Concussions: What to do post-injury and how to prevent

Concussions: What to do post-injury and how to prevent concussions

What is a concussion?

A concussion is a type of traumatic brain injury (TBI), meaning an injury to the head that affects how the brain functions. Typically, a concussion is caused by an outside force, usually a blow to the head that “shakes” the brain causing chemical changes and/or damage to brain cells. There are three levels to a concussion: Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe). While there are different severity levels of concussions, even the mild cases should be taken seriously and should seek out attention from a medical professional.

What are the signs and symptoms of concussions?

The symptoms of a concussion vary among the situation and the extent of the injury. Below is Table 1 from the Center for Disease Control and Prevention of the observed signs and reported symptoms post-concussion. The signs and symptoms of a concussion are not limited to those on this list, everyone’s situation is different meaning there will be different outcomes of the injury.

Table 1: Center for Disease Control and Prevention (CDC)

What is the recovery process?

Whether you’re an athlete or not, you must follow a return program to ensure you are safely returning to play, school, or work. A concussion doctor in Chicago, a physical therapist, and physician will work with you to create a plan and therapy guide for your recovery. Typically, there will be a process along the premises of rest, light activity, moderate activity, then back to regular activity.

How can I prevent concussions?

Prevention is crucial for concussions since the severity of a concussion increases with each injury. Depending on the sport, there are specific prevention measures you can ask your physical therapist about to reduce the risk of injury. Below a general list of things to keep in mind when going through your day to day.

  • Wearing protective gear during sports and other recreational activities

  • Buckling your seatbelt

  • Keeping the floors clear of tripping hazards

  • Protect your children in the home (For Example: block off stairways or installing window guards)

  • Exercise regularly

  • Educating yourself and others about concussions


Call today or schedule your individual phone consultation with a Doctor of Physical Therapy. You may also book for an appointment today.

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On Field Progression of the Controlled to Uncontrolled Chaos Continuum

Dr. Mary Kate Casey’s On Field Progression of the Controlled → Uncontrolled Chaos Continuum

On Field Progression – Why do we document everything else in our rehab but the most important stuff.  We record reps, sets, and time for our athletes when they are running, jumping or completing strength exercises, but we have failed our patients by not properly PRESCRIBING return to sport controlled to uncontrolled play.  

We are trusting our “gut” on frequency, intensity and duration and therefore are missing a proper evidence based progression when it comes to the on field sport specific activities and game play.  We are allowing athletes to compete in drills based on their psychological readiness and often forget to properly DOSE return to play as an exercise prescription.  This is often missed because more often than not because unless an athlete is rehabbing in college or as a pro,  patients are not monitored by a PT, ATC or strength coach during their practices. As rehab professionals, we are failing our patients by not giving our patients clear guidelines and specific drills and activities they can participate in during practice.  All too often we are keeping our athletes out until the 9 month mark, and then let them go from 0-100 without introducing them to contact and game-like play in a controlled setting. 

We treat this phase of rehab as a question mark.  We ask our players… Do you think you can go 100%? Do you feel ready to play with a defender making contact? Do you need to come out? Or Do you think you can play for 30 min?.  

After doing A LOT of research and realizing there is a lack of research in the Return to Sport Strength and Conditioning and Return to Contact Play area, I began creating my own advanced Return to Sport and Return to Contact protocols. As an elite lacrosse player, the Return to Run programs out there didn’t have the appropriate intensity and there nothing out there regarding contact play but one article by Matt Tabenar in the UK, I have modified his Controlled Chaos Continuum and made it my own.  I have developed a more clinical, specific, reproducible, and actionable model in which medical professionals can communicate to each other via the athlete and evidence based programming.   I am starting to call this Phase 6 of ACL rehab, as it currently is the “why not, let’s give it a try phase”.  With little evidence or knowledge to support the decision making, the fatigue factor that often lands our athletes on the sidelines not too soon after returning to sport with compensation injuries or the ever so dreadful re-injury. 

