Understanding Concussions: From Diagnosis to Recovery
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Join Dr. Beau Beard in Episode 51 of the Week in Review as he delves into the latest protocols and research on concussions. Discover insights on diagnosing concussions, managing post-concussive syndrome, and the importance of lifestyle factors in recovery. Whether you're a healthcare professional or someone interested in sports medicine, this episode offers valuable information on handling concussions effectively. Don't miss out on learning about the role of diet, exercise, and rest in concussion management.
Full Transcript
Beau Beard (00:00.802)
We're back for episode 51 of the Week in Review and it's just me, solo show. I thought this was more fitting for a solo episode just because I'm gonna dive into a lot of protocols, some research, basically the most up-to-date guidelines on concussion, both the acute phase of concussion, what we do in the days, weeks, months after we suffer a concussion.
a little bit about how we diagnose concussions and then also a little bit about post-concussive syndrome. So this came to mind because I actually have a patient coming in tomorrow. I haven't seen her yet. On her paperwork is stating that she was in a MVA or motor vehicle accident two years ago. And since that time has developed post-concussive syndrome. So if I back up, I've been in practice almost 14 years now. If I go back to when I was in graduate school in St. Louis,
point in time, this was right when CTE and all the kind of chronic, repetitive concussion findings were starting to come out. And I was doing a lot of coursework on concussions. were doing, I was personally leading the way for baseline testing, concussion protocols, both using a, you know, old school scout forum and then an impact computer-based program for 10 local high schools that we were doing sideline care, mainly for their cross-country teams and some other sports.
And I had done a bunch of coursework under Robert Cantu, who is still one of the preeminent leaders in concussion and concussion research.
Beau Beard (01:47.086)
As I went through school, thought, I'm gonna like, that's what I'm gonna focus on is concussion. I'm gonna be able to, if I'm being honest, use it as both a marketing technique. So I thought when I was going to come out of school, I was gonna go work sidelines, the local football team and the local sports teams, do all their baseline movement testing, concussion baseline testing, and then lo and behold, I moved to the state of Alabama. And somehow or another, the Alabama High School Coaches Association has voted that
Chiropractors cannot be the portal venture, your primary care service renderer, I guess, for concussions. We can treat the sequelae. So we can treat the cervical, the vestibular, the ocular, the rehab nature of a concussion, we can't be the primary caretaker for a concussion diagnosis. And then some other issues within the state kind of kept me off the sidelines. So I've kind of basically reduced all of this study, but it's never...
not been interesting to me. So then I saw this case come in and her paperwork was pretty thorough, kind of explaining what she's dealt with in terms of the initial injury itself, the concussion, post-concussive syndrome, all the way through, I think she said on her paperwork that she has an endocrinology appointment set for 2026 because she's noticing, I'm assuming, some systemic changes, some hormonal changes, which we'll talk about all that and how that occurs and why that occurs with concussions.
Again, I'm 41. was born in 1984 when I was in middle school and high school. Concussion diagnosis was basically left to not only a full scat form, like parts of scat form. Can you remember these three words and repeat them back to me? You know, red rubber ball, all those sayings, very, very rudimentary. If we really got our bell rung or maybe we got a stinger, you know, maybe we have sideline, you know,
EMTs or a physician, you know, doing some pupil testing and things like that, but really came down to symptoms. You know, do you have a headache? We were told if you have a severe headache or if you blacked out or knocked unconscious, you know, all we were told was, you know, maybe don't go to sleep right away. And then, you know, the old wives tale was you just might not wake up, which was probably due to some sort of epidural bleed. But I mean, I 100 % had concussions. I always think of Brett Favre when he got interviewed after he had retired.
