There is a lot of misinformation about concussions, their recovery, and their long-term effects. As someone who has participated in thousands of patients' concussion recoveries over the last decade, I can tell you that people can recover from concussions. However, sometimes the road to recovery is quick and easy; other times it can be long and difficult. In this blog post, I will share my perspective, created from research and experience, on what the journey of recovering from a concussion may look like.
Disclaimer: This post is for educational purposes only. Nothing in this post is intended to be medical advice. As with every medical issue, you should always consult with a medical professional licensed in your area.
In an earlier post titled, "A Simple Guide to a Not-So-Simple Concussion," we covered a lot of ground, introducing and defining what a concussion is, what happens to the brain during a concussion, some of the symptoms associated, what to do after a concussion, the types of treatment offered for concussion-rehabilitation, and more.
We also emphasized the importance of seeking medical attention as soon as possible to get the correct treatment for concussions depending on their severity. An accurate diagnosis and treatment plan are essential for recovering after a concussion.
In this post, we will focus on the recovery process from a concussion. Concussion recovery can be a daunting process. Concussions are a complex, multi-system injury that requires a vast understanding of human physiology. It is important to work with a trained, experienced, and certified doctor in treating concussions. Immediately after sustaining a concussion, it's important to be evaluated to make sure no life-threatening injuries exist.
One of the most challenging parts of a concussion is the variability in its presentation. Sometimes a concussion will have immediate symptoms. Other times concussion symptoms may not present themselves for 3 days. The MOST important thing everyone should do is err on the side of caution if a concussion is suspected. That's where the saying, "when in doubt, sit it out," comes from. While the first concussion has not healed, a second concussion might be fatal.
After a doctor has ruled out all life-threatening injuries, the next most important step to recovery is to rest. The research poorly defines "rest, " and many doctors have differing opinions. We know that bed rest (especially too much of it) is not beneficial. We also know that resuming daily activities too soon can be disastrous. Essentially, what we are looking for is the perfect amount of rest. Unfortunately, that doesn't exist. My general advice for “rest” is to do more than laying in bed all day, but less than your normal activity, with a primary goal of avoiding flaring up concussion symptoms, reducing (physical, mental, and emotional) stress, and just giving your brain time to settle and restore normal physiology.
A recommended schedule for the 24 hours after the head injury for an average person with a concussion:
It is completely normal to have common symptoms such as headache, head pressure, neck pain, dizziness, nausea, fogginess, fatigue, blurred vision, and sound/light sensitivity. If you have these concussion symptoms, let your doctor know so they can prescribe something to help alleviate them. It is not normal to vomit multiple times, to have a worsening headache, black eyes, and bruising behind your ears. Those are indications that you should head to the Emergency Room.
During these 48 hours, you should avoid anything that might thin your blood/promote bleeding, such as ibuprofen, Aspirin, Pepto-Bismol, and some supplements, unless your doctor advises it is safe. Your doctor will often tell you to take Tylenol (Acetaminophen/Paracetamol) for pain. If your doctor is trained in nutrition and neurochemistry, they may prescribe dietary supplementation or hormones that can help restore cellular function, modulate inflammation, improve fuel delivery and blood flow, and also help hasten your recovery.
On your third day after sustaining a concussion, you should have an appointment to be evaluated by a concussion specialist. These specialists can be medical doctors, chiropractors, physical therapists, or athletic trainers that have completed extensive training and are board certified to manage concussions. However, most general practitioners (“GPs”), chiropractors, physical therapists, and other professionals without board certifications are not typically comfortable or adequately trained to manage concussions.
From this point, every concussion journey is different. No two concussions are ever the same, even in the same person. Nearly all recommendations should be based on their examination findings and the patient's presentation.
