Moving Forward with Post Concussion Syndrome: 7 Next Steps

Brain Injury
Written By Kara Focht

Post Concussion Syndrome

Post concussion syndrome (PCS) is a complex disorder characterized by persistent physical, cognitive, visual, sleep, and/or emotional symptoms. Concussion symptoms typically resolve in a few days or weeks. PCS may be diagnosed when symptoms persist for weeks or more after the initial injury. 

The medical community is still learning about post concussion syndrome. While the disorder is not fully understood, there are known risk factors that increase someone’s likelihood for persistent symptoms.

PCS Risk Factors 

  • History: People who have had a previous concussion, brain injury, or learning disability  are more susceptible to PCS

  • Age: Older adults have an increased risk for developing PCS

  • Sex: Women are more likely to be diagnosed with PCS

  • Socio/emotional factors: People with a history of depression, anxiety, post-traumatic stress disorder, significant life stressors, a poor support system, and/or poor coping skills develop PCS more often

Moving Forward

Post concussion syndrome can be confusing and frustrating. Although the condition is not fully understood, there are many steps you can take to keep progressing. Here are some ideas: 

1. Talk to your doctor about these specific next steps

  • Ask your doctor for a referral to a multi-disciplinary concussion treatment team if you haven’t seen this type of team before. Specialized vestibular, vision, and/or cognitive therapy is a vital piece in the recovery trajectory.

  • Ask your doctor about neuropsychological testing for persistent cognitive challenges. This testing will help you better understand your strengths/weaknesses. It can also help figure out if cognitive challenges are directly related to the concussion, or something else.

  • Ask your doctor if another health condition could be impacting your recovery. B-vitamin deficiency, hormone imbalance, dysautonomia, and more can complicate concussion recovery. Your doctor may recommend blood work or other tests to get a better picture of your health.

  • Ask your doctor about trying complementary and alternative therapies for your symptoms. Acupuncture, dry needling, nutrition therapy, etc. have helped many people after a concussion.

  • Ask your doctor about supplements or medications to help with thinking skills.

  • If your doctor is not familiar with head injury, as for a referral to a neurologist or physiatrist.

2. Return to normal activities strategically

  • The brain benefits from a good daily routine and productive, meaningful activities. But, persistent changes in cognition can make people feel stuck moving forward. You can help your brain by getting back to the activities you love, strategically.

    • Some people are tempted to power through their symptoms and get back to life as quick as they can. Instead, set small goals each day and monitor your progress. Make adjustments as you go so you don’t do too much and set yourself back.

    • Some people are tempted to wait until they feel 100% before moving forward. Instead, take small steps to get back to the things you love. Try to focus on what you can do now instead of what you used to do.

3. Get additional help and support

  • Concussion recovery is not easy, and you shouldn’t have to do it alone! If you are struggling, consider these ways to get additional help and support:

    • Talk to a counselor. They can help you with changes in emotions and coping skills.

    • Talk to a friend or family member about what you are going through. Let them know what kind of support you need.

    • Try a local support group. Talk to others who are dealing with head injury and learn about local resources.

4. Take care of your brain health

  • Overall health significantly impacts brain function. Practice healthy habits to support your thinking skills. Sleep hygiene, a healthy diet, staying hydrated, decreasing stress, and exercising as tolerated are all important.

5. Try more therapy

  • Even if you’ve had therapy for your concussion, you may benefit from more. Some people see the same provider more than once, or try someone new. Ask your doctor about getting more therapy for your symptoms.

  • People also have multiple rounds of speech therapy to work on cognition. There are several reasons to try more therapy. You may be in a different place now. For example, you may be returning to work or school and want help practicing some of those skills. Or, if you have forgotten the strategies you learned a refresher can be helpful. 

6. Take your mind off of it

  • Prolonged difficulty with any type of change is hard! Dwelling on things that are hard makes them harder. Try scheduling time to journal or talk to a trusted friend/family member about what you are going through. Then do a meaningful task to take your mind off of it for a while.

7. Consider complementary treatment options

  • There are many non-traditional treatment options that people try after a concussion. Exercise, yoga, and acupuncture are some common ones. Keep reading for more information about complementary therapies. 

Complementary and Alternative Therapy

Complementary and alternative therapy options are used instead of, or along with, traditional medical approaches. Some people prefer these approaches and start them early in recovery. Others look for options when they don’t feel “cured” by traditional medical approaches. Either way, there are many options that promise relief after brain injury.

Some treatments are more likely to help than others. This section focuses on common, evidence-based options. It is important to talk to your doctor about what services you want to try before starting. It’s also important to talk to your doctor about who you want to see for different services. Not all providers offer the same standard of care and your doctor may have a good recommendation.

Dry needling

  • Dry needling uses a thin needle inserted in muscular trigger points. It’s used to improve pain and movement. A certified physical therapist may perform dry needling. 

Acupuncture

  • Acupuncture uses a thin needle similar to dry needling. The needle is inserted into specific points along the body’s meridians to help with pain management. A certified acupuncturist may perform acupuncture. 

Massage

  • Massage may promote relaxation and help with physical symptoms such as muscle tension. Some people experience an increase in symptoms after a massage so it’s important to talk to your doctor and/or physical therapist before starting. You should also look for a massage therapist experienced with brain injury.

Healthy eating

  • Healthy eating may improve your recovery trajectory. Certain foods and supplements are thought to help with brain injury symptoms. A dietician or nutritionist can provide diet education and recommendations. Your doctor may also make recommendations about healthy eating.

Exercise

  • Exercise plays an important role in brain injury recovery. Cerebrovascular promoting exercise like jogging or swimming is especially helpful. It’s important to know that some people demonstrate exercise intolerance after a mild brain injury. They have trouble with blood pressure regulation, dizziness, etc. A physical therapist can test for exercise intolerance and recommend a safe exercise program.

Yoga

  • There is a growing body of evidence that gentle yoga can help with thinking skills, stress management, etc. after brain injury. There are many types of yoga that accommodate physical symptoms. Love Your Brain provides yoga resources specifically for people with brain injuries. Ask your doctor and/or physical therapist about movement restrictions before starting.

Counseling

  • Besides typical counseling skills, a counselor can teach mindfulness/meditation and progressive relaxation to help with thinking skills and stress management.

Complementary and alternative therapy is becoming more common for post concussion syndrome. Because physical and emotional symptoms impact cognition, improvement in these symptoms may improve thinking skills. If you are struggling with cognition now and have already tried traditional therapy, adding some complementary/alternative therapy may be beneficial. 

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Kara Focht
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