Beau Beard (04:13.25)
And they're like, well, how many concussions did you have in your career? He goes, I don't know, a few. he goes, well, what is a concussion? What's the definition? They're like, anytime that you got hit hard enough to where your ears ring, you might've had a subtle blackout, you had a slight headache. And he's like, that was pretty much every time I got hit. And then that gets into this chronic traumatic encephalopathy where we see the CTE information just kind of come out and now big,
efforts to protect these players from direct head trauma, both in how they're tackling, how many hits they take in practice, different type of helmets, all these kinds of things, not targeting, all these things have come about because of concussions. a concussion, how is it, what is it, what's going on, what's happening? So concussion is coming from like what we would call a coup and contra-coup injury. So it's not, you know, just your head hitting, what's actually happening is your
brain more or less jostling around inside your skull. So the coup would be, you get hit, your brain's moving forward. The contra coup would be basically your brain's moving backwards. And it's the insult with inside the skull that then creates this, you know, internal swelling. The swelling itself creates some of the symptoms that we can see with concussion. And then the sequelae after that swelling, which can be persist for all sorts of reasons. And I'll talk about
one reason that I think it's persisting more and more and why we see more severe concussions, more post-concussive syndrome in particular youth athletes and we did ever did when I was in middle school and high school. So when we get that concussion, obviously if you get knocked unconscious, you have a concussion. If you get hit hard enough that you see stars like we're Bugs Bunny, some people may not know who Bugs Bunny is.
We're seeing stars. Maybe I have a ringing in my ears. I had a slight blip in like what happened. All these things are kind of the first rung of like, you probably have a concussion. Second would be, okay, I'm starting to get a little bit headache. I have severe headache. I can have pupil dilation. get a pupil constriction depending on swelling or what's going on with the concussion itself. I may have a non-reactive pupil area response when I kind of cover one eye that the other one doesn't respond.
Beau Beard (06:36.322)
All of these are happening for the most part, albeit we don't have structural damage. We didn't damage the optic nerve or retina or something like that, which can happen with head trauma. It's due to swelling and pressure on these neurologic structures, both from the gray matter all the way out to cranial nerves and things like that. So in this first initial diagnosis, it's really hard to diagnose a concussion without baseline testing. That's why
there have been so many of these tests and new tests that have come out. And again, when I was in school, the scat form, which was a simple form that looked at, you know, memory and, you know, recall the ability to eye tracking all these things on a scat form. And then the impact use some computer input, which is a much further detail, but without that baseline, it's kind of like, well, we don't know what you're.
baseline memory was. We don't know what your baseline visual function is, because people can have nystagmus and iris obliquity and all these things that are occurring before we had this that can throw the test off. So the sideline test comes down to rudimentary things. So if we go further, yeah, we could get imaging, we could show signs of inflammation all the way out to specific types of a PET scan, a CT scan is kind of a gold standard. But that's not necessary to truly diagnose.
a concussion because again, the symptoms of the concussion are going to be a diagnosis of inclusion. So what do we do when we got our bell rung and we think we had a concussion? So in that first zero to 48 hours, and all of this is coming more or less from the Sixth International Consensus Statement out of Amsterdam on concussion protocols and how we handle them both from diagnosis and treatment. So we look at first zero to 48 hours is called relative rest. So we don't want cocooning.
So some of the older thoughts were, we need absolute darkness, no screen time, no auditory input, we're not gonna have this kid going to school and doing work. Now we're saying relative rest. What's that mean? Short, quiet intervals of activity that might not be too in depth. Some of the things that we do see that occur as kids have a concussion is they may have a headache, but as they try to read or do work or in particular, look at a screen. So if we take a little,
Beau Beard (08:53.614)
pause on why screens and lights matter. So just throughout the day when I'm looking at the computer screen, you know, as I'm recording this podcast right now, this screen is refreshing and it's refreshing at a rate that I can't perceive unless, you know, we took a video of it you can slow the frame rate down and things like that. Also the overhead lights, we have LEDs in here. The LED light is refreshing or flickering. Your brain and your, you know, the...
the neurologic structures within your visual system are adept enough to pick this up. You just don't perceive them because again, our perception is an amalgamation of all of our sensory input. But when we have a concussion, those types of things, the blue light, the refresh rate, the intensity, the words on the screen, maybe size, how much my eyes straining, these do matter. So that's where we wanna say.
hey, we don't wanna overdo it just because of like the workload on the brain from a neuroinflammatory standpoint, but also the tax on the optic structures themselves. And kids now, now are more and more, most of their work, most of their homework is done on screen. So that does get tough.
