Importance for Parents to Accurately Identify Concussion in Children

Written by Dr. Marcus Wong


A recent research study was done by Dr. Craig J Coghlin, Dr. Bryan D Myles, and Dr. Scott D Howitt to assess the ability of parents/guardian identifying concussion symptoms in their children from sports injuries.

child-concussion-head-injuryThe study was done with parents/guardians of Bantam-aged minor hockey league athletes volunteered fro the study.  These children were age 13-14 years old.  The outcome measures were the ability to recognize different signs and symptoms listed on the Sport Concussion Assessment Tools (SCAT) as well as 8 detractors consisting of signs and symptoms not associated with post concussive syndrome.  Additional questions assessing the parents’ knowledge of concussion management and recognition abilities were also posed.

In conclusion of this investigation showed that there is still a disconnect in regards to key components of recognizing a concussion in the children.  The mothers/females of the study displayed better ability to better differentiate between true and false signs and symptoms of concussion compared to the fathers/males.

~ Journal of the Canadian Chiropractic Association/December 2009/Vol. 53/No.4

This is an astonishing study that shows that majority of the parents/guardians don’t know how to correctly identify a concussion in their children, but at the same time still allow their children to participate in physical sports such as hockey, basketball, and football.

Some basic things to look for are

  • if your child is unconscious
  • abnormal breathing
  • obvious serious wound or fracture
  • bleeding or clear fluid from the nose, ear, or mouth
  • disturbance of speech or vision
  • pupils of unequal size
  • weakness or paralysis
  • dizziness
  • neck pain or stiffness
  • seizure
  • vomiting more than two to three times
  • loss of bladder or bowel control

child-injuries-300x336 (1)If your child have any of the symptoms above contact your doctor or call an ambulance immediately, and don’t try to move your child as this may cause further damages.

If the child doesn’t have the above symptoms, monitor them for 24-48 hours for any abnormality.  If they have difficulty with sleep, disorientation symptoms, and emotional irritability contact your doctor.

The importance of treating concussion at the very beginning stages are crucial as some concussions may lead to death or disability in the child.  Therefore, this is an immediate medical emergency and be treated as soon as possible.

Keep in mind the above tips are the minimal, if you are unsure of anything contact your doctor immediately.

If you have any questions please contact Dr. Marcus Wong at

Groin Injury in Hockey

Written by Dr. Marcus Wong

In the light of the 2014 Winter Olympics I think this is a good topic to discuss.  During the past hockey seasons, many injured patients has injured their groin from playing hockey.  As many people who watches hockey realize that groin injury is a very common thing, and can affect the athlete’s performance and recovery.  Some players might not be able to reach the same level of performance again after this injury.  A major reason for this common injury is through improper training of the groin area and skating technique.

Also goaltenders suffer groin injuries as well due to the quick lateral push off movements and splits.  This injury to goaltenders are more substantial then to other positions, as it requires a very strong and healthy groin to be a goaltender.

Roberto Luongo injured in the first period against the Penguins in Pittsburgh

ant-view-of-legmed-view-of-legLets start off with describing the anatomy of the groin region of the leg.  The groin area is the medial or inner part of your thigh area.  It is made up of several muscles mainly the adductor longus and brevis, adductor magnus, pectineus, and the gracilis.  Any of these muscles can be injured through strenuous skating, which may weaken other surrounding structures such as the hip joint or the knee as these muscles comes from the hip, and attaches to the knee.

During skating there are mainly two groups of muscles that are involved, the ones that abducts the leg (move the leg outwards), and the ones that adducts the leg (move the leg inward).  The muscles which are used to abduct or move the leg outward in the initial power stroke to propel the player are the tensor of fascia lata and the sartorius.  The muscles which are used to adduct or move the leg inward in the movement to bring back the leg towards the body are the groin muscle group.  Usually the abductor muscle group is more powerful and tighter than the groin muscles, therefore, if the two muscle groups aren’t equally trained the groin muscles will be overused and injured resulting in a groin pull or strain.

