Five Concussion Treatment Directions | Dr. Matheau Denner
Show Notes:
Join us, your host Bella Paige and chiropractic physician Dr. Matheau Denner, as we navigate this complex topic, combining personal experiences with professional perspectives. We delve into the significance of post concussion syndrome and the importance of receiving appropriate treatment, especially when symptoms persist. With Dr. Denner's expertise, we break down the five key areas of treatment
From unraveling the mysteries of blood flow dysregulation to discussions around metabolic, inflammatory, and hormonal imbalances - we leave no stone unturned. We also highlight the importance of addressing and being evaluated for the five different treatment directions for a whole body apporach.
Feeling lost with what sypmtoms to focus on next? Listen in!!
Learn more about Dr. Denner’s Clinic: https://dennerchiroperformance.com/programs/concussion-assessment-and-treatment
Denner Chiropractic & Performance Concussion Blog: https://dennerchiroperformance.com/blog?page=1#blog_anchor
Finding A Concussion Clinic: https://clinics.completeconcussions.com/?lat=35.0562&lng=-80.8194&s=Charlotte%2C+North+Carolina+United+States
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Please note episode transcriptions may not be 100% accurate!
Bella Paige
Host
00:03
Hi everyone. I'm your host, Bella Paige, and after suffering from post concussion syndrome for years, it was time to do something about it. So welcome to the Post Concussion Podcast, where we dig deep into life when it doesn't go back to normal. Be sure to share the podcast and join our support network, Concussion Connect. Let's make this invisible injury become visible.
00:27
The Post Concussion Podcast is strictly an information podcast about concussions and post concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post concussion syndrome. Welcome to episode number 125 of the Post Concussion Podcast with myself, Bella Paige and Dr Matheau Dr Denner is a chiropractic physician and licensed athletic trainer in Charlotte, North Carolina, specializing in sports medicine and rehabilitation. Dr Denner uses his unique background in manual therapy, functional rehabilitation and joint manipulation to treat acute concussions, pcs and other musculoskeletal conditions. Welcome to the show, Matheau.
Dr. Matheau Denner
Guest
01:37
Yeah, thank you for having me.
Bella Paige
Host
01:39
So, to start, do you want to talk us over a little bit about what created your interest in concussions?
Dr. Matheau Denner
Guest
01:45
Yeah. So it's kind of a personal experience how I got into treating concussions and kind of the interest of taking care of patients and PCS and that whole world. So growing up I played soccer and had six diagnosed concussions growing up, five of which came from soccer, one ice skating when I was younger, but the last one put me in the hospital for a little bit a couple of days at a subdural hematoma. So it was a little bit more than a concussion. But going through those experiences and kind of going through the process of seeing different medical professionals rehabbing it, dealing with the symptoms that came along, I was in that world. And that was before I went to undergrad to be an athletic trainer and before I went to chiropractic school. It was all through kind of my high school playing career.
02:37
So once I got to undergrad I had a little interesting the concussion space, saw it a ton as an athletic trainer. But the treatment and the kind of idea around concussions, specifically PCS too, wasn't everything right I hoped for. I hoped to learn different techniques, different ways of thinking about it, but it was really traditional outlook. It wasn't until I got to chiropractic school and I had the privilege of hearing Dr Cameron Marshall talk about the concussion space and PCS and just like looking at the current literature and everything he was talking about really sparked my interest because it turned into a personal kind of goal at that point. There is a lot we could do, especially in the chiropractic world and the rehab world, so it really got me excited for continuing my education and kind of going down the route of maybe helping people out that you know we're in a similar situation as I was.
Bella Paige
Host
03:35
I really like how you said that you're trying to help people, but also the different aspects, like there is different things you can do. A lot of people reach out like what can I even do? They don't even know where to start, because you go into your GP and they don't really know much. Maybe they'll send you to a neurologist and then that's kind of where it ends for so many people, unless they can find the right people to talk to or that even have the knowledge, because it's definitely something where, like in school, it's talked about, but until you actually seek out your own education on it, it's really hard to understand what you can do for concussions. So do you want to kind of walk us through? You said there's lots of options. So when we talked before, you talked about five main kind of areas of where people can get some help. So do you want to start there and then we'll just keep going and see what happens?
