My 8 year old son was struggling to tie his shoes, despite hours of patient practice and YouTube instructional videos. Granted, all kids struggle with that fine motor task; however, I could tell he was behind compared with his peers. One day it struck me- my left handed son was being taught by his right handed mother! I raced home that night to try a reverse “leftie” strategy and… boom! He got it instantly!

That parenting experience also made me think about the right handed world we ALL live in. Left handed people still drive vehicles and reach with their right hand to adjust the radio or grab a cup from the center console. Reaching for the phone, refrigerator, or doorknob is often designed to be done with the right hand as well. Living in a right handed world develops muscle imbalances within all humans, despite handedness, and these dominant muscle patterns can possibly lead to musculoskeletal injury.

Left can also be oh so right! Consider that humans prefer to “move” to the left, or counter-clockwise. Its baseball playoff season right now, which way do the batters run the bases to score? NASCAR is currently in the chase for the cup- which way are the drivers going around the track? We just finished watching the summer Olympic games- shot put and discus is launched from an athlete rotating which direction? Even something as simple as riding a bicycle or motorcycle- we notice that it’s a little more hairy making a right turn. There are lots of daily examples of left directionality.

The human body has an asymmetrical design that promotes better counter-clockwise performance. We have a liver on the right side that weighs approximately three to four pounds, with a spleen on the opposite side weighing less than a pound. We have three lobes of lung on the right and only two on the left. The heart lies more to the left, and the diaphragm has more attachments to the spine on the right. This organ asymmetry coupled with visual/cerebral cortex asymmetry and vestibular imbalances, etc. contribute to the formation of dominant muscular patterns that without opposition can again, lead to injury.

The science of Postural Restoration™ recognizes and restores human muscle imbalances and faulty movement patterns in order to allow for a more symmetrical state of well-being. As a Postural Restoration Certified physical therapist, I evaluate patients through an asymmetrical lens, and apply treatment principles that improve symmetry through exercises, movement patterns, and functional positions that can be done during everyday activities.

Whether we acknowledge it or not, we are all asymmetrical beings living in a right handed, counter-clockwise world. Our occupational habits, recreational activities, and environmental factors all play a role in the development of faulty movement patterns that can lead to injury, and physical therapists can balance out these patterns. Next time you go for that walk around your neighborhood or on your trick-or-treating route, perhaps you should lead off by taking a right. It’s not a wrong direction!

Do you remember hearing your gym teaching yell across the gym in the beginning of gym class during the boring old warm up stretches “if you can’t feel it then it’s not working”? Well that old gym teacher wasn’t too crazy because basic stretches to improve flexibility and decrease injuries.

With just a few minutes throughout the day of stretching several large muscle groups may increase your flexibility and help to prevent injuries. Why? How do I do that when I sit in the car all day or behind a desk? Well there are tons of things you can do during the day that do not require to move things in our office or even buy new things like a chair of desk. So let’s get started!

You may want to “warm your muscles up” with a light aerobic movement for 5-10 minutes prior to stretching. Performing a head to toe routine daily can be very beneficial and this can be done with no equipment! How neat is that?!?!

Several things to keep in mind when stretching are:

• You want the stretch, but not pain.
• No bouncing, this may cause the muscle to contract rather than relax
• Each stretch should be at least 30 seconds.
• Any areas that are uncomfortable, it may be helpful to repeat for a second tretch

Check out the exercise below to help you be motivated no matter where you are.

Daily routes help to improve flexibility and range of motion around a joint. Overall, stretching can make you feel better.

It is important to stretch both sides. Daily routes help to improve flexibility and range of motion around a joint. Overall, stretching can make you feel better.

"It's the most wonderful time of the year!" Definitely for parents but not the kids. Have you looked at your child standing with their pack back lately? The average weight of a loaded school pack is 19.8 pounds! About 20 million kids are carrying 2x the recommended weight on their spines. No wonder our poor kids look like Quasimodo with their packs on and no wonder we see kids and teens each year complain of back, neck, hip and shoulder pain which is caused by micro trauma due to improper weight and fit of their back packs. This abnormal force is detrimental to growing bones and causes injury to soft tissues including muscles, ligaments, tendons, joints, nerves and blood vessels.

