Concussion: Acupuncture Treatment for Sports & Car Accident Injury

Concussion, or mild traumatic brain injury (MTBI), is common among contact and collision sports participants also from a motor vehicle accident injury.

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MTBI is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. 

Disturbance of brain function is related to neurometabolic dysfunction, rather than structural brain injury, and is typically associated with normal structural imaging findings (CT Scan, MRI). Concussion may or may not involve a loss of consciousness. 

Concussion results in a constellation of physical, cognitive, emotional, and sleep‐related symptoms. Recovery is a sequential process, and symptoms may last from several minutes to days, weeks, months, or even longer in some cases.

Pathology

1. Toxic Build-up in the brain

• During activities, a concussion can occur with any external force to the head, and it leads to a wave of energy that passes through the brain tissue triggering neuronal dysfunction. 

• The Neuron During the Injury releases its K+ (Potassium), which rushes out of the cell body and toxic Ca2+ (Calcium) ions rush into the cell, leading to metabolic dysfunction. The metabolic dysfunction results in an energy crisis which induces a massive release of neurotransmitters that interferes with cell communications.

• In most cases, this process will generally correct itself, and the majority of patients will fully recover. However, while the brain is still recovering, the reduction in cerebral blood flow may result in cell dysfunction that increases the vulnerability of the cell to the second insult. Therefore, it is crucial to support the proper blood supply and regulate the biochemical balance of the brain for the recovery. 

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2. SNEP from the spine and symptoms of concussion.

• Changes in the alignment between two adjacent vertebral bodies can lead to twisting or traction of the ramus communication. If the spinal nerve trunk in the intervertebral foramen is compressed, and consequently the vasa nervorum of sympathetic preganglionic fibers present in the spinal nerve trunk is pressed, focal ischemia can be induced. Adenosine triphosphate (ATP) production can then decrease, causing failure of the Na+/K+ ATPase pump and elevation of the extra-membrane K+ concentration. This may increase the resting membrane potential or reduce the threshold of nerve cells, leading to membrane hyperexcitability. Hyperexcited vasomotor sympathetic preganglionic fibers can be excited by even small stimuli and can then produce abnormal excitation signals. The production of norepinephrine from the nerve terminal of sympathetic postganglionic fibers increases, which activates alpha-1 receptors present in the smooth muscles of visceral arteries. This causes the vessels to contract and may reduce blood flow to internal organs or tissues. Depends on the level of the spine where SNEP occurs may induces various internal conditions such as insomnia, palpitation, anxiety, blurred vision, hearing problems and digestive disorders.

Traditional Eastern Medicine and Acupuncture Aids in Concussion Recovery

1. A TEM Herbal medicine prescription, Oreongsan (ORS), which is composed of Polyporus, Alismatis Rhizoma, Atractylodis Rhizoma, Poria (Hoelen), and Cinnamomi Cortex Spissus, has been used as treatment in patients with various symptoms such as thirst, diminished urination, edema, hangover, and diarrhea. The advancement of modern science has enabled the determination of the action mechanism of herbal medicine complexes. As result, researchers found that ORS can inhibit the upregulation of aquaporin-4. AQP4 is involved in such diverse functions as regulation of extracellular space volume, potassium buffering, cerebrospinal fluid circulation, interstitial fluid resorption, waste clearance, neuroinflammation, osmosensation, cell migration, and Ca2+ signaling. AQP4 is also required for normal function of the retina, inner ear, and olfactory system. 
   

2. Acupuncture modulates blood flow to the brain. Following a concussion, it is well documented that cerebral blood flow can decline for days, to weeks, to months, to years following a concussion, depending on the individual. Research looking at changes in cerebral blood flow following acupuncture has shown that acupuncture can increase blood flow through several main arteries supplying the brain, including the middle cerebral artery and basilar artery. Acupuncture can also improve cerebral glucose metabolism, a process that is often dysregulated following concussion.
   

3. Acupuncture helps to activate the parietal cortex and increases the amount of proprioceptive information that travels up the spinal cord to the brain. In doing so, it can improve the sensory maps in the brain. This leads to improved blood flow to the areas that are injured and allows the brain to provide the proper non-volitional shunt stability to areas of the spine and back.
   

4. Acupuncture can help balance the autonomic nervous system and tip the scales towards less sympathetic activity and more parasympathetic activity, helping to alleviate these symptoms. Many people, after a concussion, experience an increase in sympathetic nervous system activity that can contribute to symptoms such as irritability, insomnia, chronic anxiety, headaches, increased pain, sweating, and light sensitivity.