A concussion is a mild traumatic brain injury (TBI) that can cause a range of challenges, including physical, emotional, autonomic, vestibular, oculomotor, sleep, and cognitive problems, along with a myriad of other symptoms. Despite the common perception that sports cause most concussions, only about 1 in 7 are sports-related. Instead, other injuries, such as falls, motor vehicle accidents, and assaults, are more likely to cause concussions. Although most people recover within a few weeks, some may experience persistent symptoms lasting for months or even years. See: "Does Everyone Recover From a Concussion?"

Recent research has shown that molecular hydrogen (H2) has potential therapeutic effects on various neurological conditions, including traumatic brain injury. H2 is a colorless, odorless, and tasteless gas studied for its antioxidant, anti-inflammatory, and anti-apoptotic properties. This article will explore how molecular hydrogen can benefit concussions and promote recovery.

What is Molecular Hydrogen?

Molecular hydrogen is the smallest molecule in the universe and has potent antioxidant, anti-inflammatory, and neuroprotective properties. These properties make it an attractive candidate for treating various conditions, including diabetes, heart disease, and neurological disorders. In recent years, there has been growing interest in the potential of molecular hydrogen to benefit concussion patients.

Molecular hydrogen has been studied for its potential therapeutic effects on various health conditions for decades. However, its use as a medical therapy is relatively recent, with the first clinical trials conducted in the early 2000s. One of the earliest reports of the medical use of molecular hydrogen was in 1975, when it was first used to treat decompression sickness in deep-sea divers. This condition, also known as the bends, occurs when nitrogen gas bubbles form in the blood vessels and tissues due to rapid decompression, sometimes causing severe pain, possible death, and other symptoms. Hydrogen was used as a therapeutic gas to reduce the severity of the symptoms and improve outcomes in affected divers. Since that time, research on the medical applications of molecular hydrogen has expanded to include a wide range of health conditions, including but not limited to neurological disorders, cardiovascular diseases, metabolic disorders, and cancer.

Hydrogen has antioxidant and anti-inflammatory effects that dampen oxidative stress and inflammation, accompanying nearly every disease affecting all humans. Another "out of this world" issue caused by oxidative stress is neurological deficits and long-term health issues caused by space travel. New research suggests that a little as one hour of space radiation causes damaging levels of oxidative stress, which compromises thinking and decision-making and is one of the greatest challenges for space travel.

For clinicians:

Excessive amounts of reactive oxygen species (ROS) can damage the composition of mitochondrial electron transport chains, disrupt intracellular redox systems, and lead to lipid peroxidation, protein misfolding, and DNA strand breakage. This can trigger oxidative stress, activate the JNK signaling system, up-regulate pro-oxidant genes, and inhibit antioxidants associated with nuclear factor-e2 related factor (Nrf2). As a result, matrix metalloproteinases (MMP) can be induced, along with the secretion of inflammatory chemokines such as tumor necrosis factors (TNFs), interleukin (IL)−1, IL-6, and IL-8, leading to inflammation. Additionally, peroxidation and inflammation can promote cell apoptosis. This can subsequently result in the release of pro-fibrotic cytokines like platelet-derived growth factors (PDGFs), insulin-like growth factors (IGFs), and basic fibroblast growth factors (FGFs), which can promote the differentiation of monocytes into M2 macrophages, enhance fibroblast proliferation and differentiation into myofibroblasts, and amplify inflammation.

Antioxidant Effects:

One of the primary mechanisms by which molecular hydrogen can benefit a concussion is its ability to reduce oxidative stress. Molecular hydrogen helps mitigate this damage by neutralizing free radicals and, in effect, reducing inflammatory processes in the body along with other tissue stressors.

Oxidative stress occurs when there is an imbalance between the production of free radicals and the body's ability to neutralize them with antioxidants. Overwhelming a person's ability to clear or reduce these harmful interactions in the body can lead to cellular damage and inflammation, worsening the effects of a concussion.