Beau Beard (10:02.286)
We do want to encourage rest. We don't want to encourage, you know, natural light, especially first thing in the morning. So we'll see later as we get into post-concussive syndrome, hormonal and endocrine disruption can occur. So we want to kind of say that we want to start hitting the reset button if we don't already have these habits in place of, when I get up in the morning, that first 10 to 15 minutes, I'm not staring into the sun to burn my retinas. I'm trying to get indirect sunlight to basically set
my diurnal clock so I will basically wake up a little more naturally, hopefully fall asleep, but I also get a hormone cascade of basically a cortisol blunting with that. I'm gonna kind of shut down melatonin production as I get that first light in the morning. So that's important is we're trying to basically hit the reset button on the circadian rhythm with this concussion so we don't turn into post-concussive syndrome. Medications up front. So this work, you know,
I'm not able to prescribe medication. can tell you what this consensus is saying. It's saying acetaminophen and NSAID is typically okay for first 24 hours if no bleeding risk. So if we have severe enough symptoms, visual dysfunction, the worst headache of your life, obviously you need to get checked out, go to the ER, get imaging. I'm not opposed to medication for symptom relief, but one thing we do know is when we use things like
you know, substance P inhibitor or COX2 inhibitor, we can have basically an inflammatory signal that will persist longer than it should because we're basically trying to blunt the inflammatory process upfront. So now just like in the first zero to 48 hours of a soft tissue, maybe even 72 hours of a soft tissue injury, we want the inflammatory cycle to do its job, which is basically to...
You know, all these things are getting released or akadonic acids, interleukins, cytokines, prostaglandins. They all have individual jobs of, you know, initiating cellular repair, vasodilating vessels, creating a neurologic stimulus, also starting to create a limbic response of, know, what happened here and I don't want that to happen again. So we don't want to shut that off, but if it starts to persist, do we reach for medication or do we reach for other things? And we'll kind of tackle that here in a second.
Beau Beard (12:25.87)
So in that first zero to 48 hours, again, this is where we wanna get after it. We wanna encourage rest, but we're not just sticking it under dark room forever. We wanna reduce screen time. And I would say overall workload, the screen time could be zero and that's a plus if we have to work, try to do it on, oh my God, paper. And then just workload in general, right? You can get taxed. And then this is where supplementation, hydration, things like that come in when we're talking about the inflammatory response. So staying hydrated is going to be
Yeah. Paramount. Not that it isn't any other time, but you know, it's not just crushing plain water. know that, you know, hyper filtered water is harder for us to basically absorb because we don't have the, the solute for our bodies to basically grab that water out of the, the interstitial system. So a little bit of sea salt, you know, maybe we're doing some electrolytes. you know, I wouldn't be opposed to that. I don't think we want to overdo sodium if we have low activity loads. Cause again, that can flip things where we start retaining too much water and
If we talked about neuroinflammation, mean, a lot of that is fluid, know, or swelling around the brain and that can increase pressure, increase symptomatology. So we don't wanna retain fluid. We wanna have enough electrolyte base, whether that's just salt or something like an element, maybe diluted a little bit to help absorb that water. When we're talking about, let's go diet before supplement. We would hope that we're all eating a relatively healthy diet.
Let's be honest, that's not the case. And if we looked at our youth athletes, that's probably even further from the truth. in this, you know, not just zero to 48, but when we take it out into the next two to three weeks after a concussion, in particular, right, here's one thing to address. When we have multiple concussions, the likelihood of post-concussive syndrome coming on or becoming part of the picture is more and more likely because it's, kind of think about it like ringing the bell, the bell is still ringing while we have this neuroinflammatory response.
And then you ring the bell again and it's just, harder for your body to overcome this. So we want to almost attack this as we would like an autoimmune issue. And we could use something like an autoimmune protocol or we could just say, get rid of the most likely things to be inflammatory to your diet, which are, you know, some of our youth athletes, it is their diet, but we're looking at, you know, grains in particular, gluten processed foods, processed sugar.
