News & Events

Concussion Focus, What Is It? 

Over my five years as a physical therapist, I have been a part of many teams and have taken on many different roles, each of which has grown me as a professional and as a person.  One of my favorite roles is serving with the Concussion Focus team. Today I want to tell you a little about the team and what we do!  

Concussion Focus was originally started in the midst of a rising awareness of concussions. At that time, there were few multidisciplinary options for concussion treatment. Concussion Focus brought together physicians, physical therapists, psychiatrists, athletic trainers, and people passionate about and well trained in concussion management.

The Concussion Focus team continues to meet every other month.  The team is unique as we each represent separate organizations, but when we gather to meet we all take off those hats and come together to do our best to impact concussion treatment. In our meetings, we discuss ways to support each person’s individual efforts in regard to concussions, share current research and swap case studies. We also set a goal each year as a group to get the word out about advancement in concussion treatment.

This year we will be writing a series of blogs as a team with the intent of helping to provide resources to people dealing with concussions.

If you would like to learn more about concussions or Concussion Focus, please go to concussionfocus.org. Be on the lookout for more blogs to come from my colleagues on the Concussion Focus team!

Written By: Josiah Parker, PT, DPT


What can a physical therapist do for a concussion?

If you are suffering from post-concussion symptoms, you may feel helpless and think there is no way to help speed up the process of recovery. But there is a way! 3 Unexpected Treatments for Concussions – That Work!

The care and treatment of concussions have become one of the fastest growing priorities in the medical community in the last several years and rightfully so.

An estimated 300,000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. In fact, for young people ages 15-24 years, sports are second only to motor vehicle crashes as the leading cause of this form of a traumatic brain injury. (Journal of Athletic Training)

pt_concussion

Concussions are now more widely recognized in the world of sports, in work safety and in the medical world than ever before. According to the CDC, a concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head that can change the way your brain normally works.

 

1 out of every 5 people who sustain a concussion WILL NOT recover in the normal 2-3 week time frame.

Though they may appear to be functioning just fine, people suffering from a concussion may be dealing with an array of symptoms. These symptoms include time lost from school/work, time out of sports, headaches, dizziness, nausea, balance problems, fatigue, and the list could go on.

If you have had a concussion and are struggling with fully recovering, don’t wait any longer. Click the button below to schedule a consultation.

Schedule a Consultation

3 Ways We are Hurting our Backs

Lower Back Pain? Don’t Drag Your Feet!

Okay, that sounds more like the start of the motivational speech my parents used to give me when I was younger. Many of you may be asking yourself what does shuffling my feet on the ground have to do with low back pain? Well, a lot more than you might think. 

When referencing lower back pain, this is the speech I find myself giving to more and more of my patients.

When we look down at the ground, we tend to bring our body into a position of trunk flexion. By this, I mean that your chest is coming forward over your toes. When this occurs, our center of mass starts to move forward and we create an anterior tilt through our pelvis.

When our center of mass comes forward we adjust our body position to maintain our balance by extending through our lower back and, on occasion, by going up onto our toes. The body corrects its position to maintain balance with changes being processed by the change in our visual field by looking down.

When we shuffle our feet, we typically create the habit of making our initial foot contact with the toes pointed down and then sliding the foot forward instead of actually rolling across the foot as one would walk with a normal gait.

A normal gait is to make initial contact with the heel and push off the toes. When I see people shuffle their feet, there is also a tendency toward reducing the amount of contact the heel makes with the ground. We refer to this as an ‘early heel rise gait’ and will often see this gait pattern in toe walkers. These individuals will hardly make contact with the ground through their heels. When we ambulate with this gait pattern, much like when we look down, we translate our center of mass forward. Again, to correct we typically go into back extension. 

These tendencies toward back extension are what lead to the long-term potential problems.

First, there are the anatomical stresses that long-term extension can create. These conditions are often seen in increased arthritic changes in the lower back due to the increased stress through the facet joints in the spine.

Next, there is the tendency toward using you back extensors to perform lifting activities. Since these muscles are already being engaged to help you maintain your balance they will often fire more when you are lifting something leading to the increased likelihood of a potential muscle strain.

The next time you are out for a run or a walk my advice is to look up and enjoy the scenery and think about that nice heel to toe gait pattern. Your back and the rest of your body will appreciate you for it in the long run!

