Concussion

It is imperative that a concussion patient reduce brain stimulating activities and rest as much as possible for up to 24-48 hours after injury. This gives the brain a chance to initiate an effective, innate healing response.

Here is what to do to improve the healing response in this phase:

1. Rest as much as possible - This can mean less intense activities and more sleep than usual in the days following a concussion. Take this time off school or work to rest.
2. Limit (ideally eliminate) screen time - smartphone, TV, computer, gaming, social media, work, study.
3. Avoid driving a vehicle or riding a bike.
4. Use a natural anti-inflammatories like Traumeels tablets, Inflagesic (Metagenics), turmeric, SPMs, a top quality Fish Oil (Nordic Naturals) or homeopathic remedies such as Arnica. 
5. If the impact area is free of hair, use topical anti-inflammatory creams such as Traumeels. 
6. Reduce inflammatory foods - Go gluten and dairy free. Minimise processed foods, seed oils such as canola or seed oils in take-away and fried foods, sugar filled foods such as chocolate, lollies, junk food. Reduce or eliminate other foods that can promote inflammation in some people like genetically modified foods (GMO), corn, soy and egg. 
7. Eat more polyphenols - eat a rainbow with lots of brightly coloured fresh fruit and vegetables. 
8. Increase fatty acids - olive oil, fish oil, avocado oil. 

Breathing 

1. Improve oxygen supply to the injured brain to support healing using Alternate Nostril Breathing multiple times per day. 
2. Improve healing by calming the sympathetic nervous system (fight/flight) and activating the parasympathetic nervous system (rest/relax/digest) using slow, controlled, diaphragmatic breathing.

Introduce the following nutrients, the most effective for neuro-inflammation:

1. Vitamin D 
2. Glutathione - liposomal or use N-Acetyl Cystine 
3. Magnesium consumed in powder or tablet form, via the skin using oil, cream or magnesium salt bath. Magnesium is very effective via IV in the acute stage after an injury. 
4. Vitamin A 
5. Vitamin E 
6. B Vitamins 
7. Essential Fatty Acids - DHA/EPA from fish oil 

Hyperbaric Chamber

Use of a hyperbaric chamber can be a very effective tool to use during recovery to reduce swelling and bleeding and to increase the amount of oxygen getting to the brain. This therapy can be helpful if used months after the incident, however is most effective within the first 5 days of the injury. The earlier the better.

Returning To Life Activities

When returning to activities of daily living, work, study and sport, the long term health and wellbeing needs of the patient needs to be of highest priority. If symptoms increase at any stage throughout this process, it likely indicates that the current capacity of the brain and the system in general has been exceeded. This is feedback to revert back to previous levels of management and further slow the progression through the stages.

The Recovery phase can start at 48 hours and last up to a few weeks, depending on the person. The Recovery program should be monitored by a qualified health practitioner. Some Osteopaths are familiar with the guidelines specifically trained in concussion management.

The recovery phase generally involves:

• Continue with rest periods, including napping in the afternoons for up to 30 minutes to support brain recovery
• Gradually reintegrating usual cognitive activities like work, study, and reading
• Gradual return to using screens such as TV and smartphones
• Continue diet of low-inflammatory foods and nutrients as in the Rest phase
• Continue to drink more water than usual
• Continue with natural anti-inflammatories
• Gradual increase to physical activity, like short gentle walks, as tolerated (avoid symptoms). 
• Progress to walking, jogging or cycling for short duration at low to medium intensity each day. 
• If there is no increase in symptoms then progress intensity to moderate intensity, keeping duration short. 
• Again, if there is no increase in symptoms and return to school/work is tolerated then progress to high intensity. This high intensity level can include moderate resistance training. 

Exercise has an overall anti-inflammatory effect so is crucial for recovery. It is important to avoid overloading the system so start with light exercise then, only if there is no increase in symptoms, slowly and gradually increase the intensity. If there is a return of symptoms, return to the recovery phase. 

Monitor the patient’s response to this increase in relative activity level. If there is any increase of symptoms with tasks, especially fatigue, this shows a lack of tolerance and the activity should be ceased. After 24-48 hours and then retry those activities and monitor the response.  

Time in the recovery phase will vary for each individual and is only considered complete when all concussion-related signs and symptoms have been fully resolved:

• At rest
• During brain based tasks such as reading, driving, work, study or prolonged standing
• With gentle exercise and movement

Progression through the return to exercise through graded loading program must be done with careful monitoring of symptoms. Only enter this phase and increase exercise intensity after all symptoms have fully resolved at rest and are not aggravated with normal activities such as work, study or school or activities of daily living or high intensity physical activity. 

For those in sports or activities with physical contact such as football, the level of contact should also be increased incrementally. Any concussed player must have a medical clearance before returning to competitive contact sport (including full contact training sessions). 

• Start with 2-3 non contact training sessions over 7 days with at least one day of recovery in between. 
• If this is tolerated, introduce slow, controlled contact. Allow at least one day of non-contact between each day that includes contact.
• Progress to full contact in a training setting if the patient is confident to return to contact.

To progress through each level, there must not be any increase in symptoms. In the case of an increase in symptoms, revert back to the previous stage.

Return to game play should only be considered after there is full recovery from the concussion symptoms and there has been a graded return to exercise without any problems and the player is confident to return to play. It is recommended that patients get a medical clearance before returning to contact sports.  Returning too early and suffering another head injury soon after an initial injury can be the ‘second hit’ that pushes the brain inflammation to yet another level, risking longer term complications.  

It’s not just another head injury to look out for to avoid a second hit. Intake of inflammatory foods, alcohol or a period of stress or poor sleep can all inflame the brain, causing a ‘second hit’ Therefore, its important, even after returning to game play, work, study and normal daily activities to monitor diet, alcohol intake and sleep to allow the brain to continue to heal. 

If a patient does not progress through these stages within 4 weeks, suffers a second concussion in the same season, has concerns with brain function or a lower threshold for concussion, seek medical advice.