To treat the groin injury it will take time and patience.  The initial part of the treatment will be actively stretching out the scar tissue or adhesion formed from the injury.  As with any tissue injury, inflammation and scar tissue formation is inevitable.  Also loosen up the tight abductor muscles as well.  Once the pain level has decrease and the groin has healed, rehabilitation of the groin area can take place.  First will start off with light stretch exercises and active range of motion of the leg.  Next will be adding some tubing exercises for light resistance rehabilitation.  Lastly, will be strengthen exercises using light weights and properly skating technique.

If you have any more questions about groin injuries or treatment options please email Dr. Marcus Wong at

Inversion Ankle Sprains

Written by Dr. Marcus Wong

Several of us have experienced an ankle sprain to some degree in our lives.  Some, more often than others. In the game of basketball, the ankle sprain injury is one of the most common types of injury.  The two most common types of ankle sprains are the inversion and eversion sprains.  Inversion sprains are more common, but the eversion sprains are usually more severe.  An Inversion sprain is when the ankle is manipulated or “rolled” medially or “inwards towards the body”.  The eversion sprain is the opposite of inversion – the ankle is “rolled” laterally or “outwards, away from the body”.

ankle-sprain-ligsAnkle sprains can be classified by mild, moderate, or severe.

Mild cases of sprains:

  • may be tender to the touch
  • might have decrease in range of motion of the ankle joint
  • might walk with a slight limp
  • might show some signs of swelling.

Moderate cases of ankle sprains:

  • tender or painful to the touch
  • decrease range of motion of the ankle joint
  • signs of limping
  • signs of swelling and/or bruising.

Severe cases of ankle sprains:

  • there might be signs of fracture
  • very painful to the touch
  • unable to move the ankle joint
  • unable to walk on the foot/leg
  • excessive swelling/bruising.

torn-ankle-ligament1The ankle joint is made up of three bones: the medial malleolus which is part of the tibia, the lateral malleolus which is part of the fibula, and the talus.  Several tendons run along the ankle joint.  The common tendons which may be injured as a result of an ankle sprain are the peroneus longus/brevis and tibialis anterior/posterior.  In some severe cases the achilles tendon may be ruptured or injured.  Several ligaments can be injured in the ankle joint, but the most common ligaments injured in an inversion sprain is the anterior talofibular and calcaneofibular ligaments.

At the first sign of an ankle injury assess the following to determine if there is a fracture or torn ligament or tendon:

  • is there severe to uncontrollable pain
  • is the injured person able to walk 4 steps, even if its a limp.
  • is there severe pain with pressure along the sides of the ankle (medial/lateral malleolus)
  • lost of sensation in the leg or foot
  • severe bruising and/or swelling around the ankle joint especially the back of the ankle where the achille tendon is located.
  • any pain along the sides of the leg or the calf area.
  • any abnormal “lump” anywhere on the foot, ankle or leg

If any of the above symptoms or signs are present please seek emergency or professional consultation as soon as possible as there may be a fracture, contusion, and nerve damage.  As this may require surgical repair or casting / bracing by a medical professional.

If there aren’t any of the above symptoms then conservative care at home and by a chiropractor can be taken.

During the first 24-48 hours these steps can be taken:

  • Protect the injured area.  Avoid any contact by other objects.  A mild brace may be used.
  • Rest the injured area.  Avoid excessive walking and/or running.  Lie down on the bed or rest the foot on a foot stool, etc.
  • Ice the injured area.  Applying ice for 15 minutes as needed with 60 minutes intervals to help reduce the initial inflammation/swelling/bruising of the ankle joint.
  • Compress the injured area.  Using a brace or supportive tape.
  • Elevate the injured area.  This allows the drainage of the swelling/bruising of the ankle.
  • NSAIDs or Advil may be taken under supervision / direction of the medical doctor to reduce initial stages of inflammation and pain.

Treatment at the chiropractic office may consist of:

  • Scar removal using Active Release Technique®.  As scarring around the ankle joint may decrease future range of motion, and might predispose the ankle to future recurrent sprains.
  • Adjustment of the ankle joint to break away scar tissue and realigning the ankle structure.
  • Professional taping/ bracing of the ankle
  • Passive and active range of motion of the ankle joint
  • Tubing / strengthen exercises of the ankle joint
  • Rocker board exercises to retrain the neurological receptors around the ankle joint

If you have any more questions about ankle injuries/prevention or treatment options please email Dr. Marcus Wong at

Chiropractic Thaws Frozen Shoulder Syndrome


Many patients with shoulder pain are told have surgery, get steroid shots, or take anti-inflammatory drugs to relieve the pain. Unfortunately, these treatments do not always work to reliably reduce symptoms, particularly in patients with frozen shoulder syndrome.

