Concussion Baseline Testing

The first, and by far the most important step in properly managing concussions comes before the injury happens. Actually, before the season even starts! A “baseline test” is a test that is done BEFORE a concussion happens.

The purpose of a baseline test is to measure every area of brain function, which could become affected following a concussion. This way, if an athlete does get a concussion, we can compare their post-injury state to their baseline parameters to help make an accurate diagnosis, as well as to establish when they are fully healthy and are safe to return to their sport. Without these baseline parameters we have no way of determining when the brain has fully recovered.

The initial concussion is generally not a large concern, especially since our certified practitioners are highly trained to treat and manage these injuries. However, it is a second concussion, sustained prior to full recovery of the initial concussion, that is a cause for concern as this may result in long term brain damage or other larger consequences. Ensuring every athlete has a baseline test done before their season starts is the first step in decreasing the greater risk of concussions.

Professional sports organizations have been undergoing pre-season baseline testing for years, however, comprehensive testing of this magnitude has never been available to youth and amateur sports associations; partly because most healthcare practitioners are not sure where to start.

Comprehensive Baseline

Many companies have been promoting online neurocognitive tests as “baseline concussion evaluations”, however when used as the only method of assessment, these tests have been shown to be extremely inadequate (see below), as they fall very short of testing all facets of concussion injuries. As part of a complete evaluation, these tests have been shown to lend a valuable insight into neurocognitive functioning. Our comprehensive baseline testing includes tests of all facets of concussion injuries, including but not limited to:

• Memory
• Concentration
• Visual Processing/Visual Movements
• Reaction Time
• Balance and Proprioception
• Motor Strength
• Neurocognitive Testing

Truth about online-testing

Baseline testing should be repeated at least once per year and should involve more than just online/computer-based neurocognitive testing.  Medical research has repeatedly demonstrated online or computer-based testing to be insufficient on their own. Several studies have shown, and several world-wide consensus statements have concluded, that by themselves, online testing may over-estimate recovery and send players back in to harms way.  It is important to off-set your online testing with a full protocol of physical and in-person baseline neurological testing.

Here are some quotes from recent research studies examining the usefulness of a concussion program that only uses online testing:

“Neuropsychological tests should only be used as a part of a comprehensive concussion management strategy and SHOULD NOT BE USED IN ISOLATION” — American Medical Society position statement on concussion in sport – Clinical Journal of Sports Medicine, 2013

“Computer-based concussion evaluations did not provide stable measures of cognitive functioning.  Inconsistent performance on concussion assessments may lead clinicians to inaccurate determinations of cognitive function” — Broglio et al., 2007

“We conclude that the empirical evidence does not support the use of ImPACT testing (a popular computer-based concussion test) for determining the time of post-concussion return to play” — Mayers et al. Journal of Clinical and Experimental Neuropsychology, 2012

Posted by Complete Concussion-Toronto, ON

Are you a different person since your concussion?

Cranial adjusting provides faster and better recovery for concussions

Post-concussion symptoms can remain long after the original trauma. Headaches persist, brain fog does not lift and disorientation can completely take over every aspect of life.

Modern advances in brain research and imaging have proven that the sutures to the bones in the skull contain blood vessels, nerves and connective tissue, all within a space 1/100th of an inch across. They help nourish the cranium and facilitate movement of the bones that form the skull. The impact of a concussion can knock bones out of alignment and cut off the circulation within these sutures. Because the skull bones are still misaligned from the trauma, it’s difficult for normal brain function to be restored.

However, traditional treatment protocols still prevail. Concussion sufferers are prescribed rest, including plenty of sleep at night plus rest during the day. Very gradually they can return to normal activities at a pace that does not reactivate the symptoms, or cause them to worsen.

Post-concussion symptoms can continue long after the injury

Symptoms can persist indefinitely, though, since the bones will not easily recover their anatomical alignment, on their own. Having previously sustained a sport concussion can also be a strong factor in increasing the susceptibility to further concussions, as well as suffering more severe symptoms. Successive concussions may worsen the previous symptoms, even if a subsequent injury occurs months or possibly years later. These are the inner reasons so many athletes decide to retire. On the outside they may still look young and strong, but they are not.

