A Multi-Modal Approach to Concussion Recovery

Jan 31, 2019

concussion

Concussions are a massive concern globally, both in and out of sports. The Brain Injury Research Institute estimates there are an estimated 1.6-3.8 million sports- and recreation-related concussions annually. (1) Given the changes in cervical spine, vestibular, and cognitive function (2) that have been noted following a concussion, it is clear that there are many avenues for therapy to address when preparing an individual to return to sport and/or daily life. However, the incidence of post-concussive syndrome (3) and increased injury risk when returning to play following concussion (4) has made it clear that the multi-modal treatment strategy necessary to facilitate an effective recovery is grossly lacking. This is the first blog post in a series on various treatment strategies that can be utilized to facilitate this recovery. This post will focus on an overview of physical deficits seen post-concussion and nutritional/supplemental strategies that can be used to facilitate recovery. Future posts will go into greater depth on treating the physical impairments described, as well as on utilizing the listed nutritional/supplemental strategies.

Concussion results in many physical impairments, many of which can be treated by physical therapy. Three common areas that have been identified to be affected by concussion are the cervical spine, the vestibulo-ocular reflex, and attentional ability. (2) Some cervical dysfunctions that have been identified in the literature include:

1. Decreased cervical flexor muscle endurance
2. Decreased upper cervical range of motion (tested with cervical flexion rotation test)
3. Decreased cervical rotation strength
4. Decreased cervical proprioception (measured with joint position error test) (2)

The vestibulo-ocular reflex has been noted to be impaired through several tests, such as the dynamic visual acuity test and the head thrust test. (2) Lastly, research has found that individuals also have a decreased ability to maintain divided attention, as noted by the walking while talking test (let’s be honest, we all have problems with walking and talking). (2) While I will go into detail on this information in future posts, all of these deficits can be treated by a knowledgeable therapist. In addition, the following nutritional strategies may help to expedite the recovery process.

While clinical trials in humans are largely lacking, the mechanisms of action and studies in animals show solid evidence for the potential benefit of the following strategies while providing none-to-minimal risk. Some of the easier strategies to implement are the use of supplements such as fish oil, turmeric, glutathione, and ginkgo biloba, as well as antioxidant-rich foods (blueberries, blackberries, etc.). Many of these substances have anti-inflammatory components, which are essential to control the neuroinflammation that occurs following a concussion. (5) Another potentially beneficial strategy for reducing the harmful effects of concussion is mitochondrial enhancement. There are several methods for improving mitochondrial efficiency, including creatine, hyperbaric oxygen therapy, and strategies that induce ketosis, such as fasting, MCT oil use, coffee, and supplementation with oxaloacetate, PQQ, and CoQ10. And for good measure, other modalities such as melatonin, near-infrared light, and blue light-blocking glasses may also prove beneficial.

My next post will examine treatment strategies for cervical spine dysfunction as well as examining the “easy” strategies listed above. I will follow that up with two additional posts that consider treatment strategies for the vestibulo-ocular reflex and attentional ability and examine the remaining supplemental strategies. If you like the article or have suggestions for other strategies to assist with concussion recovery, leave a comment!

Disclaimer: if you or someone you know has suffered a concussion, seek medical help from an appropriate provider in your area. The treatment strategies listed above are intended to be used for discussion purposes only and should not be used as medical advice.

References

1. Schneider KJ, Meeuwisse WH, Palacios-Derflingher L, Emery CA. Changes in measures of cervical spine function, vestibulo-ocular reflex, dynamic balance, and divided attention following sport-related concussion in elite youth ice hockey players. JOSPT. 2018;48(12):974-981.
2. Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013;132(1):8-17
3. McPherson AL, Nagai T, Webster KE, Hewett TE. Musculoskeletal injury risk after sport-related concussion: a systematic review and meta-analysis. AJSM. 2018; Aug 3:363546518785901
4. Patterson ZR, Holahan MR. Understanding the neuroinflammatory response following concussion to develop treatment strategies. Front Cell Neurosci. 2012;6:58.