Written By: Nick Wegener, Director of Physical Therapy – PT, ATC, OCS, CSCS

How to Self-Diagnose Your Athlete’s Arm Pain

Late spring into early summer is one of the most common times we see shoulder and elbow injuries.  A lot of parents often ask me what “warning signs” they should be looking for with their son or daughter’s arm pain. Most importantly they want to know if the pain is serious or not. 

To a certain extent, we come from a place where we believe the motto “no pain, no gain”, and in some cases, I fully agree with that mindset. But at other times, this mindset can be very detrimental. How do you determine which pain is okay to play through and which pain is not? Here are four common arm pain areas to evaluate and guidelines to help you decide if your athlete should get the area checked out.

Pain Area #1:
Front or the back of the shoulder

Back of Shoulder Pain 

Pain and soreness in the shoulder are not uncommon with athletes, but the key is where the pain is located. Pain and soreness in the back of the shoulder usually occur when athletes use their arm to throw or serve. The muscles in the back of the shoulder often get strained.  They are small muscles and take on a lot of force when the arm is stopping after a throw or a swing.  Typically, this soreness gets better by the next day and eventually the muscles get stronger so the pain does not return.  

Front of Shoulder Pain

Front shoulder pain is a whole different issue.  We consider this pain to be concerning, and it should be closely monitored. Structures like the front ligaments of the shoulder, the labrum (cartilage in the shoulder), and parts of the rotator cuff are all stressed during overhead movements.  If your athletes are complaining of pain here, this is NOT the pain they should try to play through.  The pain can go away on its own; however, if the pain persists for more than three days or if it occurs every time they try to play their sport, go have it furthered examined by a physical therapist or a licensed health care professional. 

Pain Area #2:
Outside of the upper arm

Pain and soreness aren’t commonly experienced on the outside of the upper arm as the deltiod muscle is just about the only muscle in that area. Pain here, especially in adolescent athletes, is usually a sign of an injury to the growth plate of the upper arm.  Have you ever heard the term “little leaguer’s shoulder”?

Little leaguer’s shoulder can have delayed healing and significant downtime if left unaddressed.  Again, like in the shoulder, this pain can go away fairly quickly.  However, if it becomes persistent or happens every time the athlete tries to use their arm for activity, it is time to have it checked out.

Pain Area #3:
Inner or outer elbow  

Inner elbow pain

Pain and soreness in the elbow are not as common as the shoulder and tends not to be bothersome – unless the athlete is throwing or serving. This infrequency is why I think people don’t have this area looked at as much or soon enough.  The inner elbow is home to some key structures that are stressed during overhead movements.  The ulnar collateral ligament (Tommy John ligament) and the inner elbow growth plate (little leaguer’s elbow) are the most significant.  Once these areas start developing pain, they are usually past the mild stage and are typically in the damage stage.  

Outer elbow pain

The outer elbow rarely develops pain and usually does not develop pain without previously having inner elbow pain.  Pain in the outer elbow can be significant such as a cartilage lesion on one of the forearm bones.  This damage happens from over-compression in the joint, commonly due to a loose ulnar collateral ligament.  Like the inner elbow, by the time this area becomes painful, the damage has already set in.  

Pain localized to the inner or outer elbow should not be dismissed as the consequences can be detrimental to the longer term health of the elbow.

Pain Area #4:
Biceps or triceps muscles

Pain and soreness in muscle tissue is rarely a “red flag” for us.  Injuries to muscles can definitely be painful but more times than not, they will resolve on their own in a reasonable amount of time.  The biceps and triceps are the muscles most susceptible to getting strained in sports like baseball, softball, and tennis.

 

A lot of the time the pain is located in the middle of the muscle or, for tricep pain, down by the elbow joint. Again, these pains usually go away quickly and usually respond well to light to medium massage.  If for some reason, the pain is not fully gone in a couple weeks, then I would recommend getting it checked out.


Conclusion:

As your athlete participates in the common summer sports, pain and soreness can and will happen.  The key as parents is to continuously monitor the symptoms and use the guidelines above to help determine severity.  If the pain falls into one of the key areas, don’t be that parent that finally takes their kid in only to find out they fractured their growth plate.  On the flip side, if the pain isn’t too bad, “go rub some dirt on it” is sound advice!

