Post-concussion fatigue: Expected or a Chronic condition?
Development of Post-Concussion Fatigue After a head injury, patients can experience various common symptoms, including joint pain, headache, dizziness, nausea and fatigue. Concussions are largely an energy balance problem in…
Recovery Roadmap: Manual Therapy's Crucial Role in Concussion Care
Introduction In the ever-evolving landscape of concussion management, the profound influence of manual therapy techniques on patient outcomes is indisputable. The nuanced practice of manual therapy has, at times, been…
It is well-established that a mild traumatic brain injury has a direct impact on mental health. Healthcare professionals should be aware of a concussion patient’s emotional & psychological symptoms, and…
Historically, patients with concussion symptoms due to mild traumatic brain injury were told to rest, rest, rest. And when complete rest didn’t work, they were told to rest some more.
The research on concussions and post-concussion syndrome is evolving at an exponential rate and we are realizing that not only does prolonged mental rest not work; it can make your post-concussion symptoms worse.
Sadly, many healthcare providers are not keeping up with the explosion in post-concussion syndrome research and are still not up to speed on how to treat a concussion. They continue telling their patients that the only treatment for a head injury is mental rest. If you have fallen victim to this, you don’t need more rest; you need a second opinion.
While it is true that during the early stages following injury, moderate rest is still important, that timeline seems to be getting shorter, with longer duration rest starting to worsen symptoms for patients over time. So although you may have been told to rest at the emergency room, if it’s been more than a week, it’s time to switch it up and start finding some better concussion-supportive therapy before your symptoms worsen.
If not rest, then what?
The top 5 most effective evidence-based treatment options for concussion & post-concussion syndrome:
In this article, we are exploring the best concussion therapies to treat your mild traumatic brain injury – especially those suffering from persistent symptoms. Concussion recovery involves more than just treating the brain – a good concussion specialist will look at all the reasons why post-concussion symptoms occur and take into account your previous concussion history, your physical & cognitive symptoms, your vestibular system, mood changes and mental health disorders, and implement a concussion treatment plan that should include the following elements as part of their post-concussion treatment 5 step program:
Manual Therapy & Neck Injury Rehab
Diet & Nutritional Changes
Vision Therapy & Vestibular Therapy
Let’s explore why each one of these areas is so important to concussion recovery and helping symptoms resolve for patients suffering from post-concussion syndrome.
If you’d rather watch, here is a video explaining the Top Concussion Treatments from an Episode of Ask Concussion Doc
1. Exercise Therapy
Following a traumatic brain injury, animal (and many human) studies have demonstrated an alteration in blood flow to the brain. Recent post-concussion research has found that these blood flow changes may persist for some time following injury due to ongoing dysfunction in the Autonomic Nervous System (ANS).1,6-8 The Autonomic Nervous System consists of two opposing sides: The Sympathetic Nervous System and the Parasympathetic Nervous System.
Sympathetic And Parasympathetic Nervous System. Difference. diagram with connected inner organs, brain and spinal cord. vector illustration
The Sympathetic Nervous System (SNS)
The Sympathetic Nervous System is also known as the “Fight, Flight, or Freeze” system – this side of the ANS is responsible for increasing our heart rate, dilating our blood vessels to pump blood to our muscles, release adrenaline, dilate our pupils, and get us ready for action.
The Parasympathetic Nervous System (PNS)
The PNS on the other hand is our “Rest & Digest” system – this side of the Autonomic system is responsible for lowering our heart rate, increasing our saliva production and digestion, activating our metabolism, and helping us to feel relaxed and calm.
These two systems can be thought of as a teeter-totter. When one is up, the other is down. They fluctuate their dominance throughout our days but the system generally maintains harmony and balance.
Brain Injury creates an imbalance in the ANS with most suffering from a high “Sympathetic Tone” – this means that we get stuck in a fight or flight state. Our heart rate tends to be more elevated than normal and doesn’t respond well to increased demands; blood flow to our brain is not as responsive, our digestion shuts down sometimes leading to stomach pains, food sensitivities, and increased inflammation, our anxiety levels increase, we may get lightheaded more easily, and we suffer symptoms with slight increases in normal activities.
