Discover the intricate dance of the brain within our skulls and the surprising ways concussions can occur without a direct blow to the head.
My guest today is Dr. Perry Maynard, a seasoned board-certified chiropractic neurologist specializing in managing complex neurological cases, including post-concussive syndrome, vertigo, balance disorders, and movement disorders.
Dr. Maynard and I explore the perplexing world of concussions, dizziness, and the need for subclassifying concussions to better craft recovery strategies tailored to each individual's unique symptoms, ranging from headaches and mood disturbances to light and sound sensitivity. We share insights into how athletes navigate recovery, often battling maladaptive compensations that can lead to longer-term issues.
Our conversation doesn't stop at identifying problems; we're here to offer solutions and proactive steps for managing concussion symptoms. Shattering myths of outdated recovery practices, we emphasize the importance of proper diet, supplements, rest, and medical assessment following a concussion. Dr. Maynard and I also cover innovative rehabilitation techniques, including the role of neck strength and visual therapy in both prevention and treatment, underscoring the power of a multifaceted approach to healing the brain.
Join us on a journey through the complexities of concussions, and learn about the cutting-edge treatments and preventative measures in this enlightening episode.
Follow Dr. Perry Maynard
Instagram: https://www.instagram.com/dr.perry.maynard/
Website: https://integratedhealthdenver.com/
Facebook: https://www.facebook.com/integratedhealthsystems
Watch the video of this episode on YouTube
Review & Follow The Podcast On Your Favorite App:
https://edpaget.com/category/podcasts/
Connect with me
Website: www.edpaget.com
email: ed@edpaget.com
Discover the intricate dance of the brain within our skulls and the surprising ways concussions can occur without a direct blow to the head.
My guest today is Dr. Perry Maynard, a seasoned board-certified chiropractic neurologist specializing in managing complex neurological cases, including post-concussive syndrome, vertigo, balance disorders, and movement disorders.
Dr. Maynard and I explore the perplexing world of concussions, dizziness, and the need for subclassifying concussions to better craft recovery strategies tailored to each individual's unique symptoms, ranging from headaches and mood disturbances to light and sound sensitivity. We share insights into how athletes navigate recovery, often battling maladaptive compensations that can lead to longer-term issues.
Our conversation doesn't stop at identifying problems; we're here to offer solutions and proactive steps for managing concussion symptoms. Shattering myths of outdated recovery practices, we emphasize the importance of proper diet, supplements, rest, and medical assessment following a concussion. Dr. Maynard and I also cover innovative rehabilitation techniques, including the role of neck strength and visual therapy in both prevention and treatment, underscoring the power of a multifaceted approach to healing the brain.
Join us on a journey through the complexities of concussions, and learn about the cutting-edge treatments and preventative measures in this enlightening episode.
Follow Dr. Perry Maynard
Instagram: https://www.instagram.com/dr.perry.maynard/
Website: https://integratedhealthdenver.com/
Facebook: https://www.facebook.com/integratedhealthsystems
Watch the video of this episode on YouTube
Review & Follow The Podcast On Your Favorite App:
https://edpaget.com/category/podcasts/
Connect with me
Website: www.edpaget.com
email: ed@edpaget.com
Welcome to your Lifestyle is your Medicine podcast, where we do deep dives into the topics of mind, body and spirit. Through these conversations you'll hear practical advice and effective strategies to improve your health and ultimately add health span to your lifespan. I'm Ed Padgett. I'm an osteopath and exercise physiologist with a special interest in longevity, and today my guest is Dr Perry Maynard. Now, dr Maynard is a board certified chiropractic neurologist that specializes in the management of complex neurological cases. This includes post-concussive syndrome, vertigo, balance disorders and movement disorders. Now he works with Shane Steadman, who I interviewed in episode 12 in their Colorado clinic called Integrative Health Systems, and you can go out back and check that podcast out. So today Dr Perry and myself are going to be talking about everything concussion and dizziness. Dr Perry, welcome to the show.
Speaker 2:Yes, thank you so much. I'm excited for today. I think this is a it's kind of a hot topic, right. Everyone's talking about concussions, head injuries, which is great, but at the same time, there's so much information out there. How do you sift through good information versus not good information? So I'm really excited to talk about this topic. We see head injury patients five days a week for years and years, and years, so it's definitely what we do and what we know, so I'm excited for today. Excellent.
Speaker 1:Okay, so let's start with some definitions. What is the definition of a concussion and how do you know if someone has a concussion? Great, question.
Speaker 2:So I think this is really good, because I actually do a lot of kind of expert witness stuff and courtroom stuff and there was a doctor who used a definition from, I think, like the 90s right In that this person. He was saying, well, they didn't get hit in the head, therefore there's no way they could have possibly suffered a concussion. But when you look at some of the most up to date definitions, they usually come from the consensus statement. Now, these are for sports related concussions, but really I think you can use them towards most concussions. So this most recent one was in Berlin. It was written in around like 2019, but it just came out. So every four years, the world's experts on sports related concussions get together in a different country and they kind of update definitions, treatment standards, things like that.
Speaker 2:And when you look at some of the most up to date, really all you need is some sort of force transmitted to the body right, it can be the head, but it could be transmitted to your side, to your legs. You could fall on your butt. We do a lot of snowboarding skiing out here, so a lot of people might slide out on their snowboard and their tailbone hits the ground right. All we need is some sort of force to transmit into our skull, because really, what happens with a brain injury is this concept called Kuhn Counter-Kuh. Our brain, this big matter of fat, sits in our skull and is surrounded by cerebral spinal fluid, and what happens is when we have forces that are transmitted either directly to my head or to my body, that causes forces to enter into my head. It causes my brain to kind of slosh around right and this movement, or this Kuhn Counter-Kuh movement, creates what's called axonal shearing right, which you might get into a little bit later. But in essence, this is where we get stretching of some of these high speed connections in the brain, leading to concussions.
