Concussions

What are Concussions?

The topic surrounding concussions has been in the spotlight in the most recent years. In part, this is due to the growing trend of reported concussions. The most recently reported data from the CDC is from 2001-2010, TBIs were up by 70% across the United States.[1]

This momentum of awareness and acknowledgment of the seriousness of a concussion is also in part due to professional athletes coming forward to talk about the long-term damages concussions may cause. Most of these athletes have suffered from at least one, but more commonly several, concussion themselves while playing the sport they love. Unfortunately, most are suffering from the long-term effects of their concussions.

In fact, American Association of Neurological Surgeons has reported some stagger statistics on athletes who suffer from concussions.[2]

  • More than 300,000 sports-related concussions occur every year in the United States
  • 20% of high school football players have suffered from 1 concussion
  • 34% of college football players have suffered from 1 concussion
  • The risk of a football player having more than one concussion is 3-6x more likely than any other sport
  • Soccer players are just as likely as football players to suffer from multiple concussions

So, what is a concussion? Concussions are a form of traumatic brain injury (TBI). A traumatic brain injury, specifically related to concussions, are most often not visible. A TBI occurs because of a “blow” to the head along with possible neck injuries from whiplash type movements. When the head has taken a blow, more often than not, the head and neck moves quickly causing trauma to the musculoskeletal system (neck joints, muscles, etc.)

Even a mild form of a concussion is considered serious. A concussion occurs when the brain moves within the skull striking it against the inside which may cause micro or macro trauma. Our brains are soft tissue and to help protect it, is cerebral fluid and our skull that surrounds it. When a trauma to the brain occurs, it can cause tissue damage (blood vessels), swelling, “electrical wiring” malfunctions, or all three components together.

Your brain will respond to protect you, so when this immediate impact to the brain occurs, the chemistry within the brain starts to change. These changes can be temporary or permanent.

One of the more common disruptions that occur in the brain is the impact on the electrical activities which impacts the reticular activating system (RAS). When the RAS is impacted, it causes symptoms such as memory loss, mental confusion, fatigue, and even unconsciousness.

The challenge with a TBI is no one person who suffers from it has the same symptoms. The brain is the control center for our body. It controls everything we do including physical movements, emotional state, and even our personalities. When a brain injury occurs, symptoms will vary depending on the location of injury to the brain, but it will also impact how the brain functions very differently from person to person.

What causes a concussion?

There are two main forces that can cause a condition like a concussion. The first is a blunt force trauma to the head, meaning a direct impact. The second force is a quick deceleration movement of the head compared to the body causing the brain to move and strike the side wall of the skull. Both forces can range from mild to severe damage.

Once you’ve experienced a concussion, you are more susceptible to serious consequences if another concussion were to happen. Concussions can be devastating and deadly especially if not properly managed by a health care provider. Any concussion, or suspect of a concussion, should be taken seriously.

Anyone at any age is susceptible to a TBI; however, the most common age range for a concussion is between the ages of 5 and 40. Listed below are a few examples of causes for concussions.

  • Abuse
  • Bicycle accident
  • Contact sports
  • Fall
  • Falling object
  • Fighting
  • Motor vehicle collision
  • Shaken Baby Syndrome
  • Work accident

The highest risk sporting activities for concussions include bicycling, boxing, football, martial arts, soccer, and rugby. Despite these higher risk sports, a concussion can occur with almost any sport, which doesn’t mean we should stop playing sports; it just means we need to understand the risks and how to protect ourselves from this type of injury.

Symptoms

There are categories of symptoms for concussions-memory, physical, emotional, and sleeping. Below are symptoms within each category:

  • Memory-lack of concentration, slow processing, feeling sluggish, memory is poor, feeling foggy or can’t think clearly, grades in school may slip
  • Physical-headache, nausea, vomiting, dizziness, blurred or double vision, sensitivity to light or sound, numbness or tingling in a limb, slurred speech, seizure, and/or “not feeling ”
  • Emotional-irritable, sad, nervous, or mood swings
  • Sleeping-sleeping patterns change (too much or can’t sleep at all), difficulty falling asleep, drowsy

Symptoms that may linger on, or may be more difficult to resolve to include loss of libido, weight gain, chronic headaches, loss of menstrual cycle, early dementia, muscle spasms, loss of memory, and/or permanent emotional and personality changes.

