Concussions: Would I let my kid play contact sport???

As a Chiropractor, and a Medical Director for a number of local teams, I have had numerous hours of training and have been certified in concussion testing and management of concussions.  I do believe that concussions are an issue, but if managed properly (just as any injury) prognosis and recovery are very good. 

I've debated with numerous people about the risks of concussion in contact sport.   Would I let my child play a contact sport?  Without hesitation; YES! 
Looking at the risks of contact sports, there is a distinct possibility of getting a concussion among many other injuries including, but not limited to:  muscle strain, joint sprain, fractured bones, joint dislocations, paralysis and death. 

Lets look at the benefits of sport:  Strategy and learning to work together with others toward a common goal, meeting new friends (some life long friends), mental stimulation, and improved fitness.

I believe that the risks for disease(s) are higher for those who choose not to be active (playing video games), for those who choose to smoke or drink, for those that go out to cause trouble in the evenings because they are not playing a sport.


In simple terms, contact sports do not have a concussion problem; they have a concussion management problem.  

To the people I look up to, thanks for all you have done! Thanks Dr. Paj

I never thought about it until recently.  If you are good at what you do, not too may people make comments or give you feedback.  Its when you are bad at your job, that's when people have no problems letting you know about it.

I had a former student of mine message me and tell me that I was inspirational to him when he was a student.  I was a bit caught off guard as it has been a few years since I have taught, but it is extremely flattering and humbling to receive such praise. 

It made me stop and think about some of the people I look up to (the "who do I want to be when I grow up" moment!) 

One of the biggest influences for me in my chiropractic career has to be Dr. Jason Pajaczkowski.  I had the great fortune to do my clinical internship under his watch for 6 months (which is nowhere near enough time to learn all he knows).  I'd list all his accomplishments, but it would take too long (his business card is on legal size paper he has so many letters after his name!)  Dr. Paj (as he is fondly know by his students) has a passion for teaching and mentoring students.  One of the things I remember from Clinical Grand Rounds during exam time (which meant it wasn't that well attended) was standing room only when Dr. Paj was the clinician. 

While I was doing my internship, Dr. Paj offered me the opportunity to see him work his magic at his clinic.  It was an amazing experience to watch and learn from him.  He showed me some of the subtle signs that are missed at times by other therapists, but aid in proper diagnosis (which in turn, leads to the correct treatment.) 

I still have a pile of Dr. Paj's notes that he provided us during my internship and find myself looking back over them from time to time.  I still find that every time I look at those notes, I learn something new from them.

I look up to Dr. Paj.  I think it is important (even though it has been an number of years since he has taught me) that he knows how much of an influence he has had on what I do, and who I have become! I have reached out to let him know how much I appreciated all of his mentorship.

If you have took the time to read this post, you could probably take another few minutes to reach out to someone who you look up to and let them know about it!  I can guarantee you they will appreciate it!

Reasons why you DO NOT need to have a strong core

I have a lot of people tell me that they have a weak core and it needs to be strengthened. 

The first question I ask is; "What exactly is your core?" 

The second question is; "Why does it need to be stronger?" 

The answer to the first question is that our core is suppose to offer stability to an inherently poorly stabilized structure; the lumbar spine (the lower 5 vertebrae). 

The answer to the second question is a bit more complicated.  The simplest answer is that your core probably doesn't need to be stronger, it needs to last longer and work more efficiently. 

For most people core endurance is the limiting factor, not strength.  It matters how long your core can last for and how efficient your core is.

For instance, your core is meant to stabilize your spine.  If a certain level of contraction offers your spine stability, more contraction does not offer much more stability.  In fact, too much might also be a limiting factor!

So think about these things next time you are training your core.  It probably doesn't need to be stronger, it just needs to be more efficient!  

What actually happens when you "throw you back out"

People say it all the time; "I threw my back out."  What does this actually mean?  Did something in your back actually slip out of place?  Was it a vertebrae?  A disc? 

First off, bones (vertebrae) and discs rarely go "out of place."  This only happens with significant trauma, and if it does happen, you are in some serious trouble!  

The antiquated view of the "bone out of place" is common misconception of what actually happens when someone suffers from back pain.  Typically, the first description when someone "throws their back out" is that there was some sort of audible (sometimes inaudible) pop, click or clunk followed by increased back pain that limits mobility.  Ironically, someones back will "go out" while attempting to lift a light load (such as picking up a pen off the ground, or standing from a sitting position) but rarely from lifting a moderate or heavy load.

