Traumatic brain injuries are serious threats to individuals’ physical and mental wellbeing. They impact athletes and non-athletes alike, and understanding them is the key to their treatment and prevention. In this article, we discuss the ramifications of concussion/mTBI, its pathophysiology, and the basic tools used to diagnose it. The study and treatment of concussion/mTBI is a rapidly evolving field, and physicians and individuals should stay abreast of current research.

The Definition and Classifications of Traumatic Brain Injuries

Traumatic brain injuries (TBI) can follow an impact to the head, such as a blow or jolt, and can cause chemical changes within the brain or damage to brain cells. They vary in severity and are classified accordingly, taking into account how quickly patients can open their eyes, what their vocal responses are like, and how cognizant their motor responses are. The Glasgow Coma Scale (GCS) has historically been a common method for differentiation.

mTBI

mTBI stands for mild traumatic brain injury. “Mild” has less to do with the severity, instead indicating that overt structural brain damage is absent. mTBIs are non-penetrating, functional, and often temporary. They are always not visible on imaging, leading to high incidence of cases which go undiagnosed and untreated. mTBI is the most commonly sustained classification of brain trauma.

A concussion is a functional injury, the mildest form of mTBI. In fact, the two terms are often used synonymously. Which term is used depends chiefly on the kind of literature, sports literature usually defaulting to the term concussion and neurologic literature using “mTBI.” The medical field is in transition, considering “concussion” to be outdated terminology, though the Concussion in Sport Group has recommended that the terms be distinct, with concussion indicating complete recovery and associating mTBI with more persistent symptoms.

MTBI/STBI 

Moderate and severe TBI indicate structural damage that can clearly be seen via imaging. Moderate and severe TBI result in unconsciousness of greater than 30 minutes and amnesia for longer than 24 hours. Their Glascow Coma Scale values fall below 13. Examples include epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage, and intraventricular hemorrhage.

The Epidemiology of Concussion/mTBI.

Based on available data, there are an estimated 48 million cases of concussion/mTBI in the US each year. 3.8 million of those are sports-related concussions, while 240,000 are the result of motor vehicle accidents. Concussions now represent almost 10% of all injuries for both youth and collegiate players.

The literature—based on reported values—shows that a higher percentage of sports-related concussions are sustained during gameplay than in practice. Men’s rugby is the chief offender, with men’s US football and women’s ice hockey taking second and third place, respectively. The only sport for which the practice rate of concussions appears to be greater than those sustained during gameplay is cheerleading, usually as the result of 2+ level pyramids.

It is estimated that half of all sports-related concussions go unreported, though that figure appears to be shrinking as concussion awareness improves There has been a cultural shift where parents are keeping children out of sports to avoid the risk of concussion. Without other exercise, however, the risk of obesity and other related health concerns increases. 

Research indicates that medical schools do not prioritize recognizing diagnosing concussion/mTBI. Another study performed in 2016 found that knowledge about concussion was comparable between medical students and chiropractic students. There is certainly room for improvement to minimize knowledge gaps. According to the comparison of studies conducted in 2012 and 2018, Canadian medical schools were taking this improvement of the concussion curriculum to heart. 

The Pathophysiology of Concussion/mTBI 

Concussions have been found (relatively recently) to primarily affect the white matter of the brain. This makes up about 60% of the brain and doesn’t finish developing until after middle age. White brain matter is responsible for communication within the brain and with the rest of the body. 

At the impetus of head injury, a series of neurochemical reactions results in an ion imbalance. This causes neuronal dysfunction and increased activation which creates an energy crisis where ATP cannot be made in appropriate volumes. In cases of severe TBI, the damage to brain cell mitochondria can be permanent. Concussion also affects cerebral blood flow.

