Art of Prevention
Our mission is to decrease the prevalence of preventable injuries and athletes therein optimizing performance by decreasing the time that our athletes spend benched due to injury. We are going to distill information and practices from experts in the field of injury prevention. High level coaches and top performing athletes. We believe this information should be accessible to everyone so that we can reduce the rates of preventable injuries.
Art of Prevention
Leonard Wright's Guide to Concussion; Brain Injury Prevention and Healing in Athletes
Embark on a revealing journey through the realm of concussions in high-velocity sports with our esteemed guest, clinician Leonard Wright from the Parker Performance Institute. Leonard's expansive knowledge in functional neurology and chiropractic care illuminates the intricate process of treating brain injuries, as we scrutinize the critical role of education in averting and recovering from concussions. Through personal accounts and a deep dive into the clinical approach, we uncover the variegated symptoms that athletes face and the paramount importance of an integrated treatment strategy encompassing sports-specific care and neurological rehabilitation.
We navigate the precarious landscape of concussion prevention, shedding light on the cognitive and ocular motor indications that herald a concussion's onset and the psychological toll it can take on athletes. As we progress, we unravel the compelling narrative surrounding the potential long-term effects of post-concussive syndrome and the indispensable advancements in helmet technology that shield athletes from the perils of repeated head trauma. The episode goes beyond the baseline, exploring how strategic nutrition, like the inclusion of omega-3 fats and the smart use of supplements such as creatine, can bolster brain health and aid recovery.
The final leg of our discussion emphasizes the essence of bespoke recovery protocols and the need for a proactive stance on health, reminding listeners of the gravity of seeking professional assistance when grappling with medical concerns. We entreat our audience to engage with our podcast community, fostering a dialogue that elevates awareness and understanding of this profound topic. If our exploration into the complex world of concussions has enlightened your perspective, join the conversation by sharing your thoughts and supporting the podcast through your active participation.
Parker Performance Institute:
https://parkerperformanceinstitute.com/team/leonard-wright-dc-ms/
Recommended Reading:
Patricios, Jon S., Kathryn J. Schneider, Jiri Dvorak, Osman Hassan Ahmed, Cheri Blauwet, Robert C. Cantu, Gavin A. Davis, et al. 2023. “Consensus Statement on Concussion in Sport: The 6th International Conference on Concussion in Sport-Amsterdam, October 2022.” British Journal of Sports Medicine 57 (11): 695–711.
Ainsley Dean, Philip John, Gozdem Arikan, Bertram Opitz, and Annette Sterr. 2017. “Potential for Use of Creatine Supplementation Following Mild Traumatic Brain Injury.” Concussion (London, England) 2 (2): CNC34.
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Hello everyone and welcome to yet another episode of the Art of Prevention podcast, and yet again I have yet another amazing guest, and I've wanted to have a guest talking about the specific topic we're talking about today for quite a while.
Speaker 1:Being in the high country and seeing a lot of velocity sports athletes, what you also see is a lot of concussions and post-concussion syndrome. So concussion can happen in a variety of sports, from team sports to especially things like skiing and mountain biking, which is where I see a lot of concussions, and so I've always wanted to learn more about concussions, and there's no one better to talk to than Leonard Wright. So, leonard, thank you so much for coming on today. And, leonard, you are a clinician at the Parker Performance Institute in Dallas, texas, and there you really see a special brew of patient population. You very much see a lot of veterans and team sport athletes, especially people that have been coming back from things like concussions or repeat concussions, and you are a functional neurologist, but you're a chiropractor by training, and then you really niched down into that functional neurology training and the neurological aspect of recovery for a lot of individuals, right.
Speaker 2:Yeah, absolutely yeah, you nailed it and I like the way you said brew there, because I feel like that really caters to the nature of high country, which is lots of good coffee and lots of good beer as well. So, yeah, it is a good. It is a good brew, right. A lot of our patients, like you said, are veteran types. It's a fun clinic to work at here in Dallas. We work with an integrated team, me being one part of that team. We have sports specific chiropractors, myself who focuses on neuro specific rehab, we have a functional nurse practitioner and we have a medical neurologist who's our medical director, and we also have a clinical nutritionist as well. So within that, we do get a special brew of patients right.
Speaker 2:We get a lot of a lot of interesting cases, a lot of cases that come in that you know this is their their 12th doctor that they're going to and they're trying to figure out what's going on right and specifically with concussion, because there's a lot of unknowns out there with when it comes to concussions. Still, there's a lot of misinformation when it comes to concussions. So we really like doing podcasts, we like doing informational stuff like this, because it really is important to get the education out there about what do we need to look for with our patient types. You know, to avoid coming in and seeing us Obviously, we're there as a resource but ultimately to prevent concussions, which is why I think what you're doing is so awesome.
Speaker 1:Well, thank you. And yeah, I mean with concussions, oh my gosh. I mean I feel like what we learned in school about concussions is really the tip of the iceberg. You know, especially with, like, the new things that we're learning now about post-concussion syndrome how to assess concussion, return to play, all things that we're going to talk about today. Now, what made you initially get into like diving into concussions so much?
