While most of the attention in the media surrounding concussions seems to be directed towards football, a tackle is far from the only way to sustain a concussion. The vast majority of concussions are from a fall. Car accidents also contribute significantly.
Even within sport, there is a significantly higher risk of concussion from equestrian sports than contact sports. Concussions occur in the very young, and the elderly. Women and girls tend to be at a higher risk of concussion than their male counterparts, as well.
So what is a concussion? Our bodies are designed to be very adaptable and to have at least a degree of resistance to trauma. But, the brain isn’t built the same way. It is suspended in a layer of nutrient-rich, cerebrospinal fluid that provides some cushioning. But this fluid isn’t enough to protect us from many of the impacts we sustain to our heads. Simply put, a concussion is bruising of the brain. Whether from a fall, whiplash, or contact, the brain sustains an injury when it hits the inside of the skull.
The initial injury is caused by the impact. However, this isn’t the end of the brain injury. Following this injury, among other things, an inflammatory cascade occurs which can cause further irritation or injury to surrounding neurons (the cells that make up the brain). Soft tissue injury is also likely to occur. In fact, Terry Moore, a renowned neuromuscular physiologist in Guelph, ON, says that he has yet to see a concussion without an associated soft tissue injury, these often occurring in the neck. The inflammation and soft tissue injuries can be the cause of symptoms that persist for months, or even years, in the case of some patients I have met.
Without proper intervention, and sometimes even with proper intervention, symptoms of concussion may persist for many months or even years, and be diagnosed as Post-Concussion Syndrome. This can be life altering.
The University of Pittsburgh Medical Center, an American hospital, categorizes the symptoms of a concussion into six categories. The American Centers for Disease Control and Prevention add one more: sleep, which I will include here. People suffering with a concussion can experience symptoms from any or all categories, and symptoms may show up immediately following the injury, or later on.
“Cognitive difficulties include decreased concentration, increased distractibility, difficulty learning/retaining new information or decreased multitasking abilities. Sometimes accompanied by increased fatigue as the day progresses.”
“Impairments of the vestibular system – the balance centre of the brain – affect one’s ability to interpret motion, coordinate head and eye movements, or stabilize vision upon head movement.”
“Ocular dysfunction occurs when the movement of the eyes in tandem, or binocular eye movement, is affected. This may result in difficulties bringing the eyes together or moving one’s eyes to track motion.”
“Post-traumatic migraine symptoms include headache, nausea and/or sensitivity to light.”
“Sometimes [every time, in the opinion of Dr. Moore], the concussive blow affects the extra cranial region including the head and neck and/or spinal cord. An injury of this type may lead to ongoing headaches.”
“This occurs when someone has a hard time turning his or her thoughts off, being particularly ruminative, of suffering from excessive worry or concern.”
“Sleep symptoms include requiring more or less sleep than usual, or having difficulty falling asleep”
Early diagnosis and assessment is important to starting on the right path of treatment. Often, and especially dealing with delicate neural tissues such as the brain, beginning rehab is time-sensitive.
Diagnosis of a concussion can be multifaceted, and may include a combination of taking a history, an oral examination, a physical examination, imaging, blood testing, etc.
Many concussion patients report a large part of their concussion success to proper nutrition. A few considerations include:
The brain as an organ is comprised primarily of fatty tissues, and of those, Omega-3 fats, found in wild game meats, fish and fish oil, are very important. Omega-3 fats are “essential fatty acids” which means our bodies can’t create them and we must get them from food sources.
In our diets, Omega-3 fats are intended to be perfectly balanced with Omega-6 fats, as all things should be. However, in the modern diet, there is a significant imbalance. Omega-3 fats tend not to be shelf-stable (you know what happens if you leave fish out for too long), and are removed from most foods, whereas Omega-6 fats are shelf-stable and are often added to processed foods. This is a problem for people with neurologic injuries, as animal studies have shown Omega-3 fats to help neurologic recovery, while Omega-6 fats can actually worsen the damage.
With so little Omega-3 fats available in the diet, supplementation, and quick, is key. The first three hours following an injury have been shown to be the most significant time to get nutrition into the body, in terms of brain recovery.
In fact, Michael Lewis, MD, founder of the Brain Health Education and Research Institute, believes so heavily in the importance of Omega-3 supplementation for brain injuries that he recently published a book, “When Brains Collide”, to discuss their importance. Dr. Lewis regularly prescribes doses of fish oil many times higher than the recommended daily dose for patients with brain injury and reports tremendous results.
