CONCUSSIONS IN CHILD ATHLETES: WHAT TO WATCH OUT FOR

 

The occasional bump or bruise is expected in some sports such as football and soccer but there are certain injuries that should be treated with more than a band-aid and pat on the shoulder. One such injury is a concussion; here we provide you with some pertinent information on this often overlooked injury.

WHAT IS A CONCUSSION?

A concussion is medically defined by the American Medical Society for Sports Medicine as “a traumatically induced transient disturbance of brain function and occurs when linear and/or rotational forces are transmitted to the brain.” In other words: A concussion is an injury to the brain that affects normal brain function. They are considered a mild traumatic brain injury (MTBI) on a scale of mild-severe. However, you should not let the word “mild” or the fact you cannot physically see the injury misguide you; concussions cause injury at the cellular level in the brain and take varying amounts of time to heal based on their severity.

WHAT ARE THE SIGNS/SYMPTOMS I SHOULD LOOK OUT FOR?

There should be a licensed professional (Athletic trainer, physician, EMT, physical therapist, etc.) present at your child’s sporting event that is trained to screen and handle the situation. If this is not the case or you are at a sporting event and witness a bump, blow, or hit to the head, you can screen for the following that call for urgent medical attention: **Some cases do not show symptoms until hours or days after the event!

–      Loss of consciousness (no matter how short)

–      Dazed/stunned demeanor

–      Any other abnormal personality changes (irritable, sad, nervous)

–      Confused about the event

–      Difficulty sleeping

–      Cannot remember events before OR after the event

–      Forgets class schedule or assignments (not because they don’t want to do their homework!)

The following at any point indicate an immediate emergency department visit is necessary:

–      Loss of consciousness

–      Convulsions/seizures

–      Repeated vomiting or nausea

–      A worsening headache that does not subside

–      Weakness, numbness, or decreased coordination

–      Difficulty recognizing people or places

–      Increasing confusion, restlessness, or agitation

–      Slurred speech

WHY IS IT IMPORTANT TO IDENTIFY CONCUSSIONS AND ALLOW ADEQUATE TIME FOR RECOVERY?

During the healing process, increased vulnerability exists; this includes increased risk for worsened cellular changes and more significant long-term cognitive changes. There exists a condition known as Second Impact Syndrome (SIS) that is described as occurring when a second hit to the head is experienced prior to full recovery of the initial injury. The effects of SIS can be much more severe, and are more often than not the cause of deaths related to head traumas, as opposed to the initial concussion. If your child has ANY of the above symptoms after experiencing a hit to the head it is imperative that they do NOT return to play/activity and medical attention is received and taken seriously.

MY CHILD EXPERIENCED A CONCUSSION; WHAT SHOULD I EXPECT DURING RECOVERY HOW CAN I HELP THEM THROUGHOUT?

Post-concussion symptoms vary greatly from case to case. Physically, your child may have headaches, excessive fatigue, and difficulty sleeping. Personality/cognitive changes might include depressive symptoms, difficulty concentrating, and decreased attention. Your child’s teachers should be notified and appropriate measures taken based on their individual circumstance. Time off, shortened school days, decreased workload, and increased time for completion of assignments/exams should all be considered. Time spent on the computer, playing video games, or watching television may cause symptoms to reappear or worsen and should therefore be avoided.

Your child may experience frustration, sadness, and anger which are all common reactions since they are missing time away from friends, sports, and hobbies they enjoy. Providing your child with support, encouragement and maintaining open communication will help them through this process as they are likely to get frustrated by missing time away from friends, sports, and hobbies they love.

HOW LONG DOES RECOVERY TAKE?

Majority of concussions heal in 7-10 days. However, this varies greatly on the level of damage and it is important to know that youth athletes have a prolonged recovery since their brains are still developing. In some cases, it may take several weeks to months to return to normal activities. Your child should ease into physical and cognitive activities slowly and doctor recommendations should always be followed.

IS THERE ANYTHING I CAN DO TO PREVENT THIS FROM HAPPENING AGAIN?