Speaker 2:Yeah, so interesting background. Growing up in Texas, you know high school football is king, right. So you gotta, you gotta play high school football. I grew up playing tackle football, starting at the age of seven years old, um, going all the way through, right. So you're talking about a lot of potential impacts, uh, that succumb with head injuries, right. And so I think diagnosed, confirmed, diagnosed concussions I have four to five. If I were to actually go back in my memory and try to think about it, it may be a little bit closer to like eight concussions over the life of my football career, which ended because of a shoulder injury actually not even because of concussions, but that's a different story. But yeah, so I had concussions. Didn't really get a lot of direction other than the typical go home and rest right, sit in a dark room, and I can remember spending days in my room maybe turning on the Xbox a little bit and playing some video games and stuff like that, but for the most part just kind of resting right, until you felt like your symptoms went away. And that was it. For the most part I felt okay. But one thing I did notice that I didn't really attribute to the concussion until later on was I had a lot of irritability and I had a lot of anxiety. My concussion was more kind of what we call an affective concussion or a mood based concussion and we'll talk about what that is and all those phenotypes later on but that carried over into college.
Speaker 2:Going into college didn't really know kind of what I wanted to do, but I found chiropractic to be very interesting. I love the principles of self-healing, self-regulating, the stuff we learn in school, right. While I was in school I was struggling with memory and stuff. So I found a group of people that were talking about neurology and someone invited me to come in and they started explaining concussion and just made total sense, right, like how you could rehabilitate the brain. And the brain has this neuroplasticity to it and you're able to mold and the brain is really just a piece of clay and it's a, it's a construct of its environment, right? And if you don't, if you don't do things to help the brain recover, then it's going to struggle just like any other injury, Right? And so that was interesting to me and I just completely changed my entire focus while I was in school and I was like all right, I'm going to learn this, right.
Speaker 2:So I dove in and I started doing all the different seminars that are out there and watching courses and we had a group and it just kind of took off and got a master's degree in it. Luckily, parker is very forward thinking with that and they offered clinical neuroscience degrees. Got a master's degree in that and was in the right place at the right time, got hired at Parker University, which has Parker Performance Institute, and here we are five years later, right. So it's been a really interesting ride. But it's perfect for me because, having concussions, having gone through the therapies that I do with patients on the day to day, I'm able to talk to them at a more honest level about hey, this is what you're going to feel, this is what to expect, this is the recovery process. So it's been awesome. Unfortunate to have concussions, but I'm super thankful to be doing what I do.
Speaker 1:And now full circle you teach in that clinical neuroscience program. Now huh.
Speaker 2:I do. Yeah, I teach clinical residency portion, so the master's program has a residency within it. So if anyone were to take the master's program, I'd be the last person they see right before If they wanted to do that. It's kind of an elective course but I teach in that. They've just unveiled, actually, a Parker this isn't about them but they just unveiled another like pediatric neuroscience course that I'm going to be teaching as well, and obviously sports related concussion will be a part of that. So, yeah, I get the opportunity to teach, I speak at conferences, so it's kind of just taken off. My career has been very, very not traditional in the chiropractic sense, but it's been amazing, right.
Speaker 1:So so I feel like the first question we need to answer is what is a concussion? What is it? What are some of the symptoms of concussion? You talked about various phenotypical expressions of this injury. So what is that concussion and how does that happen?
Speaker 2:Yeah, so a concussion is essentially a direct or indirect and that's a big important part the indirect impact to the head or neck area that causes a concussive force to be transmitted on the brain right. So what happens is the head, is the skull right. You've got this big, hard, bony structure and inside of that skull you've got the brain right and it's surrounded by some dura matter which is quite strong actually, but it's in a kind of vat of fluid and it has the ability to move around a little bit. So when we're playing sports or we're riding, you know, mountain bikes or anything, and if we fall we have the potential of having a concussive blow.
Speaker 2:That direct or indirect hit is really important because a lot of coaches or athletes or parents may not understand that their kid or athlete suffered a concussive type event and there's certain statistics to support the acceleration of the head and the deceleration of the head and how quick that is and that's really science-y. But essentially it's the direct or indirect blow to the head that causes a neurochemical cascade of events that can relate to a wide range of symptoms. The ones that I check for are cognitive deficits, so you can have memory problems, traditional things that they check on the sidelines. You can have ocular motor problems, so their eye movements are not working well. That's another one that they check on the sidelines. You'll see them. Do you know? Finger to nose, looking at pupils, that type of stuff.
Speaker 1:So the follow my finger kind of thing, there's a reason people are doing that. It's not just for show, right?
Speaker 2:Yeah, and they're checking one to make sure that there's not a brain bleed or anything right. They're just making sure that all the cranial nerves are intact. But there is a reason for that. And then actually afterward you can do specific tests which we do that look at very, they graph the eyes and they look for very detailed movement discrepancies. And that's what I work on. Is the motor system of the ocular system, right? So I'm not working on improving vision, I'm working on improving the movement of the eyes, just like another chiropractor may work on improving the moving of a hip or of a knee, right. So I'm just doing the same thing, but to the eyes.
Speaker 2:So we look at cognitive you've got ocular, you've got cervicogenic, right, chiropractic obviously fits in that realm right. We've got headaches, which also chiropractic fits into, affective or mood, which I had which was more, you know, psychology based or psychiatrist based, which we refer out for but is a massive part of a concussion symptom, you know overall. And then you've got vestibular, obviously balance problems. That's very common. And then you've got your, your cardiovascular, your autonomic, right.
Speaker 2:You can have dysautonomia after a concussion too, and you get lightheaded and you go from line to standing and you go, people pass out and then they get another concussion because they pass out. Right, so that's another one. So you're talking about a concussion. It's a very complicated cascade of events and it needs to be treated as such cascade of events and it needs to be treated as such, right, it's not. It's not like back in the day when I was in the nineties and my dad's my coach at Peewee football and you get a bump in the head and he's like oh, you got your bell rung, it's okay, right. Like there are significant consequences that can come from hitting your head and it's important for people to know that.