When in doubt give us a call 402.932.7111 if you have any questions about your athletes’ arm pain.  We’d be happy to answer any questions you may have! 

Written By: Travis Manners, PT, SCS, CSCS

Tips for Managing Sleeping After A Concussion

Guest Blogger Introduction: Rebecca Lancaster, MD – Methodist Physicians Clinic

Rebecca is a graduate of Creighton University Medical School and Clarkson Family Medicine Residency.  She is a board certified Family Medicine Physician.  Rebecca began managing athlete concussions in 2010 when she became one of the first ImPACT certified physicians in Nebraska. 

She has continued to assist concussion patients in private practice and more recently at Methodist Physicians Clinic in Omaha, Nebraska. 

Her concussion patients now extend beyond athletes to include all age groups, as is consistent with family medicine, and varying degrees of head injury from acute concussions to post-concussion syndrome. Rebecca continues to be active in Concussion Focus and concussion education in the Omaha community.  Her goal in treating concussion patients is to understand where they are in their recovery,  help them through with the resources we have available and return them to their fullest quality of life after these most unfortunate head bumps.

Ah, sleep!  It is oh so important when you are recovering from a concussion, but what do you do when the injured brain does not want to sleep? 

Sleep habits become more essential post-concussion.  Scheduling regular sleep, wake times, and sticking to them helps. Here are a few tips you can implement to help manage sleep after a concussion. 

Managing a Concussion: Sleeping Tips

Aim for 7-9 hours of sleep per night. Minimize screen usage such as phones, computers, TVs, and reducing exposure to brighter lights before bed will help.

Try relaxing activities, meditation, stretching or reading if tolerated can be helpful before bed.  A short nap can be okay during the day, but if it starts to impair your ability to fall asleep, you may want to limit the duration of the daytime resting or eliminate it all together.  Physical activity is helpful during the day if you can tolerate some, but physical activity just before bedtime can make you more alert.  Decreasing or eliminating caffeine helps as well. 

And what if these tactics still do not work?

Sometimes an over the counter sleep aid like melatonin starting at a dose of 1 mg – 3 mg can be helpful to drift off to sleep easier. If headaches are a bother as well, Tylenol or Ibuprofen, at an appropriate dose for your age, prior to sleep may help.  You may also want to talk with your physician about medications that can diminish headaches as well as assist in sleep. 

Overall it is perfectly reasonable to start examining and modifying sleep habits. It may take some discipline and patience as you try a few nights with your new sleep routine. This course has no side effects and could lead to fewer concussion symptoms. If the concussion, however, has caused more difficult to manage sleep cycles, do not hesitate to seek help.

Sweet dreams!

Guest Blog Author: Rebecca Lancaster, MD


The care and treatment of concussions have become one of the fastest growing priorities in the medical community in the last several years and rightfully so.

An estimated 300,000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. In fact, for young people ages 15-24 years, sports are second only to motor vehicle crashes as the leading cause of this form of a traumatic brain injury. (Journal of Athletic Training)


Our Collaboration with Concussion Focus

What is ConcussionFocus? Concussion Focus is a collaborative group of healthcare professionals in the Omaha and surrounding area that decided to come together to provide a team approach to concussion management. 

Representing the areas of family medicine, pediatrics, neurology, athletic training, physical therapy, and other disciplines allow each professional to offer expertise in their field while communications with each other to best serve the patient’s needs.

Continue reading


Your Most Popular Dry Needling Questions Answered

Dry needling is currently one of my favorite manual treatments and I am constantly discussing it in the clinic with my patients. Due to the mildly invasive nature of the treatment, and because many people have not heard of dry needling I end up fielding many questions.

I recently received an email from a patient with several good questions and decided it would make a good blog post! If you don’t know what dry needling is check out our past blog post, “Functional Dry Needling” before reading the rest of this article.

Question 1:
Why do you feel I would benefit from needling and how does it relate to the big picture?

Dry needling is only on piece of the puzzle but it is a powerful piece. I like to explain dry needling as the ability to press the reset button on a muscle. I give the muscle a stimulus through the needle and that stimulus can help to decease muscle tension, decrease pain, increase range of motion, improve muscle activation, and improve function.

