Article featured on Complete Concussion Management
Historically, patients with concussion were told to rest, rest, rest. And when that didn’t work, they were told to rest some more.
The research on concussions is evolving at an exponential rate and we are realizing that not only does prolonged rest not work; it can actually make you worse.
Sadly, many healthcare practitioners are not keeping up with the explosion in concussion research and are still telling their patients that the only treatment for concussion is rest. If you have fallen victim to this, you don’t need more rest; you need a second opinion.
While it is true that during the early stages following injury, moderate rest is still important, that timeline seems to be getting shorter, with longer duration rest creating worse outcomes for patients. So, if you have been resting for more than a week, and are still having significant symptoms, it’s time to switch it up. More rest is likely contributing to your ongoing symptoms.
If not rest, then what?
The top 5 most effective evidence-based treatment options for concussion:
1. Exercise Therapy
Following concussion, animal (and many human) studies have demonstrated a reduction in blood flow to the brain in the early stages. Recent research has found that these blood flow changes may persist for some time following injury due to ongoing dysfunction in the Autonomic Nervous System (ANS). The ANS consists to two opposing sides that tend to work in opposition to one another. The Sympathetic Nervous System is also known as the “Fight, Flight, or Freeze” system – this side of the ANS is responsible for increasing our heart rate, dilating our blood vessels to pump blood to our muscles, release adrenaline, dilate our pupils, and get us ready for action. Our Parasympathetic Nervous System on the other hand is our “Rest & Digest” system – this side of the ANS is responsible for lowering our heart rate, increasing our digestion, activating our metabolism, and helping us to be relaxed and calm.
These two systems can be thought of like a teeter-totter. When one is up, the other is down. They fluctuate their dominance throughout our days but the system should maintain a harmony and balance.
Concussion creates an imbalance in the ANS with most suffering from high “Sympathetic Tone” – this means that we are stuck in a fight or flight state. Our heart rate tends to be elevated and doesn’t respond well to increased demands, blood flow to our brain is not as responsive, our digestion shuts down sometimes leading to stomach pains, food sensitivities, and increased inflammation, our anxiety levels increase, we may get lightheaded more easily, and we suffer symptoms with increased cognitive and physical activity.
The good news is that this problem can be tested for and rehabilitated very easily; provided you know what you’re doing!
The mainstay rehabilitation for this problem actually goes against conventional thought: exercise!
Researchers at the University of Buffalo have published numerous studies demonstrating complete symptom resolution and improved brain blood flow (as measured on fMRI) through a specific graded exercise program alone.
More recent evidence suggests that exercise might even help speed recovery in the early stages after concussion!
It is important to see someone who knows exactly what they are doing with this protocol. Testing with a trained professional must be done first to establish set points as well as your specific program. There is also more to balancing the Autonomic Nervous System that must be taken into consideration as well.
2. Manual Therapy & Neck Rehab
With every concussion, there is also a whiplash.
Studies have demonstrated that the acceleration required to cause a concussion is somewhere between 70 and 120 G’s (where G = force of gravity = 9.8m/s2). Whiplash, on the other hand has been shown to occur at only 4.5 G’s.
It is therefore conceivably impossible for a concussion to occur without also causing a sprain or strain injury to your neck! In fact, a Canadian study found that 100% of the time, these injuries are happening together.
What becomes even more confusing is that the signs and symptoms of whiplash and neck dysfunction are the exact same as concussion! Headaches, cognitive and emotional problems, balance problems and dizziness, eye movement control problems, and brain blood flow abnormalities43 have all been shown to occur in whiplash and neck pain patients.
There is actually no way to tell if the symptoms are coming from your neck or from your concussion except with testing (some specific tests that we won’t go into here). In fact, most of the patients healthcare practitioners see in this category don’t report any neck pain; which makes this all the more confusing for practitioners. In a recent unpublished study with the University of Buffalo, the researchers found that there was absolutely no difference in the symptoms that whiplash patients report and the symptoms that concussion patients report.
Concussion is an injury that typically resolves quite quickly in most people (symptoms generally disappear for 80-90% of patients within 7 to 10 days); however, whiplash symptoms can linger for up to a year or more.
So, if you are still having concussion symptoms, even if you don’t have neck pain, you may actually be suffering from symptoms that are coming from your neck; which are easily treated with manual therapy and rehabilitative exercises.
3. Diet/Nutritional Changes
With injury to any tissue, there is inflammation; concussions are no exception with several studies demonstrating increased inflammatory markers following injury.
Concussion results in a metabolic dysfunction (read: energy deficit) in the initial stages, which is why strict rest used to be prescribed early on; the thought was – anything that burns energy, such as thinking or physical activity, could increase symptoms. As mentioned above however, rest is no longer considered an effective treatment for concussion.
It is important to note however that the majority of studies examining this metabolic disruption show a recovery between 22 and 45 days after injury. In other words, beyond a 3-6 week period, there is little metabolic explanation for your symptoms; unless of course you did not rest in the initial stages and/or received a second concussion soon after the first.
Treatment options for both of these things can include simple dietary changes such as avoiding pro-inflammatory foods (red meats, refined sugars, white breads and pastas, artificial sweeteners) and replacing them with healthier options such as fruits and vegetables, fresh caught fish (salmon, mackerel, herring), and good fats (coconut oil, flax seed, almonds). These changes may help to offset an ongoing inflammatory response and reduce your symptoms.
Another option would be to speak to your doctor about a short course of anti-inflammatory medications. Note that we say “short course” as, over a prolonged period, these medications can begin to harm your stomach and gut leading to ulcers.
4. Vestibular and Visual Rehab
Dizziness is one of the most common ongoing complaints of patients with persistent symptoms. This may be due to a number of overlapping issues such as problems with the balance centres of your brain, your visual system, and/or problems with the muscle and joint sensors of your neck.
Visual system problems may also be one of the causes of ongoing cognitive complaints such as trouble with concentration and/or memory. If you find yourself reading a passage and then having to re-read it several times before you understand what it is saying, you might have a problem with how your eyes are moving or working together. Testing for each of these areas requires extensive knowledge of each of the systems and how they may interact. If you have not had extensive testing of these systems, then you are in the wrong place!