Unfortunately, helmets, mouth guards, and other protective equipment are not proven to prevent concussions at this time but are recommended in certain sports for prevention of other injuries. What you can do is ensure you and other parents encourage fair play and demonstrate positive role modeling; this has been proven to help prevent concussions and other sport injuries. It is also important to confirm rigorous education and consistent modeling regarding the children’s coaches and officials as well as adhering to strict rules and teaching proper form throughout games and practice.

References:

Cancelliere, C., et al. (2014). Systematic Review of Prognosis and Return to Play After Sport Concussion:

Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Archives of Physical Medicine and Rehabilitation, 95, S210-S229.

Centers for Disease Control and Prevention. (May 2010). Know your concussion ABCs: A fact sheet for

parents [handout]. U.S. Department of Health and Human Services, Atlanta, GA.

Eisenberg, M., et al. (2014). Duration and Course of Post-Concussive Symptoms. Pediatrics, 133, 998-

1007. (2014, May 12). Retrieved August 27, 2014.

Guskiewicz, K., Mcleod, T. (2011). Pediatric Sports-related Concussion. PM&R, 3(4), 353-364.

Harmon, K., et al. (2012). American Medical Society for Sports Medicine position statement: Concussion

in sport. British Journal of Sports Medicine, 47, 15-26. (2012, October 30). Retrieved August 27, 2014.

Purcell, L. (2009). What Are The Most Appropriate Return-to-play Guidelines For Concussed Child

Athletes? British Journal of Sports Medicine, 43, I51-I55. Retrieved August 26, 2014, from bjsm.bmj.com

WORKING WITH A STUDENT v. YOUR THERAPIST

After having worked in a physical therapy clinic for going on 3 years and having seen multiple patients on countless occasions deny treatment from a student, I decided it was time to address the fear. 

Don't get me wrong - I understand where it comes from. 

You're not wrong to assume that students will make more mistakes than certified practitioners - but how else did your master surgeon or treating physical therapist get as good as they are? Someone let them practice.

Please understand the rules and regulations for students, under no circumstances, put our patients at a greater risk to land in harm's way. 

Now, I can honestly say on behalf of our therapy staff here at CHAMPION, there's nothing a student will manually do here that they haven't practiced on their instructing therapist - your treating therapist. There's not a single exercise they'll give you without having consulted their instructing therapist, and your head therapist will always be in the room, able to watch and see you. 

Remember: these students are not yet licensed. What does that mean for their instructing therapist? Each time a student works with a patient, it's on the instructing therapists' license.  A single malpractice lawsuit could eradicate the chance of their instructing therapist being licensed for the rest of their lives; to me, that's a lot of trust in their student. 

When a student starts to see you without their instructing therapist standing over their shoulder, what does that mean? 

It means they were doing so well that their instructing therapist trusts them to work with a patient with whom they've worked before, without direct supervision. This isn't something that should concern you - it's something that should help you to trust them. If you trust your treating therapist and their sense of judgement as far as you and your injury, then you should trust that they wouldn't allow you to work with someone who couldn't effectively carry out your plan of care. And remember - even if they do seem "on their own", your head therapist will review how you did and what they want to do next with their student and help them to create the plan of care. They are by no means unsupervised.

We do preserve your right to minimize your time with students, if that's what you prefer. If you'd prefer to only be seen by a staff member, that will absolutely be arranged. This post by no means was intended to force patients to work with students - we want our patients to feel as comfortable with us as possible. Feel free to speak up should you have questions or concerns, and any changes will be handled immediately. 

HARTZELL LEO - 2 MONTHS!

Just because we haven't posted some updated photos of him in a while, here he is! 
Turned 2 months on August 14th - growing like a weed!

Disclaimer: we have no idea how he became a St. Louis Cardinals fan. 

DIAGNOSED WITH OSTEOARTHRITIS

Our last post, ARE YOU AT RISK FOR OSTEOARTHRITIS? focused on the "before" aspect of a diagnosis, and what risk factors increase your chances for a diagnosis. DIAGNOSED WITH OSTEOARTHRITIS is going to focus on the "after" aspect - what to do after you've been diagnosed. 