Cranial adjusting speeds recovery from concussions

We have developed a breakthrough technique for correcting the misalignments in the skull caused from the trauma involved in concussions. Our Cranial Adjusting Turner Style (C.A.T.S.) can realign the bones and restore the proper circulation of cerebral spinal fluid and blood to the nerves and tissues damaged by misaligned bones. We have have helped many concussion sufferers get back their lives and do it more quickly than the traditional treatment protocols.

-Cranial Adjusting Turner Style (C.A.T.S.), Dr. Roger Turner

The body-swing connection

Do you play golf?  If so, do you slice? Hook? Block? Push? Pull?  Even occasionally?  You no doubt have worked on your grip, stance, posture and rotation.  But have you considered that your own body is preventing you from holding that required posture and rotation through impact?

With a lack of joint mobility and core initiation, you likely struggle to maintain proper position and rotation during the golf swing. 

The aim of the Titleist Performance Institute (TPI) Movement Screen is to identify physical limitations that may hinder your golf performance.  TPI studied the relationships between their movement screen results and common swing faults and found significant correlations. 

Titleist identified three of the most common golf swing faults.  Loss of posture, early hip extension, and hip slide.

Loss of posture from address position to impact, is most commonly seen as a changed head position, but may appear as knee flexion or trunk flexion. The loss of posture is an indicator of an incorrect golf swing because you are unable to return the club on plane during the downswing.  To compensate, you would instinctively use your hands to square the club face at impact, which requires exceptional athletic ability to repeat consistently. 

Early hip extension makes it difficult for you to drop your arms down into the proper ‘slot’ for the downswing and can lead to blocked or hooked shots.  Early hip extension may also affect your ability to properly rotate your hips.  To compensate, you probably slide your hips during the downswing.

The slide is the undesirable excessive shift of the hips toward the target during the downswing.  This makes it challenging to stabilize the lower body during the downswing.  In addition to inconsistent contact, you will also lose most of the power created during the coiling of the upper body during the backswing.  

Based on analysis of their TPI data, Titleist identified these tests that most directly relate to the above swing faults: 

•      Overhead deep squat

•      Single-leg balance

•      Toe touch

•      Bridge 

TPI analysis shows that if you are unable to do an overhead deep squat or single-leg balance on your leading leg, you are 2-3 times more likely to demonstrate loss of posture, early hip extension, and slide. The inability to toe touch increases the likelihood of an early hip extension by 6x.  Weakness during a glut bridge test would suggest you are 5x more likely to suffer early hip extension and 6x more likely to lose your posture.

The TPI Movement Screen is made up of 38 specific tests and will identify your physical limitations (and strengths!).  I can help explain how your personal test results may impact your golf swing.  Your body will find the most natural feeling swing that it can execute; but not necessarily the correct swing. There are infinite ways to swing a club, but there is one only one efficient way based on what your body can physically do. Don't let your own body hold you back.

 Gulgin H et al, Correlation of Titleist Performance Institute (TPI) Movement Screens and Golf Swing Faults, J Strength Cond Res, 28 (2), 534-539, 2014

Are you ready for a Concussion?

With winter sports being in full swing one of the most important things that you should consider is having a full baseline concussion test done. But what exactly IS a baseline test and why should I get one?

Quite simply, a baseline concussion test is an assessment of various elements of brain function that are commonly impaired following concussion injury. The reason these tests are referred to as “baseline” is because they are an assessment of an individual BEFORE the injury occurs.

The deficits that typically occur with a concussion injury are often quite subtle and because every individual person is so uniquely different, it is virtually impossible to know how much impairment is present if we don’t know how you were when you were healthy. Every single professional, college, and university athlete goes through a comprehensive battery of pre-season baseline concussion testing each year, however there are currently no such mandated procedures for young athletes. 

