Case Study: Concussion

Patient: 15 year-old girl

Chief complaint: Constant headache, neck pain and dizziness after a concussion 2+ months ago

Back Story: The high school athlete sustained a concussion in Feb during a soccer game. At the ER, she was diagnosed concussion and was prescribed Ibuprofen. Her mom was proactive, and quickly got her involved in several rehab programs and therapies. By the time she saw me, she had gone through about 10 weeks of physical therapy, vestibular training, vision therapy, massage and chiropractic care. At that time, her neurocognitive testing (ImPACT test) had improved, but she continued to have constant headache on the top of her head, average 2-4/10 pain, and 6/10 at its worst. She also continued to have dizziness and neck pain.

Results

After 2 visits, her headache was gone for the first time in 11 weeks, and because of that, her emotional irritability also improved.

During the first month of specific Neuro-Structural Chiropractic Care, she was also undergoing speed and agility training prescribed by her MD a couple times a week. The problem was the jolting movements in this training always left her dizzy for quite some time after.

After we tweaked her vestibular exercises and gave her only a couple very specific eye exercises to do at home, she had no dizziness for the first time in weeks, and continued to be headache-free.

After 1.5 months of treatment (12 visits), she had no headache, dizziness or neck pain, and was cleared by her MD to return to play.

Discussion

1. Realistic expectation of recovery timeline

This is somewhat counterintuitive, but research has shown that young athletes recover from concussion more slowly than older athletes. ⁽¹⁾ If your child sustains a concussion, this is what you can expect. It is unlikely for the child to return to play within a couple days (2.5% probability). Most adolescent athletes make their way back to the sports within about a week (71.3% chance). ⁽²⁾ However, if your child is not able to return to play within 10 days, there is a good chance that he/she will have a prolonged recovery, which is the case for the girl in our case study. In this case, seek professional help as soon as possible.

2. Not all vestibular rehabs are the same.

Many of my post-concussive patients are slightly apprehensive when they hear vestibular rehab, because in their experience, the exercises often make them dizzy and they feel awful afterwards. But then they thought to themselves, I have to feel worse before I feel better, right? WRONG. When your rehab makes you feel worse afterward, this is a good indicator that the intensity and/or duration of the exercises are too much for your brain to handle. Less is more. Again. Less. Is. More.

Conclusion

1. If your child had a concussion, and was cleared by his/her physician to go home. Rest him/her for the first week. If he/she is not able to return to play after the first 7-9 days, seek professional help.

2. Although research suggests that the chance of return to play beyond 21 days post concussion does not increase, we beg the differ by what we see clinically. With the right therapies, the child can still make a relatively smooth recovery.

References:

1. Nesmith JD. Sports concussion in the child and adolescent athlete. J Ark Med Soc. 2010 Nov;107(6):111-4. [PubMed]
2. McKeon JMM, et al. Trends in concussion return-to-play timelines amon ghighscholl athletes from 2007 through 2009. J Athl train. 2013 Nov-Dec;48(6):836-843. [PubMed]

About the Author

Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.

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Case Study

Patient: 27 year-old male

Chief complaint: Left knee pain and swelling started 6 years ago

Back story: The patient was an avid road biker, but over time it had resulted in left knee swelling after rides and a constant ache above the knee cap. He eventually quit biking completely. When he visited our office, he was still experiencing the constant knee pain that was worse when going up stairs. On top of that, a couple times a week, he would get a severe sharp knee pain on the left without any warning, and his knee would give out.

Before visiting our office, he was instructed by his medical doctor to perform some quad exercises with minimal relief.

Results

After the first treatment, he was pain-free for 2 whole days. After 3 treatments, he no longer had the constant ache. He took a trip to Disney World with his family 3 weeks after the 3^rd visit. Despite all the walking and lifting, he did not experience a single episode of knee pain.

In fact, he has had 0 episodes of severe sharp pain in his left knee since his first treatment. 2 months ago, he was able to squat 315 lbs, which was something he had not felt stable to do in a long time. It’s been 4 months since his last knee treatment, and his knee continues to feel and work great.

Why Does It Work?

1. Correctly identifying the pain source. A thorough examination can help us narrow down the list of possible pain generators. Pain can arise from many different musculoskeletal structures, including muscles, joints, ligaments, and tendons. However, in this particular case, the pattern doesn’t match any of the above mentioned pain sources. The culprit was, in fact, some irritated peripheral nerves that are often overlooked by practitioners.
2. Treat the pain first. I’m not saying to chase the symptoms, BUT activation of the pain fiber inhibits activation of proper muscle groups. Before we go into active rehabilitation, we must bring the pain level down significantly.
3. Make sure the joints are moving well. Chiropractic adjustments for the knee is also important, because if the joint is not moving properly, it can also neurologically inhibit muscles around it and lead to pain and imbalance.
4. Gait analysis and retraining the muscles. Since the pain has been there many years, it has certainly resulted in abnormal muscle recruiting patterns. A digital gait analysis can help us correctly identify the weakness and prescribe specific exercises for it.

 Only by executing all these steps correctly are we able to attain long lasting results.

About the Author

Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families and helping people who could not get better through traditional and alternative means.

Want to keep up with future posts?

The post Case Study: Knee Pain – Chiropractor In Holland appeared first on Holland, MI Chiropractors | Brain and Body Chiropractic.