It’s not if an athlete is going to get reinjured, it’s when. This sounds very pessimistic, however its the truth.  The stats are stacked against us and we as medical professionals need to do more about it. We need to start solving the problems we see everyday in our offices and we need to start making a change.  

If we can take a more controlled and evidence based approach to On field Progressions, our athletes will be safer in returning to sport and will have had the exposure and reps they need to feel confident, prepared and conditioned to participate in a full contact game without time restrictions. 

On Field Progression of the Controlled → Uncontrolled Chaos Continuum 

Return to Participation

  • Progressing reps, sets, and enforcing time limits
    • Non-contact Drills→ Controlled Non-Contact Play → Controlled Contact Drills→ Controlled Contact Play → Uncontrolled Contact Drills (progressing reps, sets, time limits)→ Uncontrolled Contact Play
    • Non-Contact Drill- Lacrosse Shooting on goal 50% of speed, focus on change in direction landing and loading, 20 reps, 2-3 times per practice 
      • 3 man weave 

Return to Sport 

  • Progressing reps, sets, and enforcing time limits
    • Controlled Contact Drills- 1v1 – Attacker goes 100% but defender goes 50% limiting contact and aware of injury- 10 min 
    • Controlled Contact Play- 7v7 – Attacker goes 100% but defender goes 50% limiting contact and aware of injury- 10 min 

Return to Performance 

  • Progressing reps, sets, and enforcing time limits
    • Uncontrolled Contact Drills- Lacrosse 1v1 attacking player goes 100%, no limits on defender, 10 reps
    • Uncontrolled Contact Play but Controlled Fatigue Factor
      • Uncontrolled Contact Play-  100% attacker and defender in game play ½ field, subbing in and out every 5 mins for a total of 30 min per game 
      • Uncontrolled Contact Play-  100% attacker and defender in game play ½ field, subbing in and out every 10 mins for a total of 40 min per game 
      • Uncontrolled Contact Play-  100% attacker and defender in game play full field, subbing in and out every 10 mins for a total of 40 min game
      • Uncontrolled Contact Play-  100% attacker and defender in game play full field, subbing in and out every 20 mins for a total of 50 min game
  • No time Restrictions 
    • Uncontrolled Contact Play-  100% attacker and defender in game play full field 
  • Player Initiated (controlled) and Play reactive
    • Preplanning vs reactive 


Download Our FREE Controlled Chaos Athlete Tracker Today

It’s important to note that the athletes first full game should NOT be the first time they are cleared to play.  We need to do a better job of communicating with players, parents and coaches on the dosage of return to full play restrictions and how that will in turn not only provide safety for the athlete but improved performance and safety in the game.  Following this protocol, we aim to reduce the risk of re-injury, muscle strains and compensation injuries, all while giving the athlete more time to gain exposure in real game-like  situations without pushing vulnerable and fatigued muscles over the limit.  

In addition to following on Field Progression of the Controlled → Uncontrolled Chaos Continuum, it is imperative that these recovering athletes prioritize active recovery days and listen to their bodies when progressing into full Return to Performance protocol.  


Taberner M, Allen T, Cohen DD Progressing rehabilitation after injury: consider the ‘control-chaos continuum’British Journal of Sports Medicine 2019;53:1132-1136.

Call today or schedule your individual phone consultation with a Doctor of Physical Therapy. You may also book for an appointment today.

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Hip Labral Tear_Prep Performance Center

Hip Injections for Hip Labral Tear in Adolescent Athlete

What is a Hip Labral Tear?

Hip Labral Tear – in the hip labrum is a tear of the ring of cartilage on the sock part of the hip joint. A tear can occur on the anterior (front) or posterior (back) sides of the hip labrum.

Who is at risk of tearing the hip labrum?

Hip Labral Tears are a common injury amongst young athletes, specifically those involved in dance, soccer, golf, or hockey. Mainly sports with repetitive motions may cause overuse of the area and lead to a tear.

What are my options for management or repair?

