What Should I do If I think I Have a Concussion?



We hear a lot about concussions in the media these days. It seems like every day there is another report of a professional athlete being held out of competition due to a concussion. As a society, we understand that concussions can be detrimental to our health but that hasn’t changed the incidence of concussions. In fact, over the past decade, we have seen a steady increase in the incidence of concussions.

This may be because our understanding about concussions is still developing. Not too long ago we thought that concussions only had short-term effects on the brain. We now know that concussions, if not treated properly can have a much more devastating effect.

So what are concussions anyway?

Concussions are caused by a blow to the head. Evidence has shown that even multiple small blows to the head can lead to a concussion. When an individual hits their head their brain can potentially be injured as it slams into the skull. When the brain cells are injured in a concussion they stop working like they normally would. This is known as neuronal dysfunction.

Concussions can be associated with a wide variety of symptoms depending on the area of the brain that is injured. Common symptoms include sleep disturbances, changes in mood, headache, and confusion or difficulty concentrating.

What should you do if you think you may have a concussion?

If you think you have a concussion the first thing you should do is to stop playing. There are a couple reasons for this. First, If you do have a concussion this may cloud or alter your judgment making further participation in sports dangerous. Second, you want to protect yourself from sustaining another hit to the head. Multiple concussions sustained in a short period of time can have devastating effects on your brain and carry the potential for permanent brain damage.

The next step is seeing a qualified health care provider that is familiar with concussions. Don’t be afraid to ask your provider about their knowledge of current concussion clinical guidelines. These guidelines are developed based on the most current concussion research.

Most providers will recommend some physical rest and cognitive rest in the initial stages of concussions. Cognitive rest is the avoidance of any mental activity that may make concussion symptoms worse. Sometimes this means avoiding screen time, school and other cognitive tasks for a short period.

How long will it take to recover?

The good new is that most concussions resolve within 10 days.  unfortunately, for about 10 percent of people concussion symptoms may last for longer than this. When concussion symptoms persist for a long time this is known as Post-concussion syndrome.

Individuals with a history of ADHD, depression, and learning disabilities seem to have a tougher time recovering from concussions. Also if you have had a concussion in the past you may have a longer recovery than most.

What is Really Causing Your Runner’s Knee?

Runner's Knee, Knee pain, Patellofemoral pain syndrome, IT band syndrome, Plica Syndrome

Knee Pain in Runners

Knee pain is one of the most common causes of pain and disability in runners. If you are a runner you know what I am talking about. The dreaded  “Runner’s Knee”, strikes fear in the hearts of many runners. 

So what is runner’s knee?

The answer to this questions would be different depending on who you talk to. Runner’s knee is a term used by many to represent any type of knee pain associated with running. This presents a real problem for runners out there looking for a cure for their runner’s knee. The treatments and therapy they are looking up on the internet may not be effective for them because they are not addressing the true cause of their knee pain.

So what really causes knee pain in runners?

There are many causes of knee pain in runners. And it would be impossible to cover them all here. Knee pain is most commonly caused by three things Patellofemoral Pain Syndrome, IT Band Syndrome, and Plica Syndrome. This article will focus on Patellofemoral Pain Syndrome.

Patellofemoral Pain Syndrome

Patellofemoral Pain syndrome Is the most common cause of anterior knee pain in athletes. It is estimated that a majority of all anterior knee pain is a result of this disorder. The symptoms of this condition include knee pain in the front of the knee that can be on either side of the knee cap. Most commonly the pain is on the lateral side (outside) of the knee cap.

The symptoms of this condition are caused by the knee cap tracking incorrectly over the femur as the knee bends. This is often caused by tight quad muscles especially the Vastus Lateralis muscle. This incorrect tracking of the knee cap can also be caused by a weak quadriceps muscle called the VAstus Medialsis.  Each of the above situations results in the Patella (knee cap) being pulled to the outside. This causes the underside of the patella to rub more on the femur. Over time this rubbing leads to inflammation and pain in the knee. Patellofemoral pain syndrome is common in runners because of the repetitive knee bending that happens in running. If it is not treated correctly it can result in permanent damage to the underside of the Patella called Chondromalacia Patella.

Runner's Knee
Tightness in the Vastus Lateralis can cause knee pain in running

How do I prevent Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome is often a result of ramping up mileage too quickly. When a runner drastically increases miles in a short period of time the quad muscles and gluteal muscles have a hard time keeping up with the new workload. This causes tightness and pulling on the knee cap. The first step in preventing patellofemoral pain syndrome is to gradually increase your mileage.

The second step in preventing patellofemoral pain syndrome is proper stretching. All too often runners fail to stretch appropriately with running. Every runner should warm up and stretch prior to their run and should then stretch following their run. With patellofemoral pain syndrome is critical that the quad muscles are stretched especially the Vastus Lateralis.

