Alright, here comes
part 3.
Prevention and risk factors:
The first thing to reiterate is that the MOST EFFECTIVE way of reducing the chance of a concussion, and overall brain damage, is reducing the frequency, volume and power of head shots. It's as simply as that. You can do everything else right, but if you are regularly taking hard shots they wont matter. Genetics plays a big factor, but there is no way to know in advance if you are more susceptible or not. Not at this time anyway, although various genetic biomarkers are being researched. A recent study on rugby players recorded thousands of collisions and concluded that reducing speed, acceleration of hit and head to head damage was the best way to mitigate the risk of concussions
(1). So with that out of the way,
do less hard sparring, do more drills, do more shadowsparring, work on defense more. That's the bottom line.
In regards to the previously touched on subject of how a strong neck might help prevent concussions, Chris Beardsley wrote a
pretty interesting article on that subject. It seems that there is no clear correlation between the two, although a very weak neck might make you more prone. Theoretically, stronger muscles could partly help absorb some of the eccentric forces and reduce the acceleration of the skull, but it doesn't seem to be that clear cut in reality. The article concludes "
Taking these points together, we might consider whether we want to build some movement practice as well as neck strengthening into injury prevention programs, for increasing energy absorption in impacts that produce head accelerations. Movement practice might include tensing of the neck muscles, clenching mouthgards, or practicing a good posture for force transmission to the rest of the body."
Good posture, body position and being in the right place to take the least amount of damage (least amount of force and acceleration) is very important for the striking arts. If you want to mitigate damage, you have to learn how to be in a position to take a punch well.
When talking about risk factors for concussions, they are not well understood. Previous concussions without adequate rest is the most well established one
(2). Being female is another
(3). In regards to developing PCS, it seems that co-morbidities like existing anxiety and depression can be a risk factor
(4). One could hypothesise that it might have something to do with an already dysfunctional hormonal and autonomic system, and that various psychiatric and stress ailments also releases inflammation in the brain and hinders healthy neurogenesis
(5). Hard to tell exactly. Drugs and alcohol is another chicken-or-egg thing. It definitely doesn't help, although there is nothing wrong with alcohol in smaller amounts.
When considering prevention, it's always safe to say that a healthy, well-balanced, hydrated person in good shape will be less susceptible to hits. In a lot of ways, the road back to recovery is simular to the prevention. A lot of it is not well established though, and guesswork for the large part. Being in good cardiovascular shape could theoretically help mitigate some of the damage, as a lot of the issue with concussions and PCS is reduced cerebral blood flow (blood to the brain). You see it as well in fight sports, that the well conditioned fighter recovers more quickly. Being at a good place mentally, as strange as it might sound to some, is another thing that theoretically could help both recovery and prevention.
I am definitely not an expert on nutrition, but when it comes to certain dietary or supplemental benefits there is some evidence to suggest it could have both a preventive and recovery effect. With a few caveats though, but I will cover that in the recovery section.
Recovery:
There is a difference between "regular" concussion recovery and PCS recovery (I might go back to part one and clarify the definition of PCS). In regard to a concussion, the basics are the basics. Get adequate rest initially, keep the body moving gently, wait for the symptoms to subside and do not go back to contact untill you complete certain steps without any symptoms. Better to wait longer initially, than keep making the problem worse. It is very important to have a proper "return to play" protocol in place, and most contact sports have had, and improved on, those for some time. Unfortunately there is none specificly for striking sports, but they all follow the same principles. Here is an example taken from Roller Derby, which is well explained and simple:
Various dietary and supplemental choices are thought to be helpful in regards to both preventing and recovering from a concussion. A table below lists some:
Fish oil seems to be the most well researched one, and a long with curcumin, has shown some promise in studies on rodents and some smaller human trials
(6). At the current time of this writing though, there has been no high quality large human trials which has shown these benefits
(7). It is still at a very initial stage and there is a lack of solid evidence. That being said, as there are various other health benefits to having a diet rich in Vitamin D, DHA, magnesium and various other anti-inflammatory and oxidative food sources there would be no reason not to. Also, something like fish oil improves blood circulation by vasodilation, and consists of fatty acid which could theoretically improve cerebral blood flow and help battle the degeneration of white matter (fat) in the brain after a concussion (as discussed in part 1). Also something like curcumin has anti-inflammatory effects, which could theoretically help combat the over-inflammatory state of the brain during the initial stage of the concussion (also discussed in part 1). With that said, there is no magic bullet. New reasearch is being made though, including on Resveratrol and Creatine
(8).
CBD oil has shown some promise and does seem to have some neuroregenerative effects, but again, the evidence is lacking. XXX
As far as PCS is concerned, treatment is a multidimensional approach accross various health care providers. The previous advice applies, but it might not be enough. Graded exercise protocols has shown some promise and should be part of clinical practice for those who can tolerate it
(9). Cognitive therapy or neuropsychology can be a factor in helping the individual back as well. The results from our research project suggested that dysautonomia is a major factor in symptom expression, and that Body Awareness Therapy can effect the autonomic nervous system and lower parasympathetic activity. It can help reduce symptoms for SOME. Meditation, body relaxation, breathing techniques and de-stressing activities might also help alleviate the condition. Going to an optometrist and getting your binocular vision checked, especially if you are experiencing eye pain and headaches, can be a good idea. The binocular vision is often effected as a result of dealing with PCS. There has been some evidence to suggest that electrical stimulation of the vagus nerve can have a neuroprotective effect on traumatic brain injuries, but it is very preliminary
(10). More new evidence shows some promise with CranioSacral Therapy as a means to concussion and PCS recovery, but again it's in initial stages
(11). I am a member of the national concussion union and it seems some people it helps and others it does not, which is the case with a lot of the interventions for PCS. In reality, PCS is a very complex diagnosis with several factors playing into it, which is why some are considering splitting it up in several subcategories.
Lastly, using orange safety goggles and programs like f.lux that removes or lessens blue light at certain wavelenghts can help you tolerate screens and generally protect your eyes and brain. That includes normalising melatonin levels and preventing degeneration of the DHA in your eyes (link). There are several apps for this as well on either Iphones or Androids.
To summarise:
1. Eat healthy, including
plenty of fish (or supplement with fish oil)
2. Be in good cardiovascular shape (perhaps include some non-compressive and light neck stretching and strengthening)
3.
Take less punches, less often and with less force
4.
Improve your defense, improve your positioning, do more drills and more shadowsparring
5. Dont do drugs and keep alcohol consumption low-moderate
6. Get adequate rest and do de-stressing activities
After the fact:
7.
Follow a very specific 'return to play' protocol and DO NOT let symptoms worsen. Take your time.
8.
Stay away from contact for longer than prescribed
9. Try Fish oil, Curcumin, Vitamin D, Magnesium, Creatine, Resveratrol and others
10. Try CBD oil
11. If symptoms persist, try:
- Graded exercise protocols (SYMPTOM FREE)
- Body Awareness/Tai Chi, relaxation and meditation strategies
- Cognitive Therapy with a neuropsychologist
- CranioSacral Therapy
Do:
- Visit Neurologist
- Visit Neuro-Optometrist
- Use programs and glasses to filter out blue light from screens