Speaker 1:And there are a couple of phases to concussion recovery. Right, I mean, there's the acute symptomatic recovery, but then, underneath that umbrella of symptoms, are also these neurophysiological effects, so injuries to the brain and the physiology of the brain that can still linger for some time. And then we can also have that post-concussive syndrome, kind of like what you had affecting your mood, and for some people it might affect their mental acuity, their memory etc. Or all these other aspects or facets of physiology for years and years and years. And that's why we're basically on today to talk about prevention of these things. Like we can't have somebody like get hit in football, whether it's peewee or high school, and then have that mentality of, oh, just go walk it off and we're going to go back in and the next play.
Speaker 1:For various reasons, number one being we want to have primary prevention or prevention of the concussion. But then one thing that I'm really curious to pick your brain about is the second impact syndrome. So can we talk a little bit about what some coaches and parents and athletes can do for primary prevention? How do we prevent concussions from happening in tackle sports? Maybe we could talk about tackle sports first, because that's probably the most common. But then for me, selfishly, for when I'm sending this to my patients, I want to know about velocities of base sports as well.
Speaker 2:Yeah, and both are. Both are very susceptible to concussions, right, and we're not going to ever prevent a concussion from happening as long as we continue to play these sports or engage in these activities. Right, so that's an important part is like these are. These are things like even if you're not playing a sport that directly hits the head right or has the potential of a head hit for example, mountain biking you don't think you're going to hit your head right, but there is a chance that you hit a log when you're on a trail and you go flying forward, right, and that's a velocity type of concussion, an indirect hit, right. So, yeah, it's important.
Speaker 2:There's a lot of things you can talk about as primary prevention strategies. One is, especially at the youth age, is limiting the amount of exposures to head injuries, not just in games but in practice throughout the week. Right, like you don't want to be sending a bunch of you know, let's talk about tackle sports, for example, or direct impact sports. We don't want to be sending a bunch of you know, like I used to do, doing a bunch of Oklahoma drills every practice to toughen you up, right, like that's that's putting you at a higher risk of suffering a concussive blow and therefore at a higher risk of actually suffering other side effects from that to the long term stuff, the post concussion syndrome, because the more you have concussions right the first concussion usually most people recover pretty well, right? About 80% of people don't have any issues. They they recover without problem. Uh, within the three to four week window that's kind of that you know concussion window before it goes into post concussion, um, so that's a big one, right? Uh is is preventing the amount of contacts throughout the week. Two, you can wear certain devices that allow you to limit the amount of impact that a direct hit may have. So, like we'll talk about, like helmet technology that they've come up with now. A lot of the helmet technology and they have it in bike helmets now as well is creating a layer that allows for a little bit more gliding within the helmet. Right, so it slows down. There's not this abrupt stop if you do hit something. There's a little bit more gliding action. Or these football helmets or hockey helmets have a little bit more give to them to absorb the blow a little bit more is the idea, so that there's not as much of a transmission of force from one object to another object Right. So that's another good one Making sure you're wearing the proper equipment as a primary prevention.
Speaker 2:Obviously, mouthpieces a big one, right, you want to wear a mouthpiece? Absolutely, I see it. I actually in my spare time I referee high school football as well. Obviously, in Texas it's like massive. So I just do that on the side for fun. And, yeah, one of the big things you see all the time is these kids not wearing their mouthpieces and obviously we have the authority to say but I'm obviously extremely keen to it because I'm like put that, put that mouthpiece in, man, like you're not looking cool because it's dangling there like Justin Jefferson or something like that, you know, like you put your mouthpiece in where it helps absorb the blow.
Speaker 2:A big part of the transmission of force is if your jaw is not, you know, closed whenever you get hit and we're not always thinking about all right, I need to close my job before I get smacked right here, right, god forbid, you get hit from up underneath, right, or you get a transmission of force that's quite heavy and you, you know, jam your teeth together.
Speaker 2:That's a lot of force coming up from up underneath the brain that can really cause a lot of problems, right, and that's a super important one. So having that mouthpiece, one that fits you, one that's well formed, is super important as a primary prevention too. There's a lot of research out there about neuromuscular rehabilitation or neuromuscular warming up or training, and that doesn't always look like what I think it is of, like ocular motor movements, you know, trying to train that. I think that should be a part of it, but a lot of it's just, you know, warming up your neuromuscular system to have quicker reaction times, right, so that you're more able to, you know, protect yourself if you are going to get hit or blunt the blow a little bit of a direct hit or an indirect hit by having a good, quick reaction time, right. So training the neuromusculoskeletal system to be as quick as it can is another big one right. So there's a whole bunch of stuff that parents and coaches can do to try to help limit the exposure to primary concussion.
Speaker 1:So we need to limit the exposure to hits. So, those Oklahoma drills that you were talking about, maybe not the best thing. Maybe we could sub out that Oklahoma drill, which I actually don't know what that is. I grew up in Texas and I actually went the cross-country route and didn't play football ever, which was really weird, honestly, but I'm kind of glad that I did it.
Speaker 2:Well, I'll tell what an Oklahoma drill is really quick. So basically and this is how we did it You'd have two people about five yards away from each other, on their backs, head to head. So imagine one head here, one head here. They're lying down on their backs, coach blows the whistle, one's carrying the football, one's the defender. You get up and you just run at each other.
