Recovering from a concussion can be a challenging journey, especially when it comes to resuming daily activities like work or school. While it’s natural to want to return to your routine, doing so too quickly can hinder recovery and prolong symptoms. At Sydney Concussion Centre, we understand the importance of a safe and gradual reintegration. Here’s how to transition back to work or school effectively, manage cognitive load and fatigue, and ensure a smooth recovery process.

Transitioning Back to Work or School After a Concussion
Returning to work or school after a concussion requires careful planning and patience. Concussions affect the brain’s ability to process information, regulate energy, and manage stress, making it essential to ease back into your routine.

Start by consulting a healthcare professional who specialises in concussion management. They can assess your symptoms, provide a tailored recovery plan, and recommend adjustments to your workload or schedule.

A phased return is often the best approach. This might involve starting with shorter hours, taking frequent breaks, or focusing on less demanding tasks. Communicate openly with your employer, teacher, or school counsellor about your needs to ensure they can support your recovery.

Tips for Managing Cognitive Load and Fatigue
One of the most common challenges after a concussion is managing cognitive load and fatigue. Here are some practical tips to help you navigate these hurdles:

1. Prioritise tasks: Focus on high-priority tasks when your energy levels are at their peak, typically earlier in the day. Save less demanding activities for later.
2. Take regular breaks: Schedule short breaks every 20-30 minutes to rest your brain and prevent overexertion. Use this time to practise relaxation techniques or simply close your eyes.
3. Limit screen time: Prolonged exposure to screens can worsen symptoms like headaches and eye strain. Use blue light filters and take frequent breaks from digital devices.
4. Stay organised: Use planners, to-do lists, or apps to keep track of tasks and deadlines. This can help reduce mental strain and improve focus.
5. Listen to your body: Pay attention to signs of fatigue, such as difficulty concentrating or increased symptoms, and adjust your activities accordingly.

    

   The Importance of Gradual Reintegration
   A gradual reintegration is key to a successful return to work or school after a concussion. Rushing back too soon or taking on too much can lead to setbacks, prolonging your recovery.

Gradual reintegration allows your brain to adapt to increasing levels of activity without becoming overwhelmed. Start with light duties or part-time hours and gradually increase your workload as your symptoms improve.

It’s also important to monitor your progress and adjust your plan as needed. Regular check-ins with a healthcare professional can help ensure you’re on the right track and provide guidance on when to take the next step.

Take the First Step Towards Recovery
Returning to work or school after a concussion doesn’t have to be overwhelming. With the right strategies and support, you can ease back into your routine while prioritising your health.

At Sydney Concussion Centre, we are experts in personalised concussion management plans to help you recover safely and effectively. Book an appointment with our experienced team and let us help you take the first step towards a full recovery today.

Two Italian research papers written in 2012 give us the best evidence for the timing of a safe return to Sport. (1,2).  

It is well known that after a concussion, the brain has reduced energy levels, often by up to 20%. The brain weighs about 2% of our body weight but uses 15-20% of our blood flow. This is because it needs a lot of energy to perform the complex processing of all the information it receives as well as driving all the functions it performs, even when we are sleeping! 

Measuring these energy stores is very difficult but this group of Italian researchers were able to assess energy levels using a complex and costly measure called Proton Magnetic Resonance Spectroscopy (PMRS). 

A concussion disrupts the important energy stores in our brain. Here are the important points they learned from their research.  

• Eleven athletes, (3 females and 8 males) who had a Sports Related Concussion were tested using the PMRS on Day 3, 15, 30 and 45 after the concussion. They compared the results with 11 healthy matched controls, who did the same testing. The athletes with concussion had reduced energy levels, compared to the non-injured controls at Day 3  and Day 15. At Day 30 they were still less but very minimally, (and not significant), with energy levels back to normal at Day 45. 

• Those results were for the athletes who did the proper rehabilitation. However, 6 of the athletes decided to go back to sport before their energy levels were back to normal. “Why did they do that?” you ask…. It was because they felt OK.  