1. First and foremost: do not self diagnose.

See your primary care physician, or an orthopaedic specialist. A series of tests and health history questions will allow most medical practitioners to be positive about an osteoarthritis diagnosis, but for physical proof, you'll need either an X-ray or an MRI. 

Why an X-ray? More advanced cases of osteoarthritis will be visible in an X-ray.  Severe cartilage degeneration will be visible (or more realistically, will be nonexistent) by recognizing what's out of place in comparison to where they're anatomically in place.  Joints that are suffering from osteoarthritis will look noticeably different in an X-ray compared to that of a healthy joint. 

2. Talk to your doctor about your options.

Depending on the severity of your case, your doctor may present you with a multitude of paths to assess, or potentially just a fair few.

Non-surgical opportunities include but are not limited to: steroid injections to lessen inflammation and reduce pain, physical therapy to strengthen muscles and therefore lighten the load on the joint, or pain medications to allow you to continue functioning with minimal pain.

Surgical opportunities, or joint replacements, are extremely common. Depending on age or the severity of your case, you may be a prime candidate for a partial or total joint replacement. This will require physical therapy to aide your body in returning to full range of motion and strength, but most cases are completely successful and will allow you to return to the lifestyle you enjoy with less pain than in you have had in probably 5 or more years. 

3. In the meantime: less is not more.

While it may feel as though movement is going to aggravate and inflame that joint, lack of movement is consequentially worse. The lack of movement weakens the muscles, and therefore, adding more pressure on the joint when it's loaded. Lack of movement will essentially make it significantly more painful to move - and therefore, making the condition feel much worse. Movement, as well as strengthening, is key to maintaining a quality of life until the correct treatment option for you can be identified and agreed upon. 

4. Ice, and Anti-inflammatories

Icing the joints can lead to some stiffness, but it can also decrease the activity of inflammatory responses that lead to increased swelling from bone-on-bone activity and therefore, decreases the residual pain. Not only does it limit the inflammatory response by constricting the blood flow into that joint, but also allows you to feel relief temporarily until the numbness from the cold entirely wears off. An anti-inflammatory can help aide in minimizing your inflammatory (immune) response, but be sure to talk with your doctor about which anti-inflammatory works best for you and your specific medication protocol. 

ARE YOU AT RISK FOR OSTEOARTHRITIS?

What is osteoarthritis?

Osteoarthritis, also known as Degenerative Joint Disease (DJD) but more commonly known as "arthritis", is the degeneration of cartilage in a joint leading to bone-on-bone degradation. 

What causes osteoarthritis?

Osteoarthritis results in the deterioration of the cartilage that acts as a protective cushion between bones.  It is more common in the general population in partially weight-bearing joints, such as the hips and knees. As bones grind against one another, it can result in hardening of the joint, inflammation of the fluid-filled, protective bursa sacs, and possibly bone spurs and other problems that lead to pain. 

What risk factors increase my chances of getting osteoarthritis? 

Unfortunately, not qualifying for any risk factors does not guarantee you'll never have osteoarthritic symptoms, but it can help to decrease chances. Some risk factors are out of our control, but some definitely aren't!

1.  Old Age increases your risk significantly, as not only do the proteins in the body that recreate and make up cartilage become more sparse in the joints, but the fluid that protects the cartilage is produced less as you age, as well. 

2. Obesity puts added stress on weight-bearing joints, and adipose (fatty) tissue produce proteins that can lead to harmful, degrading inflammation in the joint cavities. 

3. Joint Injuries that stemmed from an accident or sports injury can increase your risk of osteoarthritis.

4. Bone Deformities or Protein Deficiencies can increase the amount of stress on a certain area of the joint that will later lead to a breakdown of cartilage, and life-long protein or hormonal deficiencies diagnosed at a young age can eventually cause an early onset of osteoarthritis. 

