Post-concussion guidelines (Eric Thelin episode 2)


Table of contents:

02:42 Post-concussion guidelines
06:06 No concussion guidelines in medical school
07:42 Rest after concussion
09:17 Return to sports concussion guidelines
11:36 Concussion guidelines for hospitals
13:25 Sport concussion patients

Concussion Stories podcast introduction

[00:00 Melanie] If I say there is hope for complete recovery for people with a concussion, you say…?

[00:07 Professor McCrea] 100%!

[00:08 Professor Maas] And in fact, you didn’t only feel it] you were outside the regular medical system, because they were not interested in you.

[00:16 Professor Sitskoorn] Neuroplasticity actually opens you up to the world. It makes it possible to develop; it makes it possible to rehabilitate.

[00:25 Professor Wilson] Traumatic brain injury has been called a silent epidemic for that reason, because it consists of changes and disabilities that are not obvious to other people.

[00:35 Dr. Zasler] If, as a physician, you felt you had nothing to offer a patient, then I think ethically, you need to say] “I don’t think there’s anything I can offer you. Maybe you should see Dr. M.”

[00:48 Professor Diaz-Arrastia] Historically, we have called these things mild traumatic brain injuries, which implies that, well… It may be a brain injury, but it’s not going to have great consequences, right? And that’s frankly not true.

About the Concussion Stories podcast

[01:05 Melanie] Welcome to Concussion Stories, a Lifeyana podcast series filled with hope. I’m here to let you know that you are not alone in your post-concussion recovery journey. My name is Melanie and I spent six and a half years learning, experimenting, and training in order to find a way to heal myself from post-concussion syndrome.

After making a full recovery by the end of 2018, I embarked on this mission to make the recovery journey easier for you. This is why I started this podcast, wrote detailed blog post and downloadable guides, offer coaching and also the course that I wish I had back when I was recovering — teaching you everything that I needed to know in order to make my recovery happen.

On Concussion Stories, we dig deep while discussing hopeful stories of recovery as well as the hard stuff in the messy middle. Let’s dive right in!

Eric Thelin

In this second episode with Eric Thelin, a Swedish brain injury researcher and resident physician at Karolinska University Hospital, we will discover how he is developing a checklist for Swedish GPs to help them know better what to do with patients after sustaining a concussion. He also shares and explains the way sport concussion return to activity protocols are helpful to apply in medical settings.

‘Mild’ traumatic brain injury = concussion

By the way, if you hear Eric speak about mild traumatic brain injury, this is just a term doctors often use for concussion. Without further ado, let’s listen to Eric Thelin.

Post-concussion guidelines

Post-concussion guidelines

If I understood you correctly in Antwerp, you said that you are going to write concussion guidelines based on your research, right?

[02:49 Eric] That is correct. So, we’re currently updating the guidelines for the management of mild traumatic brain injury patients or concussion patients in Stockholm with lingering symptoms.

[03:01 Melanie] Okay.

[03:02 Eric] We are writing them to give GPs a manual, a sort of flowchart. If a patient has persistent headaches, whom should I refer them to? The same if a patient has persistent sleeping problems, persisting vertigo, persisting anything. I think that will help a lot. 

No concussion training in medical school

I don’t think that the GP is necessarily uninterested in your problems. I think the problem lies in that the GP is, probably, to some extent, uninformed. That is because we are not getting taught anything in medical school about concussion. 

You, as a patient, fall between the cracks really. You are not really in neurology, you are not really in neurosurgery, and you are not really in rehabilitation medicine. You fall somewhere in between, which makes it very difficult.

Concussion recovery without doctors

I think another thing that we need to think about is that not everything requires doctors. I think that for mild TBI, so concussion patients, other para-medical specialties, such as physiotherapists, occupational therapists can take care of tremendous improvement for these patients.

I recovered from home

[04:52 Melanie] Yes, I fully agree. In the end, I did my recovery from home. And that is essentially also what I am helping people do through my website. Of course, it is specialized knowledge. After all these years I have acquired so many things that work and things that don’t work. But still, I can tell people what helped and what didn’t help for me, and how I did that. They can recover from home as well.

A physiotherapist, for example, will probably be much better than I at how someone should move, specifically that person. But in the end, moving, doing brain training or meditation are not things you need doctors for. So I fully agree with your position. You just need to know what to do. 

This bundle of tools of care providers that you can go to, that is not available, and it is the thing that needs to be available at the point of entry. So, the GP or the care providers at the ER need to know what to give to patients.

No concussion guidelines in medical school

No concussion guidelines in medical school

You just mentioned that, at university, you weren’t taught anything about mild traumatic brain injury, concussion, or post-concussion syndrome. Is it true?

Concussion with negative CT or MRI

[06:18 Eric] No, I would say that I didn’t learn anything in medical school about concussion. The angle with mild traumatic brain injury always is to sort of screen for those who might have a hemorrhage that requires surgery. When you don’t find a hemorrhage, you sort of go through an algorithm. 

Go home and rest

If you probably do not have a bleed, go home and rest for a week, don’t play video games, don’t read too many books, don’t stay up too late, don’t drink alcohol, and bye bye. That’s about it. That’s what you learn. You don’t really learn what the evidence is for anything of this, or what to do if a patient comes back to you later on. We are not being taught that, which is a shame.

