A 39-year-old man suffered a concussion in Jan 2018. Since that injury, he experienced
- panic attacks,
- depressed mood,
- neck pain,
- an intolerance for exercise although he had worked out daily prior to this injury.
He came to our service in September 2018. He had had assessments by a physiotherapist, chiropractor, dentist, psychiatrist and had a CT scan of his head and an x-ray of his neck and jaw. This led to chiropractic therapy, physiotherapy, a mouth guard and a trial of 2 different medications that made his symptoms worse.
He first started with both, Cognitive Behavioural Therapy for insomnia (CBT-i) and neck assessments with an emphasis on neck neuromuscular retraining. Both went on without a hitch and his insomnia resolved within 6 weeks and he had no more sleep difficulties afterwards. His neck pain and stiffness as well as his headaches also resolved after only 2 sessions of neck neuromuscular retraining. It is unusual that this is so effective with so few sessions but he was a committed patient that was adherent to his home exercise program and we feel the care he received from his chiropractor and physiotherapy also helped.
With respect to starting exercise, we started out with the Buffalo Treadmill Protocol and advancing his exercise regimen as efficiently possible. This started out as just cardiovascular exercise and his fitness improved, we added vestibular, visual and cognitive challenges as per our return-to-athletics protocol. These involved taking the patient to a nearby gym and assessing him, identifying areas that could benefit from some work and then exercises were prescribed. By the end, he had transitioned back to unrestricted physical activity.
His most interesting clinical feature was the one of the panic attacks. He could be on the golf course with friends on a beautiful summer’s day, not a care in the world, happy as could be as he would tell us, and then seemingly out of nowhere, panic symptoms would start. He had already been reassured by his GP and a cardiologist that he did not have heart issues, but his symptoms seemed too intense and real to him to be confidently reassured. We explained to him the mechanism by which panic attacks can be related to inefficient breathing (see article on Biofeedback). In fact, especially for those patients where panic attacks seem to come out of nowhere (i.e., for example, it’s hard to anticipate when one will get a panic attack unlike the patient who expects and gets a panic attack every time she goes to the mall, etc.), this seems to be more common.
We taught him how to breathe with proper technique, alone with other relaxation exercises. Then we taught him to breathe at his resonant frequency (see article on HRV training). He then became panic attack-free.
He was discharged with all his symptoms resolved and back to his regular lifestyle.
Written by: Dr. Taher Chugh
Last update: April 2019