5. Genetics has also proven to be a major factor in developing osteoarthritis, not only because of gene function, but lifestyles. Some are more prone to the breakdown of cartilaginous proteins and fibers. As far as genetically inherited lifestyles, that's probably more accurate when described as a nuture versus a nature problem. More often than not, children are going to have similar lifestyles to that of their parents. Parents who developed osteoarthritis due to being extremely active in their youth and adulthood likely passed those same habits onto their child, which could, in turn, potentially lead to the same osteoarthritic developments. 

Does meeting these risk factors necessarily mean you'll develop osteoarthritis? No. Like every medical condition, qualifying for a risk factor is not a guarantee. Simply worry about the ones you can control. 

OUR NEXT BLOG POST: What to do when you already have osteoarthritis. 

MEET THE THERAPISTS

WHAT DO WE SPECIALIZE IN HERE AT CHAMPION PERFORMANCE AND PHYSICAL THERAPY?

You all remember the "MEET THE PHYSICIANS" blog posts, correct? Well, now it's our turn. 
This is just some simple background information regarding what all of our treating therapists specialize in, and where their clinical interests lie, at this location.

Hope Hillyard, DPT

Focus lies within all aspects of orthopaedic rehabilitation and performance, ranging from pre and post-operational treatments, to balance and gait training, to generalized joint and back pain.  Dr. Hillyard's pre and post-operational treatments cover a wide variety of procedures; the most common being ACL reconstruction/meniscus repair, labral repairs of the shoulder and hip, rotator cuff repairs, and total joint replacements of the shoulder, hip, and knee. Her clinical interests include manual and manipulation of the spine, as well as high-level sports medicine rehabilitation with high school through professional athletes. As of 2017, she will be a certified Spinal Specialist by the American Board of Spinal Manipulation. 

Janice Bode, PT

Focus lies within all aspects of orthopaedic rehabilitation, with specialties including the distal lower extremity, foot, and ankle, as well as the back and core. While Mrs. Bode practices with an emphasis in non-surgical rehabilitation to allow her to focus on the cause of pain as opposed to the symptoms, she has established a reputation as one of Kansas City's best physical therapists for post-surgical rehabilitation of the foot and ankle. 

Molly Sauder, PT

Focus lies within the pelvis floor, with treatment protocols established to relieve symptoms from a wide variety of conditions; including incontinence and constipation. Mrs. Sauder also is known for an emphasis in women's health, as a number of her patients are seen to treat pelvic floor dysfunction following vaginal birth. 

Kaitlin Way, PTA

Focus lies within all aspects of rehabilitation and performance, with a similar list of credentials as Dr. Hillyard. Mrs. Way can see any patient of Dr. Hillyard's, as they share a similar professional relationship to that of a medical doctor and their physician's assistant. She has a special clinical interest in high-level recovery for sports medicine injuries, as she is also a certified Weight Lifting Coach and Personal Trainer through the American Council of Exercise, as well as a licensed Cross-Fit coach. Kaitlin has helped to design and establish many of our high-level athlete protocols during the latter aspects of their rehab to continuously challenge them at a level that will benefit them pending their return to sport.

Michael Hill, LMT, PTA, KCTP

Focus lies within massage therapy, with special emphasis on musculoskeletal treatment of sciatica, migraines, and post-operative care and scar management. Michael Hill owns Kinesio Clinic, a massage therapy clinic located within our building. He is also a licensed Physical Therapist Assistant, who is known for having an unusual edge. His ability to treat injuries from a multiple perspectives stems from his education and training in multiple treatment options that result in the same outcome. 

Pamela Carney, PT

Focus lies within holistic treatment of general pain by means of the spirit, body, and soul. She is an independent contractor who uses multiple facilities, including ours. As a board certified craniosacral therapist, she uses a combination of gentle manual therapy with functional exercise to produce physical and mental relief of pain. 

THE DIFFERENCE BETWEEN ACL AND MENISCUS TEARS THAT TELLS ALL

Fall sports have a tendency to have the highest number of ACL and meniscus tears on average compared to any other sports seasons. Between football, soccer, volleyball, cross country, and off-season basketball, physical therapy clinics are swarming with ACL and meniscus tears.

