The New Science of Concussion Recovery
Breakthrough therapies are helping athletes recover from injuries previously thought untreatable. But many doctors remain unaware of the advancements.
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In January 2013, 24-year-old Laura Fraser hit a tree while snowboarding at Fernie, British Columbia. Afterward, she felt a ringing in her ears that doctors attributed to a mild concussion, and within a few days she felt fine.
But then she had another, less traumatic fall in March 2014. That’s when her life changed. Fraser became irritable, had difficulty concentrating, and experienced headaches that worsened with exertion. “It took me three times as long to do the things I used to do,” she recalls. Her local Nova Scotia doctors told her to avoid anything that provoked symptoms, but she didn’t recover. Instead, her mental focus became so poor that she had to drop out of school.
For decades, doctors have told concussed athletes like Fraser to rest, avoid bright lights, and limit activity. Having had one concussion places you at greater risk for another, they thought. But emerging science says that’s bunk: You can recover from a concussion, with active treatments that re-condition the injured parts of your brain.
Blame the NFL for perpetuating some of our concussion misperceptions. Highly publicized lawsuits between the NFL and former football players have raised public awareness about concussions, but they’ve also confused us. For example, concussions don’t automatically result in chronic traumatic encephalopathy, the disabling neurodegenerative disorder blamed for the deaths of former football players Mike Webster and Junior Seau.
Players represented in the lawsuits maintain that the NFL concealed the dangers resulting from head injuries. But only recently have doctors developed effective concussion assessments and treatments. “Just ten years ago, the only way coaches knew to check for concussion was to ask athletes, ‘How many fingers am I holding up?’” explains Michael “Micky” Collins, PhD, director of the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program. That era of ignorance perpetuated pervasive myths about concussions, such as the need to rest in a dark room or that having one concussion puts us at greater risk for another. (It doesn’t, says Collins.) “We’ve learned a tremendous amount about this injury, and the truth is not as bad as it’s made out to be,” he says. “The reality is, it’s a treatable injury.”
Just ten years ago, the only way coaches knew to check for concussion was to ask athletes, ‘How many fingers am I holding up?’
UPMC and a handful of other concussion clinics across the country have developed a battery of active therapies that challenge patients’ vision, balance, and concentration. Standing on one foot, tracking a moving object, and other exercises retrain the brain and rehabilitate zones that may have shut down in response to head trauma.
Therapies are tailored to the patient’s particular symptom set, since researchers now recognize six different types of concussions: anxiety/mood; cervical, which can lead to headaches; post-traumatic migraine; ocular dysfunction; vestibular, or difficulty with balance, motion, and coordination; and cognitive/fatigue, which causes concentration issues. A person suffering from an anxiety/mood concussion, for example, might become prone to angry outbursts, while someone with ocular dysfunction might feel woozy when surrounded by moving objects.
The new therapies have an impressive success rate. Collins estimates that 90 percent of UPMC’s concussion program patients make a full, complete recovery. “With all the new research we’ve done and the nearly 200 papers we’ve helped to publish in the past decade or so, we now are able to provide proven treatments and evidence-based rehabilitation therapies,” says Collins. And treatments are still evolving. “As we see 18,000 patients a year, we get better at it.”
One of this year’s program visitors was Laura Fraser, whose concussion spanned three types (vestibular, ocular, and anxiety/mood). Her prescriptions included staring at a point on the wall while shaking her head, seeking out crowded places where people bustled around her, and focusing on objects at different distances. Her clinicians also insisted that she start exercising again. Running or biking, initially for 20 minutes a day, became part of her recovery program. “It was the opposite of what I’d been hearing for a whole year,” she says. But it worked. By December, she was symptom-free and cleared for more snowboarding.
“I could feel improvement every time I did the exercises,” says Fraser. “With the ‘just rest’ approach, I was waiting for something to happen,” she explains. By contrast, the active therapies gave her a sense of control over her injury.
As with any other injured body part, the brain responds better to prompt treatment.
Concussion specialists hope that the earlier treatment and active therapies can reduce or eliminate concussions’ long-term consequences. “The old exams missed a lot,” says Jeffrey Bytomski, DO, a concussion specialist at Duke Sports Concussion Clinic. Now, assessments combine vestibular, cognitive, and ocular testing that does a much better job of identifying concussions. “If we see patients early, we get them better, faster,” adds Collins. As with any other injured body part, the brain responds better to prompt treatment.
Science hasn’t yet confirmed whether the advances can stave off CTE and other residual, concussion-related damage to the brain. But they might. “We hope that better therapies will make a difference,” says Robert Cantu, MD, a leading CTE researcher at Boston University.
That’s why the National Football League has committed huge sums to concussion research. (A recent settlement with injured players also requires the NFL to pay money for research.) Its Head Health Challenge partnership with General Electric and Under Armour has devoted $40 million toward research and technology development to better understand, diagnose, and protect against brain injury.
For now, though, the new concussion treatments and findings from the NFL-funded research haven’t trickled down to community physicians, most of whom still espouse the “rest-and-do-nothing” strategy. “We’ve learned so much in such a short period of time that we’ve outpaced the general medical knowledge,” says Collins, explaining that most family physicians and even sports medicine specialists haven’t been trained in the emerging therapies.
To help spread the word, UPMC just launched its ReThinkConcussions initiative. The site offers information about the new treatments and includes video testimonials from the likes of Dale Earnhardt Jr., who sought treatment for concussions in 2012 and 2013 after back-to-back crashes. He attests to the healing power of the new protocols.
But until the new treatments reach local doctors, you’ve got to be an advocate for your own brain health. Here’s a quick guide to seeking a specialist’s help.
Should You Visit a Concussion Clinic?
There are two things to consider when evaluating the seriousness of your concussion: the severity and duration of your symptoms, and the number of concussions you’ve had.
Head injury symptoms that clear up overnight or within a few days shouldn’t pose a concern, experts say. Even a repeat concussion shouldn’t require a specialist’s care, so long as those effects also fade quickly. But when symptoms last weeks or more, or if they result from multiple head injuries, people should see a specialist—which, for now, may mean traveling out of state to concussions centers in Colorado, Pennsylvania, Massachusetts, or North Carolina. Visit ConcussionClinics.org to find one near you.
Infrequent concussions from skiing, snowboarding, mountain biking, and team sports are not all worrisome. “Sports where you’re rarely hit in the head are much less risky than ones where it’s routine,” says Cantu, who feels that concussions incurred during recreational action sports aren’t likely to result in later-life implications. “I’m more worried about 1,000 sub-concussive blows every year.”
For more on concussions, check out After the Crash: A Closer Look at the Rising Incidence of Brain Injury.