropractic. Many programs that utilize this approach of co-managing these types of conditions reap the benefits of faster return to play as well as healthier recovery from a concussion.
A concussion is simply trauma or injury to the brain. This typically occurs either through a direct impact with the head or indirect impact to the head elsewhere in the body which still causes violent motion in the head or neck. These traumas usually provide forces that cause an acceleration/deceleration motion of the head . and neck. The brain is essentially free floating inside the skull in a liquid solution known as cerebrospinal fluid. Abrupt changes or forces to the head can cause a displacement of the brain in this fluid and results in it impacting its protective skull, thus causing injury and bruising. What is often forgotten is that many concussions are essentially whiplash injuries, due to the acceleration and deceleration nature of most concussions. Because of this, once major neurological impairment, spinal fractures, and other life-threatening injuries are ruled out, some symptoms of a concussion also relate to dysfunction in the neck. For further illustration of this phenomenon, watch this video.
Many patients are surprised to hear that chiropractic can have such a profound affect in supporting concussions. To be absolutely clear, if a concussion in an athlete is suspected, it is vital that an athlete be evaluated by a properly trained health care professional, preferably one that specializes in sports. This could be a neurosurgeon, sports orthopaedic surgeon, sports chiropractor or trained athletic trainer. Once those factors are ruled out, chiropractic care should be sought to help manage residual symptoms and affects. At Mid-South Spine and Sports Performance, we have multiple ways to address concussions that can improve athlete outcomes as well as return to play. To better educate the importance of chiropractic care in concussion management, here are three approaches Dr. Detweiler uses to effectively manage concussions in athletes.
As noted before, almost every concussion will have some sort of neck involvement. If I were to ask you to describe a the typical concussion, most would describe a hit or collision that involves the head coming into contact with an object or person and then the neck and head snapping back in the opposite direction. It is important to remember that since the body is not individually separated into different parts but rather connected, it is very difficult to separate trauma like this to the head from trauma to the neck. Therefore the patient is likely to have other injuries aside from the concussion. On top of that, many symptoms of concussions seen on the SCAT-3 assessment (this is the accepted standard for concussion assessment) are symptoms that are found also in neck pain patients. In the SCAT-3 some of the listed “symptoms” specifically ask for the presence of neck pain, headaches, dizziness, and pressure in the head. Furthermore, according to return to play standards, an athlete who is not symptom free cannot progress past the first stage of return to play. This means an athlete who continues to have neck pain or headaches following a concussion cannot progress forward. So what if the patient has both a concussion and fixations or myofascial pain in neck from the trauma which caused the injury in the first place? Would it not make sense to examine and treat the neck as well? Adjustments of the neck and upper back have a long track record of resolving neck pain and headaches, and many people and research attributes chiropractic as being one of the most successful treatments for neck pain and headaches. This is why many athletic trainers and physicians prefer their athletes see a chiropractor following a concussion. If you or your child has had a concussion, you absolutely need to be evaluated by a sports chiropractor.
2) Myofascial Release
Piggybacking off the same reasoning behind the importance of adjustments from a chiropractor, any condition involving the neck will also involve the muscles and fascia of the neck as well. Myofascial release, is another service that Dr. Detweiler provides to all of his chiropractic concussion patients after they are properly evaluated. In severe trauma to the head or neck such as a concussion, often joints are subject to high amounts of forces in a very short time frame. This unexpected and quick spike in forces is too quick for muscular contraction to stabilize the joints of the neck, leaving them vulnerable to movement beyond their normal range of motion. This can in turn strain these muscles, or even sprain the ligaments holding the joint together. The body will respond to this type of trauma by entering into a protective state and locking down joint motion. This can cause severe pain, limited motion, and leads to a reinforcement of improper movement. It can also condition the body to believe that it is in danger and pain for long periods of time after the initial forces were experienced. Myofascial release is safe and effective method in reducing tension in the muscles and ligaments of the body by applying specific stretch to an affected area while also allowing the patient to fully relax and move through a range of motion without spasm. Patient’s who receive this treatment often experience an immediate increase in range of motion and decrease in muscular spasm.
3) Reflexive Performance Reset
Among the many performance benefits, injury prevention, and supportive benefits of Reflexive Performance Reset are improvements in reducing rigidity of the anterior chain and restoring proper movement such as torso flexion and neck flexion. One of the strategies used in sports such as football or hockey to reduce risk and severity of concussions is to strengthen the neck muscles to create a more solid base in which to protect the head and neck. Unfortunately as the body continually undergoes stress and trauma, especially in higher concussion risk sports such as football, lacrosse, MMA, etc., the body begins to create compensations to accomplish movement. One of these compensations in movement are in the sagittal plane during flexion of the torso. As a system of priority, if the abdomen is not strong enough or has undergone trauma and stress, to create any athletes will begin to compensate up the kinetic chain and utilize neck flexion to help provide tension to flex the torso. This is often seen by people who dip their chin to the check while doing abdominal work, or other movements that require stability in the torso such as benching or squatting. You may also see this in people who protrude the chin while doing abdominal exercises as well. This causes a dilemma as the neck flexors are now being trained to help with abdominal flexion and cannot stabilize the neck as well. This compensation pattern leaves the athlete to an increased risk for concussion as they are now less able to withstand forces to the head in the sagittal plane and keep the head from violently snapping back in a head on collision.
RPR helps address this problem by restoring proper balance in the nervous system and resetting normal motor patterns and compensations. By doing this, RPR is able to return the body to a state in which flexion of the abdomen is accomplished primarily by the abdominal musculature, allowing the neck to provide a primary action of neck stability instead of torso flexion. To learn more about the other benefits of RPR, please feel free to check out some other publications on NBSFitness, EliteFTS, or Mid-South Spine and Sports Performance’s webpages.
If you or your child has had a recent concussion and requires care, or for any other complaints or performance care needs, please check out our NEW Mid-South SSP website!