How to Recover from a Concussion

There are many myths and confusion about how to care for your brain after you experience a concussion.

Many people don’t realize the severity of even a mild concussion and that they can be caused by a direct or indirect hit to the head or body.

Not all concussions are suffered by athletes while playing sports. Falls and accidents can cause them, too. All concussions are serious injuries that can have severe repercussions if not managed properly. Proper care during the first 7 – 10 days is crucial to ensure optimal recovery.

Immediately following the Concussion Injury

  • Two to three hours following the incident you should remain awake and be monitored.
  • You should NOT DRIVE or be left alone.
  • You can now sleep for 2-3 hour increments.
  • Someone should wake you every 3 hours, and ask simple questions to ensure that a more serious brain injury hasn’t occurred.

If you feel fine following the incident but notice any of the following symptom, you should seek emergency care as soon as possible:

  • Rapid deterioration of symptoms
  • Severe headache with sudden onset • Slurring
  • Inability to be woken up
  • Repeated vomiting

Think of a concussion like any other injury such as a sprained ankle or a broken arm. What would you normally do to manage those types of injuries? Rest!

The problem is that we don’t always know what it means to ‘rest’ our brain. If you go right back to work or school, or resume any physical or mental activity, it’s as though you are going for a run on a sprained ankle, which is not conducive to healing. Remember the brain needs a LOT of energy to heal.

There is a 30-day window following the incident in which you are most vulnerable. It is crucial that during the first 10 days you refrain from any activity that could put you at risk for any kind of physical contact, even if you are feeling recovered and asymptomatic. The brain is extremely vulnerable after a concussion; even if you feel no symptoms, any further jostling or sudden movement, even small impacts, can actually cause more severe brain injury. How you feel doesn’t always coincide with how well your brain has recovered.

The Concussion Recovery Process

Step 1 – First 3-4 Days

  • Physical and cognitive REST is critical.
  • No driving, no screen time, no reading, no school, no homework, no physical activity.
  • Rest in a dimly lit room with minimal stimulation.
  • When you no longer exhibit symptoms for at least 24 hours, you can move on to the next step.

If after 4-5 days, you are still symptomatic with complete rest, see a head and neck specialist chiropractor for an examination. The underlying neck injury now needs to be assessed and addressed, and there are other exercises that may facilitate the recovery; this should be monitored very carefully with your practitioner.

Step 2 – Light cognitive activity allowed

You should still be resting for the majority of the day, but you can attempt to read a book or do homework for a 30-45 minute daily maximum. If symptoms occur during or in close proximity to the cognitive activity, this is considered a failed step and you need to go back to step 1 for a minimum of 24 hours.

Step 3 – You are now ready for a half day of work or school

No driving, no tests, no home- work, no recess, no gym, no manual labor or heavy equipment, including power tools and saws, etc.

If any symptoms arise while at school or later in the day, return to Step 2 for the following 24 hours. If no symptoms occur, progress to Step 4 the following day.

Step 4 – Full day with restrictions

This step involves exactly the same recommendations as Step 3 but you may attend work or school for the full day with restrictions. If any symptoms occur, return to step 3. If no symptoms occur, you may proceed to Step 5.

Some accommodations that should be made during this step include allowing for frequent breaks, no tests or heavy thinking, having another student take notes, doing 50-70% of the normal workload, avoiding over-stimulat- ing environments, crowds, loud noises or jostling in crowded hallways.

Step 5 – Slowly remove restrictions

Slowly start removing restrictions and prepare for a full return to school or work as tolerated. It is recommended that you lift one restriction per 24-hour period, and if no symptoms are aggravated, continue to do so until full return to work or school can be tolerated.

Step 6 – No more restrictions

A full return to work or school without any restrictions is next. Driving is now permitted. Physical activity should be kept to light walking or gentle range of motion exercises until you have fully reintegrated your normal daily activities. At this stage, another evaluation should be done by your craniocervical chiropractor to begin the process of returning to full physical activity or sports. For more information about your concussion and recovery, schedule an appointment with a chiropractor focusing on structural correction of the head and neck

Common Concussion Symptoms

Headaches | Dizziness | Blurry vision Mental fog | Slow thinking Difficulty concentrating

Emotional symptoms (moody, irritable, sad, worried)

Sleep issues (drowsiness, trouble falling asleep)

Symptoms are not always immediately present and may take up to 24-48 hours to manifest.

A concussion takes an average impact of 95 G’s of force, but a neck injury occurs at only 4 G’s of force. You cannot sustain a concussion without also having an underlying injury to the neck. Both injuries need to be managed appropriately. A Craniocervical Chiropractor will work to correct and stabilize the structure of the neck, which is vital for optimal recovery from concussion injuries.


References

McCroy P., Meeuwisse W, Aubry M. et al, Consensus Statement on Concussion in Sport – the 4th International Conference on Concussion in Sport Held in Zurich, November 2012. Clin J Sport Med. 2013;23:89-117.

Maddocks D., Dicker G. An objective measure of recovery from concussion in Australian rules footballers. Sport Health. 1989;7(suppl):6-7.

McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med. 2001;11:176-181.

McCrea M, Kelly JP, Kluge J, et al. Standardized assessment of concussion in football players. Neurology. 1997;48:586-588.

Guskiewicz K. Postural stability assessment following concussion. Clin J Sport Med. 2001;11:182-190.

Marshall C., The Diagnosis, Treatment and Management of Concussion. 2015 CAS AGM.