Head
& Neck Injuries |
Before starting this chapter I want you to
know that there is a lot of home treatments therapies you can
self apply to, not only recover faster, but recover more completely
back towards the quality of tissue before the injury.
Nerve tissue is one of the slowest tissues to regenerate.
Both the Diapulse and the ceramic magnet have been highly effective
in the production of rider recovery from head bruising and neck
injuries. Both the Diapulse and the ceramic magnets can
remain over the areas for a minimum of one hour at a time.
Keep in mind that the effective treatments times follow the
statement “twice as often is better than twice as long”
so several one hour treatments become highly effective.
Both the Diapulse and the ceramic magnets remove debris, such
as solid blood materials that flood into the area following
the injury. This process, phagocytosis, is the first step
in normalizing the injured area. But both also induce
a plastic regenerative mechanism within the injured to completely
heal them selves.
Chiropractic spinal adjustments are of great importance.
Not only does it allow the spirit to communicate with the body
but it helps put the body structure back in balanced alignment.
Know that when the body is in balanced alignment the body will
be at its healthiest. When the body is out of balance
sickness, disease, and accelerated degeneration start up.
This is another reason why the custom make arch supports are
of great benefit. They reinstate and activate the body’s
automatic balance control mechanism.
Epsom salt apple cider vinegar bath with accompanying wet skin
brushing also are among the protocols. The back of the
neck and complete thoracic (rib cage area) spinal regions are
also to be skin brushed with every bath you take and 4 to 6
times per day using a dry skin brush. Solomon seal, horsetail,
and cal phos. are among the supplementation to be taken.
Now that you understand that there is a lot of home treatments
you can employ to recover better and faster, let’s start
with “Head & Neck Injuries?”.
The following are my notes form the post graduate course
on "Head & Neck Injuries" taught by Dr. Kirk Lee,
DC, CCSP. In my opinion Dr. Lee has the best collection
of information and knowledge on Head and Neck injuries and presents
many simple ways to evaluate the overall involvement and status
of the rider following a fall and possible head and neck injury.
You may contact Dr. Lee at 517629-5505 and myself at 843-669-5794.
Remember - motorcycle safety is everyone's responsibility.
Cautionary Note
Always consult a doctor if pain and swelling continue or if
the condition doesn’t make the progress you normally expect
to see or have experienced. |
| Self-Help Supplies |
| All of the supplies needed or necessary that
are mentioned in our "Rehab Guidelines" and "Rehab
Exercising" self-help programs are available in our Bookstore. |
| Head & Neck Injuries |
| Your head is the most important part of your
body and therefore requires the best protection gear available.
There are still a few athletic events that do not require the
use of a helmet, yet. Soccer, as an example has the highest
recorded statistics on head injuries. You may ask, "How
can that be?" In baseball the pitcher can through the ball
up to speeds approaching 110 miles per hour. In soccer the ball
reaches speeds of 200 miles per hour. Plus the soccer ball is
a lot heaver than the baseball and therefore carries a higher
impact momentum force. Keeping your head and neck free from
injuries is the objective. Protective raci41 gear, such as a
helmet, has greatly reduced head and neck injuries. Helmets
are designed to protect your head but no matter how great they
are; head and neck injuries can still occur. In this presentation
we are going to discuss how to recognize head injuries and what
you can do to assist the recovery from them. |
| Emergency Helmet Removal System |
If you are not familiar with the emergency
helmet removal system known as "Hats Off" please
stop and read this chapter before go on. Click on Emergency
Helmet Removal System.
So let’s start with the two-injury classification of
head injuries. They are:
1. Closed – lacerations can be present, but there is
no opening
into the brain cavity
2. Open - laceration are present with skull fragments, meninges
showing and possible exposure of brain tissue |
| Helmet Protection |
| To learn more about how helmets protect and
fitting the helmet to your head read "Helmets" in
the "Safety Gear" section of the library. |
| Brain Injury |
There are two types of injury forces that
can cause brain injury. Both, no matter which one causes the
injury both can create bleeding and hemorrhaging into the brain
tissues.
Injuring the brain occurs in a direct proportional relationship
to the amount of acceleration placed on it. Rapid acceleration
or G-loading is another way to view this causative agent. The
two types of Brain Injuries are:
1. Coup = The actual point of impact on the individual's head
or neck with another object.
2. Contra coup = is one such problem found in head and spinal
cord injuries where the face plate didn’t flex, bend,
or break but rather transmits the impact force into the rider.
