What to do when nothing helps after a concussion?

It literally took me over thirty years, an enormous amount of stress and most of all frustration, to figure out how to keep my mother going after a series of concussions – literally. The answer certainly didn't come from the doctors my mother saw. They did not recognise the problems she was developing, and explained that it would be between the ears. That was partly true, the problem came from the brain, but I don't think they indicate that.

Better insights are at hand.
Fortunately, we are now so many years later and there are much better insights into what can happen to you after a concussion. This provides better solutions, although I should point out that the problems after a concussion cannot always be completely solved.

In the section that follows I will try to explain why the persistent complaints arise, why not everyone seems to develop problems and apparently recovers without problems, how these complaints are usually dealt with and how better solutions are possible through the latest insights. Finally, I explain which approach is most important to you and what the first steps can be.

You probably haven't done everything yet.
Let me start by saying that it is likely that you have not yet done everything to get rid of the persistent symptoms after a concussion. How do I know? After working with patients with brain injuries on a daily basis for almost 30 years and a relentless urge to find out more about the consequences and solutions after non-congenital brain trauma, I may say that I have developed a reasonable overview of what is possible. . In hindsight, the direct result of the powerlessness I had due to my mother's ongoing problems.

The standard approach
“Just take it easy for a few weeks, then the complaints will subside” or “In most cases, the complaints will disappear automatically after a concussion” or “You have to learn to live with that, adjust your life as best you can, and avoids as much as possible that makes the complaints worse” Just a few of the many statements that I hear every day.

If you belong to the approximately thirty percent who still have to deal with one or more of these things after an accident: dizziness, light and/or sound sensitivity, inability to think, nausea, constant fatigue, inability to do things for long periods of time or cannot make appointments with others because this is too much or because of persistent physical discomfort, you may be eligible for rehabilitation. If that is not possible, a combination of, for example, ergo and physio therapy follows, or you find your own way through the forest of therapists.

What this usually means is that we look at how your load capacity can be improved, you can make a better day layout, you can prevent and avoid excess stimuli and if you are lucky, your condition and physical discomfort will be worked on.

Compensation is often offered.
For some this provides relief and for a few even the solution to the problems that exist. Not for most though. As you will read on, offering compensation, improving brain reserve through natural repair is not the same as addressing the real underlying causes.

Specialised clinics.
It is therefore not surprising that at the moment a large group of people with a so-called post-concussion problem (persistent complaints after a concussion) do not want to accept it and move to, for example, the United States. In the U.S. There are several centers where there is a lot of expertise in the field of traumatic brain injury. Cognitive FX, Plasticity brain center, and the Amen clinics to name a few. In many cases, the approach there is clearly different from the one we see in the Netherlands. There seems to be a greater focus on the real underlying problems and the use of the latest knowledge from brain research in the training and treatment provided.

Striking at these centers is the use of advanced equipment such as functional MRI, SPEC scan, computerised eye functionality and fall probability measurement. Diagnostic resources that you will not come across in an average hospital or rehabilitation center in the Netherlands.

While this (relatively expensive) approach may seem successful for those dealing with mild or moderate problems, a week of therapy is far too expensive or not long enough to address all of the problems.

In any case, what we can learn from this is that we may need to look more at what is currently available about the cause of persistent complaints, and what we can use this with in treatment and training.

What is new scientific knowledge available?
In the rest of this article I will explain what scientific knowledge is currently available, and how you can use it in your specific situation.

Why is it so difficult to diagnose problems after a concussion?

Before I get into some important facts about what happens and is set in motion by a concussion or whiplash, I want to clarify the status quo around concussion diagnosis and especially who makes it.

As you now understand, or even experienced, usually no serious abnormalities are found by the doctor and in the hospital (if you have already been referred by your doctor). That is fortunate on the one hand, because no permanent damage has been detected, but on the other hand On the other hand, this is also very unsatisfactory, because there are still complaints. What is going on here?

