Understanding Concussions, TBI and PCS - You Must Know This

Concussion

A concussion is a traumatic brain injury (TBI) caused by an impact to the head or body, leading to a sudden acceleration or deceleration of the brain. This causes the brain to shift inside the skull, which stretches or tears the brain’s axons (nerve fibers), disrupting normal brain function. While this damage is functional rather than structural (meaning there’s no permanent damage to brain tissue), it triggers a cascade of events that affect the entire body.

Concussions are often called the “invisible disease” because their symptoms—such as brain fog, fatigue, and mood changes—aren’t always visible on a scan, but can be debilitating. Though about 90% of people with concussions do not experience a loss of consciousness, it’s important to understand that even without a blackout, the brain can still suffer significant trauma. Most people recover within four weeks, but about 30% of individuals experience persistent concussion symptoms (PCS).

Persistent Concussion Symptoms (PCS)

If you after 4 week of your injury still don't feel back to your self and still have symptoms you go into the category of Persistent Concussion Symptom. For those with PCS, the road to recovery can be long and challenging and often feel lonely, as most GP's will "give up" on you. I am here to tell you, you are not alone, you are not making it all up, and there are ways to address it and aid recovery.

Common symptoms include:

• Extreme fatigue
• Depression and mood swings
• Difficulty concentrating and processing information
• Sensitivity to light and sound
• Headaches and pain in the jaw, neck, or back
• Digestive changes
• Difficulty with social interactions and returning to work
• Disrupted sleep patterns.

These symptoms arise because the concussion disrupts various systems in the body, including the brain’s ability to produce energy and maintain cellular health.

The Biological Mechanisms: What Happens in the Brain

At the cellular level, a concussion leads to a surge in glutamate (a neurotransmitter) and an imbalance of sodium and calcium in brain cells. This causes the overactivation of neurons, which leads to toxic effects on nearby neurons and neurotransmitters. The cascade of events initiated by glutamate release results in excessive oxidative stress—an imbalance between antioxidants and free radicals. This oxidative stress damages cells, including mitochondria, which are responsible for producing ATP (adenosine triphosphate), the cellular currency of energy.

How Mitochondrial Damage Affects Recovery

Mitochondria are the powerhouse of cells, generating ATP needed for cellular functions. After a concussion, mitochondrial function is compromised, leading to reduced ATP production in the brain and muscles. This causes brain fog and cognitive impairment. The body attempts to compensate by increasing anaerobic (without oxygen) metabolism, but this process is less efficient and produces lactate (acid), which contributes to further inflammation and energy deficits.

The resulting energy crisis creates a vicious cycle. As ATP levels remain low, brain cells become less efficient at their jobs, leading to a depletion of energy and the persistence of symptoms. This is where the term “energy dysfunction” comes into play—brain cells are starved of the necessary fuel to function properly.

Delayed Responses and Inflammation

As the concussion progresses, inflammation and oxidative stress continue to affect the brain. Cytokines, which are proteins that regulate inflammation, flood the brain, causing further damage. The inflammation can harm the blood-brain barrier, leading to “leaky brain” syndrome, where unwanted substances can pass into the brain. This is similar to “leaky gut,” where the digestive barrier is compromised, allowing harmful particles to enter the bloodstream.

The gut-brain connection is significant, as the gut houses the majority of the body’s serotonin, a neurotransmitter that regulates mood, sleep, and digestion. When the gut is affected by concussion-induced stress, it exacerbates the mental and physical symptoms of PCS.

The Role of the Autonomic Nervous System

In concussion recovery, there’s also significant disruption to the autonomic nervous system (ANS), which controls involuntary bodily functions like heart rate, digestion, and breathing. After a concussion, the sympathetic nervous system (responsible for the fight-or-flight response) becomes overactive, while the parasympathetic system (responsible for rest and recovery) is underactive. This imbalance further impairs recovery, affecting blood flow to the brain and disrupting metabolism and digestion.

Neck Injuries and Whiplash: A Complicated Recovery

Another aspect of concussion recovery is the potential for neck injuries. Whiplash, which often occurs alongside concussions, strains the neck muscles, ligaments, and tendons, leading to joint dysfunction. This can prolong recovery time and may present similar symptoms to those of a concussion, such as headaches, dizziness, and difficulty concentrating.

The cervical spine (neck area) plays a crucial role in overall head function, and if injured, it can contribute to long-term symptoms like headaches, muscle tension, and sensory issues. This is why it’s important to address neck injuries as part of concussion treatment and recovery. Further, concussion symptoms and whiplash symptoms are the same, therefore a lingering concussion can be due to a whiplash. Whereas a concussion takes 4 weeks to recover, a whiplash injury can take up to 6 months. It's a good idea to check in with your osteopath or manual therapist to get clear on what the concussion has done to your neck area.