As detailed in "A Simple Guide to a Not-So-Simple Concussion", oxidative stress is a common feature of concussion; it can cause damage to neurons and other brain cells. Several studies have demonstrated the antioxidant effects of molecular hydrogen in animal models of traumatic brain injury. For example, a study published in the journal Brain Research showed that rats exposed to a concussive impact had significantly lower levels of oxidative stress markers in their brains when treated with molecular hydrogen gas.

At the same time, H2 has been shown to activate the Nrf2 pathway, a cellular signaling pathway that regulates antioxidant and anti-inflammatory responses, which can scavenge free radicals and reduce oxidative stress in the brain. By reducing oxidative stress and inflammation, H2 can protect brain cells from further damage and promote recovery after a concussion.

Molecular hydrogen can neutralize free radicals, molecules that can cause oxidative damage, thus reducing oxidative stress. It also leads to upregulating antioxidant enzymes, such as superoxide dismutase (SOD) and catalase. Properly using molecular hydrogen can help protect brain cells and promote healing more than the consumption of any known "superfood".

Anti-Inflammatory Effects:

Another pathway in which molecular hydrogen can benefit concussion patients is through its anti-inflammatory properties. In the case of concussions, the inflammatory response can exacerbate the damage to the brain and prolong the recovery process. Studies have shown that H2 can reduce inflammation in the brain by inhibiting the production of pro-inflammatory cytokines and chemokines. These signaling molecules recruit immune cells to the injury site and promote inflammation. H2 has been shown to reduce the levels of these molecules in animal models of traumatic brain injury, leading to a reduction in inflammation and improved neurological function. By reducing inflammation, molecular hydrogen can help to minimize the damage caused by a concussion.

Inflammation is a natural response of the immune system to injury or infection. Excessive or prolonged inflammation can lead to tissue damage and cell death.

The hydrogen molecule, despite being a weak reducing agent and having a low molecular weight, has the ability to diffuse quickly and pass through cell membranes and lipid bilayers. It can then target the cell nuclei and mitochondria, where there is an abundance of reactive oxygen species (ROS), and selectively neutralize highly reactive toxic ROS, such as -OH. Recent studies have also shown that hydrogen has a positive effect on the Nrf2 pathway, which is a crucial regulator of electrophilic/antioxidant homeostasis and helps maintain the functional integrity of cells during oxidative stress conditions. Hydrogen activates the Nrf2-Keap1 system, triggers the activation of antioxidant response elements (AREs), and promotes the expression of multiple cytoprotective proteins, including glutathione, catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase, and heme-1 oxygenase. It also activates the transcription factor FoxO1, reduces the damage of -OH to mitochondria, and inhibits the overproduction of ROS. Additionally, hydrogen inhibits the infiltration of phagocytes to sites of inflammation, thereby preventing the subsequent release of reactive substances, and down-regulates various pro-inflammatory and inflammatory cytokines such as interleukin (IL)-1β, IL-6, TNF-α, and intracellular adhesion molecules (ICAM)-1, thus achieving an anti-inflammatory effect. Moreover, hydrogen also weakens abnormal expression of miRNA associated with brain injury.

Cellular Energy Production: 

Following a concussion, there is often an energy imbalance caused by a decrease in glucose uptake by neurological tissue. Glucose is critical in the production of a cellular energy molecule called ATP. If a brain cell cannot access glucose, it cannot make ATP, leading to cell death and neurological dysfunction. Molecular hydrogen may mitigate this by increasing glucose uptake and providing a supplemental fuel source for mitochondria to produce ATP in the brain.

One of the unique properties of molecular hydrogen is its ability to penetrate cell membranes and reach the mitochondria, which are the cell's powerhouses. Mitochondrial dysfunction is a common feature of TBI. It can contribute to developing symptoms such as fatigue and cognitive impairment. By reaching the mitochondria, molecular hydrogen can help to restore their function and promote healing. Several studies have shown that molecular hydrogen can improve energy metabolism in the brain. For example, a study published in the journal Medical Gas Research found that rats treated with molecular hydrogen had higher brain ATP levels than untreated rats.


