Posted on 10/6/2017 by Melissa Bloom, P.T., DPT, NCS
Cooler temperatures, students returning to school and the start of another football season are all the telltale signs of fall. And with football back, reports of concussion will inevitably follow. While advancements continue to be made in regards to concussion prevention and treatment, the long-term effects of head trauma, specifically chronic trauma encephalopathy (CTE), remains a huge concern.
You may have previously heard of CTE from the movie “Concussion,” or even from recent media reports. CTE is a tough topic for me. My trouble with the conversation is that there are a lot of unknowns and uncertainties. With the potential for serious injuries, there is the chance for panic and decisions made on emotions versus science. Moreover, ignoring the conversation leads to misinformation. So, it’s time we talk about CTE; what is it and what it means for the future of football.
What is CTE?
CTE is a progressive neurodegenerative disease associated with repetitive head trauma. CTE involves cellular pathological changes similar, but different, to Alzheimer’s disease. The buildup of Tau protein in the brain causes cell death, atrophy and abnormal functioning. CTE can currently only be diagnosed after death by examining the brain under a microscope.
Symptoms can be physical, involving gait abnormalities and slowness of speech, or psychiatric and behavioral, including personality changes, depression and aggression. Various cognitive and processing deficits are also common with CTE, including difficulty thinking, concentrating and remembering.
One consistent scientific challenge is understanding the extent to which age-related changes, psychiatric or mental illness, alcohol or drug use, coexisting dementia or other unknown factors play a role in developing CTE. Currently, this is largely unknown and has not been accounted for in research. CTE is more common in contact sports, but other factors in these athletes may also lead to the disease.
Recent Study and Media Interviews
Earlier this year, the Journal of American Medical Association released an article on CTE. The study looked at participation in American football along with multiple physical and psychosocial variables, and they compared these factors to diagnosis of CTE. Results of this study travelled across the media quickly, with the overall conclusion that players of American football may be at increased risk for CTE. Of the 202 individuals in the study, they found 177 were diagnosed with CTE. The researchers further concluded that 99 percent of subjects who played in the National Football League (NFL) were diagnosed with CTE. What a headline.
Not to downplay the severity of CTE and valid concerns that exist about it, but I want to discuss some limitations about what we can take from these results. First, they conducted their study with football players whose brains were donated for research of CTE, creating a significant selection bias. It was known that their brains would be studied regarding a possible connection with CTE and their participation in contact sports. Individuals and their families who participated (i.e., donated their brain) may have noticed symptoms consistent with CTE prior to death, which led to their participation.
What trends did they find?
Beyond the expected motor, cognitive and psychological involvement known to accompany CTE, there were other notable trends. Substance abuse was noted in 67 percent of those diagnosed with mild CTE, and 49 percent in those diagnosed with severe CTE.
The presence of co-morbid neurodegenerative diseases was also common, including Alzheimer’s, Lewy Body Dementia (LBD) and other motor neuron diseases. In fact, more than 19 percent of the subjects with CTE presented with LBD alone. The current study was not designed to determine the impact these factors had on the development of CTE.
Even the authors note that caution must be used in interpreting the high frequency of CTE in their sample. Their results do not allow for estimates of prevalence, due to the lack of comparison groups. Additionally, the sample population was not representative of the overall population of former players of American football. The majority of players only play youth or high school levels, but most individuals in this study played at the college or pro level.
Evidence supports an association between long-term cognitive, neurobehavioral and psychiatric problems with participation in contact sports, such as football, boxing, soccer, etc. While it seems plausible there is a connection between CTE and repetitive impacts seen with American football, it is currently not possible to determine the causality or risk factors with any certainty. We need to proceed cautiously and collect additional research. However, concussion screenings and efforts to minimize concussion can improve the current health of players even if the long-term effects are unknown.
There is an inherent risk with contact sports for concussive and sub-concussive impacts. The challenge now is evaluating the risk given uncertain long-term consequences and the many scientific questions we don't have answered. For now, let’s continue to play smart, wear protective gear, get baseline tested for concussion and, should a concussion occur, thoroughly go through the rehabilitation process for safe return-to-play and activity.
Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.
Physio, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.
Posted on 3/23/2017 by Michael Staino, O.T., CHT, COMT
Negative pressure soft tissue manual therapy, or, in simpler terms
, cupping, is a mobilization technique used to treat pain, stiffness and swelling of the upper and lower extremities, as well as large soft tissue areas such as the shoulder blade or low back.
Cupping is the combination of massage movements and negative pressure with the use of a suction device on the skin. A cup is positioned at the treatment area and a vacuum is created within the cup to draw the skin and underlying tissue into the cup. The produced vacuum creates a suction effect that increases blood and lymphatic circulation, relaxes muscle tissue and support, draws stagnation and toxins out of the body and releases a myriad of pain causing factors.
Cupping for soft tissue stiffness
Following injury, surgery and prolonged immobilization, patients may experience pain, stiffness and swelling that hinder normal movement patterns. There are numerous methods to treat such soft tissue stiffness. Scar tissue can be hypersensitive to touch, restricting a therapist’s ability to mobilize the visible scar and scar tissue deep within a patient’s recovering region. Using cupping, the therapist able to gently lift and mobilize surrounding pain-free tissue and work toward the targeted region without pain and discomfort. The results are immediate and lasting, with patients gaining range of motion and tolerance to exercise with reduced swelling.
Additional cupping benefits include:
Improved muscle performance
Improved scar mobility
How does cupping work?
Cupping tissue liftLotion is applied to the skin to improve suction and contact quality of the silicone cups on the skin. Treatment time can range from a few minutes to 10 to 20 minutes depending on the patient and treatment area. The negative pressure works well in a moving technique as our therapists glide the silicone cups across the skin.
Patients will feel slight pressure during treatment, similar to a massage, and experience little to no pain. Following treatment, small, pin-sized red dots or bruising surrounding the treated area may appear.
Cupping can help to treat:
Tightness, stiffness and swelling following healed fractures
Post-operative carpal tunnel syndrome
Brachial plexopathy (pain, decreased movement and sensation in the arm and shoulder)
Rotator cuff injury
Shoulder pain and stiffness
Low back pain
Neck pain and stiffness
…And much more!
For more information on cupping, please contact a center near you today.
Mike StainoBy: Michael Staino, O.T., CHT, COMT. Michael works in NovaCare Rehabilitation’s South Jersey community and works extensively out of our Manahawkin center. Along with managing hand therapy in his market, Michael specializes in treating patients with hand and upper extremity injuries. He is an occupational therapist, certified hand therapist and certified orthopaedic manual therapist of the upper extremity with more than 24 years of experience.
Posted on 6/4/2019 by Victoria Trueba, MOT, OTR/L, CHT
Finger sprains are very common. They can cause torn ligaments and broken bones even if you don’t see an obvious deformity and are still moving your finger. Earlier treatment allows you to recover faster, identify a more serious injury to your finger and begin the most successful treatment. Whether it’s a basketball player who jammed his middle finger against the ball, an employee late to work who slammed the car door on her finger or a dog leash that became tangled and pulled on a finger, digital trauma is nothing to shake your finger at!Case in point: Mrs. F, a teacher’s aide working with children with special needs. One particular morning as the class was completing an arts and craft project, Mrs. F went to help a student who was becoming increasingly upset. As she was attempting to help the student, he accidentally grabbed Mrs. F’s finger instead of the crayon. Without thought, Mrs. F pulled away and her middle finger got twisted. She recalls the intense pain and immediate swelling she experienced after the injury; however, she thought the pain would go away on its own and that ice would help with the swelling.As the days went on, Mrs. F’s middle finger was not improving. It remained swollen, tender to the touch and she noticed bending and straightening became more limited. Her grip had been affected, and daily tasks such as grabbing the steering wheel and writing became challenging. Mrs. F remembers thinking, “But it was just a finger sprain!”Our fingers contain three joints, with the most commonly sprained joint being the middle knuckle. Our joints also have many ligaments, which serve as a type of checks and balance system that allows both mobility and