Both, ACL and meniscus, will likely result in a decreased range of motion, excessive swelling, and pain on occurrence; although some people state that they had no pain at the time of the initial tear - simply just heard a "pop". 

The huge difference will be visible at around 24 hours after the tear. Aside from the initial pain, most ambulation impairments (troubles walking) on flat ground are going to be from self-preservation for an ACL tear.  In other words, if you're limping more than 24-48 hours following an ACL tear, it's likely as a result from your being cautious, as opposed to your actual injury causing pain. Many ACL tears we see only have problems ascending stairs, jogging, or walking downhill but can walk up hills and on flat roads without an increase in pain. A meniscus tear, on the other hand, will cause fairly severe pain even just standing on it.

The reason they have this huge symptomatic difference is due to each of their respective anatomical locations. While the ACL is a ligament connecting the backside of the femur (thigh bone) to the front of the tibia (shin bone) helps to support the knee joint by protecting the femur from moving too far forward during deceleration (stopping quickly, ascending stairs, lateral movements), the menisci (2 per knee) sit on the tibia and are used as a form of biological padding to protect the tibia from colliding with the femur.  When a meniscus is torn, putting pressure on it in many forms can cause severe pain, as there is not only a torn tissue, but also there is no longer much support between those two bones when standing, walking, and even sitting, or bending the knees while laying down, depending on where the tear is located. 

This excess in pain is likely going to cause an increase in swelling for a longer period of time than that of an ACL. The process of inflammation takes 7 days to complete, but increases in pain is correlated with increases in bloodflow, with is correlated with increases in inflammation. Essentially, it's a repetitive cycle that typically results in higher levels of swelling for longer periods of time following an initial injury. 

More questions? Come see us at Champion Performance and Physical Therapy at 7510 State Line Road, Suite A in Prairie Village!

TWO-A-DAY SEASON

As our "boys of fall" begin practices again before those friday night lights turn back on, it's crucial that their bodies be as prepared as possible for the affects associated with such a strenuous routine.

1. Eat 

Carbs and proteins are going to be essential to rebuild the tissues that inevitably break down from exercise. Two-a-days are meant to maximize the time spent prior to the start of the season, meaning coaches are trying to improve your strength, speed, and confidence as much as possible to start off the season on a good note. The only way to build tissue is to break it down, first - meaning workouts will be difficult. It's crucial that you increase the calorie count when the workout routine increases, as well - by as many as an extra 1,500 calories (on average) per day, depending upon the workout and the athlete's body type. Make sure to get proteins and carbs in your system within 2 hours of finishing a workout, but your body is most efficient at allowing proteins and carbs into your cells within the first 45 minutes. Not only will your body recover faster when you're well-fed, but keeping the energy stores in your body plentiful helps to improve the duration you can withstand a workout at such a high level. 

2. Drink - and don't drink

Athletes of all ages: staying hydrated is so important. Keeping electrolytes in your system by means of gatorade or pedialyte (for quick replenishment), and drinking plenty of water throughout the day will help you to stay hydrated during those long days out on the practice field and in the weight room. It's hard to hold a practice and manage thirst in full padding in 100+ degree heat for coaches; to keep athletes properly hydrated, they'd need to allow water breaks every 10 minutes or less. This turns into an extremely inefficient practice, which is why it helps to seriously manage hydration when not in practice.

Collegiate athletes, on the other hand, also need to limit their alcohol consumption during, and leading up to the start of two-a-day practices to help keep them hydrated and firing on all cylinders. One episode of binge drinking just about wipes out all progress made in 2 weeks worth of workouts, physically, and the aftermath of a binge drinking makes maintaining mental focus very difficult. 

3. Rest

Get plenty of rest. Adjusting to such an extreme amount of high level physical activity will wipe you out - and it's crucial that athletes accommodate their sleep schedule to help reduce fatigue in the days following. Sleep is when your body does most of it's healing - and you will need time to heal and recover to be able to make it through the next day, let alone the next couple of weeks. 