A better description of what really happens is that the joints in your back (facet joints between the vertebrae) get stuck together.  The vertebrae, joints and discs in your back are suppose to move like cogs on a machine.  If it does not mesh, it can cause joints to stick together and muscles to tighten up around them as a protective mechanism.  This is why you would find restriction in range of motion (patient having a hard time bending forward, backwards or sideways).

So if you suffer from back (or neck pain), you don't have to worry about your bones going out of place.  But it is a great idea to see your chiropractor to treat the problem!

Iron Man Champ Jasper Blake teaches Dr. M about Running

With Spring right around the corner, running season has begun. This is the time of year I tend to see a variety of running related injuries flow into the clinic.

Rather than give you my take on running and running injuries, I thought I would go to a professional and ask them a number of questions about how they coach running!  

Meet Jasper Blake!  A former Iron Man Champion, triathlete and founder of the training company B78! 

***Most people don't think twice about running.  They just put on runners and head out the door, and wonder why they are sore or injured later on.  As a running coach, what do you tell your athletes to focus on?  Are there specific techniques?  Or do you just let them run with their own style?

The biggest thing people forget about running is how much impact there is. You take all of your body weight, throw it up in the air and then land on one foot. Your aerobic fitness is one thing but the ability to handle impact is another thing entirely and it's usually the one that gets people in the most trouble. 

Technically I focus on a few key areas:

1. Landing midfoot (or landing with your foot right underneath your body...not out in front, not behind)- the foot is a natural shock absorber not your heal. Land mid foot and you use your body as it was intended for running

2. Stand tall- proud posture- stack your bones. Often you will see people hunched over in various places which means they have to be engaged muscularly to hold themselves up. Standing tall allows the use of your skeleton for support

3. Slight forward lean (without hinging at the waist) allows you to use gravity for acceleration. 

4. Quick "light" cadence- be light or soft on impact and keep cadence on the higher side meaning don't lope around

Put it all together and you end up with good running technique. One really important thing to add is that in order to remains stable during impact we need great core and hip stability especially in longer events when the body starts to break down physically. All runners should have core and hip stability work in their program on a regular basis.

***What is/are the most common injury/injuries you see with running? 

Injuries that usually have to do with impact or tightness in certain areas. IT band issues are a big one and repetitive strain injuries like stress fractures are also a big one. One fairly common and odd one is when one of the small foot bones slides out of place- it's relatively easy to fix but really painful

***Is there a benefit to strength training (resistance training) to improve running outcomes (ie. would a runner benefit from going to the gym?)  Are there exercises that a runner can do that would help prevent injury?

Yes most definitely. I am a huge proponent of gym work. As mentioned above, core and hip stability is really important. I think it's also good to incorporate exercises that promote proper tracking of the knee (so lunges for example where knee tracking over big toe and not going side to side is promoted). I also like athletes to work on any imbalances and learn to move laterally with competence. Running and most endurance sports are very linear and that can cause weakness outside of linear movements which I feel puts athletes at risk of injury so I like working muscle groups that take an athlete out of linear plane.

***If you are looking to improve efficiency, should a runner try to increase stride length (decrease cadence) or decrease stride length (increase cadence)  

This is not a simple question to answer as there is so much at play but yes these are the two primary factors as it relates to speed and efficiency. Increasing stride length beyond your range of motion in terms of flexibility and muscular strength and coordination is not a good thing. So I would look first to increase cadence but I don't think that needs to go hand in hand with consciously decreasing stride length. Often when athletes try to deliberately increase stride length things get ugly because foot strike happens too far in front of the body (not underneath) and cadence decreases which is not always good. I think "efficient" stride length and cadence are on a sliding scale- when you are going slower, both will usually be on the lower end. As you increase speed both usually increase but only to a point. Eventually stride length will reach an optimal place or a place beyond which the athlete cannot coordinate or generate muscular force or cannot land on their foot properly. Likewise, cadence will increase to a rate beyond which the athlete cannot coordinate or even maintain that rate.

Balancing cadence and length to optimize what's best for each individual is the key- while maintaining the critical technical aspects that can help keep you injury free. 

***There are always questions about shoes?  I know there is no "one shoe that fits all" but what is your take on the technology of shoes?  What do you think about "pronation/motion" control shoes?  What do you think about "minimalist" or barefoot shoes? 