Depending on the severity of the injury and where you are on the spectrum, your provider will recommend either injections, medication, physical therapy, and/or a procedure to repair the area. Studies have shown that incorporating an injection as well as participating in physical therapy to be the most effective intervention. While physical therapy will help you to gain strength, endurance, flexibility, and stabilization, the injection will help with pain relief so you can participate in therapy as well as daily activities with ease.

What kind of injections will I be offered?

There are three different types of injections your provider will offer depending on your situation. The three kinds are corticosteroid, platelet-rich plasma, or a stem cell injection. The most common is a corticosteroid injection which is a powerful anti-inflammatory that can provide instant relief with the combination of an anesthetic. This is a very common injection for pain relief among athletes and those experiencing excessive pain.

What are the next steps (Hip Labral Tear)?

After your provider has offered a corticosteroid injection, be sure to make an appointment with your physical therapist for an evaluation to determine the course of action. Your therapist will customize a detailed physical activity/exercise program for you to follow during the different phases of your recovery. As you progress the intensity of the exercises will increase, therefore you will be improving performance while recovering.



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Ways to Improve Knee Extension_Prep Performance Center

Top 10 Ways to Improve Knee Extension

After ACL-R Surgery

Knee Extension – After ACL surgery, rehab can be a slow, painful process – but it doesn’t have to be!

A big part of ACL surgery rehab is improving your knee flexion (bending your knee) and knee extension (straightening your knee).

However, if you properly warm your knee up, these 10 simple steps for improving your knee extension or helping you strengthen your knee better should be easy to complete. See related article by Mayo Clinic.

Please note that all of these exercises should be approved by your orthopedic surgeon and Doctor of Physical Therapy. In order to protect your knee and the soft tissue that was repaired, you want to be approved to add these exercises.

Below you will find the secret to improving knee extension, and being able to strengthen your knee with little to no pain.

If you can follow these steps, I am confident you will meet your range of motion goals in no time and with limited to no pain along the way.

Pain Management (Knee Extension)

  • Elevate your legs for 20 mins and take your pain meds at least 20 min before


  • Ice an hour and then Wrap your knee with an Ace Wrap to minimize swelling after icing


  • Walk for 10min prior to beginning your program (bend your knee when walking)

Effleurage (Knee Extension)

  • Complete Effleurage for 3-5 min to reduce swelling
  • Gently massage your leg and pull up towards your heart

Hamstring Stretch

  • Complete Hamstring Stretch on bed 3 x 45s
  • Lie on back and use a strap to pull leg toward ceiling

Thomas Test Stretch

  • Complete Modified Thomas Test Stretch 3 x 45s
  • Lie on back and gently let surgical leg hang off edge of bed

Quad Set (Knee Extension)

  • Complete Quad Set 2 x 10 5s hold (Use Towel Roll for Cues)
  • Lie on your back, towel behind knee, squeeze quad and straighten leg

Straight leg Raise

  • Complete Straight Leg Raise 3 x 10
  • Lie on your back, Quad Set into towel, then raise leg (toes to nose)

Prone Quad Set

  • Complete Prone Quad Set  2 x 10 (5s hold)
  • Lie on your belly, toes pointing down, squeeze quad and straighten knee to ceiling

Prone Knee Hang (Knee Extension)

  • Complete Prone Knee Hang 3 x 1min Adding a minute as tolerated
  • Lie on your belly with your knee and calf hanging off the bed

Read More Article: 11 Steps To Improve Knee Flexion After ACL Surgery

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Good Bargain at Chicago Physical Therapist Prep Performance Center

If You Like a Good Bargain, You’re Going to LOVE Physical Therapy

Searching for a good bargain? It’s no secret that prices have been going up. Gas is expensive. Food is expensive. The housing market is crazy. If you’re looking for ways to pinch some pennies or stretch your dollars, physical therapy might be just what you’re looking for.

