 | We are hearing a lot more about concussions in the news these days since popular athletes are talking about their experiences with them and the kinds of symptoms they cause. But what do we really know about concussions? What causes them and what are their symptoms? Do they go away on their own or should you seek treatment? What is the treatment for a concussion and who can you go to for help with answers to all of these questions?? |
Lately I’ve had so many questions from other medical practitioners, from our patients in the clinic, and from people in the community regarding concussions that I thought we’d try and address these in Seine River Physio’s first ever blog entry. (Welcome to the “techy world” Andrea!)
Statistics
Many of us hockey fans are familiar with Sidney Crosby who played only 99 games over three regular seasons from 2010-2013 due to concussions (a typical season has 82 games) and Chris Pronger whose 18 year NHL career was ended due to concussions in 2011. Unfortunately, we just saw George Parros taken off the ice on a stretcher after sustaining a concussion in September this year and our own rookie defensemen Trouba went out the same way after slamming head first into the boards in October. And who hasn’t read about the NFL settlement for $675 million dollars awarded to over 4,500 former football players and their families for head injuries sustained while playing football.
But there are so many more concussions that don’t make the news. The rate of concussion in the NHL from 2009-2012 was estimated at between 5.05 to 8.8 per 100 games1.
Chris Zelcovich, sports reporter for thestar.com, wrote that 50 concussions were sustained in the 85 games played during the 2010 CFL season, an incident rate of .59% per game which was slightly less than the .67% recorded by the NFL2.
And these are just the reported statistics … what about all those concussions that aren’t reported or are misdiagnosed? An article from the DANA Foundation written by Brenda Patoine in 2010 recounted that the Centres for Disease Control and Prevention say that about 300,000 sports-related concussions are reported annually in the US, but that since most concussions go unreported the number of sports concussions are more likely between 750,000 and 2.25 million a year3. The British Journal of Sports Medicine estimates an even higher number, up to 3.8 million concussions in the US per year during sports and recreational activities; citing as many as 50% as unreported4.
But it’s not all about sports … my love for hockey and statistics does make me go on and on at times. A blow to the head from a fall, motor vehicle accident, recreational or work injury are also common causes of concussion. In 2004, the Journal of Rehabilitation Medicine published an article rating the incidence of mild traumatic brain injury in the general population as approximately .6%5. In 2009, the Canadian Journal of Neurological Sciences rated the incidence in Ontario as .49 to .65%6.
What is a Concussion
A concussion is a type of mild traumatic brain injury. It occurs when the brain gets shaken inside the skull. When you sustain a concussion, there are actually 5 things that can get shaken up:
Symptoms of a Concussion
A common misconception is that concussions only occur if there has been a loss of consciousness. In fact, 90% of people who sustain a concussion do NOT lose consciousness!
Symptoms of concussion can be subtle or severe. You may have one symptom or you may have many. They may begin right away, or days or even weeks afterwards.
Common symptoms include:
Treatment for a Concussion
Not everyone who sustains a concussion needs to undergo treatment. Most people recover just fine without any intervention at all. Unfortunately, there are others that suffer serious side effects that do not always go away on their own and it is important to know that there is treatment out there!
Anyone who sustains a bump on the head that causes any of the symptoms listed above should seek medical attention as soon as possible. If you are able to walk, talk, think, and see normally, your family doctor, a sports physician, or a medical walk in clinic would suffice. If there are more serious side effects, go immediately to an urgent care centre or hospital emergency room.
Once medically assessed and serious side effects from your injury that need to be dealt with immediately are ruled out, the medical practitioner will likely send you home with some general instructions. Depending on the seriousness of your concussion, they may refer you to a neurologist for more in depth testing and tell you to rest and avoid physical and visual stimulation for a couple of weeks. For less serious concussions, they may tell you that you are fine to resume life as normal right away. But what if you’ve rested for a couple of weeks and your symptoms didn’t go away … what then?
