Stroke Rehabilitation

What do you do if nothing helps after a concussion?

concussion Mar 16, 2022

It took me more than 30 years, a tremendous amount of stress, and most of all frustration to figure out how to keep my mother going—literally—after a series of concussions.  

The answer certainly did not come from the doctors my mother saw. They didn’t recognize the problems she had developed, and they explained that her issues were located in the head. While that was partly true, the problem came from the brain, there are better insights available. 

Many years have passed now, and we fortunately know a lot more about what can happen to you after a concussion. This knowledge is providing better solutions, although I must add that the problems after a concussion cannot always be completely resolved. 

In this article, I will try to explain why these persistent problems arise, why not everyone seems to develop issues and some can apparently recover without problems, how these complaints are usually dealt with, and what better solutions are possible through the latest insights. Finally, I explain which approach might best fit you and what your first steps can be. 


You probably haven't tried everything yet. 

Let me start by saying that you likely have not yet done everything possible to get rid of your persistent complaints after a concussion. How do I know? After nearly 30 years of working daily with brain-injured patients and an unrelenting drive to learn more about the consequences and solutions after congenital brain trauma, I believe I have developed a just overview of what is truly possible. And I know that these possibilities are limited by much of the current approach and treatment after concussion.  

In retrospect, this is the direct result of the helplessness I experienced while working to address my mother's ongoing problems. 


The standard approach 

“Just take it easy for a few weeks, then the problems will subside.”  
“In most cases the issues will disappear automatically after a concussion.”  
“You have to learn to live with it, and avoid doing whatever makes the complaints worse, as much as possible.”  

These are just a few of many of these types of statements that I hear every day. 

You may qualify for rehabilitation if you are one of the 30% or so who still has to deal with one or more of these after an accident: dizziness, light and/or sound hypersensitivity, inability to think, nausea, constant fatigue, inability to do activities for a long time or unable to make appointments with others because it’s too much for you or because of persistent physical discomfort. If you can participate in a rehabilitation programthen usually a combination of, occupational and physical therapy will follow, or you will find your own way through the forest of practitioners. 

What this help usually means is that they look at how your resilience can be improved, how you can make a better daily schedule, how you can prevent and avoid excess stimuli, and if you are lucky, in addition your condition and physical discomfort will be worked on. 


Quite often compensation training is offered. 

For some, compensation provides relief. For a few, it can even be the solution to existing problems. This is not the case for most patients, however. As you will read, offering compensation training and improving brain reserve through natural recovery is not the same as addressing the actual underlying causes. 


Specialist clinics 

It is therefore not surprising that at the moment there is a large group of people with a post-concussive problem (persistent complaints after a brain shake) who do not want to accept it and are moving to, for example, the United States. In the US there are different centers with a lot of expertise in the field of traumatic brain injury: Cognitive FX, the Plasticity brain centers, and Amen Clinics, to name a few.  

In many cases, the approach in clinics like these is clearly different from what we see in the Netherlands. There appears to be more attention to the actual underlying problems and using the latest knowledge from brain research in the training and treatment provided. 

Striking at these centers is the use of advanced equipment such as functional MRI, SPEC scan, computerized eye functionality and fall probability measurement. These are diagnostic resources that you will not find in an average hospital or rehabilitation center in, for example, the Netherlands. While this (relatively costly) approach may seem successful at first glance for those dealing with mild or moderate problems, a week of therapy is usually extremely costly or just not long enough to address all the problems. What we can in any case learn from this is that we may need to look more at the current knowledge about the cause of persistent complaints and what we can do with these continuing problems in treatment and training. 


What new scientific knowledge is available?  

In the rest of this article, I explain what scientific knowledge is currently available and how you can make use of it in your specific situation.  


Why is it so difficult to diagnose problems after a concussion?  

Before I go into some important facts about what happens and what is triggered by a brain shake or whiplash, I want to look at the status quo around the diagnosis of concussion and especially who makes this diagnosis.  

As you now understand or even have experienced, usually no serious abnormalities are found by the doctor or in the hospital (if you have already been referred by your doctor). On the one hand, this is fortunate because no permanent damage has been found. But on the other hand, this result is also very unsatisfactory because the complaints are still there. 

