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About The Author Mario Starnino

Mario Starnino is an Athletic Therapist and Strength and Conditioning
Coach. He graduated from Concordia University in 2013 with a
Bachelor of Science degree in Exercise Science: Specialization
Athletic Therapy. He has continued his education with different
manual therapy techniques such as P-DTR®, NKT®, VOILA®, AiM©,
FRS® while also taking concussion, functional neurology, and
vestibular courses. He also utilizes different treatment modalities
such as MPS (Micro Point Stimulation Therapy) and LLLT (Low Level
Laser Therapy) to help decrease inflammation and promote tissue
healing.
Mario is dedicated to helping people by guiding them into correcting
their movement and combining different therapy techniques and
exercises to find the source of the pain. Mario also works as a
personal trainer to drive athletes towards peak performance or helping anyone interested in
getting physically stronger for daily life whether for recreational or competitive purposes.
Helping someone understand the cause of their pain, and taking a global approach to resolving
it, leads to a better overall recovery versus symptom management alone.
Combining his physical training and therapy methodologies with different cognitive and vision
training systems like Brain Gym®, Neurotracker, and Senaptec, he is currently exploring a new
frontier in concussion rehabilitation, sports performance and improving behavioral and cognitive
functioning in children and the aging population.

“Knowing is not enough, we must apply. Willing is not enough, we must do. Absorb what is
useful, reject what is useless, add what is specifically your own” – Bruce Lee

In his personal time…

While not treating at the clinic or training clients, Mario spends his time bouldering, paddle
boarding, playing ball hockey, making kombucha, gardening, reading, and working on different
DYI projects.

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Introduction
In this Special Guide for Concussions, I share with you 7 very
powerful principles and strategies that you can implement right away during your concussion
rehabilitation and recovery.

They’re in no particular order, and they all have only one thing in common:

They all help in some way.

There’s a great saying that goes: “Little hinges swing big doors.” And it’s often
the simplest advice that wins in the end. Truth is, without knowing your current situation, I
cannot tell you which of these will work best for you. Unfortunately, there are no guarantees
that any one single strategy will work.

Over the last 10 years, I’ve been able to narrow down what really does and
doesn’t work when it comes to helping someone go through their concussion management and
rehabilitation. And the 7 principles you’re about to read are included in that.

But imagine this …how great it would be if you try just one of these “tips” every
day…within a few weeks you could have all 7 of these incredibly powerful
strategies for easing your symptoms, helping you recover more quickly, and start giving you
back the active and healthy lifestyle that you’ve lost.

So here’s my challenge to you …now that you have this knowledge in your
hands, take time every day to try out at least one of these 7 strategies. It really
won’t take long, and most of them won’t cost you anything but few minutes of
your time.

I think you’ll be pleasantly surprised by how much better you will

feel for doing so.

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7 Simple Ways To Kick-Start your

Concussion Rehabilitation.
1. Light Exercise Every Day

No matter what stage you are on in your recovery (whether acute or chronic). You need to
exercise. Period. Many people are told by their healthcare provider to rest until symptoms go
away, or rest even more if they don’t. Rest is important in the acute stages (24-48-72 hours),
but research shows that sub-threshold/sub-symptom exercise can start within the first 2-3
weeks of recovery to get better outcomes.

Exercise will improve brain function, maintain bone and muscle mass during recovery,
improve sleep quality, boost energy levels and release endorphins to combat unhealthy
mental states like depression, anxiety and stress (very prevalent with concussions).

Walking outside or on a treadmill (light or brisk), light swimming (breaststroke) or stationary

biking/recumbent bike at around 40-50% effort level for 10 to 20 to even 30 minutes is
allowed if you can. Stay within your limits to not provoke symptoms and try to increase by a
few minutes every few days or weeks. Your healthcare provider will be able to tell you when
you can start increasing the intensity and give you an individualized aerobic exercise program
that keeps the heart rate below the point where symptoms worsen.

2. Sleep: Part 1 (Limit Screen Exposure)

Screen time before bed can sabotage sleep. The blue light emitted from the screen (tv,
cellphone, computer, LED lights) disturbs your circadian rhythm (biological clock) and
decreases your melatonin production (hormone that makes you sleepy). The result is it makes
you more alert at night, making it harder to fall asleep, and stopping you from getting the rest
you need to recover. To prevent this, try to not expose yourself to screens two hours before
bed as insomnia is very prevalent with concussions.

3. Sleep: Part 2 (Quantity & Quality)

In the long-term, the most effective treatment for a concussion is sleep and rest. To limit
fatigue during the daytime, and ensure proper recovery, I recommend getting 8-10 hours per
night. Children from 6-12 years of age should be getting 10-11 hours of sleep.

