Concussions: How do we manage them?
image: @javihoffens
My first blog provided you a brief insight into concussions and how they have affected me in the past. It also shed some light on how they were previously managed.
To follow that up, I have decided to write a second piece relating to concussions and how they are best managed now a days, and what that means for us/ you as patients and us as therapists.According to the Berlin Consesus on Concussion management (a round table of experts that meets every 4 years to discuss new research and findings on Concussions)- a GCS (Glasgow Coma Scale- a scoring system used to define the level of consciousness following brain injury) a score of 15, no post traumatic amnesia (memory loss), and no loss of consciousness, is still categorized as a concussion.
Fun fact- More than 90% of concussions DO NOT result in a loss of consciousness. In my coursework, i read about studies that used Head Impact Telemetry (H.I.T.) which measures linear acceleration of the head (the rate of change of velocity in a linear direction- along a straight line- with respect to time.) One study in particular found that concussions in high school and college football players (and Aussie rules football) typically occur between 70 and 120 G’s of linear acceleration. To put this in perspective, Formula1 drivers can experience up to 4.5G’s on their body on average throughout a race. That is a huge amount of force in a relatively short period of time.
It was once thought that when someone hits their head on the ground/ ice/ or another player, the force creates trauma at the location of impact, but also on the opposite end of the brain by a contra-coup force as the brain bounces back in the other direction. This theory has been recently updated and new research suggests that trauma to the brain now occurs as fibers and cells between the grey and white matter in the brain are forced in different directions due to their different compositions, resulting in a stretching and shearing of these tissues leading to damage.
So with all the information on Concussions we have now, what does this all mean for us? for you? for me? Well, for starters, we all need to do a better job of protecting ourselves and protecting our heads from these types injuries. But this does not mean just buying a more expensive piece of headgear thinking that this will solve all and stop any future trauma. So how do we do this?
Education. Educating athletes, teachers, coaches, trainers, doctors, parents, siblings, etc. on what concussions are, how they happen and what some of the best ways to manage them are.
Removing certain types of contact (body-checking) out of sports at certain ages is another way of mitigating the risk of incurring concussions, especially during adolescence.
Teaching athletes in physical sports proper technique for tackling and managing aggression to help reduce the risk.
Strength and Stiffness of the neck
Education, in particular is also a huge determining factor in minimizing the risk of prolonged recovery. This is just as important as identifying and spotting concussions when they happen. It is proven that managing them sooner helps to reduce this risk of prolonged symptoms.
So, how do we treat concussions?The proper treatment method in the INITIAL/ ACUTE stages includes but is not limited to:
24 hours of relative rest, including a good sleep- YES, you no longer should be waking them up every 2-3 hours. You should of course still check on them, but we advise you to let them sleep if they look like they are not having any issues.
NO medication as this may cover up or mask any serious underlying symptoms that may need more urgent attention.
Gentle range of movement exercises for the neck
Gradually re-introducing daily activities such as returning to half day of school with restrictions, then to full days and eventually back to sports following rigorous testing protocols. These progressions, occur over 24-hour periods, ensuring that the person who sustained the concussion remains symptom free. If symptoms return, then we dial back the work and allow the body more time to recover.
Now that I have shared all this information, you are probably asking, what does this have to do with Physio? Well, I am trained to do thorough assessments to ensure there are no severe issues lingering from the concussion that may need more serious medical attention. Once this is determined, we put you through more testing to ensure all is okay with the rest of the body and mind. We then work to progress your abilities by putting you through graded exercise protocols to return you back to your normal self.
Another fun fact that most people do not know: There is a rather large percentage of people that have had concussions and may go on to experience Post Concussion related symptoms. These are symptoms experienced for > 4 weeks after injury. These symptoms can be caused by a number of factors including but not limited to the cervical spine, psychological issues, and metabolic issues. More often than not, many of these persistent symptoms come from the neck and its related structures, and treating this area through Physiotherapy and exercise is one of the best ways to help alleviate those nagging issues and get back to doing what you love sooner.
Just remember, this does not just apply to people playing rugby and football. This applies to kids, teenagers, adults and even elderly. It applies to anyone participating in any sport or anyone involved in a motor vehicle accident. It even applies to those who may just slip and fall and hit their head on the ground. So if you think or if you know you have sustained a concussion, don’t leave it unassessed and untreated. Get it looked at as soon as possible to avoid any longer term risks.
As always, if you have any questions or concerns, please feel free to email me at arasruslys@gmail.com and I would be happy to answer any questions.
Live active and prosper,
Aras Ruslys
Registered Physiotherapist
