Concussion – Just a bump on the head?

heat image of brain

Posted on 2/9/2017 by Melissa Bloom, P.T., DPT, NCS

 

One of the many myths pertaining to concussion is that you need a big blow to the head to get one, or that getting your “bell rung” isn’t a big deal. In fact, any impact to the head, neck, or body has the potential to create changes to the neurological function of the brain, or cause a concussion. While you most certainly can get a concussion from a high intensity football game or from a car accident, they often occur after what

may seem like a fairly light bump.

I’ve seen people with significant concussion symptoms from slipping and falling on ice, accidentally hitting their head on a cabinet door, getting elbowed in the head, or having luggage hit their head while unloading it from a plane. Additionally, I see patients from motor vehicle collisions where they never even hit their head and I see athletes where no one can pinpoint a specific hit. However, these individuals may be showing signs of post-concussion symptoms after the accident or game.

Similarly, a common myth is that you need a loss of consciousness or at least will “see stars” in order to have a concussion. In fact, a loss of consciousness is quite rare post-concussion, with occurrences of less than four to 10 percent.

An invisible condition

What makes concussions more complicated is their invisible nature. Unlike a cut or even a broken bone where we can see a bandage or a cast, the symptoms of a concussion often go unseen. The most common symptoms are:

Headaches
Dizziness
Foggy or difficulty thinking
Blurred or double vision
Sensitivity to light or sound
Changes in sleep patterns
Increases in anxiety and irritability
While the symptoms are real and can significantly impact someone’s ability to function, peers, family, co-workers and friends cannot see them.

Return to sport and return to life

Awareness and education are key to help diagnosis concussions and to help those with persistent symptoms get the proper care they need to recover. An important first step can be recognizing anyone who may be showing any of the symptoms listed above that could be connected to anyphysical impact, no matter how much of “just a bump” it was. Despite how or when someone sustained a concussion, an active rehabilitation program can help. Our concussion management clinicians complete comprehensive examinations to assess the multiple systems that are often involved post-concussion and will develop an individualized plan of care unique to each person and case.

In the past, the primary treatment for concussion was rest; it has even been called “cocoon therapy.” However, current research shows that activity and stimulation is better than excessive rest. That doesn’t mean, though, that you should go full force into your previous activities. Symptoms should be monitored and controlled; this may vary depending on the underlying factors specific to a concussion. As long as you have remaining symptoms post-concussion, having an evaluation and treatment plan set for you can help guide your activity levels and ultimately get you back to your normal symptom-free life. Treatments will depend on your individual test results, but will likely be a combination of visual exercises, vestibular rehabilitation, neck treatments, or a sub-symptom exertion program.

Common rehabilitation components

Visual exercises are provided when symptoms are due in part to your eyes not communicating well with each other and the brain. These exercises tend to involve having your eyes work more efficiently to reduce symptoms and increase visual clarity. This can involve simple eye movements or complicated tasks of watching a busy scene with many moving items.

Vestibular rehabilitation is indicated when the inner ears are somehow involved. These treatments can also be varied, but typically involve some type of head movement. You may initially get dizzier with these exercises, but they are effective in eliminating symptoms in the end.

Neck treatments may involve addressing any neck pain you have post-injury. More often than not, neck pain means that the sensors in the neck are not communicating well with the brain, leading to fogginess, dizziness, imbalance, or headaches. Specific exercises can retrain these receptors and in turn eliminate remaining symptoms.

Sub-symptom exertion training is frequently needed post-concussion. These exercises are designed specifically for you based on your heart rate, and are intended to allow the brain to safely heal and handle the physiologic challenges needed for daily physical and mental activities.

Balance and functional training may be included to make sure you are in tip-top condition to safely get back on the field or get back to work, play, and or life.

Prevention

Unfortunately, there is not a lot we can do for concussion prevention. A concussion is different than other brain injuries where there is focal damage. The changes we see post-concussion are due to sheering or pulling forces on the nerves of the brain, which in turn changes the effectiveness in how they work. Protective devices, such as helmets or mouth guards, cannot prevent these forces from occurring. They are important in preventing skull or jaw fractures or cerebral bleeding, but their limitation with concussion protection is an all too common misconception. In fact, using equipment that does not protect against concussion while perceiving there is preventative value may lead to more risky behavior and possible paradoxical increase in concussion rates.

The best thing we can possibly do is be vigilant about injuries, symptoms and being sure to take the necessary steps toward recovery. We can help you.

Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.

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