[cantab04]

Hi all,

I just joined the board and would appreciate it if someone could share their perspective on what I've been going through.

In July 2011 I was assaulted in broad daylight by a group of three young men who came up from behind me and started punching my head with their bare fists. I fell down on the floor and they continued punching me for about 25-30 seconds before taking my phone and running away. I did not lose consciousness, but did have a large bruise on my forehead and soreness around my skull.

CT-Scan was negative for abnormalities, but I immediately noticed tremendous fatigue (I'd sleep for 17 hours at a time), nightmares, loss of memory, difficulty thinking/concentrating and the inability to exercise (5-6 min of vigorous cardio was the max).

I saw a neurologist who specializes in PCS, but he didn't really help me much. I have two questions:

1. I've been trying to rest as much as possible, eat healthy and avoid strenuous exercise. Is there anything else I should be doing?

2. A physical therapist I used to see for an unrelated muscle problem (and whom I trust IMMENSELY) recommended that I try out dry needling for my SCM, trapezius and levator scapula muscles since they can often contribute to many symptoms I've had. Have others had any good experience with this?

THANKS SO MUCH!

[Mark in Idaho]

cantab04,

Welcome to NeuroTalk. Sorry to hear of your assault. We have a number of victims of assault here.

The symptoms you mention are all common symptoms of concussion.

There are connections between muscle tension and some symptoms. A more common occurrence is instability of or injury to the upper cervical vertebra joints, specifically C-1 (Atlas) to the skull and to C-2.

Those who have found success have found good NUCCA.org trained chiropractors and other Upper Cervical Chiropractor specialists.

Many also get good benefit from nutritional supplements including B-6, B-12, D3, Omega 3's, niacin, calcium, and a broad spectrum of stress oriented vitamins and minerals, etc.

It also helps to limit alcohol and caffeine to a single serving per day.

Vigorous cardio is not recommended until after 6 weeks and even then at a reduced rate such as to not cause a return of symptoms.

You don't say which symptoms are still present. It will help if you could elaborate about your ongoing symptoms and an example of a normal day's activities.

Your experience with a so-called PCS specialist neuro is quite common. True concussion specialists are very rare. Most are just the doctors schools use to examine concussed athletes prior to returning to play.

We are here for you.

My best to you.

[greenfrog]

Some good basic information on concussion recovery can be found here:

http://thinkfirst.ca/programs/concussionqanda.aspx

I recommend reading the whole thing, but you might note the following excerpt on exertion/exercise during recovery:

"7. When should I return to activity?

You should not return to activity or play until you have completed the 6 Steps to Return to Play and have been cleared by your doctor. A concussed person should be removed from activity immediately and should be assessed by a medical doctor. Given that symptoms may worsen later that night and the next day, you should not return to your current activity. When concussed, your ability to assess your situation may be impaired. Post-concussive symptoms may intensify with an increase in activity, so it is important that return to activity is gradual and monitored/supervised by a medical professional.

The 6 Steps to Return to Play include:

1. No Activity, Mental and Physical Rest until symptom free

2. Light Aerobic Activity like walking of stationary cycling

3. Sport Specific Activity like skating or running

5. Training Drills without Body Contact

5. Training Drills with Body Contact - only once cleared by a physician

6. Game Play

These steps do not correspond to days, though each step should take a minimum of one day. If symptoms return during this process, the individual should stop the activity and return to rest until symptoms resolve before they try any activity again. A physician should be consulted if symptoms persist."

[cantab04]

Wow, thanks for the great suggestions and help Mark and green frog! I will look into them all.

So my remaining symptoms are fatigue and nightmares. However, I notice a VERY DIRECT correlation between overexercising and an increase in my symptoms (esp. nighttime sweating, nightmares, long periods of sleep, brain fog, loss of memory, etc.). Most of my time since this started 8 months ago has been an upward trajectory, but I've had 1 or 2 setbacks.

On an average day I barely exercise at all. It seems like I can tolerate walking of up to 25 minutes or so. When I try to walk for an hour, I can immediately feel the symptoms coming on. Have people here had success with graded exercise? I am thinking about starting an exercise journal and gradually increasing my exercise time.

[Eowyn]

Have you read about the University of Buffalo exercise protocol?

http://www.buffalo.edu/news/10848

Key methodology:

Participants were tested initially on a treadmill to determine the exercise intensity that triggered symptoms. With individual baselines established, each participant exercised at 80 percent of that intensity every day for three weeks and then returned for a repeat test. In most instances, retesting demonstrated that participants could work at a higher intensity and the exercise protocol then was increased. This pattern continued until participants could exercise completely without experiencing PCS symptoms.

You can probably more or less replicate this at home by using the rate of perceived exertion or something like that.

[cantab04]

Eowyn, I did find this article. I've tried to replicate it, but the problem is that -- other than very recently -- I haven't had immediate symptom development during exercise. Do you know what is the primary determinant of symptom development with regard to exercise? Is it heart rate?

[greenfrog]

I have some skepticism about the UBuffalo program, mainly because the published study (1) was based on a small sample size (12 participants I think), and (2) is fairly dated, with no follow-up based on a larger sample size (despite the obvious significance of the authors' preliminary results).

If their conclusions are valid, i.e. that exercise can substantially improve PCS recovery and/or lessen symptoms (six weeks post-injury or 12 weeks or whatever), this approach constitutes a major breakthrough. But few if any reputable concussion specialists appear to have endorsed the program, and it has garnered few if any strong recommendations on this site. Essentially, after half a dozen years or so, where's the follow-up research?

However, I haven't tried the program, so I can't offer a first-hand perspective. Based on everything I've read and experienced myself, I tend to favour the more conservative ThinkFirst approach outlined above.

[Mark in Idaho]

The U Buffalo protocol does not claim to reduce all concussion symptoms. Its only claim is an ability to return to full impact exercise without head aches and such 'comfort' symptoms. Its focus is to re-establish the brain's ability to regulate and tolerate blood pressure that causes head aches and other physical symptoms.

I think the 1-6 steps (Think First) for return to play are simplistic and dangerous. It relies on the SCAT2 self-reporting assessment which can lead to under-reporting of symptoms.

The critical issue to consider is simple. Return to play standards are weighted more toward getting a player back to competition rather than focusing on the recovery of the brain and its ability to tolerate further stress or impacts.

The brain and body can do a pretty good job of telling us when to rest. Listen to your body.

My best to you all.

[greenfrog]

'"After the first three weeks of regulated exercise, we reassess the patient to see if there has been any change in physiology. The exercise program then is realigned successively to respond to the changes. In our experience thus far, symptoms disappear within several months for at least some of the patients," [Barry Willer] said.' -University at Buffalo Reporter, 19 October 2006

...

It doesn't seem unreasonable for a lay reader to conclude that the UBuffalo researchers are claiming disappearance of symptoms, point blank. This is a bold claim (seemingly liberally promulgated by the university and/or the two authors) that needs to be substantiated by more thorough research, in my view.

As for the ThinkFirst protocol (which reflects the approach adopted by various international bodies), the essential point as I see it is to proceed with exercise cautiously and incrementally (taking a step back where necessary) in order to promote recovery by staying sub-threshold of symptoms - sound advice, I think. One might dispute the later stages of the protocol (i.e., with respect to athletes' resumption of contact sports), but that is a separate issue.

[bkas4594]

"symptoms disappear within several months for at least some of the patients" - this statement is very undefined, it can mean a lot of things. I agree with greenfrog. You cannot hurry the healing process. Time and light outdoor activity are most important factors.