In part one of this two-part series I reviewed the basics of what to do when someone lands on their head or neck. Now that we have covered trauma assessment strategies … let’s talk about what to do after a concussion to improve your recovery.
Note: This blog does not take the place of professional medical care. If you are having symptoms that are keeping you from thinking clearly, I highly recommend you seek help from a professional who is trained in post-concussion care (e.g. go see a physical therapist, sports MD, or athletic trainer that has experience working with folks that have had concussions).
The basic synopsis of current research is this: returning to sports too soon, or waiting too long to return to sports BOTH prolong your recovery from a concussive episode. Not sure how to define too soon or too long? There are metrics for that - but it would probably be best for you to check in with someone about your actual symptoms and how to return to activity with the right amount of provocation of those symptoms.
During the acute phase of injury, the primary thing to do is – NOTHING. If you have sustained a concussion to any degree of severity, your main task for the first 2-14 days is to rest your body and your brain. The amount of time you need to rest is dependent upon the severity of the concussion which will largely be determined by your symptoms.
After the acute phase, and once your symptoms are stable, it is appropriate to begin aerobic activity in a safe environment. And no, partner acrobatics does not fall within the realm of safe activities in this context. Research consistently finds that if you sustain a second blow to the head within the first two weeks of your initial concussion, you are at a much greater risk of developing a more severe brain injury with longer lasting and more serious consequences than your initial injury. This is the main reason why the gold standard of care following a concussion is REST.
However, recent research does show that returning to activity as soon as possible improves your recovery, but the mechanism for this isn't totally clear. What we do know is that aerobic exercise is good for your mental and emotional health, which are often impacted by a concussion and sometimes by too much rest. Let me explain: Rest, by nature, is a solitary experience ... take a social creature from their normal habitat and place them in an isolated cocoon to rest and you put them at risk for feelings of social isolation, which can ultimately lead to depression, which has a myriad of negative consequences that coincidentally overlap with many common post-concussive symptoms (e.g. irritability, decreased concentration, difficulty learning new things, to name a few). Phew, that was a long sentence.
What does rest really mean? The basic answer is: rest depends upon your symptoms. Post-concussive symptoms vary widely -- because guess what? The brain is a complex organ and you are a complex person. Below is a fairly extensive list on how I prescribe rest following a concussive episode. Note: this list is by no means exhaustive, and varies depending on presentation.
During the acute phase following a concussion (2-14 days):
· Take time off work – especially the first couple days
· Minimize screen time, television, reading and phone calls
· Avoid drinking alcohol as thinning the blood may increase bleeding in your brain
· Avoid taking aspirin (it also thins the blood)
· Avoid inversions
· Stay hydrated
· Get as much sleep as possible, and rest your eyes
· Avoid partner acrobatics and impactful exercise
· Stay off social media and avoid the pressures of the acro community to report what happened, how it happened, how you are feeling, etc. **More on this below**
|Bright areas indicate more flow of oxygen; your brain will find alternate pathways to continue functioning.|
While this is ultimately helpful to your survival, it is a lot of extra work, perhaps explaining fatigue during recovery.
After the acute phase: Add back in aerobic exercise as tolerated. In general I recommend monitoring symptoms during activity and establishing an acceptable level of symptom provocation with my clients. This is where working with a rehab professional comes into play. Because head injuries can progress over a period of several days, I cannot write anything too specific about when YOU can safely return to activities. Examples of safe aerobic activities include: bike on a trainer (aka stationary bike), treadmill or elliptical (I know - boring), brisk walks (no jogging initially).
General course of rehabilitation: Once a client has tolerated returning to aerobic activity, I will add in strength training, incorporating cognitive and vesitbular habituation exercises when warranted. Eventually the program is progressed to include dynamic movements with impact, and ultimately if and when it is safe to do so - clients are allowed to return to sports that potentially involve impact with other people and objects. This process occurs over a period of many weeks; the time line varies depending upon symptoms.
Worth noting: because of the emotional and social nature of our brains, I often work with psychotherapists and speech pathologists to help maximize recovery from a brain injury. Having a brain injury can be a life altering event, and warrants attention as such. That being said, it need not stop you from living a fully engaged and meaningful life, and cognitive behavioral therapy can play a pertinent role in returning to activities as soon as possible following your injury. The bottom line is - if you have a concussion, there are a lot of us here to support you in your recovery.
So how do you know if you have a concussion: If you did any of the following: hit your head on the ground or someone's knee or some other hard object, landed flat on your back, or landed so hard on your bum that you are a bit dizzy, you probably have a mild concussion. Please read the following list and see what, if anything, applies to you. Note: concussions can occur with less impact than you might imagine ... if you had a fall that caused any amount of disorientation - no matter how transient - get yourself checked out, or at the very least monitor yourself for a few days for common symptoms.
Common symptoms post concussion:
- Nausea, headaches
- Light sensitivity
- Loss of balance
- Increased fatigue and irritability
- Visual or auditory hallucinations
- Vestibular disruption, dizziness
- Confusion, difficulty problem solving
- Coordination deficits
- Memory loss
Please note that brain injuries can progress over the course of several days. If any of the above symptoms return, or worsen, seek medical care immediately.
In conclusion: Finding the appropriate balance of rest and return to activity will improve your recovery from a concussion. I encourage you to ask for help - there are a myriad of practitioners in the world who are passionate about helping folks return to living engaged, healthy and active lives.
My background and why am I writing this: I have been working as a physical therapist since 2005, and spent about 6 years of my career in neuro-trauma rehabilitation (the rest being in acute medical, orthopedics, and sports medicine). My certifications in basic life support, CPR, and wilderness first-aide are current, and have been since 2003. I mention this because while I have a decent amount of experience, I am by no means an expert in trauma medicine. These blog posts are not meant to replace training, or serve as a gold standard of care. They are simply meant to start filling in the gaps in safety within the acro community.
Special thanks to Jaimie Harrow for sharing current research info from his recent participation in the national physical therapy association conference. I'm stoked to have Jaimie join this profession ... he now works in Oakland as a PT.
Thank you for reading, and thank you for taking good care of each other.
Upcoming events with Precision Acrobatics in SF:
March 24: Intermediate Day Long Intensive
April 11, 18, 25: Reverse Hand to Hand 3 Week Series
May 30: Handstand Workshop with Ariel
June 6, 13, 20: Dance Acro 3 Week Series
You can also find us at FemPower Acro Fest in Porland, OR in April
Connect with us: PrecisionAcrobaticsSF@gmail.com
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Liz's PT practice in SF, CA
***A couple of random thoughts***
If someone has experienced a brain injury, or a concussion, please do not pressure them to recall the events of their fall until they are ready to do so. Also note – this may never happen. And that’s OK.
To those of you that have experienced a concussion in acro: While it is important for the overall health and safety of the community to hear about accidents, so the risk can be better mitigated in the future, IT IS NOT YOUR RESPONSIBILITY TO TAKE THIS ON WHILE YOU ARE RECOVERING FROM AN INJURY. As such, it is likely best that you avoid social media for two weeks so that you won’t feel pressured into making some sort of public statement about your accident or injury. Please remember: your primary responsibility is to rest your brain so that you can recover. If at some point you want to share your story, or you feel comfortable discussing the mechanics of your injury – either online, or with someone you trust to represent you – feel free to do so. Please just don’t feel like it is your responsibility to be the poster child for head injuries in the acro community. I could go on about this … but I’ll stop here.