Some reflections on concussion from the author below. We can help if you do have concussion.
A Carolina Panthers player left the Super Bowl and was found to have a concussion.
By David L. Katz
Fortunately for me and the others gathered at the Katz home, we enjoyed a fabulous, Cuisinicity.com meal for the Big Game. No surprise there; my wife is the culinary genius behind the site.
Thank goodness for the wonderful dinner, because the game itself was rather disappointing. There was, I trust my fellow spectators will agree, an unusual bumper crop of penalties, some egregiously bad calls by the referees, some truly strange mistakes by players and a disquieting bounty of poor sportsmanship into the bargain. Congratulations to the Broncos and Peyton just the same, but seriously, weird game.
Alas, it also featured an announcement all fans of the game should now know is a reason for a collective wince: concussion protocol. Corey Brown, of the Carolina Panthers, left the game after a head injury, underwent neurological evaluation and was found to have a concussion.
I trust everyone now knows the ominous implications of that kind of injury if repeated periodically over the course of a career. The media attention to Chronic Traumatic Encephalopathy, or CTE, is considerable and rising. The movie “Concussion,” starring Will Smith, raises the profile further. I highly recommend the movie if you haven’t seen it, by the way. It is very well done, and beautifully acted, and entertaining even as it educates.
I have no particular expertise in CTE beyond any doctor’s basic understanding of it, and others have said plenty already. If you are interested, as every football fan should be, and certainly as every parent of a child inclined to play football must be, the relevant information is readily available. I will take the opportunity to make a different point, about the cultural malleability of “normal,” and thus, “acceptable.”
While I have no claim to the football-fan hall of fame, I like the game as much as the next guy. I am wondering more and more, though, if my entertainment is worth the price the players are paying.
Football is part of our culture, and thus normal. We might thus think that if it has occasional consequences, those, too, are normal. That may make them seem acceptable. But that’s the real danger here: complacency. We can perhaps only see it looking across cultures, rather than from corner to corner within the box that is our own.
Consider, for instance, the Gladiatorial Games of Roman times. Those were, infamously, contests to the death, whether between people, or people and wild, half-starved animals. The only vague approximations of any such barbaric entertainment in the modern world are, so far as I know, bull fighting, and the generally illegal contests between fighting dogs or roosters. There is no longer any mainstream interest in watching bloody death for entertainment.
But that’s simply because sensibilities and culture have evolved. The Romans were people just like us. Their society, too, was made up of mothers and fathers, aunts and uncles. They, too, knew love and compassion. But they cheered while watching young men, literally, kill one another. In their culture, it was normal, and thus acceptable; but I trust we agree history has reached a different verdict.
I happen to be a fan of both the late Heath Ledger, and Paul Bettany, and was thus predisposed to love the movie “A Knight’s Tale.” I’m no movie critic – I can’t say whether or not it’s a great movie – I can only say I like it.
The movie is especially noteworthy for how it handles anachronism. More than once, it features period elements, like music, and then transitions them to the modern analog, such as a rousing rendition of “The Boys Are Back in Town” by Thin Lizzy. More memorable still is a scene at a dance. Heath Ledger’s character is dancing with his love interest in the stylized manner of medieval folk dance. The music then transitions to the late, great David Bowie – “Golden Years,” to be exact – and the dancing keeps pace, morphing into what one would expect, more or less, in any given club on any given Saturday.
The director, I think, was telling us something important: The old-fashioned music and dance of medieval times would not have felt old-fashioned then. It was, simply, the music and dance of its day. It was normal. Showing medieval folk dancing to a modern audience says: this was an old-fashioned party. The director substituted “current” music and dance to show us how it felt to the participants. It was current and normal then, and no matter how it feels to us now, that’s how it would have felt to them.
That’s relevant to football. We are not willing to entertain ourselves by watching young men bash one another’s heads in with maces, as the Romans did. But we do entertain ourselves as young men bash their helmeted heads into one another repeatedly over a span of years, with all-too-often calamitous consequences.