Molecular hydrogen has also been shown to have a neuroprotective effect. In animal studies, molecular hydrogen has been shown to protect against neuronal damage and cell death.

Apoptosis is programmed cell death that occurs in response to injury or stress. Excessive apoptosis can lead to cell death and tissue damage. H2 has been shown to inhibit apoptosis in the brain by regulating the expression of pro- and anti-apoptotic proteins such as BCL-2 and caspase-3. In animal models of traumatic brain injury, H2 has been shown to reduce apoptosis in the brain and improve neurological function.

Hydrogen exhibits cytoprotective properties that improve cell apoptosis. Apoptosis plays a crucial role in the progression of concussion-related brain injury. By significantly inhibiting the ectopic expression of the death promoter Bcl-2 related X protein (bax) and the expression of caspase-3, while promoting the expression of the anti-apoptotic protein Bcl-2, hydrogen can effectively provide cytoprotection.

Hydrogen also enhances blood perfusion and reduces vascular damage caused by concussion. Vascular injury and endothelial dysfunction are key factors in the development of traumatic brain injury. Excitotoxic brain activity and metabolic failure leads to the excessive production of reactive oxygen species (ROS) and the depletion of vascular protectant nitric oxide (NO) within a few minutes, resulting in the nitrosylation of protein tyrosine residues and lipid peroxidation. This ultimately weakens the vasomotor response, causing vascular stenosis. Furthermore, after concussion, NADPH oxidases (NOXs), especially NOX2 and NOX4, which are abundantly expressed in vascular endothelial cells, are up-regulated, leading to excessive production of ROS, changes in calcium homeostasis, calcium metabolism disorders, and triggering antifibrinolysis-coagulation cascade action, ultimately leading to blood clotting and vascular occlusion. Hydrogen helps to alleviate these effects.

The available evidence suggests that hydrogen exerts a protective effect on damaged blood vessels and improves blood perfusion. It achieves this by various mechanisms such as inhibiting the degradation of cyclic guanosine monophosphate (cGMP) through phosphodiesterase, thereby increasing cGMP levels and promoting protein kinase activation. Additionally, hydrogen increases intracellular calcium levels and stimulates vascular endothelial growth factors to enhance nitric oxide production. Moreover, hydrogen opens the potassium channel sensitive to ATP and activates downstream mitogen-activated protein kinase pathways, which promote angiogenesis. Experimental studies also demonstrate that hydrogen prevents arterial intimal hyperplasia and atherosclerosis by inhibiting ROS and TNF-α/NF-κB pathways, as well as foam cell apoptosis derived from macrophages. It stabilizes atherosclerotic plaques, reduces vascular stenosis, and promotes the formation of vascular collaterals using the FIk1-Notch signal stimulated by paracrine VEGFs to improve local microcirculation.

Neuroplasticity and Neurocognitive Function:

While halting brain cell death is paramount in concussion, promoting survivability and growth of healthy cells may be equally important in full recovery. H2 has been shown to enhance the production of brain-derived neurotrophic factor (BDNF). This protein promotes the growth and survival of neurons. BDNF is essential for neuroplasticity, development, and the maintenance of the nervous system. Its dysfunction has been implicated in neurological disorders, including traumatic brain injury. By enhancing BDNF production, H2 may promote the growth and survival of brain cells and potentially improve recovery after a concussion.

This protein, BDNF, promotes the growth and survival of neurons. BDNF is essential for neuroplasticity, development, and the maintenance of the nervous system. Its dysfunction has been implicated in neurological disorders, including traumatic brain injury.

Concussions can cause various cognitive impairments, including but not limited to memory loss, attention deficits, and executive dysfunction. H2 may benefit concussions by improving cognitive function through its anti-inflammatory and neuroprotective effects. A 2019 study published in the journal Frontiers in Neuroscience found that mice treated with molecular hydrogen after a traumatic brain injury had improved cognitive function and reduced levels of inflammation compared to untreated mice. Another study in the journal Neuroscience Letters in 2012 aimed to investigate the potential therapeutic effects of H2 on cognitive function in a rat model of blast-induced traumatic brain injury.

