Originally Posted by Mark in Idaho

You are quite a perfectionist. How about trying some reality? I did not say you will be more prone to stress. Stress is stress. Some just tolerate it less. I said that stress will likely affect you more. We need sleep to recover from daily stress. Good brain nutrition helps the brain tolerate it better. You will still be able to spend time at altitude but if you were to take an ImPACT or other neuropsycholgical test at altitude, your results will show a deficit compared to others who have not suffered a concussion. Your decision making skills will be lessened. Nobody can predict if that deficit will be problematic.

You may have virtually undetectable residual factors but they will be there. Yes, it is great to have a goal of 100% recovery. We all need to have something to shoot for. Please keep in mind that any rehabilitation uses measurable factors to determine levels of healing. My knee that I tore the medial meniscus on in 1972 healed so I could resume my running. But, that minor tear became a major tear years later. My shoulders have healed to useable conditions but my bursitis has never healed to near before injury standards. My broken tib/fib healed but is prone to arthritis at the ankle joint. In all of these injuries, I regained full range of motion with the exception of my shoulders. If I push for full range of motion, then I risk inflaming the bursa.

Do a little research into cartilage. It does not heal very well at all. Especially the meniscus because its only nourishment is the synovial fluid. The synovial fluid contains lubricin (The body's lubricant) that is lost during any knee surgery. The body does not replace it properly or fully so the lubricity of the synovial fluid is forever reduced unless it is artificially supplemented. That loss of lubricity causes the cartilage to deteriorate faster.

Look at nerve fibers. They can grow at 2 to 3 mm per month. But, they will not grow unless there is a myelin sheath in place. The myelin sheath grows extremely slowly if at all.

Look at capillaries. They do not heal well at all. HBOT is often used to assist/encourage capillary repair/growth. But, in the brain, those capillaries are covered with glymph cells that do not heal well, if at all leaving the brain's waste removal system in a weak state.

The axonal damage common to concussions is also problematic. This axonal wiring does not have a road map. They reconnect by happenstance. They keep trying to connect to dendrites but get rejected until the correct dendrite is found. The neurons have as much struggle to repair. There are over 4000 different 'classes' of neurons. Even when there is a regeneration of the proper class of neuron, they still need to be programmed to be functional.

The fact that you are having head aches suggests that your concussion was not as mild as you think. Plus, research shows that there is no direct correlation between intensity of trauma or immediate symptoms and long term results. The only valid stats say that 85% of concussions recover spontaneously in the first few weeks. By recovery, they mean that primarily, those patients stop complaining to their doctors. Those of us with long term concussion symptoms rarely even meet the threshold of being symptomatic by mTBI standards.

There have been multiple recent studies that can show a difference between those who have suffered a concussion and those who have not, even after what appear to be a full recovery. They can see a difference with qEEG/AEP/VEP, high resolution MRI, and some other diagnostic procedures that my damaged mind can't remember. Older research showing this dates back to the 70's.

I suggest that those 100% recoveries, even from the rotator cuff tear you mentioned actually recovered to much less than 100%. That rotator cuff will tear again with less force. A return to full range of motion does not mean 100%. A return to full strength tests do not mean 100%.

My father suffered an almost complete non-displaced fracture of the humeral head. It took 6 weeks of immobilization before he could start rehabbing. He regained better range of motion and better than before strength but developed arthritis.

Check out neuroplasticity. There are many claims about the brain doing some miraculous things. When one looks into the specifics, neuroplasticity is not nearly as miraculous as first presented. The brain has many ways to adapt to injuries. It re-allocates less used resources to greater needs.

There is good research that shows many 'full recoveries' from brain injuries of all levels are really subjects who have learned how to make accommodations and learn work-arounds to the limits of their injuries. I have learned memory tricks to make up for much of my memory limitations.

So, here's to your positive attitude about pursuing a full recovery. You will very likely experience what appears to be a full recovery.

btw, That PA was wrong in saying you may have not suffered a concussion at all. You said you had a head ache and were a little hazy. That is a concussion even if you did not exhibit any symptoms when she examined you. Unfortunately, medical schools are way behind the times.

My best to you.