Frozen shoulder syndrome is characterized by night pain and painful restriction of shoulder movement during rotation and abduction. Only 2-5% of the general population has FSS, but rates are higher among people with Parkinson’s disease, cardiovascular disease, thyroid disease, and stroke; in fact, up to 40% of patients with diabetes suffer from FSS.

Finding an effective way to relieve FSS remains a challenge since many patients say they still experience symptoms for several years after their initial medical treatment. A recent study suggests that chiropractic treatment may provide better relief for persistent FSS.

The study included 50 patients with FSS between the ages of 40-70 years old. Patients were treated with a high-velocity, low-amplitude thrust that seeks to correct dysfunction of occipitoatlantal articulation (C0-C1 chiropractic subluxation).

After an average treatment time of 28 days, the majority of patients had substantial improvements in shoulder adduction and pain. The median average patient had their pain score drop from a nine out of ten to a two out of ten, resulting in a median 78% improvement in pain. Additionally, researchers evaluated the patients’ shoulder function by measuring their degree of shoulder adduction. Sixteen patients had regained completely normal shoulder adduction; 25 patients had 75-90% improvement in shoulder adduction; and eight showed a 50-75% improvement.

“The results of this case series are encouraging in that many of these patients’ complaints seemed to improve or resolve within 1 month of presentation, whereas, in general, it is thought that FSS symptoms can persist for 2 years or more,” the researchers wrote.

Although large-scale studies are needed to test these results, the findings suggest that chiropractic adjustment can provide effective relief of FSS.

If you have any more questions about frozen shoulder injuries/prevention or treatment options please email Dr. Marcus Wong at


Knee Pain

Written by Dr. Marcus Wong

The knee is a very complex structure of our body leading to a lot of pain after increase exercise or motions.  This is due to the fact that not every individual train their knees properly which can lead to problems even with everyday activities.  As we age our knees become weak and/or tight over time, therefore, even simple activities as running or walking in the park can lead to discomfort and long term chronic knee issues.  Certain parts of the knee is strain and other parts of the knee must over compensate leading to unbalance muscle groups in the knee.  When this happen several treatment options and rehabilitation exercises are available.

First lets describe the basic anatomy of the knee.  The knee is made up of 4 major bones: the femur, tibia, fibula, and the patella.  There are four major ligaments the hold up the knee:  medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament.



Several muscles surrounds the knee.  The major ones consists of the quadriceps femoris, hamstrings, and calf muscles.

The anterior portion of the knee is made up of the quadriceps femoris muscle.  This group of muscles comprise of 4 individual muscles consisting of the rectus femoris which is the middle portion of the thigh, the vastus medialis which is the inner portion of the thigh, vastus lateralis which is the outer portion of the thigh, and the vastus intermedius which is the portion underneath the rectus femoris.


The posterior thigh of the knee is made up of the hamstring muscle group.  This group of muscles comprise of 4 individual muscles as well: biceps femoris long/short head, semitendonosis, and semimembranosus.



Lastly the calf muscles which forms the lower posterior portion of the knee consisting of mainly the gastrocnemius and the soleus.



Majority of the patients who comes in with knee pain are usually the ones that have over used their knee.  This will result in certain parts of the knee being too tight (usually the rectus femoris and vastus lateralis) and certain parts of the knee being too weak (vastus medialis).  Muscle imbalance results and knee discomfort and pain are the symptoms.  If this is the case chiropractic treatments made be done.  Such treatment options include:

  • Chiropractic adjustments
  • Muscle stretching of the knee muscles using Active Release Technique®
  • Proper taping of the knee during acute stages for support
  • Active range of motion and tubing/strengthen exercises
  • Balance/proprioception exercises


In some more serious cases the ligaments of the knee are partially torn or fully torn, in this case medical consultation or surgery are required.  After re evaluation and/or surgery conservative care with chiropractic treatments can be rendered.

In the older population cartilage in the knee may deteriorate and decrease.  When this happens surgery may be need, but conservative chiropractic care may be used at first as well.  Proper supplementation of glucosamine sulfate may also be used.

