Concussion – The Heads Up
Not so long ago, if you sustained a concussion during a game of sport, it was expected that you would ‘suck it up’ and get on with it. Thankfully some of this mindset has changed, and the public is generally more aware of the long term serious implications of concussion.
Concussions are serious injuries, and should be taken seriously. Studies have found that a single incident of brain trauma is present in the history of between 20-30% of Alzheimer’s/Parkinsonism patients. This is compared to only 8-10% of controls. People who have suffered multiple concussions have poorer performance in tests involving memory, and executive functioning (the ability to plan, organize and complete tasks).
What is a concussion?
A concussion is a form of traumatic brain injury. Usually this is caused by a blow to the head, face or neck, however it can result from a knock to the body, in which forces are transmitted to the head.
The brain is made of soft tissue, and is surrounded by a cushioning spinal fluid, and blood. When you sustain a concussive force, the brain shifts and hits against the inside of the skull. This causes a shearing injury to axons (nerve fibres) inside the brain, which leads to areas of cell death. The brain may also be bruised or swollen where it was knocked against the skull.
MRI or CT will not show a concussion – diagnosis is primarily based on signs and symptoms.
Symptoms of concussion:
You do not need to lose consciousness to suffer a concussion. Symptoms may appear straight away following the injury, or some hours afterwards.
Presentation of a concussion can vary greatly, but may include one or some of the following symptoms:
- Visual disturbances (double/blurred vision)
- Nausea or vomiting
- Impaired balance
- Memory loss
- Sleep disturbance
- Difficulty concentrating / ‘brain fog’
- Sensitivity to light
80-90% of concussions resolve themselves in 7-10 days. If symptoms last for longer, this is deemed Post Concussion Syndrome (PCS). It is not known exactly what causes concussion symptoms to linger, however there is certainly a correlation between injury severity and ongoing symptoms. If you have sustained a previous concussion, you have a higher risk of PCS. In general, symptoms of PCS will resolve within 3 months.
What should I do if I think I have suffered a concussion?
- If a concussion is suspected whilst playing sport, you should NOT return to play on the same day. Studies have shown that athletes who return to play on the same day are more likely to have delayed neurophysiological symptoms that may not be evident on the sideline.
- Rest is still the primary treatment for a concussion. The brain is trying to recover, so if you are running around like a headless chook, it will not have the extra energy required for brain tissue recovery! Complete rest (doing nothing) is NOT recommended – it is still important to exercise gently.
- Take naps if you are feeling fatigued, even if this is during the day.
- Minimise activities which take a lot of ‘brain power’, and opt for light exercise such as walking.
- Avoid stimulants such as caffeine, as these ‘fire up’ the brain.
- Low stimulus environments are best for allowing brain recovery, so avoid spending lots of time in front of the TV or device.
Return to Sport
A previously concussed athlete should only return to play when they are symptom free AND not taking any medications that could mask/alter the symptoms of concussion. Return to play should be gradual, and there should be no symptom onset following the game.
Head Injury Prevention
Generally, people do not plan to get a concussion! But there are some things you can do to minimise risk of injury:
- Know your limits
- Try to be sensible when it comes to taking risks
- Wear a helmet
- Helmets have been proven to dampen forces and protect the head from injury when skiing or snowboarding with no increased risk of neck injury. HOWEVER, New Zealand Snow Sports Trauma and Safety found that there was an increase in concussion rates from 2010 – 2014, in skiiers and snowboarders wearing helmets. This increase raises concern that those wearing helmets are overestimating the protective capacity of the helmet and are taking greater risks with speed and/or jump-height than those not wearing a helmet.
How can a physiotherapist help?
The good news is that, if you have had a concussion, it is a very recoverable injury.
Physiotherapists experienced in concussion assessment and rehabilitation can assess your symptoms and advise on appropriate treatment. Often this will include hands on therapy to address neck issues, gaze stabilisation exercises, balance re-training, prescription of a graduated return to exercise, education regarding recovery time-frames and expectations. Evidence has shown that physiotherapy can help to reduce concussion symptoms, and aid in a faster return to normal.
If you think you may have suffered a concussion, we would love to see you – book in online here or call 03) 443 1711!