Doctors are there to diagnose and diagnose diseases.
Doctors are primarily trained to diagnose diseases (pathology). Yes and… you may wonder? Is a concussion an abnormality? Not necessarily. In most cases there is no demonstrable damage. The diagnostic equipment that is usually used is not made to detect functional problems. So in most cases you go home with the message “luckily everything is fine” or “congratulations, we have not found any abnormalities, you will have to be patient. If you have persistent complaints, come back.”

However, as you will learn in the following paragraphs, the latter does not make much sense to arrive at a better outcome.

So what's going on?
Although it is likely that the number of detections that something is going on will increase in the future, as enormous progress is being made in the diagnostic knowledge surrounding whiplash and brain trauma and we will soon be able to see for example through blood tests whether there is so-called white lane (nerve pathway) or glial (support system in the brain) damage through so-called SNTF and GFAP-BDP testing, this still does not solve the problem of what to do if there is demonstrably wrong .

Before we discuss possible solutions, let's review what we know from research.

Keep in mind that those who know the most about this topic are the researchers. Their knowledge and applications are often twenty, or more, years ahead of what is applied by doctors and therapists.

Some important facts.
In addition to what is generally known, here are a few facts about concussions and the resulting problems:

Some of us have a greater chance due to genetic predisposition to have problems after brain trauma (the so-called VAL-VAL combination).
The mental and physical health at the moment you experience an accident can be very decisive, for example whether you smoke, have diabetes, have just had an emotionally difficult time, etc.
If you have had a head injury before, the chance of problems is much greater
Your blood-brain barrier is opened temporarily or for a longer period of time allowing potential pro-inflammatory substances to enter after head trauma.

Your brain-belly interaction is disrupted.
A so-called low-grade neuroinflammation (inflammation mechanism) is set in motion to clear up damaged cells and waste products after trauma, but this often does not stop and when it does, it can easily be reactivated in the future.
Disautonomy, an imbalance in the autonomic nervous system that can cause blood pressure problems, dizziness, nausea, palpitations or a disturbed heart function. POTS (Postural Orthostatic Hypotension) is an example of this.
Central balance integration problems often arise, causing dizziness or a changed body and/or world view, which can disrupt physical, mental orientation and processing of information.
The networks associated with eye functionality are widespread and are therefore very vulnerable when head trauma occurs.
Hormone management, especially in women, can be disrupted by brain injury in which the pituitary gland starts to function incorrectly.
Superficial subcutaneous nerves around the head, neck and shoulders can become chronically irritated.
The translational force around the neck and head at the time of the accident disrupts the sensory information from the neck. This makes the interplay between the neck, the balance system, the eyes and the rest of the brain more difficult.
(In future articles we will elaborate on all the individual function disturbances described above)

Often too much attention for the psychological consequences.
And these are just a few of the most obvious things that seem to play a role in persistent complaints. I consciously did not mention the psychosomatic issues that can play a role in recovery after a concussion, they are all too often and too much attention paid, while the other factors that appear to be more important are not or hardly considered.

As you can see, a number of things are put forward here by researchers that are generally not or hardly looked at. Usually because the person who has to assess the situation has little or no specialization in order to be able to assess the functional problems that arise. And this is where there is a major gap in the current medical “care” system when it comes to the aftermath of a concussion. The diagnosis may or may not be established, the mapping of the underlying, usually functional, problems in the functioning of the brain and body after an accident is not or hardly at all.

The solutions you are looking for, if we are to believe the researchers, lie in what we have acquired in new knowledge about brain injury.
For example, we know from research that micro trauma can indeed occur in the brain and spine (the current research methods in the Netherlands are often insufficient to determine this, hopefully the new blood tests will be used on a large scale in the future). In addition, scientists show that detecting functional disturbances in the brain and the cooperation between body and brain function yield better solutions than the current approach. (all studies that are discussed can be found as an attachment under this article (-: )

What can you practically do with this information?
In the next section, I'll just point out the things I've seen in literally hundreds of patients that really make a difference (besides that research shows this).