The researchers exposed adult male rats to a single blast wave generated by a shock tube. The rats were then randomly divided into control and H2 treatment groups. The H2 treatment group received H2 gas at a concentration of 2% for one hour per day for seven consecutive days, while the control group received room air.

The researchers assessed the cognitive function of the rats using the Morris water maze test, a widely used test of spatial learning and memory. The results showed that the rats in the H2 treatment group performed better on the Morris water maze test than those in the control group. The H2-treated rats showed shorter escape latencies and swam shorter distances to reach the hidden platform, indicating improved spatial learning and memory.

The Morris Water Maze test involves placing the rats in a pool of water and measuring the time it takes them to find a hidden platform. The rats are trained on the task over several days, and their performance is evaluated based on the time they take to find the platform and the distance they swim.

In addition to the Morris water maze test, the researchers also evaluated the rats' brains' oxidative stress and inflammation levels. They found that H2 treatment reduced oxidative stress markers and pro-inflammatory cytokines in the brain, suggesting that H2 may have anti-inflammatory and antioxidant effects that could protect the brain from damage.

Health and Wellness Promotion: 

For the same reasons that H2 might benefit a patient that has sustained a concussion, molecular hydrogen may also help healthy individuals. Research has shown that H2 may also:

  1. Aid in skin health: H2 has also been studied for its potential benefits on skin health. One study found that drinking hydrogen-rich water for 8 weeks significantly improved skin hydration and elasticity and reduced wrinkle depth.
  2. Improve exercise performance: H2 may also help improve exercise performance by reducing fatigue and improving recovery time. One study found that athletes who drank hydrogen-rich water for two weeks experienced significant improvements in exercise-induced muscle fatigue (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395574/)
  3. Decrease Delayed Onset Muscle Soreness: Evidence suggests that molecular hydrogen (H2) may help decrease delayed onset muscle soreness (DOMS), the pain and stiffness that can occur in muscles after exercise (https://pubmed.ncbi.nlm.nih.gov/33555824/)
  4. Alcohol Hangovers: It is important to note that excessive consumption of alcohol is detrimental to the brain. The best way to prevent a hangover is to drink alcohol in moderation and to stay hydrated by drinking plenty of water. However, scientific evidence supports using molecular hydrogen (H2) to decrease hangover symptoms (https://academic.oup.com/ajcn/article/116/5/1208/6702415).
  5. Digestion: Some evidence suggests that molecular hydrogen (H2) may benefit digestion and gut health, including promoting bowel regularity (constipation) and reducing bowel irritation in IBS. One study published in the World Journal of Gastroenterology found that drinking hydrogen-rich water for four weeks improved symptoms of IBS, including abdominal pain and bloating.
  6. Cholesterol and Body Fat: Several studies over the past decade have investigated the potential effects of molecular hydrogen (H2) to improve cholesterol and body fat. The first such study is a randomized, double-blind, placebo-controlled trial published in the Journal of Lipid Research a long time ago, back in 2010.

With all these benefits, you may wonder how hydrogen is administered. Molecular hydrogen (H2) can be administered in several ways, depending on the individual's intended use and preferences. Here are some common ways to administer H2:

  1. Hydrogen-rich water: This is water infused with molecular hydrogen gas. It can be made using a hydrogen water generator or purchased pre-made. Drinking hydrogen-rich water is a simple and convenient way to consume H2.
  2. Hydrogen gas inhalation: Inhaling hydrogen gas is used in some clinical studies. It requires specialized equipment and should only be done under medical supervision.
  3. Hydrogen gas baths: Some spas and wellness centers offer hydrogen gas baths, which involve soaking in a tub of water infused with molecular hydrogen gas.
  4. Hydrogen gas injections: In some clinical studies, hydrogen gas has been injected into the body. This method should only be done under medical supervision.
  5. Hydrogen-rich saline: This saline solution has been infused with molecular hydrogen gas. It is administered intravenously (IV) in some clinical settings.