Dr. Matheau Denner
Guest
04:26
Yeah, absolutely so.
04:28
In the world of concussion the big focus on manual therapy, rehab and kind of what I do in the treatment room is specifically tailored to PCS.
04:39
So acute concussions we love to see them. We can do a lot in the initial stages to kind of get people set up with a game plan so the risk of developing PCS is much lower. But kind of the bread and butter of everything that we do in the treatment room and the chiropractic and rehab world is treating those patients that have symptoms lasting longer than the typical amount of time. So I feel like that's where everyone kind of goes wrong with their treatment plan, because it's all great until you're stuck with symptoms and you're battling this for an extended amount of time. That's where it gets a little bit tricky. But there's a lot of things we can do in both hands-on manual therapy, rehab, nutritional interventions to really give you the tools that you need to get symptom relief and get you back to where you were before the concussion I'd love to talk about. There's really five main dysfunctions or aspects that we treat for those PCS patients so we can dive into each one of those and talk a little bit about them.
Bella Paige
Host
05:42
Yeah, I think that's great. I think it's really important to realize that there is things you can do and different things you can do in different aspects. A lot of times we just feel so lost and, like you said, it's like you don't see acute patients very often. I'd say it's a lot less often because it's not the recommendation. We're working on that actually right now Just started working on that, on getting ERs up to speed on what they should be giving patients, because they're just getting told to go home and rest. You know and I know that that is not the answer, but if you don't get told that's not the answer, usually it's not for months later where you're like I'm still suffering, why am I suffering? Then people start to reach out for help. Let's start with one of the five main categories. What would be the first?
Dr. Matheau Denner
Guest
06:28
one, the biggest one. The first one that everyone can do and is kind of the big jumping off point is it's called blood flow dysregulation. This incorporates exercise into the treatment, but after a concussion there's actually a reduction in cerebral blood flow. There's different mechanisms in your body that tell us how much blood we should be getting and regulating depending on what we're doing Say, we're increasing our heart rate, we're getting up from sitting down. There's different mechanisms in our body that help shunt blood to the brain and elsewhere.
07:00
So this is a really common kind of dysfunction that happens after a concussion injury. Is that reduction in blood flow? So this could equal headaches, dizziness, right, trouble, focusing difficulty, you know, symptom provocation when we're walking, jogging, trying to do any physical activity. So there's a great study in 2015 by Meyer and all that showed that patients that had PCS symptoms one month from their concussion correlated really well with blood flow dysregulation. So they looked at a ton of patients, right, those who had a full recovery, they didn't have symptoms lasting longer than seven to 14 days. They didn't have this dysregulation. But those who were at a month and still had some symptoms, there was a correlation between that blood flow dysregulation.
07:48
So we're not saying that every concussion patient has this dysregulation because a lot of them it'll rehab over time and they'll kind of get better with it. But a certain population is going to have this. So a big part of the treatment is actually exercise. So Letty and all so Letty Dr Letty from University of Buffalo and a couple of other of his colleagues developed the Buffalo treadmill test. So it's a test to determine your sub symptom threshold heart rate. So it's the point where we're working out and we get a symptom increase right. We do a little bit of math and that's your point where you're working out and it's a great rehab moving forward for patients and you can get a lot of symptom relief by just moving your body, getting active. So the whole idea of rest is kind of out in the concussion world.
Bella Paige
Host
08:39
Yeah, I really like the way you explain that, because you kind of didn't just talk about what it is, because people sometimes are like, okay, blood flow dysregulation, how do I know if I have that? That is a huge thing.
