Concussion

Brain tissue is soft and is surrounded by cerebrospinal fluid, which acts as a cushion between it and the hard protective exterior (the skull). A concussion occurs when your brain bounces or twists inside your skull or experiences rapid, whiplash-type back and forth movement that causes it to collide with the inside of your skull.

This brain movement stretches and damages brain cells and leads to chemical changes in the brain. These injuries cause your brain not to function normally for a brief period of time and result in the signs and symptoms of concussion.

Motor vehicle accidents, falls, and sports injuries are common causes of concussions. Any sport that involves contact can result in a concussion. Among children, most concussion injuries occur on the playground, while bike riding, or when playing contact sports such as football, basketball, ice hockey, wrestling, or soccer.

The symptoms of concussion can be divided into four categories, which are remembering, physical, emotional, and sleep. Many patients with concussions report that they do not feel like their real selves after suffering from this type of injury. Symptoms may worsen if the brain is strained by physical activity, such as running and climbing up the stairs, or cognitive activity such as academic work.

Patients who experienced a concussion may have trouble with cognitive functions. Specifically, they may notice that they have the following:

• Trouble remembering new information.
• Feeling dizzy and cannot concentrate regularly.
• Feeling slower than usual.

The cognitive symptoms above mean everyday tasks take more time and mental effort than usual.

Physical symptoms a patient experiences can depend on the individual and the severity of the injury. Some potential physical symptoms include:

• Headache
• Dizziness
• Vomiting
• Balance problems
• Visual problems
• Sensitivity to light
• Numbness or tingling

Some symptoms, particularly symptoms that get progressively worse, may be a sign of brain hemorrhage. A patient who has a persistent or worsening headache, weakness or numbness, decreased coordination, repeated vomiting, or slurred speech, should seek immediate medical attention for further evaluation.

In addition to physical and cognitive symptoms, people with concussions may experience emotional and mood symptoms. They may feel:

• Sad
• Irritable
• Depression
• Nervous or anxious

Concussion symptoms can vary in babies. These may not be as noticeable at first, since babies do not exhibit slurred speech, walking difficulties, and other symptoms that can be caused by children and adults. Some common signs of a concussion in babies include:

• Vomiting
• Drainage from their mouth, ears, or nose
• Drowsiness

In rare cases, concussions can cause permanent damage. While most babies recover from concussions, it is important to have them checked out by a doctor.

The most common risk factors linked to concussions are falls, motor vehicle trauma, assaults, and sports. Within sports-related concussions, contact sports have the highest rate of concussions. Therefore, some of these contact sports that can lead to concussions are football, rugby, lacrosse, soccer, wrestling, basketball, volleyball, and baseball.

An athlete’s position and style of play also affect his / her risk of a concussion. For instance, studies have shown that football Quarterbacks are most likely to suffer concussions and that the overall risk of concussion was highest during NFL Playoffs. Other individual sports with high risks of concussions are boxing, karate, and kickboxing.

 Below are other risk factors, such as:

• Age – People younger than 25 and elders older than 75 years are at the greatest risk for concussions.
• Gender – Female athletes report more concussions and more severe symptoms than their male counterparts playing the same sport. For example, female soccer players are more likely to report concussions than male soccer players.
• Mood disorders – Concussions in people with mood disorders may have a more complicated recovery.
• Migraines – Studies have shown that patients who suffer migraines are more likely to suffer a concussion and / or may have a longer concussion recovery.
• Risky and / or behavioral changes – People engaging in risky behavior, such as drinking and driving, have an increased risk for concussion.

Certain complications from having concussions include:

Second impact syndrome

In some cases, experiencing a second concussion before signs and symptoms of a first concussion have resolved may result in rapid and fatal brain swelling.

Post-concussion syndrome

A small proportion of people may have symptoms including headaches, dizziness, and thinking difficulties that persist beyond 3 weeks. If these symptoms persist beyond 3 months, however, this becomes characterized as post-concussion syndrome.

Post-traumatic vertigo

Some patients experience a sense of spinning or dizziness for days, weeks, or even months after a brain injury.

Post-traumatic headaches

Various individuals experience concussion-related headaches up to seven days after a sudden brain injury.

