The Clinical Coach: Vasovagal syncope, Occipital Neuralgia & Concussion Walk Into Your Clinic (UPDATE)

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A few weeks ago I shared with you the case of Felicity.

A 14 y/o f whom 10 days ago had an episode of syncope after landing a tumbling pass.

It’s been 31 days since her initial incident.

I received a lot of emails regarding this case! Loved the input and feedback!

From doctors inquiring about the low blood pressure, the poor balance, lack of advanced imaging and cord injuries, to students sharing their input and differential dx like, transient cord dysfunction, cord compression, c/spine instability and more.

To all whom replied to the case, thank you!

A lot of great thoughts!

Now let me tell you how I’ve been managing Felicity over the last two weeks.

1. ZERO CHEER- a few days after my last email. Felicity showed up to the office. Feeling about 60% better. I was hoping more, but I’d soon find out why. To my knowledge she was supposed to be off any type of practice. She hadn’t. She was still participating in walk-throughs. No jumping. But a lot of headbanging. Which exacerbated her dizziness.
   
   As she explained her symptoms she pulled up a video of her walk-through during practice. That walk-through was 90% full speed, with the only thing missing — stunting and jumping.
   
   She explained when the symptoms occurred. It coincided with aggressive flexion and extension of the c/spine.
   
   * I don’t like to spread fear, but at this time they were not listening to the ZERO cheer activity ban. Therefore I explained that until we were able to obtain advance imaging of the cervical spine. She could not continue with practice at all in order to avoid injury to the spinal cord, as I suspected it was this type of motion that was causing some strain to it.
   
   Mom’s jaw almost fell to the floor. I ordered a flexion/extension study — which was denied a few days later by her insurance until they saw a neuro specialist in STL. They just did this Tuesday (finally).
   

2.  C/Spine Rehab - majority of Felicity symptoms come during aggressive flexion/extension of her cervical spine. While we are awaiting her visit to the neuro specialist in STL. We began c/spine rehab with 4 exercises with the goal to reduce symptoms during c/spine movement:

   1. Chin retraction

   2. Chin retraction with extension

   3. DNF isometric contraction

   4. Planks with c/spine rotation with eye fixation.

   
   She is currently not going to cheer practice at all, and she is seeing improvements in her dizziness, light sensitivity and headaches.

3. Speed Reading - Felicity had mentioned how reading would bring on a headache. She noticed the slower she read, the less likelihood of a headache. So we tested her reading speed. Over 155wpm and her head would start to ache just behind her right eye. So we started at a speed that would allow her to move as fast as possible through her reading without bringing on a headache.
   
   Over the last two weeks, we’ve increased the tempo by 5 every three days and currently sits at 145wpm.
   
   In case you are wondering how we are tracking this, we are using a metronome with a set of list of words to practice every day.

As of today we are waiting for advanced imaging. She is under strict no cheer policy, and her c/spine rehab continues to progress with great results.

If you have any thoughts on the case, please feel free to email me back!

In health and strength,

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