What is going on here? Are doctors not there to make a diagnosis and identify health problems? First of all it is good to understand that physicians (doctors) are primarily trained to diagnose diseases (pathology).  

Yes, and…isn’t a concussion an identifiable problem? Not necessarily. There is in most cases no demonstrable damage. The diagnostic equipment that is usually used is not made to detect functional problems. So, in most cases you go home with the messages “Fortunately everything is fine” or “Congratulations, we did not find any abnormalities. Youll have to be patient. If there are persistent complaints, just come back.” 

However, as you will learn in the following paragraphs, this doesnt make much sense in order to arrive at a better outcome. 

What is the matter, then? 

The frequency that issues are identified through diagnostic testing is likely to go up in the future as enormous progress is being made in the diagnostic knowledge about whiplash and brain trauma. And we will soon be able to see, for example, through blood tests whether there is so-called white matter pathways (nerve tractsor glial (support system in the brain) damage by means of so called SNTF and GFAP-BDP tests. However, this still does not solve the problem of what to do when there is a demonstrable problem going on . 

But before we discuss possible solutions, let's list what we know from research. 

Keep in mind that those who know the most about this topic are the researchers. Their knowledge and applications are often 20 or more years ahead of what is practiced by doctors and therapists. 


Some important facts 

Following are some facts you may not already know about concussions and the resulting problems: 

  • Some of us are more likely due to hereditary predisposition to have problems after brain trauma.
  • Your mental and physical health at the moment that you experience an accident can be a significant determining factor, for example, if you smoke, have diabetes, have just had an emotionally difficult time, etc.
  • If you have had a head injury before, the chance of problems is many times greater.
  • Your blood-brain barrier is opened temporarily or for a longer period of time, allowing potential inflammatory substances to enter after a head trauma:
  • Your brain-gut interaction is disrupted.
  • A so-called low-degree neuroinflammation (inflammatory mechanism) is set in motion to clean up damaged cells and waste products after trauma, but this often does not stop and if it does, it can easily be reactivated in the future.
  • Dysautonomia, an imbalance in the autonomic nervous system that can cause blood pressure problems, dizziness, nausea, palpitations or disordered heart function. POTS (Postural Orthostatic Hypotension) is an example of this.
  • Central balance integration problems often arise, causing dizziness or a changed body and/or worldview, which can disrupt physical and mental orientation and processing of information.
  • The networks related to eye functionality are widespread and are therefore very vulnerable when head trauma occurs.
  • Hormone balance, especially in women, can be disrupted by brain damage that causes the pituitary gland to malfunction.
  • Superficial subcutaneous nerves around the head, neck and shoulders can become chronically irritated.
  • The translational force around the neck and head at the time of the accident disrupts the emotional information from the neck. This makes the interplay between the neck, the balance system, the eyes and the rest of the brain more difficult.

And these are just a few of the most obvious things that seem to play a role in persistent complaints. (In future articles we will go into detail on all the individual function disturbances described above.) 

Often, too much attention is paid to the psychological consequences. 

I deliberately do not place all emphasis on the psychosomatic issues that can play a role in recovery after a concussion, as too often and too much attention is paid to them, while the other factors that appear to be more important are not or hardly considered. Having said so, I do have to mention some aspects that may play a determining role in your recovery. First of all, psychology always does play a minor or bigger role in recovery. We know that when you are dealing with adversity in a more positive way, recovery of a concussion will go much faster. Secondly it is important to be realistic and expect recovery to take considerable time, especially when it has been some time since the concussion took place. Also expecting some discomfort during the recovery period and not shying away from the things, such as moving your head quickly, or not wearing sunglasses all the time when you are light sensitive, will actually retrain the weak areas quicker. In the upcoming sections I will mention some forms of stress reduction that have really shown to be of benefit for anyone dealing with a concussion. 

As you are discovering, researchers have brought up a number of important issues here, but these issues generally not or hardly examined in patients. Usually because of the one who is the situation must assess is not or hardly specialized to be able to assess the functional problems that arise. And this is where there is a big gap in the current medical "care" system when it comes to the aftermath of a concussion. The diagnosis may or may not be established, but the mapping of the underlying, usually functional problems in the brain and the body after an accident is hardly done, or not at all. 

The solutions you are looking for lie, if we are to believe researchers, in the new knowledge we have gained about brain injury. 