Our gridiron heroes are latter-day gladiators. And their house – the house of football – inspires almost religious devotion in our culture. But that may be only because it is part of our culture. Imagine if football did not yet exist, and we were thinking of introducing it, and knew about CTE from the start. Would we add such a game and such a liability to our cultural entertainments?
The one-time editor of the Journal of the American Medical Association, and later Medscape, Dr. George Lundberg, reflected along similar lines in the New York Times recently. He discusses cultural evolution over a much shorter period than the Middle Ages to now, noting a marked change in his personal – and our societal – enthusiasm for the brutalities of boxing. Both the sport and its following have changed dramatically in recent years, and he conjectures that football is in that same queue.
My principal mission here is to point out the inevitability of culturally induced blindness to the unacceptable elements of what is currently normal. We live in a time of epidemic obesity and its complications in our children, yet continue to market multicolored marshmallows to them as “part of a complete breakfast.” This is absurd, and history will judge us accordingly, but it’s normal now – and so we overlook the hypocrisy. Cultures around the world justify practices as heinous as female genital mutilation. What passes for “normal” is self-defining, and to some extent, self-perpetuating.
Until, that is, we evolve beyond it. Looking back, what was normal yesterday often proves repulsive and contemptible today.
We speak routinely about “thinking outside the box,” but when the box is culture, that is much easier said than done. Everything we know is inside the box, as are we. The contents of the box at any given time are normal.
History turns the years into a ladder. Out of the box we all climb, into a bigger box presumably, as we gain the perspective of altitude, and roll our eyes at the mess we’ve left behind.
I love watching football. The Romans presumably loved their gladiatorial games. Both are normal in context. That doesn’t guarantee that either is right.
For the sake of today’s players, and our sons inclined to take their places, I hope we reform the game of football sooner than later. It’s a great game, but not when paid for with brains scrambled, and lives cut short.
In general, we need to recognize how readily we follow the gospel of any given culture telling us what’s normal. We need to recognize that normal is simply what we do now, and that it isn’t necessarily right. Perhaps the true measure of cultural enlightenment is how ably we judge ourselves in real time as history is sure to do in the fullness of time.
So we all know that feeling that we get after exercise – we feel generally happier, less stressed, less anxious and also sleep better. Exercise produces a rush of happy hormones we also know as endorphins. So what are these endorphins and why do they make us feel happy?
Endorphins are chemicals that are produced in our brains in response to stress or pain. Running, doing a hard workout, playing a sport or any exercise at all that increases our bodies stress response has the ability to make our brains release endorphins. The endorphins have the ability to travel through our neural networks as a neurotransmitter. One thing we do know about endorphins is that they make us feel really good. So how does this work then?
A part of the brain called the hypothalamus sends a signal to increase endorphin uptake through our bodies neural network when we subject ourselves to certain activities like exercise, sex, eat certain foods or experience pain. The endorphins then attach themselves to specific receptor sites within our neural network – these are called opioid receptors. These special receptors have the ability to block out pain signals and also to increase that euphoric happy feeling we get after we exercise. It is the same receptors that are locked onto when we take pain relief in the form of opiates.
Once we achieve a positive result in something we do, either though through exercise or simple activities like sticking to a plan you’ve made, your brain will also release another happy hormone called dopamine. Dopamine is responsible for us feeling addicted to pleasure seeking behaviors. By setting regular and achievable exercise goals that you reach it is highly possible to make exercise the trigger for your brain to release dopamine.
Serotonin is another one of our brains happy hormones that act as a natural anti-depressant. When we exercise serotonin levels in our brain increase and so does your level of happiness.
I know all these terms may seem confusing but there is another very important happy hormone called oxytocin. Oxytocin is released when we feel loved, cared for and connected to others. Your brain will also release oxytocin when you are kind to others.
