Concussions
What is it?
A concussion is defined as a traumatic brain injury induced by biomechanical forces to the head, face or neck. Our brain sits within our skull and is protected by blood and spinal fluid. The main function of the spinal fluid is to provide cushioning and shock absorption against sudden impact. When an intense and abrupt force is transmitted to the head, neck or face, our brain is jolted and can push through the surrounding fluid and hit directly against the skull. This impact can then result is bruising, swelling, damage to blood vessels and nerves within our brain, which leads to symptoms of concussion.
Mechanisms of injury
Concussions can be caused by any event resulting in a force being transmitted to the head. The top 3 causes are falls, car accidents and sports. The risk of concussion varies across different sports. However, several studies have found the highest rate of concussion to be associated with rugby and soccer.
Signs you may be suffering from a concussion
It is important to note, if you have experienced a traumatic blow to the head, neck or face, it is strongly advised you are seen by a medical professional immediately (regardless of whether you are currently experiencing symptoms or not). Symptoms may appear immediately following the incident, or may develop hours after the initial blow.
The following is a list of potential signs and symptoms you may experience;
- Loss of consciousness.
- Headache, dizziness or vertigo.
- Nausea, vomiting.
- Neck or head pain.
- Fatigue and low energy levels.
- Cognitive difficulties such as brain fog, confusion, disorientation, slowed reaction times, poor concentration and word finding difficulties.
- Blurred vision or sensitivity to light or noise.
- Difficulty with gait and balance.
- Behavioural changes such as irritability, depression or impulsiveness.
- Changes to your usual sleep/wake cycle (e.g. excessive drowsiness).
Diagnosis
Concussions are only to be diagnosed by a medical professional. Assessment with include a comprehensive history of the event, a review of the clinical presentation of the patient (including any improvements or deteriorations), a neurological exam including cognitive and physical function. If there are suspicions of further injury, a brain CT scan or MRI may be performed.
Prognosis
Most concussions are mild and resolve within 7-10 days. If the concussions lasts longer, this is now considered post-concussion syndrome, and you should be re-assessed by a medical professional. (Recovery times may be prolonged in children, and an age appropriate checklist is required for this population).
Management and Physiotherapy
Initial management of a concussion consist of physical and cognitive rest. Often this includes no exercise or sports, avoiding electronic devices (televisions, phones, computers), avoiding prolonged reading and no driving. Try avoid any task that worsens your symptoms physically or cognitively. Concussion symptoms often worsen after too much stimulation or when you are tired at the end of the day. Initially, you may find you’ll need multiple rest period throughout the day. Often a short period of rest from work or school is warranted.
If the injury occurred during sport, there is a strict return to sport protocol which should be followed. An athlete should not return to sport on the same day and should follow a graduated program (as per the picture below). If symptoms are experienced at any rehabilitation stage, the athlete is advised to drop back to the previous symptom free level.
Figure 1: From Consensus statement on concussion in sport: The 5th international conference on concussion in sport held in Berlin, October 2016 by McCrory P, Meeuwisse WH, Dvorak J, et al. Bri J Sport Med. 2017;51:838-847. doi:10.1136/bjsports-2017-097699
Following symptoms reduction, a physiotherapist can help strengthen your neck muscles in order to prevent concussions arising in the future. Evidence has shown neck strength to be directly linked to the risk of injury. More specifically, poor neck strength has been shown to be a marked risk factor for concussions.
If you would like to learn more about rehabilitation following a concussion, the physiotherapists at Back In Motion Como would love to help!
Website: https://www.backinmotion.com.au/como
Phone Number: 9313 3414