Pressing that reset button provides a window that allows us to work on treating the root cause of the dysfunction. I may follow the needling with exercises, stretches, etc which will help to reinforce the treatment and allow those changes to become more permanent.

Dry needling is only one tool in the toolbox, but my experience so far says that it is a very strong tool and one that I will continue to use more and more.

Question 2:
Do you see this as a temporary solution?

No! Needling done only by itself would be a temporary solution, but as a physical therapist I always back up my needling with other treatment so that we address the root cause of the dysfunction and not just the symptoms. I feel like in many cases needling helps to deliver results faster but my goal is not a temporary solution.

Question 3:
I see a massage therapist to help with my tight muscles, would I get the same result from just getting a deep tissue massage?

Massage is another tool in the toolbox and one that I often use, sometimes even in conjunction with the dry needling. However, needling provides a different stimulus and sometimes people respond better and faster to needling than they would to deep tissue massage. I have seen patients who responded terribly to massage respond very well to needling and vice versa. Needling is not the answer for everyone but when it works well the results are undeniable.

Hopefully this answers some of your questions on dry needling! If this has sparked more questions for you then feel free to contact us or post them in the comments section below.

Likewise if you are interested in treatment call our office today 402.932.7111 and schedule an evaluation, we would love to see you! We offer cash based options for Functional Dry Needling, and the treatment may also be covered by your insurance. 

Written by, Josiah Parker – PT, DPT

Understanding the Sports Hernia

What is it?

A sports hernia is a tear in the lower abdominal wall in the inguinal (groin) area. This typically initiates as groin (muscles that flex and adduct the hip) pain extending into the lower abdominal area. Unlike the classical hernia, the sports hernia does not result in a bulge.

Sports hernias are not related to a specific incident. Rather, gradual pain brought on by overuse and activity secondary to a strong adductor muscle group in the thigh compared to weak abdominals.

Symptoms are usually brought about by physical activity requiring twisting, kicking, sitting up, and quick bursts, but will abolish with rest. However, if not properly treated pain will immediately return with sporting activities even with a trial of rest.

Who gets them?

Anyone that is physically active may develop a hernia since it is a result of an imbalance between muscle groups which impairs mechanics.

However, it is most common in soccer and hockey players as these sports require hip flexion and adduction with kicking and skating. These muscle groups insert just below the abdominals (the area of the sports hernia) and overpower a weaker abdominal group.

How are they treated?

Sports hernias can effectively be treated with conservative physical therapy. With an effective screen, muscular and movement imbalances can be detected and corrected prior to pain.

If pain is already present, it can be treated with soft tissue therapy, maintaining hip capsule and internal rotation mobility, stretching, strengthening of the lower extremity (especially single leg) and core, and incorporating agility/plyometric activities.

Proper performance of these exercises is imperative as surgery is most likely the next option after 4-6 weeks of conservative treatment. 95% of athletes return within 3 months of a standard repair and 99% return in 4 weeks of a minimal repair.

Consult with your local physician or physical therapist for proper screening, evaluation, and treatment of abdominal or groin pain.

Written By: Eric Horstman, DPT, PT

Kachingwe A, Grech S.  Proposed Algorithm for the Management of Athletes with Athletic Pubalgia (Sports Hernia): A Case Series. J Orthop Sports Phys Ther.  2008;38:768-781.

Life-Changing Advice for People Living with Osteoarthritis

Osteoarthritis (OA), Causes, Treatments and Diagnosis

We all have that one crazy relative. I know I’m not the only one that has heard “I can tell that it’s going to rain later on today because my knee, hip, and shoulder are getting achy.” Many individuals dealing with some form of arthritis experience this phenomenon. Although it is not a 100% proven theory, decreases in barometric pressure prior to rain are thought to cause tissue adaptations that decrease support and increase joint stress.

Arthritis! Such a commonly used term, but what is it? How do we get it? What can we do about it?

What is it?

When broken down, no pun intended, osteoarthritis (OA) is a loss of cartilage within a joint. Most often found among the knee, spine, hip and shoulder; all of these joints require vast amounts of movement.

Here’s a fun fact. Knee osteoarthritis is the leading cause of disability among older individuals.