08:51
And movement is huge. We talk about that a lot. On concussion connect, we have like a yoga introductory movement class just to get people comfortable with moving again If they have kind of completely halted all these things. And people always have a really hard time finding exercises they feel like they can do. That we always talk about like nobody said you had to go do it for an hour, start slow. You know you got to start somewhere and then build up from there, which is where that buffalo treadmill test does come in. So that's really great and I think it's really important. Like you said, just because you don't fit into this category doesn't mean you won't fit into the others and you might fit into a few of them. So you know, anybody who's listening don't feel like disheartened and be like, oh, I don't deal with that. Or I tried to exercise and it hasn't helped me because there's a lot more to it than just that. So what would be a second category that can be addressed?
Dr. Matheau Denner
Guest
09:39
Yeah. So number two would be metabolic, inflammatory and hormonal. So after any injury, right, we get an increase in inflammation. It's kind of a normal process that our bodies go through and it's a healthy kind of normal thing that happens, right, we want good inflammation, we want that healing to kind of start. Where we want to stay away, or what we want to stay away from, is that chronic inflammation. So chronic systemic inflammation in our body has a strong indication of causing symptoms to linger around, specifically headache feeling off. So we can do a great job with diet and anti-inflammatory supplements with your healthcare provider to kind of kickstart that process. So I don't know, you're familiar with your listeners, with the gut brain access. I'm sure you talked about it.
Bella Paige
Host
10:24
We have talked about it a little bit before, for sure.
Dr. Matheau Denner
Guest
10:27
Yeah, so there's a strong correlation between head injuries and the lining in our gut and how our gut communicates with our brain. So after an injury we get a little bit of inflammation in our gut and the gap junctions in our stomach, right the cells that keep it together, they get a little bit spread out from that inflammation. So the particles that we eat right we break down the food tiny particles get into our bloodstream and our body. You know it doesn't like that. We go why, why are these things here? Let's create a little bit of inflammation, almost like an autoimmune response to kind of fix that process. So if you're living in that constant state of inflammation, really good way to kind of knock it out is kind of changing your diet a little bit. So avoiding kind of the refined sugars, the pasta, the gluten, dairy, it all has a good indication of lower inflammation and kind of helps symptoms in that way.
Bella Paige
Host
11:18
I love that because we have our cookbook, which is actually behind me that has a ton of gluten-free, dairy-free, low-inflammation meals inside of it.
11:26
Because so many people benefit when they change and do it slowly. I always like to say don't cut everything out at once because sometimes then you're having like a different kind of overreaction. Like cutting out gluten all at once will give you headaches. People that do keto when they do that and they switch, they go completely gluten-free in a day. Usually you get like a gluten headache for a few days because your body's not used to not getting it. So you know, slowly doesn't mean you never have to eat it. Just you know, instead of eating maybe pasta, like you said, try gluten-free pasta, try rice You're changing it up a little bit to try to get less of that inflammation. The initial phase is really hard. So slow, interactive, slow, taking things out, slow, adding other things in can be really helpful. So that's really great. And we're going to talk about one more category and after that we'll take a quick break and get back to the last two. So what would be the third category?
Dr. Matheau Denner
Guest
12:18
Yeah. So another thing we kind of look at in the office is the visual and vestibular system, so how your eyes and how your ears communicate with your brain and tell you where you are in space. So Christina Master did a study in 2019 that showed that up to 70% of concussion patients have some type of visual disturbance. A lot of times you know it's the cervical spine. It's different things In your case that's causing a little bit of the tracking issue with your eyes. In office we do something called a VOMS assessment vestibular ocular motor screen to determine what actual mechanism in your eyes may be throwing you off a little bit. So really easy to kind of sort out in the initial stages of giving you great rehab, to kind of go home.
13:06
A lot of times I've had patients, right, we have headaches from reading, trouble, you know, just feeling weird or off on outside driving. We're just dealing with some of these dysfunctions that happen. So really the best rehab is going into your symptoms a little bit. So, like you said, starting slow and we gradually build it up. So let's just say reading gave you a headache, right, maybe we work on saccades, right, we work on that motion of moving your eyes across a page and slowly but surely we kind of get that rehab to keep going and going and going. You get more used to it and your symptoms decrease over time.