By definition, Contra coup is the brain injury resulting from
a blow to the opposite side of the head. Contra coup is, too
often, a common finding in head and spinal cord injuries. To
avoid Contra coup type injuries look for flexibility rather
than rigidity in the visor and faceplate
The types of skull fractures are similar to those seen in other
broken bone injuries. They include:
1. Linear
2. Depressed
3. Basal
4. Communited
AXIAL LOADING MECHANISM
When the cervical spine is flexed to approximately 20 to 30
degrees it is placed in its most vulnerable position. The axial
loading or stacking one vertebrae on top of the other. Allowing
forces to he directly diverted to the spinal osseous structures
instead of being dissipated by the cervical musculature.
CONCUSSION (DIFFUSE INJURIES)
Concussions occur frequently in contact sports, especially those
who do not utilize a helmet. But even in sports that do utilize
helmets concussion still occur. As an example in 1999 there
was 250,000 cases of concussion reported or approximately 20%
in high school football.
GRADING SCALE FOR
CONCUSSION IN SPORTS
1. GRADE
1 (MILD)
· Confusion without amnesia
·
No loss of consciousness
2. GRADE
2 (MODERATE)
· Confusion with amnesia
· No loss of consciousness
3.
GRADE 3 (SEVERE)
· Loss of consciousness
The following guidelines for return to play are from the Sports
Medicine Committee, Colorado Medical School, May 1990, and revised
May I 991.
History of recent head trauma outside the sports setting, e.g.
motor vehicle accident, should be considered in the return to
play section for each grade of concussion. |
| RETURN TO PLAY "GUIDELINES" FOR
CONCUSSION |
GRADE 1
Following the first grade one concussion, if the athlete has
no symptoms at rest or exertion, return to the game may be permissible
after at least 20 minutes of observation. In every instance
when the athlete is symptomatic, removal from the game is mandatory.
All symptoms (headache, dizziness, impaired orientation, concentration,
memory dysfunction) must have disappeared. First at rest and
then with external provocative testing before return to competition.
Return is allowed if the athlete is asymptomatic during rest
and exertion for 20 minutes.
A second grade I concussion in the same contest eliminates the
player from competition that day. CT scanning or MRI scanning
is recommended in all instances in which headaches or other
associated symptoms either worsen or persist longer than a week.
A third grade I concussion terminates a player’s season.
No further contact sports are permitted for at least 3 months,
and then only if asymptomatic at rest and exertion.
GRADE 2
Return to competition after a first grade 2 concussion may be
soon as one week after the athlete is asymptomatic at rest and
exertion. A neurological exam should be performed prior to return
to practice. CT scanning or MRI scanning is recommended in all
instances in which headache or other associated symptoms either
worsen or persist longer than one week.
Return to contact play should be deferred for at least one month
after a second grade 2 concussion. Possible termination of season
should be considered.
Terminating the season for that player is mandated by a third
grade 2 concussion, as would any abnormality on CT or MRI consistent
with brain contusion or other intracranial pathology.
GRADE 3
One month is the typical period the athlete should be held from
contact sports after a grade 3 concussion. Return to play after
one month is allowed only if the athlete has been asymptomatic
at rest and exertion for at least two weeks. CT scanning and
MRI scanning are recommended in all instances in which headache
or other associated symptoms either worsen or persist longer
than one week. If asymptomatic, conditioning drills may be resumed
prior to one month.
A season is terminated by a second grade 3 concussion or by
any abnormality on CT or MRI consistent with brain contusion
or other intracranial pathology. Return to any contact sport
should be seriously discouraged in discussions with the athlete.
In most instances when an athlete has suffered a head injury,
which requires intracranial surgery, return to contact sport
is contraindicated. However, the final determination as to whether
an athlete may return to competition is the Team Physician’s
clinical decision. |
| SIDELINE EVALUATION |
Mental Status Testing
1. Orientation: Time, place, person and situation (what
happened?)
2. Concentration: Digits backward, months of the year backward
3. Memory: Names of teams in prior contest, President,
governor, Mayor, recent newsworthy events. 3 words and 3
objects at 0 and 5 minutes.
4. Neurological Testing
A. Pupils:
symmetry and reaction
B. Coordination:
finger-nose, finger-to-finger, etc
C. Sensation: finger prick, pinch etc.
5. External Provocative Testing A. 5
knee bends
B. 5 sit-ups
C. 5 push ups
C. Walk 10 yards
SECOND IMPACT SYNDROME
Considered the adult variation of malignant brain edema syndrome.