Speaker 2:And there's a lot of other things that occur in the concussion that we can talk about, but really all we need is some sort of force either transmitted to our head or to our body, and I think this is really important because there's so many people you see, who you know, go to doctors and they're like God, you didn't get hit to the head. There's no way you could be concussed. You know, they just slipped on ice, fell on their tailbone and they have dizziness, vertigo, migraines, and they're usually written off right. So that's really important when we look at the updated definition of concussions or mechanism of a concussion, that that mechanism doesn't need to mean that we're actually getting hit in the head.
Speaker 1:Okay, all right, that's a pretty comprehensive definition. And also, we talked a little bit about the method of getting a concussion. You know some hit to the body, but how do doctors and chiropracts, and you know neurological chiropractors, how do you figure out if someone has a concussion? And the reason I'm asking is that in sport recently they tend to have a, especially in contact sports. A doctor who screens for concussions right there and then and then allows the player to return to the field just at the rugby World Cup, is one of my sports and that's what they were doing. If they, if they pass the test, they can go back on the field. If they fail the test, then they can't. And how does that work? How do they do that?
Speaker 2:Great question. So, yeah, when you look at it, you can look at it in two ways. You can look at, like what you're talking about, in the acute setting, and then you can look at it in more the chronic setting, which is a little bit more of the world we live in. So when you look at the acute setting, especially as it relates to sports related concussions, this is where we have what's called the SCAT, and so, like I talked about the consensus statement that comes out every four years, there's usually a new SCAT as well, right? And this is a sports concussion assessment tool, just like it's kind of sounds, and within that tool, there are different checkoffs for doctors to go through, right? So if there's an individual in a concussion occurs on the field, there's, of course, first thing is looking for red flags, right? These would be things that mean like we have to go to the emergency room right now, right? So levels of consciousness is a really big thing. That's first measured is what's the level of consciousness? Is there any concern for a neck fracture or brain bleed? So those are some of the quickest things that are ruled out or should be ruled out initially with a concussion, but then within that SCAT. You have other different assessments. You have assessments that look at visual tracking, right so, the way the eyes move and different reflexes which we may get into more detail. Different testing to look at inner ear function, different tests to look at balance and then different testing to look at, quickly, different domains of executive function right, so this might be word recall, attention, different forms of memory so like verbal, visual memory right? All of these different things to get a quick glance of what's going on in that person's brain. This gives a score and that helps to determine what occurs with that patient, kind of in the acute stages, whether they are going back into play or whether they need to be assessed by a provider.
Speaker 2:Now, when you get to kind of our clinic right, where we fall into maybe seeing people days unfortunately, sometimes we tend to get people months to years after concussions it becomes a very much different game, right, you don't need to be too much concerned with is there acute brain bleed or cervical fracture? Those things have been ruled out, or if they were there, they wouldn't be in my office. So you're looking at different things, but it's similar testing to the SCAP, right? So when you look at brain injuries, really the key is how do we quantify as much of brain function as possible, right? So everything from my spinal cord all the way up to my prefrontal cortex, how do we assess these things?
Speaker 2:Okay, in concussions, eye tracking and balance and inner ear testing is used a ton right, and this is because the data seems pretty clear that these things are very much affected in most concussions.
Speaker 2:So most concussions will have some sort of ocular motor deficit, right, this means the way the eyes move. They also might have a vestibular deficit or a deficit in the part of their brain or their inner ear that has to do with understanding gravity. So when we're looking at assessing and if we want to, we can get into the details of that testing we are always assessing ocular motor function, vestibular function, but then we have ways of assessing cognitive function. So, like we mentioned earlier, things like attention, working memory, spatial memory, all these different domains to kind of get this giant picture of one's brain. Because when you look at symptoms of the concussion, right, not every headache is the same. You know, headaches could be for a variety of different reasons. Post concussion, same with dizziness, and so that's why we need to be able to quantify brain function, so that we have a good idea of what area got damaged that's generating that symptom.
Speaker 1:Okay, and I think you remember reading somewhere that in the sporting context the doctors have a baseline with their athletes. So when they compare the cognitive function they roughly know what that individual athlete would do.
Speaker 2:Yeah, so a lot of people, a lot of teams use things like impact. So there's all sorts of different standardized tools that are coming out. I was just at a Neurosight conference, the big concussion one that meets every year, and you have so many vendors, different people, so impact is one. So I played football in college. We all had to take the impact at the beginning of the season and then the end of the season and then when we would leave for our exit exam, when we were done with college, we had to take it again. So impact is one of the biggest ones. There's also Cambridge Sciences, so there's a handful of different companies that do them, but, like you said, they're standardized neurocognitive assessments and the idea is, yes, you collect a baseline at the beginning of, let's say, a season and then if a concussion occurs, then you have something to reference too. So there's a ton of different companies and people, but impact is one of the biggest ones.
Speaker 2:The SCAT isn't traditionally used as a baseline. That is an assessment tool for a concussion. Some of these other things are used more as baseline, so that's a really good thing to note is, certain things are good for assessing after a concussion and other things are better for baseline pre-things and I think there can be more than the impact which we may get to that we look at. So we do similar things to the impact and more, because I have my own biases with the impact in neurocognitive testing and concerns of people sandbagging and things like that. Granted, it can pick that up, but I like looking at more reflexive things that people cognitively can't really control.
Speaker 1:If that makes sense it does, and that's what I was going to ask. Next is when you meet someone who comes in off the street and they say well, you know, I think I have a concussion or something, but you don't know what they were like before, how do you confirm that with the test?
Speaker 2:Yeah, that's a great question. So I think with any patient it is first of all, it's a detailed history, right? What happens, right? Is there a mechanism that makes sense for this to happening? What is the course with the symptoms? So detailed history is really really important. You know, our histories can take anywhere from 30 minutes to an hour, you know.