Arguably one of the most important things that can be done to support the brain nutritionally isn’t a supplement, but is rather a whole foods diet, and the elimination of processed food. This will significantly reduce the amount of potentially damaging Omega-6 fats being consumed, while adding foods with higher nutritional value.
However, certain herbs, such as turmeric and boswellia can also reduce overall inflammation.
Some of the most interesting research coming out as of late has been the gut-brain connection. A major concept in functional medicine for a long time has been the concept that problems in the gut can have an impact on the brain and its function, but more recent research has shown that brain trauma and the resulting inflammation actually disrupts the gut microbiome (the bacteria responsible for helping us digest things). This can cause further systemic inflammation, exacerbating the inflammation going on in the brain. In light of this, probiotics and bone broth for gut health are also important considerations.
All this nutritional support to the brain is great, but we need to be able to do something with it. Blows to the head causing concussions are almost guaranteed to come with spinal injuries in the neck (even if they’re not the primary concern at the moment), and spinal issues in the neck can reduce blood flow to different areas of the brain (by up to 45% – this is really significant). With reduced blood flow to the brain, the body is less able to provide oxygen and nutrients such as the fish oil or anti inflammatory herbs, to the brain.
Many athletes give credit to chiropractors for their return to play following concussions, none more famous than Sidney Crosby who has used a chiropractor to help him through the rehabilitations of his multiple concussions.
The atlas, a special vertebra at the top of the neck, has multiple different chiropractic techniques dedicated solely to adjusting it. On its own, adjusting the atlas has been shown to regulate blood pressure.
Clarke MacArthur of the Ottawa Senators gives credit to adjustments of his atlas to his ability to return to play in the 2017 playoffs following a significant concussion.
Common upper cervical specific techniques to look for are NUCCA and Atlas Orthogonal, though most chiropractors will be able to adjust your upper cervical spine, depending on how specific your needs are.
While less researched than other chiropractic techniques, there is no shortage of testimonials regarding the effectiveness of cranial adjusting, and I have included it following several patients and friends’ very positive experiences with cranial adjusting.
The theory behind cranial adjustments is that as you breathe, the skull is intended to move ever so slightly, acting as a pump for the cerebrospinal fluid, to ensure proper flow of the fluid and dispersal of nutrients to the brain. Similar to the idea behind spinal adjustments, restoring motion to the skull so the cerebrospinal fluid pump can work as intended, helping nutrients get to the brain more efficiently, and removing waste from the brain cells more effectively.
Sacro-Occipital Technique (SOT), CranioSacral Therapy, and CATS (Cranial Adjusting Turner Style) are common techniques to look out for, although many others exist.
As exercise increases blood flow to the brain, it’s no surprise that exercise is now a recommended part of recovery for concussion, and as soon as the patient is ready. Dr. Roger Zemeck, MD and Post-concussion researcher, found that “exercise within 7 days is associated with half the rate of persistent post concussive symptoms, or those lasting beyond a month” in a study he co-authored. This does go against older recommendations of complete rest until symptoms abate.
While exercise is important, it’s important to have supervision while beginning exercise, and exercise should be light, non-contact, and very low risk, such as a treadmill or elliptical, steady state, at a lower heart rate than what may cause symptoms of the concussion to come on. Initially the threshold must be tested, hence the importance of supervision.
Under recommendation from a practitioner, specific exercises can be performed to help in rehabilitating the spine and soft tissues in the neck. These are often postural exercises and isometric exercises, designed to take stress off the neck, and hold the muscles and spine in better alignment.
Again, with injuries causing concussion causing injury to the neck, the muscles in the neck can become strained as well as the joints. Muscles of the neck can often cause referred pain into the head. And while this doesn’t necessarily contribute to the concussion directly, they can cause or add to headaches being experienced. Helping to calm the muscles in the neck can reduce the referred pain in the head, as well as improve pain and mechanics in the neck as well as potentially blood flow to the brain.
Obviously, concussion recovery can be a process, with many facets to consider in the pursuit of a full recovery. This list is by no means a comprehensive list of everything out there, but a list of what I (and patients) have found helpful in the process of recovery. Help from a good practitioner or team of practitioners can also be instrumental in recovery.
This Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read.
I want to give thanks to Susan Brandum for sharing her extensive knowledge about concussion with me in writing this article.