Its effects are caused by hyperemia from loss of the autoregulation
of blood flow. SIS occurs in athletes who are still showing
signs and symptoms from a previous head injury. When they sustain
a second injury, although injury may be mild it can initiate
an accumulative effect of deterioration. Within minutes or seconds
it will progress from an alter state to a coma.
SIS is critical even with prompt treatment of hyperventilation,
incubation and osmotic diuretics. It carries a universal morbidity
and high fatality rate.
POST CONCUSSION SYNDROME
No athlete should be able to return to any form of contact sports
with post concussion syndrome signs and symptoms. Risk of second
impact syndrome is too great. Head trauma with evidence of injury
you must think intracranial hemorrhage. It is the leading cause
of death from head injury.
FOCAL INJURIES (CONTUSIONS)
Intercranial Hemorrhage Types
1. Epidural Hematoma
Rapidly progressing blood clot, which accumulates outside the
covering of the brain. Usually occurs with fractures of temporal
bone. Dramatic deterioration in consciousness in 30 to 60 minutes.
2. Subdural Hematoma
Occurs between the surface of the brain and dural membrane that
covers the brain. Most common fatal athletic head injury. A
victim usually unconscious from injury and deterioration occurs
rapidly.
3. Intracranial Hematoma
Blood clot within brain itself Occurs with rupture of congenital
vascular lesion.
4. Subarachnoid Hematoma
Confined to surface of brain and represents disruption of tiny
blood vessels. Brain bruise.
With respect to returning an athlete to participation following
any type of cervical spine condition must be thoroughly thought
out. An accurate diagnosis, and decisions about an athlete’s
return should be based on clear criteria. Dr. Joe Torg, places
these types of injuries into three categories:
NO CONTRAINDICATION:
Experience and data indicate no increase in risk of serious
injury.
ABSOLUTE CONTRAINDICATION:
Experience
and data clearly indicate an increase in risk of serious injury.
RELATIVE CONTRAINDICATION:
There is no clear evidence of an increase in the risk of serious
injury, but sequelae may include recurrent injury or temporary,
noncatastrophic injury. The player, coach, and parents must
understand that there is some risk and agree to assume it.
These recommendations for return to play are based on data from
over 1,200 cervical spine injuries documented by the National
Football Head and Neck Injury Registry.
Parts of the brain that effect other areas of the body include
the following illustrations.
Front
Side View
Back
Middle
Front View
Left Outside
This left front view shows the controlling of the left brain
that control everything on the right side of the body.
CERVICAL CORD NEURAPRAXIA (CNN)
Clinical entity caused by developmental narrowing of the AP
diameter of the cervical canal in combination with acute mechanical
deformation of the spinal cord.
The typical clinical case involves an athlete who has an acute
transient neurologic episode of cervical cord origin. Findings
may include both arms, both legs, all four extremities, or an
ipsilateral arm and leg. The symptoms may result in sensory
changes with or without motor findings. Sensory changes include
burning pain, numbness, or tingling; motor changes consist of
weakness or complete paralysis. An episode usually lasts less
than 15 minutes, but may take up to 48 hours to resolve. Complete
motor function and full, pain-free cervical motion normally
returns.
PINCHERS’ MECHANISM
Occurs when hyperextension of the cervical spine causes the
posterior inferior aspect of the superior vertebral body and
the anterior superior aspect of the lamina of the subjacent
vertebra to come together; conversely, in flexion the lamina
of the superior vertebra and the posterior superior aspect of
the subjacent vertebral body come together. In both cases the
approximation causes a sudden decrease in the AP diameter of
the canal at the cervical level, resulting in compression of
the spinal cord.