Speaker 2:And then looking at symptoms and then you know there are certain things, patterns, you see. So I know, with balance, there is some standardized data. So there is some standardized data looking at controlled individuals, so healthy controls, and individuals with post concussive syndrome. Looking at balance and more specifically, balance when you look at a foam surface and head in different positions. So this would be like a foam pad eye is closed, head right and then head left, head forward, head back, and individuals with concussions are much more unstable in that scenario than their healthy cohorts. So balance can give a good window into saying hey, there's a little something funky going on. And then same thing with different eye tracking devices and vestibular stuff. I'd say visual reflexes, inner ear reflexes and balance are the best ones to get a good idea of where these are.
Speaker 2:The things you see get disrupted. So if you have someone in their history makes sense for a concussion and maybe not resolving, and then you see some of these patterns that you see. Then that might be where you kind of say, okay, this makes sense, where this could be related, but you're not wrong. You see someone two years later and it's like well, is it the concussion or is it the maladaptive behavior you've created from being sick for so long, which you see especially with individuals with dizziness. You have a condition called triple PD persistent perceptual postural dizziness and that condition is all based off of.
Speaker 2:There was an initial event, let's say, like an inner ear infection. That inner ear infection went away and is fine now. But they now developed this secondary condition due to a variety of different factors, to where now their brain has readapted in not such a great way, to where they look fine, but they just feel awful and it's a real thing. So you see that same thing with concussion and honestly I think some of that comes with clinical experience of seeing thousands of people. You start to learn, okay, that looks like this, that looks like this, but from a peer data standpoint, that's a balance in visual tracking. It's where there's some good normative data between healthy cohorts and cohorts that have suffered concussions.
Speaker 1:Exactly. Yeah, I remember when I first saw a chiropractic neurologist and I was training balance natural movement in fact they actually owned a gym that we just did natural movement in balancing turning eyes shut, eyes closed and he got me on a phone pad eyes open, one leg stance, no problems. As soon as I shut my eyes, boom straight off it. And I had a history of boxing and playing rugby and he's like, yeah, you still got the legacy of a concussion in there. But I was shocked how I could not stand on this phone pad.
Speaker 2:No, no, I was gonna say and that's super important, because a lot of times people don't get appropriate rehab they compensate, especially athletes. Like athletes are compensators. They can get by with the most dysfunctional movement pattern or even neurological function, but that's why they're high-level athletes. They figure it out and that's helpful for the sport. But it's not always helpful 10, 15 years later when those compensations start to fall apart.
Speaker 1:Exactly, yeah, when there's a phrase we use in osteopathy in England anyway, we call it the reservoir of compensation, and when the reservoir of compensation is drained, then you're in trouble. Yeah, All right. So someone has a concussion. Maybe it's through sports, or maybe they slipped and fell on the ice, or maybe they were in a car crash or fell off their bike. What have they? They had some sort of impact. They've got some sort of symptoms. What are the most common symptoms for a concussion?
Speaker 2:Yeah, so most common symptoms are going to be headaches, so various forms of headaches. So, and with those headaches you see a lot of light sensitivity, sound sensitivity. So individuals wearing sunglasses right when they're inside, or individuals having to wear earplugs when they're in a busy restaurant or environment, and with those headaches sometimes you can see a lot of times exercise induced headaches. So these are individuals where they try to get back to exercise and they just get debilitating migraines and we can talk about a little bit later maybe what that means. So headaches, light, sound sensitivity, dizziness, disequilibrium in vertigo I kind of chunk those into one category. But this is where individuals just don't really feel grounded. They may feel like they're spinning, they may feel unstable on their feet. Brain fog is another big one. Mood issues this could be anxiety or depression.
Speaker 2:Honestly, a great way to think about it is we're starting to subclass concussions into different forms, right, six or seven. So we have visual forms of concussions. So this is individuals with visual symptoms. Right, that could be anything from. I go to a grocery store and it's very visually overwhelming, or, using my eyes, makes me very symptomatic.
Speaker 2:We have vestibular based concussions. We already kind of talked about this. These individuals are a dizzy, we have migraine or headache forms of concussions we kind of spoke about that. We have cognitive or affective. These are individuals where they may have developed depression, anxiety or just disturbance and executive function.
Speaker 2:So I have a lot of patients like this where now when they go to they may feel fine.
Speaker 2:When they go to work, they are drained after an hour of work, right, they're exhausted and their brain endurance is not there.
Speaker 2:And then the last big thing is sleep and sleep disturbances, and this is a really hard one because, like we all know, sleep is so important for everything in healing, and so when an individual develops insomnia or different sleep disorders after post concussion syndrome, this can really impact healing. So those are the most common and even within that, when you look at certain symptoms, certain symptoms sometimes give you a window into a longer recovery. So, like individuals who have headaches that are made worse with exercise, that is usually a sign that this is going to be a longer recovery which, if we have time, we can talk about why. And same thing, individuals with vestibular symptoms or deficits post concussion tend to have a longer recovery time when you look at the research, and I would say I've seen that same thing clinically, but I'd say those are the most common symptoms and some of those symptoms might mean that an individual is in for a longer recovery than someone who might not have those symptoms.
Speaker 1:If someone has some of these symptoms, they could also overlap a lot of other problems. Do the symptoms happen within a certain timeframe of a concussion or can they happen years later?