Compressive forces on a growing spine can cause spondylosis (fracture of the vertebra). A child's constantly developing spine experiences the highest rate of growth from ages 10-12 for girls and 13-15 for boys. Their bodies are more susceptible to injury and developing compensations. Experts recommend back packs should be no more then 10-15% of a child's body weight. So a 100# child should have no more than a 10-15# on them. Heavy packs, especially if improperly worn, cause forces pulling a child's body backwards compressing vertebral joints. The student will naturally lean forwards to keep balance which causes the forward head/shoulder posture, compressing the shoulder complex pressing on nerves and blood vessels throwing their entire postural alignment out of whack. Also placing the pack on one shoulder causes asymmetrical loading on that side and strain on the opposite in efforts to compensate. In addition to what we stated above this all can result in changes in gait, balance, and even breathing!

How Do You Choose/Fit a Back Pack for your Child?

1. Choose the lightest material but also one that is well made with wide shoulder straps, a waist belt to distribute the weight evenly, as well as a good padded back. Wear pack on both shoulders not one side. It should rest on the mid back and not hanging low on the waist of hips.  Put the heaviest items closest to the back.
2. Properly picking up the load is just as important. Have your child squat keeping back straight facing the pack. Pick it up and put one shoulder in then the other. Not bending over and swinging the load over and around their shoulder.

Sensible Tips to consider:

1. Ask them to use lockers if possible. Don't procrastinate all week to do assignments where large texts are needed. Get it done and out of the way to lessen weight carried all week.
2. Ask teachers if they would help out by providing classroom texts so one could be left at home. Many texts are on line now which is great.
3. Schedule time every so often with your child to clean out their pack you'll be surprised the stuff they accumulate like full water bottles at the bottom!

Consult your PT at Superior Physical Therapy and Sports Rehab if your child is experiencing any of the symptoms mentioned above and we would be happy to evaluate/treat and most importantly teach you and your child how to prevent future pain, dysfunction or injury.

Have a Happy and Healthy School Year!
Janet S. Keller, PT
Superior PT and Sports Rehab Spring Ridge

References:

MoveForwardPT.com/APTA SpineUniverse.com Kidshealth.com

Dr. John O'Neil, DPT meets with the Athletic trainer for Loudoun Valley High School, Andrew Gordon, M.Ed., ATC to discuss how the athletes are cared for at his school

As the Athletic Trainer for Loudoun Valley High school (LVHS) for over 23 years, Andrew Gordon has diagnosed, managed, and led the rehabilitation for many students at his school who have had a concussion. A graduate of the University of Virginia for both his undergraduate and graduate studies, he has been the Athletic Trainer for LVHS since 1996, which is when he became the first full time Athletic trainer in the state of Virginia's high school systems. I had the opportunity to sit down with him and talk about the ins and outs of this ATC's view of the rehabilitative process of concussions, and how it is managed at LVHS.

What is a Concussion and how does it occur? It is a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the brain. This can result in a variety of physical, cognitive, emotional, or sleep-related symptoms. With a concussion, neuro-imaging is typically normal, and the duration of symptoms is highly variable - from several minutes to days, weeks, months, or longer in some cases. After the injury there is a metabolic crisis, resulting in an increase in energy demand with a decrease in blood flow to the brain. It is important that during this time of the crisis that the athlete does not get hit again as it can create compounding stress to the brain.

In the United States, there are approximately 300,000 concussions injuries each year. A large percentage of total concussions happen to the youth, with 70.5% of sports & recreation-related traumatic brain injury ER visits were among persons aged 10-19 years.

With athletes in particular, it is essential to take them through a progressive, stepwise return to play protocol to ensure safe return to play. It is just as important for the youth and the parents to understand the signs and symptoms of what a concussion is, as it is not as strait forward as one might think.

What are the signs and symptoms of a concussion?
It is important to note that the presentation of concussions can vary, and if there are any signs/ symptoms of a concussion, per Virginia state High School guidelines, the athlete will be immediately taken out of play for the remainder of the day to protect the athlete. Also, a loss of consciousness is not required for the athlete to sustain a concussion.

