I’ve had six notable concussions in my life usually about a year apart. My fifth one almost killed me. While unconscious, I had a vision of a stained glass Buddha telling me I was near death. My sixth can still make me unable to walk, talk, or think. Concussions are no joke. The media will often show someone getting knocked out for an hour as no big deal, but being unconscious for more than a few minutes is a sign of significant brain damage. Not even the best football players, special forces operators, or martial artists can withstand years of trauma. These types of trauma are considered mild Traumatic Brain Injuries (TBI). Anyone who drives a car is at risk for severe, life-altering moderate or severe TBI. As I found out during my ongoing years of recovery from Post Concussion Syndrome, there is a lot we don’t know about concussions. Here’s what I’ve found out over my experiences with therapuetic meditation, three physical therapists, four neurologists, a chiropractor, an accupuncturist, and much more of the medical system than I’d prefer.

tl;dr: You will heal AT YOUR INURY’S PACE NOT YOUR OWN: Sleep as much as you need, cardio exercise to a constantly increasing threshold, and retrain your eyes for screens. If your dizziness/nausea is troubling you see a physical therapist with expertise in vestibular rehab

Rules of Thumb

  • Sleep.
  • Limit screen time.
  • Don’t put yourself at risk for another concussion. Stop playing rough sports, don’t drive wrecklessly, try to avoid cops.
  • Figure out what triggers your symptoms, especially headaches. Avoid these triggers at first. Then slowly expose yourself to some of them if your normal life has these triggers.
  • Take breaks during cognitive tasks like school or work.
  • Do aerobic exercise that doesn’t trigger your symptoms.
  • When in doubt about the amount of effort to put into rehab, err on the side of too little rather than too much.
  • Don’t drink alcohol, and lay off the weed. CBD can help alleviate pain, anxiety, and/or emotional stability. NSAIDs as needed for migraine relief.
  • Keep doing what you’re able to that’s part of your normal routine.
  • Slowly practice what you aren’t able to do. Build back to normal at your body’s pace not your usual pace. This can be incredibly slow after a significant injury. Don’t consider pushing yourself, because it will only slow down your healing.
  • If needed, find medical practitioners who are knowledgable in treating concussions. Dr. Glenn at Raleigh Neurology is the best concussion rehab and diagnosis I’ve ever been to.
  • “Headaches are like your brain screaming at you”, said my last PT who was my best PT in RTP

General Care

None of this advice is specific to concussion/PCS rehab, but it sets a good foundation for healing. Eat a healthy, balanced diet. Do sometime of mindfulness meditation or contemplation. Get at least 3 aerobic workouts of 20-45 minutes per week. Sleep enough. Listen to your body. If it’s telling you not to do that next set, or drink that next beer, don’t do it. Keep up with social engagements, and try to surround yourself with friends who care about you.

Heal the Hardware

What helped me recover the most was thresholded cardio exercise. Even be five minutes of walking can greatly accelerate your recovery! PCS can leave your cerebral autoregulation disfunctional. This means that your brain can’t regulate blood flow to it, causing excessive blood pressure which can squeeze your brain and cause symptoms. It’s similar to how your electronics will get fried if lightning strikes your house. To rebuild your cerebral autoregulation, you need to do aerobic exercise that doesn’t trigger your symptoms. Under a doctor’s supervision, they’ll conduct a test where you gradually increase exercise intensity on a treadmill while rating your symptoms every minute and measuring your heart rate. Your doctor will determine the maximum BPM you can exercise at without provoking symptoms. You can do exercise below that heartrate threshold, and over time you’ll find that threshold increases. Be sure to get a good heartrate monitor for this. Thanks to Dr. Morgenlander at Duke Medicine, I felt almost completely better after two and a half months! DO NOT OVER-DO IT. I went too hard for three days in a row and ended up much worse. I could barely walk without wretching with nausea. There were days when I wasn’t sure if I could make the walk to the bathroom. After another eight months of recovery and vestibular rehab, I was finally able to start doing the thresholded cardio routine again. So do not overdo it. When in doubt, do too little rather than too much. Fight the urge to push through exercise. Do too little, not too much.

A lot of the doctor’s appointments had me rate my symptoms. I realized I was underestimating them, so doctors continually thought it wasn’t a big deal. Just because I can cope with the symptoms doesn’t mean I should. Overestimate your symptoms so doctors take your injury seriously. A lot of concussion research has been done in the past ten years, which means a lot of (older) doctors aren’t as familiar with it. Some doctors may not take this invisible injury as seriously as they should. Be sure to find a doctor that is knowledgable about TBIs.

My physical body was damaged, so some of the beginning physical therapy was to loosen muscle tension around my spine. This treatment consisted of massages, dry needling, and specific stretches and exercises. The exercise was similar to the postural workouts some trainers have posted. Dry needling helped rebuild muscle that had been damaged from years of bad posture at a desk job, helping me walk and stand with proper posture. I found that neglecting my posture for even ten minutes would bring about moderate to severe symptoms rapidly. Thankfully, the symptoms would disappear quickly when I held proper posture. Standing meditation and yoga were particular helpful for being mindful of my posture. The flexibility and strength gained from yoga further helped support my good posture. After a while of physical treatment, some of my symptoms were under control, but I still felt nauseous, dizzy, forgetful, foggy, and generally unwell.