Speaker 2:It's a great question and I think that's a really debated thing right now in healthcare, and even when you look at some of the things with athletes and NFL and people wanting to pay out for different things, when you look at symptoms and some of the like. I think when we think of that, we have to think of the timeline, right. So we take a step back and think about, like, what actually occurs with a brain injury and what is the timeline of everything? So in the acute stages of a brain injury, like initial to maybe three days, right, we have this inflammatory response that occurs right. So when we hit our head, a few things happen, right. So we get this shearing of axons. So if we think of my brain as high speed internet, those high speed internet connections can get disrupted, leading to like AOL dial up for those of you who are old enough to remember very slow. But more specifically, there is a metabolic change. So we get a disruption in electrolyte, so in like sodium and potassium within the brain. So we have different channels, ion channels, and we should keep our membrane at a certain gradient and when we suffer concussion, that gradient becomes disrupted and as that gradient becomes disrupted, it leads to this cascade of tons of things that are not so great. So inflammation, changes in energy, all this different things. So this is why in an acute stage, right Within, like the first few days, all of this is happening right. And so that's when you look at things like second impact syndrome, right, an individual taking a hit and then they get put back into a sport too soon and then they could suffer even a worse head injury and even death unfortunately and that happens, I mean that happens far too often, unfortunately these days, and that's because you're looking at the brain is still very metabolically fragile. So of course, you can see symptoms in those first few days, but you can also see symptoms for days to weeks after. Right. That is, I think, supported within the literature and the science. Right, because we're seeing the healing process occurring right, so we're seeing the acute inflammation that should be resolving and it should be getting better.
Speaker 2:So this kind of goes back to a definition with a consensus, the way healthcare looks at it, as so most symptoms should resolve within like two to four weeks, right, a little bit longer. When you're looking at, kids should be about, they give them up to about four weeks. Adults. Two to four weeks is when you should see symptoms resolve on their own. When they're not resolved at that point, that becomes defined as post-concussive syndrome. But going back to your question of, well, let's say, six months they're good and then they develop symptoms.
Speaker 2:I'm unaware of literature and there may be going into that and supporting that Do. I think personally, that is possible. I think when that happens, what you're seeing is that that individual just never healed. They just develop compensations. So I think it is possible for someone to develop symptoms months, even maybe years, later.
Speaker 2:Once again, can I find a ton of evidence that supports that? I'm not sure if that's out there, but I've seen it. And my thought is once again is that someone goes through the healing process, their brain develops a compensation strategy, right? So an example would be let's say, a lot of times when the inner ear gets damaged, our brain up regulates our visual system and we become visually dominant and maybe at first this isn't a big deal, but then it can lead to things like motion sensitivity or it can lead to behaviors where people stop moving quite as much and they stop using their inner ear and maybe they don't really notice this in the early stages and then six months later they get rear-ended in a car or they get fired from the door, some sort of stressor happens and then these things fall apart, like you said with the compensation. So I do think it's possible and I do see it.
Speaker 2:But when you look at kind of the guidelines, they sit in that like two to four week range and after that two to four week range they just get kind of labeled as post-concussive and then we can talk about what the standards say should be done.
Speaker 2:But unfortunately most physicians just say, well, rest and we'll see what happens. And then you get to six months and then once you get to six months to a year, they usually say, well, that's the best you're gonna get. And when you look at the consensus now the new consensus it advises like rest in a dark room and things like that, literally only for like two days, like two to three days, like a very short period, and then you need to be moving towards some sort of rehabilitative plan. So you really need to move quickly with concussions and the quicker you can move with them, I would say the better they're gonna get, versus like you talked about someone where their symptoms show up six months. That was probably someone who just sat in a dark room for a week or two felt better and just went back to their life. Right, it never actually was assessed by anyone.
Speaker 1:Okay, well, and the reason I asked that is like some people might be listening to this and they go oh, I've got a bit of dizziness or I've got a bit of cognitive impairment. Maybe it was that car crash 10 years ago or something and I wanted to see and I'm not saying it's not, but we'll talk about it more in a minute because my example I gave with not being able to balance on the phone pad. The chiropractor said, well, that could be due to your concussion. So I was like, oh, I still have a symptom, but maybe that's not a symptom, maybe that's a compensation, or the visual compensation is there which, when I took out my eyes by shutting my eyes, the you know, the proprioceptive conversation or the proprioception hasn't come back.
Speaker 2:I agree, and I think that's a really good point, and I think that comes back to a really detailed evaluation. You know, because I do agree, it can be hard sometimes. You know even myself who played division one football and I've done all sorts of stuff and gotten hit in the head, and you know, things pop up here and there and it's like it could be, could it be something else? And that's why, like I said, the detailed history and the examination, because, yeah, you could have had a car accident 10 years ago, but you can also develop other things too. You know. So to me a lot of times I'm trying to prove that it's not that you know. So if someone's got dizziness, well, there's a whole host of things that causes dizziness. I'm gonna rule out all these other things and if we come back and this seems plausible, okay. And also, at the same time, like the thing becomes, I sometimes think in these longer cases, like it doesn't matter, doesn't matter at this point.
Speaker 2:What we know is that we have things that are creating your dizziness. We need to fix If we can understand them. And this is the problem, because we so badly want to diagnose things, we want to put an ICD-10 code on it and we want to give it a label because there should be a standardized treatment, which sounds amazing. But when we're talking about the brain, it doesn't work that way. Other times the way I think about it is people are coming to me because they don't feel good, they're dizzy.
Speaker 2:Some people really want to know why, and I try sometimes to figure that out for them. Other times it's like, hey, we could sit here all day and hypothesize. Could it have been that from 10 years, could it not? Either way, we know we need to fix this and get you better. If you feel better and you function better doesn't really matter, because sometimes holding onto those things I think can be dangerous from an identity standpoint too. Yes, only these patients identify I have a head injury, I'm a concussion patient, I'm a TBI, this, that and it's an identity. Sometimes. I don't think that always serves individuals very well and it can be dangerous talk.
Speaker 1:Exactly Ever since my accident that's the phrase. I'm like, okay, all right, we've got something here. I actually want to put that in a different way. So in a more biomechanical sense. A lot of people come to see me and people like us manual therapists. They might have a knee pain and they all what's wrong with my knee? You say, well, I mean, it could be the vinescous, it could be the cartilage, it could be the diggings, it could be a whole bunch of different things, but your ankle doesn't move very well and your hip doesn't move very well at its weak. So we'll work on those two things and you'll get better. And they're like what's wrong with the knee? It doesn't matter. That's your complaint. But some people just love the label. Oh, you've got what's the word? Statin generic patelefemoral syndrome?
