CONCUSSIONS: WHAT YOU NEED TO KNOW TODAY

The recognition, assessment and treatment of concussions has changed dramatically over the past 20 years.  The term and diagnosis of a “concussion” was very novel in the early 2000s.  Looking back even just a few years, clients were told specific treatment protocols that today would not be recommended.  The sports science world continues to develop many new techniques to address one of the most complicated diagnosis athletes and the general public will have to deal with.

What is a Concussion?

A concussion has various ways it has been and can be defined. Put simply, the American Association of Neurological Surgeons (AANS) state that a concussion is “an injury to the brain that results in temporary loss of normal brain function” (2020). The AANS expands on this when defining a concussion medically, to “a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status or level of consciousness, that results from mechanical force or trauma” (Agarwal, Thakkar, Than, & American Association of Neurological Surgeons, 2020). Regardless of the specific definition, a concussion is classified as a Traumatic Brain Injury (TBI) and needs to be treated as a serious matter.

Who Gets Concussions?

Individuals of all ages can get concussions.  A large number of individuals in the 0-4 year range and those older than 75 years sustain concussions from falls.  The age group of 15-24 has the highest rate of concussion due to sports and motor vehicle accidents.

What Causes a Concussion?

The onset of a concussion can be from a direct blow to the head (like an elbow to the head)  from a direct hit. For instance, in soccer the blow to the head can be from head to head contact, from head to the goal post, from a ball to the head, or a bad landing of the head on the ground. The head houses the brain, and if the brain get rattled, it can cause the concussion. 

A concussion can also be caused by a sudden change in velocity in an acceleration/deceleration manner, like in a motor vehicle accident where the vehicle is rear-ended. In sport, a similar example of a whiplash injury is what some athletes experience when they get cross-checked from behind.  It is exacerbated if the cross-check is carried out very close to a wall or boards in hockey, and the head is suddenly stopped by the wall or boards.

 What are the Symptoms of a Concussion?

One of the most important aspects of dealing with concussions is simply recognizing that the athlete/individual may have suffered an injury to his brain. There are a multitude of platforms that identify the key signs of a concussion.  The AANS (2020) lists key symptoms of concussions to include the following:  

• Amnesia
• Confusion
• Headache
• Balance problems
• Double or fuzzy vision
• Sensitivity to light or noise
• Nausea
• Feeling sluggish
• Concentration or memory problem
• Slowed reaction time
• Feeling unusually irritable
• Loss of consciousness (LOC)*

*It is important to note that for many years if someone did not suffer a loss of consciousness it was not considered a concussion.  Presently, LOC is NOT a requirement for the diagnosis of a concussion to have taken place.

What Should You Do If You Expect a Concussion?

This short article is not going to give one all of the details of a concussion.  However, the purpose is for you to be able to recognize that if your teammate, friend, relative, or players you coach are showing ANY of the aforementioned signs, they should be sent to a practitioner that specifically deals with concussions. Some important aspects for the general public to know are as follows:

1. The majority of the time, an MRI or CT is NOT appropriate for diagnosing a concussion. In fact, the individual is being subjected to unnecessary radiation if CT is done.
2. The athlete should be assessed and treated by a qualified practitioner. If the practitioner does not know current protocols, they should provide specific referrals. At Metrotown Orthopedic and Sports we have practitioners that are educated in the assessment and treatment of concussions.
3. A reliable screening tool like the SCAT 5 can be completed so that the seriousness of the injury can be ascertained.
4. A cervical assessment should be done so that any malalignment or other dysfunction can be corrected or a musculature spasm around the suboccipital area can be reduced, allowing for more range of movement (ROM). Very few concussions do not have a cervical component.
5. DO NOT tell the athlete or individual to stay in their room and turn off all their electronic devices. Although that was a mainstay in treatment years ago, it has been found that type of protocol can lead to severe depression, which is one of the side effects of a concussion.
6. If the individual is an athlete and/or youth athlete, teachers, coaches, parents and the athlete all need to be told what the athlete has sustained and the treatment plan should be shared to all those noted so that all of the primary contacts are on the same page. It is important for athletes to not feel pressured to returning to play when they are unsure of themselves, as this only leads to further injury.
7. A Return to Play cannot be contemplated until the athlete has returned to their education. Teachers need to be supportive and if the injured athlete is not getting that support then the school administration needs to be brought into the picture.
8. An athlete should NEVER return to sport if he is still suffering any of the symptoms noted above. This could lead to Second Impact Syndrome where the athlete can suffer dire consequences.

What Type of Concussion Treatments Does Metrotown Physio Provide?

A physiotherapist can assess an individual to ascertain if they have sustained a concussion, they can treat the symptoms, and they can/should be very involved in the Return to Play plan for the athlete or a Return to Work for the general public. If further collaboration is required with other health professionals, referrals will be provided. Although there are various in-clinic treatment options, two such treatment options are provided below as examples:

• Monitored Submaximal Training
  • This involves having the athlete train to submaximal threshold on the treadmill or bike, a treatment which has been found to be very effective (Leddy, Haider, Ellis, & Willer, 2018).

• • Using the C-Rod
    • This tool simply trains the ocular component of the individual that has sustained a concussion and has as a result some vision problems. Such skills are important as they “play a key role in our ability to enjoy clear, comfortable and efficient vision”, and therefore their dysfunction is problematic (C-Rod Technologies, 2020). However, they can benefit from therapy such as the C-Rod (C-Rod Technologies, 2020).
      

• For those interested, the developers of the C-Rod (2020) are cited as identifying and defining the primary 3
  oculomotor skills as follows:
  • Saccadic Eye Movements
    • The ability to move eyes back and forth – both fast and slow.
  • Fixation
    • The ability to hold your focus on a target.
  • Pursuits or Tracking
    • The ability to follow an object and keep it clear and single.

This article was written by Marc Rizzardo. Do you have more questions about this article or how Marc and the Metrotown Orthopedic & Sports Physiotherapy Clinic team can assist you or someone you know in concussion treatment or anything else? Feel free to call us at 604-430-3066, email us at [email protected], and visit our website at https://metrotownphysio.com.

References

American Association of Neurological Surgeons. (2020). Concussion (N. Agarwal, R. Thakkar, & K. Than, Eds.). Retrieved from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Concussion

C-Rod Technologies. (2020). Retrieved August 23, 2020, from https://c-rodtechnologies.com/

Leddy, J. J., Haider, M. N., Ellis, M., & Willer, B. S. (2018). Exercise is Medicine for Concussion. Current Sports Medicine Reports, 17(8), 262-270. doi:10.1249/jsr.0000000000000505

McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., . . . Vos, P. E. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847. doi:10.1136/bjsports-2017-097699