Speaker 2:It's just like a high speed collision and we were doing that. I mean, I was doing that at seven years old man, and that's not anyone's fault, right, like no one, yeah, did anything wrong. It's just, that was the way we were trained. Right, like all right, the best way to be a football player is to get hit and to hit right. So we're going to do it. I think that was our warmup. We like did some basic calisthenics my dad would kill me if he was hearing this, you know, but he's a. He's like basic calisthenics and then we would just lie down and we would do Oklahoma drills, and that was what was the norm.
Speaker 2:Everyone was doing that. The Cowboys were doing that, right, like texas longhorns were doing that. Now we're replacing those drills with um. We're going after dummies, right. So we're still working on tackling, but we're not going head to head against the teammate at full speed. We've got, if you look at, you know alabama, and they're showing spring practice right now. They're not going full collision until they're doing actual scrimmages. What they're doing is they're doing fit up drills or they're doing tag off drills, where they're just going up and tackling a dummy Right. So a lot less force, a lot less risk at exposing people to concussions. So, yeah, that's a. That's a massive, massive part.
Speaker 1:Yeah, and it's almost like a game of odds, right, odds, right. So if we're having the multiplier of two forces coming together against each other, then we're multiplying the amount of force that's going on to each object right. And if we increase the volume of exposure of the head and the body to those hits, then we're increasing the likelihood and probability of something like a concussion. So we increase the likelihood of crossing that threshold to a concussion, which, as you stated, then increases susceptibility for more concussions. So it's really a game of odds.
Speaker 1:We're not thinking about the Pee Wee game or the Pee Wee championship that might be that weekend. We're thinking about longevity in sport, and not just football. But you know they might be multi-sport athletes. You know we might have a great football player or a good football player who's great at basketball or great at soccer or great at track, and if they get taken out because of a very serious head injury playing football, then that decreases their ability to play in those other sports and it can detract from their athletic play in those other sports and it can detract from their athletic performance in those other sports. Now, one thing that's also super important is looking out for second impact syndrome. So can you tell me a little bit more about what that is specifically and why it's so important to adhere to a lot of these guidelines, especially if we're coaches or parents or athletes adhering to guidelines to get out of a game or get out of a practice scenario if we have even a small suspect of a concussion?
Speaker 2:Right. So the first thing about understanding second impact syndrome is understanding. It is the parent, the coaches, the players, the teammates around the players' responsibility to notify somebody, to stop practice, stop a game and get that player out of the game. If you see someone stumbling around, their words are slurring, they have headaches. If you see their pupils are different sizes, if they obviously were on the ground for a long time and they can't remember who they are, where they are, what the score is, all these things. They've had a concussion, right. But it also could be as simple as they. They were down for a little bit. They get up, they're a little slow, they look a little wobbly and then they try to stay in the game. You know, I gotta, I gotta. A lot of it comes from pressure from teammates or letting down teammates too. Right, there's this, there's this notion of that. So you get that and then you know, god forbid, someone did stay in the game and they get another concussion soon after. What happens is the brain goes into basically shock. Okay, and that shock can shut down basic operations. Right, the brain gets so stunned it's, it's almost like a high voltage shock to the brain and it almost like resets everything right. You can. You can stop the function of the brain by doing another con, are getting another concussion in a very small window, right, and that's very dangerous. And then if you do that I mean there's been instances of people that have have died in sport because of second impact syndrome and obviously that's very dangerous. And then if you do that I mean there's been instances of people that have died in sport because of second impact syndrome and obviously that's not what we want. I mean that's very scary stuff, right. So it's important to know the warning signs of a concussion, have a plan in place, get the player out of there, because the last thing you want is the second impact. I mean, I don't think this was a true second impact syndrome, but a lot of us saw it on national tv and it brought up the idea of second impact syndrome, but to a tongue of iloa two seasons ago obviously had a lot of concussions in one season.
Speaker 2:Suffered a concussion on a sunday game. I was shoved back, fell and hit the back of his head direct contact, but actually not a concussive blow. Sunday game I was shoved back, fell and hit the back of his head Direct contact, but actually not a concussive blow with two people. It was actually his head hitting the ground so hard right. Came back, played a Thursday night game Somehow and this is not I'm not blaming anybody but somehow cleared concussion protocol.
Speaker 2:Came out I think it was, you know, towards the end of the season they had a lot on the line came out, got another concussion in a game I think it was against Pittsburgh and you saw posturing right. You saw his arms curl up. You saw and it's involuntary, he's not doing that right like that's. That is a stunned brain that is under a lot of stress. He could have had a very serious outcome from that right and that's what we want to avoid. I mean, that's very, very scary and it brought up obviously a lot of questions and obviously he didn't play the rest of the year until the next following season and he played great this year right. So hopefully he's feeling better and has no issues. But like that's very scary, scary and it's important for people to understand that that is the potential of toughing it out right and keeping a player in there is that is that result.
Speaker 1:So yeah, and sometimes when we see that posturing whether it's the, the fencer posturing, or we see, well, is that the uh, decerebrate posturing that you were just talking about okay, decorticate or decerebrate posturing.
