Concussion Physiotherapy

Concussion is a serious head and brain injury that can cause permanent effects on brain tissue. It can even change the brain’s chemical balance, causing

  • physical problems
  • mental / cognitive problems
  • behavioural problems

in both short term and long term.

I have to repeat this: medical practitioners take every concussion as a serious injury – if you know anyone who has had a head injury, they need to seek medical help immediately.

The Center for Disease Control (CDC) estimates between 2-4 MILLION people gets concussions due to sports, regular and recreational activities in the United States — and that’s a lot of them. We have to factor concussion cases that are

  1. under-reported
  2. not reported
  3. misdiagnosed

So it could be closer to 5-10 million people per year who gets concussions, and a whole whopping lot of them not being diagnosed or treated for it.

What’s a concussion?

Concussion refers to brain injuries, particularly to the brain being shaken violently.

Concussions can happen during rapid accelerate-decelerate situations, such as motorvehicle accidents causing whiplash, or when the head gets a direct traumatic hit, be it from sports or a fall. This causes a shaking of the brain, an unpredictable kind of injury to the brain, which results in

  • immediate
  • delayed changes

in the brain’s anatomy, function and chemistry.

Less than 10% of concussion injuries includes fainting (loss of consciousness)

Concussion can cause temporary and/or permanent brain problems and functions, depending on where and how severe the brain injury is.

Common causes

Concussions can happen at any age, be it young or old, male or female, and also from different causes, such as:

  • Assaults from mobbing or domestic violence
  • Sports direct blow to the head, face or neck from contact sports such as soccer, boxing etc
  • Work accidents such as falls or trauma
  • Too close to an explosion
  • Physical abuse where the head is shaken
  • Traffic motor accidents leading to trauma or impact to head (including whiplash injuries)
  • #1 concussion cause: falls
  • Playground accidents such as falling from the swing or bumping / crashing from the slide

Recovery from brain injuries and concussion isn’t simple. It’s usually complex, and can take a couple of weeks for mild ones to months and even years, depending on severity, activity level and age of the person injured

To make matters more complex, no one “gets” concussion injuries by itself – it usually comes with other problems and conditions, such as

  • neck injuries
  • head injuries
  • multiple trauma eg multiple joint or bone or muscle injuries

All of these will 100% need medical care and physiotherapy.

More serious brain injuries, such as

  • brain bleeds
  • brain bruising
  • brain tissue tears

can also happen, and will need immediate critical care by neurosurgeons.

Warning: concussions can lead to permanent brain damages. If you suspect someone you know have concussion, please take them to the accident and emergency department as soon as possible.

What does concussion feel like?

It’s…often hard to describe, because

  • concussions are very complex injuries (I know, I’ve said this multiple times, but it warrants repeating)
  • patients who live with post-concussion injuries may not have the explanation or language how to accurately express how they feel after the injury

That’s the #1 reason why patients with head injuries, brain injuries and/or concussions should work with only a few physiotherapists, together with family and co-workers who can pickup any changes.

Signs and symptoms of concussion

Concussions can have a wide spectrum of symptoms — they can affect

  1. physical (pain, weakness, imbalance etc)
  2. emotional (behavioral, response etc)
  3. mental / cognition (attention, telling time, learning, recall etc)

Some symptoms are immediate and obvious, some show up some time after the initial concussion…and some symptoms show up months or even years after the concussion.

The signs and symptoms that are immediate are easy to pickup and treat, because most of the time, patients are already in hospital or receiving medical and physiotherapy care, and health care practitioners are paying attention to recovery.

It’s the symptoms that show up without warning days, weeks, months or years later that are dangerous. Imagine someone suddenly getting dizzy as they drive a car, years after the initial injury. That will cause a lot of damage.

Risk of death, severe injuries or permanent damage can be minimized by immediate and appropriate medical treatments. This is why it’s so important to seek medical attention after any concussions or head injury AND staying the course over months and even years.

Immediate / short-term symptoms

  • Headache
  • Room spinning / Dizziness
  • Balance problems
  • Incoordination
  • Nausea / vomiting
  • Fatigue
  • Difficulty staying or getting to sleep
  • Sleepiness
  • Double or blurred vision
  • Sensitivity to light and sound
  • Slurred speech
  • Daze
  • Seizures

Cognitive (mental) symptoms can include:

  • Difficulty memorizing something new
  • Difficulty recalling recent or long term memory
  • Confused
  • Difficulty processing information
  • Difficulty concentrating
  • Worsening performance at work, sports or school

Emotional symptoms can include:

  • Anxiety and worry
  • Aggressive behavior
  • Mood swings
  • Irritable
  • Restless
  • Difficulty managing stress
  • Changes in personality
  • Changes in behavior

Longer-term symptoms

  • Muscle weakness
  • Headache
  • Dizziness
  • Tiredness / fatigue
  • Weight gain
  • Muscle tightening that remained tightened (spasticity / increased tone)
  • Increased / Decreased sexual arousal or desire out of the ordinary
  • Loss of menstruation
  • Low blood pressure
  • Early dementia

Unfortunately, some of the concussion symptoms do NOT go away in the time frames we expect. What we can say in ongoing care and follow ups are required by the medical team including physiotherapy.

