Attention all those who have taken a dive this winter on icy streets, rusty once a year skiers and novice ice skaters- this post is for you. I’m also shouting out to those 20 something weekend warriors. There’s an injury epidemic out there that we, as medical professionals, are learning more about. IT’S TIME WE TOOK A HARDER LOOK AT OUR HEADS. Concussion awareness is slowly becoming topic of discussion among concerned parents of athletes and professional sports stars alike. But what about those of us that are neither of those things? What should we understand about brain health, concussion signs and symptoms, and rehabilitation? Without further ado, I’ll try to help fill in some of those knowledge gaps. Hopefully, it will inspire us all to get serious about protecting our noggins.
The first jarring fact is that CONCUSSIONS ARE BRAIN INJURIES. They need to be treated as such, and one should not minimize their seriousness. A concussion must be followed by a thoughtful medical examination. While concussions do not show up on CT or MRI, your doctor might use those tools to rule out more serious injury. There is also a battery of tests that can be immediately done post injury to identify cognitive, balance, and visual issues and establish a baseline for recovery. In high school sports, doctors, therapists, trainers, coaches, parents, and athletes are working towards concussion identification and treatment. However, I have found that those injured outside of athletics often go under treated. I’m referencing those who slip and fall on ice, have had minor car accidents, etc. In my clinical practice as a PT, the patients I’ve treated for concussions often come in originally for other problems. Only after our examination do we discover that the fall that caused their back pain also caused their headaches, memory issues, and dizziness. In other words, they were concussed.
You might wonder how a concussion would go unnoticed. It seems like it would be obvious, right? Well, in truth, it might not be as evident as you think. One DOES NOT HAVE TO LOSE CONSCIOUSNESS to have a concussion. Concussions occur when your head moves uncontrollably in a forward/backward linear motion, or in a torsional motion. During this motion, the brain hits the undersurface of the skull. Often times, a whiplash injury associated with a car accident is the perfect mechanism to create concussive force. The person doesn’t even have to hit their head necessarily. Clinically, it is not uncommon to see whiplash patients in the office who, upon further investigation, also happen to have concussions. They might not have realized it if they didn’t loose consciousness or if the symptoms weren’t immediately apparent in the post accident melee.
So what are the signs and symptoms of a concussion? Below are some symptoms that one might see develop within the first 24-48 hours post injury:
• Memory loss
• Concentration issues
• Light sensitivity
• Balance impairment or vertigo
If you happen to get a concussion and realize it immediately, it’s time to GO TO YOUR DOCTOR. Usually, the doctor recommendation is to let your brain rest for a few days until your symptoms resolve. That means limited activity, potentially including absence from work, reading, using the computer, and exercising. This rest period is really important. If one gets concussed again while the brain is healing, even if the knock is small and seemingly innocuous, it can result in serious brain injury. For most people, symptoms of a concussion resolve in one to four weeks. Unfortunately, for 10-20% of individuals, the symptoms last beyond this point (Mucha 2016). This phenomenon is known as post-concussion syndrome. It is a relatively serious issue where a person may experience protracted headaches, dizziness, fatigue, concentration issues, memory loss, balance deficits, and anxiety. If a person has post-concussion syndrome, they need a team of people to help them medically manage their issues. This would include not only their primary care physician but also a neurologist specializing in concussion management, a neuro psychologist, possibly a neuro optometrist and otologist, and physical therapist. If the individual is a high school athlete, then school personnel like coaches and trainers would also be involved.
Our role as physical therapists is to help persons with concussions treat their balance issues, vertigo, endurance loss, and any orthopedic issues associated with the trauma. In other words, there is a lot we can do!!! With our athletes we may perform the role of helping decide when is appropriate for return to sport. Similarly, we may help the adult decide when is appropriate to return to work or recreational exercise. Before returning to full exercise or work, we want our patients to be symptom free at rest and during activity, without the masking effects of medication. The potential for recovery is really good, provided that the injury is treated with the seriousness it deserves. So, if you find yourself wondering if you or a loved one came away from that fender bender with more than just a sore back, it’s time to talk to a pro. Then you can set about the business of healing!
Elizabeth D’Annunzio Shah, PT, DPT, OCS
Image(s) above courtesy of Stuart Miles at FreeDigitalPhotos.net
Mucha A, Whitney S (2016). Concussion Basics: Assessment, Screening, and Risk Factors [Lecture Notes]. Retrieved from https://www.medbridgeeducation.com/courses/details/concussion-basics-assessment-screening-risk-factors
Elizabeth D’Annunzio Shah, PT, DPT, OCS works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)