Speaker 1:Yeah, yeah, and and it about yeah, decorticate or decerebrate posturing, yeah, yeah, and it's like, oh, you know, sometimes it's kind of funny when you're watching an MMA fight and you're like, whoa, that dude got knocked out pretty cold. That is literally a portion of the brain being shut down for a small period of time or a short period of time due to inflammation and lack of blood flow and focal injury to like, literally, brain real estate, and that's why they have these automatic responses. So it's like us like knowing the stuff that we know. Now, when we see that, like there's part of us that's like, oh man, he got not. But then there's also the part of us that's like the clinical side that's telling us like, yeah, that's a piece of their brain real estate that has really been rocked by that hit or by that punch or from these multiple incidences and insults to the brain real estate.
Speaker 1:Right, and we talked a little bit about gear. So now it seems like helmets are like three times the size of what they used to be right. Yeah, size of what they used to be right. Um, and that's to try and slow down some of these velocities that people are experiencing in practice scenarios, right yeah, a little bit of that, a little bit more obviously of just the basic protection.
Speaker 2:Um, if you looked inside of the helmets, a lot of them have a lot thicker uh padding. They have different layers of padding, some that are more firm than others. The ones that are closer to the head are more of a I guess like a memory foam type of of uh material that absorbs a little bit more and it's a progressive build right and then on the outside they have actually in the shell itself, some of the technologies is almost like a, a collapsible wall. In in nasc, if you've ever seen those, they have like the first wall on the outer. I guess not just NASCAR but of any racing they have, the outer wall that's closest to the track will actually have the ability to collapse into a more sturdy wall.
Speaker 2:The idea being you almost blunt the blower If you're getting off of a highway and there's those like, there's like the water bucket, and then there's like six or seven layers Same thing, right, what they're trying to do is they're trying to slow, progressively, slow down the impact of that car or the collision so that it's not a direct hit on a really hard guardrail. Right, same thing we're trying to soften the blow, slow down the velocity of these two extreme forces coming at each other. And then some of them, if you look, they have like little breakaway areas that are very common in certain areas where they get hit right. So common one right here. Right, common one right here. You'll see little kind of flexible pieces of plastic that will bend.
Speaker 2:So right above the forehead and then on the sides and tops of the heads as well, of the head as well yeah, yeah, the, the, the helmet, will actually kind of have the ability to flex and bend in order to again absorb some of that blow. So they've tried to create, um, some technologies that allow for for the absorption of these forces and trying to blunt the amount of transmission of force into the head. It's going to be really hard to ever completely prevent concussion in sport as long as they have these high-speed collisions. And the problem is now we're seeing a lot of higher incidents. I think a lot of that is attributed to the size of these human beings, the speed that they're moving at, the strength, right, but a lot of it is to. I think there is a little bit more reporting around it, which is good that you see increased in numbers. There still is a stat out there that there's for every one concussion that's reported, there are nine that are not reported, which is massive, right, and that's common in the youth athletes as well.
Speaker 2:So really, the best way to prevent a concussion is well, one don't engage in these activities, right, don't engage in the activities that are going to put you at risk, but people play these sports. So the next best is be honest with it, report it. You're not going to win the championship or lose the championship by going in there and being concussed right Like you need your brain to last you the rest of your life, right. The last thing we want to do is subject it to a lot of these concussive blows. So having a good plan in place is super important for any league, any coach, any team, any parent of. Okay, I think I've had a concussion. Where do I go? Who do I see? What's my plan of action? Who do I trust?
Speaker 1:Yeah, and when we were talking about the hockey players earlier, just decreasing the amount of hits that go on during the game or actually making body checks and things illegal decreased the amount of youth concussions by like 68%. Yeah, so these primary prevention measures can really decrease the incidences of concussions in a big way and that means that we're saving a lot of brain.
Speaker 2:You've seen the same thing with youth soccer as well, especially in females. They're no longer allowing heading in the high school ranks or past a certain age, right, and that's another extreme measure maybe to some people extreme. I think it's necessary to prevent headache or head injuries, right, which can cause headaches, but that's, that's a massive part of it and you're starting to see more and more of that, which is good. There's limitations in college football now in the amount of contact days you can have, like how many days can actually be contact versus skeleton drills or seven on seven, right? So, yeah, it's, it's, it's good. You're starting to see some things come out now that are showing some positive trends towards reduction in concussions overall.
Speaker 1:Yeah, and for all those, you know, hardcore people that are like, oh, it's making kids soft and stuff, it's, how about this? How about we give you four or five concussions in a row and then we see, like, what you think about these new protocols that are coming out right? Um, and then, and so I'm thinking about, like me and my next ski season, right, and one of the new technologies is mips, and I don't actually know what it stands for, but, like, a MIPS helmet is a little bit more expensive than a regular helmet. It has that extra layer, that extra netting, that which allows us to slow down the sliding and may help with slowing down some of the velocity. I know like Smith is a brand that has like MIPS helmets and stuff like that. Currently, my helmet doesn't have any MIPS in it, so I'm thinking about putting some cardboard and taping that onto my helmet for the next season or something. But I mean, what do you think of the MIPS technology?
Speaker 2:Yeah, it's the same kind of basic principle MIPS standing for I had to just look it up too so MIPS standing for multi directional impact protection syndrome, and it's a this is what Dr Google says, because I had to brush up on it too, because I'm not an avid biker. But this, this technology, makes complete sense to me and it's exciting to see that it's making its way into into biking. So a low friction layer located beneath the EPS and inner helmet layer that reduces rotational impact force, right. So, again, the same idea is what we're talking about with these concussion helmets. Are these football helmets and hockey helmets and all these different technologies where we're trying to limit the amount of transmission of force onto the skull and onto the brain right, thus limiting the amount of concussive force, the amount of neuro damage, the amount of vascular damage, the metabolic cascade that comes from that all of that is being limited, so it's exciting to see that coming out.
