“Sometimes it feels like you just can’t win.”

Recently, the two weeks leading up to the first playoff game in history at Notre Dame stadium I heard the following thoughts from some fans: Was Indiana deserving? They did not play anybody. Notre Dame had an easy schedule, as well, and they have not won a big game in 40 years. Notre Dame is picked to win; if they lose, they will show once again that they cannot win the big one.

As an ex-prep team member of the Notre Dame football team in the early 1970’s, I will always remember the fans’ assessment of our team. In 1973, we won one national title (11-0), beating number 1 ranked Alabama in the 1973 Sugar Bowl, and in 1974, we went 10-2, beating number 2 Alabama in the Orange Bowl. As you would guess, everyone loved us in 1973. In 1974, however, we were considered failures. We should have and could have won the national championship. We were underachievers according to the outside world.

As I wondered about writing my last newsletter for 2024, I could not help but think about   the phrase at the top of the page. “Sometimes it feels like you just can’t win.” Some patients come into our clinic after having major surgeries. They could have had an ACL, rotator cuff, total knee replacement, total shoulder replacement, or other challenging surgeries and/or injuries. On their recovery journey, they must learn to block out the noise of others and sometimes even friends.

Patients come into our clinic and may have been told by their surgeons, “You will be back in 4-6 weeks,” or “This will correct all of your problems.”  Friends could be telling these patients; “I had the same surgery, and I was back playing golf or pickleball and/or running in 2-3 weeks. When a patient hears things like this, the patient is set up to think they cannot win as soon as the rehabilitation process passes the dates they were told!

This statement can cause a great deal of anxiety and stress for the patient. I am sure, after having surgeries, their friends and even the surgeons meant well by sharing their stories and projections. This may not be the case with all the so-called fans- who do not even know what it is like to play football at the collegiate level, but still complain how poor their football team is, for their failure to achieve the one prize that is hardest of all to achieve.

The bottom line: please think about what you say to the family member, friend or even acquaintance who asks you for advice on how they should be progressing after surgery. I have been treating patients for over 40 years. I have listened to the physical, emotional, and mental stresses each one must experience to accomplish their goals. Each person is different. Each person must overcome their own worries and fears.

What I do know, they all need emotional and mental support. I hope in the coming year, that everyone who reads this will think more about how to support their family members, friends, or acquaintances. Most people, under the stresses of major surgery, do not benefit from being told they are not achieving their goals in a timely fashion when they are working as hard as possible to get back to their normal life. Please leave the emotional and physical work to the professional physical therapist on your team. What they need from you is support and encouragement.

Merry Christmas & Happy Holidays,

 Fran McDonald President/CEO

Physical Therapy Guide to Concussion

A concussion is a mild traumatic brain injury. It can cause lasting effects on brain tissue and change the brain's chemical balance. Concussions may cause short-term and long-term physical (body), cognitive (thinking), and behavioral symptoms and problems. Every concussion is considered a serious injury by health care providers. If you have experienced a head injury, seek medical help immediately.

The Centers for Disease Control and Prevention estimates that 1.6 million to 3.8 million people experience concussions each year in the United States. Of these injuries, 1 million to 1.8 million occur during sports in youth under age 16. Nearly 50% of all concussions occur during sports and recreational activities; the other "half" (more than 50%) are due to falls. It is understood that as many as 50% of concussion injuries go undetected, especially among older adults and in cases with multiple injuries at once (such as car accidents and intimate-partner violence).

A concussion occurs when a force strikes the head or the body. Less than 10% of concussions include a loss of consciousness (being "knocked out"). A brief loss of consciousness (lasting two minutes or less) has no impact on the recovery path a patient will take. Symptoms can start immediately or take hours to a few days to appear. Knowing the warning signs can help people access care as quickly and efficiently as possible.

A physical therapist can assess symptoms to determine if a concussion is present. They can treat your injury by guiding you through a safe and personalized recovery program

How Can a Physical Therapist Help?

Physical therapists can evaluate and treat many problems related to concussions. Because no two concussions are the same, a physical therapist will examine your neurological, orthopedic, and cardiovascular systems to best prescribe a routine to address your specific symptoms and needs.

Treatment may include:

Rest and recovery. Complete rest after a concussion should last for no longer than 48 to 72 hours. Your brain requires a balance of activity and rest to heal properly. Your physical therapist will help you and your family understand why you should limit any activity (daily tasks, work, school, sports, recreation, the use of electronics) after a concussion until it is safe to return to them. Alternating activity with periods of rest (pacing your recovery) can safely challenge the brain and help symptoms clear up as quickly as possible. Your physical therapist will prescribe the rest and recovery program most appropriate for your condition. A good rule of thumb is to stop any activity when your symptoms increase by 30% and rest until you recover from that activity before starting again.

Restoring strength and endurance. The physical and mental rest required after a concussion can result in muscle weakness and a decrease in physical endurance. Complete rest should not occur for more than 48 to 72 hours in most circumstances. Your physical therapist can help you regain your strength and endurance when the right time comes without making your concussion symptoms worse. It is important to improve your tolerance to cardiovascular exercise (such as walking or biking) before starting heavy strength training to allow for proper blood flow to your brain. It is common for weekend warriors, elite-level athletes, and everyone in-between to experience exercise intolerance with concussion and brain injury. Your physical therapist will work with you to identify and treat your particular concussion symptoms. They can help you build back to — or up to — doing 150 minutes of moderate-intensity cardiovascular exercise per week. This is the minimum amount recommended by the Department of Health and Human Services for overall health.

Your physical therapist will design a therapeutic exercise program just for you. They will closely monitor your symptoms as you participate in the program.

Stopping dizziness and improving balance. If you have dizziness or difficulty with your balance, you are not alone. Dizziness and balance problems are the top complaints after a concussion. A type of physical therapy called vestibular physical therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, helps you keep your balance and prevent dizziness. A qualified vestibular physical therapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying special treatments or teaching you specific exercises, some of which you may be able to do at home.

Improving vision. Vision challenges are common after a concussion. A full 50% to 90% of concussion patients experience challenges with their eyes, inner-ear systems, or both. The visual system is more complicated than just seeing clearly. It involves the muscles that control the eyes and the network in your brain that allows you to assign meaning and interpret what you see as you interact with the world. Skilled health care providers, including physical therapists, can help you:

• Reorganize your vision.
• Improve your tolerance to reading and to using electronic screens.
• Reduce headaches and dizziness coming from the eyes.

Reducing headaches. Your physical therapist will assess the possible causes of your headaches. They will use specific treatments and exercises to reduce and eliminate them. Treatment may include stretches, strength and motion exercises, eye exercises, and hands-on techniques like specialized massage. Your physical therapist also may use technologies such as electrical stimulation.

Returning to normal activity or sport. The number one evidence-backed treatment for concussion is early, symptom-guided, and paced progressive exercise. Cardiovascular exercise is an early priority, with the treatment program building into strength and dynamic (sports-specific) exercises as your symptoms allow. As your conditioning and strength improve, your physical therapist will help you gradually add back normal activities to your daily routine. Your physical therapist will help you avoid overloading your brain and nervous system as you increase your activity level. Overloading your brain during activity after a concussion interferes with the healing of the brain tissue. This can make your symptoms return. Your physical therapist will help you return to your normal life and sports activities in the quickest and safest way possible, while allowing your brain to properly heal.

 **choosept.com

MERRY CHRISTMAS & HAPPY HOLIDAYS