Recovery after a Concussion…A True Story

In the fall of 2016, our son sustained a concussion on the football field as the result of a direct hit. While he had been well-coached in how to hit and block properly to avoid injury, there was little that could be done to avoid sustaining a bad hit.

Thankfully, he never lost consciousness, but immediately experienced significant headache, dizziness and extreme sensitivity to light. He was checked out by the on-site EMT and was recommended to see a doctor the following Monday. Over the weekend, his symptoms increased significantly, to the point where he was wearing sunglasses indoors and experience general confusion. Riding in a car was painful, as was listening to music and any type of reading or viewing on a screen.

Our family doctor recommended the standard concussion protocol at that time: no school, no sports or physical activity, no reading, and no screens until he was symptom-free. He was 14 at the time and might as well have been told not to breathe, but we committed to following the protocol in hopes of his quick recovery.  Within a few days of this recommendation, he became restless, frustrated and discouraged. His football season was over, basketball was uncertain, he would miss a total of 18 days of school, and worst of all, symptoms were not changing and he had no outlet for his angst.

At that point, we pursued additional input at Hartz Physical Therapy and were introduced to Drew Nesbitt. The first thing that impressed us was Drew’s ability to interact with a teenager. He treated our son with respect, communicating directly with him and not through us, and he knew the culture of local sports and was easily able to talk recent scores, player highlights and top teams. He instantly put our son at ease.

Up to that time, we felt that we basically had to wait in a dark tunnel for symptoms to disappear until there could be any return to normalcy, and it was maddening to feel so helpless in the recovery process. We quickly learned that Drew was highly educated and well-researched in the concussion arena, and several studies were just beginning to reflect that some physical activity might increase the pace of recovery and strengthen brain function. He developed a multi-faceted plan that allowed our son to re-introduce activity (cognitive, vestibular, physical) that slowly re-strengthened what had been damaged. More importantly, the opportunity to DO something to work toward recovery created motivation and hope!

While Drew initiated the plan, many on the team at Hartz walked it out with our son and their commitment to his success was evident. We were truly impressed with their research and constant willingness to push our son to, but not beyond, his limit. As they worked with him, they were educating him about the injury itself, what each exercise or activity was aimed to strengthen and how he could protect himself from re-injury. In all of this, they maintained realistic goals with a hopeful perspective. It was an experience that created a deeper level of maturity and personal responsibility in our son for his own health and well-being.

We are truly grateful for Drew and the entire team at Hartz PT. Looking back, our one regret is that we didn’t go directly to their office the morning after the injury. We believe our son’s overall recovery would have been shorter with the application of current research and strategy.

~ Testimonial written by Kelly M. whose son was seen by Drew Nesbitt, DPT

Vertigo

dizzy-resized

The term “vertigo” is often used incorrectly as a synonym for dizziness. When vertigo is lumped together with dizziness, confusion and poor treatment often result.  Correct utilization of the word vertigo will allow patients to receive fast and appropriate clinical assessment by practitioners, so let’s clarify the difference.

Vertigo is clinically defined as the patient feeling as though the environment is rotating, or as though they are rotating within the environment. This is the only time the word vertigo should be used.   The most common type of vertigo for which patients seek treatment is BPPV (Benign Paroxysmal Positional Vertigo). BPPV is caused by otoconia (or “ear rocks/crystals”) that become displaced and move into the wrong portion of the inner ear. BPPV is easily treatable utilizing canalith repositioning maneuvers. Proper physical therapy assessment is often the most successful way to treat BPPV because physical therapists can accurately diagnose the location of the displaced crystals and typically can resolve the vertigo symptoms within the first visit.

Dizziness should be defined much more globally and can include: vertigo, lightheadedness, imbalance, and disorientation.  Other symptoms are often prevalent as well when a patient reports dizziness and should be relayed to a healthcare professional. This includes hearing changes, loss of balance/falls, blood pressure changes, historical head injuries, and nervous system changes. How often, how long, and to what severity these symptoms are occurring is also pertinent information that should be given to health care professionals. Properly defining what subset of dizziness, as well as any other corresponding symptoms the patient is experiencing, will best allow practitioners to direct appropriate care.

Treatment.
The cause of vertigo is unsolved. What we do know is crystals form in a person’s ear; these crystals can get lodged in one of the three rings within the ear canal, causing the imbalance. Certain positions, collectively known as the Epley Maneuver and created by Oregon ophthalmologist Dr. John Epley, help move the crystals to a location in the ear that does not affect balance. There are other maneuvers that can also be done to help alleviate vertigo, but the Epley maneuver is one of the more commonly practiced — and is the method I practice for treatment. After successfully treating hundreds of patients with vertigo, and seeing a 90 percent success rate of diminish symptoms after only 1 visit, I invite you to improve your quality of life with a visit to our office.

