The Concussion Conundrum: The Missing Piece To Recovery
Yes, we all know that concussions are bad. We usually think of athletes having to sit out for a few games of the season…but do you actually understand the severity of a concussion and how much it impacts?
Are we really doing enough to manage concussions?
Let’s talk about it.
Concussion talk can get very complex. My main objective of this blog is for you to understand the basics of what a concussion is, how it can happen, its seriousness and importance, and make you aware that there are better options to help manage symptoms and recovery like vestibular rehabilitation than just to wait it out, rest, and hope symptoms will eventually go away like we used to be taught.
Yes, there is still a lot to be learned about concussions, but a lot of what we DO know is not adequately discussed or acted upon like it should be, in my opinion.
What is a concussion?
A concussion is a traumatic brain injury that occurs from blunt force trauma, a fall, or any jolt to the brain. Although there is typically tearing of blood vessels, pulling of nerve fibers, bruising of the brain, and damage to brain cells, there is usually no signs of altered structure visible on CT scans or imaging. Therefore, a concussion is an alteration in brain function, more than an alteration in structure, making it more difficult to diagnose and appropriately treat.
What causes a concussion?
A concussion is most often acknowledged when there has been a blow to the head. Whether that means you accidentally fall and hit your head or a coconut falls on your head, either could most certainly cause a concussion.
However, you CAN get a concussion WITHOUT hitting your head!
And this is one of the big ones none of us think about.
Any quick acceleration – deceleration or rotational force can also cause damage to the brain and therefore a concussion. So think about whiplash during a car accident or even head-banging at a concert. The front of your brain is quickly accelerating and may slam into your skull (hard bone), and then will quickly decelerate causing the brain to slam into the back of your skull (again hard bone). Just as if you slammed any other body part into hard bone, this will cause swelling, inflammation, and bruising. Your brain is no exception.
What are symptoms of a concussion?
So, now your brain is bruised and swollen, triggering neurons or nerve cells to also dysfunction.
This involves a complex cascade of ionic, metabolic, and physiologic changes, sometimes called the neurometabolic cascade of concussion.
Each person’s concussion will result in varying symptoms depending on severity, type, and which part of the brain was affected. The following is a list of potential signs and symptoms of a concussion, including, but not limited to:
Headache or “pressure” in head
Nausea
Vomiting
Double or blurry vision
Dizziness
Sensitivity to light and noise
Balance problems/Instability
Feeling sluggish, foggy, or hazy
Confusion
Memory deficits
Difficulty concentrating
Inability to control emotions
More irritability and nervousness
Potential personality changes
Sleep disturbances
Increased fatigue/decreased tolerance to physical activity
Feeling “off” or “not right”
How long do concussion symptoms typically last?
Because concussions can range from mild to severe, recovery times will also differ. However, even mild concussions do require a recovery period. On average, it takes approximately 7-10 days to recover from a concussion.
Factors that influence symptom duration are age, which part of the brain was affected, the amount of impact, and if this was your first or one of many concussions.
Those who have a history of multiple concussions or history of car accidents are definitely at a heightened risk of symptoms lasting longer than 10 days. Post-concussive syndrome, or PCS, is a syndrome that occurs when symptoms persist past 90 days. If PCS occurs, not only will physiology be impacted but cognitive and behavioral changes will also occur, including but not limited to, more susceptibility for depression and anxiety, memory deficits, and sleep disturbances.
So, yes, mild concussions can resolve on their own sometimes. But, so many people fall in that middle ground of having symptoms past 10 days and just trying to fight it out in hopes that it will go away sooner than later. But, once you surpass 3 months of feeling “off”, you fall into that “PCS” category and will typically suffer with residual symptoms for way longer than necessary.
So, how can we help the brain recover faster without reaching that 90 day mark? This is where I believe the gap in concussion management to exist the most. And that is where vestibular rehabilitation should come in.
Concussions and The Vestibular System
As listed above, “pressure” in the head, headaches, vision changes, dizziness, balance problems….all of these are also symptoms of a compromised vestibular system that we as vestibular physical therapists see often.
One of the most common consequences of concussions is the disruption of the vestibular system.
The forceful impact or sudden movement that causes a concussion can result in damage to the vestibular nerve and the delicate structures within the inner ear, leading to vestibular dysfunction. Because the vestibular system is responsible for maintaining balance, spatial orientation, and coordination, its clear to see how a compromised vestibular system is in need of addressing when it comes to overcoming the impacts of concussion.
Treatment for Concussion
Knowing that a concussion causes such a negative impact on the vestibular system, a vestibular physical therapist plays a crucial role in the multidisciplinary approach to concussion management. A thorough examination is conducted that assesses eye movements, ocular alignment, motion sensitivity, memory recall, neurological screens, balance, coordination, and more specialized tests to pinpoint specific areas of dysfunction within the vestibular system.
Once an evaluation has been complete, an individualized treatment plan is tailored to the patient’s unique needs and symptoms. In the beginning, it is imperative to start working on the “re-wiring” and efficiency of the communication between the brain and the eyes and inner ear without bringing on too many symptoms.
Rehabilitation may include exercises to improve gaze stabilization, balance, and habituation techniques to help adapt to various movements. Working on the convergence of your eyes to fix ocular alignment and how the brain perceives its surroundings is also something that can be practiced and improved upon with vestibular rehabilitation.
Once vision impairments have been improved and the brain is able to tolerate more stimulation without triggering symptoms, gradual progression to increased activity, whether that be school, work, or sport, is initiated. This appropriate supervision and guidance is crucial for preventing symptom exacerbation and ensuring safe and successful recovery.
Conclusion
Concussions aren’t just a bump on the head. They are brain injuries with profound effects on the vestibular system, and can cause more detrimental long-lasting effects if symptoms persist past 90 days (as in PCS). Rest is not the only answer.
Vestibular physical therapists, with their expertise in addressing vestibular dysfunction, can play a pivotal role in guiding individuals towards a full and faster recovery. As awareness continues to grow about the importance of concussion management, it is essential to recognize the integral role that vestibular rehabilitation plays in helping individuals avoid secondary complications and regain quality of life post-concussion.
