Concussions – What You Need to Know

Today we are talking about a specific type of brain injury that is becoming more common place – concussions. Whether due to increased prevalence or becoming better at recognizing them, concussions rates are on the rise. It’s important to become more aware of what they are, what to look for, and what can be done about them.

What are they?

A concussion is typically a mild brain injury that causes a temporary disturbance in brain cells due to acceleration or deceleration of the brain in the skull. Previously thought to be a type of ‘brain bruise’, this theory has since been passed over for the ‘stretch-shear’ theory of injury. Brain tissue is made up of structures with different densities, which all have their own rates of acceleration/deceleration. Rapid and traumatic movements of the brain, whether by head of subsequently from body movement, cause these different brain tissues to ‘stretch’ and ‘shear’ in different directions, causing what is termed a ‘neurofunctional’ injury.

What are the signs and symptoms?

Concussions can include a myriad of signs of symptoms, often including one or many of the following:

  • Dizziness, nausea, vomiting
  • Loss of consciousness
  • Headache and neck pain
  • Blurred/double vision or blank/vacant stare
  • Light and sound sensitivity
  • Memory and concentration issues, confusion
  • Balance issues
  • Anxiety, irritability, sadness, sleep disturbances

How do we assess/treat them?

A multi-modal assessment that includes physical, vestibular, and cognitive testing is best. Because of the many types of signs and symptoms that can present, it is important to assess the patient from all angles to grasp the entire picture of the injury. An immediate assessment is best; depending on the severity of the injury, the patient may be required to attend the emergency room to rule out more sinister conditions (ie. Fracture or brain bleed). At the very least, the patient should be seen by a healthcare practitioner within 24 hours to assess the degree of injury and steps for management.

Treatments will depend on the patient’s presentation and subsequent assessment. No two people will experience a concussion alike; there may be similarities, but there is no ‘standard set’ of symptoms that everyone experiences. This will influence treatment decisions and care should be tailored to the patient.

Evidence-based treatments may include:

  • Exercise therapy
  • Manual therapy
  • Diet and nutritional intervention
  • Vestibular, visual and cognitive rehab
  • Education and reassurance

Concussion Myths:

  1. Concussions only happen in contact sports – they can also happen in non-contact sports, car accidents, and slip and falls
  2. Rest is best – prolonged rest can lead to poorer outcomes; rest is recommended only for the first 24-48 hours
  3. Helmets/Mouthguards can prevent concussion – while very important for other injuries, these protective devices do not protect or reduce the risk of concussion
  4. Only a hit to the head can cause a concussion – concussions can also happen with forceful impact to the rest of the body which in turn causes a rapid shift in the brain
  5. You must lose consciousness to have a concussion – ~90% of concussions have no loss of consciousness
  6. Concussions can be seen on x-rays – because concussions are ‘neurofunctional injuries’, they do not appear on any standard structural imaging such as x-rays, CT scans, or MRIs

If you or someone you know is suffering from a concussion injury, or you would just like to be better informed, please don’t hesitate to reach out to us. We would be glad to help!

-Shawn Gargoum