Concussion and Exercise: The Importance of Exercise in Recovery

= Authors =

Aarchie Soni, BHSc Health Sciences Candidate 2024, McMaster University
Jenni Diamond, OT Reg. (Ont.)

 

Recovery after Concussion

A concussion is a type of traumatic brain injury, occurring from an impact to the head or body and resulting in concussion symptoms. Spontaneous recovery from a sports-related concussion typically occurs within 2-3 weeks, however, up to 30% of patients may have longer recovery times.1 You can read more about concussions in general on our previous blog post here. Guidelines for recovery after concussions and symptom management have changed quite a bit in the past few years, especially when it comes to exercise and concussions.

Previous Guidelines: “Rest is Best”

Previous guidelines for recovery after concussion favoured a “rest is best” approach, partially driven by the finding that excessive activity soon after concussion interfered with and prolonged recovery. As such, past consensus-based recommendations emphasized physical and cognitive rest until complete symptom resolution before training or sport.2

However, it is now understood that prolonged rest is not particularly effective after a concussion. In fact, prolonged rest and social isolation may exacerbate symptoms and delay recovery.2 Instead, moderate levels of prescribed physical activity by your healthcare provider may be beneficial in recovery after concussion.1

The most recent Concussion in Sport Guidelines statement in 2016 also acknowledges that there is insufficient evidence to support the effectiveness of prescribing complete rest. Instead, it is recommended that a brief rest period of 1-2 days after injury be followed by a gradual and progressive sub-threshold (which is at levels below the onset or worsening of concussion symptoms) return to activity, determined in consultation with your physician.3

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…it is recommended that a brief rest period of 1-2 days after injury be followed by a gradual and progressive sub-threshold return to activity…

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Current guidelines: “Exercise is Medicine”

Physical exercise within days of a TBI has been shown to assist in recovery in several ways. A way in which exercise may assist in recovery after concussion includes the induction of factors that promote neuron growth and repair such as brain-derived neurotrophic factor (BDNF).2

Some resulting effects of exercise on recovery may include:

____________________________________________________________________________

…exercise may … [induce] factors that promote neuron growth and repair such as brain-derived neurotrophic factor…

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What type of exercise works best?

Concussion can often cause exercise intolerance, which is the inability to exercise to the level predicted for one’s age and fitness due to an increase in concussion symptoms. The cause of exercise intolerance is unknown, but it is hypothesised that this may occur due to changes in the autonomic nervous system, cardiac stroke volume, and blood flow to the brain.1 Symptom worsening secondary to exercise may also deter patients from exercise.2

Research has shown individualized subthreshold aerobic exercise to be an effective intervention for recovery. Subthreshold exercise is exercise at an intensity that does not exacerbate symptoms. Walking, running, and stationary cycling are all examples of aerobic exercise that can be done to support recovery.7

Research done on this particular intervention has shown that subsymptom aerobic exercise treatments prescribed in the first week after concussion safely speeds recovery.7 Aerobic exercise has also shown to increase factors for growth such as BDNF as early as 5 weeks after starting training.2

______________________________________________________________________

…research has shown that exercise can be thought of as an effective medicine to help in recovery after concussion.

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So, research has shown that exercise can be thought of as an effective medicine to help in recovery after concussion. However—as is the case with any other medicine—it is important to consult with your healthcare provider to determine the appropriate dosage for you. Excessive or intense exercise can potentially be harmful, but by working with your healthcare provider to develop a personalized training regimen, you can get on the road-to-recovery faster! For more information on concussions, interventions, and current research, be sure to check our past blog posts.

 

 

References
  1. Bezherano I, Haider MN, Willer BS, Leddy JJ. Practical Management: Prescribing Subsymptom Threshold Aerobic Exercise for Sport-Related Concussion in the Outpatient Setting. Clin J Sport Med. 2021 Sep 1;31(5):465–8.
  2. Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is Medicine for Concussion. Curr Sports Med Rep. 2018 Aug;17(8):262–70.
  3. McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med [Internet]. 2017 Jun 1 [cited 2022 Dec 31];51(11):838–47. Available from: https://bjsm.bmj.com/content/51/11/838
  4. Itoh T, Imano M, Nishida S, Tsubaki M, Hashimoto S, Ito A, et al. Exercise increases neural stem cell proliferation surrounding the area of damage following rat traumatic brain injury. J Neural Transm [Internet]. 2011 Feb 1 [cited 2022 Dec 31];118(2):193–202. Available from: https://doi.org/10.1007/s00702-010-0495-3
  5. Itoh T, Imano M, Nishida S, Tsubaki M, Hashimoto S, Ito A, et al. Exercise inhibits neuronal apoptosis and improves cerebral function following rat traumatic brain injury. J Neural Transm (Vienna). 2011 Sep;118(9):1263–72.
  6. Seo TB, Kim BK, Ko IG, Kim DH, Shin MS, Kim CJ, et al. Effect of treadmill exercise on Purkinje cell loss and astrocytic reaction in the cerebellum after traumatic brain injury. Neuroscience Letters [Internet]. 2010 Sep 13 [cited 2022 Dec 31];481(3):178–82. Available from: https://www.sciencedirect.com/science/article/pii/S030439401000861X
  7. Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatrics [Internet]. 2019 Apr 1 [cited 2022 Dec 31];173(4):319–25. Available from: https://doi.org/10.1001/jamapediatrics.2018.4397