Speaker 1:The one that all the doctors say patelefemoral syndrome. They go well, I've got patelefemoral syndrome and I can say you've got knee bone problem. Doesn't make any sense, yeah.
Speaker 2:And it's true, people wear that as sometimes a badge of honor and it's like whoa, you know, and it's actually you know who was talking about this with a patient the other day. It's like people don't realize that these labels can really do a lot of harm for people, sometimes, right, because they go to a good research, yeah.
Speaker 2:And then they see a false notice and they say you know, there's no treatment for this. You know here's success rates and I think you said it perfectly with the patelefemoral syndrome and it's like when you really break down what's happening, it's like, oh, that's not so scary, right, because people catastrophize, right. We could have a whole five hour conversation on the biopsychosocial component of all these things. And so, you know, going back, that's where I try to find that balance with patients and figure out like is this gonna serve them? Is this not gonna serve them? Do they need this, do they not need this? But at the end of the day, you have a symptom. You would like that symptom gone. It is keeping you from doing something you love. As long as it's not something dangerous where I need to get you to the hospital, it doesn't really matter. Let's just get rid of this and get you feeling better.
Speaker 1:All right. Well, let's talk a little bit about the first day, what people can do, Because when I used to play rugby which was a while actually not sometimes still play, but a little bit different after this now, back in the day, you'd have a few big hits. You go to the bar, you drink some beers, you'd have a bowl of french fries and then you go out to the night club. Now, as I understand it, alcohol, fatty foods, flashing lights are all contraindicated within the first two days of a concussion. Is that still yeah?
Speaker 2:probably not the best idea. I had a similar thing I think about this all the time with college football. Yeah, we'd get done with a game, we'd get on the bus, they'd serve us like Chick-fil-A or fried chicken, and then we'd start drinking on the bus and then you'd be up till four in the morning partying Probably not great after getting your head hit for three hours. So, yeah, so I mean, when you look at these, of course, like with anyone, if you suffer a head injury, concussion, definitely follow up with a healthcare provider to be evaluated for serious things. But within your own standpoint, yeah, I think within the first few days, taking it easy, I think, is a good idea. When you look at dietary approaches, there's different opinion, right, there's some data on things like therapeutic ketogenic diets. I think there's more mechanistic studies than there are like human trials on it. I think the mechanistic studies make a lot of sense but, as you're aware, getting individuals to follow something like a therapeutic ketogenic diet, like if they've never done it before and all of a sudden they hit their head and now they're supposed to do it I don't find to be very fruitful. But paying attention to diet, right, just smart decisions, like you said, like super palatable food, if we remember like we talked about so there becomes an energy crisis in the brain. So hyper palatable foods or processed foods not a great idea. Things that are gonna spike the blood sugar are not a great idea because they're gonna put your brain on a roller coaster. So I think even just a whole foods diet right. I think meat has its role, vegetables and things like that can fit in. So I think paying somewhat attention to the diet like I said, there are some interesting data on things like ketogenic diet and different fasting strategies, but I think the research isn't totally there. So those things are, I think are important.
Speaker 2:Paying attention to symptoms and getting as much sleep as possible early on. And then, once again, I think, getting assessed, even if you're feeling relatively okay, but it was a decent hit. I think getting assessed by someone to have a baseline. And sometimes they'll see people and I'll say, okay, things look pretty delicious, watch this for the next few weeks. And if you're getting better, great. And if you're not getting better here, and these objective things like I've seen kids early on in concussions and they look like they got their brain scrambled and then after like five days on their own, their healthy brain all of a sudden normalizes right and all the testing becomes normal. So I tend to kind of watch and wait early on to see intervention. So I think, getting assessed by someone, I think the more important thing is to not just sit like if you're at a week, two weeks, and nothing is changing. You need to get moving to see someone. So I think, honestly, what you don't do is almost more important than what you do do, in that if you don't do anything and you just think you're gonna arrest this and sleep this off, maybe you will. But, like I said, if it's you're getting to five plus days, you need to be trying to find an individual to help you early on.
Speaker 2:There's some supplement strategies. I mean the most data I've seen. There's some interesting data on fish oil in omega-3s, there's some on different forms of magnesium and then within the fish oil, like DHA. So there's been lots of studies looking at different antioxidant strategies and I think it's hit or miss. There's actually I know Thorn, the supplement company. They did.
Speaker 2:I saw this presented at the or it was shared with me at the Neurosight Conference. They have a product called Cinequil and I by no means have any association with Thorn, but they actually did an interesting pilot study with hockey players I'm not sure the level, but they used some of those pre and post pre-season benchmarks. And this product had things like glutathione, curcumin, ketone salts, so things like beta hydroxybutyrate, so some of these things where we've been talking about some of these anti-inflammatory some of these things. So the idea is ketones right. So whether you're using a ketogenic diet or exogenous ketones in the form of a salt or an ester, you help to curb that energy crisis.
Speaker 2:Remember we talked about after a head injury? Glucose systems become very unstable. So the idea is ketones might create a little bit more, even in keel fuel, so your brain doesn't go through this energy crisis. And then things like omega S or DHA help with the inflammatory aspect or resolving the inflammatory storm. The way magnesium is theorized as fitting in is you have a magnesium plug on these channels so it can help to possibly stabilize membrane potential. So those are some things where there's some interesting data. You see, things show benefit. Other things don't show benefit. I think they're pretty safe. There are things I discuss and usually recommend my patients as long as there's not contraindications. But I think those are usually some safe things that patients do well with, where I think there's decent amount of data to plug in on those different mechanisms. After concussion, right Support, energy crisis, inflammation and excitotoxicity, which is the ion channel imbalance.
