Congratulations!
Saturday capped an already exciting week. John Gaudreau ('93) finished off a season where he was USHL rookie of the year, and the championship winning Dubuque Saints leading scorer through the playoffs by getting drafted in the 4th round (104th overall) by the Calgary Flames in this year's NHL draft. We're all really excited for John and happy that all of his hard work is paying off for him.

This comes just a couple weeks after a few other players received good news. In the last month, several players have shipped out to USHL tryouts and made the team. Congratulations to Chris Tracy (Sioux Falls), Kyle Criscuolo (Sioux City), Dave Ferreira (Cedar Rapids), Matt Gaudreau (Omaha), Chris Diver (Omaha), and Gabe Antoni (Dubuque).

Our friend Mark Connors from Tri-State Elite Baseball stopped in last week to update us on how a few of the players that trained with us last off-season faired this year. Trevor Connors won tournament MVP as the Washington Township Minutemen won the Grand Slam title. Matt Rakus was named to All-South Jersey Baseball's First Team. Tyler Bright was named to All-South Jersey Baseball's Second Team. Congratulations to them and the rest of the off-season baseball crew, who all had noteworthy seasons this year.

Concussion Q&A
A couple weeks back when I asked you guys if you had any topics you wanted me to cover in a future newsletter, I got an email asking for some more information on concussions. This is a great topic, especially in light of the increase in severe concussions suffered at the NFL and NHL levels. Bigger, stronger, faster athletes and rule changes that prevent people from obstructing motion results in higher velocity collisions.

Concussions are an extremely complex injury and the implications are far from well-understood. As with all injuries, the best rehabilitation is prevention. The largest predictor of future concussion is past concussion. In fact, at last year's Friesen Physio-Fitness Summit, Dr. Josh Bloom pointed out that 75% and 92% of repeat concussions occur within 7 and 10 days of the original incident. As you can imagine, this is indicative of overly lax return to play guidelines and has caused a more conservative approach. Dr. Bloom also pointed out that risk of subsequent concussion was increased by 150%, 280%, and 350% with 1, 2, and 3 previous concussions, respectively.

With regards to severity, concussions are no longer graded on a scale of 1-3. It was generally thought that loss of consciousness indicated a more severe concussion, which is partially true. However, amnesia (a loss of memory) is up to 10x more predictive of future neurological issues than a loss of consciousness. In other words, amnesia is bad. Athletes may report a general feeling of fogginess in these cases.

Instead of just rehashing general guidelines that I think the majority of people in the sports world are familiar with at this point, I want to discuss a few of the newer revelations in concussion return-to-play concepts. 

New Concepts in Concussion Treatment and Prevention
With athletes that suffer ongoing symptoms, they may be related to a visual assymetry secondary to the concussion. The athlete basically neglects vision in one eye, which leads to feelings of dizzyness or just feeling "off" in general. Specific training forcing the athlete to use the neglected eye can resolve symptoms within a couple days. This comes as one of those "miracle cures" for those that have been suffering symptoms for several weeks or months. Because this is a relatively new concept, few practioners assess for it. My friend Pete Friesen, the long time Athletic Trainer and Strength and Conditioning Coach of the Carolina Hurricanes recommended that I have our athletes get a visual evaluation by a specialist trained in traumatic visual problems following a concussion. The only person I know that does these locally is Clint Beckley at Bryn Mawr Rehab Hospital. He also recommended athletes look into Brain Armor, which contains the Omega-3 DHA, which is implicated in a number of important brain functions.

Highlighting a somewhat related connection, Ned Lenny, a brilliant physical therapist in Cherry Hill, and I were recently talking about these injuries and he pointed out that many people suffer from concussion-like symptoms as a result of suboccipital neuropathy. In other words, the nerves that exit the spine directly beneath the back of the head become impinged as a result of contact. Symptoms don't resolve because people aren't addressing the true cause, simply waiting out the concussion.

A look at the nerves that perverse the suboccipital region

This is interesting because the eyes have direct neural connections to muscles in the suboccipital area. I have a suspicion that retraining a "neglected eye" and restoring proper structural alignment and soft-tissue pliability in the suboccipital area may just be two approaches to the same problem.  

Of equal importance is that certain postures can predispose an athlete to suffering these types of subocciptal neuropathies. While postural analysis could be a book in itself (in fact, the topic has been covered in countless books), the idea is the majority of people (including athletes) orient themselves with a forward head posture, which puts excessive pressure in the suboccipital area. Add a little contact and symptoms manifest.

Examples of progressively more "forward" head positions and associated spinal alignment

In an ideal posture, the ears would be situated directly over the acromion (bony prominence at the top of your shoulder), which would be centered over your hips, which would be centered over your feet. Forward head posture is extremely common in modern day society because we're constantly repositioning our head to read text messages, stare at computer screens and, well, generally hold ourselves in about as apathetic of a body position as possible.

There is nothing exxxxcellent about this posture.

Take Home Message
Concussions are extremely complex, but it's important to do whatever we can to avoid them. In situations where an athlete does suffer a concussion, they need to be completely shut down. Headaches are not a natural part of athletics and need to be treated with caution. Long-term consequences FAR out-weight potential short-term gains. Following a concussion, athletes should seek out a quality doc to perform a traumatic visual exam and look into getting Brain Armor. If symptoms don't resolve, consider the suboccipital neuropathy cause and go find a good physical therapist like Ned Lenny that understands the issue. When in doubt, err on the side of caution.