Following a thorough assessment of these areas a proper rehabilitation program can be set up. The research on rehabilitation for these areas is extensive with numerous studies showing resolution of dizziness, and visual abnormalities with a fairly short course of treatment.
5. Education and Reassurance (due to Psychological Comorbidities)
It has been well established that patients with a pre-existing history of depression and/or anxiety tend to have prolonged symptoms. Not only that, the symptoms of these and other mental health conditions can result in, or mimic, the same symptoms of concussion (dizziness, mental confusion, concentration problems, sadness, emotional outbursts).
Many of these issues can begin before or after the concussion, which may be due to the concussion itself, or a direct result of being mismanaged by someone giving you improper advice. In other words, being told to sit in a dark room, avoid all social contact, not go to work or school, and not do any physical activity for months on end may be causing to the very anxiety, depression, and symptoms that you are attempting to stop.
Studies examining the overlay of mental health and concussion are endless (so much so that I won’t even begin to start referencing them), and mental health will always be a big part of concussion management. In most cases, patients often feel much better following some education and reassurance. The Ontario Neurotrauma Foundation recently demonstrated to be one of the best evidence-based treatment options for preventing long-term symptoms was patient education and reassurance!
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
Jog On: Exercise Won’t Raise Your Odds for Arthritic Knees
in UncategorizedArticle featured on MedicineNet
Dr. Kim Huffman, an avid runner, gets a fair amount of guff from friends about the impact that her favorite exercise has on her body.
“People all the time tell me, ‘Oh, you wait until you’re 60. Your knees are going to hate you for it’,” Huffman said. “And I’m like, ‘That’s ridiculous’.”
Next time the topic comes up, Huffman is well-armed: An extensive British analysis of prior study data has found no link between a person’s amount of exercise and their risk for knee arthritis.
The research team combined the results of six clinical trials conducted at different places around the globe, creating a pool of more than 5,000 people who were followed for 5 to 12 years for signs of knee arthritis.
In each clinical trial, researchers tracked participants’ daily activities and estimated the amount of energy they expended in physical exertion.
Neither the amount of energy burned during exercise nor the amount of time spent in physical activity had anything to do with knee pain or arthritis symptoms, the researchers concluded.
“This helps dispel a myth that I’ve been trying to dispel for quite a while,” said Huffman, an associate professor at the Duke University Medical Center’s division of rheumatology.
“If you add up the amounts of activity that people do and also the duration of activity, neither of those is associated with knee arthritis,” added Huffman, who wasn’t involved in the analysis.
Dr. Bert Mandelbaum is chief medical officer of the Los Angeles Galaxy soccer club and team physician for the U.S. Soccer Men’s National Team.
He agreed the study “further corroborates the fact that levels of exercise in one’s personal life do not increase the risk, the onset or progression of osteoarthritis.”
So where did this misconception come from?
Huffman thinks it’s because people mistake exercise-related injuries for the effect that exercise itself has on your joints.
“Right now, the clear risks for knee arthritis are genetics, injuries and female sex,” Huffman said. “People who exercise more may be more likely to injure their knee. That’s where I think the myth comes from.”
In fact, exercise can help ward off knee arthritis in several ways, Huffman said:
“I don’t think we’re finding that simple overuse or using your joint is a problem. It’s more an association with injuries and perhaps in the setting of obesity or high genetic risk,” Huffman said.
Your best bet is to choose an exercise that poses the least risk of a knee injury, Huffman said.
“If you want to go snow skiing, I don’t think that’s a huge problem but you’re probably going to be more likely to injure yourself downhill skiing than, say, walking in your neighborhood or training for a marathon,” Huffman said. “It’s not soccer or football or skiing itself. It’s just the risk for injury during those activities.”
On the other hand, exercise provides benefits that go far beyond healthy joints, said Mandelbaum, co-chair of medical affairs at Cedars-Sinai Kerlan-Jobe Institute at Santa Monica, Calif. He played no role in the research review.
“Physical activity is essential to optimize both physical and mental health and plays a central role in facilitating life’s quality and quantity,” Mandelbaum said. “The list of benefits includes decreased anxiety, better mood, decreased levels of coronary disease, hypertension, diabetes and obesity, and therefore a longer life.”
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
6 Causes of Neck Pain
in Neck PainArticle featured on Practical Pain Management
The human neck houses incredibly important structures—the airway, the voice box, the food-entry canal (esophagus), all the nerves in the spinal cord, and of course the muscles and bones that “keep our heads on straight.” As a result of this plethora of activity, neck pain can arise from a variety of sources.
Neck pain can imply something simple like a stiff muscle, which can often be worked out with rest, therapeutic manipulation, or exercise. But neck pain can also be a warning sign of a medical emergency, such as in the case of bacterial meningitis (which can threaten one’s life) or cervical myelopathy (which can lead to paralysis). In these situations, seeing a doctor to distinguish the significance of your particular form of neck pain is warranted. Below is an overview of six potential sources of neck pain. See also our diagnosis and treatment sections for each.
1. Muscle Strain:
A strained muscle or group of muscles is often the source of neck pain. Strains can be caused by weight (including obesity), weak abdominal muscles (your “core”), or poor posture.
New studies about “tech neck” or “tablet neck” show that those who put themselves into odd positions while holding handheld electronic devices can also cause neck strain; try to avoid placing the device in your lap, which causes you to flex your neck down to look at the screen. The weight of the head on the spine, normally about 10 to 12 pounds, can increase to 60 pounds of load on the spine when the neck is flexed 60 degrees (See Hansraj, 2014).
Muscle-based neck pain can also occur from over-extending the neck. Sometimes called “belayer’s neck,” this position can be best described as a person standing at the bottom of a cliff and assuming a constant gaze upward to shift ropes and watch out for the safety of a climber. Not only are muscles affected by this position, but the facet joints of the spine are jammed together.