We discuss the pros and cons of each method of administration in a future article.

In summary, molecular hydrogen is a simple yet effective way to aid recovery from concussion and promote optimal health and quality of life.

Dr. Antonucci utilizes molecular hydrogen at his home (daily) for health maintenance. He also offers access to this contemporary intervention to his patients.

Do you have a concussion or other neurological challenge? Don’t be a stranger! Give us a call. There’s no charge and no obligation. We love to help people. Let’s see if we can help you feel your best!

Updated 3.27.23: Per request, I added more in-depth explanations for clinicians - MMA

Have you, or has someone you care about, recently sustained a head injury or a concussion? Or maybe you suffered a concussion and are on the road to concussion recovery but still don't feel like you are "yourself" again. Perhaps you found this article because you want to understand what is happening to you. Or maybe you're searching for answers to get past the brain injury and symptoms you're experiencing and return to life as it was before. You're not alone. Best estimates suggest that in any particular year, 1 in 10 people will sustain a concussion. Due to a lack of public education causing underreporting, a precise definition, standard of care, and inadequate data collection, the actual number of concussions that occur each year may never be discovered.

Concussions are confusing to everyone, including doctors and researchers, for many reasons. There is very little formal training/ medical education on concussions. In the research, there are over 30 "official" definitions of concussions established, all with different diagnostic criteria. Alone, this makes establishing a concussion diagnosis difficult. Additionally, a head injury is not always a concussion. All concussions are considered mild traumatic brain injuries, but not all mild traumatic brain injuries are considered concussions. And research suggests that as few as 23% of concussions will make a full recovery, based on the resolution of symptoms. The rest can persist to post concussion syndrome, which can last from 3 months to years (and sometimes can be considered permanent). Confused yet? Everyone else is.

What is a concussion?

A concussion is typically reserved for mild traumatic brain injuries sustained while participating in a sport. In civilian and military health care, mild traumatic brain injury is more commonly used (but even this is being debated). For the purposes of this article, we will use the terms concussion and mTBI/mild traumatic brain injury interchangeably. A mild traumatic brain injury is defined by the American Congress of Rehabilitation Medicine (PMID: 10628500) as any traumatically induced brain function with at least one of the following:

What does this mean? If a person sustains a traumatic insult to their body and/or head and has ANY neurological symptoms (seeing stars, hearing ringing their your ears, dizziness, disorientation, confusion, headache, nausea, etc.), then they had the very least, a mild traumatic brain injury or "concussion." If consciousness is lost for more than 30 minutes or they have amnesia ("lost time") for more than a day, they may have had a (more severe) moderate traumatic brain injury.

What happens to your brain during a concussion?

In 2014, Dr. Chris Giza published a seminal paper describing, in detail, the complex and system effects of a concussion. A concussion is caused by a rapid change in velocity of the head (from still to moving, or moving to still). That quick change in speed causes stretching of brain tissue, similar to when you sprain a ligament or strain a muscle. That stretching causes damage to nerve cells which disrupts signaling, causing them to "short circuit" and become active when they're not supposed to be. This is why some people "see stars" or get their "bell rung"; because the brain area responsible for seeing or hearing (respectively) is injured. At the same time, blood vessels that deliver energy-sustaining oxygen and sugar are also stretched and sometimes even torn. This causes decreased blood flow and fuel to the same over-excited areas. This decoupling of fuel and energy causes brain cells to die. The injured brain cells release chemicals that cause inflammation, which causes swelling (causing someone to experience nausea, vomiting, and headache- possibly necessitating medical attention and treatment). This process triggers both a healing response that removes dead brain cells and causes injured cells to go into a type of hibernation. This all occurs within the first 48 hours. During that time, the brain naturally begins to re-organize based on the demand. This remodeling process (called plasticity) is NOT a good thing in this scenario. This is why it is imperative to rest until this process has ended (less than 72 hours). The injury of brain tissue, combined with the reorganization of brain function, causes short- and long-term concussion symptoms. It needs to be addressed in any concussion treatment for successful concussion recovery.

