It was the last game of the regular season, tie-game, extra time. The ball is being crossed in from the left wing, and you have a perfect line on it. You see the cross coming in, you have timed it perfectly, you jump and BAM. Just as you went to head the ball into the open goal, the defender’s head met you halfway.
You sustained a blow to the head, and now you have a concussion.
You are assessed by your athletic trainer on the sideline and told that it is safe to head home and “rest” until your head heals. What does that mean? Are there things you should be doing while at home? Are there tools that you can use to help facilitate the healing process?
In this blog, we are going to highlight our three favourite concussion recovery tools for patients that they can use to facilitate their return back to sport, school and life.
DISCLAIMER: Please consult a qualified healthcare professional before self-diagnosing and self-treating your concussions. There are rare but serious cases where the following treatment methods may worsen your condition or lead to a more severe condition. This is for information use only, and you should always follow the advice of YOUR medical provider.
A heart rate monitor is a critical tool that you can use in your recovery from a concussion because it allows you to have an objective measurement of how hard your body is working during physical activity.
With an accurate heart rate measurement, you have a reliable measure of exercise intensity to ensure that you are both working hard enough to stimulate brain recovery but not so hard that you aggravate your concussion symptoms.
There are two main types of heart rate monitors, and they are both reliable sources of heart rate data: wrist-worn and chest-worn heart rate monitors.
Wrist-worn heart rate monitors are the most widely available heart rate monitors on the market now as they are integrated into many different fitness trackers such as the Apple Watch, Garmin Watch, etc.
Wrist-worn heart rate monitors use LED lights to sense changes in the skin’s light absorption and changes in blood flow. While fairly accurate, they can be interfered with by excess watch movement or highly vigorous activities. To try and minimize this, wrist-worn watches should be worn above the outer wrist bone (ulnar styloid) and tight enough that they do not move with quick wrist movements.
Chest-worn heart rate monitors are another good option for home use and are more accurate than wrist-worn monitors. However, because they only function to track heart rate and do not give pace, cadence, store music, etc, they are not the most common choice for patients.
Chest-worn heart rate monitors measure the heart’s electrical activity via electrodes in the chest strap. This makes them more accurate as they are less sensitive to movement artifacts and are a direct measure of heart activity. However, to function properly, the electrodes need a moisture layer between the sensor and the skin to read accurately, so wetting the sensors before use is recommended. Correct placement of the chest-worn heart rate monitors is just below the chest bone (sternum), with the electrodes flat on the skin and tight enough that it does not slide down with movement.
As mentioned before, you are going to use your heart rate monitor in the physical rehabilitation of your mild traumatic brain injury. We do that by using the score you achieved on the Buffalo Concussion Treadmill Test (BCTT).
The BCTT is a standardized tool conducted by a medical professional that assesses the level of physical activity where concussion symptoms worsen. It is performed on a treadmill with increasing incline and/or speed to increase physical demands until either a) you are limited by your concussion symptoms or b) you reach your maximal level of exertion measured by heart rate or effort level.
NOTE: You must be cleared for physical activity before participating in cardiovascular rehabilitation protocols. Please seek a medical diagnosis from a qualified medical professional before starting any rehabilitation protocols.
If you are limited by concussion symptoms, your clinician is going to give you a cardiovascular exercise rehabilitation protocol where you are going to exercise at or below 80-90% of your symptom-limited heart rate.
For example, if you experience symptoms during the BCTT at 156 bpm, your at-home exercise protocol will include low-risk cardiovascular exercise without letting your heart rate rise above 125 bpm (80% of 156 bpm).
At the end of each rehabilitation period, the BCTT will be conducted again, and a new heart rate will be determined to guide your exercise protocol. Once you pass the BCTT, you may be cleared to return to sport-related non-contact activities.
If you have sustained a blow to the head or body hard enough to sustain a concussion, you also endured enough force to cause whiplash of your cervical spine. It is for that reason that in many concussion patients, some of their symptoms, including neck pain, headache, dizziness, feelings of unsteadiness, and trouble sleeping, can originate from the muscles and joints of the neck and their relationship to other physiological systems. Research has shown that concussions are caused by an estimated 70-120g of force, with injuries to the neck ligaments occurring with as little as 4.5g of force (1).
A recent study found that 54% of youth athletes who sustained a concussion also had associated neck pain. The athletes who also had neck pain had a larger symptom burden, a longer time to symptom resolution, and an increased time to return to sporting activities (2).
