Acupuncture after concussion reduces symptoms & improves white matter integrity (9/25/25 Newsletter)
This week, our lead article, Acupuncture after concussion reduces symptoms & improves white matter integrity, is in the Therapies Currently Available category.
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In this newsletter: Opportunities, Pathophysiology, Therapies Currently Available, & Mental Health
Writers: Melissa Brown, Emily Sugg, & John Rosseel
Editors: Conor Gormally & Malayka Gormally
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Opportunities
Tuesday, September 30, 6 pm ET: A free webinar, Concussion: An Invisible Injury, Visible Consequences, presented by Dr. Carmela Tartaglia, hosted by the Canadian Concussion Centre. Register in advance.
Wednesday, October 8, 12 pm ET: A webinar, Sensorimotor Disruption and ACL Injury Susceptibility After Concussion: A Female-Specific Neuromechanical Model, presented by Melissa Anderson, PhD and Abby Baldwin, PT, DPT. Hosted by the International Brain Injury Society. Free for members, $25 for non-members.
Thursday, October 9, 4 pm ET: A free virtual event, Accumulating Physical and Psychological Exposures in TBI – Research and Clinical Implications, presented by Lisa Brenner, PhD, and hosted by the University of Michigan Concussion Center. The talk examines “how lifetime exposures — including concussive and subconcussive blasts, as well as psychological stressors — impact brain health and contribute to enduring clinical symptoms.” 1 CE credit.
Tuesday, October 14, 6 pm ET: A free webinar, Headache and Concussion, presented by Dr. Claire Sandoe, hosted by the Canadian Concussion Centre. Register in advance.
Last call for registration: A free, interactive Zoom program, Mindset, which includes two concussion-specific groups, will be presented by Love Your Brain beginning in October. The program includes mindfulness, education, community building, and yoga (in some groups), and includes a new affinity group, “Life After Concussion...For people navigating the lasting impacts of concussion/post-concussion symptoms.” There are two versions of the group. Register here for “Group Discussion” starting October 8 at 5 pm ET. Register here for “Yoga and Group Discussion” starting October 16 at 7 pm ET. Learn more about the Mindset programs here.
Donor Profile
Hi Conor,
I was very impressed with Concusson Alliance’s impact report. Please find a contribution check in appreciation of the great work that you are doing in bringing to the attention of the public the aftereffects of a concussion.
I’ve also sent a picture of the vehicle that I was driving when my wife and I were hit head-on in 2006. My concussion symptoms were severe after the incident for two years thereafter. Fortunately, I continued to show improvement each year for the next ten years. I rely on Adderall as an aid to deal with the post-concussive symptoms; this medication, and getting a half-hour nap in the middle of the day, has enabled me to keep practicing Law forty-five hours a week at age 78. Please continue to spread the good news. Very truly yours,
Frederick A. Jacob, Esquire
Jacob Law Group, LLC
Frederick Jacob’s photo of the car wreck in 2006
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Pathophysiology
Varsity athletes’ brains show persistent changes in cerebral blood flow up to 1 year postconcussion, despite lack of symptoms and medical clearance
Returning to play after a concussion doesn’t necessarily mean full brain recovery. In a prospective cohort study published in Neurology, Churchill et al. followed 187 varsity athletes from various sports, including 25 who sustained concussions, using MRI scans before the season and follow-up imaging after players sustained an injury. Athletes who never sustained a concussion also underwent imaging, serving as controls. Importantly, this longitudinal study focused on changes in individual brain metabolism over time. By comparing the same individual repeatedly to their own imaging data, this study attempted to compensate for differences in individual physiology. The MRI findings showed persisting changes in cerebral blood flow (CBF) in the concussed athletes’ brains even as they were returning to play and at a year after their injury, when the athletes had returned to play and daily life months earlier. The authors note that “prolonged decreases in CBF are of significant concern, likely reflecting ongoing secondary injury processes including neurometabolic impairment, neuroinflammation, and permeation of the blood-brain barrier."
