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Concussion... now what?

If you’re like me and your butt is firmly glued to the couch on Sunday watching football, you may have caught a pretty scary event in the New York Giants and Dallas Cowboys game last week. The quarterback for the New York Giants, Daniel Jones, suffered an impact to his head. Immediately following the injury, you could see clips of him drooling and clearly stumbling while attempting to walk off the field.

You likely immediately thought, he just suffered a concussion. Concussions are not always this obvious and therefore it’s important that you understand what a concussion is, how they are diagnosed, and how they are treated.

What is a concussion?

A concussion by definition is a mild traumatic brain injury. I do not say this for dramatic effect, but I feel that it is important to understand that a concussion is a type of brain injury. So, we want to take it seriously. A concussion is often caused by trauma, but not always. A concussion can occur due to rapid changes in acceleration where the brain essentially hits the skull as a result. Hence the saying, “he got his bell rung.”

How do you know if you suffered a concussion?

If you suffer a head injury or a whiplash like injury during play, driving, or at any other time, you should be assessed by a licensed professional (athletic trainer, physical therapist, or physician). Some signs of a concussion are:

  • Loss of consciousness

  • Holding of head after impact

  • Headache

  • Dizziness

  • Nausea

  • Visual disturbance or difficulty focusing

  • Tinnitus (ringing in the ear)

  • Seizure or “fencing” positioning

  • Slow return to standing

  • Uncoordinated movements, stumbling, tripping, slow moving

  • Blank/vacant look

  • Disoriented (where you are, what happened, etc)

  • Amnesia

If you have any of those signs, you should halt what you are doing and seek medical care. A severe worsening headache, vomiting, worsening incoordination, loss of control of arms/legs, dropping of face, slurred speech are all signs that you should seek emergency medical attention.

If you do not have those emergent signs that indicate a need for emergency medical attention, a trained medical professional will further assess your neck, reflexes, eye movements, coordination, speech, etc.

A common misconception is that a CT scan or MRI diagnoses a concussion. Many people are incorrectly told that because their CT and/or MRI are clear, they do not have a concussion. This is an extremely important misconception to eliminate because of the effect it can have on an individual’s recovery. Most people receive an MRI or a CT scan when a brain injury is suspected. These types of imaging are useful for detecting change in blood flow to parts of the brain, like a hemorrhage or blocking of blood vessels. These traditional imaging techniques look at the structure of the brain. A concussion generally causes a change in the FUNCTION of the brain rather than the STRUCTURE. (Caveat: Although structure is technically affected in concussion, those structural changes are generally not visible on traditional imaging studies).

If I have a concussion, now what do I do?

It is no longer the recommendation following a concussion to remove all stimuli like i-phones, TV, and music and stay in a dark room for a week or until all the symptoms resolve.

Current research recommends:

  1. 24-48 hours of cognitive and physical rest, meaning let your brain and body take a break.

  2. Following that period of rest, it is appropriate to reintroduce stimuli (lights, i-phone, physical activity, schoolwork) as long as symptoms are held at a 5/10 or below, with 10 being the highest level of symptoms and 0 being no symptoms.

  3. If you have a headache as a symptom, it is recommended to allow minimal or at least no increase in headache symptoms with the reintroduction of stimuli.

  4. While an individual re-introduces stimuli, it is suggested they pace themselves and take breaks to avoid the cumulative effects of stimuli.

Removing all stimuli for too long can prolong recovery due to sensitization following this period of total rest. Additionally, prolonged removal from school/work and social activities can create a sense of isolation and negatively affect the speed of recovery.

How long does it take to recover from a concussion?

Most sport-related concussions resolve within 2 weeks in adults and 23 days in children. However, symptoms may become “protracted” or prolonged. Unfortunately, protracted recovery from concussion is partially due to misinformation and mismanagement in the early stages following a concussion.

When symptoms are protracted or you are uncertain how to manage following a concussion, or if you are unsure if you suffered a concussion, it is wise to seek treatment from a healthcare provider that is experienced in concussion management. Physical Therapists trained in Vestibular Rehabilitation Therapy (VRT) have the skills to diagnose and treat post-concussive headaches, dizziness and imbalance.

Dr. P.J. Pruszynski at Precision Performance and Physical Therapy has advanced training in Vestibular Rehabilitation Therapy and specialized technology to assist with diagnosis and treatment of Concussions.


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