There has been much discussions in the media regarding concussions in the past few years. We often hear about concussions occurring in sports such as hockey and football. While we hear the word often, many people do not really understand what a concussion is. Many people also don’t understand how a Physiotherapist can help in the recovery process after a concussion.
What is a Concussion?
A concussion is a mild traumatic brain injury (mTBI) and is typically defined as a head injury that temporarily affects brain functioning.
How can you get a Concussion?
A direct blow to the head, face, neck, or anywhere else on the body that will transmit the force to the head i.e. an important thing to be aware of is that head impact is not necessary to get a concussion.
- Hitting your head e.g. head impact during a sporting activity either by another person, an object, or the ground
- Motor vehicle accident e.g. head impact, whiplash
- Whiplash-associated injury (often during motor vehicle accidents) because your brain floats within the cerebrospinal fluid inside your skull and when your neck whiplashes, even if there is no physical head impact, your brain can still ricochet back and forth and hit the confines of the skull
How is a Concussion diagnosed?
Often acute symptoms present as functional and not structural disturbances (i.e. diagnostic imaging is unlikely to show any changes in the structure of the brain). Your doctor diagnoses the concussion based on the symptoms you are experiencing and how they are affecting your daily function.
What are symptoms of a Concussion?
You do not have to have all of the symptoms listed below. Some of these may present immediately while others develop hours later. This means the injury can continue to evolve even if initially you seemed to be fine. This is why you should not go back in the game after getting a concussion! Some symptoms will resolve quickly on their own while others may take days or weeks to go away.
- Temporary loss of consciousness (not common – can be as low as 6% of concussions only)
- Slurred speech
- Dizziness, or “seeing stars”
- Double vision
- Tinnitus (i.e. ringing in the ears)
- Nausea, vomiting
- Headaches or feeling of pressure in the head
- Disorders of taste and smell
- Light sensitivity
- Noise sensitivity
- Appearing dazed, delayed in answering questions
- Confusion, fogginess, slowed reaction time
- Loss of memory, usually short-term
- Unusually fatigued
- Difficulty reading
- Difficulty concentrating
- Screen intolerance
- Disrupted sleep patterns, difficulty falling sleep, etc.
- Unusually irritable, personality changes
Balance / Vestibular Impairments:
- Poor balance / unsteadiness
More specifically seen in children:
- Appearing dazed
- Listlessness and tiring easily
- Irritability and crankiness
- Loss of balance and unsteady walking
- Crying excessively
- Change in eating or sleeping patterns
- Lack of interest in favorite toys
Why are Concussions a Big Deal?
Concussions are a traumatic brain injury. They have a history of being downplayed, especially in sports, but can cascade into chronic symptoms that affect the rest of your life.
What to do after a Concussion?
- Stop the activity. After an initial concussion, you have an increased chance of a second one soon after. If that happens:
- there is a greater chance of more severe symptoms
- there is a greater chance of more long-lasting symptoms
- See your Doctor within 1-2 days unless there is an emergency
- Doctors can officially diagnose a concussion
- They can also rule out other concurrent injuries e.g. cranial nerve, subdural hematoma, retinal detachment, etc.
- Seeing other health care professionals as needed:
- If vision / reading is an ongoing issue, looking up an optometrist that deals with concussion-related impairments may be recommended
- Speech language pathologist
Is rest enough?
Not always. Rest is recommended for the first 24-48 hours with very limited screen time and no exercise. After the first 48 hours, depending on the severity of symptoms, general activity and screen time can be gradually introduced and should be only as much as is tolerated.
What can Physio do for your Concussion?
- Assess the severity and irritability of your symptoms to determine an appropriate treatment plan. Monitor symptoms and refer back to family Doctor if there any concerns. Re-assess symptoms as you go through treatment plan to determine recovery stage and if treatment approach is working.
- Provide education on:
- your symptoms and self-management strategies,
- including sleep issues, noise sensitivity, reading impairments, etc.
- when to begin graded activity and how much at a time,
- give guidelines for what to do and what not to do,
- give guidelines for return to work,
- recommend restful activities instead of screens,
- give guidelines for return to sport play
- Rule of Thumb: athlete needs to be symptom-free for the same amount of time that they had symptoms before they return to contact sports – this applies especially to youth and adolescent players
- Show exercises to rehabilitate vision/reading, balance impairments.
Wearing a helmet is certainly important, however you can still sustain a concussion when you are wearing one. Risk management, playing safe, maintaining neck and upper body strength, and safe return to play are all important aspects of lessening concussion risk.