Healthy Movement for Life - Concussion
By Dr. Jill Trato, DPT
Have you ever jiggled and wiggled jello? No, I am not going to call you a jello head but, your brain is like jello!
You can see from the images above that the brain lies within the skull. You can also appreciate that the brain is surrounded by something else. That something else is the dura mater and cerebrospinal fluid. Cerebrospinal fluid provides buoyancy for the brain. It also delivers nutrients and removes waste. With trauma, it can also allow for some protection of the brain tissue.
Acceleration, deceleration, blunt and blast force acting on the head can lead to brain trauma. There is a potential for tearing of blood vessels, pulling of nerve fibers (axons) and bruising of the brain. A blow to the head can result in microscopic damage to the brain cells without obvious structural damage visible on imaging. Furthermore, there can be alterations in metabolic and neurotransmitter activity- again, alterations which are not visible on imaging. Quantifying and qualifying head injury depends upon medical assessment and severity of symptoms as well as imaging studies. Concussion and mild traumatic brain injury are typically used interchangeably.
Neurosurgeons and other brain injury experts emphasize that not all concussions are alike and that there is no such thing as a minor concussion. In most cases, an isolated concussion should not cause permanent damage. However, a second concussion soon after the first does not have to be very strong for its effects to be chronically disabling. It is important to allow neurons time to heal and for disruptions in axonal function to adapt and reorganize.
Per recent statistics of people living in the United States, about 2.8 million Americans sustain a traumatic brain injury each year. And, approximately 7 out of 10 emergency department visits for sports and recreation related brain injuries and concussions (mild traumatic brain injury) are among children aged 17 and under. Tackle football, soccer and lacrosse are in the top three sports associated with brain injury in children. Brain injury in adults is associated with sports and falls.
There are many symptoms that can manifest as the result of a concussion or mild traumatic brain injury. These include things like confusion, headache, alterations to vision, dizziness, vertigo, motion intolerance, imbalance, ringing in the ears, difficulty concentrating, light or sound sensitivity, nausea, memory loss and changes in your typical moods. It is important to recognize the signs of concussion so that a person can be assessed, treated and guided in the most beneficial way.
If a concussion leaves you with symptoms of visual disturbances, motion intolerance, dizziness, vertigo or imbalance, do not hesitate to consult with a physical therapist (and/or your MD, of course). A physical therapist can help you determine if the source of the symptoms are from the visual systems, vestibular
system, sensory integration dysfunction or all of the above. Your MD will be able to order imaging studies if indicated.
Physical therapists are able to complete a comprehensive assessment of balance, functional mobility and gait as well. Then, a specific course of treatment can be established to facilitate progress towards returning to normal function. Treatment post concussion is highly individualized and may include habituation, visual exercises, vestibular rehabilitation and balance exercises. In addition, it is important to address the autonomic nervous system into the picture and address the need for pacing, energy conservation and ideas surrounding how to adapt to the challenges of daily life such as navigating the use of screens and complex/overstimulating environments.
A typical protocol for return to sport/activity post concussion might look like this:
Phase 1: Relative rest for three days, if symptoms rise during daily tasks: rest to allow them to resolve prior to resuming an activity. Essentially, household and community activity is permitted, as tolerated.
Phase 2: After three days, gradually reintroduce aerobic activity, limit head movement and extraneous neck motions. Light activity to gradually increase heart rate—increase workload bit by bit IF symptoms do not increase. Exercises include walking, light biking. Can progress to the next phase when able to achieve 85% age adjusted heart rate without symptoms.
Phase 3: Increase head movement with activity: running, skating, swimming, foot work, stick work. Add environmental distractions such as being in a busy gym. Increase cognitive demands such as doing math in head. Should be with minimal to no symptoms with all activities.
Phase 4: Initiate sport specific activity without contact. Progress if there are NO symptoms with this.
Phase 5: Initiate scrimmage play first, then full game play if asymptomatic.
The rate at which a person progresses through the above phases will vary depending upon the severity and irritability of symptom aggravation with activity in a given phase. One person might be in phase 2 for 2 weeks and stage 3 for 4 weeks. A second, might be in phase 2 for one week and phase 3 for 2 weeks.
Protect your beautifully intricate and complex brain!
Wearing a helmet (that fits properly with the straps clicked in) is a great place to start. However, if you need to take yourself out of the game for a few days and progress through a recovery protocol of some kind, do it!!