What is a Concussion?
A concussion is a mild brain injury caused by trauma to the head due to impact or shaking. It may occur with or without loss of consciousness and can lead to temporary cognitive symptoms including headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness and excessive fatigue. If not treated early, you may develop a chronic condition resulting in the need for post concussion syndrome treatment.
What should you do if you suffered a Concussion?
If you have had a concussion, you need to rest, both physically and mentally. Children should stay home from school and not use a computer or play video games.
Usually, people can return to school or work after resting for 24 to 48 hours, as long as it doesn’t make their symptoms worse. It’s best to increase the load on the brain gradually.
People can return to light physical activity after resting for 24 to 48 hours, as long as this doesn’t worsen symptoms. It will take some time to return to full sporting activity
Enhanced Living NeuroRehab has strong experience assisting clients in returning to pre-concussion activities such as work or sport and today we review some of the most effective treatment options for concussion.
How do I know if I have Post Concussion Syndrome?
When symptoms persist for longer than a few days, A Neurologist will utilize a symptom checklist to diagnose Post Concussion Syndrome.
The primary symptom is headache and pain, but may also include vestibular issues, memory and cognition issues.
To overcome Post Concussion Syndrome, a multidisciplinary support team is recommended to encourage recovery with the top treatment options listed below.
Post Concussion Syndrome treatment options:
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Education and Reassurance (due to Psychological Co-morbidities)
It has been well established that patients with a pre-existing history of depression and/or anxiety tend to have prolonged symptoms. Not only that, the symptoms of these and other mental health conditions can result in, or mimic, the same symptoms as concussion (ie. dizziness, mental confusion, concentration problems, sadness, emotional outbursts).
Many of these issues can begin before or after the concussion.
At Enhanced Living, we focus on providing education and reassurance to all of our clients because understanding your journey and prognosis is one of the best ways to reduce concussion symptoms.
In addition to education, Cognitive Behavioural Therapy (CBT), a type of psychotherapeutic intervention which focuses on challenging and changing cognitive distortions and behaviours, can greatly improve a person’s emotional regulation and coping strategies.
And finally, many people who have sustained a concussion may have trouble focusing their attention. To mitigate this, patients can follow a mindfulness Based Stress Reduction practice, which helps them improve their attention deficits.
Before moving on, it’s important to talk briefly about cognitive rehab. One of the main symptoms of concussion is memory problems. This is a tricky area because memory is subjective. For instance, many people who have not sustained a concussion, and who have not been diagnosed with Alzheimer’s or dementia, have memory lapses from time to time. They may forget someone’s name, their pin number, or why they entered a room. It is very common for people of all ages to have these lapses in memory.
The problem is, that when a concussion patient has a memory lapse, they may very well blame their concussion. In other words, it is easy to attribute everyday occurrences to a concussion injury. A recent study, looking at self-reported cognitive changes following concussion found the majority of people who reported they had cognitive impairments tested normal for cognitive performance. The only thing that had changed was their emotional status or they had more symptoms.
So if you have more symptoms, or you have more emotional symptoms, you may start to have more cognitive problems. The body is a slave to the mind, and this is why we always start our treatment with education and CBT. Because when you feel better, your cognitive abilities also improve.
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Exercise Therapy
In the early stages after a concussion, studies have demonstrated a reduction in blood flow to the brain, with recent research has found that these blood flow changes may persist for some time following injury due to ongoing dysfunction in the Autonomic Nervous System (ANS). The ANS consists of two sides that tend to work in opposition to one another. The Sympathetic Nervous System (the “Fight, Flight, or Freeze” system) – this side of the ANS is responsible for increasing our heart rate, dilating blood vessels to pump blood to our muscles, releasing adrenaline, dilating our pupils, and getting us ready for action. Our Parasympathetic Nervous System on the other hand is our “Rest & Digest” system – this side of the ANS is responsible for lowering heart rate, increasing digestion, activating metabolism, and helping us to be relaxed and calm.
These two systems work in equal balance with each other.
When one is up, the other is down. They fluctuate their dominance throughout our days but overall the system should maintain harmony and balance, however, concussion creates an imbalance in the ANS with most suffering from a high “Sympathetic Tone” – which means that we are stuck in a fight or flight state. Our heart rate tends to be elevated and doesn’t respond well to increased demands, blood flow to our brain is not as responsive, our digestion shuts down sometimes leading to stomach pains, food sensitivities, and increased inflammation, our anxiety levels increase, and we may get lightheaded more easily, and we suffer symptoms with increased cognitive and physical activity.
