Concussion Management – Much More Than Resting (Part 1)
Concussion or mild traumatic brain injury (mTBI) is a condition that affects hundreds of thousands of patients worldwide. Its common in many groups of people from novice to professional athletes, people involved in car accidents and unfortunately it is also common in our nations military servicemen.
But current concussion management is inadequate to say the least. This is not something groundbreaking, or against the grain, this is common knowledge. I am not talking about acute management of concussions, but rather management that is necessary for weeks to months to years after the initial dangers of stabilization an hemorrhage have been addressed.
All major sports associations are taking steps to prevent permanent damage and many are requiring removal from sports participation until all possible symptoms are resolved. This is all good news, but the problem lies in concussion treatment and concussion recovery timelines.
The treatment for concussions is symptom control. Over the counter medications such as acetaminophen are recommended by most to help deal with the pain. If you have dizziness or vertigo, then a drug is given for to mask that symptom also. Depression is also a common symptom of post-concussion syndrome and is also treated with anxiety or anti-depression medication.
None of the above drugs provide any benefit to the brain for recovery.
So basically, we are dealing with your brain and possible permanent consequences and we are masking symptoms? Its one thing to mask some symptoms after eating some spicy foods that upset your stomach, but its completely different to mask symptoms from your brain that is screaming at you, loud and clear, that it is in pain.
What The Brain Really Needs
To greatly simplify brain health, the brain requires 3 basic things:
- Brain Activity
- Consistent Blood Sugar Levels
Metabolically and in my opinion, most importantly mitochondrial and cellular metabolism are up at the top of the list of factors to consider. (neurons use ATP for energy)
Oxygen – 1st things first! (Most Important?)
In this article I’m only going to discuss oxygen and blood flow that is required to recover from a concussion.
As we all know, oxygen is critical for our health. Lack of oxygen is one reason why concussions progress and can actually get worse over time. The human brain can only live without oxygen for so long. Some estimates say without oxygen your brain can only live 7 minutes, but in the case of concussions, your brain isn’t completely without oxygen, it just has less oxygen.
The reason it has less oxygen is due to decreased cerebral (aka brain) blood flow. Blood is what carries oxygen to your brain. With less blood flow going to the brain, it receives less oxygen and nutrients and is unable to keep up with the energy demands of the highly active neurons. In fact, after a concussion the brain requires even more blood flow due to the impact and trauma that occurred and the repair that will be necessary, much like any other injury.
Why Is There Less Blood Flow?
The decrease in blood flow is often due to 2 things. First, the body tries to decrease blood flow to the area if there is any bleeding, so that you don’t bleed to death. Even small micro-tears that cannot be picked up on MRI (yes, MRIs/CTs/EEGs are not perfect) can cause the body to decrease blood flow to the local area. In an acute response this is what the body should do, but over time if this is not reversed, it can lead to more symptoms.
The second reason the body decreases blood flow to the brain is as a neurological reaction and actually seems to be a side-effect rather than a real choice. What happens when the head is violently agitated is that the body has a natural neurological response in which the body tells the neck to stabilize the head.
This stabilization causes a tightening of the muscles in the neck. When the muscles contract and don’t let go, this causes decreased blood flow to the area. This is a commonly known mechanism for headaches, but not a commonly addressed or known cause in concussions.
This decreased blood flow in response to a concussion can cause the symptoms of headaches, blurred vision, pain and many other symptoms of decreased blood flow. When these muscles get stuck in this pattern, we often see a cycle of recurrent symptoms.
While decreased blood flow creates long-term problems, in the short run, it protects the head/brain by providing stabilization to the area. Remember the body is usually more worried about short-term safety rather than long-term health.
Why Do Muscles Get Stuck?
The muscles in the neck and throughout the rest of the body only have two functions, they are to create force and absorb force. Anytime the muscles can’t absorb force properly, we end up with an injury. If you get a hamstring tear or a bicep tear, at a root level, the muscle wasn’t able to absorb the demand properly. Sometimes this is due to a large and heavy object but more often I find it has to do with the speed of absorbing force.
One thing they always taught us in chiropractic school is that just as many people hurt their backs by picking up a pencil or piece of paper as they do carrying heavy objects.
Head traumas can be either of these two scenarios. It could be a large force or it could simply be a fast force. In concussions, it is usually both, but either way, the muscles were not able to absorb or deal with the force and when they give way or get strained, then the head is violently impacted and the brain suffers.
There really is no way for the brain to have a concussion without the muscles failing first and allowing the head to be uncontrolled.
I will explain how I recommend treating this portion of concussion symptom management in the next section, but given the above statement, if you are not managing concussion symptoms with some sort of muscular assessment and treatment, you are selling yourself short and in my opinion, and also prolonging your recovery time.
The first step to getting unstuck is to have a full neurological evaluation. Most of the time an orthopedist or neurologist has already done a full neurological evaluation on a patient prior to them coming to my office. Many people have had multiple MRIs and other testing also. This is how it should be, but after those steps, most often people are simply sent home to rest. This is where I feel we are falling short.
So getting the muscles unstuck can be done in many ways, but the two ways I use specifically are the manual muscle test and the Therastim (now known as ArpWave). These two tools allow me to know what muscles are not absorbing force properly and correct the improper neurological signal. By correcting the neurological signal that is improperly going to the muscles, we are able to reverse the symptoms that are associated with the muscle damage or tightening that may have occurred. We don’t just loosen muscles or massage all muscles in the area, as this can be counter-productive. Some muscles need to be “turned on” while other muscles need to be “turned off”. In part 2 I will discuss the muscles that can and should be assessed in concussion cases.
The ArpWave is a Class 2 medical device approved by the FDA for muscle re-eductaion, relaxation of muscle spasms, increased local blood circulation and prevention of disuse atrophy.
Normally in my office I only use the Therastim/ArpWave for performance enhancement, but for concussions it provides two unique benefits that can speed recovery and time is critical in concussion recovery. In fact, once I have completed the manual muscle testing process and we move on to the ArpWave process, it often is less than 10 minutes before patients see results and changes in vision, blood flow and vertigo.
The reason I use the ArpWave is 2-fold. First it is because the direct current from the ArpWave increases blood flow to the local area. As we discussed previously the brain needs added blood flow in order to repair any damage and also to provide the proper oxygen, vitamins and other nutrients necessary for the cells to function.
Secondly direct current has been demonstrated to increase ATP up to 500%. ATP is the energy used by the neurons in the brain to perform all of their functions. Adequate ATP can be critical in eliminating symptoms such as brain fog, difficulty concentrating or even depression.
Its important to know that concussion symptoms are the end product, not where your problem actually started.
Just like hormone imbalances that start lower in the body can cause migraine headaches, many of the symptoms experienced by those suffering from concussions do not originate in the brain or even the upper neck.
The neurological signal caused by a concussion is sent to muscles and then the muscles try and protect you and when these muscles aren’t functioning properly this is the most common cause of concussion pain and symptoms.