13:44
I think the biggest thing for patients even when I had my concussions, the hardest thing was realizing that my symptoms didn't necessarily equal harm or damage. Right, just instinctively you do something that causes, you know, to have a headache or something and you want to stay away from it. It's just human nature. But in reality we kind of have to go into it a little bit to get the best results. So we see that. The same with the visual and vestibular system. So if it's vertigo, if it's that dizziness symptom, right, we do a combination of treatments. But it's going into your symptoms a little bit and getting you comfortable with getting back into the normal daily routine of stuff.
Bella Paige
Host
14:24
For sure. Vestibular is something that we hear about a lot. It's definitely like a buzzword, I'd say, in the concussion world in the last few years. And you mentioned, you know, exposure therapy. I think that's where a lot of the time I got better, without noticing or without working on it, because I started to just live my life with my symptoms.
14:44
So instead of just, you know, over pushing myself, I tried to learn to find a balance. So I did a lot of it, like myself, where I was just like, but why don't we just go for a little bit? Why don't we just do it for a little bit, and when it becomes too much we stop, or we stop just before that and things like that. So it's really helpful. Something was reading. I used to do the bookmark method, I call it, where you put a bookmark where you stop reading so that you force yourself to stop reading at that moment, because if you really love books, you can just keep reading and reading and reading. But instead of setting a time where you just kind of put a bookmark there, when you hit it you could stop for 15 minutes, you can stop for the day, but it kind of just gives you a little bit and not too much, and you kind of get to gauge yourself that way, which is really helpful. So I think that's great.
15:25
Stibular therapy is something that people they hear it they say they're going to do it, but this is where, like you said, there's five main categories where I think it's really important to bring that all together and realizing that it's not just vestibular. Sometimes, if you believe you know I'm doing vestibular therapy and I'm not getting better, that's because there's so much more to this than just one thing at a time. So it's really important that whole body approach it's very, very important in concussion recovery.
Dr. Matheau Denner
Guest
15:52
Yeah, I think off of that point, booth did a study that showed that the patients that did vestibular rehab Only 25 to 50% got better. So it really takes a combination of treatments to get the best results. So I've had patients right they say I did vestibular, I'm done with that. Right, it's definitely not that causing my symptoms, but in reality maybe you just need a little bit of vestibular in this aspect and we're treating different things. So it's really the combination of all five right that gets the best results. I'm not saying that there's patients out there that just do vestibular and they get better. There's absolutely that case out there, but a lot of times, more often than not, it's not gonna take a combination of doing a lot of stuff.
Bella Paige
Host
16:35
Absolutely, and from that we are gonna take a quick break until we get on to our next two of the five main categories We've been talking about. It's the holiday season Need a perfect gift for a survivor or a suggestion to give a family member? I highly recommend the Post Concussion Cookbook and our comfy podcast footers. Go to postconcussioninc.com to purchase, or make sure you send off that link to someone today. Welcome back to the post concussion podcast with Bella Paige, and today's guest, Matheau Denner. So we've been talking about the five main categories so far. We've gone over blood flow dysregulation, metabolic inflammatory and hormones, and also vestibular system, of course, as I'm sure everyone's heard that word a few times. So do you want to talk to us about the fourth category?
Dr. Matheau Denner
Guest
17:25
Yeah. So the fourth one that really fits well in my profession as a chiropractor is the cervical spine. Dr Marshall did a research study on whiplash symptoms and concussion symptoms and they found that they correlate really well together. So they couldn't decipher if that patient had a concussion or whiplash just based off their symptoms. So we know that a concussion occurs around 70 to 120 g forces and whiplash actually occurs at 4.5 g forces. So if you've had enough force to have a concussion there's gonna be some cervical spine involvement. Is that cervical spine involvement causing your PCS or causing your symptoms? We don't know until we kind of evaluate and go through treatment.