Second Impact Syndrome (SIS)

This sounds crazy, but did you know that many people with concussion repeatedly hit their head? It's really a thing, and even serious.

Second Impact Syndrome occurs when an individual sustains a second concussion before the first has fully healed. If the second impact happens within a short window—typically within 30 days—the brain’s ability to cope with the trauma is drastically reduced, and ATP levels are further depleted. This can lead to catastrophic brain swelling, a life-threatening condition.

Nutritional Support and Supplementation

While managing a concussion, nutrition plays an essential role in supporting brain recovery. Key nutrients and supplements that can help include:

CoQ10: This antioxidant has been shown to support mitochondrial function and can help alleviate symptoms like migraines, which are common in those with PCS.

Creatine: Known for improving ATP production, creatine can help restore energy efficiency in brain cells, making it particularly beneficial for those recovering from a concussion or TBI.

A diet rich in anti-inflammatory foods (such as omega-3 fatty acids, antioxidants, and whole grains) is also essential for reducing systemic inflammation and supporting brain health. Read the whole Anti-Inflammatory Article here.

Gut Microbiom: Research has shown that the gut microbiome is deeply connected to brain health through the gut-brain axis, and optimising the gut can have a profound effect on reducing inflammation, improving cognitive function, and supporting a quicker recovery from head injuries. 

Why Gut Health Matters After a Concussion:

Inflammation Reduction:
After a concussion, the brain experiences a state of heightened inflammation, which can hinder recovery and even lead to long-term neurological issues. A healthy gut microbiome can help regulate the body’s inflammatory response, lowering overall inflammation and reducing the risk of chronic symptoms, such as headaches and dizziness, following a concussion.

Mood and Cognitive Function:
The gut-brain axis means that the health of your gut can affect mood, cognition, and mental clarity. After a concussion, symptoms like brain fog, memory issues, and anxiety are common. By optimising gut health, you can improve neurotransmitter production (like serotonin), which can help stabilize mood and enhance mental clarity and focus.

Gut-Lining Integrity:
The gut's epithelial lining is essential in maintaining a barrier between the gut and the bloodstream. After concussion, the body often experiences disruptions in many systems, including gut integrity. Supporting gut health can help maintain or repair this barrier, reducing the risk of leaky gut and preventing the translocation of harmful bacteria or toxins that could exacerbate neurological symptoms.

How to Optimize Gut Health After a Concussion:

Probiotics and Fermented Foods:
Probiotics are live beneficial bacteria that can help restore balance to the gut microbiome. Adding fermented foodssuch as kefir, kimchi, sauerkraut, and yogurt to your diet can promote the growth of beneficial gut bacteria, enhancing digestion and reducing inflammation.

Prebiotics:
Prebiotics are non-digestible fibers that fuel the growth of beneficial bacteria in the gut. Foods like garlic, onions, asparagus, bananas, and whole grains can provide prebiotic support and further promote a healthy gut.

Anti-inflammatory Diet:
An anti-inflammatory diet can help reduce systemic inflammation, which can accelerate concussion recovery. Foods rich in omega-3 fatty acids (like fatty fish and flaxseeds), turmeric, and antioxidants from fruits and vegetables can help modulate inflammation in both the gut and brain. Read Full Article Here

Supplement for the Gut

Certain supplements can support gut health and integrity, such as L-glutamine (which helps heal the gut lining), collagen (which supports tissue repair), and zinc (which has anti-inflammatory properties). These supplements, combined with proper nutrition, can assist the healing process post-concussion.

Stress:

Chronic stress can negatively impact the gut microbiome and exacerbate the effects of concussion. Incorporating practices like yoga, breathing exercises, and meditation can help reduce stress, support gut health, and enhance recovery.

Rest, Movement, and Energy Management

Rest is crucial for concussion recovery, but it’s also important to gradually reintroduce movement. Focusing on exercises that strengthen muscles without aggravating the neck or brain is key. For example, yoga for the neck and core muscles can help alleviate tension and promote healing.

Additionally, managing energy is vital. Those recovering from a concussion should prioritize activities that provide emotional fulfillment, such as spending time with loved ones or engaging in hobbies. Work and other stressors should be secondary to these essential restorative activities.

Conclusion

Concussions are complex injuries that require a multifaceted approach to recovery. Addressing the biochemical, physiological, and psychological aspects is essential for long-term healing. Whether it’s through proper nutrition, supplementation, or careful management of physical activity and stress, understanding the full scope of concussion recovery is crucial for those dealing with persistent symptoms.