Finally, it is important to strengthen the Vastus Medialis. Incorporating a leg workout into your weekly exercise routine can do wonders.

Runner's Knee, Knee pain
Vastus Medialis weakness leads to improper tracking of the knee cap resulting in knee pain

This leg workout should include single legged squats and lunges. These exercises help strengthen the Vastus Medialis thus preventing the knee cap from being pulled to the outside of the knee.

I already have Patellofemoral Pain Syndrome How do I Treat It?

Treatment for Patellofemoral Pain syndrome is much the same pattern as preventing it. A formula of rest, stretching, and strengthening, is key in decreasing pain and disability associated with this condition.

The first step in treatment is rest. This means that you need to cut back on the mileage. I know this is like a death sentence for most runners but trust me if you want the knee pain to go away you need to back off a little bit.

Second, you need to strengthen your quad muscles and your gluteal muscles. This can be done with plyometric squats a few times a week or can be done in the gym with weights and leg machines. the focus on these exercises in strengthening the inside quadriceps muscle the Vastus Medialis as well as the gluteal muscles.

Stretching and massage to lengthen and loosen the Vastus Lateralis is critical. As long as this muscle is tight it is going to pull on that knee cap. One of the favorite tricks that I like to teach my patients is the use of a rolling pin to help massage and lengthen the quad muscles. To do this take a rolling pin of any type and roll out the upper leg toward the knee. This should be done every night following strengthening and stretching.


Knee pain in runners is a very common complaint. If your pain is in the anterior and lateral part of your knee you may have Patellofemoral Pain Syndrome. Try the treatments above. If your pain is not improving after a few weeks make sure that your knee is evaluated by a qualified health care provider.


Dr. Craig Nuttall is a family nurse practitioner trained in family medicine and sports medicine. He is also an avid trail runner and outdoor enthusiast.



Why do I get clogged ears when I exercise?

Clogged ears

Why do I get clogged ears when I exercise?

Ear fullness or the plugged sensation that many people report with physical activity is commonly referred to as “Eustachian Tube Dysfunction” (ETD) this means that the inner ear is not able to equalize pressure. The middle ear is a hollow space that is periodically vented when the Eustachian tube opens. This tube is opened or ventilated when a person yawns, chews, or even talks; just like when flying in an airplane and you yawn to equalize the pressure and resolve that ear fullness or associated pain.

Clogged ear and eustachian tubes
Clogged ears are often caused by dysfunction of the Eustachian Tubes

For some people, this associated fullness is merely bothersome, and for others, it can cause significant pain and discomfort. Unfortunately for those people, it can become more bothersome with physical activity because with exercise comes increased blood flow to the mucosal lining of the nose and throat. This increased flow of blood is important for humidification and warming of air prior to it entering the lungs. As that mucosal lining becomes engorged with blood flow it can cause the Eustachian tube to close off hindering the middle ear’s ability to equalize pressure. Other irritants can cause this lining to swell, such as pollution, cigarette smoke, or even allergens (dust, pollen, molds, or even animal dander).

How do I fix my clogged ears?

Typically, conservative treatment is very effective at reducing the incidence and the intensity of ETD, it can be as simple as increasing hydration with exercise or periodically leaning the head back and yawning while running, or for others the act of chewing gum with exercise resolves the issue. Some people respond well to a nasal saline washes with a neti pot prior to exercise. If conservative treatments are ineffective, a trial of a nasal decongestant spray for up to 3 days (Afrin or oxymetazoline) may improve clogged ears.  Decongestants work by causing the blood vessels to constrict in the nasal mucosa reducing the inflammatory process. However, nasal decongestants should not be used long-term, or on a daily basis.  Runners can use them prior to a race or a longer training run when they know the clogged ears sensation will be more bothersome. A lot of providers will also have patients begin the use of a topical nasal steroid spray (Flonase- being one of the most common), steroids are used to reduce the inflammatory process and can be used long term as an effective way to control ETD. They do require ~ 7 days of consistent use to become effective, so if you get to this point, you should continue to use the nasal steroids for at least 2 weeks to determine effectiveness.

If there is a significant hearing loss involved, or your clogged ears do not resolve spontaneously shortly after stopping, or if your symptoms do not resolve with the mentioned treatments further evaluation should be sought, typically by an ENT (ear, nose and throat doctor).


Scott Summers is a Family Nurse Practitioner that specializes in Ear Nose and Throat. Scott is an avid trail runner and alpinist with several ascents in the Tetons and Mt. Rainier

Cuboid Subluxation a Common Cause of Foot Injury in Trail Running

Trail Running
Trail Running
Winter trail running in the Wasatch mountains


If you are like me trail running is in your blood. You wake up and crave dirt under your feet and the sound of the wind whipping past you as you fly through canyons and over mountain passes. There is nothing better than feeling the freedom associated with trail running. On the other hand, there is nothing more crushing to a runner than an injury that keeps them off the trail.