The good news is this problem can be tested for and rehabilitated very easily. And, there are two main ways to approach ANS dysregulation.
The first way is to raise the parasympathetic nervous system (PNS) by stimulating the vagus nerve. At home, Deliberate breathing exercises, along with meditation, are some of the things that stimulate the vagus nerve, raising our PNS dominance and impacting heart rate.
The second way to improve the sympathetic nervous system (SNS) is through exercise.
This may sound risky. However, research shows that graded aerobic exercise programs improve blood flow to the brain and assist in symptom management, with a recent study focusing on early intervention (within 10 days of injury), showing that the exercise group was 50% less likely to have persistent symptoms than those in the placebo (stretching) group, 4 weeks after injury.
It is important to see someone who knows exactly what they are doing with this protocol. Testing with a trained professional must be done first to establish set points as well as your specific and individualized program. There is also more to balancing the Autonomic Nervous System that must be taken into consideration as well as vestibular and musculoskeletal issues arising from both the brain and muscle-based symptoms of mild brain trauma.
Overall, the balance of research shows that there is great evidence to support early controlled aerobic exercise after concussion with little to no harm. Enhanced Living’s team are training in providing aerobic assessments for providing expert opinion for appropriate concussion management levels.
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Manual Therapy & Neck Rehab
With every concussion, there is also a whiplash.
Studies have demonstrated that the acceleration required to cause a concussion is somewhere between 70 and 120 G’s (where G = force of gravity = 9.8m/s2) whereas Whiplash, on the other hand, has been shown to occur at only 4.5 G’s.
It is therefore conceivably impossible for a concussion to occur without also causing a sprain or strain injury to your neck! In fact, a Canadian study found that 100% of the time, these injuries are happening together.
What becomes even more confusing is that the signs and symptoms of whiplash and neck dysfunction are the exact same as concussion! Headaches, cognitive and emotional problems, balance problems and dizziness, eye movement control problems and brain blood flow abnormalities have all been shown to occur in whiplash and neck pain patients.
A concussion is an injury that typically resolves within 2 weeks in most people and post concussion syndrome typically resolves within 3 months, however, whiplash symptoms can linger for up to one to two years.
Treatment for whiplash includes manual neck therapy. At Enhanced Living, we utilise a number of hands-on therapies including soft tissue massage, dry needling, laser therapy and TENs on top of exercise prescriptions.
We often find in our clinics that by treating the necks of patients that come in with persistent concussion symptoms, they improve quicker.
The bottom line is if you are still having concussion symptoms, even if you don’t have neck pain, you may actually be suffering from symptoms that are coming from your neck which are easily treated with manual therapy and rehabilitative exercises.
4. Vestibular and Visual Rehab
Dizziness is one of the most common ongoing complaints of patients with persistent symptoms. This may be due to several overlapping issues such as problems with the balance centres of your brain (vestibular system), your visual system, and/or problems with the muscle and joint sensors of your neck, which we just touched on.
When the vestibular system becomes dysfunctional, eye movement and vision will most likely become distorted. Similarly, as we just explored, when the neck is dysfunctional, eye movement may also become disordered.
Our physiotherapists look to and have published on the benefits of utilising neck treatments, vision therapy, and vestibular therapy simultaneously.
Because these three systems work together, it is less effective to tackle one therapy at a time. Following a thorough assessment of these areas, a proper rehabilitation program can be set up. The research on rehabilitation for these areas is extensive with numerous studies showing resolution of dizziness and visual abnormalities with a fairly short course of treatment.
A 2014 randomized control trial, looked at the efficacy of combining cervical with vestibular rehabilitation in patients that were still symptomatic 10 days after injury. After 8 weeks, 73% of the people from the group receiving cervical and vestibular rehab, had been fully cleared and were able to return to play, versus only 7% of those from the group receiving standard care (which at the time was rest).
Dizziness is a common symptom after a concussion. But in our experience and based on numerous research papers, vestibular therapy is only helpful 50% of the time in resolving dizziness. This is because of the closely linked visual problems and neck issues that may not have been addressed.
In conclusion, it’s not that vision therapy, vestibular therapy and neck therapy aren’t effective. It’s usually that they have not been addressed simultaneously. Yet another reason to work with concussion specialists who recognize that these three areas need to be treated at the same time.
At Enhanced Living, we have solid experience assessing concussions and customising a proper treatment to overcome Post Concussion Syndrome. If you experience a concussion, we encourage you to seek help straight away.