To improve your quality of sleep, I recommend setting up a sleep cave. Make your bedroom as
dark as possible by blocking out all sources of light. Use blackout curtains or pin fabric to the
window. Remove electronics from the room. Put tape over the LED indicators on small
electronics if needed. Use a sleep mask/eye shades. Ear plugs will help if you live in a noisy
area so that you can fall asleep right away or not wake up in the middle of the night.

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4. Light Sensitivity

With concussions, photophobia/light sensitivity is very common. Whether it is from the sun,
reflective glare, fluorescent lights, or screens (blue light); limiting your exposure to these
sources of light will less likely provoke your symptoms. Don’t get me wrong, I am not saying to
stay in a dark room and never come out. You need to habituate yourself to these sources of
light at a progressive rate.

-Use sunglasses for sun exposure and bright indoor lights

-If you are uncomfortable wearing sunglasses indoors, you can purchase blue-light blocking
glasses on amazon or stores that sell them.

-Most cell phones have a blue-light filter mode (or nightshift mode) in the display settings.
Make sure it is on 24/7.

-For your laptop/computer, download the free program f.lux at https://justgetflux.com/ or

turn on nightshift mode if you have it in the display settings already.

5. Know Your Limitations

Provoking your symptoms will not make your concussion worse, but it might prolong your
recovery if you constantly do so. Any activity whether mental or physical, that increases any
symptoms, should be stopped immediately and followed by rest.

Keep a journal of general activities you do throughout the week and use a timer to
approximate how many minutes it takes before symptoms get provoked. You will then try
your best to stay below that threshold before symptoms increase. Try to slowly increase this
time week to week as your endurance to these activities increases.

6. Plan Out Your Day

Every concussion is unique. The difficulty of our activities of daily life (ADLs) will vary from
person to person. Try to get a grasp of which activities are the most physically/mentally
draining for you early on. Rate them out of 5 in your journal (Easy 0.5-2, Medium 3, Hard 4-5).
An example of this would be the following;

Activity Point Value Activity Point Value

Driving 3 Points/15mins TV 2
Points/60mins
Reading 2 Points/30mins Grocery Shopping 5 Points
Working 2 points/hour Attending an Appointment 4
Cooking 3 Childcare 4
ADLs: bathing, dressing, 0.5-2 Listening to music 1
grooming.

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Before your day begins, plan out what you need to accomplish. Keep your list short as to not
be disappointed if it does not all get done in that day. See how many points these tasks total
up to. Usually if you pass 20 points, then it might possibly be too much. As you get better and
better, the intensity assigned for each task will decrease, and you will see that you can do
more and more each day. Be honest and patient with yourself. Some tasks might seem
obvious, some you have no choice, but understand that to others who have significant
limitations, completing those easy tasks that they could not before is a huge step.

7. Recommended Restful Activities

I understand how tough it is not doing the activities you love during your recovery. Take it as
an opportunity to find a new hobby that you might enjoy keeping once you are 100%. Here is
an extensively but not complete list that I’ve recommended over the years to my clients. Note:
Use a timer for your activities as use symptom tolerance as your guide to know when you’ve
done too much. I also recommend alternating between mental, physical and restful tasks so
that it gives you time to recuperate properly throughout the day.

Listening to an audiobook, quiet music, radio or podcasts.

Meditation, Spending time with a calm animal

Relaxing bath (Bonus points if you use Epsom Salt)

Gentle mild yoga, Tai Chi, QiGong, slow walk outdoors, light cardio (find a good youtube channel!)

Relaxing leisure activities: crafts, knitting, art/drawing/painting, gardening, puzzles/brain games, board
games/card games, simple cooking/baking

Light housework: folding laundry, setting a table, brushing dog, cleaning

Bonus Section:
8. Try to find and join a support group in your area.
You don’t have to go through this process alone. Most of your family, friends and co-
workers will never truly know how you feel and what this concussion is actually doing to
you physically and emotionally.

Use Google or Facebook to find community support groups, or online forums. This will
provide you with an opportunity to share your story/personal experiences, learn coping
strategies, stay motivated, feel empowered, learn about your health, receive practical
feedback, and a chance to meet members of your community. As previously mentioned,
depression, anxiety and stress are prevalent with a prolonged concussion recovery, so the
need for a support group becomes even more important.

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9. Water Intake

Staying hydrated and maintain adequate fluid intake by drinking a minimum of 1.5L per
day. To calculate the proper amount that you need, use the following formula;

Bodyweight (kg) x 0.033= # Litres per day of water

e.g. 170lbs divided by 2.2= 77kg

77kg x 0.033= 2.55L

Water will help support the delivery of oxygen and nutrients in blood so that you can heal.
Flushing out toxins and cellular waste is equally important in your recovery as your tissues
are repairing themselves.