The concussed athletes underwent MRIs shortly after injury, at medical clearance to return to play (RTP), 1–3 months post-RTP, and one year later. These scans were compared with scans of 27 uninjured athletes evaluated before the season and during their baseline testing in the subsequent preseason. Postconcussive metabolic and structural changes were measured using MRI indicators of cerebral blood flow (CBF), as well as measures of axonal integrity, including white matter mean diffusivity (MD), and fractional anisotropy (FA). White matter diffusivity describes how well water molecules move through the myelin sheaths that cover axons in the brain. Increased water molecule mobility (MD) can be a sign of white matter breakdown and cell loss, and indicates pathology on imaging. Fractional anisotropy measures the directionality of those water molecules through white matter. In healthy brain tissue, water diffuses along the axons, whereas when axonal integrity gets damaged, water molecules lose their organized path, resulting in decreased FA. Key findings are summarized below:
Cerebral Blood Flow (CBF): MRI results showed prolonged decreases in blood flow, especially at RTP and again at one year post-RTP. The researchers suggested these reductions reflected ongoing secondary injury processes, including neurometabolic impairment, neuroinflammation, and blood-brain barrier disruption. Importantly, decreased CBF was the only MRI measure to reach statistical significance when compared with uninjured controls in this study.
White Matter Mean Diffusivity (MD) and Fractional Anisotropy (FA): Increases in MD and decreases in FA peaked at RTP and gradually declined over the following year. The authors suggested these data were the result of chronic injury processes such as delayed inflammation and axonal degeneration. However, the controls also experienced similar changes in MD and FA compared to the concussed athletes, so the authors concluded that “although MD and FA are sensitive measures of postconcussion brain change, they may not differentiate from other sources of variability,” such as physical exertion and physical and mental stress.
Symptoms: Despite these MRI changes, all concussed athletes self-reported as asymptomatic at RTP and returned to normal activities.
In an editorial for the Radiological Society of North America (RSNA), Mary Henderson quoted first author Nathan Churchill, PhD, saying, “we wanted to get a handle on brain changes that last beyond symptom resolution and medical clearance to return to play.” Henderson also provided context from the head of Columbia University’s Translational Neuroimaging Laboratory, Dr. Lipton, who said, "an asymptomatic patient with brain trauma can have significant underlying pathology. Moreover, a concussed individual in the recovery phase is much more vulnerable to subsequent impacts."
Experts in the field hope to see stronger RTP guidelines than those currently in use. This study provides clear evidence that changes persist even after symptoms have resolved and athletes have been medically cleared. Future guidelines that account for silent metabolic and structural changes could reduce the risk of repeated injury, prevent cumulative neurological damage, and protect long-term cognitive and mental health in athletes.
Therapies Currently Available
Acupuncture after concussion reduces symptoms & improves white matter integrity
A group of researchers at Xi'an Jiaotong University found that four weeks of acupuncture, starting a week after a concussion, reduced concussion symptoms and improved brain tissue (white matter) integrity. Dr. Wang and colleagues followed 66 patients with mild traumatic brain injury (mTBI) to better understand acupuncture's effectiveness as a treatment option for this population. Published in Radiology, this study provides compelling evidence that receiving acupuncture was associated with greater improvements in concussion symptoms and healthier white matter fibers than a sham control treatment. This study contributes to a growing body of research that reflects an increased interest in nonpharmacological (non-medication) treatments in the world of mTBI.
The researchers split study participants into three groups (sham acupuncture, true acupuncture, and no acupuncture) following a baseline assessment seven days after the participants visited an emergency department for a concussion. The true and sham acupuncture groups used stainless steel disposable needles inserted into six acupuncture points on the front and back of the participants. True acupuncture participants had needles placed in traditional acupuncture points, combined with additional electrical stimulation through the needles for 30 minutes. The sham group's needles were placed in non-acupuncture points (locations on the body not recognized for having traditional acupuncture effects) and only experienced the initial stimulation of the insertion poke of the needle, with a fake stimulation indicated by a light going off, despite not receiving any electricity from the needles.
