Concussion Recovery, Coming Back to Sports.

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1 month post accident (left) and current (right). My face was still scarred and swollen a month after my accident.

It has been over a year since I had a concussion. I still have headache almost every day and have hard time concentrating when there’re many things going on in the back ground. Using laptop is the worst for me. I can’t use it for more than few days in a row without getting severe headache and dizziness. After a year, this accident is still affecting me and I know it will be for a long time. Maybe for 5 years, or who knows, it can be for the rest of my life.

On September 14, 2015, I hit my head in a crash, lost consciousness for a few hours and woke up in a hospital. Paramedics took me to the hospital but I had no idea if I was air lifted or took an ambulance until I saw a bill for the ambulance service. I’ve had a CT scan at the hospital, but I didn’t know I’ve had it done until a nurse told me later. When I woke up in the hospital, my awareness was so low, it took me a while to recognize who I was, where I was, and what I was doing. After several repeated questions from nurses, I slowly realized that I was meeting with my friends and I was mountain biking in Whistler.

I still don’t have a brief second of memory when the accident happened. I remember feeling “oh uh” when I went over a bridge for a drop but I have no idea how I hit the ground. I resurfaced for split seconds several times before I woke up in the hospital, but all I remember was my mind floating in the darkness. At one point, name of my boyfriend at the time came up in my foggy mind and I couldn’t even tell who he was, what he meant to me, or how he looked like.

After my friends came to the hospital, despite of losing consciousness for a few hours, I felt fine and was surprised when a doctor told me I had to spend a night at the hospital. I mentioned I had visitors in town and I can’t spend a night in a hospital, but there was no room for argument so I gave up on trying to go home. When I went to use a bathroom, I felt a bit off and slow, but it felt just like when you wake up in the morning trying to get out of bed. I wasn’t concerned about it…until I realized how badly my face  was swollen from hitting the ground. I was more worried about how terrible my face would look like than my head injury. I didn’t know how serious concussion could be. I slept thorough the night and most of the day the next day. I was surprised how much I could sleep. This was the easy part. I had no idea how bad the rest of my recovery was going to be.

I rested at home for a couple days. I didn’t notice anything significant until when I went for a walk a few days after accident. I drove to the nearest park and went for a walk on a flat gravel trail. I realized I was having hard time walking on a flat trail. The pebbles on gravel surface wasn’t flat enough and I felt like I had to readjust my balance every step I took. I was exhausted after 15 minutes of slow walk, and had to lie down in the back seat of my car before I could drive 3 minutes back home. I couldn’t believe how exhausted I was from just walking.

Since my doctors and friends told me initial rest is important, I took a week off from work and physical exercises. It should’ve been a month or months off, but for me, taking this week off felt forever, especially after going through a recovery from shoulder injury for the past 9 months and just realized I can climb hard again. Resting always had been the hardest thing to do for me, and it was the case with my concussion. Not realizing how severe concussion could be didn’t help me make a smart decision on rest either. I didn’t know much about concussion prior to the accident, and once I had a concussion, I couldn’t use any sort of screens (phone, computer, or TV), read books, or listen to radio or podcasts to gather information about concussion. I got even worse headache every time I try to look at screens, read or listen.

I was starting to feel better after a week of rest and I thought I’d be fine to go back to work. Even though I didn’t do anything but rest before work, however, I suffered through my shifts and eventually had to call in sick because of unbearable headache, vertigo, and nausea.

Within 2 weeks after accident, I started to have hard time sleeping. At first, I thought it was because of a lack of physical activity and long sleeping hours, but I’ve never had trouble falling asleep before. I was tossing and turning until 5am every night. I also had severe vertigo several times while I was sleeping. It felt like I was falling backwards and suddenly the ground disappeared and just kept rolling and rolling… I got motion sickness and woken up many times because of this vertigo.

I also had a couple scary moments that I couldn’t tell the season if it was fall or spring, and also when I saw a picture of my friend and her friend with their names on the side and I couldn’t figure out which one was my friend’s name.

At this point, I seek out for a help and got referral to G.F Strong Concussion Rehab Centre in Vancouver.

