Mild Traumatic Brain Injury: 3 cost-effective tools and strategies to jumpstart your concussion recovery today.
By the end of this brief post, you'll have concrete, actionable tools to be sure that your concussion recovery is on the right trajectory - even before you've seen a concussion specialist. And the total budget should be a one-time fee of around $100.
Mild traumatic brain injury (mTBI), often interchangeably called "concussion," is a widespread form of sport and head injury. In other posts, you may have seen me throw around the numbers "3.8 million per year..." or "1 in every 2 people globally will experience at least one TBI in their life, 70-90% of those will be an mTBI..." That's a lot. Even still, some research suggests that around 50% of concussions go unreported, making those previous estimates low.
Some unsettling icing on the concussion cake; research shows most doctors (even neurology residents) are inadequately trained in concussion, while sports coaches feel overconfident in their knowledge. Meanwhile, many youth athletes are scared or embarrassed to report concussion symptoms to their coaches and doctors.
The only reason I start here is that roughly 60% of the patients I work with are patients with persistent concussion symptoms (PCS) sent through the "we don't know what's wrong with you" conveyer belt. Sometimes folks have been riding that conveyer belt for years without a concussion specialist stopping the belt to say, "Wait a minute. I've got some concussion-specific questions and exams for you that can help."
If you've been riding that belt or want to avoid that belt altogether:
Find a Carrick-trained and/or CCMI-trained concussion specialist near you.
Enjoy reading the rest of this post.
We're about to dive into high-yield, cost-effective tools and strategies to kickstart your concussion recovery. We'll break it down into nutrition, movement, and mindset.
Movement: Exercise tools & applications.
More and more (and more and more and more) research is coming out to suggest that "rest is (NOT) best" in concussion recovery. The champion drug in concussion recovery is proving to be SSTE (Sub-Symptom Threshold Exercise). We "dose" your exercise by prescribing specific heart rate intensities for you to work at for 10-30min at a time.
The way to properly "dose" and track this is through monitoring your heart rate (HR). You can use your Apple Watch, Fitbit, Whoop, etc... But if you do not already have the means to track your HR, I use and recommend the Polar H10 chest strap ($90). It's less than an Apple Watch, FitBit, or Whoop (w/subscription fees). And, by tracking your HR during your rehab exercise, you will know that you're at the "right dose" and on track for optimal recovery.
The other way that a Bluetooth HR monitor (e.g., Polar H10) is useful is that it can pair to affordable apps ($5) like Elite HRV or ithlete to help you track your autonomic recovery through heart rate variability (HRV). After a concussion, HRV gets low, and rehab is designed to bring it back up.
Thus, having a heart rate monitor allows you to dose your exercise properly and allows you to monitor your autonomic recovery. (As a bonus, your concussion specialist will love that you came prepared with one.)
Nutrition: How and when to eat.
I dive deep into concussion dietary strategies here. The quick and dirty takeaway is this: you do not need fancy, expensive, complicated dietary strategies in concussion recovery.
The two strategies that I recommend most often to patients include:
Adopting a Mediterranean/Plant-Heavy Diet. Usually with the caveat of being gluten-free, dairy-free in the first 2-4 weeks after an acute concussion.
Adopting a time-restricted feeding (TRF) schedule that includes a 14-18hr fasting period. (We're not going to talk about this here.)
It's the first bullet that trips people up. Should they buy Mediterranean cookbooks? What makes a recipe "Mediterranean?" What if I don't eat gyros? (That last one was a joke. Gyros aren't a requirement.)
When deciding WHAT to eat, I often send patients to this tool from Precision Nutrition, and folks find it wildly helpful (I've even referred professional athletes to this tool before). It's a macronutrient (e.g., protein, fat, carbohydrate) calculator based on your age, height, biological sex, dietary preferences, daily activity level, weekly exercise level, etc...
The (free) end product is a guide that tells you rough portion sizes to be included in your meals and days. So rather than getting caught up in the "is this Mediterranean or not?" game, you can focus on getting adequate portions of minimally processed foods in your recovery.
Fill out your basic information while checking "Mediterranean" for preferred eating style. (*Paleo and Keto also work for concussion recovery. The Mediterranean diet is simply much more accessible, affordable, and adaptable to most people from most backgrounds.)
I typically tell people not to check "gain weight" or "lose weight" while in the acute recovery stages. You can always update and download a new guide as your recovery progresses.
Mindset: Breathing is powerful.
Regulating your breath is a way to regulate your nervous system. Our breath is really cool because it's simultaneously conscious and subconscious. We breathe through the night without thinking about it, and we can also slow or speed our breath just by thinking about it. How cool?!
Here we're going to look at breathwork in terms of mental/emotional help and improving physical things like HRV and sleep.
Breathwork and biofeedback are becoming growing tools in the mental health world. Mental health is HUGE in persistent concussion symptoms (PCS). Not only are anxiety, depression, irritability, and increased emotions a part of acute concussion symptoms, but those are the same symptoms and conditions that can lead to a delayed recovery.
It's relatively well-known that anxiety, depression, and PTSD are risk factors for delayed recovery. This is even shown in children, and newer research is associating certain personality traits with PCS.
This is not to say, "concussion is made up/in your head." However, it is to say, "how you are orienting to your world (anxious, depressed, traumatized) is impacting your mTBI symptoms and recovery." The best way to navigate these obstacles is through professional, third-party help like a counselor, therapist, or psychologist.
Sidebar: You will see many posts on social media, even from concussion specialists, arguing mental/emotional conditions and symptoms are caused by neuroinflammation or hormonal imbalances. While hormones and inflammation may play a PART in the puzzle, they're just that - part - not the CAUSE in the puzzle. You may have your hormones dialed in, supplements on point - and still have a shitty childhood, relationships, or job that you're not able to orient yourself to in a way that supports your mental well-being and recovery from mTBI. These are just the hard-to-swallow facts - most folks need therapy, even without a concussion history.
Bringing it back to the breath, we can leverage slow, paced breathing to improve our concussion recovery. It's largely thought that we can do this by using the breath to regulate our HRV. How do I have patients do this:
Go to Xhalr.com (free).
Adjust the settings to 5sec inhale, 5sec exhale, no holding.
Breathe following the pacer for 10-20min at a time using only your nose to breathe (no mouth breathing).
Repeat this 2 times per day. For example, 10min in the morning and 10min before bed.
This has you breathing at 6 breaths per minute, and that is a pace shown to increase heart rate variability (HRV) and alpha-brain waves in most people. These are associated with increased feelings of relaxation, pleasantness, emotional well-being, focus, decreased anxiety, decreased depression, etc...
Wrapping it all up.
If you've just sustained a concussion or know someone who has, or you've been dealing with symptoms for weeks/months/years, this should hopefully get you on or near the train tracks of concussion recovery.
Have a heart rate monitor. Use this to track your exercise dose and HRV recovery trends. Over time your HRV should improve (increase) with the right therapies, like appropriately dosed exercise and paced breathing.
Adopt a plant-heavy diet (e.g., Mediterranean Diet). Using a tool like the Precision Nutrition Macronutrient Calculator makes this process much easier to begin and track.
Breathe. Slowly. Daily. Spend 10-20min at a time with Xhalr, breathing at 6 breaths per minute through your nose. This is the freest way to "hack your nervous system" for calm and recovery.
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.