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Milwaukee's Daily Magazine for Tuesday, Nov. 25, 2014

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Jennings sustained a concussion at the Aug. 3 "Family Night" scrimmage at Lambeau Field.
Jennings sustained a concussion at the Aug. 3 "Family Night" scrimmage at Lambeau Field. (Photo: Jim Biever/Green Bay Packers)

Packers' Jennings is reminder of why concussion care is vital

Dr. Therese Miller, DC, combines fitness, rehab and chiropractic medicine to address the true causes of pain and discomfort- not just cover up the symptoms.

Let's follow a case of how concussions are treated. Although my first step would take a preventative stance, we'll talk about that in a separate blog. What most people recognize are the new rules in effect regarding head injuries and how long it takes to get a player back in the game. There are many techniques to be used and treatment guidelines are ever changing as new information and research comes out.

This is a glimpse of a research-supported approach to speed the healing process and get an athlete back in the game as quickly as possible. Let's take the example of Greg Jennings this Packers season.

Immediate treatment

Treatment begins the instant emergency care is ruled out. When an injury occurs, inflammation begins; this involves harsh chemicals and molecules being released into the surrounding tissue. These harsh molecules can irritate or damage the surrounding tissues they come in contact with, which essentially causes collateral damage.

In the case of Jennings' concussion, the primary inflammation is occurring in the brain and/or brainstem where the tissue of the brain impacted the skull. However, surrounding areas are already beginning to be impacted by this secondary damage.

In the training room, Jennings would begin receiving care to reduce inflammation and secondary damage immediately. My technique of choice is Active Release Technique (ART). A highly specific technique performed to soft-tissues (muscles and nerves in particular here), this technique increases blood flow and oxygenation to the treated tissues.

Several nerves exit the top of the cervical spine which have a direct connection to the dura (fibrous covering surrounding the brain, brainstem and spinal cord). By reducing tension on these nerves and reducing muscle spasm in musculature of the neck, blood flow to the brain and damaged areas can be positively impacted.

Immediately following a brain injury, the body's nervous system is also in a sympathetic or "fight or flight" response because one of its most precious assets has just been "attacked." Healing occurs best when the "rest and relax" or parasympathetic nervous system is more dominant. Changing the nervous system back into a parasympathetic dominant state is important for healing.

Chiropractic Manipulation or Adjusting is a great tool of choice. With over 200 Adjusting techniques to choose from, I would personally use a technique that did not include a significant of head or neck movement. This ensures no additional "shock" to the nervous system, but helps upregulate the parasympathetic nervous system to promote healing.

Treatment plan

Following the initial treatment and until symptoms are gone, Jennings would be required to rest keeping his heart rate low, avoiding any activities that could cause a second head trauma, etc all help ensure the brain can heal without additional stresses.

My treatment plan typically includes ART and Chiropractic adjustments (as needed) two to three times per week until the initial symptoms have alleviated. Active Release is used on follow-up days to increase oxygen and blood flow to speed up the healing process and ensure the nerves can move and glide freely and do not become entangled in the bodies healing process of building scar tissue.

Adjusting may or may not be used every visit. This determination is made based on the severity of continuing symptoms, which side of the nervous system is dominant (R&R or Fight/Flight) and any areas of restriction in the spinal joints. Many times, I do not adjust all three days and ART is used alone.

Once symptoms have alleviated at rest, Jennings will be evaluated under exertion. At this point in time, I typically reduce my treatments to twice per week. My ART treatments would reduce to two times per week and Adjusting would continue to be performed as needed. My adjusting technique would change, however. At this point, the brain has healed slightly and is less vulnerable to quick movements.

Therefore, my adjusting technique would transition to a "higher amplitude" technique. This means the head and neck may be moved more to produce specific movement at any given restricted joint. During this time, Jennings would be progressed from light aerobic activity to heavy aerobic activity lasting equally as long as pre-injury but all without possibility of contact.

Return to play

The criteria to allow a patient back into practice and/or competitive games are widely debated; many very credible organizations have very different guidelines and statements regarding these criteria. The NFL has created its own standardized protocols which pool the information from many of these organizations. These criteria are based on a number of factors.

To simplify them for this article, and as a general guideline: Jennings should be able to pass all neurological testing at full exertion for at least 24-48 hours before beginning back to practice.

Once Jennings begins back to practice, my role becomes more supportive. If at any time, symptoms return or neurological tests are positive with exertion, the previous stage of treatment is resumed. If symptoms do not reappear and Jennings is able to progress to full practice without any notable deficit, he would be cleared for return to play in a game

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