What is a concussion? and how you should prepare.
What is a concussion?
Concussion refers to a mild traumatic injury to the brain without an associated structural abnormality such as bleeding. It may occur with or without loss of consciousness. While concussions can occur from a direct impact, many occur without any contact to the head. A sudden abrupt stop, such as a fall to the ground or two players running directly into one another without ever butting heads, can cause a concussion. Many athletes are strong and have a wider diameter to their necks in comparison to the average person. This allows them to withstand more trauma, however it does not mean that inflammation and injury do not occur. Often athletes celebrate with alcohol and a cheat meal after a game which further exacerbates the injury cascade.
Only one of the following needs to be present for a concussion to be suspected. It is also possible to have any combination of these symptoms:
Confusion/disorientation
Dizziness
Headache
Blurred vision
Sensitivity to noise
Unsteadiness
Feeling “in a fog”
Nausea
Vomiting
"A concussion may or may not involve loss of consciousness (LOC). LOC is not a valid determinant of a concussion."
What happens to your brain after a concussion?
Depending on the direction of blow, different sheering forces in different areas of the brain take place. Neurons, when impacted, stretch and break, they then degenerate and release toxins that damage other neighboring neurons. Proteins called tau are damaged in trauma and remain as deposits in the brain that can contribute to dementia down the line.Since every brain and every trauma is different, symptoms vary in severity and duration.
Preventing Head Injuries
Equipment should be properly fitted, routinely checked and replaced or refitted when necessary (this includes protective oral devices such as mouth-guards). Always follow “safe sports techniques” as they pertain to your sport.
If an athlete only has a headache, is it a concussion?
A headache can be a symptom of a concussion until determined otherwise by a medical provider trained in evaluating concussions. If the headache started after any sudden event such as a blow to the head or face, or after an abrupt stop without striking the head, such as a hard fall, then yes, a simple headache is a sign of a concussion. In fact, it is often the only sign of a concussion.
What should be done if a concussion is suspected?
Seek medical advice from an individual who is trained in assessing and diagnosing concussions, not your average doctor. Do not have the person take ibuprofen related products like aspirin. Carefully watch the injured person for worsening symptoms. If symptoms continue to worsen, transport the person to the local emergency room for further evaluation. If the individual/ athlete has sustained a head injury and has concussion symptoms, he/she should not return to play or extraneous exercise/ mental work without being evaluated and cleared by a medical professional.
What to Watch for After a Head Injury
Signs in the first two days that do not require immediate medical intervention include:
Fatigue and desire for extra sleep Headache (mild, not worsening).
Problems with thinking, concentration and attention span (may persist for extended periods)
Marked change in personality, often with confusion and irritabilityWorsening headache, especially if associated with nausea or vomiting.
Numbness, tingling or weakness in the arms or legs, changes in breathing pattern or seizureEye and vision changes (double vision, different-sized pupils, blurred vision that is persistent or begins well after the incident).
Signs that suggest the need for immediate medical attention include:
Persistent unbearable headache, especially if worsening
Blurry vision
Dizziness
Sensitivity to light and sound
Balance problems
Altered mood and behavior ie easy aggravation
Problems with memory, thinking and sleeping
Difficulty concentrating
Onset of anxiety and depression
What is Post Concussion Syndrome (PCS)?
PCS can develop after a single injury. Broadly defined, the hallmarks of PCS includes prolonged fatigue, headache, dizziness, irritability, insomnia, and difficulty with concentration or memory, as well as intolerance to cardiovascular exercise. The standard of care for PCS has been to rest, both from physical and cognitive activity, until symptoms are resolved. But recent research suggests early rehabilitation as an effective way to address the potentially life-altering consequences of a concussion. Special consideration given to aerobic exercise tolerance, whiplash-like cervical spine dysfunction and problems with vision and balance.
Trying to play through a concussion even for a few minutes or returning to sports too soon after a concussion, increases the risk of PCS. Symptoms unfold slowly over time, sub-concussive impacts, don't cause noticeable symptoms right away, but with repeated injuries symptoms can manifest over time.
What is CTE?
Cumulative sub-concussive hits add up to measurable brain disease called Chronic Traumatic Encephalitis (CTE). Mood and behavioral changes begin to appear around ages 30 to 40, followed by problems with thinking and memory that can result in dementia later on in life.
Diagnostic Tools
Thorough neurological exam.CT scan used acutely after trauma to detect brain bleeds. Diffusion Tensor Imaging (DTI) is an MRI-based neuroimaging technique that makes it possible to estimate the location, orientation, and anisotropy of the brain's white matter tracts.
Treating Post- Concussion Syndrome
Treatment is specific to each patient but often includes elements of closely monitored sub-symptom aerobic exercise, manual therapy and therapeutic exercise for spinal dysfunction, visuomotor retraining and balance impairment. Progressive aerobic exercise has been shown to be safe and effective in improving function in patients with PCS. It also helps to increase production of bran derived neurotrophic factors (BDNF) which aids in neuronal cell health and turnover.
Most patients are prescribed an exercise program to be performed five to six days per week, with close monitoring of exercise intensity using a heart rate monitor. Exercise intensity is determined during the evaluation, and maintained at sub-symptom levels. Cervical range-of-motion, eye movement and balance exercises may be prescribed, as well.
As patients make progress, rehabilitation programs are fine-tuned to meet the demands of returning to full function in daily life and sport. Additionally, elements of injury prevention, such as cervical strengthening exercises, are incorporated as individuals return to pre-injury activities.
Sleeping after a concussion, is it bad?
Many people have heard you shouldn't sleep after a concussion, unless there is documentation of a brain bleed you can and should go to sleep after brain bleeding has been ruled out with imaging. Deep sleep is healing to an injured brain. Melatonin is a hormone released by the brain that aids in healing of nervous tissue. Melatonin supplementation can be effective in neuronal cell healing if the circadian rhythm of the individual is affected and patient has trouble getting regular sleep.
My Pearls of Wisdom
Currently the standard of care of most chiropractors is X-ray imaging of the neck after trauma, most doctors will deny any treatment unless these Xrays are carried out. The first set of Xrays after a motor vehicle accident or a major collision of any kind are helpful for determining major anatomical issues and post treatment Xrays can help support your symptoms and unveil your prognosis for osteoarthritis or loss of spinal curvature. It is very difficult to find an honest chiropractor that doesn’t over-treat. Lawyers and chiropractors all tell you that you need multiple consistent treatments to get better. I disagree on a health level that this is necessary. A good chiropractor should be able to use physical examination and technique to specifically adjust without blindly over adjusting and rely less on Xrays. There are 2 specialties of chiropractors that require their own set of Xrays. These are Nucca and Blaire practitioners. They will refuse to touch you unless you get these Xrays done. You have no way of knowing if their therapy is effective or not and if it is not, you will have to get a completely different set from another chiropractor. I also want to mention that ligament laxity and hyper-mobility of joints are facts. There are individuals with joint laxity merely due to a genetic cause. These individuals are better able to sustain trauma without disc herniation injuries but often feel that their joints continually need chiropractic care or else their muscles act up. Over treating joints can cause this ligament laxity after a whiplash injury. Often individuals are stationary at work and put off exercises that help build muscle and support joints. These individuals rely on chiropractic care and as a result require continuous care.
Resources
https://www.uwhealth.org/sports-medicine/physical-therapy-athletic-training/concussion-rehabilitation-program/39090 https://impacttest.com/
http://www.cdc.gov/concussion/HeadsUp/clinicians/index.html
For a copy of the SCAT3: http://bjsm.bmj.com/content/bjsports/47/5/259.full.pdf