The good news is that this problem can be tested for and treated very easily; provided you know what you’re doing!
The solution for this problem goes against conventional thought: exercise!
Researchers at the University of Buffalo have published numerous studies demonstrating complete resolution of signs and symptoms and improved brain blood flow (as measured on fMRI) through a specific graded exercise program alone.9-11
More recent evidence suggests that exercise might even help speed recovery in the early stages after concussion!
This type of testing and exercise prescription is usually carried out by a physical therapist, occupational therapists, athletic trainers, or chiropractors. It is important to see a healthcare provider who knows exactly what they are doing with this protocol and has received advanced training in the treatment of head injury and post-concussion syndrome. Testing with a trained healthcare provider must be done first to establish set points as well as your specific program.
2. Manual Therapy & Neck Rehab
With every concussion, there is also a whiplash element of the initial injury.
Studies have demonstrated that the acceleration required to cause a concussion is somewhere between 70 and 120 G’s (where G = force of gravity = 9.8m/s2).30 Whiplash, on the other hand, has been shown to occur at only 4.5 G’s.31
It is therefore conceivably impossible for a concussion to occur without also causing a sprain or strain injury to your neck! A Canadian study found that 100% of the time, these injuries are happening together.32
What becomes even more confusing is that the signs and symptoms of whiplash and neck dysfunction are the same as concussion symptoms!33 Headaches,34,35 problems with cognitive tasks, emotional problems & mood swings,36 balance problems and dizziness,37-42 eye movement control problems,37 and brain blood flow abnormalities43 have all been shown to occur in post-concussive syndrome as well as whiplash and neck pain patients.
Unfortunately, there is no way to tell if the symptoms are coming from your neck or your concussion except with testing (some specific tests that we won’t go into here). Most of the head injury patients in this category don’t even report any neck pain; which makes this all the more confusing for the average medical provider.
So, if you are still having post-concussion symptoms, even if you don’t have neck pain, you may be suffering from symptoms that are coming from your neck; which are easily treated with physical therapy consisting of manual therapy and rehabilitative exercises.25,35,44-46
3. Diet/Nutritional Changes
During the recovery process following an injury to any tissue, there is inflammation; post-concussion patients are no exception with several studies demonstrating increased inflammatory markers following brain injury.12-14
Concussion results in metabolic dysfunction (read: energy deficit) in the initial stages, which is why strict rest used to be prescribed as part of the immediate medical care to help the brain recover. The thought was – anything that burns energy, such as thinking or physical activity, could worsen symptoms. As mentioned above, however, rest is no longer considered an effective post-concussion treatment.
The majority of studies examining this metabolic disruption show a recovery between 22 and 45 days after injury.15-17 In other words, beyond a 3-6 week period, there is little metabolic explanation for your symptoms, provided you didn’t suffer a second concussion during that time window.
Treatment options for both metabolic dysfunction and neuro-inflammation include simple dietary changes such as avoiding pro-inflammatory foods (refined sugars, white bread, pasta, artificial sweeteners, etc) and replacing them with healthier options such as fruits and vegetables, freshly caught fish (salmon, mackerel, herring), and good fats (coconut oil, flax seed, almonds). These changes may help to offset an ongoing inflammatory response and reduce your concussion symptoms.
Although still in its infancy, there is increasing support for various supplements such as Omega-3 fatty acids, creatine, curcumin, magnesium glycinate, and melatonin.18-24 Please speak with your concussion specialist before starting on any supplements as there can occasionally be adverse effects and/or interactions with other medications that you may be taking.
If you are a healthcare professional check out one of our freeONLINE SEMINARS every week to learn all the new treatments for post-concussion syndrome.
Another option would be to speak to your doctor about a short course of anti-inflammatory medications. Note that we say “short course” as, over a prolonged period, these medications are not an effective treatment option.
4. Vestibular and Visual Rehab
Dizziness and balance problems are some of the most common ongoing concussion symptoms associated with post-concussion syndrome. This may be due to several overlapping issues such as problems with the balance centers of your brain (vestibular system), your visual system, and/or problems with the muscle and joint sensors of your neck.