Beau Beard (14:50.702)
and then we could throw dairy in there. Maybe that would be the last one with a kid because again, I just know the diets for a lot of our youth athletes. We're trying to reduce inflammation at all costs. In this phase, and we should be doing this style of eating hopefully most of the time, but again, we're trying to be a little more diligent right now. Now from a supplementation standpoint, it's not all about just anti-inflammatory. So you'll see,
Couple of the biggest supplements that we want to go after in here would be you magnesium Omega-3s creatine monohydrate so there's been a big push for creatine monohydrate for just you know neurodegenerative disorders cognitive decline on this is why because Basically, mean they've looked at this for all sorts of things from TB eyes to Alzheimer's to dementia But creatine monohydrate is going to help basically shuttle fluid where it should be going
And we'll talk about the microglial system and astrocytes that can get kicked up in this and kind of shut down that CSF processing a little bit. But creatine monohydrate for the same reasons we'd use it for any of the neurodegenerative disorders, still gonna be something we can talk about now. I'm not here to tell you that you need to be doing the mega doses. I mean, the typical dose is three to five grams a day. That's safe. People are out there doing 20, 25 grams a day for the cognitive benefits.
I'm not here to say that. I'd say you're safe with the five grams a day that's been studied, you know, and has clinical relevancy to it. One thing for sure, magnesium, again, we talked about electrolytes already. So in something like element or LMNT, what do we see? You see sodium, you see magnesium, and then you see potassium. Magnesium can be basically calm down the nervous system a little bit, especially if you look at something like magnesium glycinate.
So it has more of a parasympathetic push to it, but it's also gonna help to help with that fluid absorption. So that's high on the list. Omega-3s, again, barring no bleeding issue or bleeding has been ruled out because omega-3s can thin your blood a little bit. Omega-3s are potent anti-inflammatories to the standpoint that we even will look at RBC like omega-3 matrix with people that are chronically inflamed.
Beau Beard (17:07.852)
Then we could push further into vitamin C, high dose vitamin C has been pushed as an antioxidant for this to the standpoint where if I had personally had access, whether it's me, one of my kids, I might be playing around with some like high dose IV vitamin C therapy, maybe even glutathione dependent on genetics at that point. And that's a whole nother conversation on.
you know, have you taken care of, you know, genetic pathways like CompT and MAOA and things like that, which you need to support those before we just start taking glutathione, whether that's IV intravenously or liposomal glutathione orally. Now in here it has melatonin. So this, it even says in here with the consensus, mixed pediatric RCT results for overall PPCS. Melatonin is, you know, a hormone that's produced that's supposed to help us fall asleep.
One thing I would say is a lot of the research on melatonin shows that its biggest benefit is when we're traveling and we're outside of time zones that are two time zones away from our standard time zone. Melatonin is another supplement, like a lot of supplements, it's hard to get a good source of melatonin. And the thing about melatonin is we could also take precursors to things like melatonin. So we could take a 5-HTP or 5-hydroxy tryptophan to kind of get ahead of that melatonin surge.
Some of that comes down to genetics. But taking 5-HTP, I think, has less downside play. I'm not saying there couldn't be any negative net benefit, but I think it's mostly positive. So I would push for 5-HTP. Then we can play around, you know, those are the gold standards. So if we had our core for omega-3s, creatine, minohydrate, I'd throw magnesium, vitamin C, and then maybe melatonin. I put vitamin C, had a melatonin.
Then we can get into other anti-inflammatory things. We could look at everything from curcumin with, obviously there's different forms of bioavailable or bioactive black pepper in there to make it more easily absorbed. We can look at vitamin D right away for hormone receptor sensitivity as we start to maybe see depolarization of some of these neuronal nerve endings that can start to make sure that we're on top of that.
Beau Beard (19:28.162)
And then we, you know, things like Boswellia Phytozome and things that are potent anti-inflammatories, again, taking in the whole picture of who we're dealing with, are they on any other medications? Have we ruled out brain trauma? And what, you know, what are their symptoms? Is it a, you know, subtle concussion and 48 hours later, they're pretty much symptom free? Do we need to run labs on these people and, you know, do all these crazy tests? Probably not. But that would be the biggest one is staying hydrated, maybe some, you know,
a diet that's going to promote an anti-inflammatory diet and we want to, you we can even add in more things like olive oil from that omega-3 profile supplements that we just talked about. And then we kind of move in, you know, some of the other lifestyle things would be exercise. So in that first, you know, zero to 48, maybe we're not doing a whole lot because any exercise can increase heart rate, increase blood pressure if we have, you know, neuroinflammatory swelling around the…
The gray matter that can increase symptoms increase headache But as soon as we can we want to do low-level aerobic exercise Some of the best things for this would be you know cycling whether that's you know, a stationary bike or come at bike Sometimes that's more beneficial than walking just because walking with the impact of the steps can you know? If you have a severe enough headache can be really jarring We can get people in a pool and things like this but low-level aerobic exercise So we look at this zone one zone two even zone one
for 30 to 40 minutes is a potent anti-inflammatory. It's also going to promote blood flow. Promoting blood flow has a, I mean, whatever level we're at, tertiary, quaternary effect of promoting CSF flow. And one of the biggest things we'll see as we get further into the concussion sequelae is post-concussive syndrome has a nasty effect on basically CSF clearance, which when are you recycling or cleaning your CSF? It's when you're sleeping.