What should you do if you see someone sustain a head injury?

Always play it safe. If someone hits their head, immediately get that person to a safe and quiet place where they can be evaluated by someone trained in concussion management. The first priority is to prevent repeated concussion. If they are an athlete playing a contact sport, and sustained a sports concussion, this might be a coach or an athletic trainer. If it is not a sports-related mTBI, it may be a sports medicine/family medicine doctor, a physical therapist, chiropractor, EMT, or other health care provider. If, for some reason, nobody around is trained in managing concussions, talk to the person and observe their behavior. Here is a sample conversation that you might have.

Your job is to listen and observe. Do they sound calm, collected, clear-headed, and oriented? Are they slurring their words? They should receive medical attention and a concussion evaluation immediately if anything seems abnormal. Failure to receive proper treatment, or a second concussion that occurs before an initial concussion has not healed, can cause permanent brain damage.

What are the symptoms of a concussion?

A concussion will always have one or more symptoms. Suppose you or someone you know sustained a head trauma or any trauma that caused their head to shake violently. In that case, it should be assumed that they have a concussion unless proven otherwise by a healthcare provider trained in concussion. Symptoms may appear at the time of injury or sometimes as late as 3 days after the injury. The most common symptom is a headache, but there are more than 50 symptoms that someone with a concussion might experience. These symptoms may include including feeling frustrated or impatient, anxious, sadness, irritability, more emotional, restlessness, sweats/chills, hot/cold extremities, pressure in the head, worse symptoms after physical exertion, nausea, light headed/ uncomfortable standing, bladder discomfort/changes, irregular/rapid heart rate, trouble with memory, difficulty concentrating, slower speed of thinking, confusion, trouble word/name finding, feeling in a fog, not feeling right, fatigue/low energy, trouble falling or staying asleep, not feeling rested, sleeping too much, needing more sleep, muscle weakness, numbness or tingling, sensitivity to noise, back pain, headaches, muscle pain/aches, eye pain, skin/muscle twitching, balance problems, neck pain (stiffness), dizziness, sensitivity to light, blurry/double vision, difficulty with moving scenery, motion intolerance, visual disturbance (snow, spots), eye strain, and more. The reality is that your brain is the organ that dictates our perception and function. If it is injured, any element of our life could potentially be affected.

How do I know if I had a concussion?

If a healthcare provider determines that they have sustained a concussion, there are many inaccuracies about what to do next. Some of them are absolutely wrong, like "head injuries are part of life/part of the game," and they aren't anything to be worried about. Others are more of a misunderstanding of the facts, like "do not let the person go to sleep at night." Or "lock them in a dark room and do not engage in any activities until they are better."

Here's the truth. Concussions, like any injury, need time to heal before returning to normal activity. The critical time for rest is the first 48-72 hours. During that period, get plenty of sleep (it's perfectly fine to check in on the person to make sure they're breathing properly and they are resting peacefully- but don't wake them up), physical rest (refrain from anything more than mild physical activity), cognitive rest (refrain from any intense mental activity), and avoid any situation where a second concussion might occur. Take time off from work/school. It's essential to be extra cautious because natural healing processes are happening during that time, and sustaining another injury could be catastrophic. Contact a primary care doctor and schedule a follow-up appointment. Consult with a doctor to see if there are over-the-counter medications that could be taken to help with symptoms. Often taking NSAIDs (ibuprofen, naproxen, etc.) will be discouraged because it interferes with the inflammatory response that helps to heal the injury caused by the concussion. Tylenol is most recommended for pain, and other over-the-counter medications for symptoms.

When should I go to the hospital for a concussion?