How do we get it?

We can thank our own lifestyles for this one. OA can occur as a result of a specific injury or surgery, but in general it’s the result of daily wear and tear and muscle imbalances that lead to impaired movements. It begins as cartilage breakdown, and eventually results in two opposing bones coming in contact with one another if it is not detected early enough. 

Alnahdi et al. provides some great information through research. Read More

Those with OA are often linked to quadriceps weakness with deficits between 11-56%, and eccentric deficits up to 76%. Other areas of weakness include hamstrings, hip extensors, hip rotators, abduction, and adduction strength. These deficits make daily activities like ascending/descending stairs, getting in and out of chairs and just walking difficult. Just imagine the stress that occurs at your knee as a result of strength deficits at these levels.

What can we do about it?

Moving to warmer weather is not the answer. Just like a car, your body has impairments in alignment, muscle balance, and body mechanics. Therefore, a breakdown will occur naturally. You wouldn’t drive on a tire with 50% less air right? Then why move on a leg with 50% of the strength?

With the proper guidance through physical therapy, one can be educated in proper postures, movement patterns, strengthening of supportive tissues/structures, and exercise routines to prevent the continuum of osteoarthritis. 

If the condition becomes advanced, surgery for a joint replacement becomes an option. Knee replacements have become a common treatment in the senior population. With the right care following this procedure, individuals can return to a healthy and active lifestyle.

Take Away: Come in for education on proper movement techniques and exercise routines to maintain appropriate strength, then create an active and healthy lifestyle.

Written By: Eric Horstman DPT, PT

Question: Do you have any questions about our physical therapy techniques for arthritis pain?

Understanding Exertion Therapy

Concussion Treatment #1

The treatment of concussions has been widely debated over the past few years. What was previously known and proven with research about concussion treatment suggested that the patient must rest, both mentally and physically. This is indeed true for initial treatment of concussions. There has now been a shift with concussion treatment that suggests moderate amounts of exertion may be used to help treat those who suffer from lingering concussion symptoms.

If you read my earlier blog 3 Unexpected Treatments for Concussionsit may have stuck out to you that I used the term “exertion therapy.” You may have even thought to yourself, “is this guy insane?” People with concussions need rest. They don’t need to exert themselves!”  If this is what you thought, then you definitely aren’t alone.

As we all know, not all concussion injuries are the same. Sometimes people have symptoms months or years after sustaining an injury, this is called Post Concussion Syndrome (PCS). I will share a case study that comes to mind; he was a colleague of mine who played football and whom experienced long-term concussion symptoms.

football-official-standing

Case Study

He was a running back and had played football since he was eight years old. Throughout his career he suffered his fair share of hits and injuries and received two concussions before playing in college. On his last football game of his career he sustained his 3rd concussion, what a way to wrap up your collegiate career right?

This concussion was different than his previous injuries. He lost consciousness and had severe migraines for weeks, months and even years to follow. He had tried everything to relieve the pain. He had visited neurologists and multiple chiropractors. He had gotten mixed results and he never got rid of his migraines and overall neck stiffness. I reconnected with him years later and had heard his struggle. That was when I told him to come and get it checked out by a physical therapist. He was diagnosed with Post Concussion Syndrome.

Eighty percent of people who suffer a concussion are symptom free within 2-3 weeks of their injury. However, this means that 1 in 5 people make it past this 3-week time frame and continue to have symptoms.

 

Post Concussion Syndrome (PCS) Symptoms

  1. Elevated heart rate – Tends to be high even at rest for those with PCS.
  2. Depression – Many people with PCS begin to feel some level of depression due to their decreased tolerance to activity. This can be especially true in an athlete who is used to a regular high level of activity.

Thinking back to the case study that I shared above, there are a few techniques that can be used to help address symptoms of PCS that can speed up recovery time.

Exercise is a great start, and that’s the basis of exertion therapy. Of course I am not suggesting that three weeks after a concussion you should go out for a 10 mile run and then that evening suffer from a throbbing headache.What I am suggesting is that your daily exercise routines should be monitored by a professional.

This is crucial so that your exercise does not negatively affect your concussion recovery. Sometimes it is hard to know if your workout negatively affects you without having someone monitor you, so let me help clarify what I can do for PCS patients.