For example, we know from research that microtrauma in the brain and spine can indeed occur (the current research methods in the Netherlands are often insufficient to determine this, hopefully the new blood tests will be used on a large scale in the future) In addition, scientists show that detecting functional disturbances in the brain and the cooperation between body and brain function provide better solutions than the current approach. (All studies discussed can be found in the appendix under this article.) 


What practical steps can you take with this information? 

Often the simplest solutions are the most powerful! 

In this section, I'll point out the approaches that I've seen make a really big difference for literally hundreds of patients (in addition to research that shows this). 

It is also very likely that you already experimentally apply a number of the following items because they make you feel better. 



One of the most powerful weapons you already have for tackling post-concussion problems is sleep, believe it or not. Good quality sleep is your self-healing ability and also the ability to boost your immune system and reduce the neuroinflammation I mentioned before. Going to bed at the same time every day (you can count the hours before 12 p.m. twice) is an important key step.  

I won’t go into detail here on every item that could potentially be useful to you. But I still want to mention a number of things that we know are extremely important for good sleep because I know from experience that sleep is a problem for many of you:  

  • You go to bed the same time every day. 
  • You spend about the same time in bed. 
  • You only make up for lost sleep by doing power naps (no longer than 30 minutes). 
  • No TV, computer, or other monitors or other source of blue light 1.5–2 hours before going to sleep 
  • Totally dark bedroom 
  • Make sure your bedroom is neither too hot nor too cold.
  • Provide good ventilation in your bedroom. 
  • Your bedroom is there to sleep, not to watch television or have intrusive conversations. 
  • Dim lights long before going to sleep. 
  • Try to do relaxation exercises when you do wake up. 
  • Only use sleep medication if there is no other option (with sleep medication,you only forget that you did not sleep well). 
  • Do not eat 2 hours before bed unless you have blood sugar problems. Then, only eat a small amount of proteins and fats, such asnuts if you can handle that. 
  • Make sure your blood sugar level is constant, too low or too much blood sugar can have major consequences for good sleep. 
  • Optimal sleep means 7.5–8 hours of uninterrupted sleep, not spending 8 hours in your bed. So, it may be that if you are a bad sleeper, you will be in bed at 9 p.m. and not get out of bed until 8 a.m. the next morning. As youcan see, not all solutions need to be complicated. Lifestyle is often one of, if not the most important ingredient for further recovery.

Let’s talk about a few other things that will help your further recovery. 


Take care of your gastrointestinal system. 

There is an important connection between your gastrointestinal system and your brain. We are learning more and more about this, and I will go into this particular interaction in detail in subsequent sections. Simply put, it comes down to taking good care of your microbiome (the jungle in your stomach), especially for the good intestinal bacteria. 

What does this mean? 

  • No junk food, avoid alcohol, and limit medication use to a minimum. No gluten, milk products or derivatives thereof. Eat especially many and diverse vegetables; this in particular is essential.
  • The fiber in vegetables is the most important ingredient for your intestinal flora. Your intestinal bacteria produce end products (short-chain fatty acids) that not only keep your intestines healthy but also have a significant influence on the proper functioning of your brain. They even dampen the inflammatory process in your brain that we talked about earlier.
  • Conversely, when your brain starts working better again, this immediately has a positive effect on your intestines: better mobilityinyour intestines, better production of gastrointestinal juices and enzyme production to name a few. 


Movement is also essential. 

Your brain repairs and improves through movement, meaning the right exercise, within your capabilities (even if it’s only doing 5–10 minutes on the bike, three times a day, for example). Movement, especially high-intensity exercise over a short period of time, releases substances such as BDNF (Brain-Derived Neurotrophic Factor), growth hormone, and the body's own morphine-like substances (encephalins, endorphins). These substances in turn promote recovery, ensure the production of new brain cells and repair of networks, and also suppress neuroinflammation. 

The health of your body, in particular the proper functioning of your brain, is totally tuned to and dependent on movement. Even if only minimal exercise is possible in a day, that's where you start. There are no excuses for not doing this. Period. 


