Concussion

We recently released some information about dizziness but something we also manage within the clinic is concussion where dizziness is also a common symptom. With the beginning of rugby pre-season training starting, now is a great time to make you aware of some concussion essentials.

A concussion is a “traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain”. You don’t have to lose consciousness or even have a impact specifically to the head to cause this INJURY. Yes, concussion is an injury and should be treated as such!

The concussive head injury “initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain.” Signs and symptoms of concussion may develop immediately or more gradually over hours but do not resolve for a number of days or even longer in some instances. The brain injury often shows no abnormalities on CT and MRI scans so how do we know if someone has a concussion?
Concussion symptoms

You don’t have to lose consciousness to have a concussion. Any of the following can be signs of a concussion. Monitor these and refer to a medical professional!

At the time of a potentially concussive head injury, look out for
• Neck pain or tenderness • Double vision • Weakness or tingling/ burning in arms or legs • Severe or increasing headache • Seizure or convulsion • Loss of consciousness • Deteriorating conscious state • Vomiting • Increasingly restless, agitated or combative

As well as assessing and monitoring the following symptoms….
Headache, Pressure in head, Neck pain, Nausea or vomiting, Dizziness, Blurred vision, Balance problems, Sensitivity to light, Sensitivity to noise, Feeling slowed down, Feeling like “in a fog“, “Don’t feel right”, Difficulty concentrating, Difficulty remembering, Fatigue or low energy, Confusion, Drowsiness, More emotional, Irritability, Sadness, Nervous or Anxious, Trouble falling asleep.

Return to sport
There are a number of return to sport protocols that have been developed specific to a variety of sports. These usually incorporate a gradual return to more demanding sporting activities and should be followed thoroughly ensuring symptoms do not return at any stage during the process.
Post-concussion syndrome and treatment
– Post-concussion syndrome is any instance where symptoms of the concussion last longer than the usual recovery period.
– During a concussive event, there is often an associated whiplash disorder due to the forces involved. Our assessment and management of concussion includes assessment of the neck as some symptoms may be prolonged due to the whiplash injury and muscle strain that may occur alongside the head injury.
– A mismatch between what is being sensed by the muscles and movement in the neck, feedback from the eyes and balance receptors within the inner ear may lead to prolonged symptoms of concussion. Therefore, treating and rehabilitating the neck and managing the oculomotor (eye) and vestibular (inner ear) receptors in the rehabilitation process can assist in alleviating common symptoms such as dizziness.

Prevention
In many activities, we can aim to minimise the risk but it is difficult to fully mitigate due to the nature of the sport. There have been a number of rule changes in many sports which may have reduced the risk somewhat but is there anything else you can do?
Strength of the neck can stabilise the position of the head on contact and therefore reduce the force transmission to the brain during impact. This may have a benefit for reducing the likelihood of a concussive head injury. In addition, athletic populations who have had previous concussion often display significant strength imbalances in the neck, potentially increasing the risk of further injuries to the neck and head.

If left unmanaged, some long-term complications with concussion can remain for prolonged periods of time. Difficulties with memory, balance and concentration may be impacted so it’s important to treat the issue and ensure symptoms are no longer present prior to restarting an activity and risking another head injury.

Treat your concussion!