From Research to Real Life: Concussions & Falls
For years now I’ve been using the term concussion in my work almost daily as the Statewide Training Coordinator at the Brain Injury Association of North Carolina. I am dedicated to spreading awareness through teaching people about the signs, symptoms, and recovery process from a mild Traumatic Brain Injury (TBI). Though never had I come closer to that awareness than when I was sick, dehydrated, and so dizzy that I ran into the door frame, smacking my head on the hard floor one night. The next three weeks were a wild roller-coaster of symptoms.
I actually didn’t think anything was wrong at first, but I stayed in bed the next day to recover from feeling so sick. I got up the next morning feeling fine and drove into work. It didn’t take long of checking through emails before I started to feel fuzzy, my eyes felt strained, and my head started to hurt. I went home early hoping it was just leftover dehydration symptoms but worried it could have been more. I started thinking back to the fall: how I fell so hard my earring broke, how I threw up soon after, how I had a hard time remembering clearly what happened just before. By the end of that night, I was in so much pain, all the lights and noises bothered me. At this point my concussion symptom checklist in my head is going check, check, check. I felt all over my head for some sort of clue, and there was a shooting pain when I touched right in between my frontal and temporal lobe.
So here we go, all my knowledge and research was about to be put to the test in real life. Plus, all the advice I had given to others about a concussion needed to be more than just talk. Here are some of the things that became normal during my concussion. I am not a medical professional and this is not individualized advice – just my personal experience.
Rest at the Start is Key
Research indicates that the most rest should take place in the first 24-48 hours after a concussion. Luckily I did rest all day the first day, even though I hadn’t suspected the concussion. If I’d known what I do now, I wouldn’t have gone into work the next day. It was challenging to assess how I felt because my concussion presented perfectly fine in the morning – no symptoms. But as the day went on and I engaged in more activities, more stimulation, the more symptoms came on.
Alternate activity and rest, expanding your tolerance for stress but not taking it too far
Though previous research on concussion suggested resting as long as you can, more recent data suggests that activity after a concussion can lead to improved results faster. However, this is a really fine balance and it’s important not to push yourself too fast. In the first few days, I basically worked on the rule of thumb that for every 30 minutes of activity (anything that required cognitive demand), I needed about an hour of rest. As soon as I experienced symptoms, I stopped. I would put on a sleep eye mask and lay in bed with no noise at all (later in recovery I would play instrumental music). I just went back and forth like that, paying attention to what my body was telling me. The first few days I could hardly get through 2 hours without symptoms. Within the next two weeks, slowly the time between symptoms grew and I was able to function more normally.
Reduce Extra Stimulation
My eyes were affected the most after my concussion. It felt as if I had bees buzzing behind my eyes – like they were cross-eyed and I was straining to be able to see clearly. It was exhausting. That meant that any screen time (phones, TVs, computers) was probably taking about 5x the amount of energy that usual. Like a lot of people, my mornings typically start with my phone - first with the daily Wordle, followed by watching TikTok videos. After that I pretty much spend my entire day with some sort of stimulation – music, podcasts, computer work, TV shows, or movies. This was a whole new experience because I had to get okay with silence and doing nothing. Eventually, I could tolerate listening to audiobooks which were nice when I was reducing screens.
Keep an eye on your mental health and state of mind
Candidly - I rely on extra stimulation to distract myself from ruminating (or running away with my racing thoughts). So here I was stuck in silence with the alternative being physical pain. I definitely experienced some days when I felt so unmotivated like I could barely move from the bed. I was also really scared. I’ve heard so many stories of debilitating and lasting concussions that at times I felt hopeless – like I would feel this way forever and that felt all consuming. The research says that those with mild concussions are more likely to experience psychological symptoms, at risk for developing psychological conditions like anxiety and depression, and are more likely to delay recovery due to these factors. It’s hard to be experiencing all these symptoms that you can’t see on the outside. To everyone else you look perfectly normal. I was able to critically investigate my symptoms, see them related to the concussion, and adjust my activity accordingly. Throughout this experience I couldn’t help but think about that person that hit their head, maybe just felt off or different, and they’re not sure why.
Try to put yourself and your health first
Ignore how it may look for other people and advocate for what you need. I rested and scaled my activity but I knew I needed to start returning to regular activity if I was going to get better. That meant that when I went outside to go shopping or to a doctor’s appointment, I was wearing sunglasses and a hat indoors (I was definitely giving off creepy, serial killer vibes). Wearing a hat helps to reduce the visual field, glare from overhead lights, and focus your sight. When I could, I opted for natural lighting or kept the lights dimmed low. Trying to avoid screen time, I went out to a restaurant to eat. I had walked inside and everything felt like it was shouting at me. I made sure to request we sit outside away from the loud speakers. I eventually purchased some ear plugs to reduce the background noise in conversations. When I eventually started to slowly increase my screen time, I used blue-light glasses and reduced the brightness settings.
Mitigate factors that you can to promote healing
Research has shown to reduce caffeine, alcohol, and other irritants that might impact the brain’s recovery and more importantly – sleep. Sleep is when our body rests but our brain is actively working to consolidate memories, get rid of “waste,” and heal injured pathways. I made it a point to go to sleep early each night (which wasn’t as hard when I was reducing screen time) to get in a full 7-8 hours. I also drank more water than usual (as someone that hates water, this one was tough) and sought out brain boosting foods, like fish (packed with Omega-3), blueberries, turmeric, leafy greens, legumes/beans, flaxseed/chia, and more. My workplace was also very flexible, allowing me to work from home to reduce additional stimulation and driving time. I had to evaluate my work activities, at times only working for an hour or two a day to prevent overload. I slowly increased my workload each day as long as I didn’t have any symptoms.