Postconcussion syndrome

Some patients get persistent headaches or dizziness that lasts for weeks or months after the initial concussion.

Second-impact syndrome

This refer to preventable and serious complications that can happen after a concussion. If a person who just had a concussion….accidentally has another concussion, this 2nd concussion can cause severe, severe brain damage. Even death.

Permanent brain damage can include:

  • functional impairment and disability
  • inability to learn (even loss of previous function and learnings)
  • changes to behavior and personality
  • inability to get up or move around
  • etc

Research suggests that a person who suffers a second concussion before the initial concussion has healed has a 100% chance of permanent brain damage, and a 50% chance of death.

These are statistics that are downright bad, and no one should have 2nd concussions…but the problem is, the falls risk increases tremendously after the 1st concussion, because of direct and indirect symptoms of the 1st concussion!

For example,

  1. a football player who suffered a concussion in the game, and he isnt aware (or thinks it isnt a big deal). The coach and referee gives the go-ahead, and he continues playing, and he falls to the ground or slams into another player — that itself is the 2nd concussion already.
  2. a patient has a concussion, gets treatment, and then gets discharged home…and falls at home, in the toilet because of dizziness or trips

I cannot stress this enough. A single concussion is bad enough, we need to take extreme, extreme care to prevent a second concussion.  Any players who is suspected of concussions need to be immediately removed from the game and sent for medical care

Physiotherapists with work closely with patients and develop programs to return to life, work and play safely. Unfortunately, patients who

  • have had multiple concussions
  • issues with eye tracking
  • headaches / migraines
  • difficulty paying attention
  • difficulty learning / remembering

will take a much longer time to recover fully.

How to diagnose concussions?

Most of the time, concussion diagnosis are done by medical practitioners. That being said, there is no single assessment test or tool that can be used to confirm concussions.

Interestingly also, diagnosing concussions may not always rely on higher-tech testing, such as using MRI or CT scan imaging…because brain scans may not show any signs of brain abnormality EVEN when patient has symptoms of concussions.

This is why concussions can be complex and easy to miss / misdiagnose.

The physiotherapists will take the time to ask you all the questions needed to understand and find out all the symptoms you are experiencing; together with multiple assessments and tests to check issues caused by concussions such as

  • coordination
  • strength
  • balance
  • eye-hand
  • sight
  • smell
  • hearing
  • memory tests

How physiotherapy can help

Treatment may include:

  1. Prescribed downtime to recover. We will help you, your family, your colleagues and workplace superiors understand why you need to limit any kind of activities including daily tasks, work, school, sports, play etc after a concussion injury; until it’s medically safe to return to them. Even return to them will be gradual and not sudden. Scheduled rests and downtime allows the brain to heal and clear the symptoms of concussions faster.
  2. Restore and build lost strength and endurance. The concussion injury itself, followed by the downtime can result in disuse-related weakness (deconditioning). We will help you gradually and more importantly, safely, regain and recover your strength and endurance in a reconditioning program. Even elite athletes as well as sporty individuals will experience deconditioning. We will work hand-in-hand with you.
  3. Manage dizziness and improving balance. Some patients develop giddiness dizziness, and they may need vestibular physiotherapy to rehab the balance and vestinbular system. This is to decrease or even stop dizziness and balance problems.
  4. Manage headaches. Many patients develop headaches which can be very intense and frequent. Some of them have triggers too such as movement, light, load bearing. Treatments for headaches may include trigger point release, manual therapy, mobilization, strengthening, stretching as well as rehab tech such as ultrasound therapy and electrical stimulation therapy.
  5. Return to life, work and sport. Your symptoms will recover, with rest, time and preventing secondary injuries. As your symptoms improve and your physical strength, balance, stamina etc improves, your physiotherapist will also gradually increase activities into your daily life. The most important thing is to NOT overwhelm the brain with too much activities, as that will interfere with healing of brain tissues and chemistry…which can make your concussion symptoms worsen or return.

Where To Next?

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