My concussion symptoms at this time were:

  • Headache

  • Dizziness

  • Vertigo

  • Nausea

  • Sensitivity to Noise and Screens (Computer, phone, and TV)

  • Emotional

  • Appearing Dazed

  • Slow Response to Questions

  • Sleep Disturbances

  • Concentration Difficulty

Stupid and Stubborn part of me kept me working while I waited for the appointment with the Rehab Centre. I worked less hours and did light duty work, but what I should’ve done was to take time off. It was hard for me not to work and stay home when I couldn’t do any physical activity, use computer, watch movies, read books, listen to radio or music. Even thinking (about anything) hurt my head. It was nice to keep myself busy at work. I also was hesitant to live off of my savings after taking 2 months off for climbing trips prior to the accident.

I had a trip planned to go to Smith Rock during this time. This trip was planned prior to the concussion accident and my boyfriend was driving so I decided to go. I was a bit smarter on this trip. I slept and rest a lot. When I felt good, I went for a short hike or top roped an easy route or two. It was nice to get outdoors and have light exercises when I had the energy.

On October 23, I finally had the appointment with the Rehab Centre. They filled me in with what I should do and what I shouldn’t do in terms of concussion recovery. They recommended these for general recovery:

  • Take 10-15 minutes brain breaks every hour. Sit down on a couch, relax, and empty your mind to rest your brain. This was really helpful for me.

  • Get (or try to get) plenty of sleep at night. Avoid afternoon naps that affect the night sleep. If you can’t fall asleep at all, it may help to get out of bedroom and do relaxing activities and come back to bed. I often made relaxing herbal teas and went back to bed. I also used sleeping apps on my phone. These apps have timers, and I often played the sound of running water. It helped to empty my thoughts and fell asleep.

  • Don’t try to multi task. Avoid having a conversation while cooking, or thinking about something else other than what you’re doing. Do only one thing at a time.

  • Have a notepad and write anything, such as things needs to be done or your thoughts, to not overwhelm your brain. I still do this. I noticed my brain gets overwhelmed with information easily and I also get frustrated when I can’t remember things.

  • Exercise is very important. Include some regular light activity in your day, such as walking.

  • Have a set schedule. Don’t sleep in until late, have meals 3 times a day around the same time everyday.

  • Eat nutritional meals and drink lots of water. Try to avoid caffein for its dehydration effect.

  • Don’t smoke and don’t drink alcohol.

Also, in terms of coming back to my activities, their guidelines were:

  • Work on frequency, duration, then intensity.

    • Frequency: Start with once a week and increase it to 5 times a week. (Example, walk on a flat ground for 10 minutes, 5 times a week)

    • Duration: Once you can do the activity 5 times a week, gradually increase the duration. (Example, walk on a flat ground for 15 minutes, 5 times a week. Then 20 minutes and 30 minutes.)

    • Intensity: Once you can do the activity for 30minutes, add the intensity. (Example, walk up hill, walk on an uneven trail..etc)

  • Aim my exercise intensity for slowly up to 75% of my maximum heart rate. They recommended using a stationary bike, for its lower consequence in case I get dizzy. (Maximum heart rate is 220 – your age. I was 28 at the time of rehab so my maximum heart rate was 220-28=192, and 75% of my maximum heart rate would be 192 x 0.75 = 144.)

  • No weight training. Exercises that make me clench my teeth would build too much blood pressure in my brain.

I also learned about possible treatment options such as craniosacral therapy and vestibular rehabilitation from this meeting. (I’m not a doctor, correct me if I’m wrong on the information below).

Craniosacral therapy was a new therapy for me and it took me a while to understand what it was. I’m still not sure how it works exactly, but here’s what I understand: Craniosacral uses barely detectable gentle touch to manipulate skull bones, cerebrospinal fluids and tissues to release restriction and tensions. It can be used to treat not only brain but also any other part of a body. The rehab centre told me this treatment is not guaranteed to improve my concussion symptoms. They’ve had both cases that the patients got better and also worse. I tried craniosacral therapy anyways, and fortunately, my concussion responded really well. One of the major headaches I had was a compression headache which felt as if I was constantly wearing a tight helmet. Craniosacral loosened my skull, and I can feel the release of the compression every time I got the craniosacral treatment.

