Concussions: Are they all treated the same?

Concussions make up roughly 10% of all injuries in contact sports. Despite public awareness and athlete education surrounding concussions, a large number of athletes (50%) still under-report their concussions and return to play while still symptomatic. Although these athletes see no harm in playing with symptoms, it will prolong their recovery, and if they were to sustain a second concussion prior to the initial one healing, there is the potential for irreversible brain damage.

No two people will experience a concussion in the same way. There are a number of different symptoms that patients will experience, such as physical symptoms (headaches, fatigue, dizziness), cognitive issues (attention, concentration) and emotional disturbances (irritability, sadness). As such, assessment and treatment of concussions involves a multi-faceted approach in which many systems are examined and treated. Some of these systems include:

Cervical System: The cervical spine is particularly vulnerable following a concussion, given the whiplash mechanism, which usually occurs with concussions. Studies have shown that the range of linear acceleration needed to sustain a concussion is between 70-120 G’s, whereas a mild neck strain only requires 4.5 G’s. Therefore, it could be hypothesized that the majority of concussions might also have some degree of cervical spine injury, which may involve the soft tissue and/or joints of the neck. Continue reading more about neck injuries and concussions here.

Visual System: The visual system is largely interconnected with most areas of the brain (roughly 60%). As such, following a concussion, specific visual areas of the brain, as well as integrative pathways, can be affected, resulting in visual dysfunction. The prevalence of visual dysfunctions post concussion is roughly 40%. Unfortunately, unless an individual is assessed properly post concussion, these dysfunctions generally get missed, since often the symptoms are vague, such as having difficulty reading or concentrating. To read more about visual rehabilitation post concussion, click here.

Vestibular System: The vestibular system plays an essential role in balance, coordinating movement and spatial orientation. Following a concussion there can be direct/indirect damage to the vestibular system, which may result in the person feeling off balance, dizzy, nausea or lightheaded. Anywhere from 23-81% of patients will experience one or more of the above vestibular related symptoms post concussion. Continue reading more about vestibular rehabilitation post concussion here.

At Sheddon Physiotherapy and Sports Clinic (SPSC), concussed patients are thoroughly assessed in order to determine which systems are causing the concussion symptoms. From the assessment, patients will be given a treatment approach and exercise program tailored to their individual needs. Exercises may include visual rehab, balance retraining, neck strengthening and/or cognitive retraining exercises, eventually working towards return to sport.

Unfortunately, there is no single clinical test that can be done to know when an athlete has fully recovered from a concussion. Furthermore, symptom resolution occurs much sooner than brain recovery, which may put athletes at risk for returning to sport too quickly, especially if sport clearance is based solely on symptoms. In order to know when an athlete has fully recovered, the different areas of the brain that could potentially be affected with a concussion must be assessed. These different test results need to be compared to pre-injury values in order to know when an athlete has returned to their normal pre-concussion baseline values. As such, the best way to ensure that you return to sport safely following a concussion is to get baseline tested before a concussion even occurs. To learn more about baseline testing click here.

If you have experienced a concussion and are still suffering with symptoms, contact one of the therapists at SPSC in order to assess and treat these symptoms. If you have not suffered a concussion, but play a high-risk sport, contact SPSC regarding our baseline testing. At SPSC, we offer the most comprehensive concussion baseline testing of any sports medicine clinic in the Mississauga and Oakville area.