 

 

Concussion and Dietary Supplements: How to Feed your Recovering Brain

= Authors =

Laura Diamond, MSc Global Health Student

Gabi Kaplan, Student Occupational Therapist

Jenni Diamond, OT Reg. (Ont.)

Evan Cole Lewis, MD


 

What is a concussion?

A concussion is a mild traumatic brain injury (mTBI) that affects brain function. Symptoms include, but are not limited to:

The effects of concussion can last for several days, weeks, or months, taking a large toll on day-to-day living and activities (1).

How can my diet and nutrients affect my concussion?

For many years, scientists studied the role of pharmaceutical drugs as potential treatments for concussions. To date, these pharmaceutical agents have had minimal success in treating TBI (2).

Research has revealed that following brain injury, a wide range of changes occur in both the brain and body – these include changes in nutritional status. Scientists believe that these nutrient deficiencies may worsen concussion symptoms and prolong recovery (2).

Treating concussions with vitamins, nutrients, and minerals has great potential as an effective treatment for concussions. While still largely understudied in humans, recent animal research has shown promising results for supplementing basic nutrition to improve brain injury recovery. These nutritionally-based therapies (or “nutraceuticals”) are FDA approved and have few interactions with other drugs, making them deal candidates for concussion therapy (2).

 


Research has revealed that following brain injury, a wide range of changes occur in both the brain and body – these include changes in nutritional status.


 

Which nutraceuticals may help me?

Research reveals Vitamins B2, B3, C, D, and E may have a role in the treatment of concussion symptoms, either alone or in conjunction with other supplements or pharmacological treatments (2; 4; 8; 9).

 


… vitamins and supplements found in our everyday foods have the potential to aid in the prevention, treatment and overall recovery from concussion.


 

It’s clear that many vitamins and supplements found in our everyday foods have the potential to aid in the prevention, treatment and overall recovery from concussion.

At present, the majority of the available data is limited to animal studies. Therefore, the FDA has issued warnings against the promotion of dietary supplements in concussion treatment (10). Additionally, many of these supplements are not subject to the safety/quality standards of the FDA so the exact potency of any commercial product may not reflect what is printed on the label (8). Until more human studies are completed, the role and effects of these alternative treatment options remain unclear.

 


Many supplements are not subject to the safety/quality standards of the FDA so the exact potency of any commercial product may not reflect what is printed on the label.


 

Meanwhile, it is important to be aware that “rapid, thorough evaluation by a health care provider, followed by rest, sleep, and light exercise, are essential for full recovery from a concussion” (10). And, of course, eating balanced, nutritious meals can ensure your brain receives a wide variety of the important vitamins and nutrients listed above.

So if you or a loved one are suffering from a brain injury, don’t forget about the role nutrients and vitamins may play in your recovery. Be sure to ask your doctor which of these supplements are right for you! And of course, stay tuned for more research…

 


 

Acknowledgment

Thanks to Keren Chen, Neurology Centre of Toronto’s stellar nutritionist, for comments and review.

 