The idea that you must be completely asymptomatic before returning to any type of activity is FALSE. You can actually prolong your symptoms by staying on bedrest for an extended period of time. While it is true that there is a necessary period of rest following a concussion to allow the brain to heal, the amount of time an individual needs to rest will vary. This time frame depends on factors such as your age, the severity and number of concussions you’ve sustained, and your health status prior to the concussion. The amount of “bedrest” needed directly post concussion may be none at all, 24 hours, days, or possibly weeks but in general it is not months. You may not be 100% healed when you slowly integrate yourself back into “activity” mode, but your symptoms should have abated. It is important to start slowly with such things as doing light chores around the house or going for a walk. Periods of rest throughout the day are more appropriate than staying in bed all day. That being said, when it comes to returning to participation in sports your symptoms SHOULD be completely resolved before doing so.
So you’ve tried to gradually resume activity but you find you still aren’t back to your old self yet. Who can help you now?
Believe it or not, a physical therapist can help you rehabilitate after a concussion but it has to be a physical therapist trained in this specialized kind of care. Those called “Vestibular Physiotherapists” (or Vestibular Physical Therapists – same thing) are often trained in treating post concussion symptoms.
Most people think of physical therapy as just that: “physical” therapy where our primary focus is physical reconditioning. While concussion treatment does involve a physical component when the patient is ready, there is a lot more to concussion rehabilitation than that. There is a whole program of visual tracking, gaze stability, balance, proprioceptive reconditioning, desensitization, memory and cognitive exercises that can be prescribed based on your individual deficits. A vestibular therapist can assess you to determine which systems aren’t functioning properly and create a home exercise program tailored just for you. They can also correspond with your family doctor or neurologist so that all of your health care practitioners are on the same page. (It helps when one hand knows what the other is doing!)
Almost done gabbing…
So what does this mean for you or a loved one if you’ve suffered a concussion? Most people’s symptoms are gone within days and the vast majority (85-90%) by three months, but if yours are lingering on there is help out there in the form of treatment, guidance, and answers to your questions. People experience concussions differently and get better at different rates, but the vast majority of people DO get better. Time is an important component in healing after a concussion and so is a vestibular physiotherapist!
References
Statistics
Many of us hockey fans are familiar with Sidney Crosby who played only 99 games over three regular seasons from 2010-2013 due to concussions (a typical season has 82 games) and Chris Pronger whose 18 year NHL career was ended due to concussions in 2011. Unfortunately, we just saw George Parros taken off the ice on a stretcher after sustaining a concussion in September this year and our own rookie defensemen Trouba went out the same way after slamming head first into the boards in October. And who hasn’t read about the NFL settlement for $675 million dollars awarded to over 4,500 former football players and their families for head injuries sustained while playing football.
But there are so many more concussions that don’t make the news. The rate of concussion in the NHL from 2009-2012 was estimated at between 5.05 to 8.8 per 100 games1.
Chris Zelcovich, sports reporter for thestar.com, wrote that 50 concussions were sustained in the 85 games played during the 2010 CFL season, an incident rate of .59% per game which was slightly less than the .67% recorded by the NFL2.
And these are just the reported statistics … what about all those concussions that aren’t reported or are misdiagnosed? An article from the DANA Foundation written by Brenda Patoine in 2010 recounted that the Centres for Disease Control and Prevention say that about 300,000 sports-related concussions are reported annually in the US, but that since most concussions go unreported the number of sports concussions are more likely between 750,000 and 2.25 million a year3. The British Journal of Sports Medicine estimates an even higher number, up to 3.8 million concussions in the US per year during sports and recreational activities; citing as many as 50% as unreported4.
But it’s not all about sports … my love for hockey and statistics does make me go on and on at times. A blow to the head from a fall, motor vehicle accident, recreational or work injury are also common causes of concussion. In 2004, the Journal of Rehabilitation Medicine published an article rating the incidence of mild traumatic brain injury in the general population as approximately .6%5. In 2009, the Canadian Journal of Neurological Sciences rated the incidence in Ontario as .49 to .65%6.
What is a Concussion
A concussion is a type of mild traumatic brain injury. It occurs when the brain gets shaken inside the skull. When you sustain a concussion, there are actually 5 things that can get shaken up:
- your brain
- your neck
- your inner ear
- your eyes
- all the connections between them
Symptoms of a Concussion
A common misconception is that concussions only occur if there has been a loss of consciousness. In fact, 90% of people who sustain a concussion do NOT lose consciousness!
Symptoms of concussion can be subtle or severe. You may have one symptom or you may have many. They may begin right away, or days or even weeks afterwards.
