Concussion - A Heads Up !

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Concussion is getting a lot of attention for a variety of reasons. More people are recognising concussion when it happens, and being managed more appropriately. Management has changed quite a bit over the last 20 years or so. There was a widely held belief that rest was the only solution to ongoing symptoms – that the brain needed time to recover. It is understood that there is a period after a concussion where the brain is very hungry for blood flow and nutrients while it is trying to recover. This usually lasts 7-10 days. Often when concussed patients try to exert themselves physically or mentally when still inside this period, they get some increase in symptoms.

This is not post-concussion syndrome. It’s just the normal recovery process.

What is Post-Concussion Syndrome

Post-concussion syndrome (PCS) occurs when symptoms from a concussion (head trauma with a possible loss of consciousness) last well beyond 2 weeks as an adult and one month as an adolescent. It is found that 15% of concussion patients will experience post-concussion syndrome. It effects both males and females, young and old. Although research in 2017 revealed that girls’ soccer has the highest concussion rate of any high school sport.

Why does it happen

Post-concussion syndrome may occur because of shear forces from sudden acceleration and deceleration to the moving brain and neck, causing injury to cervical (neck) structures, vestibular (ear and balance) system and autonomic nervous system. The autonomic nervous system is impacted by micro damage to the brain, including the Vagus nerve. Therefore, this may affect sympathetic/parasympathetic control (responsible for increasing and reducing ones heart rate and blood pressure), therefore reducing or excessively increasing blood flow to the brain causing symptoms of PCS.

Symptoms of PCS you may experience:

• Headache
• Vertigo or dizziness
• Fatigue
• Difficulty sleeping
• Anxiety, depression or irritability
• Impaired memory or difficulty concentrating

How does Physiotherapy help you.

1.Undertaking an assessment of the vestibular- ocular system

This is vital part of your balance system

Treatment of the vestibular system is important to normalize and improve your vestibular and balance responses. If vision is affected after a concussion, ocular reflex training can be prescribed to improve visual motor control to reduce visual disturbances.

Vestibular rehabilitation includes:

• BPPV and positional strategies if required.
• Dynamic gaze stability exercises
• Postural control exercises
• Balance re training

2. Assessing and treating the cervical spine

The cervical spine can be treated through manual therapy using mobilisations of painful joints, soft tissue release of tight neck musculature and targeted strengthening exercises.

Looking for help?- DOWNLOAD our GUIDE on Managing Neck Pain

3. Checking for autonomic dysfunction

The autonomic side effects such as dizziness, high blood pressure, and excessive sweating can range from mild to severe.

A graded exertional exercise program can be used to assist with autonomic dysfunction through completing aerobic exercise (treadmill or exercise bike) at a specific heart rate, which does not exacerbate symptoms, gradually building up to one’s maximal heart rate.

4. Finally advice and education is so important for the management of PCS symptoms and the safe return to sport and the ability to resume normal activities.

It is therefore important that athletes and non athletes returning from a concussion progress through a graduated stepwise program. Our physiotherapists can help to guide athletes from the acute stage post-concussion back to a safe return to work, sport and life