During a recent family gathering, I found out that my Aunt had unfortunately fallen and was possibly struggling with a concussion. Obviously, this led to a discussion about concussions, how they happen, what their symptoms are, and how to manage one. Given all the current media attention, I was surprised by the lack of information that was provided to my family on concussions by various health providers. So this week’s injury time out is dedicated to all the people who, through no fault of their own, are not aware of the best available information and management of concussions.
What is a Concussion.
What is it? How does it happen? Is it serious? Concussions are a common injury in sport and in life, but many people still don’t fully understand how a concussion happens. It’s not an injury that you physically see, but the side effects of a concussion are very visible to the properly trained eye.
Concussion Injury Mechanisms
There are two concussion injury mechanisms. One is Linear Acceleration where your head is snapped in a forward/backwards movement, like whiplash from a car accident. A linear acceleration force causes the brain to strike the inside of the skull. The force then causes the brain to bounce backwards, striking the backside of the brain and creating a second impact. Second, is a Rotational Acceleration where your head is rotating like when being hit with a hard right cross punch. With a rotational acceleration the force of impact can actually cause the brain to spin or rotate inside the skull leading to micro-tearing.
Generally when a concussion occurs the clinical symptoms that are visible are a result of a functional disturbance, not a structural injury. The functional disturbance can be caused by the sudden stretching of the neuronal and axonal membranes and this initiates the neurometabolic cascade. Neurometabolic cascade is when potassium leaves a cell and calcium enters the cell. This clogs up the axon channel and causes swelling on the axon. This compression affects the flow to the nerve leading to significant neurometabolic abnormalities.
Concussions manifest with a wide variety of symptoms which may include:
- Loss of consciousness
- Impaired coordination
- Double/blurred vision
- Neck pain
- Confusion/Attention/ memory/other cognitive dysfunction
- Sensitivity to light/noise
- Ringing in the ears
- Feeling stunned or in a daze
- Slurred speech
Concussions can only be diagnosed clinically, since diagnostic imaging cannot detect a concussion and there is no blood test or computerized screening tool that will diagnose a concussion. Specific tests for concussion can include: history, oculo-motor dysfunction, postural instability, and cognitive impairment or neurobehavioral changes. There are a few things that are important to note. During the immediate stage after a suspected or diagnosed concussion, things like strenuous activity, driving, or the consumption of alcohol, anti-inflammatories (asprin or advil), and sleeping tablets should all be avoided.
The Stages of Post-Concussion Recovery
Return to Play
There are 6 stages for return to play when a concussion is involved and before you can move on to the next stage all concussion symptoms need to be resolved. If after the introduction of another stage symptoms return, then you must go back to the previous stage until all symptoms are resolved again.
- Compete physical and cognitive rest (no electronics, bright lights [indoor or outdoor], reading or loud noises)
- Gentle activity like stationary bike, elliptical or walking (<70% of max heart rate). Stretching, static core stability, balance exercises, attendance at practice or games.
- Dynamic warm up like jumping jacks, high knee drills, non-contact involvement in plays at half speed.
- Dynamic warm up like mountain climbers, plyometrics, resistance training, and non-contact involvement in plays at full speed.
- Return to full practice.
- Return to full competition.
Same goes for return to learn or return to work context. There are 5 stages:
- No school or work
- Partial day attendance with accommodations. Things like breaks as needed, reduced exposure to screens, no tests, early dismissal if symptoms return/worsen.
- Full day attendance with accommodations. Things like breaks as needed, reduced exposure to screens, no tests, early dismissal if symptoms return/worsen.
- Full day attendance with no accommodations.
- Full school or work as well as extracurricular activities.
Who Do I See?
It is very important to seek care from a professional with training and experience in acute care and management of concussions, including post-concussion syndrome. Our Capilano Physical Therapy Team has specific training and clinical experience in post- concussion care and are able to systematically assess your present situation using a modified R2P Score, a Standardized Concussion Rehabilitation Tool. We believe that our Physical Therapists can systematically evaluate cervicogenic, vestibular, visitibulo-Occular, sensory integration, and autonomic nervous system disruptions that present with concussion events. Any severe neurological impairment results in immediate referral for further medical investigation.
If you or someone that you know has suffered a concussion, get them the proper help that they need. Call 780-466-1104 to book in with one of our professionally trained concussion care therapists.