Elevate Physical Theraphy & Fitness

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March 2018

Concussions 101: What You Should Know – A Four-Part Series

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Concussions have become a highly discussed and debated topic. Because of our increased awareness, the diagnosis of concussion has increased dramatically at all levels of athletics and in the general population. However, many athletes, parents, and even clinicians lack a good understanding of the underlying condition, the several types of concussion, and the appropriate ways to properly evaluate and manage the condition. WHAT IS A CONCUSSION? A concussion is a functional injury of the brain that results in altered metabolic activity within the brain. This alteration involves changes in chemical activity, increased energy demand, and decreased blood flow within the brain. Simply put, the combination of increased energy demand and decreased blood flow results in an “energy crisis” that impairs optimal function and leads to the symptoms of a concussion. Many of these changes occur within the first 24 hours of the injury, but some of these changes can persist for multiple weeks! Contrary to widespread belief, a concussion does not involve any structural damage to the brain or surrounding structures of the head and neck. Other injuries to the head and neck may occur in conjunction with a concussion but are not required to be diagnosed with a concussion, which is diagnosed based on the individual’s signs and symptoms. Therefore, if a concussion is suspected it is imperative to be evaluated by a medical professional that can guide appropriate care and rule out the possibility of a structural injury that may require diagnostic imaging. However, if a head or neck injury is not suspected, then diagnostic imaging is not indicated, and diagnosis is based on a thorough clinical examination. WHAT CAUSES A CONCUSSION? Concussions can occur through a variety of mechanisms. Although most common in impact sports, they can also occur in non-impact sports and in incidents such as motor vehicle accidents. Typically, a concussion occurs when an impact is made with the head, or the head and neck undergo a violent acceleration or deceleration motion. These motions can place stresses on the structures within the brain that result in injury and responds with altered metabolic activity. It is important to remember that a concussion does not always require a violent motion or loss of consciousness. Even seemingly innocent injuries can lead to a concussion! Furthermore, signs and symptoms do not always present immediately, so it is important to be aware of and monitor for the signs and symptoms and seek medical care if suspected. WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION? Typical signs and symptoms of a concussion can vary between individuals. The most common symptom of a concussion is a headache, but other common symptoms may include: Additionally, symptom presentation and recovery can vary drastically between individuals and may be based on age, gender, activity level, and history of prior injury, among other factors. For instance, symptoms may be exaggerated in younger individuals due to an immature neurologic system. On average, professional athletes become asymptomatic in 1-2 days, collegiate athletes in 2-7 days, and high school athletes in 1-2 weeks! And, while most people recover in less than 2 weeks, approximately 20% of individuals take more than 3 weeks to recover! This is referred to as post-concussion syndrome and can lead to persistent symptoms that not only impact return to athletic activities but can impair mental performance and cause persistent pain. In these scenarios it is especially important to seek medical advice from a qualified medical provider that can accurately identify the type of concussion, contributing factors, and appropriate management options. WHAT TO DO… Now that you are more informed about the potential causative factors and signs and symptoms related to concussion, it is important to recognize when a concussion might be present and be evaluated by a medical professional if it is suspected. If sustained at a school-related sporting event this may be performed by the Athletic Trainer, but, if one is not present, a physician that specializes in concussion is a great option. They can decide if further testing is warranted and refer to Physical Therapy! As we will soon see in the next segment in this four-part series, a concussion is not as simple as we once thought, and Physical Therapy can be a fantastic treatment option to promote return to function.