Cuboid Subluxation and Trail Running

One of the most common injuries associated with trail runners are foot injuries. This is due primarily to the uneven surfaces that trail runners expose their feet to.

Foot injury in trail running
The cuboid bone is a common site of foot injury in trail runners

Cuboid subluxation is a common foot injury associated with trail running. This foot injury is associated with pain in the middle of the foot. This pain is often felt when the runner transitions onto the toes while running or walking. It often starts suddenly following a run on an uneven surface.

Cause of Cuboid Subluxation Foot Injury

These uneven surfaces cause extra stress on the bones in the middle of the foot. One of these bones named the cuboid bone is prone to subluxation. Subluxation is a slight misalignment of the bone. This misalignment decreases the flexibility of the foot and causes pain when the foot is in the flexed position.

Cuboid Subluxation Treatment

This pain can significantly limit the runner’s ability to run. Fortunately, this foot injury can be fixed with a simple manipulation that readjusts the alignment of the cuboid bone in the foot. Often the foot pain resolves immediately following the manipulation.


If you are suffering from lateral mid-foot pain when you run you might be suffering from cuboid subluxation. Don’t let this foot injury keep you from your trail running cravings. One simple treatment can get you back in the backcountry.


Craig Nuttall is a Family Nurse Practitioner that specializes in sports medicine. He is also an avid trail runner and outdoor enthusiast.



A Review of the Osprey Ace 50 Youth Pack

Osprey Ace 50 Youth Pack


Osprey Ace 50 Youth Pack
The Osprey Ace 50 Youth Pack ready for action

My kids are finally getting to the age, and stature suitable for more extended backcountry excursions. This has been a much-anticipated point for me as a parent. When I think of my own childhood I hold most dear my memories of backcountry adventures especially backpacking trips with my grandfather in the Uinta Mountains. I want my children to have the same opportunity to experience the beauty of nature, and feel the sense of accomplishment you can only find through a backpacking trip. I want them to connect with nature like I did as a child. I will admit that his desire is somewhat self-centered (I really need my kids to like backpacking so I have an excuse to be in the mountains more frequently).

I have realized that if I want to go on more than one backpacking trip with my children then I better do what it takes to make the trip a fun experience. Part of this is choosing appropriate backpacking gear. The most important piece of gear is the pack itself. There is nothing that can dampen the mood of a backpacking trip quicker than an ill-fitting backpack.

With a couple packing trips on the schedule and a 12-year-old son chomping at the bit to come, I set out to find the best youth backpacking pack. My quest was simple, find a pack that fit well, was durable and didn’t break the bank.

After a lot of searching, I decided upon the Osprey Ace 50 Youth Pack. I chose this pack for several reasons. First, the pack was made by a company known for high-quality packs. Second, the pack is adjustable and can be manipulated to fit a child from 10 to 18 years old. This not only improves the fit of the pack for youth but also cuts down on costs because you won’t need to buy a new pack every few years as your child grows. Finally, this pack was just the right size at 50 L for most trips. It provides just enough space for all of the essentials.

I decided to order the Osprey Ace 50 youth pack off of Amazon. It cost $148.00. I typically like to inspect the gear I buy in person. Unfortunately, I could not find an Osprey dealer in my area that sold the Ace 50. When the package arrived I was impressed with the quality of the pack. the pack looked very sturdy yet felt light.

To test the pack out we decided to take a quick trip into Granddaddy Lake in the Uinta National Forest. This involves a 4-mile approach with a steep climb and then a descent into the Granddaddy Basin. It was the middle of June and we were hoping that we would catch the end of the cutthroat spawn and get in a little fishing while we were there.

Osprey Ace 50 Youth Pack
My 12-year-old son wearing the Osprey Ace 50 youth pack in the Uinta Mountains

I loaded up the Osprey Ace 50 Youth Pack with about 15 pounds of clothing food and gear for the trip (15 pounds is about 20% of my son’s body weight) and headed off. Everything fit well in the pack, in fact, there was a lot of extra room for more gear if needed.

The pack exceeded all of my expectations on this trip. My son continually commented on how comfortable the pack was. The straps on the pack were very adjustable. There is a slider for the backstraps that allows you to quickly adjust the height of the straps to better fit your child. this pack is designed to fit a child as young as 10 years old all the way up to adult sizes. It really only takes about 30 seconds to adjust this pack to the optimal fit. There are also several other straps that adjust the fit of the pack.

While on this adventure we experienced a few afternoon thundershowers. The Osprey Ace 50 comes equipped with a built-in rain cover. It was very easy to access in a pouch at the bottom of the pack. It covered the pack easily and kept everything dry.

