Concussion is a brain injury caused by a blow to the head, or forceful shaking of the body and unfortunately, is more common then we may realize. It can be the result of a sports injury, motor vehicle accident or any other fall or accident. You do not have to lose consciousness to get a concussion and may even have a concussion without realizing it. Symptoms can include headache, confusion, dizziness, nausea, vomiting, slurred speech, insomnia and fatigue. These symptoms can be mild, moderate, or severe and can occur immediately or as a delayed response. These symptoms can be more prolonged and severe with multiple concussions.
The current medical approach to treatment is rest both physical and mental and over the counter pain relief such as Acetaminophen. Rest is important, as well as a thorough examination by an MD that may include a CT scan or an MRI. Many of these symptoms may disappear on their own or may become sub-clinical, meaning there may be no recognizable signs and symptoms now, but may show up later in life as mental clarity and thought processing issues, mood disorders, migraines, and a multitude of other problems involving cognitive functioning. They are currently linking exposure to concussive force (such as a grenade, or other head trauma) to PTSD in veterans of war.
In my clinic I have observed, with both adults and children, problems with concentration and mood, both immediately and years after the incident. I also have had many patients report to me that they “just don’t feel like themselves”, or have anxiety. Though important, I really don’t think rest and over the counter pain relief is enough. Clinically, I have observed the difference that Acupuncture, Chinese Herbal medicine, massage, and Chiropractic work can make with these cases. These modalities can rectify the flow of blood in the brain after trauma. With any traumatic injury there is an inflammatory response that occurs. This is normally a good thing, sending nutrients to the area to help it heal. In many cases of traumatic injury, however, after the inflammatory response is over there is a lot of “debris” (old blood cells, and sometimes lymph) left behind. In Chinese Medicine we call this blood stagnation. It is literally stagnant, de-oxygenated, nutrient void blood, and inflammation. It is not nourishing the area (in this case the brain), and is preventing fresh, nutrient rich blood from getting to the area to help the tissue heal. This is also why an old injury can cause problems later on in life if not properly treated. The lack of circulation degrades the area over time.
There are many excellent Chinese herbs for improving circulation. We usually use several different herbs at a time in a formula. Xue Fu Zhu Yu tang and Tong xiao huo xue tang are two of my favorite formulas for improving circulation in the upper body and head. They can be combined with other formulas, or single herbs to address additional concerns that may go along with concussion such as anxiety, PTSD, fear etc…These formulas are chosen based on pattern differentiation after a thorough assessment of each patient and therefore may be different for each patient.
Acupuncture is extremely helpful also. The insertion of local and distal, (away from the area), needles are important for circulation as well and work synergistically with herbal medicine creating the best possible outcome when used together. Acupuncture also has an analgesic (“anlˈjēzik” pain relieving) effect that is welcomed with lingering pain and headaches. Acupuncture has also been shown through fMRI (Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity) to have an effect on the brain via the nerves/acupuncture channels. For example, when a needle is inserted into GB 37 (an acupuncture point used for vision problems) it modulates activity in the vision related cortex of the brain. The same can be said for other acupuncture points involving mood and memory.
Massage therapy, like Acupuncture, not only feels great but manually gets in there and gets the blood moving to release trigger points and other myofascial restrictions. I have seen chiropractic work be helpful as well. With the force needed to cause concussion it is almost certain that some vertebrae will be out of alignment. Putting these vertebrae back in alignment is important for proper nerve function and releasing muscle tension. When everything is in the proper place our blood flows better.
While it is important to seek medical attention after injuries that would cause a concussion Chinese herbal medicine, Acupuncture, Massage, and Chiropractic treatments can not only help with relief of symptoms such as pain, headaches, confusion, and mood issues but can also prevent these from being a recurring problem in the future. I think it is also nice to know that we have other options for treatment other than rest and pills.