Fruit: Nature’s Answer to Your Snack Cravings

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By Kyle Blix, CPT, Cert. Ace Fitness Nutrition Specialist Are you working hard in the gym but not seeing the changes you’re going for with your weight or body composition? It may very well be your diet–and more specifically, your snacks. Perhaps the greatest contributor to seeing results in with any exercise program is the diet. A week of hard lifting and strenuous cardio can be seriously undercut by poor food decisions. This is because food plays such a critical role in rebuilding the cells of the human body. As a personal trainer and nutrition counselor, I stress the importance of eating real, whole, unprocessed foods as much as possible, because they’re proven to be the most nutritionally dense and thus keep the body healthy and lean.(1) When strategizing for proper nutrition, one of the most helpful questions to ask first is:  What are the foods that you know, without a doubt, are holding you back? And more specifically, what are the snack foods that you’re eating in-between and after your meals? Often times people will get into a whole food diet only to go off the rails when it comes to their snack habits, which in turn can sabotage their progress of sculpting a lean physique. Here,  we turn to nature for the solution–fruit.  When used as a snack replacement, fruit is one of the easiest ways to keep your body healthy and lean without sacrificing flavor and satisfaction. Fruits are nature’s ultimate snack hack. To better understand just how fruit interacts with our bodies, we must address fructose. Simply put, fructose is fruit sugar. It’s a monosaccharide, the simplest form of carbohydrate, and thus it digests very easily.(²)  Fructose is also found in processed foods as well, more commonly under the name high fructose corn syrup (HFCS). It’s a cheap way to sweeten processed foods and is found in a variety of products. However, there’s a big difference between HFCS and natural fructose from fruit.  The negative effects of high fructose in the diet are known to cause metabolic issues, such as obesity, high blood pressure and type 2 diabetes. But the naturally occurring fructose in fruit is completely different. Unlike HFCS, fructose does not cause a rapid rise and subsequent drop in blood glucose levels, giving it a fairly low glycemic load. Glycemic load is the measure of how a carbohydrate impacts your blood glucose levels.(³)  Fruit has a fairly low glycemic load and contains a good amount fiber and water, which, when consumed together, help to mitigate the effects of fructose on blood sugar. For this reason, most fruits take a while to digest and hit the liver-insulin system slowly.(4)  This is beneficial because consuming foods with a low glycemic load reduce the chance of health problems like diabetes, hypertension, obesity and heart disease. Compare eating two apples, with a total of 38g of fructose sugar, to a can of Coke containing 39g of HFCS or cane sugar. One is going to keep you satisfied and fuller, and the other is going to cause a huge spike and crash. They both have completely different effects on the body. The nutrient density of fruits cannot be ignored. They’re rich in fiber, vitamins, minerals, as well as a plethora of phytonutrients and antioxidants. Plus they’re incredibly filling, and delicious. Fruits have been shown in multiple studies to reduce the risk for type 2 diabetes, heart-disease and as well as different types of cancer. In one particular study, research found that the risk of heart disease is reduced by 7% for each daily portion of fruit.(5) Fiber especially has many benefits. The soluble fiber found in fruits has been shown in several studies to reduce cholesterol levels as well as slow down the absorption of carbohydrates.(6)  This benefit carries over into weight loss as well, as fiber plays a critical role in increasing satiety, which in turn leads to consuming fewer calories. On the caloric front, fruits come with more good news! They’re relatively low in calories, which means you can consume a variety of fruits before coming anywhere close to what the average bag of chips would cost you, for example. The average apple comes in at 95 calories, a banana 100 calories, an orange 45 calories and a carton of strawberries at 145 calories. When you habitually eat fruit, you’ll be less inclined to turn to snacks that are devoid of nutritional value. To drive it home, the most useful way to work fruits into your diet is to use them as a complete snack replacement.  Fruits are nature’s ultimate snack-hack. Take any and all sweet snacks that you would normally eat after a lunch or dinner and simply replace them with a variety of fruits. For example, you could pack two bananas and a Tupperware of berries to take with you to work. Or toss them in a smoothie along with a plant-based protein powder for a meal replacement. They’re portable, tasty, and most importantly, incredibly nutrient-dense. You could even start with eating only fruit for breakfast and you would already be on your way to a much healthier day than if you picked a sugary cereal or a bagel. Armed with this knowledge, try incorporating more fruit into your diet combined with your exercise program to see those results you’re hoping for and realize the multitude of health benefits from fruit!   References: 1: Slavin, Joanne L., and Beate Lloyd. “Health Benefits of Fruits and Vegetables.” Advances in Nutrition 3.4 (2012): 506–516. PMC. Web. 16 Mar. 2018. 2: The Britannica – https://www.britannica.com/science/monosaccharide 3:Eleazu, Chinedum Ogbonnaya. “The Concept of Low Glycemic Index and Glycemic Load Foods as Panacea for Type 2 Diabetes Mellitus; Prospects, Challenges and Solutions.” African Health Sciences 16.2 (2016): 468–479. PMC. Web. 16 Mar. 2018. 4:Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010 Jan;90(1):23-46. doi: 10.1152/physrev.00019.2009. Review. PubMed PMID: 20086073. 5: Luc Dauchet, Philippe Amouyel, Serge Hercberg, Jean Dallongeville; Fruit and Vegetable Consumption and Risk of Coronary

Get Strong to Run!

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This week, we are sharing our favorite exercises for Getting Strong to Run! Inspired by our Elevate PT’s preparation for the LA Marathon this month, she is going to show some necessary strengthening exercises that are crucial to running injury-free. PHASE 1: Glute Activation Prior to a run, activating your glutes is so important in order to help stabilize the pelvis during your jog, and to reduce the load on your knees and lower legs. Isometric holds are important to allow higher focus on recruiting the correct muscles, and improving neuromuscular activation at the brain. Here are our 4 favorite glute exercises: 1. Side plank with Clam Hold 2. Single Leg Bridge Holds 3. Banded Squat Holds 4. Standing fire hydrants holds PHASE 2: Core Strength Having a strong core, especially with rotational strength, is so important for runners because it helps power and propel your run while also protecting your spine. A stable trunk is the starting point for *safe and efficient movement* and will also help protect your lower extremity kinetic chain while you run! Here are 3 of our favorites: 1. Banded Dying Bugs 2. Isometric Lunge with Diagonal Chop 3. Plank on medicine ball with Diagonal Mountain Climbers   PHASE 3: Leg Strength “Is strength training really necessary?” Research shows that adding strength training twice a week for 12 weeks improves speed by 8% and VO2max by 10% on average for endurance runners! Since running is a “single leg ballistic activity,” we really focus on single limb support strengthening. The split squat progression you see in the video works the calf as it’s progressed to the toe and then into a hop. Aside from glutes, calf strengthening is often a missed strength exercise, and an area of weakness that leads to injury in runners. Our top 4 exercises for Leg Day? 1. Banded Hex Bar Dead Lifts 2. Split squat, progressed to toe, progressed to ballistic hop 3. SL squat with a row 4. Crab Walks and Monster Walks