Concussion Management Therapy in Vaughan
More than 200,000 concussions are experienced annually across Canada. It is commonly believed that most head injuries are sport-related concussions, but these injuries frequently occur during car accidents, work-place injuries, and in slip and fall incidents as well.
At The Pain & Wellness Centre, we often see patients experiencing both new and chronic concussion-related symptoms. We feel that arming patients with the right information about these injuries is one of the most important steps to successful recovery. In this article, we will discuss what a concussion injury is and how to recognize symptoms and touch on the appropriate steps for management of these injuries.
What is a concussion?
A concussion (also often referred to as a mild traumatic brain injury) can be thought of as a dysfunction in brain cells that happens following injury. This means that during a concussion, there is no actual brain damage, but the cells in the brain (called neurons) undergo changes in how they function. They do not work for a period of time, and this can lead to the generation of certain symptoms. How long? We do not know yet, but everyone seems to be a little different.
While a direct blow to the head is the most likely way of sustaining a concussion injury, it is important to recognize that concussion injuries can occur following a blow to the body or neck, where force is transmitted up to the head, resulting in an acceleration/deceleration injury. This could occur if a person slips on the ice and falls backwards, or in a car accident where the head and neck are whipped forward upon impact.
After a head injury, the brain cells fire rapidly and atypically, often using up a lot of the available energy on hand. This can lead to the person experiencing a cluster of short-lived symptoms from loss of consciousness, dizziness, ear ringing, or altered vision. After this short-lived series of events, it is not uncommon that people will feel a little better. However, an energy crisis is occurring in the brain cells, as they have used up their stored energy, and the effects of the injury prevent them from making more energy! This is why a concussed person may start to feel much worse in the coming hours to days.
Recognizing the Symptoms of a Concussion
No two concussion injuries will present the same from person to person, and a combination of many symptoms will usually occur shortly after injury. With time, some symptoms will recover, and some may take a bit longer. Many concussion injuries improve dramatically over the first 7-10 days, with some taking up to two weeks to even a month for a full recovery.
Some of the more common signs and symptoms are listed below:
- Headache or pressure in the head
- Dizziness or loss of balance
- Nausea and/or Vomiting
- Light and/or sound sensitivity
- Fatigue, low energy or disturbed sleep, feeling foggy
- Blurred and/or double vision
- Poor concentration, reduced focus, confusion, or short-term memory impairment
- Altered mood (irritable, moody, sadness)
- Loss of consciousness (less than 10% of injuries)
What should I do if I am worried that I have sustained a Concussion Injury?
Many concussion injury diagnoses are made after a person visits the hospital or their family doctor following the injury. An initial period of absolute rest from work or activity may be recommended. The international guidelines for management of concussion injuries recommend that this period of absolute rest should ideally be no longer than 48 hours, upon which a progressive return to physical and cognitive demands should take place. At the Pain & Wellness Centre, our trained rehabilitation specialists can assist you with this.
When seeing a patient with a concussion injury, our therapists will perform a detailed physical examination, in which they will ask you questions about your symptoms and how they are affecting your environment. They will inquire about your sleep and nutrition so that they can intervene and advise on steps you can be taking to optimize your recovery. They will examine your head, neck, and any other part of your body, so that they can understand how your musculoskeletal tissues are contributing to your injury. They will perform a detailed neurological examination which will look at your vision and balance. They may also perform a treadmill test to see how your heart rate and symptoms respond to a change in activity. For a mild traumatic brain injury, evaluation and management is very important.
Once you have completed your assessment, our therapists will outline a plan of management that addresses hands-on treatment, self-symptom management, a guided and structured return-to-work or school plan, and an outline of how to use physical activity to assist in your recovery. You may also be given specific exercises to help with your vision or balance and recommendations on how to change your sleep and nutrition.
What is Post-Concussion Syndrome
As previously mentioned, most concussion injuries will resolve or significantly improve over the course of a couple of weeks and up to a month. However, a percentage of these injuries will take longer. Persistent post-concussive symptoms, also called post-concussion syndrome, occurs when concussion symptoms last beyond the expected recovery period after the initial injury. This may be a constellation of several symptoms that have remained since the injury or a single or couple of symptoms that failed to improve from an initial cluster of symptoms.
When an individual develops persistent concussion symptoms, the first question that needs to be asked is whether there has been appropriate injury management. We know that a concussion injury affects the energy production and function of the brain cells. If the person continues to engage in activities that are physically or cognitively demanding, such as exercise or the use of screens at work, this may compromise or delay the course of recovery. Psychological stress can also be a significant barrier to recovery. An individual may be resting and off work, a high degree of stress related to something in their personal life can consume attentional resources and energy needed to recover.
Another common scenario is that an individual sustains a concussion injury, and they are told to rest. Absolute rest is only suggested for the first couple of days, and beyond this can be extremely detrimental and delay recovery. Resting and avoiding symptoms altogether will contribute to the persistence of symptoms. Experiencing mild symptoms while you gradually return to physical and cognitive activities is a normal part of recovery and should not be seen as something to avoid.
We also know that concussion injuries tend to occur concurrently with whiplash injuries to the neck due to the most common mechanisms of injury being acceleration/deceleration injuries to the head and neck. There are many structures in the neck that can produce concussion-like symptoms. In fact, headaches, dizziness, nausea, vomiting, sensitivity to light or sound can all be symptoms of whiplash! It is not uncommon for a person to sustain a concussion injury, only to suffer persistent headaches a month later, with the neck (not the brain) being the primary cause. Our qualified manual therapists will also thoroughly assess your neck to see whether your care should include direct treatment to the neck.
It is also possible that inner ear or problems with vision can occur following a head trauma and, in these scenarios, it may be necessary for co-management with an optometrist or ENT.
Generally speaking, if you have completely recovered from your concussion injury, there is no strong evidence to support the fact that you will be at a higher risk of sustaining a subsequent injury.
If you have completely recovered from your concussion injury, then any subsequent concussion injury should be treated as a new and separate injury. The risk of a more challenging recovery comes into play when you have NOT completely recovered from an injury and you sustain a second concussion. This can lead to a much longer and more challenging recovery.
When you suffer a concussion injury, the energy in your brain cells is lowered. This puts you in a vulnerable state. If you sustain a second injury in this initial period of vulnerability, some of the brain cells may not be able to survive, and in rare cases a second injury is fatal. This is why an athlete is never to return to competition on the same day of injury, in what is known as the return to play protocol.