Stress management 

Stress management is also something that you can initiate and maintain yourself, or with some help from a therapist or the internet, regardless of what you have experienced or what situation you are in. According to researchers, these are the most effective ways to make your brain experience less stress and improve recovery: 

  • Meditation. Even just three minutes of meditation already has a significant effect. This can simply be monitoring your breathing. The effect is further enhanced if you do this first thing in the morning.
  • Mindfulness is helpful for many who find meditation difficult. When you start, a guided body scan via an app or instructor can workvery well.
  • Yoga and/or tai chi, in addition to the physical benefits associated with body awareness, control and feedback, both have a very beneficial effect on mental well-being.


Things I would have liked to know myself 

I have not yet shared the knowledge that I am going to share with you now. I am going to show you what seems to be the most effective in practice. In other words, this is what I would have loved to know when dealing with my mom's problems! 


Your brain reserve 

One of the remarkable things I have seen over the years is that when there is enough “brain reserve,” there are more possibilities to deal with problems after a concussion. This is also the reason why some seem to have little or no complaints, even if there is a major head trauma. If you have a lot of brain reserve and all other conditions (such as good health, nutrition, sleep, etc.) are correct, a lot can go wrong without it appearing to cause major problems in your daily life. 

How to understand this? Imagine you are using your brain optimally, you have academic and mental challenges and you can act on them. You live a healthy life and get enough sleep, and you don't smoke and are in great shape. Your brain reserve depends on these things, so your brain reserve is quite large, say 60%. After your accident, your brain reserve is 10%, but basically your brain is still fine. 

On the other hand, if you only have 10% brain reserve to start with because you are dealing with a chronic disease, a monotonous life with few challenges and/or you have already experienced a concussion, then it is a completely different story. The same head trauma all at once has much bigger consequences. Your life is turned upside down, and unlike that person with a great reserve, you may have all the symptoms you can imagine, and you may never be the same, after experiencing the same head trauma. This is the reason why two people can experience the same accident and come out seemingly completely different. 

Compensation is not really a solution. 

Learning to compensate by making what already works even stronger is therefore not really a solution. The weak functions created by the head trauma are still there and so is the real underlying problem. Another trauma or physical, mental or overtraining strain will likely bring the problems back upfor the simple reason that they've never gone away. 

How can you rebuild your brain reserve and restore the functional imbalance that has arisen? 

So it is, although there seems to be nothing more to do because you have learned to compensate, or have built up enough brain reserve, after a brain shake thing to find out where the weak spots originated. 


What really matters 

A summary (in addition to the lifestyle factors we discussed earlier) of what really seems to matter to brain recovery: 

  • Reducing brain (neuro) inflammation 
  • Addressing central vestibular problems 
  • Strengthening eye, head, and balance integration 
  • Optimizing eye functionality and targeted eye and brain training 
  • Training the weak networks and areas in the brain 
  • Address physical instability and dysfunction, including around the jaws, neck and skull 
  • The use of multitasking in which body and head learn to work together again 
  • Strengthening the energy system at the cellular level, for example through hormesis 
  • Reducing preexisting autoimmune problems 
  • Optimizing the brain-gut cooperation 
  • The use of photobiomodulation (low level intensity, therapeutic laser) 

There is more that matters, but there is a good chance that when the underlying weak functionality after brain injury is tackled with the aforementioned approach, you are a number of significant steps further. 

The reality at this point is that only some of these things will be or have been used to help you recover further (if you’re lucky). 


The correct sequence and intensity is very important. 

Before you want to do anything with this approach (in addition to what you have already done), it is important to realize that you must do this approach in the right order, with the right intensity, and with your individual load capacity and combination of the already existing underlying factors (such as existing immune, degenerative problems, energy reserve at cell level, etc.) in mind. 


Training a few times for longer periods is not the solution. 

For example, training for 2 hours several times a week is not the solution, while it is important to build up and improve basic fitness and strength by, for example, walking, light exercise plus short bouts of resistance training  (this is very important for improving circulation to your head and the release of Growth factor and other hormones that help repair and optimize the brain), your brain likes intensive, short exercise, with many repetitions (at least 4 times a day). Change training in time when possible, because your brain likes variety and continuing with the same training has no or less and less effect. At the same time, it is important to check that you are not constantly crossing the limits of metabolic load because this can set back your progress days if not weeks.  


