concussion recovery: why experts say you should move more and rest less
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during rehabilitation therapy for concussions, engaging in light activity, such as walking on a treadmill, can help you heal faster.
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concussions occur when a person experiences a blow to the head or body that causes the brain to bounce off the skull, and this type of hit needs to be significant. typically, it takes an acceleration of about 70 to 100 times the force of gravity for a concussion to occur, which is why it’s commonly seen in contact-sport athletes, such as those who play hockey or football.
however, many other injuries can cause a jolt that strong, so not only athletes are susceptible to the injury.
roughly one in 10 canadians will report a concussion each year, but the number of people who experience them could be much higher due to the number of incidents of concussion that go unreported.
“it’s frequently missed in the emergency department if people come in with multiple injuries,” said dr. cameron marshall, a sports specialist chiropractor and founder of complete concussions and concussion fix, programs geared toward helping healthcare professionals manage concussions and patients heal from persistent symptoms.
he continued, “if someone’s in a car accident (and) they’ve broken their leg, the concern is the leg. everyone’s looking at the leg. no one’s really asking the right questions or asking … ‘how’s your head? do you feel foggy?’”
he also notes that many concussions go unmissed because the symptoms that are presented during an injury could be dismissed as something entirely different, such as shock. people carry on about their business, thinking that they’re just “worked up” from whatever it is that caused the concussion.
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“they may not recognize it for three or four days later,” said dr. marshall, even though symptoms tend to happen immediately.
when people have a concussion, they are diagnosed based on clinical signs and are typically told to go home, rest, avoid light and it’ll go away. however, experts now have a better understanding that rest could be the worst thing you could do for a concussion.
the common and not-so-common symptoms of concussion
there are many symptoms associated with a concussion, some of which are more commonly known, while others may be more subtle.
for example, headaches, dizziness and mental fogginess tend to be expected when a person complains of a concussion. a person may also experience nausea or vomiting, ringing in the ears and slowed processing.
however, difficulty sleeping, an increase in anxiety, depression and sadness, are not usually expected, but can be symptoms of concussion. people can also experience visual impairment, balance issues and irritability.
since there are no tests that can give a good reading for the diagnosis of a concussion, medical providers have to base their diagnosis on reported symptoms, either from the person who suffered the concussion or their loved ones.
“there’s certain signs that other people can see, and then there’s symptoms that people self-report,” said dr. marshall.
medical providers can only base a diagnosis on those two observations, making it challenging to diagnose, and a person must have at least two signs for a concussion to be considered.
why resting with a concussion can make things worse
when that positive diagnosis is given to a person who has sustained a concussion, their main medical advice is often to go home, put their feet up, turn off the lights and rest until it goes away. they are told to avoid physical and cognitive activity to go easy on the brain, and to say goodbye to their day jobs for a couple of weeks.
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however, these recommendations are now considered “the worst thing you can do,” and resting could end up doing far more harm than good.
now, people should lean into something called symptom-limited activity.
“you can essentially do anything that doesn’t significantly increase your symptoms,” said dr. marshall. “we want people to go for walks. we want them to do some household chores. you maybe take a day or two off work at most, but then you start a graduated return process.”
as long as the activity in question doesn’t significantly provoke symptoms, it’s what a person should be doing after a concussion, and it all comes down to the autonomic nervous system.
when a person sustains a concussion, their autonomic nervous system, which regulates involuntary bodily functions, becomes dysregulated. resting for an extended period, even in a healthy person, will only further dysregulate things.
“now, every time they even stand up, they get dizzy, they feel off, they feel out of whack, right? we’re doing the wrong things,” said dr. marshall.
he also notes that the best way to fix autonomic nervous system dysregulation is through movement or exercise, and it can make a huge difference in people who recover from concussions fast, or those who experience lingering symptoms for months or even years following their injury, which is known as post-concussion syndrome (pcs).
“the current research shows that if you do nothing, you get a concussion, you do the bed rest thing, you don’t do anything, 30 to 40 per cent of people are going to end up with persistent concussion symptoms,” he said. “with exercise, you could cut that in half, so you drop that maybe to 15 to 20 per cent.”
essentially, the more movement a person can do after suffering a concussion without triggering severe symptoms, the better off they’ll be.
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other concussion treatments that don’t involve rest
if someone goes through the first week and continues to move and do as much as possible but still has symptoms at the seven to 10 day mark, more can be done. dr. marshall notes that rehabilitation treatments are a great place to start.
this involves working with a specialist who will assess a person’s capacity to perform activities, as well as other aspects such as diet to tackle inflammation and mental health support.
they’ll also investigate if there are any other injuries that could be prolonging the symptom period, such as whiplash.
“concussion is acceleration of the head and whiplash is acceleration of the neck, and they happen together,” he said.
that’s when neck-based rehabilitation can be incorporated into the treatment plan, which may include massage, physiotherapy, visual or vestibular rehabilitation, or manual therapy and chiropractic.
each specific symptom is addressed through concussion treatment plans, which specialists are now seeing has a much more positive impact than the rest-it-off method of yesteryear. the goal of this form of treatment is to give people the best possible outcome, because when concussion symptoms don’t go away, it can lead to a challenging future.
“they can’t work, they can’t function, they can’t do anything,” said dr. marshall, noting that when rehab is started early, they can improve their outcomes by roughly six to eight times.
changing how people look at concussions
dr. marshall and other concussion specialists want to change how people see concussions in the hopes of taking what is now known about treatment versus rest to create a more evidence-based recovery.
even for people who have been dealing with pcs for years, new therapy programs can make a difference because there is no permanent brain damage after a single concussion. repeated concussions can lead to chronic traumatic encephalopathy (cte), which is an irreversible degenerative brain disease caused by repeated head injuries.
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when it’s just a single concussion, though, there is no brain damage. it’s all nervous system-related, which can be mitigated over time.
dr. marshall has worked with people who are days out from their injury and those who are a decade out, and it’s the same: once those steps are taken to mitigate the dysregulation, the symptoms lessen. that said, those who were told to rest by their doctors may have had to endure hardships and health issues for much longer than they should have.
“it’s insane how bad, how much longer it takes because it just gets more and more ingrained,” he said. “people’s lives get smaller and smaller, and they get more and more disabled, they get more and more anxious, they get more and more depressed, they get less and less active, and all of these things make their symptoms worse over time. the longer it’s been, the worse their system is, and now you just have to dig yourself out of this massive hole.”
the myths associated with concussion recovery, such as there is no treatment and rest is the answer, are those that have caused harm to patients for years. another big one, according to dr. marshall, is that once a specific time has passed, there is nothing a person can do. there is no statute of limitations on healing from a concussion, and people don’t have to “get used to your new normal.”
it’s the hope that medical providers will catch up to the research done surrounding the injury so that people can regain control over their healing following a concussion.
“we know that you can treat this,” said dr. marshall. “you can get better, and it’s not that complicated. it just takes the right knowledge base in order to do it.”
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