Even though energy levels take 30+ days to recover, the athlete’s symptoms settled much quicker,  on average by Day 15,  post injury. As they ‘felt’ ok,  they thought they were ready to go back to sport. (Interestingly all 6 were males – 2 soccer players,3 boxers and a rugby player) 

• All 6 of these athletes sustained another concussion, whilst their brain was still low on energy from the first concussion. The results showed that the second time around, they had more symptoms (4-6) compared to the initial injury (2-3) and they took, on average, 41 days for the symptoms to settle. That’s almost three times longer than the single concussion athletes.  

• The most telling result was the time for the energy levels to get back to normal for the double concussion athletes. This was 81 days(av) – THREE TIMES LONGER than the athletes who didn’t return to sport 

WHATS THE LESSON TO BE LEARNT? 

1. Feeling good (that is, no symptoms) is not a great measure for return to sport. 
2.  Having a second concussion before your brain has recovered from the first, creates longer term issues and may be the end of your season! 

References 

1. Decrease in N-Acetylaspartate Following Concussion May Be Coupled to Decrease in Creatine Roberto Vagnozzi et al, J Head Trauma Rehabil (2012). 

1. The Importance of Restriction from Physical Activity in the Metabolic Recovery of Concussed Brain, Giuseppe Lazzarino et al, Chap 25, Brain Injury – Pathogenesis, Monitoring, Recovery and Management, (2012). 

Our certified clinics specialise in all aspects of concussion treatment. Our approach is to first take you through a series of assessments and special tests to determine your main symptom drivers. Once we know what’s driving your symptoms, then we can apply the appropriate steps to address it. 

Exercise Therapy 

Many patients become intolerant to exercise after concussion.  This is due to dysregulation of the Autonomic Nervous System (ANS) and brain blood flow. 

Following a short period of rest and symptom-limited activity, guided sub-symptom threshold exercise therapy has shown to safely and gradually improve blood flow and speed recovery. 

Manual Therapy 

Headaches, balance and visual issues, dizziness and blood flow abnormalities are symptoms of both concussion and neck injuries (or whiplash). 

Oftentimes ongoing concussion symptoms are coming from your neck, which can be treated with manual therapy and specific exercises to improve function. 

Vestibular Rehabilitation & Vision Therapy 

Visual disturbances and dizziness are common following concussion. 

A balance and visual rehabilitation program may help to reduce symptoms such as dizziness, visual abnormalities, concentration issues and memory problems, among other symptoms 

Diet & Nutritional Intervention 

Within 3 hours after a concussion, the lining of your gut begins to change because of the close relationship with the brain, known as the ‘Gut-Brain Axis’.  This system is tightly linked with your immune system, inflammation, the Autonomic Nervous System, and your hormones (Hypothalamic-Pituitary Axis). 

Chronic fatigue, low energy, cognitive problems, headaches, anxiety, low mood, and a variety of other symptoms can be traced back to poor gut health. 

Cognitive Problems 

These common complaints such as fogginess, trouble concentrating, and memory impairments are multifactorial and require a comprehensive approach. 

Understanding exactly what is going on and why you feel a certain way can help to improve recovery. 

Did you know that nearly 50% of the brain is dedicated to processing visual information? We normally have two eyes which can work together as a team. Following a concussion, there is often an interruption in communication between the eyes and the brain.  

Your eyes work together with your vestibular (inner ear) and proprioceptive (touch) systems to maintain balance and help you accurately navigate the world. If your visual system is feeding inaccurate information to these systems, they may cause ongoing symptoms.  

If this happens, you may find you get sore eyes, headaches, or dizziness after using your vision. You may even get light sensitivity and/or misjudge where objects are.   

Here are some common vision problems that may occur following a concussion:  

1. Eye focusing (accommodation) 

 Efficient eye focusing is the ability to maintain clear vision when looking at up close and accurately switch focus between close and far. Difficulty with eye focusing skills can cause blurry & fluctuating vision at near (e.g., for reading and computer work) and difficulty switching focus between objects (e.g. from reading to the whiteboard).  

If you have an eye focusing problem, you may find your eyes fatigue quickly. Vision at near can flicker between clear and blurry, causing watery eyes, eyestrain, and headaches.  

2. Eye teaming (vergence skills) 

This means when we look at an object, both our eyes are pointing at that object in a precise and coordinated way, giving us single comfortable vision which we can sustain for long periods. This is good eye teaming. 