There is a known condition called Second-Impact Syndrome which is serious. If someone has experienced more than one concussion, their risk of permanent brain damage goes up. For each concussion, one may experience, the risks of long-term damage and risk of death goes up exponentially.

Concussions and the impact it can have may be life altering, so medical attention and management of this condition is always advised.

How is a concussion diagnosed?

Concussions are rarely diagnosed with imaging like an MRI or CT scan. The only time your physician may order such a test is to determine if the brain is bruised or bleeding. Your health care provider such as an athletic trainer, physical therapist, or your physician will start assessing your neurological state immediately if they suspect a concussion.

A neurological assessment may include:

  • Balance
  • Coordination
  • Hearing
  • Orientation to date, time, location, etc.
  • Reflexes
  • Vision

In a case where there is suspect of a more severe concussion, neuropsychological testing may be ordered. So, what is neuropsychological testing? It is when a health care provider, such as a psychologist, assess your ability to problem solve, memory recall, concentration, and reasoning skills. These higher-level functions of the brain will be challenged and tested to determine how much damage was caused by the concussion.

Treatment

Treatment for a concussion is basic. The goal is to allow time for your brain to heal while managing symptoms such as headaches, nausea, vomiting, and dizziness. Time is the ally for healing. On average, most concussions resolve on their own within 7-10 days of onset. To minimize your risk of long-term effects, a health care provider should guide you through the recovery phase.

Commonly your health care provider will ask you to stop all activities that stimulate your brain; this can be quite challenging. Activities you may be asked refrain from while in the healing phase may include:

  • Avoiding use of technology-computers, mobile devices, etc.
  • Play sports
  • School and/or homework
  • Reading
  • Watching TV
  • Work

Once the initial phase of healing has begun, return to physical and mental activities can be begin, but again follow the recommendations of your health care provider. With concussions, especially if the neck is involved with the trauma, a physical therapist (PT) can help a concussion sufferer safely return to activities.

First, your PT will work with you to help with alleviating any muscle soreness, dizziness, or headaches you may be experiencing. He or she may introduce manual techniques with your neck (link to neck pain article) or vestibular system (link to dizziness article). Clearing the neck by making sure it is in alignment and muscle tone and balance is restored is a key component to the recovery from a concussion.

Also, if you are experiencing vestibular symptoms such as dizziness, your PT can assess if this is coming directly from the ear(s) or your brain. He or she may be able to treat your vertigo type symptoms safely, but not everyone responds well to this form of treatment.

With appropriate timing during the healing process, your PT will start introducing low-grade physical activities. He or she will use mild exertion exercises to challenge your system and then he or she will test your neuro system to see if the physical activity resulted in an exacerbation of cognitive deficits or not.

If not, then your physical activity level will be advanced with the supervision of your PT. If cognitive deficits are demonstrated, then your PT will instruct you on proper exercises and activities levels to stay within as your brain may not be ready for more activities or challenges.

This process is controlled and managed by your health care provider, like your PT. Returning to activity levels too early can impact long-term recovery efforts. Everyone heals differently. Therefore there is not the standard time for recovery from a concussion.

Next Steps

Immediate medical attention is always advised if you suspect a concussion. Early intervention and treatment will lower the risk of long-term effects.

If you are an athlete and an athletic trainer (AT) or physical therapist was onsite at the time of injury, he or she will immediately assess your condition. If a concussion is suspected, you will not be able to return to play until medically advised. Almost always, your AT or PT will be in direct communication and work collaboratively with your physician to manage your concussion recovery.

If you suspect a concussion and there is no immediate access to an AT or PT, it is advised you seek medical attention immediately from your physician. He or she will be able to diagnose and establish a treatment plan with you.

As a consumer of health care, you have a choice in selecting your provider. Do your homework and make sure you find a PT who has excellent outcomes, top rated customer feedback, and is cost effective.

In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

To find a highly qualified PT in your area, please click on Find A Clinic. This link will help you find a PT that has top national rankings for treating concussions.

[1] https://www.cdc.gov/traumaticbraininjury/get_the_facts.html

[2] http://www.aans.org/patient%20information/conditions%20and%20treatments/concussion.aspx

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