A person who has suffered a head injury should be immediately evaluated for a concussion by a sports trainer, coach, or medical professional.

The patient and witnesses to the injury will be asked how the injury happened, the type of force involved, and what areas of the body were affected alongside the concussion. Discussing the injury with the patient and witnesses can help clarify the diagnosis:

Force

Understanding how the injury occurred may help estimate the force of the hit or blow that caused the concussion. The greater the force involved the greater the chances for more severe symptoms.

Loss of consciousness

Whether or not the patient lost consciousness, and if so, for how long, does not determine the severity of a brain injury; instead, it’s one indicator – 85% of concussions do not involve loss of consciousness and many of those are worse than concussions in which the patient lost consciousness.

Location of injury

Where the brain was injured can determine concussion symptoms. For instance, an individual who suffers an injury to the back of the head (either by a direct blow or whiplash) may experience blurred vision, problems balancing, and fatigue.

During a physiotherapy session, physiotherapists can evaluate and treat many problems related to concussions. Because no two concussions are the same, a physiotherapist will examine your neurological, orthopedic, and cardiovascular systems in order to best prescribe a selected routine to address your particular symptoms and your needs in all of your daily environments.

Some of these physiotherapy treatments include:

Restoring your strength

The physical and mental rest required after a concussion can result in muscle weakness and a decrease in physical endurance. Your physiotherapist can help you regain your strength and endurance when the right time comes without making your concussion symptoms worse. It is common for athletes to experience exercise intolerance with concussions and brain injury. Your physiotherapist will also work with you to identify and treat your particular concussion symptoms.

Improving your balance

If you have dizziness or difficulty with your balance following a concussion, a type of physiotherapy called vestibular physiotherapy may help. The vestibular system, which includes the inner ear and its connections with the brain, helps you keep your balance and prevent dizziness. A vestibular physiotherapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying special treatments or teaching you specific exercises, some of which you may be able to perform at home.

Reducing headaches

Your physiotherapist will assess the different possible causes of your headaches and use specific treatments and exercises to reduce and eliminate them. Treatment may include stretches, strength and motion exercises, eye exercises, hands-on techniques like specialized massage, and the use of technologies such as an electrical stimulation device.

Rest

Your physiotherapist will help you and your family understand why you should limit any kind of activity after a concussion until it is safe to return to your activities. A period of rest helps the brain heal and helps symptoms improve as quickly as possible.

Returning to your regular activities

As symptoms ease and you’re able to regain your normal strength and endurance without symptoms reoccurring, your physiotherapist will help you gradually add normal activities back into your daily routine. Your physiotherapist will help you avoid overloading the brain and nervous system as you increase your activity level. Overloading the brain during activity after a concussion interferes with the healing of the brain tissue and can make your symptoms return.

Once the concussion symptoms have subsided, a patient may return and resume regular daily activities. Below are a few great treatments for concussion recovery:

Avoid risky activities

Patients should not return to high-risk activities (sports, physical education, or high-speed activity) if any post-concussion symptoms are present. Other safety considerations while symptomatic include driving, bike riding, heavy lifting, and working with machinery.

Sleep

It may take time for the brain to heal after a concussion. Therefore, in addition to physical rest and plenty of sleep, the brain needs to be mentally rested as well. For that reason, reading, playing video games, and using the computer or another device should be avoided until all concussion symptoms have been resolved.

Acupuncture

Some patients have reported acupuncture helps alleviate concussion symptoms, such as pain and insomnia.

Pain-relievers

Headaches may occur in the days or weeks after a concussion. To manage pain, as your doctor if it’s safe to take a pain reliever such as acetaminophen or naproxen. Avoid other pain relievers like ibuprofen and aspirin, as these types of medications can increase the risk of bleeding.

Caffeine

Studies have shown that caffeine contains neuroprotective qualities in patients with traumatic brain injuries. It indicates that higher caffeine levels are associated with more favorable outcomes in the six months following a brain injury.

Fish oil

Fish oil supplements may speed healing for those with concussions and other mild brain injuries. However, while fish oil is considered as a safe supplement, if there is any sign of bleeding on the brain, it is recommended to avoid taking fish oil as it may cause excessive bleeding.