Concussion is a traumatic brain injury caused by a direct blow to the head or an acceleration-deceleration (whiplash) mechanism. It is usually suffered during contact sports such as rugby, hockey and football but is also common in activities like dance, horse riding and gymnastics where head injury is a risk.
Initial symptoms can vary between individuals and a loss of consciousness although common is not always present. The most common symptoms following concussion are loss of consciousness, headache, nausea and dizziness but a broad range of symptoms may be present.
Four main mechanisms work together to provide us with balance and normal brain function. Damage or dysfunction to one or a combination of these systems can contribute to to the symptoms of concussion and are discussed below.
Energy crisis refers to the energy balance of the brain and its blood supply through the arteries of the neck. Following a concussion energy producing Potassium ions exit the neuron, while Calcium ions rush into the cells. When the Calcium enters, it causes the blood vessels to constrict, resulting in decreased blood supply to the brain. This diminishes blood flow to the brain and causes the increased demand for energy, hence the Energy Crisis.
Vestibular (inner ear) dysfunction
The vestibular system consists of a series of canals within the inner ear that act as the bodies internal ‘spirit level’. This system can be altered following a concussive injury which will cause dizziness, nausea and balance disturbances. This can be very unsettling and if not treated appropriately may also leave athletes prone to further musculoskeletal injuries on return to play. The vestibular system can be treated by a Physiotherapist or Osteopath trained in vestibular management and in most cases if caught early resolves without lasting effect.
The occulomotor system refers to the cooperation between the visual system and brain. Our eyes are one of the main systems responsible for our balance as they tell us about our environment and the position of our body. If the visual system is compromised it can provide false information to the brain and subsequent balance problems. This can also be treated by a Physiotherapist or Osteopath trained in occulomotor rehabilitation.
Sub occipital nerve dysfunction
The nerves arising from the top of the neck and base of the skull are known as your sub occipital nerves. These are responsible for transmitting valuable feedback about body position to the brain. Following a head injury these nerves
can be pinched by surrounding joints and muscles which inhibits the communication of valuable information to the brain and again lead to balance disturbances. As with vestibular and occulomotor dysfunction this can also be treated by a Physiotherapist or Osteopath.
What to do if you suspect a concussion
Research has shown that the symptom of concussion resolve in 80 – 90% of cases within 7 – 10 days. In some cases symptoms can last for considerably longer and have been known to last for periods of a year or more.
The first thing to do if you suspect a concussion is to seek and assessment by a medical professional trained in concussion management. This will lead to an assessment of brain and balance function that will establish the level of dysfunction and which systems have been compromised. This will then allow the assessing clinician to establish the best course of management for you.
What to do when symptoms have resolved
When you have been told by your treating clinician that symptoms have resolved you will be taken through a comprehensive return to play protocol that will last for six days if you are symptom free.
What if I ignore concussion guidelines?
Ignoring concussion guidelines can have very serious consequences. Athletes returning to play with a concussion are vulnerable to a wide range of injuries including something call ‘second impact syndrome’ which has been known to lead to death of an athlete. Other consequences include prolonged concussive symptoms and vulnerability to musculoskeletal injuries due to an athletes poor balance, spatial awareness and timing.
If you are unsure about concussion and feel that you or someone you know may be suffering from this injury get in touch with our concussion team, we will be happy to help.
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