Tag Archives: recovery

Case Reports Suggest Mechanisms for Resolving Concussion Symptoms through Osteopathic Manipulative Treatment

Two case reports published in The Journal of the American Osteopathic Association document improvements in concussion-related symptoms following an initial session of osteopathic manipulative treatment (OMT), according to the American Osteopathic Association.

“OMT has long been an instrumental tool in treating athletes,” said Dr. Naresh Rao, an osteopathic sports medicine physician who will be the team physician for USA Water Polo in Rio de Janeiro for the 2016 Summer Olympics. “With manual techniques including craniosacral therapy, we as osteopathic physicians have the ability to help the body restore the flow of cerebrospinal fluid through the central nervous system to promote healing and get our athletes with concussion-related symptoms back to their normal activities.”

In the first case report, a 27-year-old man was treated three days after a snowboarding accident, in which the patient fell and wasn’t wearing a helmet. He suffered from headache, nausea, dizziness and tinnitus during the days after the fall. After one 25-minute OMT session, the patient reported the dizziness, tinnitus and nausea had resolved and his scores on the Sensory Organization Test (SOT), a computerized measure of balance, improved from 76 before treatment to 81 after treatment.

The second case involved a 16-year old girl with a history of three head injuries, the most recent involving a head-to-head collision. Three weeks after that injury, she reported headache, fatigue, mood swings as well as memory and concentration problems that limited her ability to participate in school and band.

The authors evaluated the girl using the Initial Concussion Symptom Score (CSS), which measures progression of symptoms on a scale of 0 to 144, and the Balanced Error Scoring System (BESS), a 0 to 30 scale measuring vestibular dysfunction. On the day after her first OMT treatment, her CSS decreased from 53 to 22 and her BESS improved from 22 to 17. At the end of six treatments, her CSS was 0 and BESS dropped to 14.

“These cases are consistent with the clinical experiences of osteopathic physicians who use OMT as part of a multidisciplinary approach to concussion,” said Dr. Rao. “While the mechanisms of healing are not well understood with concussion, formal studies measuring OMT’s impact on recovery and quality of life are much needed to demonstrate its efficacy as a viable therapy where there are very limited therapies to date.”

The full case reports are available online:

http://jaoa.org/article.aspx?articleid=2498827

http://jaoa.org/article.aspx?articleid=2498831

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Study Shows Less Physically Mature Ice Hockey Players Have Prolonged Concussion Symptoms

A study led by a Hasbro Children’s Hospital sports medicine physician found that male student ice hockey players in earlier pubertal stages had a significantly increased risk of prolonged symptoms from concussion compared with advanced pubertal and postpubescent players.

Research by Peter Kriz, M.D., found that less physically mature players took on average 54 days – 21 days or nearly 40 percent longer – to recover compared to more physically mature players. Kriz said the findings further highlight the need for student athletes in collision sports to compete with similar-aged players and that there is risk in having younger, more talented athletes “play up” on varsity teams.

“Unlike other contact-collision scholastic sports with a high incidence of concussion, high school ice hockey lacks stratification by age grouping, largely because of prohibitive costs associated with equipment, transportation and ice time incurred with fielding varsity, junior varsity and freshman teams,” said Kriz. “Consequently, it’s not uncommon at the varsity level for younger, less physically mature players to oppose older players with increased strength, power and speed.”

The study, currently published online in The Journal of Pediatrics, assessed disparities in age, size, and physical maturity level among concussed adolescent ice hockey players 13 to18 years of age, and was performed at Hasbro Children’s Hospital, Boston Children’s Hospital, and South Shore Hospital, in Weymouth, Massachusetts. Additionally, the study also found that lighter weight among males and heavier weight among females increased the probability of experiencing prolonged concussion.

Concussion has been reported to be the most common youth ice hockey injury, representing more than 15 percent of all injuries in nine to 16-year-old players and nearly 25 percent of injuries among male high school players.

The study’s results challenge recent opinion, which has suggested that collision sport participation be postponed until freshman year or 14 years of age. “Sixty-five percent of freshman male ice hockey players in our study were in early stages of pubertal development and none were postpubertal,” said Kriz.

The findings also support concerns within the youth athletic community that adolescents might have longer recoveries from concussions than adults.

