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Misconceptions of Concussions and Care for Post-Concussion Syndrome

What a concussion IS NOT

A major misconception is that a concussion is a brain ‘bruise’. Similar to a bruise on the thigh, it was thought to best manage it by protecting it, resting it, icing it, etc. As more and more research has been done we’ve come to realize that this isn’t the case with concussions and this style of care may actually hinder progress.

While we’re on the topic of what a concussion is not, here’s a few more:

  • A localized neurological dysfunction

  • A coup-contra-coup injury

  • An isolated brain injury (usually)

  • Your brain hitting the inside of your skull

So what is a concussion?

Concussion is a brain injury and is defined as

a complex pathophysiological process

affecting the brain, induced by biomechanics forces.

*consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport

In simpler terms, a concussion results from a force imparted to the head (e.g. car accident) leading to a neurochemical cascade of events in the brain and body. Concussion is interchangeable with the term mTBI (mild traumatic brain injury) which is often used in it’s place.

Unfortunately, when it comes to a consensus on concussions there are only a few things that we mostly agree on:

  • Mechanisms

  • Signs

  • Symptoms

And that’s it!

What signs and symptoms may accompany a concussion?

Here are some things you MIGHT see in a concussed individual:

  • Loss of consciousness (NOT ALWAYS)

  • Balance problems

  • Glazed look in eyes

  • Delayed response to questions

  • Vomiting

  • Confusion about location, date, or time

Here are some things you MIGHT experience if you yourself have a concussion:

  • Physical symptoms

  • Headache

  • Nausea

  • Dizziness

  • Sensitivity to light

  • Sensitivity to sound

  • Cognitive symptoms

  • Loss of focus

  • Memory problems

  • Attention difficulties

  • Difficulty completing mental tasks

  • Sleep symptoms

  • Sleeping more than usual

  • Sleeping less than usual

  • Trouble falling asleep

  • Emotional symptoms

  • Anxiety

  • Depression

  • Panic attacks

Notice how I used the preemptive ‘MIGHT’ before each category, while these signs and symptoms may be present often with concussions, each and every case will be different.

You’ve sustained a concussion, now what?

Often times individuals will recover from a mTBI by simply allowing time to pass and taking a break from the activity that initially was responsible for the injury.

Unfortunately, there is a large population who is being mistreated and under diagnosed. A large number of individuals who experience a concussion will develop long-lasting symptoms that fall under the diagnosis of Post-Concussion Syndrome (PCS). Often times patients will be cleared to return to sport/school/work once the major debilitating symptoms of the initial injury have cleared, but they still experience other symptoms such as brain fog, attention issues, dizziness, sensitivity to light, etc.

For neuronal health (cells of the nervous system) 3 things are needed:

  • Stimulation

  • Oxygen

  • Glucose

If we think about the old habits of concussion care (increase sleep/sit in dark room, no exercise) we are already taking away two of the important factors for brain health (stimulation and oxygen). Now I’m not saying to go straight to what you were doing before, the brain is in a compromised state and needs to be gradually exposed to increased levels of stimulation and exercise.

This is where the neurologically trained physician comes into play. Through a complete history and evaluation, the appropriate exercise selection and dosage will be determined and prescribed. Symptom responses will be monitored throughout the whole process ensuring that the appropriate amount of stimulation and exercise are being done.

The third component of neuronal health, glucose, is missed most often in general medical treatment of concussions. For the appropriate exercises to be of benefit, the appropriate fuel source must be there for the brain (think of exercising on a completely empty stomach).

For a number of reasons, an individual may slip into a state of dysglycemia after suffering a concussion. The physician will inquire about dietary habits and may even order blood work to determine what is currently happening physiologically in the individual.

We hope this information has proven useful for you. If you yourself or anyone you know has sustained a concussion and continue to have symptoms, please feel free to reach out with any questions or schedule an appointment.

Dr. Brad Muse, DC, ATC

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