Certain occupational activities, sports, hobbies, and even sleeping in an odd position can lead to musculoskeletal neck strain and pain as well. A fall or car accident can spur muscular neck pain in the form of whiplash, leading to potential long-term damage or disability.
2. Cervical Disc Herniation:
In between the vertebrate in your spine are discs that serve as a cushion to the vertebrate above and below. Sometimes, through trauma or normal age degeneration, the outer hard layer of a disc breaks, and the inner, gel-like nucleus pulposus squeezes out, irritating the nerves behind it. This action is referred to as a herniated, bulging, slipped, or ruptured disc. When discs rupture within the cervical spine—that is, the vertebral column in the neck area, the movement can produce pain. Symptoms can also include pain between the shoulder blades or pain/numbness that radiates down the arm to the hand or fingers.
3. Rheumatoid Arthritis:
For individuals with rheumatoid arthritis (RA), neck pain typically comes years after the diagnosis; over 80% of patients who have had RA for 10 years wind up experiencing cervical spine issues (See Hamilton, 2000) as the disease can lead to damage in the hands, wrists, elbows, knees, and ankles. At higher risk are male patients and those with a positive rheumatoid factor, which your rheumatologist can likely share with you.
The good news is that neck pain is rarely the first known symptom of rheumatoid arthritis. When it does present in the neck, RA usually affects the atlantoaxial joint. This particular joint pivots the head so we can look left and right, up and down. As RA loosens ligaments, erodes bone, or causes thickened tissue around joints, the spinal cord and brain stem can condense, requiring urgent medical attention. Therefore, although rare, RA retains its spot on the list of possible neck pain causes even when there is no evidence of RA in the peripheral joints (eg, hips, knees).
4. Meningitis:
One of the most dangerous sources of neck pain is bacterial meningitis (also called meningococcal meningitis), as a person can go from neck stiffness to death in a matter of hours to days. The three membranes that coat and protect the brain and spinal cord, running through the neck and back, are called meninges. The dura mater guards the outside, the arachnoid mater serves as the webbed middle layer, and the pia mater shelters the central nervous system as the inner layer of meninges.
While the meninges shield our central nervous system (CNS), there are certain bacteria, viruses, and even fungi that can inflame and destroy these layers. Two of the most dangerous bacteria that can threaten one’s life rather quickly are called Neisseria meningitidis and Streptococcus pneumoniae. The bacteria are passed through saliva and the most common symptoms include fever, headache, and stiff neck. If you experience such symptoms, it is important to seek immediate medical attention.
While the highest global incidence of meningitis outbreaks occur in Sub-Saharan Africa, Centers for Disease Control and Prevention (CDC) data show that outbreaks can also occur in communities, schools, colleges, prisons, and other populations around the US. Viral and fungal forms of meningitis also exist, but are often less severe.
5. Tumors:
Since the airway is contained in the human neck, a lifetime of inhaling a toxic substance, such as asbestos, wood, nickel, dust, or tobacco, could mean that neck pain is being caused by a tumor. At least 75% of head and neck cancers are caused by tobacco and alcohol use (See Blot, 1988). Cancers in the neck usually involve abnormal cell growth in the squamous cells, which are the moist, mucosal cells that line the mouth, nose, and throat. Less often, neck cancer originates in the salivary glands or thyroid glands.
Sometimes cancer originates in squamous cells elsewhere in the body and then spreads to a neck lymph node, creating a lump. This cancer is called metastatic squamous neck cancer with occult primary. Symptoms can include pain or a lump in the neck or throat.
Human papilloma virus (HPV) is a growing culprit in oropharyngeal cancers; according to the National Cancer Institute, HPV is the source of 26,000 new head and neck cancers each year.
6. Cervical Myelopathy:
This version of neck pain usually indicates that immediate surgery may be needed. If you notice pain or numbness in your arms or legs, frequent tripping, or sudden bladder incontinence, it may be because the spinal cord is being compressed. Known as cervical myelopathy, the condition can lead to permanent disability or paralysis if left untreated, which is why surgery is usually advised.
Degenerative cervical myelopathy, also called osteoarthritic or cervical spondylosis, occurs when any of a host of degenerative problems occur, such as herniated discs, swollen ligaments, or bone spurs. Bone spurs, also called osteophytes, can grow as a result of osteoarthritis, poor posture, or traumatic injury; changes that are more common with age. Continued degeneration or trauma can lead to cervical stenosis, which means that the space in the spinal canal has narrowed. When this narrow canal pinches the spinal cord, myelopathy, or neurologic deficits (abnormalities in body function), can occur.
Overall, diagnosing neck pain can be tricky, but with the proper medical exams and tests, your doctor can narrow down the cause of your pain to make an accurate diagnosis.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
11 Chronic Pain Control Techniques
in Chronic PainArticle featured on Spine-Health
While preparing for any chronic pain coping method, it is important to learn how to use focus and deep breathing techniques to relax the body. Learning to relax takes practice, especially while in pain. It is beneficial to be able to release muscle tension throughout the body and start to remove attention from the pain.
Coping techniques for chronic pain begin with controlled deep breathing, as follows:
After relaxation and focus are achieved, imagery techniques can be used.
Eleven specific imagery and chronic pain control techniques that are effective for pain management include:
Some of these techniques are probably best learned with the help of a professional, and it usually takes practice for these methods to become effective in helping alleviate chronic pain. It is often advisable to work on pain coping strategies for about 30 minutes 3 times a week. With practice relaxation and chronic pain control can become strong and last for a long time.
After learning these techniques, chronic pain relief and relaxation can be produced with just a few deep breaths. These techniques can then be used while being engaged in any activity, working, talking, etc. With enough experience, a greater sense of control over the chronic pain and its effects on life can be felt.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
What is Osteoarthritis and Everything You Need to Know
in OsteoarthritisArticle featured on Medical News Today
Osteoarthritis (OA) causes inflammation in the joints and the breakdown and gradual loss of joint cartilage. As the cartilage wears down, a person experiences pain and difficulty with movement.
OA is a common joint disorder. It develops in the hand, for example, in 1 in 12 people over the age of 60, according to the Arthritis Foundation.