Often the simplest solutions are the most powerful!
It is very likely that you are already using some of the things from the following passage through trial and error, because it makes you feel better.

One of the most powerful weapons you already have for tackling post-commotion problems is sleep, believe it or not. Your self-healing ability and also the ability to reduce your immune system and the neuro-inflammation we talked about earlier is quality sleep. Going to bed at the same time every day, counting the hours before 12 twice, is an important key.

Sleep
Although I don't want to go into detail in this writing on every item that could possibly help you, I would like to mention a few things, now that we are talking about sleep. Because I know from experience that sleep is a problem for many of you, I would like to point out a few things that we know are extremely important for good sleep:

• Do you go to bed the same time every day
• Do you spend about the same time in your bed
• You can only make up for lost sleep by taking so-called power naps (no longer than 30 minutes)
• No screen or other source of blue light one and a half to two hours before bedtime
• Totally dark bedroom
• Make sure your bedroom is neither too hot nor too cold
• Ensure good ventilation in your bedroom
• Your bedroom is there for sleeping, not for watching television or having intrusive conversations
• Dim lights long before going to sleep
• Try to do relaxation exercises when you do wake up
• Only use sleep medication if there is no other option (with sleep medication you only forget that you did not sleep well (-;)
• Don't eat 2 hours before bed unless you have blood sugar problems. Then only eat a small amount of proteins and fats, such as nuts, if you can tolerate them.
• Make sure your blood sugar level is constant, too low or too much blood sugar can have major consequences for good sleep
• Optimal sleep means 7.5-8 hours of uninterrupted sleep, not spending 8 hours in your bed. So it is possible that if you are a bad sleeper you are in bed at 9:00 in the evening and only get out of bed at 8:00 the next morning.

As you can see, not all solutions have to be complicated.

Lifestyle is often one of, if not, the most important ingredient for further recovery.
Here are a few other things that will help you further recovery:

• Take good care of your gastrointestinal system.
  There is an important connection between your gastrointestinal system and your brain. We're learning more and more about this, and I'll go into detail about this particular interaction in subsequent sections. Simply put, it comes down to taking good care of your microbiome (the jungle in your belly). Especially for the good gut bacteria.

What does this mean:

No junk food, avoid alcohol, limit the use of medicines to a minimum, no gluten, dairy products or derivatives thereof and especially many and various vegetables. The latter in particular is essential.
The fiber in vegetables is the most important ingredient for your intestinal flora. Your gut bacteria produce end products (so-called short fatty acid chains) that not only keep your gut healthy but also have a great influence on the proper functioning of your brain. They even help to dampen the inflammatory process in your brain that we talked about earlier.
Conversely, when your brain starts working better again, you immediately exert a positive influence on your intestines: Better mobility of your intestines, better production of stomach intestinal juices and enzyme production to name a few.

• Movement is also essential.
  Your brain recovers and improves through exercise. The right way of moving, within the possibilities that you have (even if it is only three times 5-10 minutes on a sitting bike, for example). Movement, especially high-intensity movement over a short period of time, releases substances such as BDNF (Brain Derived Neurotrophic Factor), Growth Hormone and the body's own morphine-like substances (Encephalins, Endorphins). These substances in turn promote recovery, ensure the production of new brain cells and repair of networks and also dampen neuroinflammation.

The health of our body, in particular the proper functioning of your brain, is totally tuned and dependent on movement. Even if minimal movement is possible in a day, that's where you start. There are no excuses not to do this. Point.

• Stress management.
  Also the next point is something that you can initiate and maintain yourself, or with some help from a therapist or the internet, namely stress management. Regardless of what you've been through or what situation you find yourself in. According to the researchers, the most effective ways to make your brain experience less stress and recover better are:

Meditation, even three minutes has a significant effect. This can be just monitoring your breathing. If you do this first thing in the morning, the effect will be further enhanced.
Mindfulness is experienced as very helpful by many who find meditation difficult. When you start, a guided body scan via an app or instructor can work very well.
Yoga and/or Tai Chi, in addition to the physical benefits associated with body awareness, control and feedback, both have very beneficial effects on mental well-being.
Things I would like to know myself.
I have not shared the knowledge I am about to share with you before. I am going to show what seems to have the most effect in practice. In other words, the things I wish I could have known when I was dealing with my mom's problems!

