Concussion is a topic that is getting a lot of media attention lately for a variety of reasons. The positive side of this is that more people are recognising concussion when it happens, and being managed more appropriately. There is a slight downside though, which is that sometimes people are expecting worse outcomes because they have heard so much about ‘post-concussion syndrome’ and chronic traumatic encephalopathy (CTE).
For the sake of keeping this article short, let’s just talk about what is actually normal, because concussions certainly do happen frequently.
By definition, a concussion is a force or stress applied to the brain – usually by the head stopping or changing direction suddenly. This doesn’t have to be from a direct blow to the head.
It has a temporary effect on the way the brain works and leaves no trace on frequently used scans that check for brain injury (CT and MRI). The changes in brain function may cause a variety of symptoms – headache, nausea, dizziness, disorientation, balance problems, mood changes, fatigue or sleeplessness. There are over 20 symptoms on the most current checklist (the SCAT5).
If you are diagnosed with a concussion, best practice 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’s now known to be only true in part. We know 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. CTE is not yet well understood, as findings are currently limited to a narrow selection of high level athletes not representative of the general sporting population.
The AIS and AMA (Australian Medical Association) has a very good return to sport guideline for concussed patients. You can find it at https://concussioninsport.gov.au. It involves an initial period of rest after a diagnosis is made, then a gradual, step wise increase in activities with monitoring between stages.
Physiotherapists have a large part to play in this monitoring process and can prescribe exercise and balance activities to help with recovery. Cognitive screening is important as both physical AND mental exertion can provoke symptoms. Ultimately your doctor should rule on readiness to return to sport.
Definitions vary, but you do not have post-concussion syndrome unless your symptoms are persisting well beyond two weeks as an adult, or a month as an adolescent. It can come as a shock sometimes that a ‘normal’ concussion can last that long, but there it is. There are a variety of risk factors for having persisting symptoms, but probably 70% or more of concussed patients recover within the above time frame if they follow a graduated return to sport program.
It is true that a significant minority of people do develop post concussion syndrome and have lingering symptoms. A team approach of medical, neuropsychology and physiotherapy management may be necessary to rehabilitate those athletes.
About the Author:
Ross completed a Bachelor of Exercise Science at UTAS, followed by a Masters of Physiotherapy at the University of South Australia. He has spent the majority of the last six years in musculoskeletal private practice, with a short stint as a senior musculoskeletal physiotherapist at the Launceston General Hospital.
Ross has now returned to private practice with a wealth of experience. He has a particular interest in blending strength and condition concepts, and modern pain science, to help people take control of persistent problems. Ross has also upskilled as a vesitbular physiotherapist, being able to treat vertigo and dizziness, post-concussion syndromes, whiplash associated disorders and headaches.
Outside of work Ross is a keen volleyball player at the Launceston Volleyball Club, and ‘has his hands full’ with three young children.