OA is a progressive disease, which means that symptoms worsen over time.
There is no cure, but treatment can help manage pain and swelling and keep a person mobile and active.
Symptoms
OA leads to pain and stiffness in the joints.
In the early stages, a person may have no symptoms. Symptoms may occur in one or more joints, and they tend to appear gradually.
When symptoms develop, they can include:
The progression of OA involves:
Effects
Cartilage is a protective substance that cushions the ends of the bones in the joints and allows the joints to move smoothly and easily. In people with OA, the smooth surface of the cartilage becomes rough and starts to wear away. As a result, the unprotected bones start to rub together, causing damage and pain. Eventually, bony lumps form on the joint. The medical names for these are bone spurs or osteophytes, and they can lend a knobbly appearance to the joint. As the bones change shape, the joints become stiffer, less mobile, and painful. Fluid may also accumulate in the joint, resulting in swelling.
While OA can develop in any joint, it commonly affects the knees, hips, hands, lower back, and neck.
The knees
OA usually occurs in both knees, unless it results from an injury or another condition.
A person with the condition may notice that:
The hips
A person with OA in the hips may find that any movement of the hip joint, such as standing up or sitting down, can cause difficulty or discomfort.
Pain in the hips is a common feature of the condition. OA in the hips can also cause pain in the knee or in the thighs and buttocks.
A person may experience this pain while resting as well as while walking, for example.
The hands
In the hands, OA can develop in:
A person with the condition may notice:
For some people, the finger pain decreases and eventually goes away, though the swelling and bumps remain.
Anyone who experiences joint stiffness and swelling for more than 2 weeks should see a doctor.
Causes
Doctors do not know the exact cause of OA, but it seems to develop when the body is unable to repair joint tissue in the usual way.
It often affects older people, but it can occur at any age.
Genetic factors
Some genetic features increase the risk of developing OA. When these features are present, the condition can occur in people as young as 20 years old.
Trauma and overuse
A traumatic injury, surgery, or overuse of a joint can undermine the body’s ability to carry out routine repairs and may trigger OA, eventually leading to symptoms.
It can take several years for OA symptoms to appear after an injury.
Reasons for overuse or repeated injury include jobs and sports that involve repetitive movement.
Risk factors
A number of risk factors increase the chances of developing OA.
Other conditions
Some diseases and conditions make it more likely that a person will develop OA.
Diagnosis
A doctor will ask about symptoms and perform a physical examination.
No definitive test can diagnose OA, but tests can show whether damage has occurred and help rule out other causes.
Tests may include:
X-rays and MRI: These can reveal bone spurs around a joint or a narrowing within a joint, suggesting that cartilage is breaking down.
Joint fluid analysis: A doctor will use a sterile needle to withdraw fluid from an inflamed joint for analysis. This can rule out gout or an infection.
Blood tests: These can help rule out other conditions, such as rheumatoid arthritis.
Treatment
While no treatment can reverse the damage of OA, some can help relieve symptoms and maintain mobility in the affected joints.
Interventions include exercise, manual therapy, lifestyle modification, and medication.
Medication
Medication can help reduce pain.
Physical therapy
Various types of physical therapy may help, including:
Assistive devices
Various tools can provide physical support for a person with OA.
Do not use a splint all the time, however, as the muscles can weaken without use.
Surgery
Some people may need surgery if OA severely affects the hips, knees, joints, or the base of the thumbs.
A doctor will usually only recommend surgery if other therapies have not helped or if there is severe damage in a joint.
Some helpful procedures include:
Arthroplasty
This involves a surgeon removing the damaged areas and inserting an artificial joint, made of metal and plastic. Some refer to this procedure as a total joint replacement.
The joints that most often require replacing are the hip and knee joints, but implants can also replace the joints in the shoulder, finger, ankle, and elbow.
Most people can use their new joint actively and painlessly. However, there is a small risk of infection and bleeding. An artificial joint may also come loose or wear down and eventually need replacing.
Arthrodesis
This involves a surgeon realigning, stabilizing, or surgically fixing the joint to encourage the bones to fuse. Increased stability can reduce pain.
A person with a fused ankle joint will be able to put their weight on it painlessly, but they will not be able to flex it.
Osteotomy
This involves a surgeon removing a small section of bone, either above or below the knee joint. It can realign the leg so that the person’s weight no longer bears down as heavily on the damaged part of the joint.
This can help relieve symptoms, but the person may need knee replacement surgery later on.
Complications
Septic arthritis is joint inflammation caused by bacteria. Joint replacement surgery slightly increases the risk of this infection.
This is a medical emergency, and hospitalization is necessary. Treatment involves antibiotic medication and drainage of the infected fluid from the joint.
To discover more evidence-based information and resources for arthritis, visit our dedicated hub.
Lifestyle tips
A range of strategies can help ease the symptoms of OA. Ask the doctor for advice about suitable lifestyle adjustments. They may recommend:
Exercise and weight control:
Exercise is crucial for:
Current guidelines recommend that everyone should do at least 150 minutes of moderate-intensity exercise each week.
A doctor or physical therapist can help develop an exercise program, and it is important to follow their instructions carefully to prevent further damage.
Choose activities that will not put additional strain on the joints. Swimming and other types of water-based exercise are a good way to keep fit without putting additional pressure on the joints.
Learn more here about suitable exercises for arthritis of the knee.
Assistive devices and adjustments
A loss of mobility due to OA can lead to further problems, such as:
A physical or occupational therapist can help with these issues. They may recommend:
Supplements
Some research has suggested that people with low vitamin D levels have a higher risk of OA. Also, in people with a low vitamin C intake, the disease may progress more rapidly.
Low levels of vitamin K and selenium may also contribute, but confirming these findings will require further research.
Some people use supplements for OA, including:
The American College of Rheumatology note that there is not enough evidence to support the safety and effectiveness of these supplements for OA. They recommend asking a doctor before using them.
Outlook
OA is a common disease that causes joints to deteriorate, leading to pain and stiffness. It tends to appear during middle age or later.