References

  1. MFMER. (2018). Concussion. Retrieved from https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594
  2. Haar, C. V., Peterson, T. C., Martens, K. M., & Hoane, M. R. (2016). Vitamins and nutrients as primary treatments in experimental brain injury: Clinical implications for nutraceutical therapies. Brain research, 1640, 114-129.
  3. ODS (2018). Riboflavin. Retrieved from https://ods.od.nih.gov/factsheets/Riboflavin-Consumer/
  4. Hoane, M.R. et al. Treatment with vitamin B3 improves functional recovery and reduces GFAP expression following traumatic brain injury in rats. J Neurotrauma. 2003 Nov;20(11):1189-99.
  5. ODS (2018). Vitamin C. Retrieved from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
  6. ODS (2018). Vitamin D. Retrieved from https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  7. ODS (2018). Vitamin E. Retrieved from https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/
  8. Ashbaugh, A., & McGrew, C. (2016). The role of nutritional supplements in sports concussion treatment. Current sports medicine reports, 15(1), 16-19.
  9. Hoane, M. R., Wolyniak, J. G., & Akstulewicz, S. L. (2005). Administration of riboflavin improves behavioral outcome and reduces edema formation and glial fibrillary acidic protein expression after traumatic brain injury. Journal of neurotrauma, 22(10), 1112-1122.
  10. Hume, A. L. (2018). FDA warns companies against promoting dietary supplements for concussions. Pharmacy Today, 24(9), 16.
  11. ODS (2018). Omega-3 Fatty Acids. Retrieved from https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/
  12. NCCIH (2018). Coenzyme Q10. Retrieved from https://nccih.nih.gov/health/coq10
  13. Kalayci, M., Unal, M. M., Gul, S., Acikgoz, S., Kandemir, N., Hanci, V., … & Acikgoz, B. (2011). Effect of Coenzyme Q 10 on ischemia and neuronal damage in an experimental traumatic brain-injury model in rats. BMC neuroscience, 12(1), 75.
  14. ODS (2018). Magnesium. Retrieved from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/

Sex After Brain Injury: What Does This Look Like for Me?

= Authors =

Gabi Kaplan, Student Occupational Therapist

Jenni Diamond, OT Reg. (Ont.)

Evan Cole Lewis, MD


 

 Sexual Function following a Brain Injury

Sustaining a brain injury can lead to a variety of physical, cognitive, emotional, and behavioural issues that can change your sexual functioning and intimacy experiences.

 


Women & men may experience sexual issues differently


 

For instance, following a brain injury, you may be experiencing (1,2):

Women and men may experience sexual issues differently (2).

 

Some of the most commonly reported issues following a brain injury are (2):

Women Men
Difficulties with initiation and arousal Difficulties initiating sex
Difficulties with orgasm, or reduced sensation Difficulties reaching orgasm, or less intense orgasm
Difficulties with lubrication, leading to vaginal dryness Getting and maintaining an erection
Painful sex Premature ejaculation
Discomfort in positioning Body positioning and movement
Changes in menstruation
Inability to masturbate

 

These changes in sexual function might be due to (1,2,5):

 

Autonomic Dysfunction and Concussions

Following a concussion (also known as a mild traumatic brain injury), you might be experiencing similar sexual functioning issues that are listed above. One plausible reason for your changes in sexuality may be due to autonomic dysfunction, which can occur after a mild traumatic brain injury (mTBI) or concussion (3).

 


… one plausible reason for your changes in sexuality may be due to autonomic dysfunction…


 

Our autonomic nervous system is involved in influencing certain involuntary bodily functions, such as our:

In fact, innervation of sexual organs is primarily mediated by the autonomic nervous system (4). So when this system is not properly functioning, your sexual response can be impacted.

 

What can I do to improve sexual functioning and intimacy?

  1. Communicate with your partner

Don’t assume your partner knows exactly what you are going through. Try your best to be as open as possible when speaking about all aspects of your brain injury, including your sexual issues.

 

  1. Plan and prepare for sexual activities (1,2)

 

  1. Pay attention to your body position during sex (1,2)

When having sex, position yourself so that you are not causing pain or dizziness. If you are having balance issues, position yourself to avoid falling or exacerbating the symptoms.

 

  1. Try new things to increase arousal and/or comfort (1,2)

If you are having difficulties getting aroused, try watching movies or reading books/magazines with sexual content. Additionally, try initiating sexual activity with foreplay, which can help psychologically and physically prepare you for sex. If penetration causes pain due to vaginal dryness, consider using a lubricant.

 


… your doctor, nurse practitioner, occupational therapist or psychotherapist… may be able to help you in identifying the underlying issue, manage your symptoms, and help develop a solution.


 

  1. Speak with your healthcare provider and seek advice (1,2)

This might include your doctor, nurse practitioner, occupational therapist or psychotherapist. They may be able to help you in identifying the underlying issue, manage your symptoms, and help develop a solution. Often, speaking about sex and sexual issues makes people feel uncomfortable or embarrassed. Try to remember that sexual activity is a normal aspect of our everyday lives. In addition to speaking to healthcare professionals, you may choose to talk to close friends or family members.

