Concussion & Return to Sport
Concussion and Return to Sport
What is a Concussion?
A concussion is a brain injury that is associated with usually short-lived, transient deterioration of brain function. A concussion is a functional injury rather than a structural one.
What Causes Concussion?
Concussions can occur from a direct blow to the head or body. A hard skull casing protects our brains, so when the head or body encounters an impact, the softer brain bounces up against the hard skull wall, injuring it. You can think of it as a bruise. We aren’t exactly sure of what is going on inside the brain during a concussion, but p signals in the brain get mixed up, delayed and a bit lost due to a change in normal chemical signalling between neurons (brain cells).
Retrieved from https://giphy.com/gifs/brain-concussion-NhXhI7kHCwxRC on 01/07/2020
What are the Concussion Symptoms?
Symptoms of concussion vary widely, so it is essential to take brain injuries like concussions seriously so that everyone can get the best care possible and avoid any complications. When in doubt, get checked out by a qualified professional. Sometimes this is available pitchside, or you might need to visit your GP or the emergency room, depending on the severity of your symptoms. If you have any critical symptoms or loss of consciousness – call an ambulance.
(Australian Sports Commission, 2020)
How is Concussion Diagnosed?
When a concussion occurs, there is no structural change in the brain, so there aren’t any scans that we can do to detect a concussion. A scan like a head x-ray, CT or MRI might be needed to rule out other types of brain problems, including bruising, swelling, bleeding, and skull/neck fracture (Denay & Martin, 2020).
New research for diagnosing concussion centres around cutting edge imaging techniques, which detect changes in brain cell chemical and electrical functioning (Chong & Schwedt, 2018). There are also new tests to detect protein abnormalities in the brain, indicating damage (Schwab, Tator & Hazrati, 2019). Research in animals also suggests that disruption to the blood-brain barrier function may occur in concussion (Johnson et al., 2018). All of this research is very early and isn’t recommended for medical use just yet because the reliability and accuracy of the tests still require validation.
You Have A Concussion. What Should You Do Next?
If you have sustained a head injury, you should be immediately removed from play and assessed. A pitchside or emergency room health professional will use a series of questions, clinical tests and observations to decide if you have a concussion or not or another injury. Depending on the severity of your symptoms, further tests might be needed, which you can only get at a hospital. It’s important not to skip this bit, even if you feel alright. Concussion symptoms can lag by an hour or more, so rest and thorough testing are critical (Olson, Ellis, Selci & Russell, 2020). Continuing to play with a concussion is the most influential factor we know that prolongs concussion symptoms and slows recovery (Elbin et al., 2017).
If your symptoms are deemed minor, your pitchside professional can assess and diagnose you. You will probably also be referred to your GP if this is the case. If there is no pitchside professional available, or your pitchside person doesn’t have concussion specific assessment training, you should visit an emergency room just in case. Depending on the severity, an ambulance is advisable to transport you there without moving your neck.
Immediate after-care for a concussion is essential. The vital do’s and don’ts can save you a lot of trouble in the long run.
The other thing to remember is that if pain relief medication is needed, avoid anti-inflammatories in the first 48-72 hours (Ghosh et al., 2019). Common over the counter anti-inflammatory medications in Australia are:
- Nurofen, Advil, Bugesic (ibuprofen)
- Voltaren, Dinac, Fenac (diclofenac)
- Celebrex (celecoxib)
- Naprogesic, Naprosyn, Aleve (naproxen)
What are the Concussion Treatment Options?
Generally, concussion treatment is rest followed by a steady reintroduction to a healthy life. With a bit of knowledge, this transition may usually be home-based with a bit of common sense. You will need to see your GP or trained health professional for clearance before returning to your sport.
Concussion symptoms usually deteriorate when you fatigue or your brain has had too much stimulation. In the early stages, simple things like going for a walk, watching TV or scrolling on your phone can be enough to tax your brain into being tired. Slowly, things should improve, and you’ll need fewer rest periods throughout the day. Once you can get through the day, you can return to school or work in small doses, progressing back to full time.
If you are having difficulty getting over the fatigue and symptoms from a concussion, you can do concussion rehabilitation. This rehab consists of a variety of training types based on the symptoms you’re experiencing. The main areas of brain function related to concussion symptoms are body pain, thinking, emotional, behavioural, consciousness and sleep disturbance (BMJ, 2016). Tailored rehabilitation reflects your unique cluster of symptoms. This rehab might include a thorough education program to understand your concussion, balance retraining, vision retraining and strict guidelines for returning to different types of exercise.
The recommended and typical course of recovery from a concussion is below. You can expect 2-3 days of symptoms and a steady return to work, school, or uni over the next two weeks. After that, you can begin your return to sport testing, which can occur in as little as five days for adults and ten days for children.