Research suggests that as early as 48 hours is the best time to begin "physical activity," defined as light walking without exertion and/or prescribed, supervised, graded, light aerobic exercise. This type of exercise can be implemented and aid in recovery by helping blood flow, decreasing inflammation, increasing chemicals that help your brain heal, and improving your emotional state. This exercise must be done under the supervision of a trained specialist to prevent further injury.
Depending on your situation, the specialist may also be able to prescribe a course of brain rehabilitation exercises to help your brain regain its healthy function. These exercises are critical to decreasing recovery time. After a concussion, your brain function begins to remodel. Certain areas/networks of your brain (that are injured) are not as efficient, so your brain uses other areas/networks to perform daily tasks. In the short term, this is beneficial, but if left uncorrected can lead to long-term inefficiencies and persisting concussion symptoms.
Taking your time in the recovery journey to talk to your concussion rehabilitation expert before starting any exercise program during this delicate period is important. Remember that taking it slowly and resting are key components of recovering from a concussion successfully.
Understanding how long a concussion takes to heal is an important part of managing this condition for children, adults, and athletes alike. Unfortunately, the answer is not straightforward, as different people can take varying lengths to recover from a concussion. Athletes recover from their injury most quickly, usually in 10-14 days. In non-sport-related concussions, adults are typically symptom-free in 3 weeks. Children and teenagers sustaining both sport and non-sport concussions often recover the slowest. Their concussion symptoms may last up to 30 days. Anyone with symptoms past 30 days is considered to have a protracted recovery and absolutely needs treatment. This occurs in approximately 30% of all concussions.
Researchers have been able to identify several concussion symptoms and factors that are correlated with a longer recovery time:
Healing is an interesting term. Cuts heal... as scars. Bones heal... but their break can still be seen on X-rays for life. Concussions may "heal" on their own, but the brain may be dysfunctional for life, if not treated.
Most research leading up to 2015 defined "recovery" as restoring symptoms to baseline (prior concussion). Using that definition anywhere from 33-70% of all individuals with concussions will have symptoms 3 months after injury (PMID: 27784191). Approximately 10% of all individuals with concussions will have permanent (defined as greater than 3 years duration) symptoms.
Other studies suggest that "while symptoms may abate, only 27% of the concussions fully spontaneously recover (based on fMRI); each additional symptom reduces the recovery rate by 20%" (PMID: 27784191)
If someone has a concussion and doesn't seek care, their odds are stacked against them. They may "heal" or "recover" and may not notice any differences in their life compared to before their concussions. But they may also develop migraines or ADHD 2 years later, seemingly disconnected. Or, they may be the 1 in 10 that will always have symptoms.
Fortunately, our understanding of the brain and how it works, and breaks have grown exponentially, especially in functional neurology. Functional neurologists specialize in using techniques to improve the function of the nervous system, especially the brain. They work to identify and treat the underlying causes of various neurological symptoms and conditions.
Some of the things a functional neurologist may do include:
The goal of a functional neurologist is to help improve the overall functioning of the nervous system, leading to improved quality of life for patients, including those suffering from concussion.
A concussion is a serious brain injury that requires the attention and supervision of a trained professional. Concussion recovery is not uniform and tends to be different for each concussion. Many people with concussions will fully recover, but every brain injury needs to be evaluated appropriately. A functional neurologist trained by the Carrick Institute and certified by the American Board of Brain Injury and Rehabilitation is a great choice to manage a concussion. They have extensive training and experience in diagnosing, managing, and rehabilitating concussions.
Functional Neurology, as defined by the American College of Functional Neurology, is "a health care specialty focused on the assessment, quantification, and rehabilitation (or treatment) of the human nervous system, utilizing sensory and cognitive-based therapies, to promote neurological plasticity, integrity, and functional optimization."
Functional neurology was the brainchild of chiropractic neurologist Prof. Frederick R. ("Ted") Carrick in 1978. He began studying the effect of chiropractic applications on the brain and called the work "chiropractic neurology." In the mid-1980s, the term "functional" was introduced to medicine but was associated with functional somatic syndromes or functional neurological disorders. It was, however, recognized that individuals suffering from functional syndromes presented with more complex symptoms than disease-specific abnormalities. Much of the research on functional neurology has historically been associated with the field of psychiatry, dating back to the roots of neurology in the late 1800s and continuing through the early 1990s.