If you have any more questions about knee injuries/prevention or treatment options please email Dr. Marcus Wong at

Golf Season is Here !!!

Written by Dr. Marcus Wong

The sun is finally out and it looks like its here to stay!!!  Many people start to dust off their golf bags if they haven’t done so already.  Some even started hitting balls at the driving range already couple months ago in the rain and cold breezy weather of Vancouver.  But after a long period of sitting on the couch and the holiday festivities of Christmas and then the Winter Olympics, and the ending playoff run of the Vancouver Canucks, many of us are left out of shape and not quite fit for a nice long season of golfing.  After all low back pain and elbow injuries are the most common conditions suffered by golfers.




Every time you take a swing the spinal rotation of the golf swing can reach up to 160 km/h, which can leave a lot of stress on your body.  Here are some tips to follow to prevent such injuries to your body:

  • Strength training of your core muscles are very to important prevent injuries.  The muscles stabilizes your spine and body through each swing, and acts as shock absorbers to prevent sprains and strains.  Core muscle flexibility and strength also increase proper oxygen flow in the body.
  • Warm-up and cool-down both before and after your game or session for a 20 minutes, which include gentle stretching and range of motion exercises, as well as a brisk walk or gentle jog to loosen the muscles and joints.  Muscles which should be stretched include your low back, hamstrings, quadriceps, calf muscles, etc.
  • Stay hydrated by drinking plenty of fluids before, during and after your game.  Remember that once you are thirsty, you are already starting to dehydrate.  Dehydration affects your energy level and your physical functioning and performance.  When your body and energy level decrease, this is when your body is most prone to injuries.
  • Use a wheeled golf cart for carrying heavy clubs. If you must carry your golf bag, buy the ones that have two shoulders straps.  This will spread the weight across a greater area on your back, so there isn’t one side of your back that is stressed throughout the day.  If there is only one strap, alternate sides frequently.  If you find that your bag is getting too heavy, put it down and take a break.  Taking breaks frequently is important, its your body telling you to stop and rest. Further stress will once again make your body prone to injuries
  • When wheeling your golf cart, push rather than pull.
  • Golf requires long periods of standing.  Frequently alternate your weight from one foot to the other or rest one of them on your golf bag or cart.  Taking breaks and sitting down if you get dehydrated or really tired.  Gentle stretching of your hamstrings, quadriceps, and calf muscles throughout the game.
  • Make sure you have the proper shoes for your type of feet.  Golf shoes with short cleats are the best.  Some times you may need orthodic insoles custom made for your feet.
  • Use the right technique for your physical capacity and limits. Adopting a golf swing based on your physical and biomechanical capacity is important.  Amateurs are usually better off adopting a classic golf swing, which enables the hips to turn nearly as much as the shoulders to minimize spinal twisting.  If in doubt, consult a golf pro.
  • Sleep well the night before the game, and have an overall healthy diet.  Eat before games and after games to replenish your body.  Playing hungry in any sport is not optimal for the body as your body tires quickly and your body will be prone to further injuries.

Preventing Shoulder Injuries

Shoulder injuries in golfers are common due to the repetitive nature of the swing.  This is a type of repetitive strain injury.  Therefore, a proper swing is very important as you don’t want to repetitively add stress and strain to your shoulders.   To reduce shoulder pain, try these two tips.

  • Shorten the back swing slightly. Instead of ending the club head at the 3 o’clock position, stop at the 1o’clock position.
  • Strengthen your shoulder, scapular, chest , and back muscles. Your chest and back muscles are large and generate the power in the swing.

Preventing Elbow, Wrist and Hand Injuries

  • Select larger and softer club grips and use a neutral grip.
  • Select irons with large heads and graphite shafts to lessen vibration.
  • Select the correct club length.
  • Strengthen your forearm muscles.

Chiropractors can help prevent backpack problems by showing you golf exercises and stretches. Should you suffer an injury from golf, a chiropractor can also provide treatment for your low back pain or shoulder/elbow injuries.




Enjoy yourself this golf season, remember to prepare yourself and prevent injuries before they occur is most important!!!!

If you have any more questions about golf injuries/prevention or treatment options please email Dr. Marcus Wong at