“Our findings have important implications for policy decisions related to grouping for high school ice hockey players,” explained Kriz. “While economic considerations often dictate whether a school fields ice hockey teams other than varsity, we support, at the very least, the establishment of junior varsity ice hockey by state interscholastic leagues for the purposes of player development and improved safety for undersized, peripubertal male players.”

Additionally, policies pertaining to high school football and boys’ lacrosse — two other collision sports which commonly permit underclassmen to “play up” on varsity teams — may ultimately be impacted by these findings, as lighter, less physically mature players may be at risk of prolonged concussion symptoms.

Kriz recommends that, until further studies determine valid physical maturity indicators, arbitrary age and grade cutoffs should not be used to determine when adolescent athletes are ready to participate in collision sports.

“Until such studies are available, collision-sport high school athletes should play in leagues grouped by relative age,” said Kriz. “Highly-skilled, peripubertal collision sport athletes should also be discouraged from ‘playing up’ at the varsity level with post-pubertal competitors three to four years their senior.”

In accordance with recommendations from the American Academy of Pediatrics, Kriz encourages youth hockey organizations to provide the option of non-checking divisions for players who remain in earlier stages of pubertal development, players who are undersized, players who have significant concussion histories precluding them from participating in collision sport participation or for players 13 years old or younger seeking safer alternatives to body checking leagues.

This study was funded in part by the National Federation of State High School Associations Foundation and the Rhode Island Foundation.

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High-Fructose Diet Slows Recovery From Brain Injury

A diet high in processed fructose sabotages rat brains’ ability to heal after head trauma, UCLA neuroscientists report.

Revealing a link between nutrition and brain health, the finding offers implications for the 5.3 million Americans living with a traumatic brain injury, or TBI. According to the Centers for Disease Control and Prevention, an estimated 1.7 million people suffer a TBI each year, resulting in 52,000 annual deaths.DSC06935-B2

“Americans consume most of their fructose from processed foods sweetened with high-fructose corn syrup,” saidFernando Gomez-Pinilla, a professor of neurosurgery and integrative biology and physiology at UCLA’s David Geffen School of Medicine. “We found that processed fructose inflicts surprisingly harmful effects on the brain’s ability to repair itself after a head trauma.”

Fructose also occurs naturally in fruit, which contains antioxidants, fiber and other nutrients that prevent the same damage.

In the UCLA study, published today in the Journal of Cerebral Blood Flow and Metabolism, laboratory rats were fed standard rat chow and trained for five days to escape a maze. Then they were randomly assigned to a group that was fed plain water or a group that was fed fructose-infused water for six weeks. The fructose was crystallized from corn in a dose simulating a human diet high in foods and drinks sweetened with high-fructose corn syrup.

A week later, the rats were anesthetized and underwent a brief pulse of fluid to the head to reproduce aspects of human traumatic brain injury. After an additional six weeks, the researchers retested all the rats’ ability to recall the route and escape the maze.

The scientists discovered that the animals on the fructose diet took 30 percent longer to find the exit compared to those who drank plain water.

The UCLA team also found that fructose altered a wealth of biological processes in the animals’ brains after trauma. The sweetener interfered with the ability of neurons to communicate with each other, rewire connections after injury, record memories and produce enough energy to fuel basic functions.

“Our findings suggest that fructose disrupts plasticity — the creation of fresh pathways between brain cells that occurs when we learn or experience something new,” said Gomez-Pinilla, a member of the UCLA Brain Injury Research Center. “That’s a huge obstacle for anyone to overcome — but especially for a TBI patient, who is often struggling to relearn daily routines and how to care for himself or herself.”

Earlier research has revealed how fructose harms the body through its role in contributing to cancer, diabetes, obesity and fatty liver. Gomez-Pinilla’s study is the latest in a UCLA body of work uncovering the effects of fructose on brain function. His team previously was the first to identify the negative impact fructose has on learning and memory.

“Our take-home message can be boiled down to this: reduce fructose in your diet if you want to protect your brain,” Gomez-Pinilla stressed.

Sources of fructose in the western diet include honey, cane sugar (sucrose) and high-fructose corn syrup, an inexpensive liquid sweetener. Made from cornstarch, the liquid syrup is widely added as a sweetener and preservative to processed foods, including soft drinks, condiments, applesauce and baby food.

The average American consumed roughly 27 pounds of high-fructose corn syrup in 2014 — or just shy of eight teaspoons per day, according to the U.S. Department of Agriculture. That’s a drop from a decade ago, when Americans consumed more than 36 pounds of the syrup per year.

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