Speaker 2:Obviously, I'm looking at some of the helmets that they've got here. Some of them are $300 for this right, and some of them are a little cheaper that have the MIPS technology, but I think it's an absolute must to have, right, one of the big things with this too, and we didn't really talk about yet is is neck strength is massive, right, yeah yeah, strengthening the neck is a massive part of controlling the head and limiting the amount of angular or velocity rotational force on the head right. So we have a device at the clinic. We'll talk about this later. It's called the, the.
Speaker 2:The iron neck is what it's called, and that's a bit extreme, but going to the gym and just at least like doing isometrics with your head, push up against the, you know, like a foam pad or on the ground, right.
Speaker 2:Or one of the things I tell patients at home that may not have an iron neck, because most people don't, is, you know, just work on isometric strength right, kind of put your hand behind your head and just push back into it, or push back into it on this side and push back into it on this side, right, if you have access to a neck you know there's old school ones out there where it's like the head, the headset, with the chain that comes down and you chain a bunch of weights to it and just do like this, right, like that's all good. I just think it's really important to strengthen the neck in whatever way you can. I would talk to any personal trainer. I would talk to any strength and conditioning coach that has any. You know, any knowledge of this is a good asset. Chiropractic physicians would be a good one as well. Just reaching out to somebody that can help you with that is massive to preventing the amount of transmission of force right, especially in these indirect concussive blows that we may see.
Speaker 1:Yeah, and that's a tricky one because, ironically, when people get take like a hit to the body, that will increase the movement of the neck and it might cross that threshold for velocity. So neck strengthening is a really key thing, especially if you're someone who has had a concussion previously. The stronger your neck is, the more you're able to control the whipping of the head back and forth which may cause or be a causative factor for a brain injury. Are there any nutritional approaches that we can take to decrease the likelihood of sustaining a concussion or facilitate the recovery process from a concussion?
Speaker 2:Yeah, I think preventing a concussion through nutrition is more like like, just like it is. It's more of a wellness goal. There's not a lot of research to support like, oh, if you take a ton of glutathione, you're not going to have as big of an inflammatory response or whatever, right Like. I don't think that there's anything to support that. But one of the things you can do is obviously eating a well balanced diet that's very high in omega-3 fatty acids. The brain is majority fatty acids, right and by eating a lot of these foods salmons, certain types of fish actually one of the better ones for omega-3s is mackerel. If you ever had mackerel before, it's kind of like canned, almost looked like tuna. You can get it at Whole Foods and Trader Joe's and stuff, but it's very high in omega-3 fatty acids. Almonds which I have right next to me, actually I've been snacking on before this Almonds are good Omega-3 fatty acids sources. Avocados, another good one, right. So there's a lot of different.
Speaker 2:There's a lot of different nutritional things you can do to kind of you know, as a young, as a parent that has a young athlete, that you can do to help their brain thrive just to grow right. Our brains continue to grow, for men until we're about 25, 26. For females, it's a little bit earlier than that that it stops growing. So that's I always tell patients. That's why men make stupid decisions later in life, because our brains haven't fully developed yet. But but you can. You can do these things early on to help continue to encourage the brain to grow right and encourage it to have a well balanced inflammatory response right. If you're eating a bunch of Chick-fil-A or if you're eating a bunch of which is good, by the way, but try to limit that If you're eating a bunch of these inflammatory foods, you know yeah man Takis which are phenomenal as well, right.
Speaker 2:Yeah, those are great. So if you're eating a bunch of Takis or you know these things that are cooked in a lot of like sunflower oils and canola oils that are maybe a little bit more high in in these more high pro inflammatory fats, right, or oils, then your brain is going to react differently than the individual with a, you know, well balanced diet that's eating good that they're. They're kind of global cellular inflammation level is low and maybe they don't have such a large reactionary response, right. That also helps with the gut brain access, which is super important for, you know, brain health as well as the healthier your gut is, the healthier your brain function is and the healthier the response to an inflammatory condition is right. So you're not going to freak out if you eat, you know, a food that maybe you're allergic to as much, or if you hit your head, you're, you're going to have a good, appropriate inflammatory response, have the natural progression three to four weeks and then be done most likely right, versus someone that's eating a bunch of Takis and Chick-fil-A and then they're like, oh man, I've got a headache that's lasted for two months. It's like, oh okay, well, let's look at your diet, right? That's one of the first things I talk about with patients is let's look at your diet, let's look at what you're eating, let's look at the nutritional supplements we can add in.
Speaker 2:I just had a patient this past week. She was a volleyball player, 16, first concussion. So, okay, she got hit in the head with a volleyball on a serve, wasn't looking during a warmup and got hit and actually we gave her a supplement called Sinequil. No, uh, no, uh money here to be made from this supplement. I don't get any, any money from this at all, but it's a good. It's a good supplement. It's what it has is it has good DHA, omega fatty acids. It has amino acids for growing new neurons.
Speaker 2:Right, you don't grow new neurons, by the way, that's a myth. You grow new connections from existing neurons. So you basically have the same amount of neurons at the end of development of the brain as you do at the end of life. You don't really lose neurons unless there's like some sort of stroke or something that causes an actual loss of volume. But what happens is the amount of connections between neurons is what allows it, and that's what we try to work on in our practice. So Sinequil good source of omegas, good source of amino acids, anti-inflammatory stuff like trans-resveratrol, glutathione, um, you know, you've got your coq10s, all of these things in there and it's just a powder and we put it in water and we have them take it. She reported. She was like, oh, once I started taking that it, I felt great, right so she had a good response with it.