• Brain reserve
  One of the remarkable things I have seen in recent years is that when there is enough “brain reserve” there are more possibilities to deal with problems after a concussion. This is also the reason why some people seem to have few or no complaints, even if there is significant head trauma. If you have a lot of brain reserve and all other conditions (such as good health, nutrition, sleep, etc.) are correct, a lot can go wrong without it seeming to cause major problems in daily life.

How to see this? Suppose you use your brain optimally, you have plenty of academic and mental challenges and you can act on this. You live healthy and sleep enough, you do not smoke and you are in excellent condition. Depending on the severity of your head trauma, your brain reserve is quite large, say 60 percent. After your accident it is still 10 percent, but basically your brain is still pulling everything fine.

If, on the other hand, you only have 10 percent brain reserve to start because you are dealing with a chronic illness, a monotonous life with little challenge and/or you have already experienced a concussion, then it is a completely different story. The same head trauma has much greater consequences all at once. Your life is turned upside down and unlike that person with a large reserve, you may have all the symptoms you can imagine, and you may never be the same again, with the same head trauma. This is also the reason why two people experience the same accident and come out apparently completely different.

• Compensation isn't really a solution.
  Learning to compensate by making what already works even stronger is not really a solution. The weak functions caused by the head trauma are still present and so is the real underlying problem. Subsequent trauma, physical, mental, or overtraining overload is likely to resurface the problems for the simple reason that they never went away.

How can you rebuild brain reserve and restore the functional imbalance that has arisen?

So, although there seems to be nothing to worry about because you have learned to compensate, or have built up enough brain reserve, after a concussion, it is a matter of finding out where the weak spots originated.

Things that really matter.
A summary of the things (besides the lifestyle factors we discussed earlier) that seem to really matter:

• Reducing so-called brain (neuro) inflammation
• Addressing central vestibular issues
• Strengthening eye, head and balance integration
• Optimizing eye functionality and focused eye, brain training
• Training the weak networks and areas in the brain
• Addressing physical instability and dysfunction, including around the jaws
• The use of multi-tasking where body and mind learn to work together again
• Strengthening the energy management at the cellular level, for example through so-called hormesis.
• Reducing pre-existing autoimmune problems
• Optimizing the gut-brain collaboration
• The use of so-called photobiomodulation

There are more things that matter, but there is a good chance that when the underlying weak functionality after brain injury is addressed with the aforementioned approach, you are a number of significant steps further.

The reality at the moment is that with a bit of luck, only a few of these things are or have been used to help you further recover.

The correct sequence and intensity is of great importance.
Before you want to do anything with this approach (besides what you have already done) it is important to realize that you do this in the right order, with the right intensity and with your individual load capacity and combination of the already existing underlying factors (such as already present immune, degenerative problems, energy reserve at the cell level, etcetera).

Exercising for long periods of time is not the solution.
To give an example. Training for two hours a few times a week, for example, is not the solution, as this would be the case, for example, if you want to rebuild your condition (by the way, there is less and more intensively often more, but that is for another article). Your brain likes intensive, short and with many repetitions (at least 4 times a day). Change training in time when you can, because your brain likes variety and continuing with the same training has no or less and less effect. At the same time, it is important to carefully check whether you are not constantly going over the limits of metabolic load, because this can give days if not weeks back.

The things that really make a difference in practice.
To give you the best possible idea of ​​what additional possibilities there are in your specific situation, I now give a summary with a short explanation about the things that not only the researchers show that they can be valuable in finding better solutions after concussion , but which also really change my patients' practice.