Speaker 1:What about creatine? We had Dr Tommy Wood on the show. I don't know. He was talking about some studies on football players. At the beginning of the season they measure creatine levels. End of the season, they measure creatine levels and the ones you had the concussions at the least creatine.
Speaker 2:Yeah, no, totally so. Creatine is another one. I probably got exposed to some of that stuff maybe a few years ago. I was not aware of it for a few, you know, up until maybe a year or two ago. Right, I always thought of it as the muscle building supplement. But yeah, there's really interesting data on headaches and migraines, depression and different mood disorders and also concussions, like you said. So sometimes I will use creatine monohydrate with patients. Yeah, that's another one I think can be helpful early on with supporting that energy crisis within the brain.
Speaker 1:The interesting thing that he said as well was that if you're not supplementing with creatine and it was sorry more importantly, if you haven't ever been tested, you don't know your creatine levels so you can get a blood test Then, if they're low, you should potentially take some supplements. And I mentioned that to a few of my friends in the community here and they were like I'm not going to get a headache.
Speaker 1:Sorry, I'm not going to get a concussion. And Tommy Woods' answer was well, you don't know when. So if you have, let's say, stronger neck muscles and you have more creatine in your system, you're less likely to get the symptoms from the concussion.
Speaker 2:Yeah, I think so. So I mean neck strength totally 100%. There's data showing that. I don't remember the numbers so I'm not going to say it but for every so much pound of strength within the neck, you see a reduction in risk of concussion. Honestly, I think this is why, when you look at athletes that really are not in a good position, a lot of times it's like adolescent females and soccer players. My theory is is because they're bobbleheads. Their necks are like pool noodles, right, and so when we talk about transmitting force into the head, my neck plays a huge role in limiting how much force is being transmitted from either a whiplash injury, an auto injury, an auto injury, things like that. So, neck, I think there is data to support that that can help to prevent concussions. There also was Dr Joe Clark out of Cincinnati. He runs their concussion rehab program with all their athletes and he actually just published on neurovisual therapy improving and lowering the risk of concussions in their athletes, so showing that vision therapy may be beneficial in keeping their athletes, or lowering the risk of their athletes, from getting concussions, which I think is really interesting. So I am aware of that and I think that makes sense.
Speaker 2:I'm not aware if there's been any data on that with creatine. Here's the thing Things like that are safe. Creatine is one of the most studied supplements in sports science and it's cheap. I mean you could get two months worth of serving for 30 bucks. It's a pretty cheap intervention, I mean. That's why I kind of like the product by Thorne, the Sinequivel.
Speaker 2:Once again, it was one study and it was a small population size, but they were looking at these different hockey players and they were following them with these different baseline and this supplement product, once again, that has the ketone salts, the glutathione, all these different things in it seem to have a beneficial intervention. So I know for me, maybe just because I'm in this space, I do those things like I snow board, I do jiu-jitsu, I'm active and I'm at risk. So I'm taking things like creatine, I'm taking fish oil, I'm taking some of these other supplements, I'm doing neck strengthening and here's the thing at the end of the day, they all have benefits and have very little downside. So I don't see the downside in doing these things. And, like I said, neck strengthening and vision therapy we do have data to show that it does seem to be helpful in preventing and mitigating concussions in athletes.
Speaker 1:All right. So we've looked at how a person might get a concussion, how that can happen. We've looked at ways to prevent it, the ways it gets diagnosed. Now let's talk about ways we can treat it. So if someone goes through this, you know two weeks, the kid a little bit longer, maybe four weeks, and they're still not right. What do you do in this situation?
Speaker 2:Right off the bat, like we mentioned earlier, I kind of think of these different subclasses. So every patient, I'm instantly trying to think what subclass are you? Are you purely a visual or ocular motor type concussion, because then you might really benefit from something like vision therapy, or are you more of a autonomic subtype concussion? So these are individuals that develop what's called dysautonomia, so it's dysregulation, their ability to regulate things like heart rate, blood pressure. So this goes back to when you look at individuals who have post concussive headaches and exercise intolerance. Those are not good indicators of a very short recovery because cerebral blood flow has been disrupted. So, not to get into this long tangent, but my brain has very specific ways where it regulates cerebral blood flow, three main mechanisms, and those can get disrupted, meaning that my brain becomes very inefficient and allocating blood flow. We only have so much blood to go around and if we're inefficient, that's not good. So right off the bat, I'm taking an individual and I have ways of assessing all of these different subtypes. I'm saying, okay, are you one of them, are you all of them? And, depending on what we find, depends on what we do. So we do a lot of vision therapy in our clinic we do a lot of vestibular rehab and balance rehab. I work with a lot of patients with autonomic conditions, so things like POTS and orthostatic intolerance. So we have ways of kind of approaching that and that's where the different tools fit in.
Speaker 2:So we know that hyperbaric is a really big buzz thing in the TBI world. We know things like neurofeedback and my thing is there's no one tool to rule them all. There's no one tool that I'm aware of that is good for every concussion. And this is why you have patients who say, well, vision therapy cured my concussion, and then you go and do vision therapy and you're like that didn't do anything. And then you're like, well, someone said, try hyperbaric, that didn't do anything.
Speaker 2:The better you can diagnose the subtype of concussion, the better you can create an appropriate treatment plan. Right, and it could be all these different things, or it could be, honestly, I'm sending them to cognitive behavioral therapy and for neurofeedback, you know, or I'm doing vision therapy. So really it comes back to the analysis. And can I analyze all these different things that we know can be disrupted, find which ones, and then we have treatment strategies or protocols for all those, or I have referral sources for those right, because we don't necessarily do it all, and I say, hey, you're this kind of subtype, we need to go this way, and I think that's what makes all the difference in getting better, because it's tailored towards that person.