And that's when your microglial system is basically activated and basically scrubs that CSF that's hopefully being pumped through that blood brain barrier, which can be opened up with this depolarization of the neuroinflammatory response around your brain, which starts to affect CSF clearance, which is a part of the post-concussive syndrome. So as we move forward here,
Beau Beard (21:50.511)
You know, it kind of gives us a list here, you know, zero to two days relative rest, short calm walks, no screens for 48 hours, simple meals, hydrate, blah, blah, Day two onward, it's standard aerobic exercise, 80 to 90 % of heart rate. I'd say that's a bit much. So 89 % of heart rate. So if we hit 80, 75 to 80, we're at ventilatory threshold two. I think that's a bit much upfront. Now you get a week or two out, yeah, you could start getting into that and then impact probably becomes a bigger player. what we choose for aerobic exercise probably matters.
more at that point. We talked about sleep, making sure that we get enough. We talked about diet, all these things. So one thing we wanna dive into in my realm is, are they presenting with any dysfunction from a cervical vestibular visual standpoint? So again, when we look at those scat forms and our impact concussion baseline test, we'll see the visual testing, cardinal signs of gaze, pupillary response. We'll look at convergence, divergence.
Do they have any saccades? So, you know, do their eyes kind of jump as we're trying to go through smooth pursuit? Do they have any nystagmus? Does their eye kind of beat as we get to the end ranges or even at rest? Now, we can't be extremely sensitive with our testing because we don't have the tools. We're just basically using our observational skills with the patient in front of us.
If somebody's dealing with severe enough concussion symptoms or it's persisting, we can always send them to a concussion specialist that has specialized equipment like a nystagmometer that can count the beats of nystagmus as we go through eye movements or at rest, things like that, but you climb the chain as necessitated. But when we see that there's maybe lack of range of motion, maybe they had a whiplash injury, which is very common with these where we see a contracou and we maybe at least see an inhibition or a shutdown of what's called
deep neck flexor, so the muscles that lay on the front side of the spine that are gonna be kind of responsible for this, you double chin position. Why does this stuff matter? So let's go one at a time. So cervical insult range of motion restriction. So for the top three vertebrae of your cervical spine, the muscles that are around there, so we have kind of, you know, your superior and inferior oblique, and then a couple other muscles that kind of make this, you know,
Beau Beard (24:13.452)
the top of the cervical spine or this little triangle. Well, Frankie Scali, who actually went to the same grad school that I did, was the person who made this discovery of what's called the myodural bridge. So in particular, superior and inferior oblique suboccipital musculature actually attached directly into the dura of your spinal cord. Why does this matter? When we see a whiplash or a cou-contracoup injury,
Whether that's in a car accident, know, a football game, soccer ball to the head, a fall, falling on your butt, right? Like an impact can create the same effect. What we tend to see with a typical whiplash injury is what? Inhibition due to like an extreme stretch or load through the deep neck flexors. When we see an inhibition of this, whether that's injury or just basically how somebody presents, we see an uptick in suboccipital muscle.
hypertonicity or activity and maybe even some trigger point formation of basically just a neurologic kind of stranglehold. So you can imagine if I have a pain or myofascial pain that's coming from this musculature, that's gonna be a symptom that we can address. Then we look at input from the cervical, the facets, the cervical joints themselves. So neurologically rich area in this upper cervical spine.
