Concussions – Enhance your awareness and take appropriate action
By Erica Clark, PT, DPT
Concussions are a hot topic. Professional sports organizations are adopting new concussion guidelines. For example, NFL players do not return to a game if a concussion is suspected. Improper fouls are met with stricter penalties. Scientists have begun to link degenerative brain disease with repeated head injuries. So it is certainly understandable to be concerned, even frightened, if you or a loved one sustains a head injury. The goal of this post is to help you, the reader, understand how the brain is affected after a concussion and learn what steps to take if a concussion is suspected.
First, understand that there are activities that increase the chance of someone sustaining a concussion. Contact sports such as football are clearly high risk. However, athletes in other sports like soccer and lacrosse are reporting more concussions. In my PT career I have treated patients with concussions due to falls, biking accidents, motor vehicle accidents, and construction/handyman activities. It is true that some activities bear greater risks than others, and while we tend to focus on sports, all of us are vulnerable to concussions.
Let us start by defining concussion. According to the CDC, “A concussion is a type of brain injury caused by a bump, blow or jolt to the head or by a hit to the body that causes the brain and head to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometime stretching and damaging brain cells“. I will add that a concussion can happen with or without loss of consciousness. Only in a small amount of concussion injuries (about 10%) is there a loss of consciousness. There are more than 3.8 million concussions a year in the USA.
The chemical change experienced in the brain affects each person slightly differently, but there are some common symptoms. The brain processes information more slowly than before the injury and requires a decrease in stimulation to allow it to heal. While the average recovery time for a concussion is 14 days, some people have symptoms for months. In some extreme cases symptoms can last for years.
Concussion symptoms can be broken down into four clusters:
- Cognitive: Fogginess, memory fatigue, cognitive fatigue
- Sleep alterations: Difficulty falling asleep, fragmented sleep, too much or too little sleep
- Somatic symptoms: Headaches, dizziness, nausea, light sound sensitivity
- Mood disruption: Irritability, feeling sad, anxiety
The symptoms above can overlap or be independent of one another. The most common symptom after a concussion is a headache, which occurs over 70% of the time.
So, what should you do if you sustain a concussion? First, identify if you need to seek immediate medical attention. It is critical to seek immediate medical attention if any of these symptoms are present after your injury:
RED FLAGS: Loss of consciousness, amnesia , dazed or confused, vomiting, seizure , asymmetrical pupil size
If you do not have any of the above symptoms, then decide what activities increase your symptoms. These are known as triggers. Then make an effort to limit exposure to them in your everyday life. Next, get some sleep and rest your body. According to the CDC, “Rest is very important after a concussion because it helps the brain to heal. Ignoring your symptoms and trying to ‘tough it out’ often makes symptoms worse.” Rest means both physical and cognitive rest. Hopefully, by slowly increasing exposure to your triggers, you will help the brain heal and decrease your recovery time. If your symptoms persist and do not steadily decrease with rest, be sure to seek medical attention.
Your risk of a prolonged recovery increases if you have certain specific signs and symptoms. These include: loss of consciousness, post-traumatic amnesia, history of a prior concussion, ADHD, migraines, mood disorders, and being female. As stated above, if your symptoms are not resolving and decreasing with rest, finding a healthcare provider that understands and has a history of treating concussion patients is critical. Treating the post-concussive patient requires a multidisciplinary approach with a variety of providers. Depending upon your symptoms and severity you may be referred to one or more of the following specialist: neuropsychologist, physical therapist, behavior optometrist or cognitive therapist. If you are not happy with your care you can always seek out second or even third opinions. Post-concussive syndrome is the most common reason that people return to the emergency department within 72 hours. If left untreated the person with sustained concussion symptoms may have difficulty with academics, relationships, job performance, physical ability, and mental health issues.
The big take away is that we are all vulnerable to sustaining a concussion, and some of us participate in activities that increase that possibility. For most people symptoms should resolve with a few weeks with the appropriate amount of rest and graded exposure to aggravating factors. If symptoms do not resolve or your symptoms worsen, remember to seek medical professionals with experience in treating concussion.