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To Play or Not to Play? That is NOT the Question

Posted By Scott R. Greenberg, MD, Thursday, October 6, 2011
Updated: Thursday, January 30, 2014
Yesterday, hockey fans – were rocked by the news that Sidney Crosby would be placed on injured reserve (IR) on Monday, October 10th. There had been much anticipation surrounding Crosby’s return to the ice being sidelined since January when he suffered a severe concussion – a concussion that has left him with recurring headaches and dizziness.

Frankly, I am relieved to hear that the Pittsburgh Penguins’ medical staff decided that he is not yet ready to make a comeback. It’s not that I don’t want Crosby back in the game – I do. He is a dynamic player who brings incredible energy every time he takes the ice.

But, post-concussion syndrome requires more than a quick fix or a lessening of symptoms, which is difficult because among sports-related injuries, post-concussion syndrome is one of the most elusive and challenging problems to treat. While many patients will recover from their concussion, just as many will not. To make matters worse, as an athlete sustains repeat concussions, the chance of recovery becomes less

Since I don’t treat Crosby, I cannot speak to what his doctors are seeing. I do know that most patients who suffer from post-concussion syndrome will have normal blood work, normal MRI examinations, and normal vital signs. Since we cannot "see” an apparent cause of their symptoms by these traditional tests, a conventional treatment for post-concussion syndrome does not exist. Those that suffer from this disorder are asked to rest and possibly undergo physical and occupational therapy until symptoms resolve. They say waiting is the hardest part – add chronic pain to that and you have a recipe for disaster, proven by the Dave Duerson, the former Chicago Bears safety who suffered from the physical and psychological symptoms of post-concussion syndrome for more than 10 years before taking his own life last February. Duerson shot himself – in the heart, not the head, in order to preserve his brain which he requested be donated to science – specifically the science of looking at the long-term impact of severe hits to the head, the same type of hits that have grounded Crosby.

There is a better way to address post-concussion syndrome than just waiting it out and dealing with pain. In fact , we at the Magaziner Center for Wellness have been using innovative regenerative joint procedures to get many professional and collegiate athletes back in their respective games. We have had great success with prolotherapy, a holistic procedure that involves a series of injections into damaged ligaments, tendons, and joints that produce a healing response within the damaged tissue, ultimately leading to repair of the damage. The mechanism for this non-surgical repair is mediated through immune system modulators which cause the concentration of cells known as macrophages and monocytes along with chemicals known as chemokines, to remove microscopic debris and fix damaged tissues.

Agents used for Prolotherapy restoration include lidocaine, dextrose, phenol, glycerin, and more recently growth factors derived from the patient’s own body known as platelet rich plasma (PRP). The exact mixture or substance used in prolotherapy is not nearly as important as the precise diagnosis and treatment into the area of damage that is causing the symptoms of post-concussion syndrome.

So, how do injections into the neck and head cure the problems of concussion and head injury? The answer has to do with a complete understanding of what happens during a head injury. I have studied films of the hits that have caused devastating concussions and observed that trauma to the skull does not just damage the brain; it also creates a significant whiplash injury to the neck and the base of the skull. Within these areas lies the brainstem, an area of the brain that controls our balance and coordination, and supplies nerves to the muscles that control the eyes, ears, face, and portions of our autonomic nervous system (ANS). Injury to the cervical and skull base changes the relationship between the brainstem, base of the skull, and cervical canal, causing increased pressure on the nerve control that I have described above. This leads to many of the symptoms of post-concussion syndrome. Fortunately, prolotherapy and
PRP injections (injections of a patient’s own platelet rich plasma) into these damaged areas can normalize the relationship between the skull base and cervical canal, and relieve excessive pressure on the nerve. Once this happens, symptoms of post-concussion syndrome resolve!

Prolotherapy and PRP injections are certainly the silver lining around a dark cloud, but must be used with caution. Having performed well over 50,000 procedures in my career, I know it takes an extreme amount of skill and dexterity to treat damage from concussion. However, successful treatment leads to regaining the patient’s life, allowing them to function again without pain, headache, blurred vision, and all of the other
lingering symptoms of concussion. While there has never been a controlled clinical trial on prolotherapy for treatment of post-concussion syndrome, the results speak for themselves … on and off the ice.

Tags:  concussion  sports medicine 

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