And if we get locked down in that area, the mechanoreceptive and the proprioception that would occur with normal range of motion is not occurring. And just like if when you hit your head on a corner of something, you'll rub it aggressively. That mechanoreceptive input is competing with the pain of that area. We can compete with pain by moving our neck if it moves. The other thing that is, mechanoreception can also help with feedback or proprioception. So if we see vestibular,
issues, people are having vertigo, they're off balance. We need to make sure that, you know, that's not in cervicogenic nature. Because again, your vestibular apparatus is kind of going to work on this pitch yaw roll like a pilot. Your neck's got to be able to move appropriately for the semicircular canals to pick up, you know, function. got to make sure we can test those out. In particular, we test out eye function. Then we have to start matching these together because if we have undue tension in that suboccipital triangle,
Beau Beard (26:29.806)
can create tension on the dura, can create spinal cord symptomatology. We may already have swelling from a neuroinflammatory standpoint, which is kind of maybe backing up or slowing down CSF flow. And then all these things start playing together. So our job from the conservative musculoskeletal standpoint is visual testing, you know, and that's like I said, cardinal signs of gaze, gaze stabilization, convergence, divergence, pupillary response, smooth pursue, like very basic tests, vestibular testing.
That can be, you know, single leg balance, single leg balance, closed. Going further to what's called a CTSI-B test, which is looking at those three ranges of motion with repetitive motion, eyes open and closed. Then we can get into hands-on assessment of the musculature, the joint structures of the cervical spine, even upper thoracic spine. The musculature, is there dysfunction that persisted before or since? Don't know. We're seeing it in that day, but we want to make sure.
And then we're always doing our due diligence from neurologic exams, workups there, imaging as needed. So that would be the whole conservative musculoskeletal side of making sure that we don't have any of those issues that are not showing up later. Because sometimes people won't present with that. And as we go through this persistent neuroinflammatory cascade, we can see a change in, we call it sensory motor input or output. So if I lack clean input, whether that's from a vestibular,
function, how my neck's moving or how my eyes are functioning, it's going to have motor output changes. So it becomes this kind of vicious cycle. So then let's say we get somebody that, you know, maybe they're, you know, they have multiple concussions. They're two to three weeks out and we're starting to notice that maybe they're not dealing with, you know, the severe headache that's constant. They're not dealing with neck stiffness and things like that. But all of a sudden we're starting to see that, you know,
I hate the term brain fog because it's so just generic and seems overused, but basically brain fog, inability to focus. Maybe they're tired of lethargic all the time. You can usually see it in these people's eyes and their face. Just look kind of out of it, kind of a cloudy thing, almost like they're sick. And maybe if we even go even further, we do see endocrine disruption. We start to see...
Beau Beard (28:52.91)
you know, we start to see all sorts of things can occur. And I'm kind of looking for an article here real quick. So when we look at.
Beau Beard (29:03.758)
Pull this
also work. You know, I mean, I'm looking at an article right now, the influence of menstrual cycle phases on post-concussion outcomes and symptom reporting. And we could like go in reverse with that.
Also looking at low dose naltrexone for treatment for post-concussive syndrome. So post-concussive syndrome, more or less, the neuroinflammatory response after concussion is primarily caused by immune cells that have been activated. So the microglia, the astrocytes. But when that process doesn't shut off, and this is where I'm gonna get into one of my kind pet hypothesis here, we see that the release of inflammatory mediators and blood brain,
barrier disruption or recruitment of peripheral immune cells just goes through the roof. I think a lot of that's happening because we're already running around, whether we're a youth athlete, we can worry or pro athlete with a not common, a higher, more common level of inflammation just at a baseline. So we see people are relatively more unhealthy. We know that metabolic disorders run amok.
We know that 70 % of the US populace is overweight now. We're dealing with things that are bombarding us, whether that's a true inflammatory response or just a higher stress response in terms of artificial lighting, screens, just the input of all of this stuff from social media, computer, whatever it is.
Beau Beard (30:39.138)
I think that we're at a higher level of stress inflammation and then you have your bell rung, you have a neuroinflammatory response, it's much easier to keep that bell ringing and then we kind of come into this, you know, basically post-concussive syndrome. And if we got down to the nitty-gritty, it's like, you know, if we see this immune activation after this initial response, well, the immune activation is normal, right? That's going to help clear that neuroinflammatory response, but...