Common symptoms include:
- Vertigo (the sensation that the room is spinning)
- Dizziness (including lightheadedness, “foggy head”, or just feeling “off”)
- Nausea, vomiting
- Imbalance, problems with coordination
- Headaches, neck pain
- Tinnitus (ringing in the ears)
- Visual disturbances
- Sensitivity to light and noise
- Speech difficulties
- Poor sleep, fatigue, difficulty concentrating, poor memory
- Emotional disturbances such as irritability, restlessness, anxiety, and depression
Treatment for a Concussion
Not everyone who sustains a concussion needs to undergo treatment. Most people recover just fine without any intervention at all. Unfortunately, there are others that suffer serious side effects that do not always go away on their own and it is important to know that there is treatment out there!
Anyone who sustains a bump on the head that causes any of the symptoms listed above should seek medical attention as soon as possible. If you are able to walk, talk, think, and see normally, your family doctor, a sports physician, or a medical walk in clinic would suffice. If there are more serious side effects, go immediately to an urgent care centre or hospital emergency room.
Once medically assessed and serious side effects from your injury that need to be dealt with immediately are ruled out, the medical practitioner will likely send you home with some general instructions. Depending on the seriousness of your concussion, they may refer you to a neurologist for more in depth testing and tell you to rest and avoid physical and visual stimulation for a couple of weeks. For less serious concussions, they may tell you that you are fine to resume life as normal right away. But what if you’ve rested for a couple of weeks and your symptoms didn’t go away … what then?
The idea that you must be completely asymptomatic before returning to any type of activity is FALSE. You can actually prolong your symptoms by staying on bedrest for an extended period of time. While it is true that there is a necessary period of rest following a concussion to allow the brain to heal, the amount of time an individual needs to rest will vary. This time frame depends on factors such as your age, the severity and number of concussions you’ve sustained, and your health status prior to the concussion. The amount of “bedrest” needed directly post concussion may be none at all, 24 hours, days, or possibly weeks but in general it is not months. You may not be 100% healed when you slowly integrate yourself back into “activity” mode, but your symptoms should have abated. It is important to start slowly with such things as doing light chores around the house or going for a walk. Periods of rest throughout the day are more appropriate than staying in bed all day. That being said, when it comes to returning to participation in sports your symptoms SHOULD be completely resolved before doing so.
So you’ve tried to gradually resume activity but you find you still aren’t back to your old self yet. Who can help you now?
Believe it or not, a physical therapist can help you rehabilitate after a concussion but it has to be a physical therapist trained in this specialized kind of care. Those called “Vestibular Physiotherapists” (or Vestibular Physical Therapists – same thing) are often trained in treating post concussion symptoms.
Most people think of physical therapy as just that: “physical” therapy where our primary focus is physical reconditioning. While concussion treatment does involve a physical component when the patient is ready, there is a lot more to concussion rehabilitation than that. There is a whole program of visual tracking, gaze stability, balance, proprioceptive reconditioning, desensitization, memory and cognitive exercises that can be prescribed based on your individual deficits. A vestibular therapist can assess you to determine which systems aren’t functioning properly and create a home exercise program tailored just for you. They can also correspond with your family doctor or neurologist so that all of your health care practitioners are on the same page. (It helps when one hand knows what the other is doing!)
Almost done gabbing…
So what does this mean for you or a loved one if you’ve suffered a concussion? Most people’s symptoms are gone within days and the vast majority (85-90%) by three months, but if yours are lingering on there is help out there in the form of treatment, guidance, and answers to your questions. People experience concussions differently and get better at different rates, but the vast majority of people DO get better. Time is an important component in healing after a concussion and so is a vestibular physiotherapist!
References
- http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0069122Donaldson L, Asbridge M, Cusimano MD (2013) Bodychecking Rules and Concussion in Elite Hockey. PLoS ONE 8(7): e69122. doi:10.1371/journal.pone.0069122.
- http://www.thestar.com/sports/football/argos/2011/04/07/cfl_concussions_not_always_revealed_to fans.html
- http://www.dana.org/media/detail.aspx?id=25076#_edn1
- Br J Sports Med. 2013 Jan;47(1):15-26.
- Cassidy et al, J Rehabil Med 2004; Suppl. 43: 28–60.
- Can J Neurol Sci. 2009 Jul;36(4):429-35.
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