Speaker 2:And that's why it just kills me when you have people out there with a single modality, selling it to everyone and pushing it on everyone you know. Seven to $10,000 later for this one modality is like maybe, maybe. What indicator do you have to show that that makes sense with generating their symptoms? So that's kind of how we approach it and that's how I think individuals going to a doctor should hope to see that it's being approached in that manner. Now you mentioned TBI in there.
Speaker 1:What does that stand for?
Speaker 2:Traumatic brain injury. So when you have TBI and that's probably good, because sometimes these terms do get thrown around right we have concussions, and and then within TBI, right, we have mild and severe, and these all come, there can all be different scoring systems that can classify, like, the severity of a traumatic brain injury. So, going back to like, we talked about that SCAT, and then there's some other assessment tools that have to do with level of consciousness amnesia, right, did I lose memory? So there's kind of grading scales to grade those different things. But when we say TBI, traumatic brain injury is what I mean. That includes concussions.
Speaker 1:TBI.
Speaker 2:Yes, yeah, just kind of. They're all different, kind of like spectrums where you have mild to moderate, to severe, all right.
Speaker 1:And you not only work with concussions, you also work with dizziness. Yes, dizziness can be part of the symptoms of concussion. It can.
Speaker 2:It can also be a whole lot of other things too, so that's a great point. So it can be with concussions. To keep it simple, when you think about dizziness, for the most part not all the time, maybe 70, 80% of the time dizziness is a mismatch. It is a sensory mismatch between one of three systems Visual my eyes, vestibular, my inner ear, or proprioception. More specifically, my cervical spine Can. The rest of my body, yes, but my neck, my inner ear and my eyes are hardwired together within my brain to give me an understanding of where I am in the world. So most of the time there's an issue in that system. Now you can also have metabolic things that contribute to dizziness, so blood sugar, blood pressure, there can be vascular reasons, there can be thyroid.
Speaker 2:I'm not saying all dizziness is that. There can be a lot of different reasons and we go through all those different things, but I'd say, more often than not, a lot of dizziness or vertigo. Specifically, there's usually some sort of mismatch in that system. So that could be damage to the inner ear or the nerve itself and that can come from either a blunt force, trauma, an infection, an inflammatory issue and that's disrupting the signal. I could, of course, have damage to my eyes. More often than not, when vision is causing dizziness, it's either because the eyes are not moving very well together, so maybe they're not tracking well, or they don't work in sync. So when an individual is getting maybe double vision or triple vision or things like that, a lot of times it's more the way they're perceiving visual information. So that's why a lot of people with dizziness they go to their optometrist and the optometrist is like you guys are good, you got 20, 20 vision, your retina looks good. And they're like I don't really know what's going on and this is actually the hardware.
Speaker 1:The lens is okay, but it's the software behind. The lens is not okay.
Speaker 2:Exactly and honestly, this is where I'm going to give a shout out to neuro optometrist. So neuro optometrist are great in this category. I work with a ton of great neuro optometrist and they're optometrist but they think kind of like chiropractic neurologists in the software aspect of the brain, and so I think those individuals are really great in the concussion world as a side note. But so, yeah, the software aspect and then neck issues. This could be maybe a whiplash injury, neck pain. We know that neck pain, right, just having chronic neck pain, can create proprioceptive deficits. And when we say proprioceptive deficits, we mean your ability to understand where that joint is in the world, right, so my brain, and know that my head's neutral versus right, versus left. I have muscles and I have joint receptors. I have these different abilities within my cervical spinal nerve to understand where's my head and that gets transmitted into my brain. It merges with my inner ear and my vision and hopefully they all say the same thing. But, like I said, when there's a disconnect, that's when people get dizzy, right, they either get vertigo where that's true spinning, or people explain it all sorts of different ways. So I think this is important. We talk about that is dizziness. Is man.
Speaker 2:If I've seen one symptom that can get described in just wacky ways, it's dizziness, because some people are like that's not dizzy. I feel like the right side of my head is floating or I feel like my left jaw is spinning. You hear all sorts of really funky explanations, and it makes sense, because you are altering someone's sense of reality so that the conscious perception becomes God knows what, and so sometimes the way someone describes something does give you an idea like true. Vertigo is usually vestibular and it's usually a certain things Versus. When you look at people who feel like they're floating or bobbing, this is usually the odolythic. This is another part of the inner year that has to do with gravity versus an individual where they're like when I'm in a busy visual environment.
Speaker 2:So the way someone does describe their symptoms and the way they trigger like history. History when it comes to vestibular disorders is so important. I always tell young docs and students a detailed history when it comes to dizziness. You should come out of that history knowing or having a good idea what it is, and then the point of your exam is to prove yourself right or wrong. That's really how it should go. We've gotten away from that as healthcare providers. Right, the doctors jot down a few different words, they key in on one word, they order a test and that's it. So history is really important when it comes to dizziness.
Speaker 1:You're right, Most doctors well, they don't have time to think about it. You know, like the MDs, they're very quick. But I've got the same as you 20 minutes, half an hour for a case history and then half an hour to figure out whether I'm right or wrong I might have a hypothesis and it's a real luxury to be able to do that, and I think that's why us, as complimentary healthcare practitioners, you know, exist, because we can take the time and we can sometimes unravel the box of things that the normal MDs don't have time to do.
Speaker 2:Yeah, no, I agree. So, and that's that's how I always go about things. Because then also to your testing is purposeful For our people going in and just like are doing different. You have seen this with doctors. They're just doing tests to check a box, right, like if we think about a neurological exam, it's like, okay, I got cranial nerve, you know one, through this, I got reflux, as I have sensors. Like, let me just check the box versus okay, here's the history, here are the things I want to check.