It's always better to err on the side of safety. Unless someone trained in concussion evaluation has advised that a hospital visit is unnecessary, it's always safe to go to the hospital. Not many people have regretted going to the emergency room and being told: "everything is alright." If you are not able to be evaluated, here are some things to consider

Imaging is only warranted under particular conditions (typically over the age of 60, severe headache, unmanageable neck pain or instability, suspected skull fracture, deteriorating neurological signs, or multiple episodes of vomiting), in which case a non-contrast CT scan of your brain will often be ordered. If at least one of the conditions of the Canadian CT Head Rules are not met, a brain scan is likely unnecessary. MRIs are rarely helpful in the diagnosis or management of concussion. You should not return to regular activity until a second concussion evaluation is performed, the testing has normalized (you may still have symptoms), and you have been "cleared" to return to your normal activities by a licensed and trained healthcare provider. Returning to sports or activities too soon and sustaining another concussion may result in a more severe concussion, or second impact syndrome, which can have deadly consequences.

When should I get treatment for a concussion?

Your body is miraculous at healing itself. However, healing does not always equate to "getting back to normal." For example, your body will heal if you get cut, but a scar will remain. If you roll your ankle, it will heal. Still, that ankle will be more susceptible to future injuries if it is not rehabilitated. The same is true for brain injuries. Research suggests that for a first concussion, the concussion symptom will resolve in approximately 10 days for adults and 14 days for children (and typically 50% longer for multiple concussions). This is true in many circumstances, but in many cases (10-77%), symptoms will persist for months or years, which has been called "post-concussion syndrome." Research has also found that fewer cases actually resolve without treatment when looking at brain function instead of symptoms. This is true even for a mild TBI, or mild concussion, and may lead to chronic traumatic encephalopathy (or CTE).

Commonly, after 10-14 days have passed, and a patient is not feeling back to normal again, a primary care provider will refer the patient to a concussion specialist. These specialists are often neurologists, physical therapists, chiropractors, neuropsychologists, athletic trainers, occupational therapists, optometrists, or other disciplines trained in concussion management.

Additionally, the relationship between head injury and neck injury is often overlooked. The mechanism of injury that causes a concussion may also injure the neck, especially in women. Therefore, an evaluation by a chiropractor or a sports medicine physician is essential to resolving concussion symptoms (particularly neck pain).

What is the best treatment for a concussion?

When it comes to concussion treatment or concussion treatments, there is no "one size fits all" treatment. Brain injuries are as unique as one's brain; therefore, a concussion program for a brain injury must also be as unique as each brain.

Doctors use two main methods to determine what type of concussion therapy will be prescribed: symptom-based or function-based approaches.

The 50± concussion symptoms used to be divided into 3 types: physical symptoms, cognitive symptoms, and emotional symptoms. More recently, these symptoms have been further categorized into categories. These categories are called concussion subtypes (or phenotypes). We will expand upon these phenotypes in other articles.

The proposed subtypes of concussion are:

  1. Affect
  2. Autonomic
  3. Cognitive
  4. Oculomotor/Visual
  5. Vestibular

There are also 2 "associated categories" that often occur secondary to the subtypes above:

  1. Somatic
  2. Sleep

By assessing your symptoms and assigning them to their proper phenotype, a doctor can choose to manage your concussion symptoms with medications or refer you to a concussion clinic for a specific type of symptom-based concussion therapy.

Symptoms-Based Management

Symptoms-based management is a traditional method of treating concussions (and many other conditions). In this style, care is directed at eliminating symptoms with a "cookie cutter" approach, with little consideration for brain function. This type of treatment typically involves medications or therapies to reduce symptoms affecting the individual with the concussion. Drugs and some therapies are very effective at reducing symptoms but often come with undesirable side effects, do not address underlying brain dysfunction from the injury, and sometimes have rebound effects (symptoms worsen when therapy is discontinued). While people feel better with the symptoms-based approach, the FDA has not approved any drugs to treat concussion. No evidence supports that medications or drugs effectively resolve or shorten a concussion's duration.

