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What is a Concussion and Post-Concussion Syndrome?

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What is a Concussion?

A concussion is a mild Traumatic Brain Injury (mTBI).  The American Congress of Rehabilitation Medicine (1993) defines mTBI as an “acute brain injury resulting from mechanical energy to the head from external physical forces” (American Congress of Rehabilitation Medicine, 1993). 

Concussions can be caused by physical trauma such as a contact sports injury, a fall, an assault, or car accident.   A concussion occurs from a sudden trauma or blow to the head, in some cases the brain moves within the skull.   

According to the Center for Disease Control, the sudden movement of the head can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells (CDC, 2019).

3.8 million cases of concussion occur each year in the United States, 65% occur in children and adolescents (Faul, Likang, Wald, & Coronado, 2010).  Concussions result in 1.365 million emergency room visits and 275,000 hospitalizations annually with associated direct and indirect costs of $60 billion in the United States (Daneshvar et al., 2011). 

What is Post-Concussion Syndrome?

Post-concussion syndrome is lingering symptoms for weeks or months following a concussion.  Deficits may last up to 6 months.

Post-concussion syndrome is diagnosed by having 3 of the following symptoms after an injury to the head: headache, dizziness, vertigo, fatigue, memory problems, difficulty concentrating, insomnia, irritability, depression, anxiety, personality changes, sensitivity to noise and light (Bowman, 2019).

Patients over 40 years of age are more likely to experience post concussion syndrome.  Prevalence rates of post-concussion symptoms vary between 11-82%, depending on diagnostic criteria (Polinder et al., 2018).

Signs of a Concussion

  • Jolt, bump, blow, or trauma to the head
  • Loss of consciousness
  • Confused after the injury
  • “Blacked out” or can’t remember events prior to the injury
  • Mood and behavior changes
  • Poor balance
  • Slow reaction time

How Can a Concussion Impact Your Health? 

  • Headaches
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Bothered by light or noise
  • Fatigue
  • Concentration or memory problems
  • Ringing of the ears

Risk Factors for Concussion:

To prevent concussions wear a seat belt while riding in the car and wear a properly fitted helmet while playing sports.  Avoid contact sports such as American football, rugby, hockey, soccer, etc. 

If a concussion does occur, follow your healthcare provider’s advice for a period of initial rest followed by rehabilitation to prevent post-concussion syndrome.    

Potential Complications of a Concussion:

Concussions may be an emergency.  In rare cases a hematoma or bleeding of the brain may occur.  Computerized tomography (CT) scans are specialized imaging to rule out red flags. 

What to Do if You Have a Concussion:

If you think you have had a concussion, consult a specialist right away for a neurological examination.  Try to recall the mechanism of injury and how you felt during and after the injury.  Did you lose consciousness, feel dizziness, or experience nausea?  If the concussion was sports-related, cease playing sports until receiving medical clearance to return to sport.

Your practitioner will monitor your progress.  They will recommend a brief period of physical and cognitive rest before beginning rehabilitation.  Common rehabilitation techniques include neck and upper back treatments, eye movements, and balance training.  

Concussion Assessment:

To assess for a concussion your practitioner will perform a thorough case history and neurological examination.  In some cases specialized brain imaging may be recommended.

Assessment for concussion will include the following components:

  • Neck assessment to assess for musculoskeletal dysfunction
  • Vestibular assessments to assess your balance and postural stability
  • Oculomotor assessments to assess eye movements and postural stability
  • Motor function to assess reaction times and motor impairments
  • Exertion tolerance to determine tolerance level to exercise

 (Quatman-Yates et al., 2020) 

Treatment Options for Concussion and Post-Concussion Syndrome:

Researchers studied when was the best time to implement physical rehabilitation after a concussive injury.  They mentioned allowing for physical and cognitive rest for 24-48 hours post concussion (Schneider et al., 2017).

Physical therapy is considered feasible and safe even within the first few weeks after injury to help facilitate prompt recovery and prevent the onset of secondary effects from post concussion symptoms (Lennon et al., 2018).

