Concussion Facts and Treatment.
What is a concussion?
A concussion (also called a mild traumatic brain injury) occurs following a rapid acceleration to the head and neck, the brain moves in the skull causing shearing or stretching of the neurons (brain cells).
A concussion can occur as a result of direct a fall or blow to the head but also without direct head trauma e.g. a fall or slip on the spine, whiplash due to MVA or a sport (think MMA) or a fall off a bicycle or in a myriad of ways in the home, school or workplace.
This trauma causes shock to the cells; this creates an imbalance of molecules within the brain and a large reduction of blood to the brain, which creates an energy deficit. While the body tries to repair this as fast as possible, there is a time lag and the brain does not work properly for some time.
The body’s healing response requires a huge amount of energy
While we do not know the exact time it takes to recover we do know that complete rest (physical, visual and auditory= no work, reading, writing, looking at screens of any kind, no listening to music) is essential for the first 5 – 8 days after injury.
The biggest concern surrounding concussion comes from this delicate period post concussion where the energy deficit is maximal.
Following a suspected concussion the person should be removed from play, work or school situation, assessed and placed on total rest in order to recover from the energy deficit. Studies have shown that any activity, mental or physical, can delay the process of recovery and should be avoided until the person is completely symptom free.
It is important to note that a person reporting he/she is feeling better does not mean that the brain has recovered! Athletes in particular, are keen to please teammates, coach and parents … and return to play as soon as possible. Where a concussion is suspected regardless of the environment, total removal from the scene is the best approach pending a more detailed evaluation.
Research shows that the correct management during this immediate post injury period is crucial to the brain’s full recovery.
It is also well known that the brain is very vulnerable during this period of recovery. Because the brain is already in a state of shock and imbalance, another impact to the head at this time can cause an even greater imbalance with significantly longer recovery times and potentially devastating consequences. Studies have shown that even a lesser impact during this recovery window, can cause serious additional injury.
Signs and Symptoms
Immediate red flag symptoms requiring immediate medical attention: Please take your person to the emergency department or dial 911 if you have any concerns whatsoever. It is likely that if concussion occurs during sport that the coach or athletic therapist will recognize and assess the athlete and make treatment decisions on the spot. However many concussions occur where there is no trained onsite person to assess: here are some guidelines we should all be aware of in the event that we find ourselves in this exact situation.
Here are the red flags;
Loss of consciousness.
Severe or worsening headache
Very drowsy and can’t be wakened
Decreasing levels of consciousness more than 2 hours after injury, cant recognize people or places
Unusual behavior, irritable, confused
Weakness, loss of motor skills, or numbness arms or legs,difficulty swallowing
Slurred speech or unsteady on legs, loss of balance.
Fluid leaking from ears, bruising behind ears, 2 black eyes.
Inability to remember what happened 30 minutes before and leading up the injury
Difficulty speaking or repeating the same questions or if you continually have to tell them same things.
Care at home
– Do not allow your person to sleep for at least 3 hours after injury.
– Do not administer any pain medications unless specifically prescribed by a physician.
– Wake your person every 2 hours throughout the first night: make sure they respond when you wake them – if difficult to wake or unresponsive please call 911.
– Book an appointment with us for a full evaluation (neurological, cognitive and physical) within 24 hours on injury.
Physiotherapy Management Post Concussion.
Generally most concussion symptoms will resolve within 2-4 weeks post injury. However in a percentage of cases patients may complain of residual headaches, neck pain, visual or balance (vestibular) issues.
Trimetrics physiotherapists are trained in assessment and management of post concussion symptoms such as these. We like to see concussion patients as soon as possible after injury to educate about the process and put the all important, early care plan in place
We use our assessment skills to determine the source of any or all accompanying headaches, neck or back pain. In addition to our standard orthopedic tests we assess the cranial nerves, vestibular and ocular system in addition to the cognitive functions of memory, concentration, balance, reaction time, and grip strength.
We treat what we find using manual therapy, myofascial release, ART (Active Release Technique) IMS (intramuscular stimulation or dry needling), acupuncture, eye exercises and vestibular rehabilitation to reintegrate the aspects of the injured brain back to normal.
Results of this detailed evaluation determine the care plan for that individual. Where a baseline test has been done we have an accurate measurement of the person pre injury against which to evaluate recovery. Where we do not have a baseline we rely on other tests (exertional, cognitive ) to assess the degree of recovery and plan appropriately.