Speaker 2:We give it to, we recommend it for for most of our patients, and it does really well right, and it's just a nice thing to give patients when they get done with a visit with us on their first visit and we're like, hey, I want you to take this. It's, you know, it's pretty safe. I mean, it is safe, it's a good supplement and it helps. It's really good. Creatine is the most important one, though, that I want to touch on with this is creatine.
Speaker 1:Big fans of creatine over here at the eye prevention podcast I've got two episodes that I've already done on creatine, so let's I mean you can't stop talking about it though, right?
Speaker 2:no, creatine is massive and creatine, as you know, is the most researched dietary supplement on the market. I mean it has the widest body of research to support it, which is good, because it shows that there is benefits to taking creatine as a recovery agent after concussion and really as a as just a good brain supplement to it boosts. It boosts brain function. It's a really good supplement to take. So creatine is massive. I start patients at about five milligrams of creatine and then we build up, I go to 10, I don't go higher. There is some research that supports 1520 milligrams after concussion. I don't really go that far. I go up to 10 milligrams and kind of keep them there. But it's a great supplement. That's one that I can't recommend highly enough for and it's really safe. Actually, you know, younger athletes too, there's, there's. It can be beneficial for them.
Speaker 1:So yeah, and could you tell us a little bit about some of the mechanisms behind, like how creatine actually helps someone after a concussion?
Speaker 2:Yeah, so from what I understand and we have a clinical nutritionist on on staff, like I mentioned earlier, and she kind of manages this but from what I understand, creatine in the brain and really in the body allows us to do a couple of things. One is it helps with uptake of water, right, water retention, which can be good for hydrating the brain and keeping it nice and full of fluid. Most of our brain is water, right, it's fat and water essentially is what our brain is, right, so it needs good hydration. So creatine can help with that. It can help with vascularization and getting blood flow and improving blood flow into the brain, um, and and helping with kind of that, that vascular recovery that occurs after concussion as well, right, and keeping that nice and strong. Actually, there's a stat out there that I think is really interesting. It's your brain is about two to 3% of your body's mass, but it takes up 20% of your cardiac output, right, so one pump of the heart, 20% of it's going up to this relatively small and insignificant structure and mass relative to the rest of you, right? So blood flow is huge, huge, huge. I can't encourage it enough with our athletes.
Speaker 2:One of the first things we do with our patients is, in addition to the supplementation with the creatine and some of the Senequel and stuff, is actually getting them on a treadmill or a bike and starting to exercise them. Because it shows that the people that get back on to a more regular sub-threshold exercise routine and that gets into more of like the Buffalo treadmill test, which is an important test to do after a concussion. If you're not familiar with that, we can spend a whole hour just talking about that. But once we figure out sub-symptom threshold for concussion then we can start to exercise them at that. And that's the first thing I do with the patient is warm them up on a treadmill or on a on a bike and get their heart rate up and then they're ready, right, and if they're taking creatine it helps kind of get the brain nice and vascularized and opening up those vessels for the delivery of the blood.
Speaker 1:Yeah, and I think that's an awesome segue into recovery strategies, in case someone who is listening to this has had a concussion or is recovering from a concussion. So injuries to some of the vasculature and some of the blood vessels, some of the really small blood vessels that are going to the brain, that's been shown to happen with the concussion. So actually like not doing the total rest of sitting in a dark room and then maybe getting some Xbox in, but maybe doing some things like getting on a stationary bike or getting on a treadmill or going for a walk outside as long as you can take the sunlight, and things like that right.
Speaker 2:Right, yeah, absolutely, it's massive. So, like you said earlier in the pod, there's three phases of this concussion rehab. There's the acute phase, 24 to 48 hours after you suffer the concussion and how you manage that is different than the subacute phase, right? So in the 24 to 48 hours, basically what we're trying to do is ensure that there's not a brain bleed, right? So recovery of that is going to look a lot like hey, just go home and rest, you know, tolerate what you can. There's some research to support fasting. I'm not recommending that because not everyone is, you know, healthy enough to go into fasting and stuff like that. But 24 to 48 hours rest.
Speaker 2:After that time to start getting active, right, that subacute phase that lasts from 48 hours really up until about three weeks, four weeks, you're looking at a little bit more activity, gradual progression, not into sport again, but into just general activity, right? Going on walks, engaging in work or school again is okay, as long as you don't have symptoms. The second your symptoms start to come, on back off. Go, lay down. So your symptoms back off, drink some water, hydrate, you know, eat a good meal, fuel your brain and then go back to whatever activity it was that you were trying to do right. But it's important to gauge your capacity during that subacute window and hopefully after that you've recovered and you don't have concussion symptoms anymore. But then, if you do, you're having what's called post-concussion syndrome, right? So basically you have a lingering inflammatory response or a lingering vascular vascularization issue and that's that kind of four weeks into chronic nature of of where we come in with our clinic and what we do to try to manage the symptoms of that concussion right. So that could look like exercise at symptom threshold, starting to incorporate diet. We may do some functional tests to look at hormones which can contribute to the lingering symptoms because those have been disrupted, with, you know, hpa axis being all thrown off and the adrenal glands being thrown off. That's kind of where you go to a clinic like ours and you work with a team that specializes in that right.