Because it is not the intention of this article to give detailed explanations on every subject (this article would soon take the form of a book) and there are already several articles that discuss this in detail (see also attached reference list) do I short this so that you at least understand the essence.

Reducing so-called brain (neuro) inflammation
The immune system of the head (the so-called microglial system) reacts differently than that in the body. When a head trauma activates this system, it remains active or it can be reactivated very quickly, for example with stress, physical overtraining, etc. Activation of this system is responsible for so-called "brain fog", inability to think, difficulty with mental tasks, need too much sleep etc. (see also the video with detailed explanation about neuroinflammation and what you can do with it)

Addressing central vestibular issues
Although not everyone experiences dizziness after whiplash or head trauma, in practice we see that this system often causes serious problems. The integration between the balance system, the body and the head no longer works properly. This not only has consequences for the control of the posture apparatus and the movements and orientation of limbs, but it can also have major consequences for the processing of information in the higher parts of the brain. With the control of eye functionality, this is one of the most widespread networks and therefore also the most vulnerable. Recent research (Carrick et al.) shows that standard balance tests are not sufficient and that when looking at the head and body positioning in other planes in a more advanced way, significant disturbances come to light. In my own practice, we see this kind of underlying problem to varying degrees in about 75 percent of people who have to deal with the consequences of a concussion.

Strengthening eye, head and balance integration
Several studies show that specific training of eye functionality, in combination with head positions and the balance system, offers many advantages and positively influences recovery after head injury. I would like to point out that this must be done very specifically. Training the head and eyes in all directions generally leads to the application of compensation, which we do not want.

Optimizing eye functionality and focused eye, brain training
Remarkably many people I see in practice have already gone through a whole process with different therapists. When I ask what has benefited them the most, they often answer that it was eye training by a neurologically or functionally trained optometrist. Not entirely surprising because the control of the eyes is often disrupted by accidents. The beauty of eye functionality is that literally a large part of the brain is directly or indirectly involved in the functioning of the eyes. Specific eye movements (i.e. specific in type and direction) can be used to specifically train functionally weaker areas of the brain.

Training the weak networks and areas in the brain
Your brain is very smart at avoiding obstacles. When networks or areas are disrupted by a trauma, well-functioning areas take over tasks. An imbalance arises and with it a conflict in the brain. Tasks are no longer performed optimally and efficiently. Several studies show that specifically addressing the weak functionality leads to better results and more efficient use of the brain. In practice I see that specifically stimulating and training the weak areas of the brain is an important part for further recovery.

Addressing physical instability and dysfunction, including around the jaws, neck and skull
Not only are many pain complaints around the shoulder, neck and head caused by subcutaneous nerves (subcutaneous nerves) becoming chronically inflamed as a result of trauma, we also see that movements of the cervical spine, in the posture, and around the head are chronically disrupted. The erroneous movement patterns in turn lead to erroneous information flow to the brain. Several studies show that normalizing this sensory information flow (which is essential for the proper functioning of the brain), movements around the shoulders, trunk stability, the neck and even around the jaw, makes a lot of progress after accidents. . I can confirm this, but make the comment again that this cannot be done randomly. The more specific the better.

The use of multi-tasking where body and mind learn to work together again
When 1-6 are optimized, cognitive training, for example, word games or simple maths can be added to the other training. Neurocognitive examination, functional MRI and SPEC scans (for example, Quantitative EEG is a good alternative to, for example, very expensive Functional MRI or SPEC scan that are not accessible in the Netherlands), can provide detailed information about which tasks and associated areas are weakened. In this way, the various weakened functions are linked together and function is restored to a higher level.