4. Take Advantage of Breaks

Any breaks you're given during a workout - take them. Instead of having to run to drink out of a fountain, keep a large water bottle with you to help you minimize time spent running to get to and from the drinking fountain. 

5. Know Your Body

When you realize you're beginning to severely overheat, back off of a workout. It's imperative that you listen to your body. We understand that most coaches are tough on their players, and therefore, expect them to finish the workouts and only take breaks when allotted with the entire team. The best thing you can do in these situations is back off whatever you're doing; whether it be running, burpees, lifting, etc. by slowing down your pace, lifting a little bit less weight, or taking more time to recover between sets. 

6.  Talk to the Coach

Need an excuse for a break? Go talk to your athletic trainer about a stretch for an "old injury" or a "cramp" or go talk to a coach about something he may want you to do. This will give you some time to recover while still being productive. 

HERNIATED DISCS

When people say they have a "slipped" or "ruptured" disk in their neck or lower back, what they are actually describing is a herniated disk-a common source of pain in the neck, lower back, arms, or legs.

Anatomy

Discs are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots. The discs between the vertebrae allow the back to flex or bend. Discs also act as shock absorbers.

Discs in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the discs are similar but smaller in size.

Cause

A disc herniates or ruptures when part of the center nucleus pushes through the outer edge of the dick and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs.

Risk Factors/Prevention

In children and young adults, discs have high water content. As people age, the water content in the discs decreases and the disks become less flexible. The discs begin to shrink and the spaces between the vertebrae get narrower. Conditions that can weaken the disc include:

• Improper lifting
• Smoking
• Excessive body weight that places added stress on the disks (in the lower back)
• Sudden pressure (which may be slight)
• Repetitive strenuous activities

Symptoms

Lower Back

Low back pain affects four out of five people. Pain alone is not enough to recognize a herniated disc. See your doctor if back pain results from a fall or a blow to your back. The most common symptom of a herniated disc is sciatica—a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve. Other symptoms include:

• Weakness in one leg
• Tingling (a "pins-and-needles" sensation) or numbness in one leg or buttock
• Loss of bladder or bowel control (If you also have significant weakness in both legs, you could have a serious problem and should seek immediate attention.)
• A burning pain centered in the neck

Neck

As with pain in the lower back, neck pain is also common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (trapezius muscles). The pain may shoot down the arm. The pain may also cause headaches in the back of the head. Other symptoms include:

• Weakness in one arm
• Tingling (a "pins-and-needles" sensation) or numbness in one arm
• Loss of bladder or bowel control (If you also have significant weakness in both arms or legs, you could have a serious problem and should seek immediate attention.)
• Burning pain in the shoulders, neck, or arm

Diagnosis

To diagnose a herniated disc, your doctor will ask for your complete medical history. Make sure to tell him or her if you have neck/back pain with gradually increasing arm/leg pain. Tell the doctor if you were injured.

A physical examination will help determine which nerve roots are affected (and how seriously). A simple X-ray may show evidence of disc or degenerative spine changes.

MRI (magnetic resonance imaging) or CT (computed tomography) (imaging tests to confirm which disc is injured) or electromyography (a test that measures nerve impulses to the muscles) may be recommended if the pain continues.

Treatment

Nonsurgical Treatment

Nonsurgical treatment is effective in treating the symptoms of herniated discs in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures.

• Rest and over-the-counter pain relievers may be all that is needed.
• Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
• Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
• After any spasms settle, gentle heat applications may be used.

Any physical activity should be slow and controlled, especially bending forward and lifting. It is extremely helpful to partake in physical therapy, as all strengthening movements will be monitored and safe. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the lower back, exercises may also be helpful in strengthening the back and abdominal muscles. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift.

If these nonsurgical treatment measures fail, epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks.

Surgical Treatment

Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdiskectomy or laminectomy, depending on the size and position of the disk herniation.

