22
votes
Concussion treatment: the insidious myth about resting protocols that even doctors still believe
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- Title
- I Got a Concussion. I Didn't Get Better. It Turned Out Even My Doctors Had Bought Into a Powerful Myth.
- Authors
- Isobel Whitcomb
- Published
- Mar 17 2024
- Word count
- 3981 words
Neuropsychologist perspective, first trained in TBI rehab, though that's no longer my area of study:
I'm so glad that this is coming to mainstream consciousness, but I'm immensely frustrated that it has taken so long. Head injury specialists have recommended relative rest for, well, 17+ years as the article reports, but there has been so much BS perpetuated by poorly educated physicians and allied health professionals.
For example: long-lasting cognitive symptoms of mild TBI (concussion is mild traumatic brain injury) do exist but are rare. They are usually tied up in a complex health history, long-lasting affective and physical symptoms, and multiple concussions close together (like within a couple of weeks).
That does not mean they don't happen, though many docs will interpret it that way.
It also doesn't mean that long-lasting physical and affecting symptoms are rare. They are much more common than persistent cognitive symptoms.
And all of that together does not mean that concussions should be treated as life-altering in general. They just can be.
The idea of full rest was nonsense and always has been. The number of patients I've seen who have been told or allowed to believe that high cognitive load (e.g. school work or work-work) might hurt their brain after a concussion is alarming. It won't. The reason you recommend a reduction in workload is to reduce the number of people failing while in early recovery.
The reason you want total rest from contact sports or equestrian sports is that getting another concussion within a couple of weeks of a prior concussion really may result in much longer-lasting symptoms.
The idea that a few concussions spaced out results in behavioral and cognitive decline over time due to CTE (which is a pathology in the brain, seen on microscopes, not a clinical syndrome) has never been adequately established. People who have hundreds and thousands of concussions do indeed have more CTE, and people with more than a few concussions have more CTE than those without concussions. But behavioral and cognitive change over a lifetime in athletes with and without CTE seem to be similar. Some people just have terrible declines and bizarre or dangerous behavior, and on autopsy, a good number of them have CTE. Tons with CTE on autopsy never have those behavioral changes.
That said, I believe in CTE, as would any responsible scientist/practitioner, but the conclusions drawn from its existence are far too overblown relative to the science. CTE is one of many pathologic changes that can compound with others to increase risk of dementia (the clinical syndrome). Most people with a dementia, even one with a diagnosis supported on autopsy, have multiple pathologic changes. That is, most people with Alzheimer's related changes have more protein and cerebrovascular problems than just the Alzheimer protein problems, and the more you have in combination, the worse your symptoms and faster your decline.
That's why a history of brain injury is a risk factor for dementia. That includes all severities of brain injury, including moderate and severe. A mild concussion or a few over your athletics days, spaced out sufficiently, will not cause you to decline over time unless you are the rare exception.
What we do know is that poor education during recovery leads to poorer outcomes. People have longer lasting post-concussion symptoms if they are not educated that the brain will heal over time. It almost always does, and people need to be given that expectation.
They also have to be told that physical and affective symptoms may persist and need to be treated individually (headaches, dizziness, depression, anxiety, etc). They also need to know that those symptoms can cause difficulty thinking, but that doesn't mean the brain is falling apart.
We also know that putting people with typical concussions and long-lasting symptoms in rehab groups with people who have moderate or severe TBI (where long lasting symptoms are the rule, not the exception) makes them recover more poorly.
Isolation and total rest have always interfered with recovery. But if the doctors don't know that, then how will the patients know? There are neurologists that refer to me who truly believe that a concussion, years ago, with no loss of consciousness, may have set off a cascade resulting in Alzheimer's onset in the patient's mid-50s. That's not a thing. The problem is always something else.
Sorry for the rant (?). It's meant to be an info dump in support of the article and the patient who made this a personal crusade. I'm happy to answer questions.
If you're curious, there is an in-depth video on CTE and its promotion in the media and medical community that I can dig up.
Interested in your video link if you can find it.
A friend's teen was sent home from sports concussion just a few months ago. The child was told by his doctor to sit in a dark room with nothing to do at all and told to not even think about anything or look at anything. I don't know what they expected an energetic teen to do at all! He went nearly out of his mind. I sent the article to my friend right away of course.
I hope more people know about this.
I just went through 5 years of saved reddit posts and bookmarked YouTube videos and couldn't find the one I wanted. I'll give it another look tomorrow. If I can't find that one, I believe I have a good but very long critical paper on CTE related issues, though it is probably jargony.
Beginning to feel smugly superior of all the times I got right back into it after big spills
Ah, oops. Never mind. Still I've never been able to rest after a concussion but I've never heard of blackout resting for multiple days.
So, I'm seeing the 'best' idea is to keep going and do everything you do normally but also do it slowly if you feel bleh. It's a long read, so maybe don't bonk your head before you read it, but I think it's a trove of information.
I had a concussion a few years ago. The doctor who examined me recommended laying off the screens, but continuing to do gentle things like coloring, listening to music/audiobooks, doing word searches and taking a break and a nap if my head started to hurt again. She also recommended I take walks outside, and drink plenty of water, but take a break from the caffeine. Somewhat of an in-between of what the article recommends and the old school theory of total blackout.
Anticlickbait duty: The concussion treatment of rest is a myth. There's more and more evidence for active treatment like rehabilitation and excersize.
From the article:
@cfabbro, mind another round of title anticlickbaitification :)?
Done. Let me know if the edit it sufficient.
I'm curious where the clickbaity title even came from. Was it a push notification? That said, I do think it's a more descriptive title than the actual headline.
boxer_dogs_dance often writes their own headlines/titles.
In this particular case, it was probably actually Slate themselves using it as a headline variation. From their Twitter:
As concussion science transformed, an insidious myth took hold. Many doctors still believe it.
News orgs these days do all sorts of BS in order to find the most effective headline at driving traffic to the site. Some will A/B test headlines, using different ones for different social media sites/search engines, or even change them based on the visitor's referrer or geo-IP location. Some will intentionally use a more clickbait/controversial headline to start with, then swap it out for something slightly more reasonable/toned-down once the initial wave of traffic dies off. Etc. It's super annoying, and one of the major reasons Tildes has title editing, so we can try to combat some of that a bit.
cc: @updawg
I'm doing this less after the Three Cheers app allows posting articles.
I'm still finding the right balance. Changing the title within the app isn't easy