Function-Based Management

The second approach to concussion treatment is function-based management. This type of management uses a systematic approach to collect health information (history, etc.), and concussion symptoms and measure brain health through particular types of testing. The provider will then examine the function of each phenotype, compare your values to normative data, and identify what functions/areas have sustained an injury and need rehabilitation. This method allows the provider to uncover the root cause of your symptoms, often employed by functional neurologists trained explicitly in concussion care.

The function-based approach to concussion is central to functional neurology (See "What is Functional Neurology"). This approach looks at the brain's functional integrity through sophisticated testing, advanced imaging, and/or a thorough physical examination. The data collected from these evaluations are then interpreted, considered against your concerns and goals, and compared against solid scientific research to create unique treatment plans that help rehabilitate the brain through neural plasticity (See "What is plasticity?"). While there is not a lot of research supporting the efficacy of these programs, there is support for their safety. With everything in life, when making a decision, you should always consider potential risks to potential benefits.

How does functional neurology help concussion recovery?

A primary cause of concussion symptoms and post-concussive syndrome is remodeling brain function and inflammation. These changes occur due to genetics, plasticity, or the brain's remodeling to injury. Functional neurology attempts to identify decompensated functions (not functioning normally) and create a treatment program to restore their function, once again, through plasticity. By prescribing specific sensory, motor, and cognitive exercises, a functional neurologist or a provider trained at the Carrick Institute, and certified by the American College of Functional Neurology can literally re-wire the brain after an injury. They employ therapies that include vision therapy, physical therapy, occupational therapy, speech therapy, sports medicine, physical rehabilitation, chiropractic, vestibular therapy, mental health coaching, balance training, cardiovascular conditioning, cognitive rehabilitation, coordination training, sensory-motor processing drills, QEEG-guided neurofeedback, hyperbaric oxygen therapy (HBOT), photobiomodulation, nerve stimulation, and other modalities. Remember, the most important treatments are the ones that are appropriate for the individual concussion, and that's impossible to determine without a formal consultation and a comprehensive evaluation.

When can I return to return to activities or sports after a concussion?

Ensuring that a person follows a returning to activities (RTA) or returning to play (RTP) protocol after a concussion is critical to prevent permanent damage. Ideally, every person in the world would have a Brain Health Assessment before sustaining a concussion. If so, the healthcare provider could measure precisely when the person's brain has healed and when they can resume normal activities/contact sports. However, many people are not proactive about their brain health, so that's not usually the case. When baseline testing is not present, a concussion doctor tries to aim without a target. We look at symptoms, assessments, performance, and tolerance to increased demand to determine when a patient has returned to "normal." The challenge is that your normal may differ from someone else's. Once we have established that you have achieved your normal, pre-concussion status, we begin a graduated return-to-activities and then a return-to-play protocol (article coming soon).

Contact us if you're interested in a free consultation to determine if Dr. Antonucci and his team are a good fit for your concussion. We love getting to know and helping new people.

Please share this article on your social outlets. Understanding concussions and how they can be treated may change someone's life, or at least give hope to someone who may feel like they've run out of options.

Functional Neurology, Defined.

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."

The History of Functional Neurology

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." Shortly after, in the mid-1980s, the term "functional" was introduced to medicine but was associated with functional somatic syndromes or functional neurological disorder. 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, the field of chiropractic neurology gained traction as a specialty in chiropractic. Carrick founded an institution called the Carrick Institute, which was solely dedicated to providing education 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 a chiropractic neurologist.

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 began to draw 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 had to impact the nervous system in humans and even in 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 the context of 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. Disease, as Jeffery Bland so eloquently stated in his 2017 publication in the journal Integrated Medicine, "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 the functional medicine model, 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."

What is a functional neurologist?

Technically the term functional neurologist is not given or supported by any regulatory or authoritative body. Healthcare providers that have completed the 2 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.

What can functional neurology help?

Functional neurology, as a diagnostic and treatment paradigm, 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 1978.

Functional neurology treatment has been known to be effective for patients with:

What types of treatment are included in functional neurology?

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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