In the neck, an anterior cervical diskectomy and fusion are usually recommended. This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. Bone is placed in the disc space and a metal plate may be used to stabilize the spine.

For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together.

Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.

PAIN AND MEMORY

Louis Gifford said that learning about the biology of memory was very informative. For example, he thought certain pains were like advertising jingles that get stuck in your head- they're annoying, don't serve any purpose, and are hard to get rid of.

Here are some other interesting connections between pain and memory.

PHANTOM LIMB MEMORIES

People with phantom limb pain have vivid perceptions that a missing limb is present and painful. Although there are no sensory signals coming from the missing limb, the parts of the spinal cord and brain that process these signals remain, and they can get activated by mistake. When this occurs, they create perceptions about the limb that feel uncannily real.

Ronald Melzack showed that these perceptions are congruent with memories of how the limb felt prior to amputation. For example, phantom limb pain is less severe in people who were not in pain immediately prior to amputation.

BLOCKING PAIN MEMORIES WITH DRUGS

Clifford Woolf performed research showing that if surgery patients receive painkillers beforethe surgery, they experience less pain after the surgery. Why would that be, if the drugs eventually wear off and do nothing to prevent the tissue damage resulting from the surgery?

His explanation is that post-surgical pain is caused in part by “pain memories” created during surgery, and that the formation of these memories can be blocked by “preemptive analgesia.” According to Woolf:

The post-operative pain is a manifestation of switching on the memory of the pain that occurred during the surgery. … As we search for the molecular basis of pain, we keep uncovering associations between pain and memory. Blocking such associations can provide a new basis for treating pain.

THE MEANING OF A MEMORY

The way we remember pain depends on the emotional context of the painful event. Onestudy shows that women going through childbirth and gynecological surgery both report high levels of pain. But months later, the women who gave childbirth “forgot” to some extent how much pain they felt, while the women who had surgery overestimated their self-reported pain levels. Apparently the emotional context of pain and its meaning matters for how it is remembered.

A recent article in the New York Times discusses some similar research with marathon runners – they underestimate self-reported pain levels at the finish line if they were also feeling good about the race.

I have a wise neighbor who noticed something similar with his kids after a trip to Disney Land - they didn't seem to enjoy it much - they whined all day about long lines and short rides. But as soon as they got home, they begged to go back at 9am the next day. He called it Disney Amnesia.

I think he had an intuitive understanding of a cool effect studied by Daniel Kahneman (author of the incredible Thinking, Fast and Slow). The peak-end rule states that when someone tries to recollect how much they hated or enjoyed a particular experience, they put too much emphasis on how they felt at the end of it. (They also excessively weight the peak intensity of the experience, and almost totally disregard duration.) This is why people (especially my wife) have a hard time remembering just how boring a vacation was. Or how much pain they suffered in a colonoscopy.

This is all very interesting, but I must admit there may be major differences between “memories of pain”, which are consciously accessible, and “pain memories”, which are more like sustained sensitivities to threatening stimuli. But there are similarities - in each case, the way we feel in regard to past experience depends on idiosyncratic and imperfect processes involving interpretation and emotional context. 

I think one way that therapists can help clients with chronic pain is giving them a new way to frame past experiences of injury, and better ways to respond in an emotional intelligent way to new injuries.

How do we get annoying jingles out of our head? Listen to something different. How do we forget how much our back hurt the last time it "went out"? Create as many new memories of pain-free bending as possible.

And how do we prevent new injuries from turning into chronic pain? Experiences are more likely to become indelible memories when accompanied by extreme emotion and stress. Personally, I lead a pretty sporty life, so new aches, pains or injuries are always showing up. Each time, there is a part of me that gets emotional and stressed: "Oh no, this is the end of my soccer career!"

But there is another part of me that knows I might be in a narrow window of time where my emotional reactions to this new pain can play a role in how long it will last. So I try to relax, be mindful, and talk myself down from any thoughts of catastrophe. I also give my body a chance to engage in whatever instinctive protective movements or postures it wants.