The symptoms of concussion are varied and affect different parts of the brain:

• Physical—headache, dizziness, amnesia, nausea, fatigue, vomiting, blurred vision, tinnitus, sensitivity to light or sound
• Cognitive—slower reaction times, confusion, “fogginess,” difficulty learning, forgetfulness
• Emotional and Behavioral—sadness, changes in personality, anxiety, increased impulsivity, easily irritated, increased emotionality, nervousness, depression
• Sleep—nonrestive sleep, oversleeping, disturbed sleep cycle, difficulty falling asleep

Severity of symptoms are given by the patient on a 0–6 scale. The effects of concussion/mTBI are cumulative. Two trauma events in close temporal proximity increases the risk of irreversible brain damage, especially when the second event is delivered within a period of vulnerability. This makes diagnosing and treating concussion/mTBI properly even more urgent. Athletes and non-athletes should not “shake off” head injuries, instead receiving the proper care and allowing adequate time to heal. The Google-generated recovery estimate of 7–10 days is misinformation.

Our bones support us, protect our organs, and allow us to be mobile. However, when those bones sustain—or develop—damage, these processes can be inhibited. Bone spurs result from damaged joints more often than most people realize. These growths can cause pain and limit movement if they grow to abnormal size, so they should be managed early on. Here we explore how spurs form, the symptoms they can initiate, and how to treat them.

What Are Bone Spurs?

Also referred to as osteophytes, bone spurs are bony projections that grow on the fringes of bone. They are most commonly found near joints, especially in the feet, knees, hands, and spine. These bony outgrowths are not inherently painful in and of themselves; in fact, they are part of the body’s healing mechanism. When joints are damaged, the body produces new bone material to repair cartilage, and this is often manifested as spurs. 

Joint damage is the biggest cause of spur formation, though the cause of the damage does vary, including sources within one’s control like diet and overuse and those outside of one’s control (genetics, congenital bone problems, and spinal stenosis). The most prevalent cause of joint damage leading to spur formation is osteoarthritis, the chronic wearing down of cartilage. This correlation may indicate why bone spurs are highly prevalent among the population 50 years and older, affecting about 80% of men and 60% of women.

Sometimes bone spurs go undetected without x-ray diagnosis. If they do not press on nerves or other bone, they can be relatively innocuous. If, however, they interact with other parts of the body, such as a spine narrowed by spinal stenosis, the result is usually pain.

Common Symptoms

The best case scenario when an individual has bone spurs is that they simply go unnoticed. If no side effects present themselves, spurs may go undiagnosed and untreated. Sometimes, however, the abnormal bulges can cause trouble. Because spurs usually form in the joints, the result is often the bony mass rubbing against other bones. The exact symptoms that arise are dependent on the location of the spur. 

• Spurs on the bones of the feet can lead to plantar fasciitis.
• Spurs near muscle groups can cause spasming, cramping, or weakness.
• Spurs in the limbs can result in stiffness or limited mobility and even lead to tendonitis or tendon tears.
• Spurs can sometimes be seen as visible bumps on the extremities.
• Spurs in the legs can result in weakness or numbness.
• Spurs that form on the spine can pinch spinal nerves, inhibiting mobility or causing the spine to seize up.
• Spurs that grow on the spine can also lead to bladder control problems, though this symptom is rare.
• Spurs can also break off and get stuck in the lining of the joint. When this happens, they are referred to as “loose bodies.” They can lock up the joint, limiting mobility.

Regardless of where they form, spurs can cause pain that isn’t necessary. When any of these symptoms arise, be it pressure on the nerves or restricted movement, it is wise to seek treatment.

Treating Bone Spurs

When spur growth makes ignoring them impossible, there are a few methods to treat the problem. The most effective, especially if spur growth is on the spine, is spinal decompression. This natural and noninvasive process can pull the protrusion of bone off of compressed spinal nerves, relieving the pain.

Remedies to “dissolve” bone spurs at home should be treated with healthy skepticism. Strengthening regimes like physical therapy are better based on sound physiological principles and empirical evidence of improving joint strength and range of motion. In very severe cases, a patient may need to undergo surgery to have spurs removed, but this necessity is rare. 

Preventative Care

Prevention is the best medicine, and stopping spurs before they form is no exception. Wearing supportive and good-quality shoes can keep spurs from forming on the bones of your feet, especially if those shoes do not rub against your feet. Be wise in how far you push your body when you exercise or even perform regular tasks. Allow your body time to rest so your joints do not become strained and damaged. 

Vitamin D is an essential nutrient for proper bone formation, and getting sufficient sun and enough calcium in your diet will help to strengthen and protect your bones. By taking good care of your body, you can protect your bones from the worst effects of bone spur formation.

