Concussion – Unsafe at Any Impact?

3D color illustration of human anatomy highlighting the brain and attachment to cervical spine

Posted on 9/9/2022

One of the myths about concussion is that it takes a big blow to the head to get one.

A second is that getting your “bell rung” or “seeing stars” isn’t a big deal.

They’re just that. Myths.

The fact is any impact to the head, neck or body has the potential to cause a concussion. In turn that can temporarily shift the neurological function of the brain.

While a hit to the head during a high-intensity football game or from a car accident can result in concussion, less intense trauma can do the same.

In my years of practice, I’ve seen people with significant concussion symptoms from a slip and fall on ice. And from accidental encounters with a cabinet door to taking an elbow to the head.

And from luggage falling out of the overhead bin. There’s a reason for those cautionary announcements when the plane lands.

I see patients suffering from motor vehicle collisions who never even hit their head, and I see athletes who can’t pinpoint a specific hit. Yet they showed concussion symptoms after the accident or game.

A third common myth: concussion requires a loss of consciousness.

Wrong.

A loss of consciousness is not the norm. Losing consciousness happens in less than 10% of concussion cases.

Concussion: an invisible condition

Young female, eyes closed, holding her hands at the temples with imaginary white rings circling her head.What makes concussion more complicated is its invisible nature.

Unlike a cut or broken bone where you can see physical trauma, concussion can often go unseen.

So you need to look for common symptoms:

  • Headaches
  • Dizziness
  • Foggy or difficulty thinking
  • Blurred or double vision
  • Sensitivity to light or sound
  • Changes in sleep patterns
  • Increases in anxiety and irritability

Any of these symptoms can significantly impact your ability to function. They could also indicate a deeper type of trauma.

It’s critical that if you experience one or more of them, tell someone and get checked out by a medical professional.

Concussion PT: return to sport and return to life

As physical therapy specialists, our job is to promote awareness and education across the many types of health conditions our patients come to us for.

Patients sometimes come to us for physical therapy from a doctor’s recommendation after medical treatment. Or they may come to us of their own accord.

In either case, we’ve seen that starting physical therapy early can be hugely beneficial in a successful recovery.

An important first step is recognizing any of the symptoms listed above that could be connected to a physical impact, even if it seemed like “just a bump” on the head.

Despite how or when someone sustained a concussion, the current recommendation to help is an active treatment and rehabilitation program. Our concussion rehabilitation clinicians will do an assessment to develop a care plan unique to each person and case.

In the past, the primary treatment for concussion was total rest, sometimes called “cocooning.”

More recent findings show that after an initial 24-48 hours of rest, a combination of carefully prescribed physical and mental activity is better than total rest. That doesn’t mean, though, that you should go full force into your previous activities.

Rather, as long as you have lingering symptoms post-concussion, the care plan set for you can help guide your activity until fully healthy, safe and ready to safely return to your sport or normal symptom-free life.

So, what are some common concussion rehabilitation treatments?

Visual exercises can help when symptoms are due, in part, to the eyes not communicating well with each other and the brain. These exercises can help increase visual clarity due to the eyes working inefficiently. This may involve doing simple eye movements or complicated tasks of watching a busy scene with many moving items.

Vestibular rehabilitation is used when the inner ears are involved. The inner ears control balance and keep us oriented to the space around us. Treatment can be varied but typically involves head or body movement activities. You may initially feel dizzier with these exercises, but they are effective in eliminating symptoms in the end.

Neck treatments can address any neck pain or the many symptoms that can impact the neck after concussion. Sometimes after an injury, the nerves in the neck stop communicating well with the brain. This can lead to a sense of fogginess, dizziness, unbalance or headaches. Specific exercises can retrain these nerves and, in turn, clear up remaining symptoms.

Sub-symptom exertion training is frequently recommended post-concussion. This training is designed specifically based on a heart rate that would increase your symptoms. In basic terms, it’s a way to set a safe exercise program to help gradually return you to pre-concussion activity levels. For athletes, this can be one of the first steps of a Return to Play protocol.

Balance and functional training may be part of your full rehabilitation program. This training is used to restore/maintain strength, balance and walking safety.

Concussion prevention and one last myth

Unfortunately, there’s not a lot to be done in preventing concussion.

Protective equipment, such as helmets or mouth guards, may protect against other serious injuries but can’t prevent a concussion.

They are important in preventing skull or jaw fractures or cerebral bleeding, but their limitation in concussion protection is an all too common misconception.

In fact, using equipment can lend a false sense in thinking it can prevent concussion.

The best approach is being vigilant about injuries and any post-injury symptoms.

Early recognition of concussion can lead to faster recovery. Knowing what to look for and awareness of the myths surrounding concussion can help protect against a delayed recovery. A concussion isn’t less impactful just because it didn’t knock you out or have you seeing stars.

Lastly, always take the important steps for recovery. Many people will recover on their own. But if you or someone you know have lingering symptoms, we can help.

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Melissa Bloom, P.T., DPT, NCS, is a board-certified specialist in neurologic physical therapy. She is Select Medical’s Outpatient Division's national coordinator of concussion and vestibular services and treats patients at NovaCare Rehabilitation in Baltimore, MD. Melissa has served as a board member on the American Physical Therapy Association's Vestibular Specialist Interest Group and as the Chair of the Georgia Neurologic Special Interest Group. She specializes in vestibular and concussion rehabilitation and has lectured nationally on both topics.

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