The authors utilized DTI, an advanced type of MRI imaging used to measure the connections between different brain areas, to analyze detailed images of the participants' white matter following acupuncture therapy. These scans revealed a significant improvement in white matter integrity following true acupuncture, whereas sham acupuncture and the control group showed no improvement in their imaging. The researchers also observed improvements in the participants' self-reported symptoms and long-term recovery, as measured by the self-report Rivermead Post-Concussion Symptoms Questionnaire (RPQ-16). Participants filled out the RPQ-16 during their baseline assessment, immediately after the four weeks of acupuncture, and at a follow-up assessment 6-12 months later. The RPQ-16 is a commonly used concussion symptom index, comprising 16 questions about symptoms and whether the patient has experienced any within the past 24 hours. This self-report data indicated that the true acupuncture group was the only group to report a significant drop in concussion symptoms.
The correlation between the structural changes shown in the DTI and the self-reported results of the RPQ-16 highlights how acupuncture can be a nonpharmacologic option for the treatment of concussion symptoms. According to Dr. Wang and colleagues, this study is one of the first experiments to utilize neuroimaging to compare the effects of true acupuncture, sham acupuncture, and a control group in patients with mTBI. However, the study did not utilize imaging during the participants' 6-to 12-month follow-up. In the future, the research group wants to track their patients beyond one year to evaluate the durability of the treatment's benefits. They are hoping to test this theory on a broader spectrum of mTBIs to better understand acupuncture's efficacy as a treatment. Overall, they hope to further highlight non-invasive treatments for concussion symptoms and brain health after mTBI.
Mental Health
Practicing self-compassion can mitigate the long-term mental health impact of TBI
An article published by the Brain Health Association of America suggests that practicing regular self-compassion leads to the mitigation of mental health issues (anxiety, depression, etc) after a traumatic brain injury (including concussion). Kyla Pearce, PhD Director of Programs and Research at the LoveYourBrain Foundation, provides background information on self-compassion as well as the results of two studies, investigating the impact of Compassionate Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT), respectively. Dr. Pearce notes that both CFT and ACT help patients to “develop kinder thinking habits,” while ACT helps patients put emphasis on accepting negative emotions as a part of life. In a twelve-person study of CFT, researchers incorporated the therapy into the rehabilitation process post-injury. The participants determined that monitoring shame and self-criticism through CFT led to an easier reintroduction into life after their TBI. A ninety-three-person study of ACT split patients with mild to moderate TBI into an ACT program or an active control group for eight weeks. While the ACT participants received specialized therapy, the control group received traditional TBI rehabilitation. Dr. Pearce notes that participants who underwent ACT “experienced significantly greater reduction in psychological distress… and improvements in psychological flexibility.” In addition to these therapies, Dr. Pearce recommends practicing “meditation that emphasizes mindfulness and kindness,” and participating in community support programs. Notably, the free Love Your Brain Mindset program is still accepting applications; see the “Affinity Groups” section for concussion-specific groups.
Dr. Pearce argues that self-compassion is made up of three core components critical to the TBI recovery process: mindfulness, self-kindness, and common humanity. To practice mindfulness is to acknowledge feelings without letting them overwhelm you. The first step is to acknowledge feelings without spiraling into self-pity. This mental adjustment can calm depression and anxiety by giving emotions more perspective. The second is to practice internal, or self-kindness; while negative thoughts are inevitable, adjusting the emphasis from a negative to a helpful mindset can curb their impact. The final component is common humanity; to remember that an individual with TBI isn’t alone. Dr. Pearce encourages patients to reach out to those who are also struggling and find a community of support.
Dr. Pearce acknowledges that more research is needed to establish how self-compassion can impact the long-term mental health effects of TBI. She argues that these initial studies show promise and state, regarding TBI recovery, “common humanity is an antidote to shame, and mindfulness allows us to disentangle from intrusive memories and feelings.”
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