There is currently no cure, but researchers are looking for ways to slow or reverse the damage. Lifestyle remedies and pain relief medications can help manage it.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
Common Sports Injuries and How to Treat Them
in Sports Related InjuriesArticle featured on Arkansas Surgical Hospital
Most sports injuries result from either overuse of a joint or damaging a joint through tearing or spraining ligaments or muscles. Some of the most common sports injuries include torn ACLs, shoulder dislocation, torn rotator cuffs, and sprained ankles. During the late summer months, emergency departments and orthopedic specialists see a sharp uptick in these injuries. Sports such as baseball, basketball, volleyball, and tennis contribute to the increase in sports injuries.
Sprains
Sprains or strains are the most common sports injury, with ankle sprains affecting 25,000 people every day. Any sports activity that requires running, lunging, or shifting on your feet can lead to an ankle sprain, which is the stretching or tearing of ankle ligaments. A strain is damage to the tendons or muscles. Both cause swelling, pain, and the need to stop using the ankle for a while.
To minimize your risk of ankle sprains, make sure you stretch and warm up properly before any sports activities. Stretching helps warm up the ligaments and muscles and makes them more flexible. More flexibility means less chance of overextending the ligaments and causing damage.
Torn ACL
Knee injuries can be devastating to casual exercisers as well as athletes. The ACL (anterior cruciate ligament) in the knee is one of the major ligaments controlling joint movement and preventing overextension of the knee. The ACL connects the upper and lower leg bones. Most torn ACLs are the result of sudden stopping and starting movements or shifts in direction. They are common in basketball and other sports that may cause the individual to shift balance quickly. Jumping and landing, as in volleyball, can also cause a torn ACL. If you are exercising or participating in a sport and hear or feel a sudden “pop” in your knee, you may have torn your ACL. A torn ACL will cause severe pain, the inability to put weight on your leg, and swelling.
As with any potential sports injury, the first step in prevention is proper preparation. Stretching and warming up will help prepare the ligament for exercise. Stretching after workouts will also help keep the joint from tightening up and becoming injured.
Exercising correctly is also crucial. Practice landing and jumping properly. Your knees should be straight for jumping and bend when landing. Try not to twist your knees when you’re jumping or coming back down, which increases stress on the ACL. Changing directions should also be practiced so you can do it without twisting the knees.
Shoulder Dislocation
A dislocated shoulder has a wide range of symptoms, including deformity of the joints, severe pain, swelling and bruising, instability or locking of the joint. There may also be weakness, burning, or numbness in the neck or arm. Some people may experience shoulder spasms that increase the pain. Unfortunately, there is a 7 in 10 chance of a repeat shoulder dislocation after the first one. For this reason, it’s imperative to learn ways to prevent it in the first place and minimize the chance of recurrence.
For tennis players and others who rely on their shoulder joint, warm-up and stretching are a good idea, but they should also take the time to strengthen the shoulder joint, so it’s less likely to become dislocated. Exercises can be as simple as pushing out against a wall with your arm; elbow flexed as though shaking hands with someone. Repeat this up to 20 times, holding for 5 seconds each time. Then push the arm and shoulder inward, pressing the bent hand into the opposite palm, repeating 20 times for 5 seconds each time. Resistance band exercises can also strengthen the shoulder joint, as can working with lightweight dumbbells.
Many shoulder dislocations are the result of falling and catching yourself improperly. If you do fall, resist the urge to catch yourself with your hands, as this frequently leads to a shoulder dislocation or broken arm bone. Keep your arms bent close to your body, spinning so that you land on your buttocks or side. Wearing protective gear on your shoulders can also help prevent repeat injuries.
Torn Rotator Cuff
Fraying or the tearing of rotator tendons in the shoulder is known as a torn rotator cuff. While physically active people are most susceptible to a torn rotator cuff, you can also sustain a torn rotator cuff even if you are sedentary. The pain of a torn rotator cuff may be sudden and severe or begin as a nagging pain when using the shoulder for routine activities such as shaking hands, lifting things, putting on clothing, or reaching behind the body. Severe pain at night due to swelling may interfere with sleep.
Exercise focusing on strengthening the small cluster of muscles in the rotator cuff. Combine activities that strengthen the entire shoulder area with some exercises specifically for the rotator cuff. Lower resistance with multiple repetitions is best for strengthening the area. Keeping the movements small and controlled will also help.
The Takeaway
Increased activity and participation in sports are good for your health, and changes in the weather makes it more enjoyable. To make sure you can continue to enjoy your activities, the crucial elements are proper warm-up, exercises to strengthen your joints, and knowing how to move correctly to minimize the possibility of injury. Working on balance and stability is also helpful. Yoga, tai-chi, and other activities that focus on slow stretching and enhanced, safe movement can help reduce injuries. Knowing your limits is also essential. If you haven’t played basketball for a few years, a rigorous game the first time out isn’t a good idea. You need to relearn how to move safely and make sure your muscles and ligaments are properly toned and warmed up every time you play.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
When to Turn to Spine Surgery When Nothing Else Will Do
in Spinal Surgery, SpineArticle featured on Brigham Health Hub
For many years, Diane Daigneau of Woburn, MA, was able to successfully manage her back and neck pain. Through occasional chiropractic treatments and mild pain relief medications, she was able to continue to work and play.
A few years ago, however, she discovered that circumstances can change dramatically, to the point where even the best non-surgical care fails to provide adequate relief. Such was the case during the summer of 2013, when the pain radiating through Diane’s back, neck, and arms had become so debilitating and persistent that no physician was recommending anything other than cervical spine (neck) surgery.
From Manageable to Intolerable
Diane likes making things pretty. More than that, it’s her job.
She often spends several hours hovering over a single piece of furniture while meticulously applying delicate gold or silver leafing, or some other type of elegant exterior. It’s a mentally and physically demanding job, particularly for someone who has struggled with back and neck pain. But Diane’s pain was never so bad that she ever worried about not being able to do her job or any other enjoyable pursuits. That changed suddenly during a family vacation at the end of July 2013.
Diane woke up on the second morning of her vacation with a new kind of pain. “The pain was unbearable,” says Diane. “It was something like I had never experienced before. There was nothing I could do.”
