Concussion: What really goes on in the brain.

Have you or someone you know suffered from a concussion and been confused by the diagnosis and lack of management? This article may open your eyes to the options now available to help effectively manage symptoms of concussions.
 
For many years, concussions have been known about, but it is only recently that we are learning about the effect’s concussions can have on the brain later in life.  We know that if left untreated, concussions can lead to Post Concussion Syndrome and in recent years, there have been many new studies on what impact a concussion has on the brain with alarming conclusions in relation to Chronic Traumatic Encephalitis (CTE). This has resulted in a rapid overhaul of the concussion management and rehabilitation.
 
All concussions are a form of brain injury: 
Concussions involve a complex pathophysiological process affecting the brain. The cause of a concussion is usually from a direct blow to the head, neck or face, but can also include other parts of the body that result in excessive force transmitted through the neck. This excessive force can lead to immediate or delayed impairments of neurological function that can resolve spontaneously over minutes to hours. However in approximately 20% of cases, concussions do not spontaneously heal which results in Post Concussion Syndrome. 

Concussions are most commonly seen in contact sports including AFL, NFL, and boxing. Concussions are also commonly seen in the elderly or those at risk of falls, and the military population, however as anyone who has suffered a concussion knows, they can happen to anyone at any time, including those who have been in car accidents. Neurological symptoms of a concussion can include (but are not limited to):
-       Headaches, brain fog, difficulty concentrating, confusion
-       Memory changes
-       Dizziness, Blurred Vision, balance problems, fatigue
-       Sensitivity to light/noise
-       Loss of consciousness.
Although loss of consciousness is a major indicator of concussion, it is by no means crucial to rule it in and no two concussions are the same - every individual will have a different set of symptoms and therefore their recovery journey will be different.
 
Post Concussion Syndrome:
20% of all concussions do not heal spontaneously and thus people are left with ongoing signs and symptoms of a concussion. Post Concussion Syndrome has the same signs and symptoms as a concussion including headaches, dizziness, brain fog, sensitivity to light and sound, fatigue etc. except these symptoms can last for months to years. The headaches experienced can vary from tension type headaches (most common) to migraines. Post Concussion Syndrome can be very frustrating and debilitating for sufferers however with proper management, it does not need to be. Better outcomes are seen if it is diagnosed and treated early. Treatment often requires a combination of hands on therapy, vestibular rehabilitation and exercise prescription to help sufferers return to work/school/sport/activities of daily living as quickly as possible. 
 
So what actually happens in the brain when you get a concussion?
When the head is knocked or forced into a position, it causes the brain to move within the skull 1-2mms. The force causes the nerve endings within the brain to become damaged. When these nerve endings are damaged, they can stop transmitting as normal and a lot of energy needs to be spent to try rebuilding connections and carry out regular daily tasks. This can account for a large amount of fatigue following a concussion.
 
When these neurons are damaged, they can ‘die’, which can also spread to the neurons around the area also becoming damaged by association. Less connections can mean slowed connections within the pathways connecting the brain. Microtubules help provide support to the nerves within the body, and when they are damaged, they can dislodge Tau proteins. When these Tau proteins clump together, they disrupt transport and communication along the neuron, and can drive the breakdown of brain tissue as seen in Chronic Traumatic Encephalitis (CTE). This process is not dissimilar to the pathological process seen in Alzheimer’s and dementia
 
This process of breakdown can be managed with a speedy diagnosis and adequate rehabilitation to keep these nerve endings active and preventing long term detrimental effects of CTE.
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Return to activities:
It is very important following a concussion to not rush back into all activities at full speed.
Returning too quickly can overload the brain, and lead to longer recovery times. A slow and graduated return is the best for long term recovery from cognitive deficits.
 
Before returning to sport, you will need to have at least 10-14 days of active rest and be cleared by a medical professional. Repeated concussions to an individual that has not adequately recovered from the initial blow can lead to more severe subsequent concussions and significantly longer recovery periods (which may require a large amount of rehabilitation). The earlier the return to activity the better, but it must be under supervision to ensure it is safe and within tolerable limits.  
 
Going back to work/school too quickly following a concussion can be very taxing on the brain. The same goes for reading, computer and video game usage.  It is important to gradually build the cognitive load over a period of time as to not overstimulate the brain too quickly. Before returning to work/school/driving as normal, there should be next to no symptoms. Start working/studying from home and see if symptoms exacerbate. This may take a few days to build up to. From here, you can build up into half days/reduced hours and progress at a controlled rate
 
Things you can do to speed up your recovery:
- Nutrition – eating plenty of fresh fruits and vegetables rich in antioxidants, vitamins and minerals to help recovering cells get the nutrients they require
-Avoiding use of alcohol, sedatives or recreational drugs – these can exacerbate symptoms, delay recovery and mask levels of damage
 - Sleep – sleep is vital in helping recover from injury for muscular and neurological cellular healing
- Rehabilitation - consulting with a rehabilitation specialist to discuss ways to gradually reintroduce aggravating factors back into your day and manage persistent symptoms
 
Where to from here?
If you are struggling to get back into doing daily activities following a concussion, consult with a rehabilitation specialist here at Melbourne Headache Solutions as to how to adequately and timely return to the activities you are struggling with. Treatment options may include:
-       Persistent Headache – structured manual therapy targeting the headache causing joints of your spine
-       Dizziness/balance problems – Vestibular rehabilitation working on balance, coordination and spatial orientation
-       Fatigue – exercise prescription targeted to manage fatigue and gentle re-entry into cardiovascular and resistance training
 
If you have suffered a concussion or are suffering from Post Concussion Syndrome and want to know how we can help you, contact one of our rehabilitation experts for more information on (03) 9486 7543 today.