It's kind of the compliment cascade of the innate immune system, but then you get basically active immunity that kind of comes into play secondarily, which promotes further microglial and astrocyte activation, which kind of contributes to tissue damage. So basically you're not able to shut off that process. it becomes in essence, again, poor term because we call so many things autoimmune, but your immune system itself becomes the issue. Excuse me.
Beau Beard (31:39.587)
which again can present with all of the post-concussive syndromes that we just talked about. But then you can have endocrine disruption. We can have behavior disruption as we start to see the further this goes. Basically your body is just running at a detriment, which is really no different than if we were just running around with general, know, increased levels of inflammation. What do we tend to call that? We tend to call that autoimmune. And then we label it autoimmune.
based on the symptomatology or the tissue, the organ system, whatever, that's actually providing the symptoms. But it started with a systemic issue and then it kind of came down to maybe, on your genetics, your lifestyle, your diet, your liver gets beat up, your pancreas gets beat up, whatever it is, allergies. And in this case, we have neuroinflammation, so that runs amok. And then all of sudden, the cascade of mediators that are going to start.
you know, within your brain from your pituitary or hypothalamus, the limbic system getting involved here, start to have basically a descending pathway of dysfunction. And we can see all sorts of things from, you know, menstrual cycle disruption to altered insulin sensitivity and resistance, which gets back to when we get into that first phase of concussion, we want to say, okay, our job is to treat the concussion, but also our job is to treat the...
the organism and the organism needs to try to drive out as much systemic inflammation as possible so we can manage the concussion, but also not have any these further effects, which takes me back to we, ideal world, are trying to get people to live more of this lifestyle, you know, normally or on the day to day. So if I would like to see, you know, this might sound crazy, if we were doing
baseline concussion testing, whether it's a scat form, an impact, you know, whatever computer program that we're also including, you know, a movement profile in there, not just the things that are on the scat form. So something like we do in our office, which is called a selective functional movement assessment. looking at top tier movements to see like, what was your single leg balance like? You know, what was your neck range of motion like before you got your bell rung? But then also lifestyle things, you know, how much sleep were you getting before this?
Beau Beard (33:58.071)
What is your diet like before this? What's your hydration like before this? What medications were you on? What supplementation were you taking? Knowing those things and knowing what kind of organism is basically being thrown into this concussion scenario is gonna make all the difference in the world of knowing, well, you know, this is the biggest lever we gotta pull because you are largely inflamed and have a terrible diet, but you're pretty active and you drink enough water. It's like, okay, that's where we need to go over here besides our typical protocol.
So, I mean, there is a lot, a lot to cover with concussions. kind of, everybody kind of understands how they happen. And again, it doesn't always have to be head impact. You can have these from, know, falling, you know, directly on your butt, having a whiplash with no impact. Again, it can be your brain moving inside your basically brain pan. And then, you know, what status was the organism before they came into this?
and then backing out of that. And if you're dealing with a concussion, go through the standard protocol. If you're dealing with what seems to be turning into post-concussive syndrome or symptoms, I would find somebody that is well-versed in this can A, test everything adequately and not go overboard on testing, but also maybe even play quarterback or triage because sometimes it's a team approach. Maybe you need.
you know, a neurologist, a functional neurologist, somebody that understands the nutrition piece, a conservative musculoskeletal specialist. And sometimes you get lucky and one person can handle a lot of that stuff just based on their training. So I hope that helps, you know, somebody out there that has dealt with, has kids that might deal with, has personally dealt with this, might be dealing with it, get some information to, you know, set the stage on these things. But I encourage you again, if you just, like I said, look up the six international consensus statement.
Um, you know, from 2023, that is kind of still the gold standard. There are things that you can do outside of that. I mean, we can do all sorts of stuff, hyperbaric chambers and, you know, crazy supplementation, but there's basics. There's fundamentals. Just like if somebody comes to me and they want to, you know, deadlift 500 pounds, of the first questions we're going to ask is, can you touch your toes? Same thing here. If you got your bell rung, I'm not going to jump to, Hey, we're going to do, you know, uh, 10-pass ozone therapy with hyperbaric chambers. I'm going to say, Hey,
Beau Beard (36:19.053)
Are we drinking enough water? How's your diet? Are you getting enough sleep or are doing some screen time? And then we can move from there. And I hope you would do the same. So I hope you got something out of this. I hope you learned a little something and I'll see you all next time.