 


References:

  1. Model Systems Knowledge Translation Center (2011). Sexuality after traumatic brain injury. Retrieved from: https://mrri.org/wp-content/uploads/2016/02/tbi_sexuality_moss_.pdf
  2. Ahmad, T. & Yeates, G. (2017). Sex and sexuality after brain injury. Headway: the brain injury association. Retrieved from: https://www.headway.org.uk/media/4995/sex-and-sexuality-after-brain-injury-e-booklet.pdf
  3. Esterov, D., & Greenwald, B. D. (2017). Autonomic Dysfunction after Mild Traumatic Brain Injury. Brain sciences, 7(8), 100. doi:10.3390/brainsci7080100
  4. Kaplan, H. I. & Sadock B. J. (1995). Comprehensive Textbook of Psychiatry. 1(6) 1296
  5. Purves D, Augustine GJ, Fitzpatrick D, et al., (2001). Autonomic Regulation of Sexual Function. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK11157/

 

Concussion and Cannabis: Could CBD be used following brain injury?

= Authors =

Laura Diamond, MSc Global Health Student

Gabi Kaplan, Student Occupational Therapist

Jenni Diamond, OT Reg. (Ont.)

Evan Cole Lewis, MD

April 9, 2019


 

The therapeutic benefits of cannabis

Cannabidiol (CBD) is one of over 100 cannabinoid compounds found in the cannabis plant. CBD has been shown to have many potential therapeutic benefits, including neuroprotective effects (1). Results of clinical studies support its use in some conditions associated with difficult to treat epilepsy and for symptoms related to multiple sclerosis (2,3,4,5). There is emerging support for its use in other areas such as chronic pain, anxiety, and Parkinson Disease to name a few (6). Currently, however, little is known about the role of cannabis in treating concussions and post-concussion syndrome.

 

Cannabis and concussion: What we know so far…

Majority of the existing research on CBD and concussion has been limited to animals. Most notably, a 2012 study on rats revealed that administration of CBD after brain injury had long-lasting, positive effects on the brain, including reducing the severity of the injury and restoring overall neurological function (1).

 


… medicinal cannabis may pose as an option for treating concussion-related chronic pain, specifically headaches.


 

More recently, however, this research has been shifting toward humans. A 2018 study reviewed previous hospital charts and displayed that medicinal cannabis may pose as an option for treating concussion-related chronic pain, specifically headaches (7). However, these novel findings are quite preliminary and more studies are needed to validate the results.

 

The future of cannabis-concussion research

Recently, many researchers have been interested in advancing these emergent findings and investigating this alternative concussion intervention. In fact, Dr. Gillian Hotz is currently embarking on an ongoing study investigating the effects of CBD in combination with an anesthetic for individuals with traumatic brain injury. Her preliminary findings suggest that this treatment improves cognitive function in mice (8).

In addition, one of the first double-blind studies exploring the effects of cannabis and concussion is expected to be conducted this summer by NEEKA Health Canada, the NHL Alumni Association and Canopy Growth Corporation, a cannabis company. This exciting new study will explore the efficacy of cannabis on reducing post-concussion syndrome impairments, such as depression, PTSD, and progressive dementia, among 100 previous NHL players.

The possibility of CBD as an effective intervention for post-concussion syndrome is without a doubt exciting! Stay tuned for future studies in this emerging field, and for the results of this upcoming study on professional hockey players.

 

If you or a loved one are suffering from a concussion, be sure to speak to your physician or contact NCT  to discuss which treatment options are best for you.

 


 

References:

  1. Pazos, M. R., Cinquina, V., Gómez, A., Layunta, R., Santos, M., Fernández-Ruiz, J., & Martínez-Orgado, J. (2012). Cannabidiol administration after hypoxia–ischemia to newborn rats reduces long-term brain injury and restores neurobehavioral function. Neuropharmacology,63(5), 776-783.
  2. Davies, S. (2018). Cannabis Scheduling Review Part 1: The therapeutic and medicinal benefits of Cannabis based products–a review of recent evidence. London: Department of Health and Social Care.
  3. Devinsky O, Patel AD, Cross JH, et al. Effect of Cannabidiol on Drop Seizures in the Lennox–Gastaut Syndrome. N Engl J Med 2018;378:1888–97. doi:10.1056/NEJMoa1714631
  4. Friedman, D., & Devinsky, O. (2015). Cannabinoids in the treatment of epilepsy. The New England Journal of Medicine, 373(11), 1048-1058.
  5. McCoy B, Wang L, Zak M, et al. A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome. Annals of Clinical and Translational Neurology 2018;5:1077–88. doi:10.1002/acn3.621
  6. Russo, EB. (2018). Cannabis Therapeutics and the Future of Neurology Front. Integr. Neurosci. https://doi.org/10.3389/fnint.2018.00051
  7. McVige, J., Bargnes, V. H., Shukri, S., & Mechtler, L. (2018). Cannabis, concussion, and chronic pain. Neurology, 91(AAN Sports Concussion Conference, Indianapolis, December 04, 2018: Vol. 91, Issue 23 Supplement 2).
  8. Lief, E. (2018). Work Continues On A Pill To Treat Concussions. Retrieved from https://www.acsh.org/news/2018/09/25/work-continues-pill-treat-concussions-13441

Concussion and Cannabis: Could CBD be used following brain injury?

