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Concussion is a traumatic brain injury which is induced by biomechanical forces. It results from a knock to the head, face or neck, but it can also occur from a knock elsewhere that transfers force to the head and neck. It involves short-lived impairment of neurological function, and evolves rapidly with symptoms changing over the first few hours/days.
The sudden force applied to the brain during a concussion triggers a cascade of events on a physiological level. There is a disruption of the normal cellular processes within the brain, with significant changes in potassium, calcium and sodium levels, coupled with impaired blood flow. This leads to an alteration in the release of many neurotransmitters, with widespread haphazard firing of excitatory neurons, and this uses up a lot of extra energy, causing an energy crisis in the brain. It can take up to 30 days for these changes to return to normal levels, which raises many questions regarding appropriate time frames for a return to sport and normal activity.
There is no definitive test for concussion, it is diagnosed based on clinical signs and symptoms. There are several standardised assessments that can assist in diagnosis during the initial phases of concussion, such as the SCAT6, SAC and ImPACT test. These tests on their own may not be overly useful if we don’t know what is normal for that person. If you play a sport where there is risk of concussion, it can be very helpful to see your Physiotherapist or GP to conduct a baseline test before the start of the season.
Many of the common symptoms are widely known, such as headache, dizziness, double vision, confusion, nausea/vomiting and balance issues, however there are a lot of symptoms of concussion that are less obvious. These include:
Concussions recovery looks different for everyone, however there are several main phases that should be considered in the road leading back to a return to sport. Click on each phase below to view details:
In the first 24 hours, an initial rest period from all physical and mental activity (including phone/computer usage, study and work) is advised. A gradual return to normal activities and work/study can then take place, at a pace that does not worsen any residual symptoms.
Once normal activities have resumed, a graduated return to exercise/sport can be commenced, which is a process that has 6 stages. A minimum of 24 hours should be given between stages to ensure symptoms do not reappear, which means the minimum time for a safe return to sport is 7 days.
The first stage involves an initial cardiovascular challenge such as walking or an exercise bike session, and later stages involve more complex running and non-contact training drills. If the concussion symptoms reappear or worsen during any stage, it indicates the concussion is still present, as the brain can’t cope with the higher oxygen and blood flow requirements. In that case, the person should continue to rest for another 24-48 hours, and try the activity again.This process should be led by a health practitioner such as your physiotherapist.
Phase 5 involves returning to contact drills and “full” training, where there is potential for head contact. It is important to note that medical clearance is required for this phase– which can be provided by your GP or Sports Physician. Once this clearance has been provided, and full training is tolerated well a return to sport can occur (it is not required to get another clearance for game play).
What many people don’t realise is that the neck will usually also sustain a whiplash injury in conjunction with a concussion. It takes about 70G’s of force to cause a concussion, but only about 15G’s of force to cause a whiplash.
Whiplash can be responsible for many of the ongoing symptoms experienced during a concussion, particularly headache, neck pain, dizziness, difficulty concentrating, ringing in the ears, sensitivity to light/noise and visual disturbances. The vestibular system (located within the inner ear and helps to coordinate balance and information between your eyes, ears and brain) can also be impaired in concussion, and contribute to similar symptoms as the neck.
This is where involvement of your physiotherapist is so valuable, as not only can they guide your return to exercise and sport, but also assess and treat your neck and vestibular system to ensure recovery is as smooth and complete as possible.
80-90% of concussion episodes are resolved within 7-10 days, however we do know the brain can take up to 30 days for the chemicals and blood flow to return to normal levels. In this 30 day period, we need people to take extra care to ensure they do not sustain a second concussion, as symptoms can be much more severe if another episode occurs before the brain has returned to normal.
Unfortunately, some people continue to suffer well beyond this time period. Optimal post-concussion syndrome management involves the care of a multidisciplinary team such as GP, Sports Physician, Physiotherapist, Neurologist, Psychologist and sometimes even a Neuropsychiatrist.
It is important to understand that there are significant changes that happen within the brain during a concussion, and thus this injury should be treated with care and respect. A gradual return to activity and sport is needed, with medical clearance from a doctor provided before a return to contact training. There is an important role for physiotherapy in supervising the gradual return to exercise/sport program, as well as ensuring there are no contributing neck and vestibular issues that may hinder recovery.
If you are concerned about concussion, book in to see us today for a baseline test, or assistance with managing a safe and successful return to sport.
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