• Cognitive Symptoms: Fogginess, difficulty concentrating, memory deficits, cognitive fatigue
• Somatic Symptoms: Headache, dizziness, nausea, light/sound sensitivity
• Mood Disruption: Irritability, feeling sad, anxiety
• Sleep alterations: Difficulty falling asleep, fragmented sleep, too much/little sleep

When does the athlete return to play?
Concussions, and the direct or indirect contact that resulted in a concussion can affect a variety of structures in the body, and thus a variety of testing needs to occur. This includes the assessment of strength/range of motion, oculomotor screening, vestibular testing, balance, and gait testing.

Additional criterion prior to return to play include:

• Clear oculomotor exam
• Clear vestibular exam
• Symptom free with cognitive or physical exertion
• Able to handle a full day/schedule at school
• Normal neurocognitive data

Questions with Andrew Gordon, M.Ed., ATC

What is done in the pre-season at Loudoun Valley high school (LVHS) for concussions?

For the Athlete: The individual has to sign a form (along with the parents) prior to play indicating the return to play protocol and signs/symptoms of a concussion. IMPACT test baseline testing is performed for freshman and juniors, or individuals new to sport. Individuals in low-contact sports do not need to take this test, as the incidence of concussions is very low. The highest incidence for boys is football, and for girls, soccer.

For the Parents: Andrew Gordon gives a parent meeting informing them about the concussion protocol at LVHS.

For the Coaches: Required completion of yearly concussion online course.

What happens when an athlete has a suspected concussion?
On field testing: If the individual has a potential mechanism of injury, and has any signs or symptoms, the athlete is done for the day. He then re-evaluates them the next day, and if a concussion is diagnosed by Andrew Gordon, it is a minimum 5 day recovery period to return to sport. The majority of concussions happen during games/matches of contact sports, all of which are required to have an ATC present.

In the Classroom, after injury: Andrew implements classroom accommodations as needed to not stress the healing individual, and to insure proper recovery. This can range from using sunglasses at school, no white boards, time allowed for each class, and getting the athlete out of the classroom prior to a fire drill.

Can sensors in the helmet help prevent or help identify concussions?
Short answer: No.

Long answer: This item has been extensively studied and has not been found to help identify concussions, and has resulted in many unnecessary evaluations that do not lead to better outcomes. Aside from concussions, valid sensor technologies can offer objective data that have been used to improve player safety and reduce injury risk, although this would be more for research purposes, rather that injury identification.

Message for the students?
Report your symptoms! With proper management of a concussion, you are much more likely to return to play faster than if you had pushed yourself through the symptoms. If you give Andrew Gordon 2-3 days now, you don't have to give him 2-3 weeks later. The goal is to get the athlete ready for playoffs, as he is looking more for the long term health of the athlete.

Message for the parents?
Same as the students, keep an eye on the symptoms, especially during academic tasks. Pushing the individual too much cognitively or physically can delay rehabilitation. Simple items such as looking at phone/television screens can sometimes over stress the individual, and delay rehab.

Time to Take a Stand!

Physical therapists use sound, scientifically proven principles of human anatomy, physiology, movement and psychology to help patients lead healthy, pain-free lives.

The therapist will conduct an initial evaluation followed by several progress notes to document progress over time. A comprehensive analysis establishes a 'clinical baseline' and identifies muscle imbalances, causes of pain and joint alignments. This is the foundation for short and long-term goals designed to help individuals recover completely. In fact, physical therapy can address every aspect of recovery including:

• Strength/Range of motion
• Ocular motor screening
• Vestibular testing
• Balance/gait testing

Superior Physical Therapy and Sports Rehab

• Spring Ridge
  9093 Ridgefield Dr., Suite 201
  Frederick, MD 21701
  Phone: 301-696-5595
• Thomas Johnson
  65D Thomas Johnson Drive
  Frederick, MD 21702
  Phone: 301-663-7898
• Purcellville Orthopedic Physical Therapy
  850C East Main St.
  Purcellville, VA 20132
  Phone: 540-751-1970
• Frederick Indoor Sports Center (FISC)
  1845 Brookfield Ct
  Frederick, MD 21701
  Phone: 301-663-7896