Speaker 2:Okay, I see that there, I see that there, and I think even to and you see this a lot in the manual world also is also a lot of times I will do intervention, right then, and there to see, like, am I correct? Right, so like, I think this system is a little funky. Yeah, it looks a little funky. Okay, can I do something to tweak that? Okay, is business a little bit better? Okay, cool, check, note it. Or is it a little bit worse? And so my exams as well are very dynamic and they help me to develop a treatment plan so that when I'm done, I also know that the treatment strategy I've chosen most likely is going to work. And that's the problem in the rehab is, traditionally, it's all very cookie cutter, it's all based on habituation techniques which are you get dizzy with? Turning your head, just turn your head, just keep turning your head.
Speaker 1:At some point I do sensitize yourself to it, sort of thing, yeah.
Speaker 2:And there are cases where that does make sense, but for most people that is hell, and you know, you hear that right.
Speaker 2:How many people do you hear go to this table to rehab and they're like I felt terrible for six months and then I think it was started to get better, or I felt terrible for six months and I just stopped, you know. And so I think you should be able to make these micro changes, not saying you'll fix someone in a visit, but coming out of the initial or first few visits, you should feel pretty confident, like okay, yeah, I think we got this. This makes sense. Here are the things we see. Here are some interventions. Things are changing. I feel confident that if we continue on this treatment plan, here's what we should see, versus just giving everyone the same plan and crossing your fingers that in a few months they're better.
Speaker 1:And what so? What do you do in your clinic for the different interventions for eyes and neck or the stability you have? You have different treatments for all those things.
Speaker 2:Yes, we do so we do, like I said, we have. So when we let's talk about vision, so we do do some vision therapy here. I also work with, like I said, some neuro optometrist, so there's certain things that they do much better than I do. So the certain things I refer out to, certain things we can do in house. But when you're looking at eyes, like we said, the question is one are they on even playing ground, right? So our eyes need to be even in the up and down playing, but also this plane here, right, and so we have different therapies that sometimes people's eyes are deviated, like this, or one eyes higher than the other, so it's like one camera seeing this image, one camera seeing that image. So we have different therapies and ability to fix and work on that in both directions when individuals have issues in tracking. So we have really two different things that eyes can do. They can track something of interest and stay focused on it. This is called a pursuit, or we have what's called a secad, which is the ability to go from one point of interest to another point of interest quickly, right, to keep it simple. We have some other ones, but if those are disrupted, then we have different therapies to work on rehabbing saccades or pursuits, and then we also some individuals when it's more of a interpretation. We have different therapies to improve the software, visual perception or making sure that the eyes are both processing the same thing. So we have different therapies and strategies for that and a lot of them are very traditional vision therapy techniques.
Speaker 2:Right, that you might get at other neuro optometrists and then with this type of the rehab you know, I'd say the biggest difference is the ability to merge it all together. So when you go to a neuro optometrist this is a generalization, but everything a lot of times is seen through the lens of the eyes, yeah, which sometimes is a little bit of vestibular rehab sprinkled in there. If you go to a vestibular therapist, everything is thought through the lens of the inner ear and they may do some vision stuff here or there. And then if you go to a lot of manual therapists they're really good with the neck but no one's really good at all three and merging together and that's what we try to understand and do with a lot of our therapies is, in a session, being able to merge vision therapy with vestibular rehab, with cervical or so maybe I'm doing some manual work on a neck, and then I'm working on proprioception, and then we're layering in inner ear, because what I try to do is I try to separate all of them, so do things to the neck, eyes, inner ear, but then we need to merge them all together Is, at the end of the day, in the real world.
Speaker 2:They don't work by themselves, they work in unison, together, and so that's the big difference is, instead of having this myopic lens of this one system, it's honestly the magic is more being able to marry them all together.
Speaker 1:I have a lot of respect for the chiropractic neurologists and chiropractic neurology. I think what you guys are doing is fantastic. There's there's obviously different styles of osteopathy, different styles of chiropractic, and I think the more that we can sort of level up all our manual therapy professions, the better we can serve our clients and patients. And it sounds like that's what you guys are doing over there in Colorado, so I commend you great job.
Speaker 2:Thank you, I appreciate it and great job to you as well. This information is got to get out there and and, like we're both aware, there's a there's a lot of people struggling and unfortunately, our healthcare system, at least here in the states, is not, unfortunately just not set up to help these people. We're really good at surgery and keeping you alive Anything else we're not the best and so I think this is where both of our professions really can shine. I think this is where we fit in in the healthcare model.
Speaker 1:So I understand that you work primarily in your clinic. Is that correct?
Speaker 2:Yep, yep, I do in yep, here in Denver.
Speaker 1:So if someone wanted to find you, how would they find?
Speaker 2:you, yep. So best ways to find us. So website, so integrated health Denvercom is our website. You can also follow us on social media at integrated health systems, but also Dr Perry Maynard also on social media like Facebook, instagram. But our website is great because on our website we have links to a ton of educational content. So our YouTube page and we've done I've done tons of lectures on this topic, on things like dysautonomia. Dr Stenman has done a ton on migraines, functional medicine. So it's really cool because there's a ton of educational content, kind of like you're collecting here. And for individuals who are curious about either working with us or chatting with us, we also offer free 30 minute consult, not just with people in Colorado, but people across the country. You know we work with people on the East Coast, down in Texas, pacific Northwest, kind of all around, and you know some people fly out to come see us or sometimes we're able to find providers for them in their area, which is really nice as well.
Speaker 1:Great Well, thanks very much for sharing all those resources with us and hopefully from from this podcast, people will find you and get some more education and maybe even come. Come and see you and Dr.
Speaker 2:Stenman. Well, thank you so much. I had a great time, it was great podcast and, yeah, thank you for having me.
Speaker 1:Thank you for joining me in my conversation with Dr Perry Now. If you've enjoyed listening to and learning from this podcast, please leave a comment and leave a suggestion for future guests that you'd like this podcast to feature. If you're an apple, you can leave us up to a five star review if you're so inclined, and I would really appreciate that if you did, and remember, if you're my direct help, email me at edadadjitcom or visit my website at projectcom and you can learn a little bit more about what I do and how I can help you make your lifestyle your medicine.