Physical Therapy Saves Cost

A study that looked at the claims data of 472,000 Medicare beneficiaries with back pain found that when PT was the first treatment, costs were 19% lower than when people got injections first and 75% lower than for people who were sent straight to surgery. The study also found that in the year following diagnosis, people who got PT first had costs 18% lower than those who got injections, and 54% lower than those in the surgery group.

Another example happened in 2006 when Virginia Mason Health Center in Seattle teamed up with Aetna and Starbucks. They sent workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great that Virgina Mason was losing money on treating back pain, so Aetna ended up paying them more for PT treatments because they were saving so much money.

Physical Therapy First Means Fewer Visits…

A paper published in Physical Therapy looked at outcomes when patients went to a PT first vs. seeing a physician first for back pain. It found that patients who went to their physician first needed 33 PT visits on average, while those who went to their PT first only needed 20. Seeing a PT first saves money, but it also saves time. Isn’t it a good bargain? Check now for best physical therapy near me.

It Also Means Better Outcomes

A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit.

High quality research consistently shows that taking advantage of direct access and getting to your physical therapist quickly leads to better outcomes in fewer visits with lower costs. We think that’s a deal worth taking advantage of.


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wrist pain in the gymnast - consult Prep Performance Center in Chicago

Wrist Pain in the Gymnast

Gymnastics is an extremely intense sport both emotionally and physically. The physical demands of this sport unfortunately leave gymnasts susceptible to almost any injury under the sun. Wrist pain is very commonly experienced by gymnasts, males, and females alike. Distal Radial Epiphysitis, also called “Gymnast Wrist”,  specifically, is a common diagnosis that may explain this wrist pain amongst gymnasts due to the sport’s repetitive nature. 

Upper body injuries are more common in male and female gymnasts compared to other sports. The upper extremities are weight-bearing joints and absorb direct forces in all events of both men’s and women’s gymnastics. Acute injuries, such as a wrist fracture, often occur from a fall on an outstretched arm. However, injuries related to overuse and overtraining, such as Distal Radial Epiphysitis, are more common in gymnasts. 

The Diagnosis and How This Occurs:

– Distal Radial Epiphysitis, also known as “Gymnast Wrist”, is a growth plate injury to an adolescent gymnast with immature, growing bone structures
– The growth plate is prone to injury because the ligaments and joint capsule of the wrist are stronger than the cartilaginous growth plate 
– Repeated loading and wrist hyperextension cause the body’s forces to be directed to the radius bone which has not yet fused. This causes inflammation and widening of the growth plate. This often occurs with dorsal wrist impingement. 

Common Symptoms:

– Several weeks of unilateral or bilateral wrist pain 
– Usually occurs gradually, without history of acute trauma 
– Worsened pain with load bearing activities and when the wrist is extended 
– Pain relieved with rest 
– Range of motion normal or slightly limited due to pain
– Possible decrease in grip strength 
– Tender to palpation along the distal radius 
– Swelling may be present 

Differential Diagnoses:

– Dorsal Wrist Impingement 
– Scaphoid Stress Fracture 
– Carpal Ligament Sprains (Scapholunate and Lunotriquetral Ligament Injuries) 
– Triangular Fibrocartilage Complex Injuries 
– Ulnar Impaction
– De Quervain’s Tenosynovitis 
– Distal ulnar or radial stress fracture 

Pertinent Tests/Diagnostic Imaging:

– X-ray findings will typically appear normal
– In severe cases, a widening of the growth plate or ulnar variance may be visible
     – X-rays may be recommended 6-12 weeks post diagnosis or when symptoms subside to verify proper healing, but are usually not necessary if the initial X- rays appeared normal 
     – Routine X-rays may be recommended for about 6 months to one year post injury if the initial X-ray showed a lot of damage to the growth plate
– MRI is not usually necessary 

Risk Factors:

– Repetitive stress predisposes the wrist to acute injury, overuse injuries, and degenerative damage 
– Adolescent athlete with premature growth plates 
     – Adolescent gymnasts ages 10-14 are more likely to have wrist pain
– Recent growth spurt causing transient weakness at the growth plate