Researchers recommend a multimodal approach that combines balance rehabilitation of the vestibular system, eye movements for rehabilitation of the visual system, and cervical rehabilitation (Grabowski et al., 2017). 

Cervical Manual Therapy

  • Research shows that manual therapy and exercise for cervical dysfunction demonstrated clinical and patient-reported benefits (Wong et al., 2021). 

Vestibular Rehabilitation and Vision Therapy

  • Vestibular rehabilitation in children with concussion is associated with improvement in symptoms as well as visuovestibular performance.
  • Vision therapy had a successful or improved outcome in the vast majority of cases that completed specific eye movements (Gallaway, Scheiman, & Mitchell, 2017).

Neuromotor Retraining

  • Manual therapy is recommended to restore cervical spine range of motion, vestibular rehabilitation is recommended to improve gaze stability and visual motion sensitivity, and neuromotor retraining is recommended to improve postural stability and sensory integration (Teare-Ketter, Fiss, & Ebert, 2021).

How Can We Help?

We can help you if you are considering conservative treatment options for concussion or post-concussion syndrome.  To determine if you are a good candidate for conservative care, we recommend a consultation and a complete posture analysis for specialized patient centered care options. 

After ruling out complications with your physician we can discuss best options based on objective measures.  All new patients are valued, will felt heard, and will have an objective analysis performed prior to discussing treatment options. 

We care about you and your health outcomes.

References:

American Congress of Rehabilitation Medicine (ACRM). Definition of mild traumatic brain injury. J Head Trauma Rehabil (1993) 8:86–7.

Bowman, J. (2019) Post-Concussion Syndrome, Healthline

Burns, K. (2021) Concussion and Post-Concussion Syndrome, American Posture Institute Blog

Center for Disease Control and Prevention (2019) Heads Up, Brain Injury Basics, What is a concussion

Daneshvar, D. H., Nowinski, C. J., McKee, A. C., & Cantu, R. C. (2011). The epidemiology of sport-related concussion. Clinics in sports medicine30(1), 1-17.

Faul M, Likang X, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths 2002-2006. Atlanta, GA: US Department of Health & Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

Gallaway, M., Scheiman, M., & Mitchell, G. L. (2017). Vision therapy for post-concussion vision disorders. Optometry and vision science94(1), 68-73.

Grabowski P, Wilson J, Walker A, Enz D, Wang S. (2016) Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility. Phys Ther Sport. 23:22–30.

Lennon, A., Hugentobler, J. A., Sroka, M. C., Nissen, K. S., Kurowski, B. G., Gagnon, I., & Quatman-Yates, C. (2018). An exploration of the impact of initial timing of physical therapy on safety and outcomes after concussion in adolescents. Journal of neurologic physical therapy: JNPT42(3), 123.

Polinder, S., Cnossen, M. C., Real, R. G., Covic, A., Gorbunova, A., Voormolen, D. C., … & Von Steinbuechel, N. (2018). A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Frontiers in neurology9, 1113.

Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., … & Silverberg, N. (2020). Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy, American Academy of Sports Physical Therapy, Academy of Neurologic Physical Therapy, and Academy of Pediatric Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy50(4), CPG1-CPG73.

Schneider, K. J., Leddy, J. J., Guskiewicz, K. M., Seifert, T., McCrea, M., Silverberg, N. D., … & Makdissi, M. (2017). Rest and treatment/rehabilitation following sport-related concussion: a systematic review. British journal of sports medicine51(12), 930-934.

Teare-Ketter, A., Fiss, A. L., & Ebert, J. (2021). The utility of neuromotor retraining to augment manual therapy and vestibular rehabilitation in a patient with post-concussion syndrome: a case report. International journal of sports physical therapy16(1), 248.

Wong, C. K., Ziaks, L., Vargas, S., DeMattos, T., & Brown, C. (2021). Sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis. International journal of sports physical therapy16(1), 12.




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