| | Ask the Doc – Concussion Treatment 101

Author / Tim Cummings

5-7 Minute Read

So you have a concussion. Got your bell rung. Seeing stars. Can’t seem to remember what happened immediately after you took that hit. 

And now things are getting weird. You can’t read words on a printed page or screen without getting a headache. Your short-term memory seems to have disappeared. You’re as irritable as a hungry bear. You want to sleep all night and all day. 

This isn’t a muscle injury that will heal in 4-6 weeks. This isn’t a bruise that you can train and play through. This isn’t a broken bone that you can cast, rest, and heal in 6 to 8 weeks.

You’re most likely suffering from Post-Concussion Syndrome (PCS). Though this problem only occurs in an estimated 10-20% of high school athletes who sustain a concussion, and somewhere between 5 to 30% in adult populations, the effects of PCS can take you out of the game and make day to day life difficult to navigate.

Why am I writing about concussions and PCS on a blog notorious for dropping training knowledge bombs, face-melting nutrition advice and recipes, and the premier podcast in strength and conditioning? Here are a few reasons:

  • 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.
  • We spend, directly and indirectly, over $60 billion per year treating concussions in the U.S. on a yearly basis.
  • Many folks who sustain a concussion don’t seek immediate medical advice or treatment.

It’s that third point that I want to address today. 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 with their heads. The most important component in a traumatic brain injury situation is that the athlete who sustains the injury receives the right 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 and your ability to train and compete must 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 the diagram below. This is a close-up of your brain when it becomes concussed:

Depolarization shoves Calcium (Ca2+) into the nerve axon, pushing Potassium (K+) out, swells the axon, and decreases energy production in the brain.

On the left side of the diagram, you’ll see a description of the depolarization and neurotransmitter release, which creates a devastating cascade effect. Put simply, your brain gets really bad at using glucose (sugar) for energy…including fueling your mitochondria (the powerhouse of the cell) to make more ATP. Less ATP production means less ATP for utilization. Said another way, your brain is running out of energy to perform its normal functions, from sprinting and lifting to just recalling your daily chore and to-do list.

Treating PCS

Here’s where we can step in and do better at treating PCS. Lifestyle modification is key. If you are suffering from a concussion, these modifications are vital to healing your brain and getting back to doing the things you love to do:

1. Avoid any screens with blue light (that means computers, tablets, TVs, cell phones, and the like). Blue light heightens brain activity (read: energy consumption), something an injured brain can’t spare. If you can’t avoid the blue light of technology, you need to pick up a pair of blue light blocking or gaming glasses and wear them throughout the day to help filter out the blue light from those screens.

2. Sleep in a pitch-black room. Research has shown that even putting a penlight on a sleeping person’s leg increases brain activity. It needs to be cave-like in your room when you sleep.

3. Modify your diet. Reduce your carbohydrate intake. Carbohydrates are not the friend of an injured brain (carbohydrates are broken down into simple sugars in your body, and simple sugars are broken down into glucose-the fuel your brain can’t use when you’re concussed).

4. There is an alternative fuel source that 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, low carbohydrate intake, low-calorie intake, or untreated Type 1 diabetes. With my clients, I recommend a ketogenic (low carbohydrate, moderate protein, high fat) diet to supply the necessary fuel substrates (ketones) needed for their brains to heal. Recently, 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. These supplements are not cheap, and there are some shady players trying to sell ketogenic products that are more akin to snake oil.  But purchasing a good ketone supplement is a small price to pay compared to the lost opportunities from missed practice or work time and the myriad of medical expenses you will incur if you don’t take personal responsibility for optimizing the healing environment for your brain.

Calling In Your Support

Once you’ve dialed in the lifestyle factors you can control, it’s time to assemble your team.

If you need nutritional help, Power Athlete’s nutrition coaches Samantha Flaherty and Rob Exline are subject matter experts who can help you create a tailored plan and give you the accountability you need to get back on course.

If you’re having eye troubles such as difficulty focusing, double vision, or light sensitivity, you would be well served to find a vision professional who specializes in neuro optometry. These professionals understand the interplay between the brain, eyes, ears, and vestibular system and can be essential to full recovery if nutrition, lifestyle, and other rehab strategies are falling short. 

Last, you need to work with a rehabilitation specialist who has experience in working with athletes and individuals with vestibular deficits like the ones created by PCS. It’s not enough just to take a few weeks off, or “lightly” practice. The complex inputs on the vestibular system, and by extension the nervous system, demands an individualized and progressive plan designed by the appropriate rehabilitation professional. 

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 Vestibular-Ocular exam, it is likely that you still have some deficits affecting your physical and mental performance capabilities. Don’t wait to get the help you need. Find a qualified professional to help point you in the right direction to recovery.

RELATED CONTENT

Blog: Power Athlete Concussion Protection Training by Tex McQuilkin

Podcast: EP 485 – One Thousand Battles w/ Tait Fletcher

Podcast: EP 460 – The Grift of Injury, w/ Dr. Matt Zanis

YouTube: 6-Way Manual Resisted Neck Training

Nutrition: The Keto Protocol 

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SOURCES

Image Source: Fayock, Dr. Kristopher. Sport-Related Concussion. An Overview and Update for the PCP. 2014, www.slideplayer.com. Accessed 14 July 2021.)

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AUTHOR

Tim Cummings

Tim received his Bachelors of Arts in Exercise Science from the University of Missouri-Kansas City in 2004, and his Doctorate of Physical Therapy from Southwest Baptist University in 2010. He has worked with the Titleist Performance Institute, the IMPACT concussion group, MovNat, and The Ready State in his professional career. Currently owns and operates a performance-based physical therapy practice, Restore/Thrive, with his wife in their home garage gym in Overland Park, Kansas, and became a Power Athlete Block One Coach in September 2020.
Dr. Cummings utilizes his PT background and the Power Athlete Methodology to optimize performance, reduce injury risk, and rehab his clients and athletes through movement assessment, coaching, and individualized program design.

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