= Authors =

Laura Diamond, MSc Global Health Student

Gabi Kaplan, Student Occupational Therapist

Jenni Diamond, OT Reg. (Ont.)

Evan Cole Lewis, MD

April 9, 2019


 

The therapeutic benefits of cannabis

Cannabidiol (CBD) is one of over 100 cannabinoid compounds found in the cannabis plant. CBD has been shown to have many potential therapeutic benefits, including neuroprotective effects (1). Results of clinical studies support its use in some conditions associated with difficult to treat epilepsy and for symptoms related to multiple sclerosis (2,3,4,5). There is emerging support for its use in other areas such as chronic pain, anxiety, and Parkinson Disease to name a few (6). Currently, however, little is known about the role of cannabis in treating concussions and post-concussion syndrome.

 

Cannabis and concussion: What we know so far…

Majority of the existing research on CBD and concussion has been limited to animals. Most notably, a 2012 study on rats revealed that administration of CBD after brain injury had long-lasting, positive effects on the brain, including reducing the severity of the injury and restoring overall neurological function (1).

 


… medicinal cannabis may pose as an option for treating concussion-related chronic pain, specifically headaches.


 

More recently, however, this research has been shifting toward humans. A 2018 study reviewed previous hospital charts and displayed that medicinal cannabis may pose as an option for treating concussion-related chronic pain, specifically headaches (7). However, these novel findings are quite preliminary and more studies are needed to validate the results.

 

The future of cannabis-concussion research

Recently, many researchers have been interested in advancing these emergent findings and investigating this alternative concussion intervention. In fact, Dr. Gillian Hotz is currently embarking on an ongoing study investigating the effects of CBD in combination with an anesthetic for individuals with traumatic brain injury. Her preliminary findings suggest that this treatment improves cognitive function in mice (8).

In addition, one of the first double-blind studies exploring the effects of cannabis and concussion is expected to be conducted this summer by NEEKA Health Canada, the NHL Alumni Association and Canopy Growth Corporation, a cannabis company. This exciting new study will explore the efficacy of cannabis on reducing post-concussion syndrome impairments, such as depression, PTSD, and progressive dementia, among 100 previous NHL players.

The possibility of CBD as an effective intervention for post-concussion syndrome is without a doubt exciting! Stay tuned for future studies in this emerging field, and for the results of this upcoming study on professional hockey players.

 

If you or a loved one are suffering from a concussion, be sure to speak to your physician or contact NCT  to discuss which treatment options are best for you.

 


 

References:

  1. Pazos, M. R., Cinquina, V., Gómez, A., Layunta, R., Santos, M., Fernández-Ruiz, J., & Martínez-Orgado, J. (2012). Cannabidiol administration after hypoxia–ischemia to newborn rats reduces long-term brain injury and restores neurobehavioral function. Neuropharmacology,63(5), 776-783.
  2. Davies, S. (2018). Cannabis Scheduling Review Part 1: The therapeutic and medicinal benefits of Cannabis based products–a review of recent evidence. London: Department of Health and Social Care.
  3. Devinsky O, Patel AD, Cross JH, et al. Effect of Cannabidiol on Drop Seizures in the Lennox–Gastaut Syndrome. N Engl J Med 2018;378:1888–97. doi:10.1056/NEJMoa1714631
  4. Friedman, D., & Devinsky, O. (2015). Cannabinoids in the treatment of epilepsy. The New England Journal of Medicine, 373(11), 1048-1058.
  5. McCoy B, Wang L, Zak M, et al. A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome. Annals of Clinical and Translational Neurology 2018;5:1077–88. doi:10.1002/acn3.621
  6. Russo, EB. (2018). Cannabis Therapeutics and the Future of Neurology Front. Integr. Neurosci. https://doi.org/10.3389/fnint.2018.00051
  7. McVige, J., Bargnes, V. H., Shukri, S., & Mechtler, L. (2018). Cannabis, concussion, and chronic pain. Neurology, 91(AAN Sports Concussion Conference, Indianapolis, December 04, 2018: Vol. 91, Issue 23 Supplement 2).
  8. Lief, E. (2018). Work Continues On A Pill To Treat Concussions. Retrieved from https://www.acsh.org/news/2018/09/25/work-continues-pill-treat-concussions-13441