Along with intense pain, she had limited range of motion in her neck and numbness throughout her neck, shoulder, arms, and chest.
She ultimately headed back home for an MRI, which revealed that two herniated (bulging) discs were crushing nerves in her cervical spine.
A Surgical Solution
Through a colleague, Diane was referred to a spine neurosurgeon for a consultation. Based on her condition, the doctor recommended a two-level anterior cervical discectomy (disc removal).
The doctor started the procedure by approaching Diane’s spine through the front of her neck instead of through her back. There are two distinct advantages to this method. The most important is a significantly reduced risk of damaging the spinal cord. The other is less cutting of muscle, which helps to reduce postoperative pain.
Once the affected area of the spine was reached, the doctor completely removed both bulging discs to take the pressure off of the nerves. Next, to maintain the integrity of the spine, he snugly inserted a graft into each area where a disc had been removed.
The carbon fiber cages used for Diane’s surgery are now the standard of care for discectomy and fusion in the doctor’s practice, and a significant advance from the combined use of grafts (natural or synthetic) and titanium plates. A multi-center study, in which the doctor participated, demonstrated that using a carbon fiber cage alone provides the same strength and functionality as provided by a graft and titanium plate. However, the comparative simplicity of the carbon fiber cage – less material, fewer parts – decreases operation time, reduces the impact on surrounding tissue, and minimizes manipulation of the esophagus.
No Surprises
Diane admits that her recovery hasn’t been easy, but neither has it been a surprise. “I knew all along, step by step, how things were going to be for me,” she explains. “It’s not fun, but at least you’re feeling confident that things are going in the right direction.”
The doctor is similarly confident about the progress of Diane’s recovery. He told Diane that the carbon cages and fused vertebrae eventually will make her neck so strong and stable, as strong as it was before, that she could participate in extreme sports within a year.
Although she finds that claim to be reassuring, Diane doesn’t plan on jumping out of any airplanes in the near future. She’s quite happy to simply be walking, jogging, working – or waking up – without the fear of back and neck pain.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
What is Secondary Osteoporosis?
in OsteoporosisArticle featured on MedicalNewsToday
Osteoporosis is a bone disease that involves a loss of bone density. It causes the bones to become more fragile and prone to fractures. Secondary osteoporosis develops either as a result of a medical condition or as a side effect of a medication.
Osteoporosis affects about 10 million people in the United States. The disease may be primary or secondary. Primary osteoporosis occurs as a result of the natural aging process, whereas secondary osteoporosis occurs due to other reasons.
This article describes the difference between primary and secondary osteoporosis. It also outlines the possible causes of secondary osteoporosis and provides information on the symptoms, diagnosis, and treatment options.
Primary vs. secondary osteoporosis
Doctors categorize osteoporosis into primary and secondary osteoporosis.
Primary osteoporosis is a consequence of the aging process. In females, hormones such as estrogen and progesterone decline after menopause. These hormones are essential for healthy bones, and when their levels are low, the body becomes less able to produce new, healthy bone tissue.
Secondary osteoporosis develops when an underlying medical condition or the use of a certain medication interferes with the body’s ability to produce new bone tissue.
Causes of secondary osteoporosis
Secondary osteoporosis may develop when certain medical conditions or medications interrupt the formation of new bone tissue. An imbalance between the loss of old bone and the production of new bone leads to a lower bone turnover rate. The result is a loss of bone density.
Medical conditions
Medical conditions that may lead to secondary osteoporosis include:
Medications
In most cases, secondary osteoporosis occurs as a result of taking certain medications, which include those below.
Hormones and medications that affect the endocrine system
The endocrine system is a network of glands that produce and secrete hormones for a wide range of bodily functions. Hormones and other medications that affect the endocrine system may cause secondary osteoporosis. Examples include:
Medications that affect the immune system
The immune system consists of various organs, cells, and proteins that work together to protect the body from pathogens and toxins. Medications that affect the immune system may cause secondary osteoporosis. Examples include antiretroviral therapy and calcineurin inhibitors.
Medications that act on the central nervous system
The central nervous system (CNS) consists of the brain and spinal cord. Medications that affect the CNS can increase the risk of secondary osteoporosis. These include anticonvulsants and antidepressants.
Medications that affect the gastrointestinal tract
The gastrointestinal tract consists of all the organs involved in the digestive process. Medications that affect the gastrointestinal tract can increase the risk of secondary osteoporosis. An example is proton pump inhibitors, which reduce the production of stomach acid.
Symptoms
People with osteoporosis are usually unaware that they have the condition, as they typically do not experience any symptoms. Often, people only receive a diagnosis of osteoporosis following a bone break from a fall or sudden impact.
The most common injuries associated with osteoporosis are:
As the bones become increasingly fragile, people may experience fractures in other parts of the body. Seemingly harmless activities, such as sneezing or coughing, can sometimes cause these fractures.
Some older people with the condition may develop a stooped posture due to bone fractures within the spine.
Diagnosis
A doctor will perform a thorough medical examination to look for conditions that may cause secondary osteoporosis. They will also take a full medical history to help identify any medications that may be associated with the condition.
Simple screening procedures can help identify possible causes of secondary osteoporosis. These procedures may include:
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
Options for Treating Arthritis in the Knee
in Arthritis, Knee Injuries, Knee Pain, Knee SurgeryArticle featured on The Noyes Knee Institute
Knee osteoarthritis can occur when the cartilage around the knee wears down. Without the protection of cartilage, bones in the joint grind together, causing inflammation and pain. In severe cases, a knee surgeon might recommend knee replacement or arthroscopic surgery. Fortunately, many non-invasive options help relieve the pain of arthritis in the knee.
Osteoarthritis and Rheumatoid Arthritis: What’s the Difference?
Knee osteoarthritis is a progressive condition in which the subchondral bone suffers damage as the cartilage slowly wears away. This type of arthritis is common in middle-aged and elderly patients and happens more frequently in females than males.
