Concussion aka Traumatic Brain Injury

Updated: Jun 4, 2020

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.