A concussion has been defined as “a traumatic brain injury induced by bio-mechanical forces”.⁴ It is often associated with sport and sporting injuries, but can, however, occur in many cases, from a direct or indirect blow/force to the head, neck or face. So this condition can happen in sport, during car accidents, falls or simply by accidentally hitting your head against a hard object.¹ ² ³ ⁴
The forces on the brain are rotational and angular, meaning that a concussion can occur without a direct blow to the head.² As a result of these blows, there is shearing stress on the brain that can cause various symptoms, depending on the severity of the concussion.²
What are the symptoms of a concussion?
Concussions can cause various symptoms depending on the severity of the injury. These symptoms often occur immediately after the injury, but can also be delayed by a few hours and may include cognitive, neurological, physical, behavioural and clinical effects.⁴
A few more common symptoms include:
- Headaches or your head feeling “foggy”;
- Loss of consciousness at the time of injury or memory loss;
- Balance impairment, such as an unsteady gait;
- Slow reaction times;
- Sleep/wake disturbances;
- Dizziness and/or vertigo;
- Loss of concentration.
Most concussion symptoms resolve within 72 hours but can take up to 7-10 days to resolve on their own.⁴ ¹ ² If symptoms last longer than 10 days, a person will develop Post-Concussion Syndrome. In this case, symptoms can last for weeks or months and, in some cases, may only resolve with further treatment.
Management of Concussion
Following a concussion or suspected concussion, a person should be checked by a healthcare practitioner who has experience with concussions, in order to rule out more serious brain injury. Following that (and if a concussion is diagnosed), the most important treatment is rest. This allows the brain to settle and is able to use its own natural energy to heal itself after the stress endured. Complete rest for up to 48 hours is recommended immediately after a concussion.³ However, the exact amount of complete rest is still being debated in medical circles, as well as what “rest” actually means. Excessive physical and cognitive (brain) activity has shown to prolong concussion symptoms, so it is advised to refrain from performing such activities.
There does seem to be a consensus that rest includes the following:²
- No screen time (no computer, phone or television use).
- No reading from a book or other reading source.
- Avoid bright lights in any room. Wear sunglasses if sitting outside.
- If the patient is sensitive to sound, they should use earplugs.
- Avoid strenuous activity. If tolerated, a slow and short walk is suitable, provided it does not increase symptoms or cause an increase in heart rate.
- Often, people suffering from a concussion want to sleep – this is acceptable, provided more serious brain injury has been ruled out.
Management of Concussion with Physiotherapy
As a result of the forces occurring on the head and neck during a concussion, effects resembling whiplash may occur at the cervical spine.³ ⁴ Cervical spine or neck injury during a concussion has been shown to prolong the symptoms of dizziness, headaches and vertigo.³ ⁴ This is where Physiotherapy can be incredibly helpful.
Physiotherapy management may include treatment of the neck, vertigo and balance. These techniques include hands-on therapy, strengthening of the cervical muscles and re-training joint awareness in the neck. General balance exercises have also been shown to assist with joint awareness and reducing dizziness and neck pain.³
Vestibular rehabilitation is also a treatment performed by Physiotherapists. The vestibular system is responsible for connecting information from head movements and limb position to maintain visual and balance control.³ It includes a whole host of areas such as the ears, brain, eyes and postural muscles, and all these need to work together at all times.
Examples of balance exercises and vestibular rehab:
A concussion can bring about both short-term and long-term effects on our bodies. Most resolves within 10 days. However, symptoms lasting longer than that may require some intervention. You can discuss with your Physiotherapist on the best management for you if you have suffered a concussion.
- Leddy J, Sandhu H, Sodhi V, Baker J, Willer B (2012). Rehabilitation of Concussion and Post-Concussion Syndrome. Sports Health: Orthopaedic Surgery. 4(2) 147-154.
- Scorza K, Raleigh M, O’Connor F (2012). Current Concepts of Concussion: Evaluation & Management. American Family Physician. 85(2) 124-132.
- Leddy J, Baker J, Willer B (2016) Active Rehabilitation of Concussion and Post-Concussion Syndrome. Physical Medicine and Rehabilitation Clinics of North America. 27 437-454.
- Images courtesy of Rehab My Patient.