18:13
But a strong correlation between cervical spine complaints and a lot of the symptoms that present with PCS. So just to kind of give a framework of how it works with the cervical spine, right, if certain muscles in our neck are tight and they're constantly telling our brain that we're in a position that we're not right, our eyes and our vestibular system are on a kind of interact with that. So say our SCM, the muscle right here is cranked on and really tight right. It's on a tell my brain that I'm tilting my head this way and that's where patients get a lot of dizziness or they just feel off or weird until you address that Muscular kind of imbalance. So there's a lot we can do on the manual therapy side of things. Right, to actually loosen this muscle up, but then also giving you the rehab tools to help strengthen and coordinate the muscles around your neck to keep away that tension and tone from coming back.
19:11
So I think in the cervical spine, joint manipulation or the chiropractic adjustment done in the right way can be an effective tool.
19:18
Of course you would have to get an evaluation and really not for everybody I'm not saying that as a blanket statement but for the right case, joint manipulation, manual therapy, can be really effective at lowering overall symptoms and not what the typical kind of mindset is.
19:34
So it's just not for headaches, right, we see it in brain fog, we see it in fatigue, right, if we're constantly living in this state can kind of affect different systems. So I think a cervical spine is a huge component, along with visual vestibular. That's why we like to treat all of them together, because if we just do vestibular rehab or just do visual right into the neck, right it could be throwing the eyes off and vice versa, right, I've, movements have strong correlation with neck tightness. So it takes a combination of specifically those three to really get the impactful results that we want. So I think like a great option would be going to a rehab professional that's well-trained in this kind of concussion space, because they can actually do the treatment right In office, diagnose and get you back to where you need to be.
Bella Paige
Host
20:23
I think that's really great, because neck issues is something a lot of people mentioned. When we go back to, like the blood flow dysregulation on the movement, so many people are like, oh, but my neck hurts too much to that or I can't do that because my neck it's very common. I hear all the time my neck, my neck, my neck or I have all this pain at the base of my head, all those types of things. So definitely an important thing to get looked at. Talk to a professional, always always recommending that because you can hear all this stuff, but sometimes it's really important and it is always really important to get addressed by somebody who knows what they're talking about. And sometimes that's not always easiest to find, but there is people out there that understand these things and can help you. And so let's talk about the fifth. What is the last of the five main categories?
Dr. Matheau Denner
Guest
21:11
Yeah, so arguably the biggest component is the psychological piece of it. So improper or poor education on the healthcare practitioners part is a huge cause of PCS and symptoms and kind of the mismanagement of care a little bit. So if you're being told to sit in a dark room right, wear sunglasses, don't work out, don't move your body, get off your phone for extended amount of time can lead to this idea that, right, I'm damaged, I need to protect it, right, I can't do the things I want, which in the end really leads to more symptoms and longer recovery time. So I think, just like educating patients that there's a lot we can do in the initial stage we're not talking about traumatic brain injury, we're talking about mild traumatic brain injury or the concussion. I mean, there is so much you can do in the initial stages you shouldn't feel like you don't have the resources or you're damaged or anything like that, cause there's a lot of information out there that we can kind of get you in touch with, to kind of get you in the right places with the right healthcare providers. So I think the psychological component is massive.
22:24
There's also different theories about right, the nocebo effect. We all heard of placebo. You know taking a placebo drug right can have a profound positive impact. But what's not talked about so well is the nocebo. So if we attribute everything in our life to the concussion, we can kind of paint this picture of exacerbating symptoms and not really having the recovery we want. And it's not really your concussion right, it's kind of the position that you got put in or that you're currently in. So just say, we had headache one day, right, maybe you would have had that headache originally, right. If it's just a healthy kind of day you have a headache, it might be part of the picture. So just not attributing everything to concussion and knowing that a symptom provocation doesn't necessarily equal damage. So I think once patients understand that I was the same way, once I kind of got that reassurance that I'm not gonna hurt myself even more by moving my body or doing things, it gave me like a huge kind of motivation to keep going, get out there and really kickstarted recovery in that way.