stability. When Mrs. F was finally evaluated by an orthopaedic physician four weeks after her injury took place, she was diagnosed with a grade 1 injury to a ligament on the side of her joint – the culprit of her limited mobility. Grade 1 ligament injury is detected when there is localized pain and tenderness over the involved joint, noticeable swelling and possible bruising.Depending on the grade of the strain, different treatment options are available. In Mrs. F’s case, a grade 1 injury is less severe on the scale of 1 to 3. As the severity increases to grade 2 and grade 3, the integrity of the ligament is further injured, which results in a less stable joint and a need for prolonged immobilization. In some cases, these injuries may require surgery.We were able to treat Mrs. F’s grade 1 injury with 7-10 days of immobilization in a custom removable splint for eight weeks. This allowed the swelling to go down and the ligament to begin healing. Afterward, she wore fabric buddy tapes around her index and middle fingers to protect the middle finger from a sideways force. Needless to say, don’t be fooled by a ‘simple’ finger injury! Although Mrs. F had a grade 1 injury, she was still significantly affected in her ability to complete daily activities. By the time she began therapy, she had lost a considerable amount of motion in her finger and had begun finding ways to grip without using her middle finger. Even a low grade strain may require therapy due to stiffness, weakness, swelling and hypersensitivity to touch. Make sure to have an injury evaluated in a timely manner and get the appropriate treatment to avoid deficits in doing the things you love most.
By: Victoria Trueba, MOT, OTR/L, CHT. Vicky is an occupational therapist and certified hand therapist with NovaCare in Trinity, FL.
Posted on 7/20/2017 by NovaCare Rehabilitation and NovaCare
The dog days of summer are upon us, but you don’t have to stop exercising outside just because of the warmer temperatures. NovaCare Rehabilitation’s Paul Hansen, ATC, from our Minnesota community, and NovaCare’s Andy Prishack, P.T., ATC/L, center manager, from the Fair Oaks, VA center, explain how to keep safe while enjoying some of your favorite summer activities.
• Avoid exercising between the hours of 11 a.m. to 3 p.m. as that is considered the hottest part of the day. Limit high intensity workouts to either early morning or early evening hours when the sun’s radiation is minimal.
• Stay hydrated by drinking a glass or two of water before you head outside. If possible, carry a bottle of water or even a hydration pack and take a drink every 15 minutes even if you’re not thirsty. The easiest thing to do is pay attention to the color of your urine. Pale and clear means you’re well hydrated; if it’s dark you need to drink more fluids.
• Wear clothing that’s light in color, lightweight and has vents or mesh. Microfiber polyesters and cotton blends are good examples. The lighter colors will help reflect heat and the cotton material will help with the evaporation of sweat.
• Feeling nauseous, dizzy or exhausted, along with moist and flushed skin are symptoms of heat exhaustion. Stop what you’re doing and get out of the heat. Remove or loosen any tight clothing and apply cool, wet cloths. Slowly drink a half-glass of cool water to rehydrate yourself and continue doing so every 15 minutes until you feel better.
With the temperature rising, many are also headed to the nearest body of water with kayaks, surf and paddle boards. Water sports are an excellent way to get in exercise and challenge our upper body strength and balance. Heather Wnorowski, P.T., from NovaCare Rehabilitation’s Sewell, NJ center, has a few tips to keep in mind for the water sports novice and seasoned pro.
• Always get in an adequate warm-up. While the temperatures may be warm, it doesn’t mean our muscles are. Dynamic stretching is a great way to get your blood circulating and muscles warm before hitting the water.
• Since water sports are heavily dependent on our shoulders, it’s important to strengthen your postural and rotator cuff muscles in order to avoid repetitive stresses and impingements of the shoulder.
• Don’t forget the rotational mobility of your mid-back! Kayaking and other paddle sports involve a lot of thoracic spine rotation in order to propel you forward. Make sure you’re able to twist from side to side without pain before heading out for a day on the water.
• Last but not least is balance! Balance is an important part of maintaining an upright position while on the water. Practice standing on one leg at home. Once you’ve mastered that, try standing on a foam cushion and closing your eyes. Make sure you have someone or something nearby to hold onto in case you lose your balance.
Have a great summer and be sure to stay safe out in the heat!