Post-concussion protocols (Prof. Tenovuo part 2)


Post-concussion protocols are outdated. At least, in regular medical settings. However, Professor Tenovuo points toward return to play concussion protocols that may be of help during concussion recovery. In addition, Melanie shares how a combination of concussion research and common knowledge come a long way, too. 

If you haven’t yet listened to episode 1, please find it right here: post-concussion symptoms.

Table of contents:
02:20 Post-concussion protocol
05:28 Concussion and rest
06:49 Screen time post-concussion
08:13 Concussion recovery protocol: research-based

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!

Professor Tenovuo

Welcome to the second of four episodes with Professor Olli Tenovuo. He is a professor of neuro-traumatology at the University of Turku in Finland, and most of all: an advocate for patients experiencing post-concussion symptoms. The first episode covered post-concussion symptoms with Professor Tenovuo.

Post-concussion protocol

In this episode, we discuss post-concussion protocols, which will give you hands-on information about how to approach getting back to your normal activities. How to and how not to approach rest after a concussion? Let’s get started.

Return to play concussion protocol

How do you feel about post-concussion protocols? There is a big gap between what concussion protocols are now available and what we need, right? 

[02:50 Professor Tenovuo] Yes and no. I think that in traditional medicine, the traditional healthcare system has a lot to learn from sports medicine. In many sports, there are lots of athletes who suffer concussions. In American football, ice hockey, soccer, and many other sports concussions are prevalent. 

Within the field of sports medicine, they have had very clear post-concussion protocols for a long time already. How to diagnose these injuries, how to help these athletes recover, and how to get them to return to play?

Early return to play after concussion

So, in sports medicine, they have a clear stepwise post-concussion protocol. Of course, they try to get these athletes back to the game as soon as possible. Research and experience have clearly shown that if an athlete returns to play pre-maturely (when he or she is still symptomatic), there is a high risk for new injuries and prolonged recovery.

The concussion return to play protocol

Therefore, in sports, there is a clear concussion return to play protocol that you have to go through step-by-step to recover. First, you have to be symptom free in your normal daily life. Then you can start training. If the symptoms reappear when you start training, you have to continue normal daily life and continue a rehabilitation program also. 

Once you manage training without symptoms, you can start rehearsal games and a heightened level of training. If you still are okay by then, you can slowly return to play. But every step needs a certain period to ascertain that everything is okay.

Concussion and rest 

We should have that kind of post-concussion protocol for non-athletes in normal clinics as well. I think that in many cases, we have caused problems for patients. For example, they have had to return to work, although they are still clearly symptomatic. This means that their brains do not have the energy to recover, because they have to use their energy to do the work.

Rest after concussion

[06:00 Melanie] Yeah. Not to confuse our listeners, we already know that bedrest isn’t what you need.

[06:10 Professor Tenovuo] No.

[06:11 Melanie] What is most important is to keep your activity levels up. So go for a walk or try to cook something in an isolated environment, without having the radio on and having a conversation at the same time. After that, take a rest again. 

Cognitive rest

And rest doesn’t mean binge watching Netflix or something, but rest means meditating or deep breathing, for example. After you feel your symptoms subsiding, you can take on something else. This is the way that I recovered, too.

Screen time post-concussion

[06:49 Professor Tenovuo] Yeah. Actually, our modern world is so connected – everything is happening on screen. For example, this too.

[07:03 Melanie] This too, yes.

[07:03 Professor Tenovuo] But that screen life is not a good thing for a recovering brain. For example, in a randomized trial with children with concussion, one group of children was allowed to use screens, and the other group was not. Those who were allowed to use screens, had clearly longer lasting symptoms than those who were not allowed to have screen time. 

Screen time (after concussion) is demanding

Therefore, it is actually quite demanding for our brains to do something on screen, whether you watch TV or use the internet or are on your phone. There is too much information to handle.

[08:10 Melanie] Yeah, exactly. This is so interesting. 

Concussion recovery protocol: research-based

You refer to one research paper right now. This information can be used by patients. Before, other researchers told me or doctors told me: you are just one who recovered, you have used research for your recovery that is not peer reviewed and hasn’t been translated into protocols. So you can not use it, because it is not fully proven yet.

Combine concussion research and common knowledge

As a patient you are in the middle of everything. You do not want to use everything that is out there, because there are a lot of people trying to earn money from people who are desperate. However, if you turn to science, and you find one paper that concludes A and another says A, you don’t need 15 papers. After 2 papers, you can say: “Well, if there’s smoke, there might be a fire, and I can try this.”

For example, if you combine the research you just referred to on screen time with common knowledge, you can conclude that it may be quite intensive to be on screens. Limiting screen time is something that really might help people recover faster, especially during their breaks.

Every concussion is unique

[09:30 Professor Tenovuo] Yeah. Of course, we have to remember that although many patients have similar symptoms, every patient is different. That is one major problem in developing any efficient intervention for TBI (traumatic brain injury): every patient is different and nobody has the brain injury as someone else. 

Therefore, you cannot expect that there will be a treatment that will help everybody. There are certainly treatments that help some people. And for somebody else, it is totally ineffective, because they have a different type of injury or a different type of problem.

Concussion course: we share the same biology

[10:18 Melanie] Yes. For example, in my concussion course, I translated what I did and what helped me and what not. It’s out there and people can choose if it would help them too. It is focused mainly on being human. And there are certain things that we as humans, and our injured brains, need – and things that harm us. And those are similar, right? Our biology is the same. 

However, our injuries, the way they present themselves, our symptoms, our situations, our lives – they are different. And that’s what I built into the course as well. It needs to leave room for everybody individually to adapt to that.

[11:10 Professor Tenovuo] Yeah, of course, there are things that are almost universally harmful for people and for brains, and things that are beneficial. For example, being in nature and the like probably have some kind of evolutionary base.

[11:35 Melanie] Exactly.

What are your thoughts?

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.

If you want to support this podcast, head on over to Thank you for listening to this concussion stories episode by Lifeyana. May you will be well and may you be happy.

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