Try to move your body when you can manage it
It was about a week before I felt comfortable exercising because when I was so dizzy the last thing I felt comfortable doing was moving. Research shows that those after a concussion are more vulnerable to additional head injury. This is particularly scary because if you hit your head while you are still healing, the consequences can be catastrophic or even fatal. My typical exercise consists of both cardio and strength training 2-3 times a week. I wanted to be safe but I also knew I wanted to get back for its physical and mental health benefits. Research indicates that exercise elevates your heart rate and therefore blood flow to the brain, promoting the healing process. If you are not a typical exerciser, it may still be helpful to incorporate daily walks after concussion. I started with a walk around my apartment complex for about 30 minutes. With no major symptoms, I next tried an exercise class - planning to scale every element to just keep my body moving (but not overdoing it or risking additional head injury). This was another area where I had to be okay doing something different from everyone else. Instead of a barbell I used the PVC pipe, running was scaled to walking, and squatting was to a box, no throwing anything overhead (like a wallball) and up-down motions (such as a burpee) were scaled to a box. Whatever exercise you are used to doing, be smart, stay safe, and scale appropriately. Stretching or yoga are also some options for low stress body options.
Listen to your body, talk with your doctor, and keep track of your symptoms
I knew the red flags for a concussion and was sure to keep an eye out for them: worsening headache/vomiting/dizziness, dilated pupil, slurred or troubled speech, etc. I messaged my doctor on the first night of symptoms because I knew the importance of tracking your symptoms. I’ve seen so many people with a history of concussion but no record of it at all. So when it came to accessing services with long-term symptoms, it was more challenging to get help. I visited my doctor’s office and he sent me for a CT scan to make sure there were no abnormalities (bleeding, swelling, etc. in the brain). Mild TBIs are basically classified into two categories: complicated and uncomplicated. As with many concussions, my CT scan came back “normal” meaning I had an uncomplicated mild TBI (in the medical sense – I would say it was very complicated to go through). I went through the experience tracking my percentage of activity and how I felt to assess if I was doing better. I would say the first week I went from a 25% to a 50%, up to a 75% the next week, and 3 weeks in I’m about at 90%. I’m very lucky to be feeling as well as I am but I’m still limiting my exercise, slowly increasing difficulty, and returning to regular activity with caution.
Expect some ups and downs, adjust your activity accordingly, and make smart decision
There were times when I thought I was basically over it. I went into work, did my normal activity with little to no breaks. By 3 o’clock I started to feel a little fuzzy behind the eyes so I went home early. Later that night and the entire next day I was suffering with a headache that would not go away as well as sensitivity to light/noise. I had to start from scratch - only one hour of work, limited screen time, no exercise, and my sleep/eye mask close at hand.
This experience was not one I ever expected and has been filled with ups and downs. I couldn’t help but think about how scary and overwhelming concussions may be for individuals with less knowledge about brain injury. My doctor explained concussions to me and recommended no regular activity until 5 days of no symptoms. That was pretty much it though – there is no road map to follow because everyone experiences it differently. I was educating people, guiding my own treatment, even though it may have seemed strange to other people. Due to scheduling, I actually didn’t get to the doctor and testing until about a week after the incident (which I do recommend sooner intervention).
Honestly, I was concerned about how expensive a trip to the emergency room would be and waited for my primary care doctor because I hoped it would be cheaper. My outpatient CT scan ended up being about $500 out of pocket. I reached out to a medical professional that does concussion assessments and treatment, they were very nice but the assessment alone was $600 (not taking insurance). They sent me the papers and I never responded back, too overwhelmed with the monetary concern. More than that, I was barely functioning in the early days after the fall. All the noises, lights, traveling to different places, etc. - I can’t imagine trying to navigate an emergency room, doctor’s visit, or emergency scans during that time.
All of this to say that I was not the perfect patient after my concussion. However, I tried to make educated decisions the best I could to put my health first. It’s not easy to navigate the after effects and you never know what each day will bring. All I can say is there is help out there if you experience a head injury - mild, moderate or severe. There is help if you’re in it for a month or if it’s been years. I’ve met some people that don’t feel like they can reach out because it’s “just” a concussion or because it’s “mild” feel like they aren't as bad as people with worse initial injuries. The Brain Injury Association of North Carolina is here to help any and all individuals impacted by a brain injury. If you’re in the thick of it and not sure what to do next, reach out – we’re here for you.
Lauren's Concussion Essentials/Kit
Drink plenty of water and nutrient rich foods to help recovery.
Massage the muscles in your face that may be tense leading to headaches.
Keep moving and try light, scaled exercise
Less Screen Time
Opt for audiobooks, music, or podcasts with built-in breaks as you may still get tired easily.
Get a full 7-8 hour sleep and when symptoms come on, reduce stimulation (lights, sounds, movement, etc.).
Helps to reduce glare from lights and reduce the field of vision.
Helps to reduce the intensity of light but avoid wearing them constantly.
Helps to reduce the intensity of noise but avoid wearing them constantly