CONCUSSION
- Caren Winckler
- Sep 8, 2022
- 4 min read
Updated: Dec 19, 2022
We are all enjoying the freedom of sport these last couple of months. For players, parents and couches alike, the uncertain reality of CONCUSSIONS place a slight shadow over this bright sport season.
Today I would like to give a bit more information on what Concussion is, what we can do to prevent it if possible and what to do and expect if we are dealing with a concussion.
WHAT IS A CONCUSSION?
It has been described as a metabolic, physiological and microstructural injury to the brain.
The brain consists of nerves that is divided into left and right halves with central structures that connect the two halves. These central structures are vital for communication between the two halves. During concussion the central part become injured as the halves pull away from it. These nerves then get torn or broken. There is further shearing forces between the nerves that forms the white and grey matter of the brain.
HOW DOES A CONCUSSION HAPPEN?
Previously we all thought that concussion happens when you bump your head really hard. What the researched have shown us is that you can in fact sustain a concussion WITHOUT your head striking an object, such as a whiplash injury.
HOW DO I KNOW THIS IS A CONCUSSION?
Concussion is a clinical diagnosis, meaning that we can only diagnose it by symptoms and clinical tests. Unfortunately MRI or CT scans is not sensitive enough to detect these injuries.
In up to 90% of cases, there is no loss of consciousness with the result that almost half of all concussions go unidentified or undiagnosed. It may or may not include amnesia. Alterations in metal status, which usually resolves in 7-10 days occur for most adults. Symptoms can be defined into four categories:
Cognitive ( meaning difficulty to concentrate and difficulty to remember and study)
Sleep or Fatigue (some patients can’t sleep, others want to sleep all the time)
Emotional (irritable, tearful, anxious, short tempered)
Somatic (headaches, dizziness, neck pain)
CAN A CONCUSSION GET HEALED?
Most concussions recovery completely. Research shows that 20% of concussed patients continue to report post-concussive symptoms for months and even years after an injury. Research has shown that the injury typically resolves, assuming no recurrent insult, within days to weeks after the injury is sustained (Giza CC et al. 2001).
Children and adolescents are far more susceptible to concussion, take longer to recover, may have more memory and mental processing issues, and are more susceptible to rare and dangerous neurological complications.
WHY IS A QUICK RETURN TO SPORT CONSIDERED DANGEROUS?
If a person sustain a second concussion or recurrent concussions and the brain is not allowed enough time to recover the following injuries can occur:
A condition called chronic traumatic encepalopathy (CTE) is caused by repeated head injuries. The problem is symptoms only start years after the injuries. Symptoms include mood and cognitive problems that may worsen over time and cause dementia. CTE can only be officially diagnosed on autopsy through brain tissue analysis.
Second Impact Syndrome (SIS) is a condition to be believed to be the sudden death in athletic children and young adults, SIS occur when a second concussion occurs before symptom resolution from the first concussion, resulting in catastrophic brain oedema. This topic is a bit on the controversial side at present.
CONCUSSION IN RUGBY
SARU views concussion very seriously. All couches, referrees and medical staff need to be trained in the protocols of concussion. The Boksmart program has very good information with regards to this.
HOW CAN I PREVENT OR REDUCE THE EFFECT OF CONCUSSION?
The Boksmart program describe the 5 E’s of concussion prevention, this is freely available and worth the read.
What we can underline is the neck strengthening that is part of this protocol. Neck strengthening exercises need to done 2-3 a week throughout the year.
HOW LONG SHOULD A CONCUSSED PLAYER REST AFTER A CONCUSSION INJURY?
These protocols are well researched and obtained from the rugby Boksmart program:
Players 18 years and younger: a minimum of two weeks off before starting the 4 day Graded Return to Sport process (earliest return to play = Day 19 post injury)
Players 19 years and older: a minimum of 1 week off before starting the 4 day Graded Return to Sport process (Earliest return to Play = Day 12 post injury)
THE DO’S AND DON’TS AFTER A CONCUSSION
Alcohol intake: until symptoms has cleared
Driving: after a concussion you may have delayed reaction times and concentration
Rest: The brain needs as much rest as possible, so avoid exercise, studying, computer work, bright lights and loud noise.
Sleep: Tiredness and drowsiness is common following concussion. Once they have been medically assessed and their condition has stabilised, allow them to sleep as required. If they are unable to wake up normally, take them to the hospital.
Medication: Do not give them anti-inflammatory medication and do not let them take sleeping tablets or aspirins. Consult your doctor for pain medication.
WHAT CAN A CONCUSSED PATIENT DO TO IMPROVE THE RECOVERY?
If you or someone you know has suffered a concussion, the lingering effects can be frustratingly stubborn. Lack of balance and coordination, headaches, and dizziness may remain, even after the traditional waiting period of 24 hours has passed. Concussion management or rehabilitation is especially important to prevent long-term effects. At Winckler and Steyn Physiotherapists our physiotherapists will design an individualized program to treat your concussion symptoms safely and effectively.
References
Giza CC, Hovda DA. The neurometabolic cascade of concussion. Journal of athletic training. 2001 Jul;36(3):228.
McLendon LA, Kralik SF, Grayson PA, Golomb MR. The controversial second impact syndrome: a review of the literature. Pediatric neurology. 2016 Sep 1;62:9-17.
McKee AC, Daneshvar DH. The neuropathology of traumatic brain injury. InHandbook of clinical neurology 2015 Jan 1 (Vol. 127, pp. 45-66). Elsevier.
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