It’s Concussion Season: All You Need To Know (And Then Some) About Concussions

Winter is upon us and with it, the season of slip-and-falls, both accidental and sports-based, and therefore, also “concussion season”. How do you know if you have sustained a concussion?  Who can help you figure out if you have one? How do you know when you can go back to work or sport? Why is dictating your own “recovery period” potentially very dangerous? Read on and find out…

A concussion is not a brain bruise

The current Berlin Consensus Statement defines concussion as a traumatic brain injury induced by biomechanical forces [1], meaning the rapid acceleration and deceleration of the brain, leading to an energy deficit in the brain cells. With a concussion, there is no structural change or damage so imaging like X-rays, CT scans or MRI’s do not detect concussion.  A concussion is actually a functional brain injury [2], meaning it affects how well the brain can work.

The most current understanding for the mechanism of concussion is that rapid acceleration and deceleration of the brain leads to a stretching and “shearing” injury. Think of two different materials rubbing back and forth together quickly, like getting a friction burn on our skin. Our brain has two main tissue layers of different densities – white matter and grey matter. When the brain rapidly accelerates and decelerates, these differing tissue layers do not move at the same rate so the connections between the layers get stretched and “sheared” and cause a temporary disturbance in the cells. A cascade of events leads to an imbalance between energy supply and demand within the body and the onset of various symptoms of concussion [2,5].

Why “feeling better” is not sufficient data to clear return to work or play

Did you know that the average clinical (i.e. symptom) recovery for concussion is 7-10 days, but the average physiological recovery for concussion takes 22-30 days [2]. This means that you “feel better” (i.e. clinical recovery) long before your brain has actually recovered and regained normal function (i.e. physiologic recovery) [2].

This is why so many concussion patients say they felt a lot better in a few days so they decided to try going back to full-time work, school, or sport and then felt a lot worse shortly thereafter. They basically asked their still-recovering brain to work at normal, high levels, which takes a lot of cellular energy, when their brain was still in a state of energy-deficit. This mistake can contribute to delayed recovery, persistent symptoms, increased risk of musculoskeletal injury, more severe physiological dysfunction, cumulative concussion injury through a secondary impact, and increased risk for neurodegenerative disease [4,5].

Why you should never “wait and see” after a slip, fall or impact

We seek out medical assessment and care for cuts, broken bones, and muscle/joint pain, so why do we choose not to get assessed by a healthcare practitioner for concussion following a slip-and-fall, direct impact to the head, or a forceful impact that affected the whole body? We often want to “wait and see” how an injury progresses before we seek care but this is not how a concussion should be managed! Research has shown that visiting a healthcare provider with training and expertise in concussion management within the first 5 days following a concussion can help to alleviate symptoms through proper assessment, education, reassurance, and treatment [2,6].

Thorough assessment is key (it might not be a concussion) let us diagnose you properly!

As well, the amount of acceleration that it takes to cause a concussion injury ranges from 70-120 G’s, where ‘G’ is equal to the normal gravitational acceleration (9.8 m/s2) [2]. Let’s compare this to the 4.5 G’s it takes to sustain a whiplash injury and mild strain to the neck muscles [2]. What can we infer from this? If you have had a trauma with enough impact to cause a concussion injury, your neck has also undergone similar rapid acceleration and deceleration. It is conceivably impossible to have enough acceleration of the brain to cause concussion without also surpassing 4.5 G to the neck [2]. Therefore, with a clinical diagnosis of concussion also comes a whiplash injury and strain to the muscles of the neck/upper back.

Finally, some of the small muscles at the back of the head/neck have the highest number of neurological connections neurons providing feedback to our brain regarding our eyes and our vestibular/balance systems, which can have a big impact in concussion management [2]. The affected muscles and joints of the neck/upper back are treatable, especially by manual practitioners such as chiropractors, physiotherapists, and registered massage therapists through a combination of soft tissue therapy, joint mobilization/manipulation, rehabilitation exercises, and patient education. This is where “The Choice Difference” has an impact – we work together as a team to assess and treat all of the symptoms of concussion to help optimize your recovery.

Not all health care providers are equally as educated in concussion assessment

To summarize, I am advocating for your brain and body’s health to please not “wait and see” with a potential concussion injury – we can help! The recommendation would be to seek out a healthcare practitioner who has specialized training in concussion assessment and management for your symptoms. I am one of three healthcare practitioners at Choice Health Centre who have received further education in concussion and can provide a thorough assessment, treatment plan and specific recommendations on your activities of daily living to help you manage your symptoms and fully recover from your concussion.

Concussion research is rapidly evolving and those of us staying abreast of that research know so much more today about the effects of concussions on the body and brain than we did even in the past decade! We are here to apply that knowledge to help you recover safely and optimally.

References

  1. McRory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838-847.
  2. Complete Concussion Management Inc. (2019). Complete Concussion Management: Online Practitioner Certification Course [Course notes]. Retrieved from www.completeconcussions.com.
  3. McCrea M, Guskiewicz K, Randolph C, et al. Jan 2013. J Int Neuropsychol Soc. 2013;19(1):22-33.
  4. Kamins J, Bigler E, Covassin T, et al. What is the physiological time to recovery after concussion? Systematic review, 28 April 2017. Br J Sports Med. 2017;0:1-7.
  5. Signoretti S, Lazzarino G, Tavazzi B, Vagnozzi R. The pathophysiology of concussion, October 2011. American Academy of Physical Medicine and Rehabiliation. 2011;3:S359-S368.
  6. McRory P, Feddermann-Demont N, Dvořák J, et al. What is the definition of sports-related concussion: a systematic review, June 2017. Br J Sports Med. 2017;51(11):877-887.

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