The critical steps that offer real change in practice 

In order to give you the best possible idea of ​​what additional possibilities there are in your specific situation, I now list and briefly explain the things that not only the researchers show can be valuable in finding better solutions after concussion but that really change my patients in practice. 

Because it is not the intention of this piece to give detailed explanations about every subject (this article would soon take the form of a book) and there are already several articles that go into this in detail (see also attached reference list), I make this section brief so that you at least understand the essence. 


1. Reducing brain (neuro) inflammation 

The immune system of the head (the microglial system) reacts differently from that in the body. When a head trauma activates this system, it remains active or it can be reactivated very quickly with, for example, stress, physical overtraining etc. Activation of this system is responsible for so-called brain fog, not being able to think, difficulty with mental tasks, needing too much sleep, etc. (See also this video with extensive explanation about neuroinflammation and what you can do with it.) 


2. Addressing central vestibular problems 

Although not everyone experiences dizziness after a whiplash or head trauma, in practice we see that this system often poses significant problems. The integration between the balance system, the body, and the head no longer works properly. This not only has consequences for the control of the posture apparatus and the movements and orientation of limbs, but it can also have major consequences for the processing of information in the higher brain regions. With the control of eye functionality, this is one of the most widespread networks and therefore the most vulnerable. Recent research (Carrick et al.) shows that standard balance tests are inadequate and that when looking at more advanced ways of positioning the head and body in other planes, significant disturbances come to light. In my own practice, we see this kind of underlying problem in varying degrees in about 75% of people dealing with the consequences of a concussion. 


3. Strengthening eye, head, and balance integration 

Several studies show that specific training of eye functionality, in combination with head positions and the balance system, offers many benefits and positively influences recovery after head injury. I do want to note make that this training must be done very specifically. Training the head and eyes in all directions generally leads to compensation, and we do not want that. 


4. Optimizing eye functionality and targeted eye, brain training 

A striking number of people I see in my practice have already gone through a whole process with different therapists. When I ask what they have benefited from most, they often answer that it was the eye training by a neurological or functional optometrist. This is not entirely surprising because the control of the eyes is often disturbed by accidents. The great thing about eye functionality is that literally a large part of the brain is directly or indirectly involved in the functioning of the eyes. Specific eye movements (i.e. specific in type and direction of movement) can be used to specifically train functionally weaker brain areas. 


5. Training the weak networks and areas in the brain 

Your brain is very smart at avoiding obstacles. When networks or areas are disrupted by trauma, well-functioning areas take over tasks. This means an imbalance and with it a conflict in the brain. Tasks are no longer performed optimally and efficiently. Several studies (see also list at the end of this article) show that specifically addressing the weak functionality leads to better results and more efficient use of the brain. And in my own practice, I see that specifically stimulating and training the weak areas of the brain is an important part of further recovery. 


6. Address physical instability and dysfunction, including around the jaws, neck and skull 

Not only are many pain complaints around the shoulder, neck and head caused by subcutaneous nerves (subcutaneous nerves) becoming chronically inflamed by trauma, we also see that movements of the cervical spine, in posture, and around the head are chronically disrupted. The erroneous movement patterns in turn lead to erroneous information flow to the brain. Several studies show that normalizing this sensory (feeling information) information flow (which is essential for the proper functioning of the brain), the movements around the shoulders, the trunk stability, the neck and even around the jaw, provides much progress after accidents . I can agree with this, but please reiterate that this cannot be done randomly. The more specific the better. 


7. Cognitive training through the use of multitasking so body and head learn to work together again 

When those six items are optimized, then cognitive training, for example, word games or simple math, can be added to the other training. Neurocognitive research, functional MRI and SPEC scans (quantitative EEG, for example, is a good alternative to, for example, very expensive functional MRI or SPEC scan that are not accessible in the Netherlands), can provide detailed information about which tasks and associated areas have been weakened. In this way the various weakened functions are linked to each other and function is restored to a higher level. 


8. Strengthening the energy system at the cellular level, for example, through hormesis 

This is a topic that is currently receiving a lot of attention. The energy factories at the cellular level are very vulnerable to the consequences of trauma. After trauma and especially when neuroinflammation happens, a “cell danger response” occurs. This is a survival response in which the mitochondria (the scientific name for the energy factories) no longer produce energy. This of course is not really useful if you want to have more energy or recover from a trauma.  