Vision is Expensive

Imagine a budget where the currency is chunks of work done by bodily functions. Vision is exteremely cognitively expensive, but healing is pretty expensive too. You have to balance this budget to keep healing going smoothly. Our eyes have been an incredible boon to our species’ continued survival. They take in incredible amounts of info quickly enough during a single sweep of a room. Imagine the incredibly complex problems in computer vison. Now imagine how sophisticated that could get over millions of years. Make sure your contacts or glasses prescriptions are up to date. You may have to repair that part of your brain while it’s still functioning, so any slight strain on eyes can slow down the all-hands-on-deck healing scenario. When I got my latest prescrpition, it felt like I was finally spatially aware. Go to an opthalmologist not your corner store optometrist to get checked.

Lately, I’ve been rehabbing with Netflix. Limit screen time because it is hard on our eyes. I had to be aware I couldn’t binge watch things like I used to. The optical attention needed was sometimes too much. Be sure to reintroduce screen time slowly since most of our lives depend on it. A tool like f.lux or computer reading glasses will help ease eye strain.

Your Vestibular System

A good metaphor is a computer with five mice plugged in. It would be so hard to work unless you have something coordinating those inputs. Likewise, the vestibular system keeps your senses in sync, which keeps you experiencing a single reality instead of five. When your vestibular system is damaged, you will constantly feel dizzy, nauseous, or perturbed. The idea around vestibular rehab is provoking mild symptoms and then letting the brain “realize” this stimulation is normal. When your brain thinks this is normal, it creates fewer symptoms. Some vestibular exercises I had to do (and still have to do) in order of increasing difficulty:

  • Put thumbnail sized printout of an ‘E’ on a blank wall. Shake your head side to side while keeping your eyes on the ‘E’. Go only as fast as you need to keep the ‘E’ in focus. Repeat with nodding your head up and down.
  • Keep your elbows around ninety degrees. Toss a ball to around eye level into alternating hands and keep your eye on the ball.
  • Repeat the ‘E’ exercise but with a patterned, distracting background.
  • Repeat the ball toss exercise while walking a straight line.
  • Walk a straight line while keeping your eyes on a focus point. Do a full 360 turn at some point in your walk. Repeat rotating the other way. Be sure not to run into things.

Suprisingly, video games are a great way to keep your eyes and vestibular system sharp. It’s for your health! The spatial awareness, quick decision making, and perception required by some games makes it a valuable recovery tool when you can handle it, try incorporating videogames into your physical therapy routine. Don’t get so lost in the game you fail to notice symptoms arising.

Medications and Supplements

Don’t drink, as the symptoms of being drunk are fairly similar to those of a concussion. Although THC can help with migraines, lay off the weed as it can shorten your already damaged memory and attention span. CBD can help alleviate pain, anxiety, and/or emotional stability. Take NSAIDs as needed for migraine relief. Higher quality fish oil supplements helped my cognitive abilities, taking about a month to feel the difference. There’s a lot of crap fish oil on the market, so be sure to consult your doctor and your own research. Testosterone triggers healing in males. I provided my body with the building blocks for testosterone: zinc (zinc picolinate), magnesium (magnesium threonate), BCAAs (2:1:1), and the fish oil previously mentioned. I noticed my head recovered quicker after taking all four supplements for a week. Things that would take me days to heal now only took a night.

My third neurologist Dr. Glenn at Raleigh Neurology prescribed me amitriptyline, atomoxetine, and proprananol. Amitriptyline helps prevent migraines, but it took about 4 months of doctor’s consulations to find the right dosage for me. Now it largely prevents chronic migraines, but it doesn’t help migraines from doing things I know trigger my symptoms. For treatment of acute migraines, an NSAID like ibuprofen helps. Atomoxetine (Straterra) helps you focus, similar to Ritalin or Adderall. Atomoxetine is a norepinephrine reuptake inhibitor. Because it works on norepinephrine rather than dopamine the effects can take up to a month to show up, but it’s not nearly as addictive as Ritalin or Adderall. Due to Ritalin or Adderall’s effect on dopamine, they can be highly adictive, but very quick to take effect. Straterra can drastically worsen your depression and/or suicidal thoughts. Be sure to do your own research and ask experts questions.

Emotional Winds and No-Sail

Although a rarer symptom, I noticed a permanent shift in my emotions. I found myself more impulsive, falling for advertising, and blurting out unprofessional things at work. I started experiencing anxiety and panic attacks as part of my PCS. After a period of craning my neck, over-exerting, or doing nothing, I would be buffeted by gusts of emotions: sadness, grief, uncontrolled laughter, ecstasy, pity, despair. I called these emotional winds. They could sail my boat into rocks, but it provided me impetus to learn how to take down my sail. When despair comes a knockin’, don’t try to be immovable; try to provide nothing to move.

During my past concussions, I would usually become reaquainted with language, problem-solving skills, and kinesthetics. Each dose of perspective gave me a newfound respect for the complexity of a human brain. I wish they gave me a respect for my own body, but luckily I got to learn that lesson before my first twenty five trips around the sun. Three years away from my old self is a long time. I’m not sure if I’ll ever get back, but I am sure I don’t need to go back. I’m lucky to be given perfect opportunites to dissolve into the fragile, ethereal beauty of being alive. I hope the lessons I’ve learned through this trial can help prevent the suffering of you or your loved ones.