Problems with the visual system may also be one of the causes of ongoing cognitive complaints such as trouble with concentration and/or memory. If you find yourself reading a passage and then having to re-read it several times before you understand what it is saying, you might have a problem with how your eyes are moving or working together. If so, this may require vision therapy (also known as neuro-optometric rehabilitation) as opposed to occupational therapy or cognitive therapy.
The reason these categories are placed together is that it is often difficult to tell where persistent symptoms of dizziness and visual issues are coming from. Sometimes these issues require physical therapy or chiropractic care (mostly vestibular therapy and manual therapy/rehabilitation of the neck) and sometimes you require neuro-optometric rehabilitation or vision therapy from a neuro-optometrist.
Testing for each of these areas requires extensive knowledge of each of the systems and how they may interact. If you have not had extensive testing of these systems as part of your head injury care, then you are in the wrong place!
Following a thorough assessment of these areas as well as a thorough neurological examination, a proper rehabilitation program can be set up. The research on rehabilitation for these areas is extensive with numerous studies showing resolution of dizziness,25-27, and visual abnormalities28,29 with a fairly short course of treatment.
Physical Therapists, Chiropractors, and Athletic Trainers, click here to learn more about the treatment of post-concussion syndrome in our free online workshops!
5. Education and Reassurance (due to Psychological Comorbidities)
It has been well established that patients with a pre-existing history of depression and/or anxiety tend to have an increased risk of post-concussion syndrome. Not only that, the symptoms of these and other mental health conditions can result in, or mimic, the same symptoms of concussion (dizziness, mental confusion, concentration problems, sadness, emotional outbursts, and mood swings).
Many of these issues can begin before or after the head injury, which may be due to the brain injury itself, or a direct result of being mismanaged by an uninformed healthcare provider. In other words, being told to sit in a dark room, avoid all social contact, not go to work or school, and not do any physical activity for months on end may be causing the very anxiety, depression, and triggering symptoms that you are attempting to eliminate.
Studies examining the overlay of mental health conditions and post-concussion symptoms are endless (so much so that I won’t even begin to start referencing them), and mental health will always be a big part of concussion management. In many cases, patients often feel much better just learning about their condition and learning that it is 100% treatable given the right approach. The Ontario Neurotrauma Foundation recently demonstrated to be one of the best evidence-based treatment options for preventing long-term symptoms was patient education and reassurance! Just by helping the patient to be better informed about their condition and the effective treatment options available for post-concussion syndrome allows concussion patients to be empowered to seek out effective post-concussion treatment.
Hopefully reading this article has even made you feel better about your condition. In more serious cases you may need to see a psychologist, psychiatrist, or other mental health professional such as a social worker. If you feel that you are depressed or hopeless, please talk to your doctor or seek the help of a mental health professional!
There is help out there! The trick is finding the right clinic, practitioner, or team that can help you. Click here for our interactive map to find a concussion specialist clinic near you!
If you are a healthcare professional that wants to learn how to provide effective, evidence-based treatment for post-concussion patients, click here for FREE WEEKLY SEMINARS!
What to Do For a Concussion at Home
If you are reading this blog and realize that you have not been able to find a good concussion clinic close to where you live, there are other options that you may find helpful. One such amazing resource that we have found is the Concussion Fix program. The Concussion Fix Program is an online concussion treatment program that is designed to help patients with persistent symptoms figure out what is driving their symptoms and how to fix them. The program is based on the latest scientific research and is tailored to the individual needs of each patient. The program teaches patients how to balance the autonomic nervous system, how to improve their diet to fix metabolic and neuro-inflammatory issues, and how to safely return to work and life. The Concussion Fix Program has helped thousands of patients worldwide get back to living their lives without the debilitating symptoms of post-concussion syndrome. If you can’t find a good clinic near you, the Concussion Fix is an extremely inexpensive and effective program for reducing your post-concussive symptoms.
Complete Concussions specializes in collaborative, evidence-based concussion care. Our evidence-based training programs and integrated healthcare technologies empower multidisciplinary teams to implement standardized care for those impacted by concussions.
Our network and patient database enables large-scale research to advance concussion management, and ultimately, the long-term health and well-being of concussion patients and also teach them some concussion care at home.
We analyze leading research to develop best-in-class approaches to concussion care.