A concussion is considered a Mild Traumatic Brain Injury (mTBI). It can occur by a direct or indirect blow to the head in a collision in sports, motor vehicle accident, or a simple slip and fall accident.
Unlike other injuries that can be clearly diagnosed, there is no gold standard assessment that can confirm a concussion diagnosis. That means, that taking a scan to the brain will not show any “brain bruising” or any other abnormalities.
Most commonly, we see symptoms such as dizziness, headaches, brain fog, fatigue, and neck pain. To complicate matters, there is commonly a whiplash type injury to the neck or other area due to the collision.
In addition, to the previous symptoms, a hallmark sign of a concussion is exercise intolerance.
Commonly, symptoms become worse with exercise or any time the heart rate is elevated. It is vital that an individual get properly assessed if a concussion is suspected because as we stated, a concussion is a Mild Traumatic Brain Injury not a Major one! It is essential to rule out a Major injury.
Concussion symptoms are mainly caused by neuroinflammation within the brain from impact. This can set of a cascade of hormonal changes.
The first few days and weeks post- injury it is vital to calm this inflammation down. This will build a proper foundation for rehabilitation and treatment (if required) in the weeks to follow.
The previous belief that rest and time spent in the dark would heal a concussion is completely outdated and incorrect. That may decrease symptom severity in the short term but will inevitably lead to exacerbation of symptoms once an individual returns to sport, work, or activities of daily living.
Below is a stepwise process to maximizing recovery and restore cognitive performance.
Step one: Calming Down the Hyperactive Nervous System. Restoring Autonomic Balance.
When neuroinflammation occurs, our nervous system enters “flight or fight” (sympathetic) mode. This means we are in a constant state of “over stimulation”. In this situation an individual may have irritability, difficulty sleeping, become light sensitive, and get exacerbation of symptoms when trying to participate in their usual activities.
In the first few days it is vital to restore the “rest and digest” (parasympathetic) branch of our autonomic nervous system. Unless we restore autonomic nervous system balance, we cannot resume normal activities without continual flare ups.
A thorough assessment is required to design each individual’s treatment plan, however, below is a checklist that we generally follow. In many cases, in the 48 hours following injury, school or work should be avoided to focus on the follow items.
Goals: restore sleep, begin activity, decrease inflammation
Avoid continual bed rest.
Although avoiding school and work for 48 hours. Daily chores, reading, other activities of daily living are encouraged.
Limit screen time (especially in the morning and 2 hours before bed)
Get daylight first thing in the morning especially before looking at screens. Even looking out the window is sufficient.
Get 1-2 light walks preferably outdoors for 10-15 mins each.
Drink lots of water
Limit inflammatory foods such as processed sugars, cereals, alcohol, fast food etc.
Focus on healthy fats such as fatty fish, avocados, olive oil.
Focusing on eating whole foods.
Avoid caffeine or other stimulants.
Vital exercise: Relaxing Breathing 2 x day 10 minutes
Get comfortable on your back. Slowly breath into the belly, through the nose, and out the mouth. Breath in for roughly 4-5 seconds and focus on breathing out for 8-10 seconds.
Helpful Supplements: Omega 3 fatty acids (EPA), glutamine, magnesium bisgylcinate (before bed), creatine.
Step two: Increase Blood Flow and Restore Exercise Tolerance
If your symptoms persist after 2 weeks, it is time to get a specific plan to ensure proper recovery. An experienced clinician will test your baseline exercise tolerance and set up a plan for you.
Once your aerobic exercise tolerance is established a specific aerobic plan/cardiovascular plan will be prescribed.
It is helpful to continue the previous steps.
It is important to start exposing yourself to stimulating environments such as, shopping, restaurants, and social outings.
Step three: Rehabilitation of Neck and Vestibular Systems
In your initial assessment there will likely be some vestibular, ocular, and other musculoskeletal deficiencies.
Specific vestibular exercises based on deficiencies.
Specific rehab exercise can restore strength to other areas of the body.
Step four: Restore other Hormonal or Health Issues
In a small number of cases after following the previous steps diligently symptoms such as fatigue, restlessness, anxiousness etc. still exists. The reality is, for many people a pre-existing condition has been lying underneath the surface. When a concussion occurs, an individual’s symptoms that have gone unnoticed become more noticeable due to the brain’s inability to overcompensate.
Some of these conditions may include:
Inflammatory conditions such as arthritis, bowel disorders
General anxiety disorder
In addition to, the previous steps, a multidisciplinary approach including psychotherapist and endocrinologist may be necessary.
Most concussions can be treated with simple at home steps. Historically, the adage of rest and quiet time is the opposite of what we should be doing. A proper assessment from our clinicians will ensure an accurate diagnosis and personalized plan to ensure symptom resolution and return to sport or work.
Dr. Andrew Synnott, DC