Therefore, patients who are experiencing symptoms originating from the neck (cervical spine) should receive treatment of the affected muscles and joints, and there are ways to do this at home.
Research has shown that manual therapy and rehabilitation of the cervical spine, including myofascial release therapy to the affected muscles, improve concussion symptoms over 8 weeks of treatment up to 4 times faster than those that did not receive treatment. (3)
You may want to work on the suboccipital, cervical paraspinal, upper trapezius, and sternocleidomastoid muscles, among others. If these muscles are dysfunctional following a concussion-related whiplash injury, they can worsen common concussion symptoms such as headache, neck stiffness, dizziness, and trouble sleeping.
To treat these muscles, various myofascial release tools, such as lacrosse balls, acupressure balls, foam rollers, and other soft tissue manipulation tools, can help relieve tension and improve symptoms when used in conjunction with a Complete Concussions rehabilitation program.
The Concussion Tracker app was developed by the Complete Concussions team to be a game changer in the interdisciplinary management of concussions. It is the most valuable concussion tool because it provides you, your healthcare team, your coaches, parents, or teachers with an integrated platform for comprehensive information on your recovery journey.
At the beginning of your season, updated baseline scores will go directly into the app. This will allow athletic trainers and other sideline personnel to accurately diagnose whether or not you have a head injury in real time.
If you do sustain a head injury, the most important component in the treatment of your concussion is ensuring that you do not sustain a second head injury before your initial injury has recovered. Therefore, the concussion tracker app has an integrated platform where all members of the treatment and support team have access to current symptom burden, testing scores, previous baseline tests, imaging or other lab test results, clearance letters, etc, so that everyone is fully informed on where you are in your recovery process.
In addition, if you require a referral to another healthcare practitioner, such as for psychological counseling, in-depth visual or vestibular rehabilitation, occupational therapy, etc., all multidisciplinary team referrals can be conducted through the Complete Concussions system.
As mentioned above, all of these benefits are for the exclusive use of the Complete Concussions Clinical Network. If you are passionate about the care of your concussion patients, find out how to become a clinic and join the Complete Concussions Clinical Care Network today!
For more information on the concussion tracker app, click here or find the app in the app store for Apple App store or Google Play store for Android.
A symptom diary is a great tool to use after sustaining a mild traumatic brain injury, especially if symptoms have been persistent. Sometimes, it can be hard to see how much progress you have made if you are still currently having symptoms, and this can lead to further frustration. Furthermore, it can be helpful during the rehabilitation process to isolate specific triggers for specific symptoms, which can help your healthcare providers tailor your rehabilitation program to your condition.
Since concussions are so unique, each individual is going to have different symptoms and different triggers and recovery trajectories can vary. This is normal, but having specifics about each of these components can aid in both the mental and physical aspects of concussion recovery. For example, note how long you can be on the computer before your headache worsens and track that over time. Also, is it doing anything on the computer? Reading? Typing? Youtube? Work tasks? Each of these descriptors can help your healthcare provider develop a treatment plan to fit you and your current symptoms best.
Secondly, it can be a great measure of progress over time if the recovery process is slow. Our brains tend to overemphasize events that have happened most recently, which can cloud your ability to look at the past and see how far you have come. For example, you could get frustrated because you can’t run for more than 15 minutes before your headache worsens, so you can’t go back to practice. You feel like you have had symptoms forever, and you aren’t getting better. But then you read in your symptom diary that two weeks ago, you would have to take a break after walking upstairs because your headache was so intense, meaning that going from a flight of stairs to a 15-minute run is actually good progress, and you are on your way to recovery.
Lastly, symptom diaries can be extremely helpful regarding sleep difficulty. Keep track of everything that you did that day, particularly at night, and start to track how it affects your sleep. You want to make note of how much physical activity you performed, how you felt waking up, alcohol/coffee intake, amount of screen time, how much screen time you had before bed, etc.
Also, you can easily track these symptoms in the Concussion Tracker app when you have an open injury at one of our clinics.
In conclusion, concussions are an injury that everyone is going to experience differently. While it is important to get assessed by a trained concussion therapist, there are still things that you can do at home to aid in your own concussion recovery. Through the utilization of heart rate monitors for correct pacing of physical activity, trigger point devices for treating whiplash symptoms, symptom diaries to track progress and triggers, and the Concussion Tracker App to integrate your care across your support network, you can be well on your way to a full recovery and back to doing the things that you love.
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