You Hit Your Head, Now What?
Concussions are more common than you might think. Small concussions can happen without bystanders even realizing. Despite this, so little is understood on what a concussion actually is. How do you identify one? What can be done to help with symptoms? How can you prevent one?
When I got a concussion in 2014 (bad snowboard fall), the doctor who I visited with told me to take it easy and rest, that there wasn’t any treatment for concussion. At the time, that was the advice you gave as a medical professional. Very few providers knew anything about concussion treatment, nevermind rehab for concussion. In recent years, concussion rehab has proven to be extremely effective, and each year we continue to learn more and more on how to help people recover.
What is a Concussion?
So, what is a concussion? Previously, a concussion was thought of to be bruising of the brain, with the brain physically hitting the skull and sustaining a physical injury. What we now understand is that there is no physical injury to the brain. Your CT and your MRI will look completely normal. Your brain will look normal. But… you don’t feel normal! Something must be wrong.
When you get a blow to the head, the brain accelerates and decelerates and the layers and cells of the brain pull and stretch, allowing abnormal chemical exchange within your brain cells which causes electrical chaos. A LOT of energy is spent to restore order (which is often why we initially feel so tired after a concussion) and it takes weeks for the energy in your brain to get back to baseline levels. So, a concussion is a temporary energy deficit. It is a functional injury, not a physical injury of the brain.
Diagnosing a Concussion
There is no gold standard to diagnose a concussion, but if you have had a blow to the head and any cognitive, physical, emotional or sleep related symptoms- safe to say you have a concussion. It takes about 4 weeks for the energy in your brain to get back to normal and it is paramount that in that time you ensure you do the following:
See a doctor and rule out any red flags like a skull fracture or a brain bleed.
Avoid getting another concussion. This is especially important within the first 4 week timeframe. Why is that so important? Your brain is already in a low energy state. If you get another hit to the head, it’ll go into an even greater energy deficit. Why is this a problem? Go low enough and it will cause cell death, which can cause irreversible effects to your brain. No one wants that. Not worth putting yourself in a dangerous situation. Doesn’t mean you absolutely can not ski or snowboard or be in a car, but use your best judgment. Maybe don’t go off that jump or drive above the speed limit for those 4 weeks as your body is recovering.
NO MORE REST! “Go home and rest” was always the old school advice after hitting your head. Yes, you want to take it easy in the first 3-5 days, however initiating a walking and gentle exercise program ASAP (as long as it does not exacerbate symptoms or put you at risk for hitting your head) has shown to significantly improve concussion outcomes.
Eat a non-inflammatory diet. That means no processed foods/sugar/red meat/dairy/alcohol. It will improve your chances of full recovery. Omega-3 and turmeric are great supplements to add to your regimen during the first 4 weeks to help reduce inflammation and help with healing. Drink plenty of water. Check out the Mind Diet for more information.
Limit triggers and limit stressors. This may mean working/going to school for a fraction of the time you normally would. Try to keep your daily activities at a sub-symptom level.
Take care of your nervous system. Your nervous system is in a heightened state after a concussion- specifically, your sympathetic nervous system (fight or flight response) is in overdrive and your parasympathetic (rest and digest, relaxed state) is not as active. The best way to combat this is to focus on increasing that parasympathetic nervous system- deep breath, meditate, laugh, sing/chant, pace yourself with activities.
Ensure you are sleeping well. This is a very important part of healing so try limiting screen time before bed and take sleep supplements if needed.
See a PT! If you have a concussion, you always have whiplash. If in 10 days, your neck is bothersome or you have a tension headache…manual work, dry needling and targeted exercises can be a huge help.
How a Physical Therapist Can Help
If you still have persistent symptoms after the 4 weeks is up, there are 5 categories of causes as to why you may still have symptoms, related to blood flow, persistent inflammation, visual or vestibular, neck or psychological. A PT specializing in concussion can help weed out which of these categories you may have deficits in and start you on the path to recovery. The biggest take away is that there is so much that can be done for concussion. Reassure yourself that your symptoms are not forever and can be addressed!