COPD is a debilitating condition that affects millions of people across the globe. Treating COPD can prove difficult because the root cause of the condition varies between individuals. However, emerging research suggests that spinal manipulation and other natural and noninvasive treatments can be effective initiatives for relief. 

What Is COPD?

COPD (chronic obstructive pulmonary disease) refers to a group of conditions that causes respiratory problems due to airflow blockage. In patients with COPD, progressive airflow is limited and lung function declines, making even simple tasks like walking upstairs difficult. Examples of COPD conditions include chronic bronchitis and emphysema.

The prevalence of COPD is widespread, affecting more than 16 million Americans each year. It is ranked sixth globally in the causes of death for both men and women. COPD is most commonly caused by the inhalation of tobacco smoke, though other factors which influence the lungs—respiratory infections, air pollution, and family history—can also contribute to the condition. 

COPD is diagnosed using a breathing test called spirometry. Patients are asked to breathe into a small machine that is connected to a mouthpiece. This is used to monitor the rate and volume of the airflow that the patient breathes in and out over a period of time. Unfortunately, many COPD cases go undiagnosed, and even for those that are diagnosed there is no cure. Instead, treating COPD is a matter of managing pain and breathing patterns. 

Treating COPD with Spinal Manipulation 

A body of evidence exists that suggests that manual therapy has the potential to increase the flexibility of the thoracic excursion and chest wall, subsequently leading to improvements in exercise capacity and lung function. These alterations in respiratory mechanics can lead to improvements in patients with certain chronic respiratory diseases, including COPD and chronic asthma. 

The term manual therapy usually accounts for a variety of techniques, including soft tissue therapy and joint mobilization or manipulation. Another powerful form is spinal manipulation, the application of high-velocity, low amplitude force to move a joint complex which is usually effective in decreasing pain and improving range of motion in the joints. Both manual therapy and spinal manipulation are non-pharmacologic interventions for treating COPD, and they have been shown to improve exercise capacity in patients with the debilitating condition.

Spinal manipulation works to increase thoracic mobility, consequently reducing the strenuous work of breathing. The importance of increasing exercise capacity, the more general result of the application of spinal manipulation, cannot be overstated, as research shows exercise capacity to be a predictor of mortality in cases of COPD.

“Use of Spinal Manipulation Therapy for Management of COPD” 

The research into spinal manipulation’s efficacy in treating COPD is still relatively unexplored. However, in February of 2016, authors Wearing, et al. published their findings on the subject in The Journal of Alternative and Complementary Medicine. Their article “Use of Spinal Manipulation Therapy for Management of COPD” was a systematic review geared toward investigating the result of administering spinal manipulation therapy and other modalities to patients with COPD.

In the study, spinal manipulation was defined by application of high-velocity, low-amplitude targeted pressure. The effect of other modalities falling under the manual therapy umbrella were also explored in conjunction with spinal manipulation therapy, as was pharmacological intervention. Pooling the body of research, Wearing, et al. included in their review primary research studies with participants of legal age (18 years) with an existing diagnosis of COPD for which the effect of spinal manipulation therapy on COPD was tested.

Six articles met the inclusion criteria and so were included for review, each with statistically small sample sizes (1 to 33 participants aged 55 to 85 years). The six studies included were broken up as such: three randomized controlled trials which employed exercise therapy from a pulmonary rehabilitation program, one case series, one pre-post observational study, and one single case study.

The conclusions of the review suggest strongly that spinal manipulation therapy is an effective measure in treating COPD. Following spinal manipulation, patients in five of the six studies reported improvements in both exercise performance and lung function. Furthermore, all three of the randomized trials indicated that combining exercise therapy with spinal manipulation treatments was more effective in the treatment of COPD. 

It should be noted that it was not uncommon for patients to report minor adverse effects—mainly muscle soreness—in the 24 hours after treatment. This resolved within that 24 hours without any additional intervention. This soreness did not outweigh the benefits of spinal manipulation and exercise therapy for patients with COPD. Authors Wearing, et al. call for greater research into spinal manipulation’s efficacy in treating COPD, especially when combined with exercise therapy.