Treating Concussions


This probably doesn’t sound like the post you’ve been waiting for. This is, however, a post I’ve been meaning to write for quite some time. As the only PT at my clinic who treats patients suffering from Post-Concussion Syndrome (PCS) I want to write about this topic for a few important reasons:

  1. The CDC (Centers for Disease Control) estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities every year. You probably know someone (or are someone) who has sustained a concussion.
  2. We spend, directly and indirectly, over $60 billion per-year treating concussions in the U.S. on a yearly basis.
  3. Many folks who sustain a concussion don’t seek immediate medical advice or treatment.

It’s that third point that I intend to address now. Reducing concussions is, to a certain extent, a fool’s errand. Accidents happen. People are going to play sports, run around and have fun, and occasionally slip/fall/run into something leading with their heads. The most important component in a traumatic brain injury situation is that the victim of the injury receives immediate treatment. Sitting in a dark room and waiting to feel better is a recipe for disaster. Seeking professional help and restoring your normal day to day functional abilities should be priority number one.

Let’s talk briefly, and as plainly as possible, about what happens when you sustain a concussion in terms of physiology. I’ll start with a diagramConcussion Pathophysiology

This is your brain when it becomes concussed. For those non-science majors, note point #3 in the diagram “Calcium in the cell impairs ATP production in the mitochondria, worsening energy crisis”. Put more simply, your brain is running out of energy to perform it’s normal functions. ATP, the energy produced by your body for everything from sprinting performance to recalling your daily chore list in your brain, isn’t produced at adequate levels when you have sustained a concussion.

To the left of the diagram you see a description of the depolarization and neurotransmitter release. Hang in there with me. In a nutshell, this means your brain gets really incompetent at using glucose (sugar) for energy.

And here’s where we start with our current methods for treating PCS. Lifestyle modification is key. If you are suffering from a concussion, start with these modifications:

  1. Avoid any screens with blue light (that means computers, tablets, TV’s, cell phones, and the like). Blue light heightens brain activity (read: energy consumption), something an injured brain can’t spare.
  2. Sleep in a pitch black room. We’ve discussed the ins and outs of the importance of sleep here. It’s doubly important when you’re trying to set the stage for your brain to heal that you optimize your sleep hygiene.
  3. Modify your diet. Reduce your carbohydrate intake. Carbohydrates are not the friend of an injured brain (carbohydrates are broken down into simple sugar in your body, and simple sugar are broken down into glucose-the fuel your brain can’t use when you’re concussed).
  4. There is considerable research demonstrating that an alternative fuel source can fuel the brain for all of the functions it requires energy for. That fuel source? Ketone bodies. Ketones are produced in the liver during bouts of intense exercise (not recommended if you are concussed), low carbohydrate intake, low calorie intake, or untreated Type 1 diabetes. Initially I recommended that my PCS patients consider a ketogenic (low carbohydrate, moderate protein, high fat) diet to supply the necessary fuel substrates (ketones) needed for their brains to heal. I still support that recommendation. Within the last year, though, there have been several companies that have started making exogenous (synthetic) ketones that you can mix as a drink to derive the same cognitive benefits that previously only came about when following a strict ketogenic diet. There are a host of brands if you do a simple search on Amazon, but I would recommend one of the following three brands in particular: Keto O/S, Kegenix, or KetoCaNa. These supplements are not cheap, but they are a small price to pay compared to the lost earnings from missed work time and myriad of medical expenses you will incur after a concussion if you decided not to take personal responsibility for optimizing the healing environment for your brain. (Side Note #1: Please contact my favorite dietician, Robyn Johnson, here, if you need help sorting out the nutrition component)

After you accounted for your light exposure, sleep, and nutrition, it’s time to get to work in restoring the normal function of your brain. This can be a multi-disciplinary process. I have been trained to administer vestibular rehab (restoring the normal function of reflexes that occur between the eyes, the brain, and the 5 canals in each of your ears that gives you sense of your body’s position in space). Sometimes vestibular rehab isn’t enough. If a concussed patient has a particular vision deficit, I refer them out to a neuro-optometrist to address the visual changes they have sustained. (Side Note #2: If you live in the Kansas City area, I highly recommend Dr. John C. Metzger at Kansas City Vision Performance Center if you have any visual deficits after a concussion).

Each concussion patient has a different experience. Though an estimated 80-90% of cases “resolve” in two weeks, if you’re part of the 10-20% of cases that don’t get better, you need to seek treatment ASAP. Even if you’re “recovered”, if you haven’t had a thorough vetibular-ocular exam, it is entirely possible, if not altogether likely, that you still have some deficits that are effecting your physical and mental capabilities.

Don’t wait to get the help you need. Find a qualified professional to help point you in the right direction to recovery.

One last side note (#3, for the record): if you have sustained a concussion, or even if you haven’t sustained a concussion and participate in a contact sport such as American football or ice hockey, you should seriously consider avoid the consumption or administration by injection of non-steroidal anti-inflammatory drugs (NDAIDS). This class of drugs has been shown to increase blood-brain barrier permeability. If you’re already concussed, receiving one of these drugs (Aleve and Toradol are two common forms) you’re making the problem worse. If you’re not yet concussed but taking these drugs, you’re opening the door for a more severe traumatic brain injury should you become concussed. Think long and hard about how much you enjoy your current mental capabilities before heading down the pharmaceutical pathway.

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