Fortunately, there are many things to do to start, restore and even strengthen energy production. Exposing yourself to low doses of stressors is a good example of this. This is called hormesis. Examples are exposure to heat (for example, infrared sauna), cold (cold shower) intermittent fasting, where no food is eaten from the evening meal for example over a period of 14–16 hours and physical activity, such as high-intensity interval training (adapted to your individual condition) good examples of this. I often hear from patients that consistent application of the hormesis principle yields a lot of energy. (Also take look at the Energy Masterclass.) 


9. Reducing preexisting autoimmune problems 

This may not be the most obvious way to get rid of your symptoms after a concussion, but in practice it turns out to literally be a lifesaver when you have to deal with it (unnoticed). (Autoimmunity is on the rise in Western society, and many of us will sooner or later be affected by this phenomenon. In the US, for example, it is predicted that 10%–20% of the population will be directly affected).  

I know from personal experience that it usually takes 20–30 years to get a diagnosis. It is striking and also the reason why I want to mention this is that in many of those who have to deal with post-concussion problems where no progress is made or where nothing is successful, the reason can often be sought in underlying auto immunity. However, there is a big catch. Most people don't know they are dealing with autoimmune problems until they reach stage 3 where there is significant tissue damage and an army of problems. 

How do you find out if this is an issue for you? The first clue is if there are one or more people in your family who have thyroid problems, psoriasis, Crohn's, ulcerative colitis, chronic vitamin B12 deficiency, celiac disease, disruption that does not respond to anything or they have simply received an autoimmunity diagnosis. 

Furthermore, there are nowadays predictive studies in which literally 20 years before there is real autoimmunity, it can be demonstrated against which tissue type you produce antibodies (for example, those from Cyrex labs in the US). Although autoimmunity can never be resolved, a lot can often be done to make the periods of remission longer and more frequent (this is an important topic for another article). However, it is important to identify whether there is this kind of preexisting problem occurring at the time of a concussion. This is all the more important when you are producing antibodies against your own brain tissue (you dont know this until it is tested, just like you dont know whether you have a genetic predisposition to recover after brain injury). 


10. Optimizing brain-gut cooperation 

I talked briefly about this before. In a nutshell, you can say that brains and their optimal recovery capacity depend on a properly functioning gastrointestinal system. If you were dealing with recurring gastrointestinal problems before your concussion, it is now even more important to tackle this issue (not necessarily by a specialist who only focuses on a so-called leaky gutwhich can also be caused directly by brain damage, for example).  

Gastrointestinal problems will have to be addressed at all times from north to south, i.e., from the mouth to the intestines. For example, a stomach that produces too little stomach acid will have to be dealt with first, even if there is a permeable intestinal wall. (Also take a look at the masterclass Your Second Brain). 


11. The use of photobiomodulation 

Photobiomodulation is the use of low-intensity red and infrared therapeutic laser. In addition to electromagnetic and direct, low voltage current to stimulate the brain, these are probably one of the most promising therapeutic applications in helping the brain to recover better. Although the use of these applications seems intense, this is not the case in practice. There are literally hundreds of studies showing that the use of therapeutic laser for brain trauma offers many benefits and undeniably aids the recovery process without any adverse consequences.  

What I experience in practice is that a certain category of patients literally indicates that when the laser is used, the light switches on again. Laser helps with energy at the cellular level (for example, it activates the mitochondrial function we mentioned earlier) and has a lot of influence on dozens of repair processes at the cellular level.  

Another advantage of laser treatment is that it does not take long, is noninvasive, and very specific! You can literally stimulate the weak parts of the brain and network directly.  

Another application that has been used with success in traumatic brain injury is to activate and stimulate stem cells by exposing the blood vessels to the head to red light. 


There is realistic hope. 

With this I conclude the summary of my thirty-year-long quest, through which I hopefully not only saved you a lot of time and energy, but also gave you renewed, realistic hope and showed that you probably have not yet done everything to find better solutions to the problems after your concussion. 

Arjan Kuipers 

N.B. Keep an eye on this website for new messages and especially watch the masterclasses 1. Energy, 2. Your Second Brain, 3. 10 things you can do to optimize your brain 4. Sleep. 


Scientific references