Before you can understand the true value of a baseline test you must first understand how it can help to keep your brain safe and healthy. A concussion is due to a significant acceleration, or deceleration, of the brain within the skull. The initial signs and symptoms of concussion are due to a massive electrical storm, known as the Excitatory Phase, due to the impact. Contrary to popular belief, there is no “damage” that happens during a concussion. The injury simply creates an imbalance within brain cells that causes them to burn more energy than they can produce. This creates the second concussion phase known as the Energy Crisis. These energy stores continue to burn for hours to days after injury hitting their peak low-point around day 3 to day 5 after the injury has taken place. This is typically why a person will experience extreme fatigue following a concussion and is also why the initial treatment for concussion involves complete brain rest - it is an effort to conserve energy so that we can help our brain cells restore. Following this continual decline in energy over the first 3 to 5 days, the energy stores gradually start to build back up over the next 1 to 3 weeks depending on how well you are managed through proper diet and guidance from your healthcare provider.

During this recovery period, prior to the fully energy levels being restored, the brain is extremely vulnerable to any additional trauma. In fact, even smaller impacts can cause another concussion during this phase, and these second concussions can be quite dangerous.

Numerous research studies have found that if the brain fully recovers its energy back up to pre-injury levels and you suffer a second concussion, there will be little to no compounding effect. This means that the injuries will not add up to be a worse injury. It will simply result in another concussion.

BUT…

These same research studies have found that if a second concussion is sustained prior to your energy being completely restored, your energy levels plummet. A second concussion sustained prior to full recovery from the first can result in severe brain injury and in some cases, death. Because the energy stores are already depleted from the first injury, a second injury causes even further depletion to beyond the point in which the brain cells can survive. This results in permanent damage of the affected regions of the brain.

Here is the problem:

The symptoms of a concussion DO NOT reflect the actual recovery of the brain! So even after someone feels 100% better and believes that they are no longer concussed, they are still not fully recovered from a brain energy standpoint…and this is where the danger lies. Numerous studies have shown that after the symptoms of the injury have subsided, brain energy levels are still very low and people still show deficits in balance, reaction time, visual tracking and processing speed, memory, concentration, and numerous other higher order processing abilities.

There is no X-ray or brain scan that can determine when you have received a concussion or when your brain has recovered to the point where you are safe to return to sports. The best tool we have available to ensure that you are safe to sustain another impact is to measure you at baseline (before injury) and then measure you again when you think you have recovered. This way we can pick up these very subtle deficits that indicate that you may not be fully recovered and are therefore vulnerable to a severe, and potentially permanent, brain injury.

Your doctor can’t tell you when you have recovered…unless they have the data from all of these testing metrics from before you were injured. If they tell you that you are recovered without comparing you to your PRE-INJURY status, they are guessing. No one can see the energy levels in your brain. You can’t rely on how you feel; you must be tested.

Today's Modern Chiropractor

As a modern Chiropractor we take a functional and biomechanical approach to assessing, diagnosing and managing neuromusculoskeletal conditions. These conditions range from and include; acute and overuse injuries from sports training and competition, back and neck pain, headaches, and repetitive strain disorders from work.

Modern Chiropractors are not just back specialists anymore. Using various hands-on soft tissue and manual techniques in combination with appropriate patient education and exercises, Chiropractors restore the natural function of the body to allow it to heal properly, recover from injury, and improve overall health and performance. As modern Chiropractors we combine the art and philosophy of Chiropractic practice with the latest scientific literature in Chiropractic and Sports Medicine to provide a well-rounded and evidence-based approach to correcting neuromusculoskeletal conditions.

Now, through continual research and education, many other factors are thought to be at play with pain and dysfunction. While alignment/motion of the spine is important, proper functioning of the soft tissues around the spine are thought to be equally as important. Chiropractors are now trained to effectively examine, diagnose, and treat not just spinal dysfunctions, but the soft tissue dysfunction too, as one rarely exists without the other! 

This is why we use cutting edge Functional Movement screenings, soft tissue techniques such as Active Release, Trigenics and Kinesiotaping along with traditional chiropractic mobilization and manipulation to help each of our patients.