Staying away from high-risk head impact activities like tackling, heading a ball or accidentally getting hit again reduce the risk of something called ”second-impact syndrome. This delayed course of action is to protect your brain from long-term memory, emotional, thinking and movement difficulties called ”post-concussion syndrome” (Leddy, Baker & Willer, 2016). There is some evidence to suggest that a second concussion injury after the first one hasn’t finished healing can lead to brain bleeding with long term damage and can be fatal, although this is a hotly debated topic (McLendon, Kralik, Grayson & Golomb, 2016).
(BMJ Publishing Group, 2016)
For more information, get in contact with your GP or PhysioWorks physiotherapist, who can advise you on your best course of action. Guidance is essential for a concussion because every brain and brain injury is very different!
Common Causes of Headache & Migraine
Specific Migraine - Headache Types
- Neck Pain
- Bulging Disc
- Wry Neck
- Text Neck
- Pinched Nerve
- Cervical Radiculopathy
- Facet Joint Syndrome
- Neck Sprain
- What Causes Cervicogenic Headache?
- How Do You Get Rid Of A Neck Headache?
- When Should You Be Concerned About A Headache?
What's Causes Cervicogenic Headache?
Your neck headache originates from a variety of musculoskeletal and neurovascular structures. These structures include the upper three neck joints, C2/3 disc, spinal cord coverings, and neck muscles. Dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).
Upper Neck Joints
The most likely source of your neck headache is a dysfunction of your upper neck joints. Your neck muscles or nerves become involved from pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.
The most common cause of a neck headache is the dysfunction of your upper three neck joints. The most common neck joints involved are your:
- atlantooccipital joint (O-C1),
- Atlanto-axial joint (C1/2), and
- C2/3 cervical spine joints.
In simple terms, your neck joints can cause a neck headache or pain if they are either too stiff or move too much (e.g. wobbly and unsupported by weak muscles) or locked in an abnormal joint position, e.g. a locked facet joint or poor neck posture. Once your neck joint becomes stressed and painful, the pain signals refer to the trigeminocervical nucleus in your brainstem. You start to feel a neck headache or, in some cases, face pain!
Your neck and headache physiotherapist can assess and correct neck joint dysfunctions that result in a neck headache. Their professional diagnosis and treatment are essential for neck headache sufferers.
Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse—this further demands your overworking muscles resulting in muscle fatigue-related symptoms. Your deep neck flexors are frequently weak or lack endurance. Your neck muscles work best when they have healthy resting tension, length, strength, power and endurance.
Your skilled physiotherapist assesses and helps you correct any muscle imbalances that result in a neck headache.
Cervical and Occipital Nerves
Nerves in your upper neck may become pinched by extra bony growths, e.g. arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in the neural motion known as neuromechanosensitivity or abnormal neurodynamics. Irritation of your upper neck structures refer to pain messages along the nerves and cause your headache. In simple terms, your neck is the "switch", nerves are the "power cords", and your headache is where the "light" comes on.
Your headache physiotherapist can assess your neuromechanosensitivity.
How Do You Get Rid Of A Neck Headache?
Quality neck physiotherapy can have a speedy and effective result for relieving your neck headache—the key to better treatment response in confirming your diagnosis. After your assessment, your physiotherapist will start you with treatment techniques that address your problems.
Your neck headache treatment may include all or some of the following techniques:
- Stiff neck joints may need to be loosened or unlocked via joint mobilisation (gentle gliding techniques), joint traction or, in specific cases, a gentle and localised joint manipulation technique.
- Hypermobile (or dynamically unstable) joints may require specific deep neck muscle strengthening exercises to stabilise, control and limit the joint movement available.
- Tight or overactive muscles may require muscle stretching, neck massage, acupuncture, dry needling, trigger point release or other relaxation techniques.
- Weak muscles may require specific strengthening exercises. This weakness may include your postural shoulder blade and neck muscles.
- Nerve dysfunction identified by your physiotherapist will depend upon your specific examination findings. Neurosensitivity is a common finding that needs addressing with attentive, professional care.
- Posture correction via specific posture exercises, posture awareness techniques, posture taping, or a brace.
- Provide helpful advice on preventing neck dysfunction in the future, e.g. workstation setup, ergonomics, awkward neck positions and postures to avoid.
Who Treats Cervicogenic Headaches?
In addition to relieving your neck headaches, your physiotherapist aims to address why you are experiencing neck headaches. After all, helping you to avoid future neck headaches is a crucial component of your rehabilitation. Chronic headache sufferers typically resolve their neck headaches within days or weeks.
Relief of your neck headache is quite often immediate! If a neck headache solely causes your trouble, it is common to experience instant relief as you walk out of the clinic.
Depending on the severity and the specific underlying causes of your neck headaches, most sufferers will experience a reduced headache after your initial consultation.
For more information, please consult your neck headache physiotherapist.