Education is key to helping the individual understand the nature of the injury and the precise steps need to ensure a full recovery. A concussion that is not correctly managed can lead to a range of long term psychological issues including anxiety and depression, which may well be avoided with well-timed education and treatment.
In certain cases we will collaborate with other care providers, as needed e.g. chiropractor, naturopath, massage therapist or neuropsychologist where a multi disciplinary approach is what is needed to serve the individual.
Brain Recovery Diet
Given that inflammation in the brain cells due to concussion, there is increasing evidence that the damaged brain tissue is responsive to natural interventions (both brain super foods as well as individually prescribed natural supplementation) to support healing.
The information here is the work of Naturopathic Doctor, Paul Hrkal who has special interest in brain health and has partnered with Complete Concussion Management to integrate the most current evidenced based nutritional data with the other treatments we provide to ensure the most holistic approach possible for brain recovery.
Please visits his comprehensive website www.paulhrkalnd.com for more information or questions.
“People that have a concussion undergo a very brief period (minutes to hours) of increased energy production as brain cells try to restore balance followed by a period of reduced brain function, as the ability of brain cells to produce energy is greatly impaired. This state can last 7 days or longer (30 days in severe cases) depending on the severity of the injury. While in this “impaired” state, the risk of a concussion appears to increase when the brain has suffered a prior concussive injury and has not yet fully healed.
Unfortunately, at this time there are no neuro-protective treatment options that exist to improve symptoms after a TBI or post concussive syndrome. Drug and pharmaceutical approaches have shown limited benefits and currently are not recommended as a treatment. Now many scientists are starting to study a wide range of natural compounds and vitamins that have promising broad-spectrum, neuroprotective and anti-inflammatory activity. Curcumin, green tea, essential fatty acids, resveratrol, and vitamin E are some of the compounds with potential therapeutic benefit.
Considering the large number of changes that occur after a brain injury a potential solution also needs be able to have a broad spectrum of therapeutic action. Unfortunately drugs can be very effective but are inadequate in TBI since they usually address one very specific factor. This is where nutrition and natural substances can be a very powerful tool to speed up injury recovery and promote healing. The foods that you eat can powerfully reduce the amount of overall inflammation in you have in your body. Specific evidence based natural supplements can also address a wide range of targets including mitochondrial function and neuro-inflammation. Additionally this approach can also improve the ability of your brain to heal during and after a concussion if employed as a preventative strategy. If you are looking to improve your overall brain resilience or want address the chronic effects of a brain injury consider enhancing your brain metabolism with nutrition and natural supplementation.”
To date, there is no information that helps us know how to prevent a concussion. While helmets for sports help protect the skull there is no evidence that they prevent concussion: the trauma to the brain cells within the skull.
Baseline testing takes the guesswork out of the return to play/ work decision. Is highly recommended for young athletes or individuals engaged in sports where concussions are most prevalent: football, hockey, rugby, soccer, MMA, and lacrosse.
The first, and by far the most important step in properly managing concussions actually comes before the injury happens. Actually, before the season even starts! A “Baseline” test is a test that is done BEFORE a concussion happens.
The purpose of a baseline test is to measure every area of brain function, which could become affected following a concussion. This way, if an athlete does get a concussion, we can compare their post-injury state to their baseline parameters in order to help make an accurate diagnosis as well as to establish when they are fully healthy and are safe to return to their sport. Without these baseline parameters we have no way of determining when the brain has fully recovered.
The initial concussion is generally not a large concern, especially since our certified practitioners are highly trained to treat and manage these injuries. However, it is a second concussion, sustained prior to full recovery of the initial concussion that is a cause for concern as this may result in long term brain damage or other larger consequences. Ensuring every athlete has a baseline test done before their season starts is the first step in decreasing the greater risk of concussions.
Professional sports organizations have been undergoing pre-season baseline testing for years, however comprehensive testing of this magnitude has never been available to youth and amateur sports associations; partly because most healthcare practitioners are not sure where to start.
Complete Concussion Management™ has solved this problem by providing accessible, comprehensive, research-proven pre-season and post-injury concussion evaluations, diagnosis, and treatment for amateur athletes and sports associations in local communities across Canada.