I tried vestibular rehabilitation as well. Vestibular systems are balance sensing organs deep in ears, and our sense of balance consists of information from vestibular systems and what you see through your eyes. When there’s a difference in the information from vestibular systems and the vision, it cause dizziness. Vestibular rehabilitation consists of vision exercises and gentle physical exercises. I was told that this rehabilitation would be hard on my brain and could temporally worsen my symptoms. When I did my vestibular rehab exercises, my symptoms got worsened significantly that I had to ease off from given exercises. Since my response to the rehab exercises was worse than what my physiotherapist expected, she recommended that I get my vestibular checked to see if there’s any damage. Thankfully, my vestibular was not damaged so I only have to focus on rehab exercises. I still do the rehab exercises now. On a bad day, these exercises still gives me headache and dizziness, but I just have to keep working on it.

In addition to these treatments, I followed the recommendation for general recovery. I ate well, hydrated well, had a steady schedule for my days and tried to made my tasks as simple as possible. It was helpful to have guidelines constantly reminding me to rest. I also started to go for a slow walk on flat trails more frequently. I was feeling much better than when I went for a walk for the first time after the accident. I could go for a slow walk for 30 minutes. I still had to walk carefully, in a way that I could keep my head level steady while I walk. Every time I missed a tiny step and had a slight jarring move, I could feel my brain shifting within my skull and cold sweat running down my brain.

In November, 6 weeks after accident, I started exercising on a stationary bike using a heart rate monitor. I had to start from my heart rate 80-90 for 15 minutes. I gradually increased the frequency, duration, and then the intensity. It took me a while to figure out how much and how soon I can increase the intensity. At first, I increased the intensity too soon after I reach the 30 minute duration. My brain was overworked, and my symptoms worsened significantly. I had to start the heart rate from 80-90 again, and go through the process of gradually building up my tolerance. This happened several more times before I finally could figure out how much my body can tolerate without pushing too much.

I started traversing at a bouldering gym about 2 months after accident. My concussion physiotherapist recommended it, and I was happy to start climbing again. I absolutely could not take a fall so I traversed low, not even a meter up, and only with jugs. Once I felt confident, I started to traverse higher, but every move in control, while watching out for my heart rate to not exceed what it should be. In January, 4 months after accident, I slowly started to climb outside on top ropes then lead easy climbs. After 6 months post accident, I could start to take lead falls as long as I get a dynamic/soft catch.

I started to come back to my regular duty at work 4 months after accident and gradually increased my hours. It was a slow process, but after 6 months, I was back to most of my regular routine for my activities and work.

I’m back climbing, taking lead falls without any issue with my brain. Bouldering falls have too much impact on my head and I can only have 3 or 4 of 2 meter (6 feet) falls a day, before my head start to feel foggy. I still can’t do much activities that involve jarring move to my head such as running or mountain biking, but fortunately falling on backcountry ski didn’t bother me as long as it was a soft powder day. More than anything, I’m happy that I can do rope climbing, which is what I’m passionate about. I still have to be careful on my time on my hour spent using computers. I definitely feel more compression headache and fogginess after long hours using computers, and if I keep using it for more than a few days, I will have worse symptoms and it can last for a week. It takes longer to write a blog post and I apologize for delays on my posts, but I finally learned how to take care of my body. I will rest my brain/body if I need to.

 

I thought I’d put this together since I couldn’t find much information on concussion recovery specifically with coming back to sports. Most information out there said don’t go back to the sport unless you’re completely symptom free. Depends on a person, it can take years to be completely symptom free. I was willing to do anything to get back to my sport as soon as possible and I wanted to know what I could do. I didn’t have the best recovery, but I’m happy with how I improved once I figured the right path. My concussion recovery is still on going. If anyone has thoughts or recommendations, I would appreciate comments and suggestions.

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