Understanding Concussions: Causes, Symptoms, and Treatment

A concussion is a “traumatically induced transient disturbance of brain function” (National Health Institute). It is a type of traumatic brain injury (TBI) that results from a blow to the head or a violent shaking of the head and body. A concussion disrupts the normal function of the brain, leading to a variety of physical, cognitive, and emotional symptoms. Concussions are common in contact sports, but they can also occur due to falls, car accidents, and other forms of trauma.

Let’s dig into the specifics.

What is a Concussion?

A concussion is a brain injury that occurs when the brain is rapidly shaken inside the skull. This can happen when the head is hit, bumped, or jolted. The sudden movement then leads to chemical changes in the brain and damage to brain cells. The damage to your brain cells is responsible for the “transient disturbance of brain function” piece of the definition above.

Here’s an analogy: Your brain has developed a beautiful, smooth, streamlined road map of all of the cool things you do throughout your day - from driving, to working, to exercising, to speaking and thinking and problem-solving. Then you sustain a concussion. This injury disrupts those pathways enough that either A) you can no longer use that pathway that you’ve always relied on or B) your brain can only use that pathway so much before it tells you to stop (i.e. causes a symptom like headache, brain fog or dizziness).

The goal of concussion treatment is two-fold: 1) recognize your thresholds / sensitivities and modify your life to nurture recovery and 2) perform active rehabilitation to re-wire those pathways so that you can return to normal function quickly and completely.

Common Misconceptions About Concussion

Certain ideas have entered the social landscape that are not true. Here are a few truths to get you headed in the right direction:

• You do not need to actually hit your head to suffer a concussion - whiplash or a jarring of the neck is enough to cause the brain to shake inside the skull and sustain a concussion.

• You do not need to lose consciousness to suffer a concussion.

• You should NOT cocoon after your head injury. Cocooning is when you avoid all stimulus - think of the outdated advice of sitting in a dark room, avoiding light, avoiding screens, avoiding too much brain work. This has actually been shown to worsen symptoms and delay recovery from conccusion.

• Your neck does not need to hurt to be involved in your symptom profile and recovery. A concussion injury occurs at 60-100 g-forces or greater; a whiplash injury occurs with as little as 4.5 g-forces. Even if your neck does not hurt, you could have underlying neck dysfunction that is contributing to your concussion symptoms.

Symptoms of a Concussion

Concussion symptoms can vary widely depending on the severity of the injury and the individual. They may appear immediately after the injury or may not be noticed until days or even weeks later. Common symptoms include:

• Physical Symptoms: Headache, dizziness, nausea, balance problems, and fatigue. Sensitivity to light and noise is also common.

• Cognitive Symptoms: Difficulty concentrating, memory problems, confusion, and feeling mentally "foggy" or slow.

• Emotional Symptoms: Irritability, sadness, nervousness, or anxiety.

• Sleep Disturbances: Difficulty falling asleep, sleeping more or less than usual, and insomnia.

It's important to note that symptoms can evolve over time and may worsen before they get better.

When to Seek Immediate Medical Attention: While this is a rare occurrence, certain signs indicate a need for immediate medical attention:

• Persistent or worsening headaches

• Repeated vomiting

• Seizures

• Significant confusion or disorientation

• Slurred speech

• Weakness or numbness in limbs

• Changes in behavior or personality

These symptoms may indicate a more serious brain injury and require prompt evaluation by a healthcare professional.

Diagnosis of a Concussion

There is no single test to diagnose a concussion. Your brain is far too complex to capture in a single test, so medical providers us a variety of them to create a big picture of your brain’s status. This may include:

• Medical History and Symptom Review: Discussing the events leading to the injury and the symptoms experienced.

• Physical Examination: Assessing physical signs of function. The four main pillars of this are exercise intolerance (sometimes called autonomic dysfunction or dysautonomia), cervical (assessing the patient’s neck for a whiplash injury), visual (assessing changes in visual processing and coordination) and vestibular (assessing balance, coordination, and spatial orientation). For more information on working with Dr. Joe, see his Physical Therapy services. For more information getting back to exercise, explore Dr. Joe’s Return to Exercise programs.

• Cognitive Testing: Evaluating memory, concentration, problem-solving skills, and more.

When medical folks define and diagnose “concussion”, they leave it broad enough to cover all cases. Through treating several hundreds of them, I recognize that one concussion is one concussion. It’s YOUR concussion. It’s so unique to you that it’s tough to compare it to another. This is where we need to go beyond diagnosis and into active rehabilitation.

Treatment of a Concussion

Here's a closer look, backed by the most up-to-date scientific research, at the steps involved in concussion recovery and treatment:

Relative Rest for 48-72 Hours: After a concussion, it is important to perform relative rest both physically and mentally for 48-72 hours after your injury. This does not mean complete rest. Do less than you usually would, and let your symptoms guide you. Do not put yourself in a position to sustain another concussion. Physical activity is okay if it does not worsen your symptoms. Cocooning, or sitting in a dark room and avoiding everything, used to be encouraged but several research articles have shown that this actually worsens your symptoms and prolongs your recovery timeline.

Early Active Rehabilitation, Starting at Day 2: At Complete Concussion Care, active rehabilitation is a key piece of treatment. Ideally this starts as early as 2 days after your injury with symptom-guided exercise (and physical activity) and an assessment of your cervical spine to check for a whiplash injury that may be contributing to your symptoms. By 5 days after your injury, visual and vestibular assessments and treatments are started. Ultimately, active rehabilitation ties in all of these domains and becomes specifically targeted to get you back to the activities you love!

Ongoing Symptom Management: Recognizing your sensitivities and thresholds is key early on. This awareness helps you pace yourself with challenging tasks (like returning to work, school or exercise). It’s okay and completely safe to have mild symptoms as you’re doing normal activities. Over-the-counter pain relievers like acetaminophen can be used to manage headaches. Just to be safe, skip the ibuprofen or aspirin initially to limit the risk of bleeding.

Return to School, Return to Play, Return to Sport: Ideally, you or your child should return to school by 10 days after the head injury. This may start with accommodations, and that is completely okay and very normal. Return to play and return to sport is an ongoing process that is guided by your physical therapist, athletic trainer and coach. For safety, you or your child will be guided through 6 steps as part of a gradual return to play & sports. You can find return-to-play and return-to-sport resources from the Centers for Disease Control here and here.

Finding a balance between nurturing healing and engaging in active rehabilitation is key to your quick and complete recovery!

The Importance of Proper Management

Proper management of a concussion is crucial to ensure a full recovery and to prevent complications. Ideally, this starts at 2 days after your injury. It’s important to understand that everyone, and every concussion, is on a unique recovery timeline. Some folks recover within a week; some folks take several months to recover. Engaging in early concussion treatment increases your chances of a quicker, more complete recovery.

Conclusion

Concussions are a common part of life that requires an experienced specialist on your side. Understanding your injury and having a toolkit to manage symptoms and actively rehabilitate your concussion is crucial to ensure a successful, complete recovery.