10. Protein Intake

Maintain adequate protein intake to help build and repair body tissues. You should be
consuming 0.8-1.5 grams per kilogram of bodyweight. Note that this is a rough estimate
encompassing many different types of people in different levels of physical activity. You
should consult your Doctor or Dietician to get your proper number.

11. Vegetable Intake

Grandma’s advice to eat your vegetables still hold true. You should eat 5-6 servings of
vegetables and fruits per day of different colours to get a variety of different nutrients
(vitamins, minerals, fiber) and phytonutrients (anti-inflammatory) in your diet.
Precision Nutrition has a color chart to help give you some options and variety of what to
eat.
https://www.precisionnutrition.com/color-chart

12. Meditation Technique

I use and recommend meditation to my patients as it will help you reduce stress, control
anxiety, enhance self-awareness, improve sleep and may help control your pain.

There are many meditation techniques out there such as diaphragmatic breathing, body
scan, mantra repetition, mindfulness meditation, etc. You can start with a simple
technique called Box Breathing. If you do it before bed, it can lower your cortisol levels
and down-regulate the sympathetic (fight or flight) response to help you sleep.

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Box Breathing
Step 1. Sit on a chair or lie on your back with your knees straight or bent (whichever is
more comfortable).
Step 2. Close your eyes, your mouth, and slowly breathe in through your nose as you
count to four (or more as you progress).
Step 3. Hold your breath for another count of four (or the same number as your inhale).
Step 4. Exhale through your mouth for an equal final count.
Step 5. Finish by holding your lungs empty for the same count.
Step 6. Repeat several times. You can do this for 5-20mins as needed.

13. Music for Anxiety

It has been well established that patients with a pre-existing history of depression and/or anxiety tend
to have prolonged symptoms. Not only that, the symptoms of these and other mental health conditions
can result in, or mimic, the same symptoms of concussion (dizziness, mental confusion, concentration
problems, sadness, emotional outbursts). Neuroscience says that the following song reduces anxiety
by up to 65%. I find it extremely calming and enjoy listening to this in times of stress.

Weightless - Marconi Union

You can find more information on this as well as more song options by following this link;

https://www.inc.com/melanie-curtin/neuroscience-says-listening-to-this-one-song-reduces-
anxiety-by-up-to-65-percent.html

14. Get Assessed vs. Dr. Google

To get the best help possible, instead of visiting Dr. Google, it is highly recommended you
go seek out a healthcare provider who has taken continuing education courses in
concussion management and rehabilitation. They will be able to give you the most
guidance for treatment recommendations, give specific exercises, tell you what stage of
rehab you are on, recommend individualized return to school, work and play protocols,
etc. An Athletic Therapist would be a good example of someone to seek out.

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Conclusion
So, there you have it: 7 things (plus 7 big bonus tips) that you can do TODAY to
improve your concussion symptoms and kick-start your rehabilitation.

There’s obviously so much you can do too, and I could go much more in-depth
than the principles I’ve given you here, but these fundamentals, if you apply them thoroughly
and are disciplined, will make a huge difference to the quality of your life.

Athletic Therapists and Concussion Specialists can make a huge difference to your life.
I hope this is the beginning of a great, long-term relationship where myself and
my colleagues from Neuro Health Performance become the source of leading edge
health advice for you and make a real difference to your life.

Dedicated to Restoring Your Health,

Mario Starnino, B.Sc., CAT(C), CSCS®

Certified Athletic Therapist/Thérapeute Du Sport Agréé
Certified Strength and Conditioning Specialist

955 Boul Saint-Jean, Pointe-Claire, QC H9R 5K3 (Brunswick Medical Center)

Tower 2 (left side of building when you walk in), Second floor, Door 212 (Research Center)

mario.g.starnino@gmail.com
514-839-2736

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Health Advice Disclaimer

We make every effort to ensure that we accurately represent the injury
advice and prognosis displayed throughout this guide.

However, examples of injuries and their prognosis are based on typical

representations of those injuries that we commonly see in our Athletic Therapy
clinic. The information given is not intended as representations of every
individual’s potential injury. As with any injury, each person’s symptoms can
vary widely and each person’s recovery from injury can also vary depending
upon background, genetics, previous medical history, application of exercises,
posture, motivation to follow a therapist’s advice, and various other physical factors.

It is impossible to give a 100% complete accurate diagnosis and prognosis

without a thorough physical examination and likewise the advice given for
management of an injury cannot be deemed fully accurate in the absence of
this examination from one of the specialists at Neuro Health Performance.

We are able to offer you this service at a standard charge. Significant injury risk
is possible if you do not follow due diligence and seek suitable professional
advice about your injury. No guarantees of specific results are expressly made
or implied in this guide.

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