Raise of hands for those that get the “norm” 8-10 hours of sleep. When does your body cue you to fall asleep and wake up? Try not to confuse this as when you think you should go to sleep and when your alarm wakes you up. If you could stay up until midnight and sleep until 8, would your lifestyle allow you to do so? What about sleeping for 7 hours at night and 1 hour during the afternoon?
A podcast that I found by Peter Attia, The Drive, episode 221 Understanding sleep and how to improve it, describes chronotypes: the time of day when you feel the most awake, when you are hungry, etc. People that report having insomnia may not truly be an insomniac…what if their chronotype simply does not match their current lifestyle? After a brain injury, as many of us manage on a day to day in our professional careers, someone may have been able to compensate their mismatched chronotype/lifestyle before an injury. Now, they are telling you all of their symptoms and that they are sleeping all the time. Well, think about it. Has their chronotype changed? Is it the same as pre-injury and they are unable to tolerate the mismatch now? We are excited to have an open discussion below on this topic, so make sure you put your comments in the box below!
Follow this link for a more in depth definition of chronotypes: https://www.sleepfoundation.org/how-sleep-works/chronotypes
Nutrition & Concussion Part 2: Gluten Case Study
Welcome back for part 2 of our Nutrition & Concussion series! This post is a case study on a 13 year old female that sustained a concussion playing basketball. She completed treatment and her return to play protocol, although was still complaining of a 5 minute headache on a daily basis. This headache was not associated with any activity in particular, and in fact went away with physical activity. At this time, with no known cause of the headaches, I had the athlete journal her eating habits for 2 weeks everyday. This included what she ate/drank, when she ate/drank, and when the headache occurred and for how long. We noticed a trend: her headache occurred within 30 minutes after consuming any gluten. I hated to put her on a specific lifestyle change at such a young, influential age, however it was the only thing we had not tried to get rid of her headaches once and for all. The athlete and parent were both more than willing to try going gluten free for 4 weeks to see what happened. Sure enough, the headaches stopped altogether once she substituted her foods with gluten free products. Now, 6 months later, the athlete has completed a gluten re-introduction process and is able to tolerate small amounts of gluten at a time without remorse. She waited until she knew her body was ready (this was a very mindful 13 year old) and listened to her body when it started becoming symptomatic again, by taking out the foods that caused her the headache. With mindfulness and guidance, we can help our athletes reach their goals and change their life long term for the better.
Nutrition & Concussion: Part 1
You know the phrase, “you are what you eat”? Well after a severe injury or illness I have found this to be truer and truer for every athlete I work with. After sustaining a concussion, the blood brain barrier becomes compromised and causes a lack of filtration of toxins. This leads to symptoms such as fatigue, brain fog, lack of concentration, poor memory, etc. The brain literally has no moat to protect it! As clinicians we have to educate our athletes on how to restore the blood brain barrier, protect the brain, and give it an optimal environment to heal on its own. Side note: a great professor once said, “The body will heal itself, we just have to give it the tools to do so.” What kind of tools should we have in our toolbox? At Dr. Fitzgerald & Associates, we look at what foods cause inflammation due to the body’s increased inflammatory response after injury. As with orthopedics, concussion injuries also go through the same inflammatory process and some people get stuck in this phase of healing. This is when they need the tools in our tool box to get through the “stuck”. What do these tools look like? For starters, research what foods may cause inflammation. Many of these include gluten, dairy, nightshades, and caffeine. It takes a special kind of artist to guide someone through dietary changes, especially to make sure they are getting enough protein and fats which is what the brain and blood brain barrier are made of. Really challenging someone to focus on what they can eat vs. what they cannot, keeping their focus positive vs. negative, is key to improving nutritional habits and concussion symptoms associated with them. Secondly, how do you know they are getting enough protein? See below for recommendations from Houston Methodist Orthopedics & Sports Medicine; it’s a great resource! Craving more on nutrition and concussion? Stay tuned for part 2 of this series: a case study on how cutting out gluten abolished an athlete’s symptoms completely.
Updating the Return to Play Timeframe
The above article is associated with World Rugby and their new announcement requiring all athletes that have been diagnosed with a concussion being sidelined for a minimum of 12 days. Formerly this minimum requirement was 7 days across the world, a standard practice regardless of sport. At Dr. Fitzgerald & Associates Vision In Motion clinic, we see numerous athletes, of all ages, that did not think their head impact was “a big deal”. It was only when they began realizing, days later, that they had a headache with certain tasks of daily living, or that they became dizzy when they sat up from lying down, and that they forgot their neighbor’s name across the street. Just like with delayed onset muscle soreness (DOMS) after exercise, symptoms of a concussion can also be delayed. It is important to gain a thorough history of mechanism of injury, symptom provocation, and discuss nutrition, exercise habits, and sleep hygiene when evaluating and treating a concussion. It is equally as important to utilize the return to play protocol appropriately, and monitor the athlete’s heart rate throughout each phase, since symptom provocation may be delayed up to 24 hours, heart rate will tell you immediately if the athlete will have a side effect from any physical or cognitive activity.
Train Your Brain to See Again!
Happy Friday! 3 weeks until we host our Train Your Brain to See Again Clinic, July 8-9. We will be covering a wide variety of material related to concussion/TBI, stroke recovery, and multi-sensory systems therapy (aka, our Pinnacle Program). This clinic is open to optometrists, physical therapists and assistants, occupational therapists and assistants, athletic trainers, and doctors. If you plan on staying overnight, hotels near us include the Tru Hotel and the Marriott. Both of these have blocks reserved for this clinic, all you have to do is drop the Dr. Fitzgerald & Associates name and request to be put in that block of rooms! The clinic will run from 8-5 with a lunch and learn built in, so be ready to “drink from a firehose” as we call it here at the office. This will also be a great opportunity to build connections with other healthcare providers and build a team of professionals to refer to and work with.
When to use Symptom Management vs. Therapeutic Exercise in Concussion Rehab
Symptom provocation after suffering from a concussion/TBI is different among each individual I see. Each day I see someone, I start out with a history of what they have been up to, how much water they’ve been intaking, what they’ve been eating (many times people are not getting enough calories), what their sleep quality is like, and then end the subjective portion of my session with them filling out a symptom survey. This symptom survey is especially important for objective documentation because it gives you, the clinician, and insurance an idea of how the patient is processing their symptom provocation. I do all of this before I even consider what their session will consist of that day. When someone approaches me with significant headache, nausea, or dizziness those are the “Big 3” red flags that tell me this person is not going to benefit from initiating visual, vestibular, or cognitive skills right away; they need symptom management first so their brain and body benefit from the therapeutic exercise. It is not until someone reports to me asymptomatic and with complaints of visual dysfunction, difficulty focusing, memory loss, etc. that I begin a session with therapeutic exercise. This is when it is appropriate to push their brain and body to work effectively together as one system.