Concussion Protocols: 3 Step Approach

Written By Patti Johnstone

Most research in this field reports that nearly 70% of concussions are recovered within a few weeks however there are still nearly 25% that cannot return to work or sport within 6 months or greater post concussion. What’s going on here?

Concussions have been greatly undermined and misunderstood within our medical communities. Many sports medicine doctors started to reconsider their thinking around excessive rest post injury and reexamined what might be happening between the Autonomic Nervous System (ANS), cerebral blood flow and ventilation (CO2 exchange). Here’s how concussion protocols have changed for older adolescents (+ 15 yrs) to young adults (~25yrs old). This model studied elite athletes - Division 1 athletes in college contact sport.

1) Stabilizing the Overactive Nervous System- when someone receives a concussion- say while playing contact sport- the nervous system is in a highly sympathetic state. This is important and mandatory. Once the athlete receives the hit, drops, is assessed and either deemed stable or to be monitored, the brain is working hard to organize and restore function. If the athlete is concussed, the nervous system may collapse into a more neural protective state (FREEZE) or it may stay charged up in FIGHT or FLIGHT. AND it could be doing both- pressing the gas while having your foot on the brake. Consussion is very disorgranizing to the ANS. The point is, PAY ATTENTION! What’s happening to this athlete?

  • Are they sensitive to light & noise?

  • unable to eat?

  • shallow breathing/ difficulty stabilizing breath?

  • experiencing angry outbursts/ rage?

  • overwhelmed visually by movement or crowds?

  • balance? Struggling with balance and changing planes of motion

Recommendations:

  • avoid screen time for 48 hrs post concussion- this includes cell phones & VIDEO GAMES!!

  • mirror breathing and slow it down for the athlete. Think simple- Nasal In Nasal Out before you go into deep exhales bc that may be too hard right now & further disorganize their system.

  • touch their joints or get them them to touch their joints like elbows and shoulders, wiggle their toes, roll their ankles or touch their ribs. This has a way of bringing sensation back to the athlete and it can be calming for them which can invite the PNS to come online and stabilize the ANS.

  • minimal movement within 48 hours such as walking around but not intense movement just yet.

2) Reducing Inflammation & Improving Blood Flow- this is done on a nutritional and supplementation level. Most leading experts in this area recommend reducing or eliminating processed food and increasing healthy fats and protein intake while reducing carbohydrate intake. This will help reduce inflammatory response in the brain. Improving the gut-brain axis is important during this phase because the vagus nerve gets stimulated post concussion & this can increase permeability in the gut lining. So it’s a good time to cut the crappy food out!

Add healthy fats like:

  • Avacados

  • Omega 3 fats like Salmon, Anchovies, Mackeral and Herring

  • Omega 3 supplements with high DHEA (+400)

    Reduce Omega 6 Fats that are found in:

  • Peanuts/Peanut oil

  • Seed oils

  • Chicken

  • Cured meats

  • Dairy products

  • Processed foods like: chips, corn chips and crackers

    When your team of sports medicine and physio therapists deem that it’s appropriate to increase blood flow, work with them on their exercise protocols and monitor how you feel post training session. This will help them to help you heal quicker. Your brain/NS is keeping the score here so you can’t outsmart it. It will respond based on it’s capacity. Work on regulating your NS and provide a nourishing environment for these 2 steps to occur because it’s 70% of the work.

3) Rehabilitation. This is where your team of trauma trained sports medicine and physio therapists will work judiciously with you and expand your progress as your symptoms dissipate. They will help you to adapt to where you need to. Returning to normal may be possible or it may look different. Be open to learning new ways to develop and expand in your sport.

Depending on the concussion sub-type most athletes in this age range and older are able to start rehabilitation wihin 5-7 days. Despite where you are in your concussion recovery, you can still apply these 3 steps to yourself.

Be good to yourself! You’ve got this!

Patti Johnstone
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Nervous System Basics