When to Seek Medical Attention: 

– Persistent pain that does not improve with rest over time 
– If this condition progresses it could lead to a fracture of the growth plate or ulnar variance 
– Ulnar Variance: if Gymnast Wrist becomes chronic and goes untreated, the growth plate may close prematurely resulting in cessation of radial growth too early, while the ulna continues to grow
     – Positive Ulnar Variance (the ulna appears longer): may result in altered wrist biomechanics, decreased wrist range of motion, and altered loading in weight bearing positions of the wrist 
     – Progressive damage to the ulnar side of the wrist may increase risk for chronic wrist pain and dysfunction

Ulnar variance - consult Prep Performance Center

Principles and Goals of Wrist Pain Treatment:

– Decrease the stress that is causing the pain
     – Stop weight bearing exercises for about 6 weeks or until symptoms subside 
– Wrist rehab to achieve symmetrical wrist range of motion and strength 
– Improve shoulder flexibility and thoracic spine mobility 
– Alternative training and conditioning aimed at improving upper body and core strength to decrease the stress on the wrist joint when returning to gymnastics 
– Stage 1: correct impairments in joint mobility, muscle length, and neuromuscular control in the spine, shoulder, and upper extremity joints
– Stage 2: continue manual techniques to correct impairments, progress exercises in neuromuscular control, introduce sport specific activities in limited weight bearing positions
– Stage 3: address impairments with manual techniques as needed, advance exercises in neuromuscular control, progress sport specific activities to full weight bearing positions  

Return to Sport:

wrist braces - consult Prep Performance Center in Chicago

– Once there is a decrease in pain, and range of motion and strength have been restored, the gymnast can begin a gradual increase in training load
– It is important that there is careful attention to sport biomechanics and proper form/ technique to limit further damage or re-injury 
– Wrist braces may also be worn to limit excessive wrist hyperextension 

Exercises to try if you may have Wrist Pain in Gymnast:

Wrist specific exercises 
     – Hand arch and splay 

Hand arch and splay - Prep Performance Center in Chicago
     – 4-way wrist strengthening (flexion, extension, ulnar and radial deviation) 

Upper body exercises 
     – It is important to have stabilization in proximal joints such as the shoulders and spine in order to improve stability and decrease stress in the elbow, wrist, and hand 
     – Scapular retraction and Shoulder ER at 90-90 
     – Planks and Side Planks 

Exercises to treat wrist pain in the gymnast - Prep Performance Center in Cebu
Training modifications 
     – Supported handstands on a wall, block, or table to decrease weight through the wrists and hands 

PT Role in Preventing Wrist Pain:

Overuse injury prevention
     – Limit excessive loading of the wrist
     – Maintain wrist joint flexibility
     – Incorporate wrist strengthening into training
     – Emphasize proper technique to reduce unnecessary stress 
     – Strengthen core and upper extremity joints to reduce stress on the wrist joints 
     – Wrist braces may be used in skeletally immature gymnasts to decrease the load on the wrist joints and help prevent early closing of the growth plates 


Benjamin HJ, Engel SC, Chudzik D. Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete. Current sports medicine reports. 2017;16(5):322-329.
Boucher B, Smith-Young B. Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report. Physical Therapy in Sport. 2017; 27:38-49.
DiFiori JP, Puffer JC, Aish B, Dorey F. Wrist Pain in Young Gymnasts: Frequency and Effects Upon Training Over 1 Year. Clinical Journal of Sport Medicine. 2002;12(6).
Hart E, Meehan WP, 3rd, Bae DS, d’Hemecourt P, Stracciolini A. The Young Injured Gymnast: A Literature Review and Discussion. Current sports medicine reports. 2018;17(11):366 375.
Poletto ED, Pollock AN. Radial Epiphysitis (aka Gymnast Wrist). 2012;28(5):484-485.
Trevithick B, Mellifont R, Sayers M. Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics. Journal of Hand Therapy. 2019.
Written for PREP Performance Center by Gianna Scala, SPT

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