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Last year the department of Health and Human Services (HHS) declared a public health emergency to address the “opiate crisis”. According to HHS opiate overdoses accounted for more than 42,000 deaths in 2016, more than any previous year on record. An estimated 40% of opiate overdose deaths involved a prescription opiate. The statistics show that this problem is not limited to drug addicts. Many of these people are Veterans, the elderly, and people with chronic pain from traumatic injury. The FDA is currently taking steps to make it harder for doctors to prescribe these pharmaceuticals. While this seems like a reasonable measure to protect the health and welfare of patients, it is leaving many with chronic pain wondering how they are going manage.
Back in May, 2017 the FDA endorsed Acupuncture, Massage Therapy, Chiropractic and Yoga as a non-pharmacological way of treating pain. These are all excellent ways to manage pain. As an Acupuncturist, about 50% of my practice consists of pain management. In my clinic I see varied types of pain, from the “normal” neck/shoulder/low back pain, to chronic headaches/migraines, pain from injury (both acute and chronic), recovery from surgery, herniated disk pain, sciatica, arthritis, etc… Most of these people see either a full recovery or reduction in symptoms. In many cases they are able to discontinue their pain medicine, with their doctors direction.
Acupuncture helps by improving circulation, releasing trigger points, and triggering our body’s natural pain relieving and “happy” neurotransmitters. Acupuncture points are located near bundles of nerves and blood vessels. When the acupuncture needles are stimulated it creates a local perfusion of blood flow to the area. This extra blood flow to the area works to deliver nutrients to the affected area helping to heal the injury and reduce pain. It also triggers the circulatory and lymphatic system to take the cellular waste products away, to make way for the fresh, oxygenated blood to freely access the area. Systemically, an acupuncture treatment sends feedback to the brain via the peripheral nervous system. Some signals that acupuncture can send to the brain can trigger the release of epinephrine and norepinephrine, these are the bodies natural painkillers. Certain combinations of points can also tell the brain to bring the body back to the parasympathetic nervous system. This is the calming part of the nervous system often characterized as “rest and digest”. It is the opposite of the stress response (sympathetic nervous system), and tells the body to relax, including the muscles. Sometimes just being able to mentally relax is half the battle. This is often seen in neck and shoulder tension. It seems that the more stressed that we are the more our shoulders creep up to our ears, therefore relaxing the mind and body are extremely helpful with this type of pain and tension.
Trigger points must also be addressed when treating pain. A trigger point is essentially a “knot”. Due to many different reasons the nerves are firing at the junction where the nerve meets the muscle and telling it to contract in a local area. Directly releasing this with an acupuncture needle is one method that is used to break that signal that the nerve is sending to the muscle. Interrupting this signal causes the muscle to relax, which ultimately relieves pain and improves circulation.
Acupuncture is multifaceted and can help with much more than just pain. With opiate use in particular, it can also alleviate the withdrawal symptoms from discontinuing the drug such as irritability, restlessness, and alternating hot and cold sensations. It does this by encouraging the lymph and circulatory system to flush out toxins that were created by the opiate use. The acupuncture points that are chosen also send feedback to the brain via the nervous system, and as discussed above, bring the body out of the sympathetic nervous system, to the parasympathetic system. Once you are out of the acute stage of withdrawal, acupuncture is also helpful for adapting to the stresses and anxieties of life, and moderating any damage that may have been done to the digestive system or liver. Acupuncture is able to regulate the endocrine system via feedback from the nervous system. This can regulate neurotransmitters like serotonin, which is considered our “happiness hormone”. I think everybody in today’s fast paced could use a little more of this.
Another tool that we have to use is Chinese Herbal Medicine. I have seen many profound changes in my patients from using Chinese herbs along with Acupuncture. They work as internal medicine, regulating many different systems of the body including the circulatory system, endocrine system and nervous system. They work from both the root and manifestations of the issue, bringing the body back to homeostasis (aka balance). The goal of the herbs is to fix the function of these systems so that the body can do their job on their own, without needing the herbs for the rest of your life.
