Daya Alexander Grant, Ph.D., M.S. for Yoga Medicine® shares some information on concussions – the most common head injury. Learn how yoga can benefit concussion recovery and how to practice safely as you heal.
Yoga for the “Invisible” Injury
“Are there any injuries I should know about?”
Most yoga teachers begin class with some form of this question. The goal is to become aware of any current physical limitations that a student may be experiencing. This is so that the teacher can make the asana practice accessible by offering the appropriate modifications to protect the injury.
Unfortunately, head injuries are rarely acknowledged – either by the teacher or by the student. Most teachers are not very knowledgeable about concussions, and students recovering from one often remain silent since it can be difficult to articulate their symptoms.
With the heightened awareness of concussions in recent years and the benefits of yoga being touted to a larger audience, it is valuable for yoga teachers to learn about this particular injury.
What You Should Know About Concussions
A concussion is defined as a mild traumatic brain injury, but it hardly feels mild for the person experiencing it. Upwards of 3.8 million concussions occur in the U.S. annually1, with the most common causes being sports-related incidents, falls, motor vehicle accidents, and blast injuries (among veterans). A recent study showed that 1 in 5 teenagers reported having at least one concussion2. Every brain is unique and each concussion manifests differently, but common symptoms include headaches, dizziness, insomnia, mood changes (e.g. irritability, sadness, nervousness), sensitivity to light and sound, difficulty with balance, concentration, and memory, and generally feeling like you’re “in a fog”.
Cognitive dysfunction after concussions is due to transient cellular damage, but not destruction. 80-90% of concussion symptoms typically resolve within 7-10 days, although this tends to take longer with younger people and for those who have had multiple concussions. It is important to note that even after symptoms dissipate, the brain may still have microstructural damage which can cause a resurgence of symptoms in stressful or taxing situations. While most students who attend a yoga class will be outside of the acute injury phase, they still may be dealing with repercussions of the injury.
Benefits of Yoga for Concussion
Yoga means “to yoke” or “to unite” the body, mind, and spirit. That intention is precisely what people who have had concussions are seeking. Furthermore, a gentle yoga practice can offer cognitive, physical, and emotional improvements for someone healing from a concussion.
The general consensus in the neurotrauma community is that prolonged restrictions after brain injury (e.g. sitting in a dark room with no sounds) are actually detrimental to recovery. Instead, doctors now advise patients to avoid strenuous physical or mental activities for the initial 24-48 hours after a concussion. After that period, the patient will follow a gradual and personalized return-to-play protocol. The goal is prompt re-engagement in social and physical activities that do not worsen symptoms or put the brain at risk for another injury.
Yoga is an effective way to improve quality of life and reduce symptoms after a concussion. In a recent study that I co-authored, adults with traumatic brain injury (TBI), including concussions, participated in an 8-week pilot yoga program. At the end, participants reported improvements in quality of life and self-perception, as well as a reduction in negative emotions3. The empirical research on yoga for concussions is in its infancy, but several studies focusing on TBI as a whole have demonstrated the benefit of yoga and meditation on information processing and mental fatigue4, attention5, strength and endurance6, and memory7.
Tips for Working with Yogis who are Recovering from a Concussion
As yoga teachers, we can implement three simple practices to encourage a welcoming and healing environment for anyone dealing with a concussion.
- Create a safe and peaceful environment where the student can be exactly who they are on that day. Some days, it’s hard to leave your house with a concussion. The world is overwhelming and the simplest tasks can be exhausting. Attending a yoga class may be the one activity they do that day. So it is important to make it a positive and supportive space as much as possible.
Emphasize the Breath
- We’ve all experienced the benefits of a deep breath. But sometimes it’s easy to forget how powerful that tool is amidst the chaos of daily life. Anyone with a concussion will benefit from conscious breathing – specifically, slow, deep ujjayi breaths. Not only will the breath bring their mind in to the present moment and benefit them physiologically during practice, but it will also help them deal with the overstimulation and intense emotions they’re experiencing off the mat.
Keep it Simple
- A concussed brain processes information slower, since the myelin (insulation around the neurons’ axons), which is responsible for fast signal transmission, is damaged. Therefore, it’s important to keep instruction to a minimum. Too many words are difficult for anyone to follow, especially someone who has had a brain injury. While alignment is always important, choose your cues mindfully so as not to distract from the goal of helping your students turn their attention inward.
Yoga is designed to meet people exactly where they are on any given day. Let’s keep that in mind as we work with students who have had concussions, since every day is different. As yoga teachers, we have the honor of giving everyone the tools to re-connect their body, mind, and spirit – which, after a concussion, can feel like a daunting task.
Citation #1 Daneshvar DH, Nowinski CJ, McKee A, & Cantu RC (2011). The epidemiology of sport-related concussion. Clinics in Sports Medicine, 30(1): 1–17. DOI: http://doi.org/10.1016/j.csm.2010.08.006
Citation #2 Veliz P, McCabe SE, Eckner JT, Schulenberg JE (2017). Prevalence of concussion among US adolescents and correlated factors. JAMA, 318(12):1180–1182. DOI: 10.1001/jama.2017.9087
Citation #3 Donnelly KZ, Linnea K, Grant DA & Lichtenstein J (2017). The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury, Brain Injury, 31(2): 208-214. DOI: 10.1080/02699052.2016.1225988
Citation #4 Johansson B, Bjuhr H & Rönnbäck L (2012). Mindfulness-based stress reduction (MBSR) improves long-term mental fatigue after stroke or traumatic brain injury, Brain Injury, 26(13-14): 1621-1628. DOI: 10.3109/02699052.2012.700082
Citation #5 Cole MA, Muir JJ, Gans JJ, Shin LM, D’Esposito M, Harel BT, Schembri A (2015). Simultaneous treatment of neurocognitive and psychiatric symptoms in veterans with post-traumatic stress disorder and history of mild traumatic brain injury: A pilot study of mindfulness-based stress reduction, Military Medicine, 180(9): 956–963. DOI: https://doi.org/10.7205/MILMED-D-14-00581
Citation #6 Schmid AA, DeBaun-Sprague E, Gilles AM, Maguire JM, Mueller AL, Miller KK, Van Puymbroeck M, and Schalk N (2015). Yoga influences recovery during inpatient rehabilitation: A pilot study, International Journal of Yoga Therapy, 25(1): 141-152.
Citation #7 Azulay J, Smart CM, Mott T, Cicerone KD. A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome. J Head Trauma Rehabil. 2013 Jul-Aug;28(4):323-31. DOI: 10.1097/HTR.0b013e318250ebda