Understanding concussions

If you are a trainer, athlete, medical or military personnel, coach or concerned parent, this information can help anyone understand traumatic concussions. It is estimated that over 55% of all High School athletes have suffered a concussion and most of those are not properly identified.

The lack of early diagnosis is very dangerous since the possibility of a second concussion is very high and can easily lead to permanent brain injury (CTE/chronic traumatic encephalopathy), paralysis or death.

A concussion is a complex pathophysiological process that occurs in the brain. The brain is suspended by a fluid that surrounds it. Any abnormal force will result in a disturbance in the brains normal microscopic chemical activity.

Concussions do not require a loss of consciousness (LOC). Just a ride on a roller coaster can result in a concussion or a sudden stop. Any direct or indirect head trauma or even an impulsive force or rapid change in barometric pressure can result in a concussion.

Concussions usually result in some or all of these immediate findings; nausea/vomiting (projectile), blurred vision, slurred speech, fever, vertigo (dizziness),seizure, sudden sweating, loss of smell/taste/hearing/vision, loss of memory, ringing in the ears and immediate medical attention is required. Other symptoms may occur and nothing is solid since the literature is still evolving.

If you suspect that anyone may have a concussion, the first key is to assess if they have basic life support and so verification of a good airway, normal breathing and strong circulation (ABCs) must be established.

The next step is to observe the person’s motor skills, speech, thinking, social skills, common sense values and basic energy levels. Also if they avoid bright lights or loud sounds, but any symptom may occur and may take several days to develop.

Not allowing someone to sleep prevents the hiding of any advancing neurological condition. This is necessary since most concussions do not have any anatomical stamp, but they will have functional symptoms that are more noticeable. Often advance testing is not necessary since the majority of concussions have no changes as noted on an x-ray, CAT scan or MRI.

Current standard imaging provides little benefit to detecting a concussion, but the use of BOLD (blood oxygen level-dependent) technology is proving very helpful. This functional MRI (fMRI) shows promise with the ability to show altered blood supply to areas of the brain that have been compromised. Some blood testing for S100B protein has shown success.

Dr. Joseph Maroon (Neurosurgeon, University of Pittsburg) has invented the gold standard for concussions. The ImPACT test is a series of computer-based evaluations that are geared at detecting the many possible functional losses of a concussion. This is the most common test applied to over 50% of all US High School athletes, prior to beginning any athletic activity.

Many sports such as amateur boxing, children’s club sports and even general recreational activities have no pretesting concussion requirements, which put those participants at a higher risk.

The Standardized Concussion Assessment Tool (SCAT) test (currently 3rd edition) applies more of a sobriety skills (coordination/balance), mental recall and medical findings. The SCAT is a combination of information as collected by a certified athletic trainer, trained doctor/medical staff, coaches, parents or other fellow athletes and friends.

Typically the nerves located in the brain called cranial nerves are the affected. Having someone look up and down and move in their eyes in an “X” pattern will show either smooth (normal) or staggered (abnormal) eye movements (nystagmus).

A new protocol requires that the eyes be held in the upper corner position for 20 seconds, then returning to center. Often a concussion patient will dissolve and not be able to hold that position and it often results in nystagmus and/or an instant headache or nausea.

Past treatment involved primarily rest and avoidance of bright lights, loud sounds, physical and mental stress. This was and is necessary to allow the restoration of the microglia cells that are normally dormant, but become active following trauma. Failure to resolve this reaction results in immunoexcitotoxicity and is also found in the process of Alzheimer’s, Parkinsons, ALS and vascular dementia.

Concussions will result in altered cerebral blood flow, altered protein and glucose metabolism, decrease in (potassium) K+ and higher levels of calcium (Ca+). The altered blood supply to the brain is best treated with manipulation, fish oil, turmeric (curcumin), vitamin D3, resveratrol, green tea, potassium and magnesium.

Here is the list of the dosage recommended for a 150~175 pound, 18-35 year-old male to reverse the post-concussion effects on the brain.

Potassium 2500 mg/day
Fish oil 3000 IU/day
Turmeric 500 mg/day
Vitamin D3 3000 IU/day
Resveratrol 300 mg/day
Magnesium 250 mg/day
Green Tea 300mg/day (3-4 cups/day)

Elevating the person’s dietary protein levels with a supplement rich in BCAA’s helps promote the neurological system to recover and boost the body’s immune system. Good quality proteins are necessary since the body will assimilate them more efficiently.

Beginning exercise should begin with low-impact and low intensity exercise programs. Mental stress must be introduced gradually with a consistent re-evaluation of concussion findings.

Manipulation is necessary with post-concussion syndrome, since the re-establishment of normal cerebellar blood supply. Vestibular exercises are effective when dizziness is associated with any concussion.

The process of concussion evaluation should be provided by a qualified physician only. The entire process is very complex and requires specific training.

It is very important for everyone to be familiar with concussion recognition to prevent the possible of return to play too quickly, but don’t mistake this information for an excuse to make the critical decision for anyone to be cleared to return to normal activities.

Yours in Health!

Dr. David Ryan

Columbus Chiropractic Center Director

About the Author
Dr. David Ryan has an extensive background in both coaching and playing professional sports, and has been the team physician for several highly ranked teams. Dr. Ryan now serves as the current Co-Chairman of the Arnold Sports Festival (www.arnoldclassic.com) and is a former Medical Director of this internationally acclaimed event.

Dr. Ryans numerous articles have been published in International Medical Journals, Muscle & Fitness Magazine as well as on the popular BodyBuilding.com website. Visit Dr. Ryans home page on here: www.drdavidryan.com and his YouTube page here.