Problems with eye teaming can cause double vision, headaches, visual fatigue, tension around the eyes and words can appear to float or move on the page.  

3. Eye tracking (oculomotor skills) 

Eye tracking skills include the eyes’ ability to accurately jump between targets (saccades) and smooth eye movements to follow a moving target (pursuits). If you have difficulty with your eye tracking skills, you may find yourself losing your place when reading, skipping words and lines. You may notice that your eye-hand-body coordination may be affected e.g. catching a ball.  

While some patients have visual symptoms that settle over time, others may need some support to get back on track. 

 Patients who have visual symptoms from concussion can benefit from seeing an Optometrist who has a special interest in the visual aspects and rehabilitation of concussion (neuro-optometric vision care). There, a thorough evaluation of your visual skills and eye health will be performed.  

Optometrists can work together with you & your other healthcare professionals to tailor a program to reduce your visual symptoms and help with the impact of concussion on your visual system. The treatment offered can include glasses, sometimes with specific tints, prisms or occlusion, and neuro-optometric vision therapy. We will also give you strategies to help reduce your symptoms from day to day. If needed, we may also refer you to other specialists for their expertise.  

Celine Zhang graduated from the UNSW Bachelor Optometry/Science course with First Class Honours. She has also completed the Specialist Certificate in Management of Paediatric Patients (Optometry) from the University of Melbourne. 

She has completed additional training with the Neuro-Optometric Rehabilitation Association & Optometric Extension Program Foundation and is currently pursuing her Fellowship with the Australasian College of Behavioural Optometrists.

Celine Zhang practises at Eyecare Plus Kareela and Eyecare Plus Bankstown in Sydney. https://www.eyecareplus.com.au/kareela/ 

To recover effectively from concussion a structured approach, both physically and cognitively, is important. The following outlines our recommended process.  
These stages run concurrently with each stage being assessed by our practitioners to ensure your effective recovery and safe return to activity. 

It is important to remember that this is a guideline only – every concussion is unique so the rehabilitation process has its own ‘nuances’ and curve balls which is why we strongly recommend that you have our practitioners support you through the process to make it as efficient as possible. 

Sydney Concussion Centre practitioners look forward to helping you navigate your concussion rehabilitation process! 

The answer to this question is “Yes” and “No”. 

Concussion is caused by an acceleration and deceleration of the brain inside the skull. Due to this, the nerve cells in the brain to become stretched and stimulated, resulting in a surge of electrical activity. This causes the initial symptoms of a person falling to the ground, finding it difficult to stand up and generally being disorientated. This may only last a minute or two but the surge utilises a huge amount of energy which the brain finds difficult to restore to normal levels; hence, the ongoing symptoms of concussion.  

What if you could limit the effect of the acceleration/deceleration injury to the brain. Neck strength has been suggested as one way of limiting the effect of the concussion on the brain, however it’s not really as simple as that. 

Research has shown that decreasing the forces applied to the head can possibly reduce the likelihood of suffering a concussion. Reducing these forces to the head is more related to neck stiffness, not necessarily neck strength. Increasing neck stiffness could reduce the forces applied to the head therefore reducing the chance of suffering a concussion.  

There is a big difference when an athlete is prepared for impact and when they are not.  

When an athlete knows an impact is coming, they are more likely to tense up and contract their neck muscles and therefore increase their neck stiffness. When an athlete is unaware of a potential impact, they are more likely to be relaxed and therefore reduce their neck stiffness.  

It is important to note that an athlete with a stronger neck will have greater neck stiffness and therefore a decreased chance of sustaining a concussion.  Generally, it comes down to whether the athlete is ready for impact or not. The athlete who is unaware of potential impact will be more likely to suffer a concussion injury.  

Ultimately improving your neck strength will reduce the likelihood of concussion as long as the athlete is prepared for the impact. Improving an athlete’s ‘game awareness’ could lead to a decreased chance of concussion because they will be more likely to know when a potential ‘concussion hit’ may be about to happen, hence they will be prepared for the hit. This comes with experience but can also be accomplished with coaching proper technique and game preparation.