In the late 1980s, chiropractic neurology gained traction as a specialty in chiropractic. Carrick founded the Carrick Institute, which was solely dedicated to educating and training chiropractors in neurology to help patients with brain and nervous system disorders. Chiropractic Neurology became regulated by the American Chiropractic Neurology Board (ACNB), an autonomous regulatory body supported by the American Chiropractic Association. Chiropractic neurology officially became recognized by the ACA and the Federation of Chiropractic Licensing Boards in 1998, allowing a chiropractor certified by the ACNB to call themselves chiropractic neurologists.
The field continued to grow within the chiropractic profession, and other manual therapists began to take notice of the attention that chiropractic neurology was attracting. It drew interest from providers from many different backgrounds, including physical therapy, occupational therapy, optometry, medicine, naturopathy, acupuncture, veterinary medicine, kinesiology, and more. These practitioners recognized the potential of physical medicine to impact the nervous system in humans and animals.
At that same time, there was an explosion of national interest in understanding the brain. The 1990s was coined the "decade of the brain," in which substantial governmental funds were allocated through the National Institutes of Health to research brain function, brain disorders, the nervous system, brain injury (including traumatic brain injury), mental health, other neurological disorders, and treatment for these disorders. It was in this decade that many scientific accomplishments occurred, including the development of fMRI BOLD neural imaging and the discovery of neural plasticity.
In the early 1990s, biochemist Jeffery Bland, Ph.D., FACN, FACB, introduced the concept of functional medicine to the world. The term functional in medicine differs from traditional medicine in several ways, but most significantly in its objective. Conventional neurology aims to identify and treat symptoms and diseases of the brain and nervous system. Jeffery Bland so eloquently stated in his 2017 publication in the journal Integrated Medicine, "disease is an endpoint, while function is a process." Functional medicine and functional neurology are less concerned with treating symptoms, arriving at a diagnosis, or naming a neurological disease and are more focused on understanding the multi-factorial, complex, and dynamic processes contributing to symptoms, disease, and dysfunction and intervening to halt or alter those processes before the endpoint of disease is reached.
The core concepts in functional neurology share commonality with those of functional medicine and other alternative care models, just more specifically applied to the brain and the central nervous system. With the growing number of non-chiropractic providers becoming interested in chiropractic neurology, in 2008, the American College of Functional Neurology was formed to become an independent certification agency for what had become the multi-discipline healthcare specialty of functional neurology.
On this topic, I had an 8-year-old savant patient on the autism spectrum in 2009 that explained the relationship between traditional and functional medicine in the most brilliantly simple way I have heard anyone do to date. He said, "Dr. Antonucci, understanding the values and the differences between traditional and functional medicine is relatively simple. Traditional medicine saves peoples' lives, while functional medicine gives people their lives back."
Technically the term functional neurologist is not given or supported by any regulatory or authoritative body. Healthcare providers that have completed the two years of coursework in functional neurology mandated by the American College of Functional Neurology and have passed the board examinations to earn credentials often refer to themselves as functional neurologists to identify their specialty training.
As a diagnostic and treatment paradigm, functional neurology has been able to restore and transform the lives of millions of patients with many different symptoms, diagnoses, neurological diseases/neurological conditions, and even patients just seeking better brain health since its inception in 1978.
Functional neurology treatment has been known to be effective for patients with:
Although functional neurology has its roots in chiropractic, a functional neurology practitioner can have a background in any licensed healthcare field, bringing their treatment tools. The tools utilized by functional neurologists aim to identify brain dysfunction and restore neurological integrity.
Treatment tools commonly used by functional neurology practitioners include:
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