So no matter how hard it may seem to get yourself moving on some days, putting one foot in front of the other and pushing yourself to move and exercise is not only good for your muscles and joints but also stimulates your brain. You’ll produce your very own happy hormones, reduces your stress levels and have you wanting to repeat it all over again next time. Give your fellow team mates, friends and family an encouraging kind words regularly as well- it will not only help them feel happy but will increase your happiness as well.
Okay. So you’ve decided to embark on a fitness regime in order to shed some kilo’s, get fit or just for fun. New gym membership. Check. New sparkling runners. Check. Gym gear (a bit tight at the moment). Check. Alright, let me at that treadmill/rower/crosstrainer/zumba class!
“Hold on a second – what about your warm-up!”
“Warm-up” you scoff, “you’ve got to be kidding. No time to waste on that”.
Sorry folks, but the warm-up is an important part of your exercise routine and plays a crucial role in preparing your body for exercise. Skimp on the warm-up and you run the risk of injury during exercise or sport, as well as reduced performance levels.
“But what’s so important about doing a few stretches?” I hear you ask.
A proper warm-up involves more than just standing around stretching and talking. It prepares your body for the exercise/sport it is about to undertake and should simulate the actions involved.
The benefits of a warm-up are:
1) Increase in core body temperature
2) Preparation of muscles, tendons and joints for the stresses/strains of activity
3) Increase in nerve impulse conduction to muscles
4) Increase in blood flow to muscles
5) Increase in respiratory (breathing) rate
Let’s have a closer look at each of these benefits.
1. Increased core body temperature – this is important as it prepares the body for the change in activity level from being sedentary to exercising and gets the body into a ‘ready’ state. This also results in an increase in muscle temperature which makes them more pliable, supple and loose.
2. Prepares muscles, tendons and joints for activity – each sporting activity stresses the body in different ways so it is vital to prepare in a way that simulates these activities. For example, if you are a basketballer you need to include in your warm-up the jumping, running and change of direction that occurs during the game. If you pump weights at the gym, it is vital to perform a warm-up set of each exercise at a lower weight to allow your body to adjust to each specific movement.
3. Increased nerve conduction – muscles that are in a ready or aroused state react quicker and more efficiently than muscles that aren’t prepared for activity.
4. Increased blood flow to muscles – through increased blood flow there is an increase in oxygen flow to muscles as well as nutrient flow. This increased flow allows for improved performance
5. Increased respiratory rate – prepares the lungs for an increase in activity level and improves oxygenation of the blood flowing to the muscles.
Okay, so now that we know why we are performing a warm-up, what should it involve?
One common misconception out there these days is the importance of stretching as part of a warm-up. Note I said part of a warm-up.
Stretching on its own does not constitute a warm-up – rather it forms a critical part of one.
An effective warm-up has a number of very important key elements, which work together to minimize the likelihood of sports injury and prepare the individual for physical activity.
These key elements are:
1) The general warm-up
2) Static stretching
3) Sport specific warm-up
4) Dynamic stretching
1. The general warm-up
This consists of light physical activity such as walking, jogging, easy swimming, stationary bike, skipping or easy aerobics. The intensity and duration of the general warm-up is dictated by the fitness level of the participating athlete. For the average person, this part of the warm-up should last between 5 and 10 minutes and result in a light sweat.
2. Static stretching
Yes! Static stretching. This is a very safe and effective form of basic stretching. There is a limited threat of injury and is beneficial for overall flexibility. All the major muscle groups should be included for a period of 5 to 10 minutes.
Debate has raged about whether static stretching should be part of a warm-up and some studies have shown that static stretching can have an adverse effect on muscle contraction speed and therefore performance. It is for this reason that static stretching is performed early in the warm-up and always followed by sports specific drills and dynamic stretching. It is important these first two elements are completed properly as it allows the more vigorous and specific activities of elements three and four to then be performed.
3. Sport specific warm-up
In this part, you are specifically preparing the body for the demands of your particular sport or activity. During this part of the warm-up, more vigorous activities should be employed. Activities should reflect the type of movements and actions which will be required during the activity.
