31 May Concussion
It’s not just a contact sport injury. I’ll explain the current evidence around what it is and how to manage it.
What is it?: Concussion is a type of mild traumatic brain injury. It has originally been described as a ‘coup-contrecoup’ injury where the brain would hit the inside of the skull and then bounce back and hit the other side of the skull which would create a bruising on the outer part of the brain. Further research has lead to the belief that concussion is more of a stretch or shear injury to the deeper area of the brain. Regardless, we know it sets off a series of events at the brain cell level that results in altered neurological effects.
Cause: It is caused by a blow to the head or a violent shaking of the head and body. The more concerning risk is that of ‘Second Impact Syndrome’ in the hours and days following the initial injury. This occurs if you sustain another impact while the brain cells are still recovering and can then lead to a much more severe and even fatal brain injury.
Signs & symptoms: Initially can include: Loss of consciousness, seizures, vacant stare, delayed responses, slurred speech, confusion, disorientation, incoordination, balance problems, emotional or memory disturbances. Further symptoms can also develop including a headache, nausea, vomiting, dizziness, ringing in the ears, neck pain, sleepiness, excessive fatigue, depression, and anxiety.
Confirm diagnosis: The SCAT tool can help to diagnose concussion in the early stages. It is then important to rule out a more severe brain injury, so referring to the hospital for a CT or MRI scan is recommended especially when there is a loss of consciousness, vomiting or worsening condition. It is recommended to see a doctor or therapist who specialises in concussion management within 24-48 hours. It is also important to note that every concussion has an element of whiplash and some of the symptoms of whiplash and concussion are exactly the same. So this is again why it is important to see a therapist that specialises in concussion.
How to treat it: The main treatment involves rest for the first 24-48 hours, then returning to doing normal activities such as reading or watching tv, provided they don’t provoke symptoms. Then, under the guidance of your therapist, a graduated return to school/work then return to play program can begin. Research has shown that symptoms don’t reflect the recovery of the brain, so just relying on symptoms to make a return to play decision is not appropriate. Working with a therapist who can assess more objective measures such as balance, reactive time, cognitive ability, memory, visual processing and physical capacity and compare these with pre-injury levels where able. The therapist should also treat the neck/whiplash during this period as appropriate.
Recovery time: Symptoms usually resolve in 3-8 days, but it has been found it can take up to 22-30 days for brain cell metabolism to return to pre-injury function. Therefore if you return to play too soon there is a higher risk for the second impact syndrome as previously mentioned, but also for developing post-concussion syndrome. This is when symptoms become longstanding (more than 4 weeks) and recovery from this will depend on the main symptoms experienced.
To find a therapist who specialises in concussion (such as myself) speak with your GP or search here.
Check out this video from Dr Cameron Marshall from Complete Concussion Management Inc.™ (CCMI) for more information.