Thursday, June 21, 2018

Clarifying Concussions: What Should I Do If I Get One?

As the world has been made increasingly aware over the past several years, concussions – otherwise known as mild traumatic brain injuries – are scary.  The more they are studied, the scarier they become.  Until recently, the conversation about concussions centered primarily on the sport of football, but alarming statistics once muted in the discussion by lack of awareness are now getting the spotlight.  For instance, more than twice the number of concussions were diagnosed last year compared to the number of new cases of diabetes; of those concussions, 39% could render the concussed more likely to have a catastrophic head injury leading to neurologic disability if coupled with multiple concussions.

Though half of the reported concussions happen in youth sports (only an estimated half of all concussions are actually reported), the other half are due to common traumas that most experience throughout life, with prevalence by far the highest from ages 3-13, when balance, coordination, and strength are still being developed.  Common symptoms starting immediately after until around two days following a concussion include brain fog, difficulty concentrating, dizziness, emotional symptoms (anxiety, depression, confusion, irritability, etc.), fatigue, headaches, nausea/vomiting, and sleeping problems. 

For future reference, if you or a loved one experiences signs of a concussion, the following will walk you through the steps to ensure an optimal recovery:

Step 1: Pretend that you sprained your ankle or tweaked your back, and just rest.  For the few hours following a suspected concussion, remain awake under supervision and refrain from driving.  Then, sleep for 2-3 hour periods if possible, having someone periodically wake you in order to ask basic questions that will help rule out a more significant brain injury.  Rapid onset of more serious symptoms (severe headache, slurring, unconsciousness, repeated vomiting, etc.) would be the cue to seek emergency medical care. 

Step 2: It takes 95 G's of force to cause a concussion, but only 4 G's of force to injure the upper neck, making it impossible to suffer a concussion without also having an underlying neck injury.  The upper neck is where the brainstem, which is responsible for coordinating your internal functions, is located; the importance of having the upper neck evaluated by an Upper Cervical Practitioner far outweighs the lack of awareness on the subject.  Have the upper neck issue corrected as soon as possible, as it otherwise becomes akin to having a pebble in the shoe on the side of a sprained ankle, only this pebble compromises the hub of your nervous system.  Then, be re-evaluated consistently for at least a few months. 

Step 3: Just as walking on a sprained ankle is ill-advised, so too is a lot of stimulation (driving, exercise, school, screen-time, work, etc.); if you want your brain to heal, you have to give it time.  For 3-4 days post-concussion, continue to stay home in a dimly lit space and avoid stimulation.  Proceed to the next step once symptom-free.  If, after 4-5 days, symptoms remain, go back to see the Upper Cervical Practitioner for a sooner re-evaluation. 

Step 4: Simple mentally-stimulating activity (reading, listening to low volume music, etc.) may resume for no more than about an hour throughout one entire day and, so long as symptoms do not reoccur, it is then OK to proceed to the next step. 

Step 5: For half a day, return to school or work, but get a ride and avoid stimulation beyond your standard, in-person task list.  Students are advised to avoid tests and homework, recess, or gym class; adults should do no heavy lifting, operate dangerous machinery, or perform manual labor.  If symptoms arise during any step, return to the previous step; if consistently asymptomatic, proceed to the next step. 

Step 6: Return to school or work for a full day, being mindful to stay away from over-stimulating things like loud music or screen-time and over-stimulating environments that involve large crowds or critical thinking.  Alert whomever it may concern of a need to take more frequent breaks and of an expectation for roughly two-thirds production in your normal workload. 

Step 7: Take your time, but steadily return to your normal activities of daily living, removing one above-suggested restriction per day (one day gym, next day full study regimen, for instance).  The more the steps are rushed, the slower the healing process.  Seek re-evaluation from an Upper Cervical Practitioner a week to ten days post-concussion. 

Step 8: Get back to your normal routine, beginning with driving, then your typical class or workload and, assuming you are still asymptomatic afterward, vigorous exercise. 

After symptoms subside, there is still about a month-long window within which another even small impact can do greater harm.  For optimal healing, your brain requires normal blood and cerebrospinal fluid flow in combination with the cell tower of your internal network, the brainstem, being able to properly regulate the nervous system's response to stimuli, hence the role that the Upper Cervical Practitioner plays in balancing and stabilizing your upper neck.

If the above steps are followed immediately, healing time is shorter and long-term affects can be minimized. 

Sources: The CDC, The Headcase Company, Upper Cervical Health Centers of America

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