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Concussion
What is a Concussion?
A concussion is a type of traumatic brain injury (TBI) that occurs when the brain experiences a sudden and rapid movement inside the skull. This movement can be caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head. Concussions are often associated with sports-related injuries, car accidents, falls, or other situations where there is a sudden impact.
The acute signs and symptoms largely reflect a functional disturbance, rather than a structural injury, meaning there is typically no visible damage to the brain on imaging studies like CT scans or MRIs. Instead, we see neuronal stretching, chemical and metabolic changes, alterations in blood flow, and an inflammatory response affecting brain function. The brain is left in an energy crisis which can last for hours, days or even weeks. We believe this crisis, along with other physiological processes, contribute to the physical, cognitive, behavioural and emotional signs and symptoms seen in individuals with a concussion.
Concussion Signs & Symptoms
The signs and symptoms of a concussion can vary from person to person, and they may not always be immediately apparent. Symptoms can develop right after the injury or may take hours or even days to manifest. It's essential to be aware of both physical and cognitive symptoms, as well as changes in mood or behavior. Below are common signs and symptoms of a concussion.
Physical
Headache
Dizziness
Balance problems
Nausea or vomiting
Sensitivity to light noise
Blurred or double vision
Fatigue or lack of energy
Cognitive
Confusion or feeling foggy
Memory problems or amnesia about the event
Slowed reaction time
Difficulty concentrating
Feeling mentally "off" or not sharp
Loss of consciousness (not always present)
Emotional / Behavioural
Irritability
Mood swings
Anxiety or nervousness
Depression
Changes in personality
Sleep
Trouble falling asleep
Excessive sleepiness
Disturbed sleep patterns
Early Concussion Management (First 72 Hours)
Early concussion management is crucial to promote recovery and reduce the risk of complications. If you suspect that yourself or someone has sustained a concussion, follow these steps for early concussion management:
Stop Play or Activity: If the concussion occurred during sports or physical activities, stop play immediately. When the brain is in an energy crisis, as seen early after a concussion, it is more “vulnerable” to subsequent trauma. This means that relatively minor second blows to the head may produce more severe or irreversible changes in brain function.
Seek Medical Attention: It's important to see a healthcare professional as soon as possible. While concussions may not always require emergency care, a prompt evaluation is essential to rule out more severe injuries, provide guidance on management, and assess the severity of the concussion.
Monitor for Red Flags: These include seizures, loss of vision or double vision, loss of consciousness, increased confusion or becoming less responsive/drowsy, weakness or numbness in more than one arm or leg, repeated vomiting, severe headache, or increasingly restlessness, agitation or combative behaviour. If any of these red flags manifest, go to your nearest emergency department.
Avoid Medications Without Guidance: Avoid taking over-the-counter medications without consulting a healthcare professional as they may mask symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be avoided initially, as they may increase the risk of bleeding.
Relative Rest: In the past, you may have been told to rest for weeks in a dark room after a concussion. New research indicates relative (not strict) rest is more beneficial. This means you can do activities of daily living including walking and other light physical and cognitive tasks as tolerated in the first 24-48 hours. Be sure these activities do not result in more than a mild and brief exacerbation of your symptoms.
Limit Screen Time: For the first 48 hours, you may also find it helpful to reduce screen time or to take frequent breaks when using screens. For most individuals, auditory stimulus is tolerated well, so listening to music or podcasts are fine during this time.
Sleep: Sleep is important, so do not feel the need to wake up during the night if you are sleeping comfortably.
An excellent resource is the Concussion Awareness Training Tool
Concussion Treatment
The treatment of your concussion involves managing symptoms, allowing the brain to heal, and preventing further injury. It's important to note that there is no specific medication to cure a concussion; rather, treatment focuses on supportive care and gradual return to normal activities.
Physiotherapy can play a valuable role in the management and rehabilitation of individuals who have experienced a concussion. The goals of physiotherapy for a concussion typically includes reducing symptoms, improving function, and facilitating a safe return to normal activities. It's important to note that the specific approach may vary based on the individual's symptoms and needs.
Assessment and Evaluation
We will conduct a thorough assessment to understand your symptoms, limitations, and overall functional status. This may involve evaluating balance, coordination, posture, and any musculoskeletal issues.
Symptom Management
We can address specific symptoms associated with a concussion, such as headaches, neck pain, and dizziness. Manual therapy techniques, acupuncture and pain relief modalities may be used to alleviate tension, discomfort and pain.
Balance and Vestibular Rehabilitation
Concussions can disrupt the vestibular system, which plays a role in balance and spatial orientation. Your therapy may incorporate exercises and activities to improve your balance and vestibular function.
Vision Rehabilitation
A concussion can affect various aspects of vision, including eye tracking, convergence, and sensitivity to light. Your recovery many include vision rehabilitation which aims to improve your visual skills and comfort.
Exercise Prescription
Gradual and carefully prescribed exercises can be part of your rehabilitation process. Exercises may focus on improving your strength, flexibility, and endurance. The intensity and complexity of exercises are typically adjusted based on your individual tolerance and symptoms.
Cervical Spine Rehabilitation
Neck injuries are common in concussions, so your therapy may include exercises and manual therapy techniques to address cervical spine issues. This can help reduce symptoms such as neck pain and headaches.
Education
We will provide education about concussion, its effects, and strategies to help with your symptom management. This may include guidance on pacing activities, managing triggers, and promoting a healthy recovery.
Gradual Return to Activity
We will work with you to create a structured and gradual return to normal activities, including work, school, and exercise. This process is tailored to your specific symptoms and progress. Cooperation with your work or school will also be done to ensure a safe and successful return to all activities.
Collaboration with Other Healthcare Professionals
We may work in collaboration with other healthcare professionals, such as neurologists, sports medicine specialists, or occupational therapists, to ensure a comprehensive and coordinated approach to your care.
Social and Support Groups
Support through your concussion recovery is highly beneficial and we have a few groups who we recommend:
Pink Concussion - online support groups for young women with concussions
Ontario Brain Injury Association - online support groups run by Social Workers
Concussion Recovery Timeline
Each concussion is unique, and individual recovery times can vary. Some people may recover fully within days, while others may take weeks or longer. The majority of individuals recovery within one month.
Post-Concussion Syndrome (PCS) refers to a collection of symptoms that persist for an extended period after an individual has experienced a concussion or mild traumatic brain injury (mTBI). PCS is complex, and the symptoms can vary widely among individuals. Factors that may influence the development and persistence of PCS include the severity of the initial concussion, pre-existing medical conditions, psychological factors, and individual differences in how the brain responds to injury. Although recovery may look different at this stage, physiotherapy continues to be valuable at improving symptoms and aiding in returning to normal activities.
Concussion Treatment Near Me
Concussion treatment is most effective with a team approach including vestibular physiotherapists, neurologists, neuro-ophthalmologists and family physicians.
Healing Vertigo has advanced vestibular physiotherapists with experience in treating concussions. We provide care in-person at our clinic in Hamilton as well as virtually to individuals across Ontario. We will work with you and your local community of healthcare providers to ensure full collaborative care is provided. Contact us today to learn more or book an appointment.
Disclaimer: This advice is not meant to be a substitute for advice from a medical professional regarding diagnosis, prognosis, or treatment. Always seek advice from your physician, physiotherapist, or other qualified healthcare provider with questions you may have regarding a healthcare condition. The information of this website and email, including but not limiting to text, graphics, videos, images, and other materials are for informational purposes only. Reliance on the information on this website and email is soley at your own risk.