Bella Paige
Host
23:36
I think that's huge. The mental health aspect of this is ginormous. We talk about it a lot. It's actually kind of why I started. All this is because I was in that category 10 years ago where you got told just to stay in a dark room. The sad thing is is people are still getting doled that. That kind of irks me a lot. But I was the result of that. I was the result of staying in a dark room doing nothing and then trying to get out of that took me so much longer than it should have, because it affected me. All of a sudden, everything was way too bright, everything was way too loud. All of a sudden, my headaches were like well, they were already really bad. I had a lot of. There's a lot to it than just that. But it definitely does show that like we don't want to do that anymore. And I don't say you know what, if you're having the worst headache of your life and you can't get out of bed, you're allowed to rest.
24:25
I'm not saying you're not allowed to rest, but just don't stay there, don't get stuck there for days on end. And, like you said, that headache. We talk a lot about how we have a headache Monday and then we make that headache last till Friday. And I'm not saying it wouldn't have lasted, I'm just saying we can make it worse by working ourselves up, by knowing that it's going to be here all week, by stressing ourselves out. It's not that it doesn't exist, it's that we can definitely make things worse with our thoughts, and so it's a lot about questioning those thoughts using our own power of thought. This is where talk therapy can be huge, of being like am I really feeling this bad? We talk a lot I just gave a talk on this down in Toronto, canada, the other day about putting our symptoms in the background instead of always having them in the front.
25:10
Sometimes we, everything we do, we're like oh, what about my eyes? Or what about my head, or what about this? How about we put them back? How about we put them behind you and then carry on and you know what? They might still be there, but if they're in the front of your mind, it's all you're going to think about. You're not going to get through it. All you're going to exist is with this.
25:26
So we really want to focus on living our life while we're still going to therapy and treatment and all those types of things to the best of our ability and that might look very different every day, as I have seen concussion survivors, from you know, can barely walk and can barely get out of bed to still working full time and still doing everything they plan to. So there's lots of spectrum, lots of variations, especially to these five categories. You don't always know what you're going to need, but it's definitely somewhere to start. It's definitely something to look into is have I even addressed all of these? Have I addressed the five categories that we just talked about, or have I addressed one of them? Well, maybe it's somewhere to look into, and so I think that's really important.
Dr. Matheau Denner
Guest
26:07
Yeah, absolutely.
Bella Paige
Host
26:08
So we've talked about a lot just going over this five main categories. It's a lot to take in and it's a lot to consider and get into. Is there anything else you would like to add before we end today's episode?
Dr. Matheau Denner
Guest
26:19
Yeah, I think if you're out there and you're looking for a healthcare provider, you can go on complete concussion management and they have a find a clinic so you can. It's a free resource. There's a world map of clinicians around your area so if you're in the Charlotte Southeast area my clinic will pop up so you can find, you know, the healthcare provider to hopefully get you the resources that you need if you're struggling out there. So I would look for a rehab professional, so either PT or chiropractor on that map because they can give you the really the resources to fix those five kind of dysfunctions that we talked about. So even if you've had symptoms, you know, for a year lasting longer, there's still a lot of stuff you can do.
Bella Paige
Host
27:07
Yeah, for sure. I think it's great. It's really important, like we're here as, like your, your addition, I always like to say where everything, where everything that clinics don't do, which is, like you know, community, knowing that there's people there for you, having people that ask questions about general things that are going on, but it is really important to still see professionals and, like you said, even though you're a euro, there's still things you can do. And my favorite thing about the concussion world is that the research is just growing and growing. Every year, more things are coming out, more people are getting into the research, more funding is going into it. So don't be afraid, because maybe what you haven't tried yet just came out yesterday. So don't forget to you know, keep looking, keep trying, and thank you so much for joining us today and sharing some of your experience with helping concussion survivors.
Dr. Matheau Denner
Guest
27:56
Yeah, thanks for having me.
Bella Paige
Host
27:57
Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to the post concussion podcast and be sure to help us educate the world about the reality of concussions by giving us a share To learn more. Don't forget to subscribe.
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