[07:27 Melanie] Yes, it is a shame and something that absolutely needs to change. Especially now that the information that has been uncovered by CENTER and TRACK TBI is out there. 

Rest after concussion

Rest after concussion

There are a few things that are really remarkable when I hear this. The first thing is, you’re still quite young in the field. And you just mentioned the word ‘rest’ as advice. This is what you were taught at university?

[08:00 Eric] Yes. 

Resting the first days after brain injury

Regarding acute injury, meaning the first week after you hit your head, I don’t think it is necessarily bad to take it easy. That would be the first days after an injury, depending a little bit on how hard you sustained it. These patients may be influenced by alcohol or may have drugs in their systems. 

Do not rest your way to health

It is always good to relax the first days after an injury. But you should not be resting your way to health. This is not something that you will rest off. You’re going to have to walk and exercise it off in the long run, definitely.

[08:50 Melanie] Yeah. I am not looking to criticize university or something. I am trying to find out why a lot of patients still get the advice to rest. How persistent is it that our medical students are still learning that rest is best after sustaining a concussion?           

Return to sports concussion guidelines

Return to sports concussion guidelines

[09:17 Eric] I think it is good to have a tiered system. If you are in sports and have a concussion, there is the ladder to get back to activity. 

Getting back to activity after concussion

First, you start with resting for a day or so, and then you start with some light exercise. After that, you can try a 30-minute aerobic training session. If that feels okay and you don’t have any symptoms, you start doing heavier exercise training. If you don’t have any symptoms after that, you can return to contact sports again, like hockey or soccer.

Taking steps back in recovery

However, if you do feel symptoms, like an increase in headaches, vertigo or nausea, you take a step back. You keep on that level until you feel fine before escalating the level of training. 

Concussion symptoms flare-ups

This concussion protocol is quite debated: there is no perfect evidence for this. I think it makes perfect sense to feel your own body; to feel how much and when the symptoms come. I am not saying that you should go to bed and sleep for a week when the symptoms come. I think it is good to acknowledge that there could be symptoms that you want to listen to and not push yourself too hard.

Brain training: push and release

[10:57 Melanie] That is true. I always compare it to going to the gym. The brain is just like trying to build muscle in the gym, in my experience. At least, the injured brain. Well, also the healthy brain. 

If you want to train your brain, you want to push it a little and then release it. You push it a little more, and release it. You don’t want to push through it, because you will get an injury. Everybody knows it. It’s the same thing for your brain, from my perspective.

Concussion guidelines for hospitals

Concussion guidelines for hospitals

So you say that it would be a good idea to look at the return to sports concussion guidelines and transfer that to current protocols in hospitals and GPs, right? 

[11:44 Eric] Yep.

[11:45 Melanie] So that is one thing that we can use in conventional medicine guidelines. And different countries can also learn from each other.

[11:52 Eric] Definitely.

Change concussion guidelines in hospitals

[11:52 Melanie] I think it is a really interesting idea that will generate fast progress if we were to transfer knowledge from all sides, and see if it works in other countries, or see if it works in other settings, like in a hospital instead of on the sports field. Do you feel that this is one way to change protocols rapidly as well?

[12:16 Eric] Yeah, definitely. 

Most concussion patients are older people

I think it should also be acknowledged that usually, when you are working in sports for instance, concussion affects healthy young people. They are different, because the majority of patients that have concussions today are old people. In Sweden, the median age that is admitted to emergency rooms is around 70. 

Therefore, it is a problem: what kind of rehabilitation do we give to the elderly? That probably needs to be a little bit different from the treatment that you as a young person get after an injury. 

Tailored concussion guidelines

So you need to look at the patient in front of you, and then tailor best practice rehabilitation protocols for that particular patient. I do believe that for you, for instance, it would be perfect to apply some sort of a sports protocol and tailor that to your experience. 

Sport concussion patients

Sport concussion patients

A problem with sports concussion is that a lot of these concussion patients want to participate. They want to push themselves: they want to get out there. There also may be money or a sports career involved. If they do show symptoms and weakness, they will not be able to play. They will not get any money, and they will probably not advance in their sports career.

Concussion recovery for health

However, if you have a better and more long-term goal, like getting healthy, and you don’t necessarily have to recover quickly, you have a long game to play. Perhaps sports protocols need to be tweaked to the normal life that people who aren’t athletes live. 

Tailoring post-concussion guidelines

The guidelines definitely need to be tailored to the specific age group that concussion patients are in, and their activity level, perhaps even educational background and so on.

[14:27 Melanie] Yeah. I can imagine. It is quite a job you have got.

[14:33 Eric] Yeah.

[14:34 Melanie] I am confident that you will uncover a lot of information and translate it into good post-concussion guidelines and checklists for doctors.

Share your thoughts with me?

Now, I would love to hear from you. What do you take away from this episode? Is there something that you can apply to your life right away? Head on over to and leave your comment now.

And if you want to hear and read more Concussion Stories, actionable steps and inspiration, be sure to subscribe to the Lifeyana email list while you’re there, so that you never miss out on new materials we constantly make for you.

Support Concussion Stories

If you want to support this podcast, head on over to Thank you for listening to this concussion stories episode by Lifeyana. 

May you be well, and may you be happy.

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