NO CONTRAINDICATION TO PARTICIPATION
· Resolved burner
· Spina bifida occulta
· Type 2 klippel-feil
congenital one-level fusion
· Developmental stenosis
of spinal canal (canal/vertebral body
ratio
<0.8)
· Mild ligamnentous sprain with no laxity
· Healed, stable compression fracture of vertebral body
· Healed, stable end-plate fracture
· Healed
"clay shoveler’s fracture"
· Healed
intervertebral disc buldge
· Stable, one level anterior or posterior surgical fusion
RELATIVE CONTRAINDICATIONS TO PARTICIPATION
(Provided individual is asymptomatic and neurologically normal
and has full range of pain free motion)
· Recurrent acute and chronic
burners
· Developmental canal stenosis with episode
of CCN, intervertebral disc disease, MRI evidence of cord compression
· Ligamentous sprain with mild laxity (<3.5 mm anteroposterior
displacement and 11 degrees rotation)
·
Healed. Non-displaced Jefferson fracture
· Healed,
stable, mildly displaced vertebral body fracture without a sagittal
component or neural ring involvement
· Healed, stable
neural ring fracture
· Healed intervertebral disk
hemiation
· Stable, two-level anterior or posterior surgical fusion
ABSOLUTE CONTRAINDICATIONS TO PARTICIPATION
· Odontoid
agensis, hypoplasia, or os odontoiduni
· Atlanto-occipital
fusion
· Type i Klippel-Feil mass fusion
·
Developmental canal stenosis with: ligamentous instability,
cervical cord neurpraxia with signs or symptoms
lasting more
than 36 hours, multiple episodes
of cervical cord neurpraxia
· Spear tackler’s
spine
· Atlantoaxial rotatory fixation
·
Ligamentous laxity (>3.5 mm A? displacement or 11 degrees
rotation)
· Vertebral body fracture
with a sagittal comonent
· Vertebral body fracture
with associated posterior arch
fractures and
or ligamentous laxity
· Vertebral body fracture with
displacement into spinal canal
· Healed fractures
with associated neurologic findings or
svmptoms,
pain, or limitation of cervical ROM
· Intervertebral
disc herniation with neurologic signs or
symptoms,
pain or limitation of cervical ROM
· Anterior or posterior fusion of three or more levels
SPINAL STENOSIS
Spinal canal stenosis increases the risk of CCN recurrence.
The risk is inversely related to the ratio of the spinal canal
diameter to the vertebral body diameter. Stenosis is measured
by dividing the width of the body of the vertebrae into the
width of the canal.
Treatment Measures For Head & Neck Injuries
Bleeding & Bruising Into The Brain Areas (Concussions &
Strokes)
Concussions are generally traumatic in their onset and cause
bruising and/or bleeding and hemorrhaging of a blood vessel
into the surrounding brain tissue areas. Any level or degree
of a concussion is very serious. Concussions are similar to
strokes that are produced by a ruptured blood vessel or blood
seeping out of its normal vascular channels into unwanted areas
of the brain. Blood leaks out of its vascular channels
and infiltrates into the surrounding area causing a surrounding
tissue to malfunction. Concussions can be complicated by high
blood pressure, post traumatic blackout head injuries,
and weakened blood vessel walls. The objective here is two fold:
1. To stop the bleeding
2. And remove the blood clots from the surrounding tissues as
soon as possible. |
| Diapulse |
The Diapulse
is the best tool to treat this condition (see Head Injuries,
a double blind study on great success of Diapulse treatments)
but one is not available ceramic magnetics have had good success
with this condition. Garlic is also very helpful with this condition.
See Garlic. Use the North Pole surface
over the part of the head that was injured.
Treatments
You may also click on Rehab Guidelines
for additional self-help methods to assist your body in its
healing process. Ceramic Magnets
Place the North Pole surface over the specific skull area for
45 minutes to 1 hour four to five time per day (or more if necessary)
to arrest the blood leakage problem. If it is available the
best tool of choice is a Diapulse. See the hyperlink to . |
| 2. RICES-S Rule Let's Review. |
A very effective successfully step-by-step
treatment procedure to guide you through new injuries (acute)
is called the "RICES-S Rule". Each letter of the rule
stands for an action or actions you must immediately perform
to successfully manage the new injury. The management of initial
traumatic injury, swelling, edema, and shock is included in
this rule. If you do not own or have excess to any electromagnetic
devices you can apply cold using the guidelines provided in
the chapter The rule is as follows:
1. R = Rest (place the Injury a state of physiological rest
& stay
off of it)
2. I = Ice (apply cold therapy to the involved site)
3. I = Immobilization (movement or motion will worsen an existing
injury)
4. C = Compression (use a support wrap or elastic ace
bandage)
5. E = the immediate application of electromagnetic therapies
and the Elevation of the involved area up to or above the
heart. The elevation of the involved area helps to manage
the swelling by keeping the involved area in a raised
position, which allowing gravity to help remove the
unwanted swelling and/or edema.
6. S = treat for shock (For an explanation and treatment of
Shock, please see the shock chapter.)