Strengthening the energy management at the cellular level, for example through so-called hormesis.
This is a topic that is receiving a lot of attention at the moment. The energy factories at the cellular level are very vulnerable to the effects of trauma. After trauma and especially when neuroinflammation occurs, a so-called “cell danger response” occurs. A survival reaction in which the so-called mitochondria (the scientific name of the energy factories) no longer make energy. Not really useful if you want to have more energy or recover from a trauma. Fortunately, there are many things that can be done to initiate, restore and even strengthen energy production. Exposing yourself to low doses of stressors is a good example of this. This is also known as hormesis. Examples are exposure to heat (for example infrared sauna), cold (cold shower) intermittent fasting, in which no food is eaten from the evening meal for a period of 14-16 hours, for example, and physical activity, such as high-intensity interval training (adapted to your individual needs). condition) good examples of . I often hear from patients that applying the hormesis principle consistently yields a lot of energy gain. (Also check out the energy masterclass)

Reducing pre-existing autoimmune problems
This may not be the most obvious way to get rid of your complaints after a concussion, but in practice it literally turns out to be a "life saver" when you have to deal with it (unnoticed). (Autoimmunity is rampant in Western society and many of us will experience this phenomenon sooner or later. In the US, for example, it is predicted that 10-20% of the population will be directly affected). I know from personal experience that it usually takes 20 to 30 years to get a diagnosis. It is striking and the reason why I want to mention this is that for many of those who have to deal with post-commotion problems where no progress is made or where nothing works, the reason can often be sought in underlying autoimmunity. There is, however, a major snag. Most of us don't know if they are dealing with autoimmune issues until they reach stage 3 where there is significant tissue damage and an army of problems.

How do you find out if this is happening to you?

In the first place, the fact that there is one or more people in your family who has thyroid problems, psoriasis, Crohns, Ulcerative Colitis, Chronic vitamin B12, Celiac disease, disturbance that does not respond to anything or because there is simply a diagnosis of autoimmunity.

Furthermore, there are currently predictive studies in which it can be shown literally twenty years before there is really autoimmunity against which tissue type you make antibodies (for example those of Cyrex labs in the US). Although autoimmunity can never be solved, a lot can often be done to make the periods of remission longer and more frequent (this is important material for another article).

Optimizing the abdomen, brain cooperation
I've said something about this before. In short, you can say that optimal recovery capacity and brains depend on a properly functioning gastrointestinal system. If you already had to deal with recurring gastrointestinal problems before your concussion, it is now even more important to tackle this topic. Not necessarily by a specialist who is only focused on a so-called leaky gut (which can also be caused directly by brain injury, for example). Gastrointestinal problems will always have to be dealt with from north to south, ie from the mouth to the intestines. For example, a stomach that produces too little stomach acid will have to be dealt with first, even if there is a permeable intestinal wall. (also look at the “second brain masterclass”).

The use of photobiomodulation
In other words, the use of low-intensity red and infrared therapeutic lasers. Besides electromagnetic and direct, low voltage current to stimulate the brain, probably one of the most promising therapeutic applications in helping the brain to recover better. Although the use of these applications seems intense, in practice this is not the case. There are literally hundreds of studies that show that the use of therapeutic laser for brain trauma offers many benefits and undeniably aids the recovery process without adverse effects. What I experience in practice is that a certain category of patients literally indicates that when the laser is used, the light turns on again. Laser helps at a cellular level with energy management (for example, it activates the mitochondral function we talked about earlier) and has a lot of influence on dozens of repair processes at the cell level. Another advantage of laser treatment is that it does not take long, is not invasive and very specific! You can literally stimulate the weak parts of the brain and network directly. Another application that has been successfully used in traumatic brain injury is to activate and stimulate stem cells by exposing the blood vessels to the head to red light.

There is realistic hope.
This concludes the summary of my thirty-year quest, which I hope not only saved you a lot of time and energy, but also hopefully gave you renewed realistic hopes and showed that you probably haven't done everything yet to find better solutions to the problems. find your concussion.

Arjan Kuipers

N.B. Keep an eye on this website for new messages and especially watch the masterclasses on 1. Energy, 2. Your second brain, How do I keep my brain healthy and 4. Sleep

Free Zoom meeting with Arjan - after completing the Brain and Neurotransmitter Questionnaire
References