HARTZ Physical Therapy is happy to assess all patients that report dizziness. Our therapists are specially trained to treat a wide variety of dizziness disorders, including forms of vertigo, and are always willing to refer to another specialist, if indicated. Many insurance plans allow you to be seen as a Direct Access patient and therefore, do not require a physician’s referral prior to beginning physical therapy.

Concussions

Woman with vertigo. Young patient suffering from dizziness

In recent years, high profile professional sports have made concussions the topic of frequent discussion and helped fuel public interest on their appropriate management.

WHAT IS A CONCUSSION?   A concussion is a change in brain function following a force to the head that may be accompanied by a temporary loss of consciousness.  It is identified in awake individuals with measures of neurological and cognitive dysfunction. A concussion, therefore, is actually a mild form of traumatic brain injury and something that needs to be taken very seriously. Outdated misconceptions such as, if you didn’t lose consciousness it’s not that serious of an injury, are thankfully being replaced by more education and awareness.

According to the American College of Sports Medicine, concussions have increased at all age levels of sports participation over the last few years. Therefore, it is very important that all athletes, regardless of age, are aware of post-concussion symptoms. Parents also need to be educated so that they may closely watch a child after injury for signs of impairment. A child should be monitored for days if a concussion is suspected even if he/she reports feeling okay.

HOW CAN I IDENTIFY A CONCUSSION?   Symptoms of a concussion may reveal themselves in many different ways and can occur days after the initial trauma. Immediate signs of a concussion include loss of consciousness, confusion or disorientation, vomiting, and/ or amnesia. Delayed symptoms include headaches, dizziness, feeling tired, nausea, and cognitive difficulties. If a concussion is suspected during a game or practice, the athlete should stop play immediately. Previously, athletes could be cleared to return the same day, but neurologists have determined that it is not possible to make accurate immediate assessments after the injury and it is too dangerous to risk returning too soon. Athletes under age 18 are managed more conservatively because recovery time after a concussion has actually been shown to be longer in adolescents than adults.

TREATMENT OF A CONCUSSION: If a concussion is suspected, an athlete should take the following precautions:

  • EVALUATION BY A MEDICAL PROFESSIONAL who is educated in concussion management. MRIs and CT scans are rarely able to diagnose a concussion, therefore testing will include a thorough clinical exam that includes symptom assessment, physical exam, neurological exam, and a balance exam.
  • PHYSICAL AND MENTAL REST in an effort to reduce chance of further injury and to allow for the brain to fully heal. It is even recommended that the injured athlete refrain from activities including school work, TV, and other device use that may stress the healing brain.
  • MONITORING of the young athlete for changes in mood, sleep habits, headaches and other symptoms is essential. Return to sports participation is considered once the athlete’s symptoms have resolved.
  • A CONCUSSION REHABILITATION PROGRAM that involves progressive and gradual return to physical activity could be an important step for full recovery. This program is often advanced under the guidance of a physical therapist educated in concussion management and starts with basic light aerobics such a walking, biking, and/or swimming. If the athlete continues to have no symptoms with a specific phase of activity they may advance to a more advanced phase. An example of such a progressive therapy program would be:
  1. Light aerobics but no resistance training
  2. Sport-specific exercises of variable intensity but no head contact
  3. Light sports practice, drills and progressive resistance training
  4. Full contact practice
  5. Return to competition

If you are an athlete or the parent of a young athlete, it is important to become educated on concussions, their symptoms, and their treatment so that athletes and the medical community can work together to reduce the chance of a long-term injury associated with head trauma.

 

TMJ – Jaw Pain

What is TMJ?

TMJ is the acronym used to describe the temporomandibular joint. This joint is a hinge that connects the lower jaw to the temporal bone of the skull. (The temporal bone is in front of the ear on each side of your head.) Why is this joint so important? Well, it’s flexible, letting our jaw move up and down (for things like talking, eating, yawning and more!). If there is a disorder of the TMJ, you may experience varying levels of pain. These disorders of the temporomandibular joint are referred to as TMD.

What Causes TMD?

The cause of TMD is not conclusive; however, there are some suggested causes such as:

  • Injury to the jaw or muscles of the head and/or neck,
  • Grinding or clenching teeth,
  • Stress (regularly tightening face/jaw muscles),
  • Rheumatoid arthritis in the TMJ

What are TMD symptoms?

  • Pain while chewing
  • Swelling of the face
  • Limited flexibility in being able to open your jaw
  • Popping noises when opening or closing your jaw and/or the jaw being stuck in a slightly open position

Think you’re experiencing TMD symptoms?

  • As a precautionary measure, start eating soft foods to minimize the effort spent on chewing. Additionally, avoid chewing gum and yawning.
  • Learn your options in treating TMJ prior to signing up for a surgical procedure. There are varying treatment measures that can be taken – including physical therapy. (Remember, direct access helps you get treatment, fast.) Learn about more treatment options here.

-Wayne McKinley, PT, OCS