PCS patients who are seeing me are taken through a graded exercise test, which helps me to find how high they can get their heart rate prior to their symptoms getting worse. I then use this information to help them develop a program they can use to get moving again.

If this situation describes you or someone you know then contact us today to get a more comprehensive evaluation!

Written by, Josiah Parker – PT, DPT

Question: Do you have any questions about exertion therapy treatment for physical therapy?

3 Unexpected Treatments for Concussions – That Work!

I often get asked about what I do for a living and when I respond that I am a physical therapist many people ask me what kind of injuries I see. My response usually begins with the orthopedic injuries, which everyone kind of already expects, but one area in particular that almost always catches people off guard is when I tell them that I treat concussions.

What can a physical therapist do for a concussion?

That is a great question! Let me share with you the basics on what a concussion actually is.

Concussions: A mild form of traumatic brain injury, which is caused by a bump, blow, or jolt to the head. These injuries may be classified as mild but the symptoms they cause can be devastating to the people who are experiencing them.

Symptoms: Dizziness, headaches, poor balance, trouble concentrating, depression from lack of participation ability. Surprisingly, the symptom most correlated with a lengthened recovery is dizziness. For more information on the basics of concussions visit www.concussionfocus.org.

Now that you understand the basics of a concussion, I promised that I would begin to reveal the three unexpected concussion treatments…and here they are!

  1. Exertion therapy is used to help get the body back to regulating its normal functions like heart rate, and also returning the patient back to sport or work.
  2. Finally, the musculoskeletal piece is used to help with neck or back pain, which often goes hand in hand with a concussion.
  3. Vestibular therapy is used to help address dizziness, headaches, and lack of balance.


In order to avoid getting too long winded, I will be breaking down each one of these three main areas in future blog posts. For now I know this is a very general overview so if you have any further questions feel free to contact me!

Written by, Josiah Parker – PT, DPT

Question:  What do you want to know about concussion therapy?

Football Concussion Crisis: How to Respond

 – Advice from a Physical Therapist to a Concerned Mother

I absolutely love this time of year – temperatures are not quite so warm, the trees will soon start changing colors, and most importantly football is back! But my love for this sport has lead to many, serious conversations about football injuries. There is a common theme among these conversations, concern.

As you probably guessed, concussions are the prevailing topic of concern. The frequency of these conversations has led to writing this blog post. What should you do if your child sustains a concussion?at

As a parent your first line of defense is an athletic trainer, if the team has access to this person.  Athletic trainers are extremely adept at dealing with these injuries and will likely take point in your child receiving any medical attention that is needed.  But what if you don’t have access to an athletic trainer? My goal is to educate those of you who don’t have access to an athletic trainer on what to look for and what to do.

Concussions can be difficult to diagnose due to the subjective nature of the symptoms. Your child may be suffering from a concussion if they report:

– a persistent or worsening headache
– feeling dizzy/nauseous
– mental fogginess
– or a range of other similar symptoms

If these symptoms are reported after a blow to the head, medical attention should be sought out as soon as possible through the child’s pediatrician or an emergency room.

The initial goal is to rule out more serious, life threatening conditions such as a brain bleed or skull fracture which can be identified through imaging (unlike a concussion.) Once those are ruled out the initial recommendations will be rest from physical and mental activity.

“80 – 90% percent of concussions resolve within three weeks – but for those that don’t, further medical attention may be needed.”

If further medical attention is required, start with a doctor who has had further training on how to deal with concussions.  There is a list of suggestions available on www.concussionfocus.org.  This physician may suggest modifications to activity, medication, or rehabilitation to help return to normal function.

Concussions can be a scary ordeal, both for the affected individual and their family, but with the proper treatment most kids are able to get back to football, and other desired activities.  If you are in need of rehabilitation, or need help figuring out where to start, contact us today!  You can also visit the Concussion Focus website listed above for more details on concussions and for resources on how to treat them.

Written By: Josiah Parker, PT, DPT

Question: What questions do you have for a physical therapist about concussions?

Jennie A., Collegiate Track & Field Athlete

Athletes’ Training Center has worked to specialize workouts to fit my athletic needs. The strength coaches have a one on one personal connection to fix minor details that have had a major impact on my athletic performance.