It seems that one athlete can have a concussion and recover without prolonged symptoms and return to normal activities and others can suffer chronic headaches, concentration problems, difficulty with focus and attention, depression, etc. for many months or even years. Some times the severity of the impact does not seem to match the duration or severity of the injury.
What could explain such differences in outcome. The answer lies in:
- 1st. Understanding the neuro-chemistry of concussion. A concussion is a mechanical insult that alters chemistry, resulting in a chemical insult.
It is difficult for most clinicians to appreciate this because after structural damage has been ruled out by imaging like MRI and CT, the only mainstream assessment is neuro-psychological. Abnormal findings then are labeled psychiatric, ignoring the mechanical cause of the condition. These findings are then either not treated and the patient waits for spontaneous resolution, or symptoms are treated with medication which does nothing to address the underlying problem.
- 2nd. Chemical insults in the body are handled by the immune system.
The immune response is individualized and is determined by genetics, previous health history, diet and nutrition pre and post injury, among other pre-disposing factors.
At 29 years of age, professional soccer player Ross Paule states "The symptoms are at their worse when I'm tired and sick," he said. "It's like the concussions broke down my immune system. It's a serious thing,”. He has been retired due to post concussion syndrome for 5 years.
- 3rd. Mechanical and chemical insult to the brain alter the function of pathways in the nervous system.
The pathways affected is determined by the location of the injury and the course the inflammation takes after the injury. We know that the most obvious pathways affected or perhaps the ones we have identified, involve the balance (vestibular) system and the extraocular (eye movement) systems. In these cases we have to remember that we are not rehabilitating injured muscle, we are rehabilitating injured brain and neuronal tissue.
Failing to understand this concept will dramatically reduce the chances of a favorable outcome. The sports injury world clearly understands the healing process of injured muscle tissue, ligaments and tendons. We know precisely how long these tissues need to repair before we begin rehab procedures. For example when I had my ACL ligament reconstruction surgery, the doctors and therapists involved had a clear understanding of the process and the capacity the injured tissue had each week post surgery for recovery of function and improvement of strength and endurance.
It is precisely a lack of this type of understanding of injured neuronal tissue and how to determine the differences between different people with different bio-chemical and immune system make up, that we have such poor outcomes for concussion for some and good outcomes for others. We are depending on luck.
- 4th. The Gut / Brain connection. This last reason for the differences we have to post concussion care is worthy of its own post and will be the subject of our next post. Studies have shown leaky gut syndrome 6 hours post concussion. This causes a cascade of events that result in a chronic heightened immune response that can impact long term brain function.
“That’s because the brain and the gastrointestinal (GI) system are intimately connected — so intimately that they should be viewed as one system, rather than two.”