Post Concussion



What is a Concussion?

Concussions are a complex pathophysiological process affecting the brain induced by biomechanical forces. More simply, a concussion is a mild traumatic brain injury resulting from movement of the brain. Concussions are often associated with traumatic injuries to the head in sports, but can also occur where no direct contact to the head is made. These can include car accidents, whiplash and slip and fall injuries. The common element in all concussions is movement of the brain within the skull.

Studies have shown that the movement of the brain during a concussion results in stretching of axons. This stretching causes a thinning of the axons and therefore an increase in the leakiness of these cell membranes. The body attempts to deal with this leakiness by using active pumps to maintain balance. The energy required for these pumps need to be delivered to the brain.

So what’s the problem? In addition to stretching of the axons, concussive events result in a decrease in cerebral blood flow. This reduced blood flow can last 7 to 14 days in adults or up to 30 days in adolescents.

What are the Symptoms of a concussion?

The symptoms of a concussion can vary from individual to individual. Some common symptoms associated with a concussion can include:
Light or sound sensitivity
Balance problems
Sleep disturbances
Difficulty concentrating
Memory problems
Feelings of anxiousness or depression
Symptoms similar to these can be experienced after a neck injury, especially if there was no trauma to the head.

In the acute phase, the goal is energy conservation. Rest is often prescribed and sleep hygiene plays an important role. Tasks that involve information processing and concentration are not recommended in acute phase of recovery after concussion, especially if they are triggering symptoms. Our visual system is intertwined with so many additional systems, resting your visual system allows your body to positively deal with the energy crisis. Therefore, rest from sports should also include a rest from watching sports and other complex visual activities.

This doesn’t mean that bed rest is the treatment strategy of choice. Activity should be as tolerated and should not attempt to challenge visual, concentration or balance tasks. Due to the nature of the injury, the primary activity that is often prescribed is light walking below the threshold of symptom onset.

What is Post Concussion Syndrome?

75-80% of concussions will resolve within an expected time period once the energy crisis has resolved. A very small percentage of cases will persist beyond the normal healing time frame and can enter into what is known as post concussion syndrome (PCS). The actual cause of PCS is not well understood. Initial symptoms’ intensity, a history of headaches or migraines and a history of depression or anxiety can add to an increased risk of prolonged resolution of post-concussion symptoms.

Concussion Rehabilitation

If your symptoms are persisting or you are unable to identify the triggers for your symptoms, a concussion assessment by a physiotherapist experienced in assessing and treating concussions should be considered. At Family Physiotherapy, a comprehensive assessment will include a detailed examination of the nature of your injury and any predisposing factors that may be prolonging your symptoms. A thorough assessment will also include concussion specific analysis of the the visual and processing systems to ensure that appropriate rest, recovery and rehabilitation strategies can be adopted. Concussion rehab involves a team approach and your doctor, physiotherapist and massage therapist may all play a role. If visual symptoms continue to persist, your physiotherapist may refer you to a vision therapy centre.

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