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What Is A Concussion and What Can Physiotherapy Do For You

Anatomy of the Brain

 

The brain is made up of soft fatty tissue that is well protected by layers called meninges [1]. The brain rests inside the skull for further protection. There is however a small amount of space for the brain to move around in the skull [1], much like Jell-O inside a bowl. Unlike Jell-O, the brain is not uniform and is made up of billions of neurons [1].

 

What is a Concussion?

 

A concussion is an injury to the brain. It can be caused by a direct blow to the head, neck, or indirect force elsewhere in the body resulting in rapid movement of the brain within the skull [1-3]. This rapid movement causes brain tissue to stretch, and causes chemical changes to the neurons [1,3]. Neurons are responsible for communication and send messages from the brain to the body. These messages are responsible for everything from moving a body part to controlling emotions [1].  With chemicals in the way, it creates a challenge for the brain to communicate and function the way it usually does [1].  Think of trying to have a conversation with someone in a quiet room versus at a loud concert. The brain has to work harder to do what it would like to do, and it takes time for the brain to recover to normal conditions from this injury [1,3,4].

 

What are the Signs and Symptoms of a Concussion?

 

The signs and symptoms of a concussion vary between individuals. However, one may experience any of the following physical symptoms: headache, nausea, vomiting, confusion, dizziness, balance deficits, visual deficits, fatigue, light or noise sensitivity [1-4]. One may also experience cognitive changes such as difficulty with concentration, memory, and fogginess of thought [1-4]. It is possible to also experience emotional changes such as irritability, sadness, and anxiety [4]. Sleep can also be affected by a concussion, either disturbed sleep or increasing amounts of sleep [4]. It is important to note that an individual does not need to lose consciousness to suffer a concussion [1,2]. Signs and symptoms of a concussion do not necessarily present right away [2]. It can take several hours to days following an incident to display signs and symptoms [1-4]. Most individuals recover in 10-14 days after obtaining a concussion [2]. Early management is critical to a speedy recovery. If you or someone you know is suspected to have suffered a concussion, it is important to seek immediate medical attention.

 

Post-Concussion Syndrome

 

Although many individuals recover quickly, it is possible for a prolonged recovery. Post-concussion syndrome (PCS) occurs when concussions symptoms persist beyond the normal course of recovery [1-3]. These symptoms can occur at rest or during increased physical or cognitive activity [2,3].

 

What can Physiotherapy do?

 

Physiotherapists use a variety of techniques to assist in your recovery for both acute and chronic concussions. This includes, but is not limited to:

Exercise therapy [1,2,5-9], such as aerobic and strengthening exercises

Vestibular therapy and oculomotor therapy [2,3,5-9], such as balance, head-eye movement, and visual tracking exercises

Cervical spine manual therapy [2,5-7,9], such as soft tissue release, neck mobilization, and acupuncture

Education [2-9], such as return to sport, return to work, and how to manage symptoms

 

Physiotherapists with specialized training in concussion management can perform Baseline Testing prior to a concussion, which can be used for comparison and help guide return to play after sustaining a concussion injury.

 

Laura Fedy, McMaster University PT Student

 

[1] Concussion legacy foundation. Team up against concussions [PowerPoint]. c2015 [cited 2018 Aug 18].

[2] McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2018;51:838-47.

[3] concussionfoundation.org [Internet]. Boston: Concussion Legacy Foundation; c2018 [cited 2018 Aug 18]. Available from: https://concussionfoundation.org/concussion-resources

[4] cattonline.com [Internet]. Vancouver: British Columbia Injury Research and Prevention Unit; c2018 [cited 2018 Aug 18]. Available from: https://cattonline.com/overview-what-is-a-concussion-medical-professionals/.

[5] Schneider KJ, Iverson GL, Emery CA, McCrory P, Herring SA, Meeuwisse WH. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47(5):304-7.

[6] fowlerkennedy.com. [Internet]. London: Fowler Kennedy; c2018 [cited 2018 Aug 18]. Available from: http://www.fowlerkennedy.com/wp-content/uploads/2017/02/Post-Concussion-Treatment-Guidelines.pdf.

[7] completeconcussions.com. [Internet]. Oakville: Complete Concussion Management Inc; c2018 [cited 2018 Aug 18]. Available from: https://completeconcussions.com/.

[8] Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell MR, Sparto PJ. Vestibular Rehabilitation for Dizziness and Balance Disorders After Concussion. Journal of Neurologic Physical Therapy. 2010; 4:87-93.

[9] Makdissi M, Schneider KJ, Feddermann-Demont N, Guskiewicz KM, Hinds S, Leddy JJ, et al. Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med. 2017;51(12):958-68.  

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