When we think of a concussion, we often think about football players or someone who has taken a blow to the head. While this is where a lot of concussions happen, many more happen in ways that are less talked about. Whiplash, such as from a car accident, can cause a concussion as the brain strikes forcefully against the skull and shears neurons that descend from the brain. In the same way, a fall can cause a concussion – even without a blow to the head, especially in older adults.
Who Gets Concussions?
Concussions can occur in older adults who slip or fall (even without hitting their head!), children, athletes at all competitive levels, military personnel who sustain blast injuries, adults who slip on the ice getting into their car…etc. Basically, anyone can get a concussion.
What is a Concussion?
A concussion is a trauma to the brain significant enough to cause a brief change in mental status or consciousness. Recovery for a concussion has a natural healing time of 4-6 weeks. That means that unless you have signs that you will need rehab immediately, often the best course of action to take during that time is resting appropriately under observation of medical provider.
That said, in my experience there is a lot of confusion about what appropriate rest means, and furthermore what is appropriate is unique to each individual. Too much rest is not helpful, and too little is certainly not helpful, and either of those could be harmful or delay recovery. So please, if you or someone you know has had a concussion (or you even suspect they had one) get clarity on what “rest” means from a provider who is well versed in concussion rehab.
Symptoms of a concussion can be vague and are different for each person. Many people never end up seeking care or are misdiagnosed. Catching a concussion early is very important because the research supports that early intervention results in much better outcomes.
Early Symptoms of Concussion
- Headache
- Neck Pain
- Mood changes
- Fatigue
- Sleepiness
- Nausea
- Dizziness
- Difficulty Sleeping
- Sensitivity to light/sound
- Double/blurred vision
- Confusion
- Balance deficits
- Focus/memory deficits
Post-Concussion Syndrome
Many patients, especially those who were not diagnosed or did not receive rehab or proper guidance early on, end up with long lasting symptoms that they just accept as “part of their life now.”
Once it has been 3 months since the original injury, these
patients technically no longer have a concussion, but rather post-concussion
syndrome, which indicates chronic symptoms. However, patients often don’t
realize that these symptoms are still treatable and are not
something that they have to live with!
So why do symptoms persist for so long with post-concussion syndrome? The body and brain find ways for you to keep doing what you have to, by compensating for deficits rather than addressing root causes. For example, when you have a deficit in the part of your nervous system that tells your brain where your body is in space, you compensate by relying on vision for balance. This works okay for a while, but dizziness occurs when your vision is over stimulated, such as when you are trying to look around while hiking, or are in a visually stimulating space such as the grocery store, or when you can’t access your vision well, like in a dark movie theater.
Symptoms of post-concussion syndrome
- Dizziness
- persistent headaches and/or neck pain
- reduced tolerance to lights/sounds
- feeling unsteady, especially when walking or in busy environments
- fatigue
- a sense of fogginess or feeling “not quite right.”
Persistent fatigue or feeling “not quite right” are common symptoms of post concussion syndrome
What can be done to help?
When a person experiences dizziness or balance deficits, the affected systems need to be trained with specific exercises at optimal dosages. Over time, these treatment strategies reduce your symptoms by teaching your body to move away from compensation and strengthen the parts of your system that have become weakened.
As I mentioned before with rest, knowing exactly how much to do and when is key for achieving recovery. Doing too much can overwhelm your system, whereas not doing enough will not result in any gains. That’s why working with someone trained in concussion rehab is essential for you to continue to improve without exacerbating your symptoms.
Longer-term Symptoms of Untreated Concussion:
- Loss of libido
- Low blood pressure
- Loss of mensturation
- Fatigue
- Muscle weakness
- Growth problems (children)
- Weight gain
- Early dementia
- Chronic headaches/dizziness
What to do if you experience a concussion:
- Decrease your screen
time.
- Try to spend less time looking at a computer screen, phone, or i-pad.
- Allow yourself rest.
- After a concussion, most people feel the need to sleep more than usual. This allows the brain to heal. Give yourself permission to spend extra time sleeping.
- Continue to engage in light aerobic exercise.
- While vigorous physical exertion may worsen symptoms and delay healing, light aerobic activity can help you heal faster. If you are not sure how much to exert yourself safely, a physical therapist can perform an exertion test to determine how you respond and give you guidelines for how to exercise on your own.
- Listen to your
symptoms.
- Stimulating environments and even changes in head position can provoke symptoms. If you notice triggers like these, allow yourself to experience mild symptoms but avoid situations that cause symptoms to become severe.
Important Note: Depression and anxiety are one of the most common symptoms following concussion. In 90% of cases these symptoms resolve with time. However, in some cases these symptoms can be more severe or persistent, especially if there is a history of depression or anxiety, or presence of stressful life events. Many patients benefit from more in depth care in this arena, such as meeting with a psychotherapist in addition to physical therapy to achieve full recovery.
Dr Derya Anderson has extensive experience working with patients who have had a concussion. She also has attended continuing education courses (below) that are specific to concussion management:
May 2019 Stress, Movement and Pain. Speaker: Seth Oberst, PT, DPT
July 2018. Concussion: Vestibular System Abnormalities and Ocular Motor Examination. Taught by Susan L. Whitney, DPT, PhD, NCS, ATC, FAPTA
March 2018. Concussion Basics. Assessment, Screening and Risk Factors. Taught by: Anne Mucha, PT, DPT, MS, NCS and Susan Whitney, DPT, PhD, NCS, ATC, FAPTA
March 2018. Clinical Subtypes Following Concussion: A conceptual Framework for Evaluating and Managing Concussion. Taught by: Anne Mucha, PT, DPT, MS, NCS and Susan Whitney, DPT, PhD, NCS, ATC, FAPTA
October 2017 Vestibular Dysfunction- An algorithmic based Evaluation and Treatment. Speaker: Barry Morgan, PT
March 2017 Innovative Approach to the Management of the Cervical Spine: Maximizing Outcomes in Fewer Visits. Speakers: Jeff Ryg, PT, DPT, OCS, FAAOMPT. Kristen Carpenter, PT, DPT, OCS, FAAOMPT
November 2015 Orthopedic and Neurologic Perspectives on Concussion/Mild Traumatic Brain Injury Management. Speakers: Wendy Kriekels, PT, DPT, NCS, David A. James, PT, DPT, OCS, SCS, CSCS, Michael R. Greher, Ph.D., ABPP-CN, Katherine S. Dahab, MD, CAQSM, FAAP
Nov 2015 APTA SIG Event: The Role of Physical Therapy in Concussion Care. Speaker: Ann McNamara, PT, MPT, CCCE