4. Dynamic stretching
Finally the warm-up should finish with a series of dynamic stretches. Caution should be taken with this form of stretching as it involves controlled, soft bouncing or swinging motions to take a particular body part past it’s normal range of motion. The force or the bounce of the swing is gradually increased but should never become radical or uncontrolled. These exercises should also be specific to the sport or activity.
Another important factor to keep in mind when undertaking any new exercise regime, is the time it takes for the body to adapt to training. If you have had a period of time away from sport or activity, then your body won’t be used to the stresses and strains put on it from exercise. It can take up to 4 to 6 weeks for your muscles, tendons and joints to become adjusted to the movements involved in your sport or activity.
During this period it is advisable to start with low to moderate intensity exercise which gradually builds over time. Heading straight up the red or blue arrow as your first exercise session in 3 or 4 months isn’t a great idea. Starting out with flat walks or jogging and gradually increasing time and intensity is a better way to start. After 4 to 6 weeks you will be at the stage where you can tackle more intense sessions.
The same goes for weight training. Starting with lighter weights and more repetitions will allow your tendons and joints in particular, to adapt to lifting load. Going too heavy too soon can lead to tendon injuries or severe muscle and joint soreness.
There is a common belief that there is not much you can do for osteoarthritis because the joint damage has already occurred and can’t be reversed. However it is often the inflammation of the tissue surrounding the joint and instability from the weakened tissues that lead to pain from an arthritic joint.
Our physiotherapists may be able to help you decrease the inflammation and pain around the joint and get you moving again. Here is some information about osteoarthritis and how we can help.
What is osteoarthritis?
Arthritis is a name for a group of conditions that cause damage to the joints in our body, usually causing pain and stiffness
Osteoarthritis is one of these conditions and it affects the whole joint, including bone, cartilage, ligaments and muscles
It is most prevalent in the joints of the hips, knees, neck, lower back, fingers and big toe, but can occur in any joint
It is degeneration of the joint structures, namely the cartilage (protective cushioning on the bony surfaces) and its underlying bone surfaces
Bony growths or spurs commonly known as osteophytes are common in osteoarthritis
Ligaments and muscles around the joint also deteriorate in osteoarthritis
It normally affects a joint on one side of the body i.e. it doesn’t normally occur bilaterally like other arthritic conditions
There are other arthritic conditions you may have heard of such as rheumatoid arthritis, juvenile arthritis, and ankylosing spondylitis.
Signs and symptoms
Swelling of the joints
Symptoms usually develop and worsen gradually over months or years
Affecting ability to carry out normal daily activities
Clicking/grinding in the joint
Loss of flexibility in a joint
What causes osteoarthritis?
Previous joint trauma/injury
Being overweight greatly increases your risk
High joint stress/repetitive use/heavy loads
There is an increase risk as you age and there is more ‘wear and tear’ on the joints
Arthritis can be diagnosed by taking a thorough history and physical examination
X-ray can help confirm a diagnosis – you may need to see your doctor to get a referral
Our physiotherapists can help you with:
Strength and exercise programme
Joint mobilisation/soft tissue techniques
Aids or braces
Weight loss programme
Medication and joint supplements – your doctor can guide you on the best options
Surgical options such as joint replacement
Pre-operative rehabilitation has been shown to improve outcomes post-operatively, so if you are requiring surgery come and find out how you can help speed up your recovery with pre-hab
Some hints for the colder months
Cold weather can exacerbate joint pain and joint stiffness. Remembering a few common sense tips can help people with osteoarthritis survive cold weather:
Dress warmly and layer up
Exercise indoors to stay motivated and warmer
Use a heated pool for exercise – talk to your physiotherapist for local options and classes
Ensure your vitamin D levels are adequate
You don’t have to wait for the warmer months to reduce pain associated with osteoarthritis! Book an appointment with a physiotherapist online 24/7,