Rheumatoid arthritis (RA) is a disorder of the autoimmune system which leads to chronic inflammation. RA usually presents in both knees at the same time. Other joints, including fingers, toes, ankles, and wrists may also be affected.
Both types of arthritis respond to the conservative treatments listed below. However, as an auto-immune disorder, RA also requires specific medical care.
Treatments for Arthritis in the Knees
Weight Loss
For every pound of weight lost, you relieve four to six pounds of pressure from the knee. Carrying a significant amount of extra weight puts extra strain on knee joints which aggravates arthritis symptoms. However, even if you are not obese, losing just five to ten pounds could significantly relieve arthritis pain.
Avoid Aggravating Activities
While it’s important to continue exercising and moving your knees, overdoing it can make problems worse. Avoid the following activities if you notice pain or swelling up to 24 hours after participation:
It may not be practical to avoid all of these activities every day, but reducing them as much as possible should help alleviate arthritis knee pain.
Anti-Inflammatory Medications
NSAIDs can be extremely helpful in easing arthritis pain. However, it’s important to use prescription or over-the-counter anti-inflammatory medications only as recommended by your physician. Overuse can cause serious side effects.
Knee Injections
Steroid or synthetic lubricant injections such as Synvisc may be recommended when diet and other lifestyle changes are ineffective.
Physical Therapy
Physical therapy and “knee-friendly” exercises are often recommended to help regain strength and flexibility in the knee joint.
Knee Surgery
When conservative methods fail, it may be time to consider knee surgery. Many people automatically think of total knee replacement when they think of surgery for treating knee arthritis, but there are several other surgical options to consider:
You and your knee surgeon will determine the surgical option that’s best for your situation. If you have sustained additional knee injuries, other procedures may be performed simultaneously as surgery to correct arthritis.
Should I see a Knee Surgeon?
If you have tried conservative therapies, but your arthritis pain continues to get worse, it may be time to consider surgery.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
What Happens After ACL Surgery
in ACL Injuries, Knee SurgerySee our recommendations for helping your knee recover (and when to call the doctor) after surgery. Find out what to expect from your rehab program, when you’re likely to start walking, and when it’s safe to start swimming and running.
Recovery from ACL Surgery
After anterior cruciate ligament (ACL) surgery, move your ankles up and down an average of 10 times every 10 minutes. Continue this exercise for two to three days to help blood circulation and to prevent blood clots from forming in your legs. If you develop acute pain in the back of your calf, tell your doctor. This could be an early sign of clots.
Elevate leg
Keep your operated leg elevated at a minimum of a 45-degree angle. Prop your leg on cushions or pillows so your knee is at least 12 inches above your heart for the first three to five days after surgery. Keep your leg elevated if your knee swells or throbs when you are up and about on crutches. Don’t put pillows behind your knee because this limits motion of the knee. Place pillows under your heel and calf.
Take pain medication
Expected pain and discomfort for the first few days. Take pain medications as your doctor advises. These could be over-the-counter painkillers, such as ibuprofen or acetaminophen, or stronger narcotic drugs.
Bend knee
Slowly begin bending your knee. Straighten your leg and bend your knee. If necessary, place your hands behind your knee for assistance bending your knee. The goal is to achieve a range of motion of 0 to 90 degrees by the time you return for your first post-operative visit a week after surgery.
Monitor for fever
A low-grade fever – up to 101 degrees Fahrenheit or 38.3 Celsius – is common for four or five days after surgery. If your temperature is higher or lasts longer, tell your doctor. Your temperature should go down with acetaminophen.
Remove bandage
The dressing on your knee is usually removed the day after surgery. There may be some minor fluid drainage for two days. Sterile dressings or bandages may be used during this time. After surgery, keep the wound clean and dry. Take sponge baths until the sutures are removed.
Rehabilitation
Your rehabilitation program to restore range of motion to your knee begins the moment you wake up in the recovery room. During the first week after surgery, most patients are encouraged to lift their legs without assistance while lying on their backs. These are called straight leg raises. By the end of the second or third week, patients usually walk without crutches.
Sessions with a physical therapist usually begin seven to 14 days after surgery. During physical therapy, weight bearing is allowed if you did not have a meniscus repair.
A range of motion of 0 to 140 degrees is a good goal for the first two months.
Don’t work your quadriceps early on because this can stretch the ACL graft. Stationery bike riding or lightweight leg presses are recommended during the first three months after surgery. These exercises strengthen the quadriceps while using the hamstrings to protect the ACL graft.
Don’t swim or run for five months. You can swim with your arms, without paddling your feet, at about two to three months after surgery.
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm
Top 5 Most Effective Evidence-based Treatment Options for Concussions
in Sports Medicine, Sports Related InjuriesArticle featured on Complete Concussion Management
Historically, patients with concussion were told to rest, rest, rest. And when that didn’t work, they were told to rest some more.
The research on concussions is evolving at an exponential rate and we are realizing that not only does prolonged rest not work; it can actually make you worse.
Sadly, many healthcare practitioners are not keeping up with the explosion in concussion research and are still telling their patients that the only treatment for concussion is rest. If you have fallen victim to this, you don’t need more rest; you need a second opinion.
While it is true that during the early stages following injury, moderate rest is still important, that timeline seems to be getting shorter, with longer duration rest creating worse outcomes for patients. So, if you have been resting for more than a week, and are still having significant symptoms, it’s time to switch it up. More rest is likely contributing to your ongoing symptoms.
If not rest, then what?
The top 5 most effective evidence-based treatment options for concussion:
1. Exercise Therapy
Following concussion, animal (and many human) studies have demonstrated a reduction in blood flow to the brain in the early stages. Recent research has found that these blood flow changes may persist for some time following injury due to ongoing dysfunction in the Autonomic Nervous System (ANS). The ANS consists to two opposing sides that tend to work in opposition to one another. The Sympathetic Nervous System is also known as the “Fight, Flight, or Freeze” system – this side of the ANS is responsible for increasing our heart rate, dilating our blood vessels to pump blood to our muscles, release adrenaline, dilate our pupils, and get us ready for action. Our Parasympathetic Nervous System on the other hand is our “Rest & Digest” system – this side of the ANS is responsible for lowering our heart rate, increasing our digestion, activating our metabolism, and helping us to be relaxed and calm.