Speaker 2:So recovery can look very different for people. But it's important to understand the different phases and each different phase has a different aspect of recovery, right? A lot of people can go that right after impact to three weeks and maybe not see a practitioner and be like you know what? I'm good, I feel great, not need anybody, right? Maybe only go to one person and that's the ER or your primary care, and they order a CT scan and they're like, hey, you've got a concussion. Go rest, right? Well, in my opinion, rest for 24 to 48 hours is OK and then getting active again is the most important part, right? So, yeah, it's, it's really important.
Speaker 2:Recovery from a concussion is very variable. It can look like me just doing a bunch of eye movement therapies with a patient, some exercise, a little bit of balance therapy, working on neck proprioception with certain devices like the neck care emotion guidance lights, which are different, right. It could be going to a psychologist and talking about the trauma and dealing with the emotional side of things. Right, it could be nutritionally addressing the gut, brain access right, and making your gut healthier so your brain is healthier and reduces inflammation there. And, like I said, seeing a practitioner that can do some testing to look at your, your hormones and stuff. So all of that super important in the recovery process.
Speaker 1:Oh man, amazing. So, leonard, today we've talked about so many different things, going from the basic definition of what a concussion is to primary prevention, preventing that second impact syndrome. We talked about some gear so helmets, wearing mouth guards, neck strengthening, and then nutrition and then recovery strategies. So so many different things. But at the end of each one of these podcasts I like to kind of sum everything up into one little piece or nugget of advice. So, if you had to sum up everything that we talked about, what is your ounce of prevention for people that don't want to get a concussion or don't want to get another concussion?
Speaker 2:My one ounce is understanding your history right. If you've had a history of four or five concussions, maybe tackle football isn't in your future right, and I hate to say that but it's important. I had to realize that right, it's important. I had to realize that, right Like, I had a handful of concussions. Had I had another one, it could have been bad. Right Like, and, and I think that that's really important.
Speaker 2:So, knowing your medical history, understanding how you've responded to previous concussions right, taking the necessary precautions, getting a good helmet right If you're going to continue to engage in these different sports, wearing the proper equipment, wearing the mouthpiece, you know strengthening the neck, you know working on these rehabilitation or these kind of priming strategies to get the brain ready and have quick reaction times and making sure that the reaction times are brisk to protect you, those are kind of the things that I would say are the most important for individuals to kind of take with them. We're not ever going to. As long as there's contact sports or even high velocity impacts, indirect maybe even a car accident, you're going to have concussions right. So I can't say that we'll ever prevent them unless they come up with some crazy alien technology that we don't know about yet, but the important thing is knowing your limits, knowing the signs and symptoms of the concussion and then knowing what to do afterward.
Speaker 2:Having a plan in place. It's important to talk with your coach of your son's Little League team or your daughter's Little League team and saying, hey, if my daughter got a concussion, what are we going to do? Right, having a plan is super important. And then having a plan internally too for you. Who do I take? Who do I go talk to? What do I do in all these different phases? Right, so we're always happy to talk to people at the clinic. Just give resources, give webinars, you know talking about this stuff so we can be a resource, obviously, but there's a lot of good resources out there as well.
Speaker 1:And how can people find you and your clinic, like websites that they should go to or ways in which they can see your speaking schedule and things like that.
Speaker 2:Yeah, so go to parkerperformanceinstitutecom is our website. You can go to parkeredu slash seminars. You can go there parkerseminarscom to see where I'm speaking at. I have a couple of speaking engagements going on this year. I'm speaking in Monterey, mexico, at the Central American Congress for Sport, so I'll be speaking there. I'm speaking at Parker Seminars in Dallas in July. I'm speaking at the Texas Chiropractic Association at the end of June, so I've got a few speaking opportunities.
Speaker 1:So you guys are in the Dallas area.
Speaker 2:Yeah, yeah, so if you're in the Dallas area or if in um, if you're in Monterey, mexico, in the beginning of June for some reason, uh, come see me and uh, we would, we would love to. I just think it's awesome you can reach out to me on social media. My, my social media handle is LC Wright. Um, uh, on LC Wright 23 on Instagram, I do have a professional one, leonard Wright Cairo, as well. So if you want to reach out to me on there, you can get on my Instagram there, hit me up. And yeah, I'd be happy to talk concussions, happy to talk how I manage concussions as a chiropractor right, because that's very different than a medical neurologist who manages it very differently. Like, I'm managing the symptoms right, and I'm managing the musculoskeletal system and how it relates to the concussion, so it's fun to talk about that. Obviously, we have the whole other side of the clinic as well. So, yeah, we'd love to love to chat about it.
Speaker 1:Oh, man, and we're definitely going to have you on again because I feel like this is such an important topic that is just now getting a lot of publicity and is more in the public eye. But gosh, I think this is so crucial that people understand concussions and brain injuries. So thank you again, Leonard, for coming on and volunteering some of your time to help people prevent these concussions from happening in the first place.
Speaker 2:Yes, thanks for having me. I appreciate it. It was fun. It was fun.
Speaker 1:I hope that you enjoyed this episode of the Art of Prevention podcast. If you did enjoy and or benefit from some of the information in this podcast, please be sure to like, subscribe and share this podcast, or please give us a five-star review on any platform that you find podcasts. One thing to note that this podcast is for education and entertainment purposes only. No patient is formed and if you are having any difficulty, pain, discomfort, etc. With any of the movements or ideas described within this podcast, please seek the help of a qualified and board-certified medical professional, such as your medical doctor or a sports chiropractor, physical therapist, etc.