7. S = correctly fit a support product such as splint, crutches,
etc. |
| 3. Cold Application Guidelines |
If swelling is present immediately after
an injury has occurred, apply cold therapy. Cold therapy aids
in slowing circulation and unwanted bleeding in the injured
area. The swelling that typically occurs is a result of the
pooling of blood around the injury due to the trauma delivered
to the cells and surrounding tissues. By applying cold therapy
as soon as possible, you reduce the unwanted blood flow, swelling,
and edema. This process also slows muscle spasm and decreases
the pain reaction. Cold therapy should be applied as follows:
1. Large Areas
1. 20 Minutes On
2. 2 Hours Off
3. Repeat.
2. Median Size Area
1. 15 Minutes On
2. 2 Hours Off
3. Repeat
3. Small Areas
1. 10 Minutes On
2. 2 Hours Off
3. Repeat
It should be noted that the application of cold therapy in excess
of 20 minutes at a time may cause additional bleeding, swelling,
and possible frost bite.
Another essential part of cold therapy application is compression.
Compression is the practice of wrapping or bandaging the injured
area of the body to give pressure to slow and stop the bleeding
and, at the same time, adds support. Although cold therapy is
applied on and off for short periods of time over a 3 day or
more, if necessary, compression should be applied continuously.
The functions of compression are to:
1. Slow and stop the bleeding
2. Redirect existing fluids, causing the swelling, back into
their
vascular channels
3. Splint and support the injured area
Note: blood and other body fluids out of their
proper vascular channels (swelling & edema) greatly prolong
and extend the body’s normal healing time periods. The
faster you can control, stability, and eliminate any swelling
the shorter the healing time will be. |
| Quick Swelling Reduction |
Another way to reduce swelling is by drinking
a glass of "Orange Juice". This action shifts body
fluids from its peripheral tissues into its digestive track.
This is an old body builder technique called "Carbing Up".
Carbing up is short for the process of elevating the levels
of carbohydrates in your digestive track. When this is done,
the body automatically shifts its body fluids from the periphery
into its digestive system. The overall effect for the body builder
is the exaggeration of his or her body muscle tone and definition.
The overall effect in injury management and treatment is a reduction
of unwanted swelling and/or edema to the injured area.
Nothing beats the total effectiveness of swelling and
edema reduction by electromagnetic therapies, such as Diapulse,
ceramic magnets, Violet Ray Tube, and the multiple Wave Oscillator.
N-I & N-2 Ceramic Magnets
work exceptional well as well, not only immediately reduce swelling,
but to control pain as well. The Tesla High Frequency Coil Violet
Tube also reduces swelling and pain. |
| Acute Injury Vs Chronic Injury |
An acute injury is one that is a new or has
just immediately happened, such as bruises, burns, cuts, sprains
or surgery. A chronic injury or ailment is one that is persistent,
continues to come back over and over again, or is long-lasting,
like migraine headaches, stiff joints, loss in joint range of
motion, cramps, arthritis, bad backs, or the aggravation produced
by old injuries.
Whichever the case, acute or chronic, the proper application
of cold with compression and moist head can offer immediate
temporary relief from pain or other symptoms.
Basic Rules For Acute Injuries
(Immediate)
1. Apply some form of cold therapy combined with compression
as soon as possible after the injury has occurred. Note: To
avoid the risk of frostbite, use of a wrap or cloth towel between
the skin and the cold pack is recommended.
2. While compression should be used continuously, cold therapy
should be alternated - on for 20 to 30 minutes, off for 2 hours,
and repeat. This may go on in intervals up to 72 hours following
the injury.
3. After all bleeding and swelling have stopped and the body
has transitioned through its "Shock-Reaction", stabilized,
and shows outward sighs of recovery, moist heat may then be
applied.
Basic Rules For Chronic Injuries
(recurring or long-lasting)
1. Almost all forms of chronic conditions can be treated by
applying moist heat therapy.
2. However, when the injury or ailment involves nerves, bones,
ligaments, or tendons and unwanted signs and symptoms come on
quickly, immediately apply cold therapy and compression. Simply
follow "Step 2" under basic rules for acute injuries.
3. Experiment with "Contrasting Therapy", or alternating
both heat and cold. Apply heat therapy first, then apply cold,
and repeat. If this does not give the relief you expect, go
to the therapy that gave the most relief. Most of the time it
will be cold therapy.
4. The best home remedy is Epsom Salt & Apple Cider Vinegar
bath. Apply cup of Epsom Salt and one cup of apple cider vinegar
to a hot bath tub (104 degrees of less) and soak for 20 to 30-minutes.
Do not rinse off, but rather simply dry off and go to
bed. The nest morning is when you will notice the therapeutic
difference.
Note: Whether you are experiencing serious
acute pain or persistent chronic pain, it is always best to
consult a physician or follow a respected recommended management
and treatment rehabilitation plan.
Remember
Always consult a doctor if pain and swelling continue or if
the condition doesn’t make the progress you normally expect
to see or have experienced. |
|
