Over the last few decades, more and more research has surfaced questioning the current concussion recovery management protocol. After a mild traumatic brain injury, an athlete is often asked to rest and restrict exercise. In a few weeks, they are given a steady return-to-play guideline to follow and are often cleared to return within a month.
New Concussion Recovery Guidelines
Nowadays, more and more athletes are being asked to combine rest and light cardiovascular exercise, such as walking for 1-2 hours per day within 24 hours after injury. They are told to wear a pair of dark sunglasses to decrease light exposure and stay away from screens. Athletes are shown to recover faster this way because gentle exercise increases circulation to the brain and clears away damaged and inflamed cells. With circulation come all the nutrients we need to heal, and this allows the recovery process to continue faster.
Designing a return-to-play program is very important and must include input from all members of the sports rehab team. The lingering cognitive impairments can include processing speed, memory, attention and awareness. For a hockey player, lacking these crucial skills after a concussion can lead to a second hit and more impactful concussion if they return to play too early.
Natural Medicine and Concussion Recovery
The same way muscles require amino acids to repair after a workout, the brain requires essential fats and other key nutrients to repair after injury. The nutritional support at the onset of concussion is such an important step in brain repair and can definitely reduce many of the post-concussion symptoms if implemented immediately. High doses of omega-3 fatty acids can rebuild the brain tissue and reduce the inflammation from the injury. Vitamin D is an important nutrient for cognitive function and has been linked to a reduction in Alzheimer’s disease risk. Vitamin B12 is a key step in the formation of myelin sheath, the protective layer around nerves. Without this, nerve repair may be compromised and show up as poor memory, focus and concentration.
Strengthening Brain Tissue after Injury
Cognitive rehabilitation must fit into a physical rehabilitation program. This includes many of the puzzles and tests used for monitoring Alzheimer’s and dementia patients. They help to strengthen the nerve connections in the brain and improve processing speed. Even once an athlete has returned to play, continuing with these tests for the next few months will further support cognitive function.
The Risks of Not Having a Concussion Recovery Program
Many athletes will suffer minor concussions and never end up going to the doctor. Many may not experience any symptoms and be ready to play again within a week. More severe concussions create lasting changes in brain structure, which are susceptible to further injury. It is often these second impacts (called second impact syndrome), which are significantly worse and can put an athlete out for months. There is also a risk of brain bleeding after a second injury which can be fatal. After a series of concussions in a short period of time, an athlete must make an important decision as to whether or not the risks of playing the sport outweigh the benefits.
Long Term Consequences of Repetitive Brain Trauma
The long term effects of repetitive brain trauma have been known and studied for decades. Many retired athletes suffer tremendous amounts of mental illness and dementia in their mid-life. Some have even commit suicide, but never make the newspaper headlines. The movie “Concussion” in 2015 highlighted the tremendous influence the NHL, NFL and other major sports leagues had to “hush up” the scientific evidence linking traumatic brain injury to these devastating diseases. The term Chronic Traumatic Encephalopathy (CTE) was used to describe ongoing brain inflammation as a result of repetitive trauma.
Since this movie was released, research studies unveiled the long-term effects of sports-related concussion. Major league sports have been forced to make changes to protect their athletes and are monitored by a 3rd party for concussion management of their players.
Permanent Brain Change after Repeated Concussion
A systematic review of 3819 studies of former athletes showed a positive correlation with number of concussions and severity of depression scores. Only two studies evaluated the risk of suicidal ideation. The authors concluded that repetitive brain trauma and an increased risk of neurodegenerative disease was inconclusive. However it was clear that neuroimaging studies had shown changes to the structure and neurochemical balance in the brain after repeated trauma.
Considering Medical Retirement after Many Concussions
On a recreational level, medical professionals are starting to have conversations with patients about sports retirement. The American Academy of Neurology released a practical guide for practitioners to help in their discussions of medical retirement from sports. The review highlighted 10 athletes under the ages of 35 and their battle with repetitive head trauma. The guide encouraged practitioners to consider not only the clinical and radiographic evidence of injury, but the athlete itself. Many athletes play high-level sports because of pressure from other coaches and parents, financial motivations, and strongly identify themselves with a sport. Removing someone from a social network built entirely around a sport is not to be taken lightly.
Conversations about medical retirement must include a discussion on the long term risks and the significant impact they can have to academic performance, career success and healthy aging. Providing MRI imaging can prove to be a helpful visual for athletes who have sustained a series of concussions. By opening up this conversation, the athlete may become more aware of the effects of the lasting concussion symptoms and make a decision for themselves.
We Only Get One Brain
The brain is an incredible organ with powerful functions, but unfortunately has limited potential to regenerate from severe damage. Making important decisions about sports from an early age is a difficult but crucial step in supporting a healthy life and strong retirement.