Cupping is also a great tool. It involves the placement of cups on the skin to create suction. This improves blood flow and creates a myofascial release. Fascia is a thin layer of connective tissue that is pervasive throughout the body and can get stuck between the skin and muscle layers. Releasing this restriction can significantly improve blood flow. Michael Phelps brought a lot of attention to cupping during the 2016 Olympics. Those purple marks are considered blood stagnation. It is literally stagnant, de-oxygenated, nutrient void blood and inflammation. This presses on nerves and gets in the way of fresh blood getting to the damaged area, causing pain. This builds up over time due to trauma and “life”. The darker the marks and the longer they last, the more blood stagnation there is in that area. Cupping moves this blood along so that the body may process it and get fresh, healing blood to the area.
In short, it is all about balancing the multiple systems in the body along with the mind. Chinese medicine (acupuncture, herbs, cupping) excels at this. We do not just mask the pain or other issues that you may have, we work to fix them at their root cause. This system of medicine has been around for over 3,000 years because it is extremely effective at balancing the body and mind, and treating you as a whole person, not just “shoulder pain”, or “anxiety”.
School has started and the weather is starting to change. Cold and flu season is approaching fast. Now is a really good time to take good care of yourself so that you may stay healthy this winter. Here are a few good Traditional Chinese Medicine (TCM) tips on staying healthy this season, and what to do if you get sick.
- Cover your neck, shoulders and head from the wind and cold. In TCM wind is the “carrier of 100 pathogens” and it likes to invade at the area of C7 (where your neck meets your shoulders). Keeping this area covered is a great first line defense in preventing wind invasion aka common cold. This also applies to fans in the room (especially above the bed) and air conditioning vents that blow directly on you (this goes for the summer also). This is especially relevant if you have a tight neck and shoulders, or get frequent headaches.
- Get plenty of rest. In the winter the natural flow of energy is to go within and rest. You can observe nature doing this. The leaves are falling from the trees, plants are retreating underground and animals are preparing to hibernate. We should do the same (as best as we can in our busy society).
- Stay warm. This is just general good advice from all cultures. I have heard many people say that it is the pathogen that gets you sick, not the cold. While this may be true, keeping warm and getting plenty of rest is great support for your immune system, and helps keep our defenses up.
- Eat appropriately for the season. Nature knows what is best, and it is advisable to eat what is in season. Root veggies will be harvested soon, and most are high in vitamin C, as well as vitamin A, vitamin B, and many antioxidants. These are all very appropriate for soups and stews. It is good to make your own bone broth as well. From a TCM perspective soups and stews are very nourishing and warming, which can be beneficial for most people going into the winter season. In general, cooked food is best and is recommended all year for people with digestive problems. This also includes drinking room temperature water. Adding cold/ice water to your body can make the body work harder by slowing the digestive process.
- Acupuncture has been shown to regulate numerous systems in the body. It can improve digestive and respiratory function, regulate hormones and reduce stress. It helps the parasympathetic nervous system regain control of our bodies. This is the “rest and digest” side of the nervous system associated with relaxation and recovery. When everything is functioning correctly your immune system is stronger and your body is more resilient to illness.
- Chinese Herbal Medicine can offer assistance as well. There are many herbal formulas directed at regulating the immune system. Huang Qi (Astragalus) is a well known immune tonic. It is usually combined with Bai Zhu (Atraclyodes), and Fang Feng (siler) to make up Yu Ping Feng San, a popular formula for preventing illness. A trained Chinese medicinal herbalist may use this formula as a base formula to address frequent illness. These herbs can be combined with other herbs that are specific to the individual needs of the patient based on TCM diagnosis. A great point to stimulate/rub is Stomach 36 (ST36). It is located on the front side of the leg, about 4 finger widths from the bottom of the kneecap and 1 finger width (to the outside) of the tibia (shin bone)
- Avoid Sugar. Much of our immune system is dependent on a healthy gut. Eating too much sugar will disrupt the bacteria balance in the gut by feeding the bad bacteria. This can make it harder for the immune system to do its job.