I think the number one goal of shoe companies is to sell you shoes so as much as they innovate they also need to keep throwing out new stuff so people buy shoes. Hence the movement from overbuilt shoes to minimal shoes now to Hooka type shoes- it all goes round and round and round and it's a bit ridiculous. 

There is no one size fits all- I think people who grow up in overbuilt shoes usually end up with issues- I believe barefoot kids are a good thing. But i've never been overly sold on barefoot adults on pavement- we may have been born to run in bare feet but pavement is relatively new. 

I personally like a neutral shoe that is not over built and without any posting. Then if you have issues you see a foot specialist for an appropriate orthotic and use a neutral shoe with it. 

I like my shoes uncomplicated- I use a Saucony Kinvara- it's light, neutral, no bells or whistles, just simple and I love it. However, if my run volume starts to get really high like in Ironman training I sometimes needed a bit of support or the muscles in my feet started to go a bit and I would get a bone that slid out of place which caused problems so sometimes an orthotic would help curb this.

I believe in rotating shoes so you are creating slightly different stress loads from time to time

I believe in running off road on varied terrain a great deal so you work yourself laterally and build some overall strength

I think the single greatest cause of injury is not shoes but inappropriate training or run mileage increases that don't respect ones ability to tolerate impact. If you build people up in a way that allows for adequate recovery between sessions and you do it progressively over time you can avoid many types of injuries  

***If you had one tip for an amateur runner (say training for 10km), what would it be?  

Respect the impact- build your mileage and intensity intelligently.

******************************************************************************

Thanks to Jasper Blake for taking the time to answer my questions!

To find out more about Jasper Blake and what he can do for you, please visit : 

http://www.b78.is/jasper/

http://www.b78.is/2015/03/jasper-blake/

You are not a Hero if you play or work through pain...you are just dumb

It is a theme:  "It doesn't hurt that much..."  "I can play through this..." 

We see it in the media with professional athletes.  Scoring the winning goal in the Stanley Cup with a broken foot, or getting knocked out, and 3 plays later catching a touchdown pass in the Super Bowl.

We see these people as Heros!  We want to emulate them.  If someone can play hurt, then why shouldn't I be able to go to work even though I can't lift my right arm over my head?

Here is a better question:  Why not find out what the problem is, and deal with it?  Why not get the treatment it need and get better before you return to work and/or play?

I have seen the shift in sport over the last decade.  With the implementation of concussion protocols in professional and amateur leagues, the increased reliance on medical staff with decisions relating to return to sport, and advancements in technology to help with a proper diagnosis, people are starting to realize that injuries are serious and should be taken seriously.

"No pain, no gain" was from the 1980's.  That doesn't hold up anymore.  If it hurts, if you can't do the things that you need to do for work or sport, get it taken care of and don't return until you are recovered.  

Choose the Blue Pill and continue on with your blissful ignorance, or Choose the Red Pill and find out how far down the Rabbit Hole you will really go???

"This is your last chance. After this, there is no turning back. You take the blue pill—the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill—you stay in Wonderland and I show you how deep the rabbit hole goes. Remember: all I'm offering is the truth. Nothing more." (Morpheus speaking to Neo in the Matrix movie)

One of my favorite lines from the movie "the Matrix" where Neo has the choice to return to his "normal" life, or to find out what "the truth" really is.

As I see advertisement after advertisement for a variety of pain medications, gels and creams claiming to stop pain and allow you to return to your regular activities, it makes me wonder how many of us would choose to ignore the actual cause of the pain/problem.

I, for one, have always been curious about the truth behind what pain generators are, how poor mechanics and movements can be a cause or influence pain, and why we experience pain.  It is one of the reasons I went through all the education I did.  I am finding "how deep the Rabbit Hole goes" as I am always learning something new.  The more I work on good functional movement, the more I realize that I have a lot to learn.  I realize that I have colleagues and mentors that know a lot more than I do, and they are always learning something new. 

So it makes me wonder...what would you do?  Would you rather treat symptoms with pills, creams and gels while you go on with your life?  Or would you like to find out what the real causes of your symptoms are.  If you choose the later, realize that it may require some of your time and patience.  It may require you to get some treatment to help alleviate symptoms.  It may require you to spend some time to do rehabilitation, exercises, or to put some effort towards being healthier.  It may require effort on your part, but I can assure you that it will benefit you. 

So what would you choose, the Blue Pill? Or the Red Pill???