This pack has now been used on several occasions. Each time it is used I am amazed at the versatility and durability of the pack. 12-year-old boys are not always easy on gear (just ask the tent my 12-year-old took on the last campout). This pack continues to look brand new even after significant abuse.

I would fully recommend this pack to anyone out there looking for a good quality well fitting pack for their son or daughter. The nice thing about this pack is that it will grow with the child. this is a good thing because with the quality this pack is made with it will be around for a while. The pack also comes is different volumes if you are looking for a pack that is bigger or would like something on the smaller side. You just really can’t go wrong with the Osprey Ace 50 youth pack.




New Balance Vazee Summit Trail Running Shoe Review

New Balance Vazee Summit

New Balance Vazee Summit

I have been left with a bitter taste in my mouth after running in New Balance Shoes in the past, but there has been nothing but the savor of sweetness and satisfaction with their new trail shoe the Vazee Summit.

Billed as a comfortable yet aggressive trail shoe with an instinct for wet and slippery surfaces, we wanted to see if these shoes live up to the hype. At Gear Professor we believe that you can’t make a good decision about purchasing a product unless you are armed with accurate information about how that product will perform. We also love getting our hands on new gear. Here is how the Vazee Summit stacked up:

As with all research it is important to start with a plan of how you want to conduct the study. For this review, we decided that we needed to test out these shoes on a variety of surfaces in both wet and dry conditions. To do this I took these shoes to the trails of the Wasatch Mountain range, the rugged coast line of California’s Crystal Cove State Park and all the way across the pacific to Taiwan.

After this extensive testing it is safe to say that The Vazee Summit by New Balance is a shoe that can hold it’s own on a variety of surfaces: the results of the Vazee Summit testing are as follows.

When you first put on this trail shoe the unique tongue construction wraps your foot in billowy softness making your foot feel safe, protected and ready to hit the trails. This shoe fit my foot well. I like a snug secure fit and this met both of those requirements. If you have wide feet or prefers a lot of toe splay this shoe may not be the best choice for you. The shoes did seem to fit true to size.

The outsole is made up of aggressive multidirectional lugs that are made with Hydro-Hesion Rubber construction. New Balance states that this rubber has a stickier grip on wet surfaces. We tested this claim out in multiple locations. First these shoes were taken to crystal cove state park where they were worn on the slick tide pool rocks. The shoes were tested along side a control of bare feet, and a pair of Solomon wings pro. Compared to the control and Salomon Wings Pro, these shoes performed well. I only fell once in them compared to the many times I fell in both my bare feet and the Salomon’s. These Shoes were also taken up steep wet trails in torrential rain on a trip to Taroko Gorge National Park in Taiwan. Again these shoes performed well on these slick surfaces. With each step I felts secure in my footing. The shoes performed well in muddy conditions as well. The lugs are spaced far enough apart that they did not hold onto excess mud. A huge benefit when you forget to bring a spare change of shoes and your friends decide to go to dinner right after you go for a long run in the mud. Nothing worse than walking into a restaurant with shoes caked in 4 inch thick mud.

Overall the shoes had good grip on wet surfaces, dry surfaces, and on both sand and gravel. Though the shoes are designed for the trail we tested them on the pavement as well. They had a generally smooth ride and were comfortable for shorter distances. The rubber on these shoes is quite soft and wear patterns were noticed early in the review. These shoes wore down at a rapid rate when we were testing them on hard surfaces.

Rock plate
The Vazee Summit sports a fore foot rock-plate for foot protection from sharp objects. The rock-plate was tested by jumping off of an 8-10 foot bolder onto sharp gravel multiple times as well as on some very rocky trails in the Wasatch Mountains. The rock plate withstood all of my best efforts to damage my feet.

With a 10 mm heel-toe drop the Vazee Summit trail shoes are not made for the minimalist. That being said these shoes did not have the large rubber box feel on my feet like some trail shoes tend to have. Even with the 10 mm drop and aggressive lug stack there was ample ground feel and responsiveness when using this shoe.

The Vazee Summit is a great trail shoe for multiple terrain types especially slick environments. It has a nice look and a snug, secure, comfortable fit. They are light and the rock plate protects the forefoot well. The rubber that is used on the outsole is great on wet slick surfaces such as wet rock or gravel but this makes the shoe vulnerable to wearing down rapidly. Overall this shoe looks good, performed great in a variety of situations, and had a nice responsive ride. New balance has definitely impressed me with the Vazee Summit trail shoe.

Welcome to Gear Professor

Welcome to Gear Professor a site dedicated to testing and reviewing outdoor products. Our goal is to push each product we review to the limits and have fun doing it! Come back soon for a review of the New Balance Vazee Summit trail running shoe.