These two systems can be thought of like a teeter-totter. When one is up, the other is down. They fluctuate their dominance throughout our days but the system should maintain a harmony and balance.
Concussion creates an imbalance in the ANS with most suffering from high “Sympathetic Tone” – this means that we are stuck in a fight or flight state. Our heart rate tends to be elevated and doesn’t respond well to increased demands, blood flow to our brain is not as responsive, our digestion shuts down sometimes leading to stomach pains, food sensitivities, and increased inflammation, our anxiety levels increase, we may get lightheaded more easily, and we suffer symptoms with increased cognitive and physical activity.
The good news is that this problem can be tested for and rehabilitated very easily; provided you know what you’re doing!
The mainstay rehabilitation for this problem actually goes against conventional thought: exercise!
Researchers at the University of Buffalo have published numerous studies demonstrating complete symptom resolution and improved brain blood flow (as measured on fMRI) through a specific graded exercise program alone.
More recent evidence suggests that exercise might even help speed recovery in the early stages after concussion!
It is important to see someone who knows exactly what they are doing with this protocol. Testing with a trained professional must be done first to establish set points as well as your specific program. There is also more to balancing the Autonomic Nervous System that must be taken into consideration as well.
2. Manual Therapy & Neck Rehab
With every concussion, there is also a whiplash.
Studies have demonstrated that the acceleration required to cause a concussion is somewhere between 70 and 120 G’s (where G = force of gravity = 9.8m/s2). Whiplash, on the other hand has been shown to occur at only 4.5 G’s.
It is therefore conceivably impossible for a concussion to occur without also causing a sprain or strain injury to your neck! In fact, a Canadian study found that 100% of the time, these injuries are happening together.
What becomes even more confusing is that the signs and symptoms of whiplash and neck dysfunction are the exact same as concussion! Headaches, cognitive and emotional problems, balance problems and dizziness, eye movement control problems, and brain blood flow abnormalities43 have all been shown to occur in whiplash and neck pain patients.
There is actually no way to tell if the symptoms are coming from your neck or from your concussion except with testing (some specific tests that we won’t go into here). In fact, most of the patients healthcare practitioners see in this category don’t report any neck pain; which makes this all the more confusing for practitioners. In a recent unpublished study with the University of Buffalo, the researchers found that there was absolutely no difference in the symptoms that whiplash patients report and the symptoms that concussion patients report.
Concussion is an injury that typically resolves quite quickly in most people (symptoms generally disappear for 80-90% of patients within 7 to 10 days); however, whiplash symptoms can linger for up to a year or more.
So, if you are still having concussion symptoms, even if you don’t have neck pain, you may actually be suffering from symptoms that are coming from your neck; which are easily treated with manual therapy and rehabilitative exercises.
3. Diet/Nutritional Changes
With injury to any tissue, there is inflammation; concussions are no exception with several studies demonstrating increased inflammatory markers following injury.
Concussion results in a metabolic dysfunction (read: energy deficit) in the initial stages, which is why strict rest used to be prescribed early on; the thought was – anything that burns energy, such as thinking or physical activity, could increase symptoms. As mentioned above however, rest is no longer considered an effective treatment for concussion.
It is important to note however that the majority of studies examining this metabolic disruption show a recovery between 22 and 45 days after injury. In other words, beyond a 3-6 week period, there is little metabolic explanation for your symptoms; unless of course you did not rest in the initial stages and/or received a second concussion soon after the first.
Treatment options for both of these things can include simple dietary changes such as avoiding pro-inflammatory foods (red meats, refined sugars, white breads and pastas, artificial sweeteners) and replacing them with healthier options such as fruits and vegetables, fresh caught fish (salmon, mackerel, herring), and good fats (coconut oil, flax seed, almonds). These changes may help to offset an ongoing inflammatory response and reduce your symptoms.
Another option would be to speak to your doctor about a short course of anti-inflammatory medications. Note that we say “short course” as, over a prolonged period, these medications can begin to harm your stomach and gut leading to ulcers.
4. Vestibular and Visual Rehab
Dizziness is one of the most common ongoing complaints of patients with persistent symptoms. This may be due to a number of overlapping issues such as problems with the balance centres of your brain, your visual system, and/or problems with the muscle and joint sensors of your neck.
Visual system problems may also be one of the causes of ongoing cognitive complaints such as trouble with concentration and/or memory. If you find yourself reading a passage and then having to re-read it several times before you understand what it is saying, you might have a problem with how your eyes are moving or working together. Testing for each of these areas requires extensive knowledge of each of the systems and how they may interact. If you have not had extensive testing of these systems, then you are in the wrong place!
Following a thorough assessment of these areas a proper rehabilitation program can be set up. The research on rehabilitation for these areas is extensive with numerous studies showing resolution of dizziness, and visual abnormalities with a fairly short course of treatment.
5. Education and Reassurance (due to Psychological Comorbidities)
It has been well established that patients with a pre-existing history of depression and/or anxiety tend to have prolonged symptoms. Not only that, the symptoms of these and other mental health conditions can result in, or mimic, the same symptoms of concussion (dizziness, mental confusion, concentration problems, sadness, emotional outbursts).
Many of these issues can begin before or after the concussion, which may be due to the concussion itself, or a direct result of being mismanaged by someone giving you improper advice. In other words, being told to sit in a dark room, avoid all social contact, not go to work or school, and not do any physical activity for months on end may be causing to the very anxiety, depression, and symptoms that you are attempting to stop.
Studies examining the overlay of mental health and concussion are endless (so much so that I won’t even begin to start referencing them), and mental health will always be a big part of concussion management. In most cases, patients often feel much better following some education and reassurance. The Ontario Neurotrauma Foundation recently demonstrated to be one of the best evidence-based treatment options for preventing long-term symptoms was patient education and reassurance!
The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.
Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.
If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.
Phone:
503-224-8399
Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209
Hours
Monday–Friday
8:00am – 4:30pm