Post-Concussion Protocol: Tips for Recovering in 7 Days

(Newswire.net — May 27, 2016) National Harbor, Maryland — What actually happens when an athlete goes into the “concussion protocol?” Neurologist Harry Kerasidis, MD and Co-Founder of XLNTbrain.com describes how the brain responds, and what steps to take to heal from the mild traumatic brain injury and have a safe return-to-play and return-to-learn. * 

Immediately after a concussion occurs, the brain begins the healing process. Over the course of next 24 hours, it’s critical to accept my treatment strategy and do…

Nothing.

The brain physiology, blood flow and neuronal pathways all need to rest. Particularly in the first 24 to 72 hours, I recommend minimizing any activity that provokes the symptoms of concussion. This includes physical and mental stimulation that may interrupt the healing process by forcing the brain to work. I use the phrase “brain sprain” because like an ankle sprain, you have to limit movement so the muscles, tendons, and ligaments get a chance to return to normal before adding any more pressure to the wound. 

During the acute phase, meaning the period of time immediately following a concussion injury, the brain requires rest while dealing with the metabolic demands of repairing the affected brain cell membranes which have been stretched. PET scan studies show that glucose, the primary energy source, is not able to freely get into the brain cells as usual, preventing the cell’s ability to get the fuel to supply the demand for repair or proper functioning into the cell. In other words, the damaged brain cells are grasping for energy, but they cannot get the fuel.

Thus, the need for rest, as well as healthy foods, plenty of water, and perhaps nutritional supplements are needed to support the healing process. 

Within a day or two of the concussion, while symptomatic at rest, don’t jog, run, lift weights, or do any kind of physical exercise because it pumps more blood into the “leaky” brain cells that are trying to heal. Also, avoid any mental activity like reading, writing, texting, learning, even talking. Avoid the sunlight or well-lit rooms when sensitive, because the eyes and nervous system pathways that take in visual stimuli may also be affected. Even watching movies, playing video games, loud music, working on the computer, or trying to fix something may all exasperate the concussion healing. The brain is involved with everything we do, so for the first day or two, just rest.

When the initial symptoms have dissipated, that doesn’t mean the concussion has healed and the athlete is ready for action or the classroom. Now, we move into a phase I refer to as “relative rest,” minimizing mental and physical stimulation until the athlete is symptom free during activity. Relative rest refers to gradually liberalizing mental or physical activity, still avoiding those that provoke the athlete’s concussion-related symptoms. 

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As mentioned earlier, once the injured player is free of symptoms at relative rest, I begin a 5-Step Progressive Exertion recovery guide, which is built into my platform that monitors symptoms and guides the timeline for a return-to-practice and gameplay.

During this recovery phase, each day presents tasks with increased levels of difficulty. Should any of the concussion symptoms reappear, then it’s back to the previous level of activity, which did not provoke symptoms.

However, if the athlete progresses each day through recovery without provoking any symptoms, then the brain is healing from the trauma. When the athlete can complete all of the “5-Steps” of the Progressive Exertion plan and their cognitive performance remains at baseline, then they can seek medical permission to return-to-play.

Typically, this allows for a seven to ten day cycle. But it could vary, and I’d recommend erring on the side of caution, without rushing the return to normal activity and gameplay.

One of the reasons recovery time can vary is because athletes with a history of previous concussions may require longer periods of time to heal. A study reported in Neurosurgery in 2007, indicated the presence of long-term residual visual-motor disintegration in concussed individuals with normal neuropsychological measures. Most importantly, athletes with a history of previous concussion demonstrate significantly slower rates of recovery of neurological functions after the second episode of mTBI.

Many other factors influence the concussion recovery time in addition to previous history of concussion like the severity of the force of concussion, level of headache pain, previous or family history of migraines and personal lifestyle factors such as history of drug abuse, alcohol use, exposure to toxic environments, previous brain-related impairments, even genetic history. Every brain is different, every brain injury varies. Most healthy athletes, however, will see significant improvement within 7 to 10 days following their concussion, with 93 to 97% recovered by day 30.

Relieving Pain

In the first 24 hours after sustaining a concussion, the person should not take any pain medications. A pain medication can “mask” the symptoms, which could result in misdiagnosis of the concussion, or even something more serious. As stated, many concussion symptoms will take several minutes, hours, or days to arise. After this 24-hour period, and during the first 72 hours, should the athlete experience a severe headache, I recommend taking an anti-inflammatory, over the counter, acetaminophen. naproxen, aspirin, and ibuprofen (NSAID-type medications) should not be used at first, as they may increase the risk of bleeding. Beyond this, ask your doctor for help with addressing any other pain. 

Sleep

Insomnia is a common post injury symptom. I recommend a temporary sleep aid. Over the counter remedies are usually made of antihistamines which are sedating for most people and help improve sleep quality. However, it is not uncommon for some people to paradoxically become more alert with antihistamines worsening the insomnia. Short-term use of traditional sleep aids is appropriate in this setting. A doctor may even recommend taking imipramine, a tricyclic antidepressant, which not only helps with sleep but also can help protect against headaches and improve cognitive performance.

* Excerpt, “Concussion-ology: Redefining Sports Concussion Management for All Levels,” by Harry Kerasidis, MD

About Harry Kerasidis, MD

Neurologist Harry Kerasidis, M.D is the founder and medical director for the sports concussion management platform XLNTbrain, based in Maryland. He is also the founder of Chesapeake Neurology Associates in Prince Frederick, Maryland and serves as the Medical Director for the Center for Neuroscience, Sleep Disorders Center and Stroke Center at Calvert Memorial Hospital. Dr. Kerasidis authored Concussion-ology: Redefining Sports Concussion Management for All Levels, published in December.