Concussion & Return to Sport
Article by Zoe Russell
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.
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).
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!
More Info
Article by Matthew Hewitt
Headache Causes
Headaches and migraines, unfortunately common, can greatly affect our lives. Understanding their types and causes is key to effective management and treatment.
Headaches and migraines can stem from a variety of factors. These include conditions related to the neck and jaw. Some specific types you might experience are neck, tension, cluster, and migraines.
Neck-related issues like neck pain, facet dysfunction, and pinched nerves can also lead to headaches. Additionally, jaw conditions such as TMJ pain and dysfunction can cause jaw headaches.
Headache Symptoms Differ
Identifying a headache's location, duration, and intensity can help pinpoint potential causes and effective treatments. This information isn't definitive but helps distinguish possible headache or migraine types.
Common Headache Types
Tension-Type Headaches
Tension-type headaches usually feel like a band across the forehead, extending into the neck. They are continuous, non-pulsating, and may be accompanied by neck or shoulder tenderness, but not nausea or increased sensory sensitivity.
Jaw Headache
TMJ or jaw-related headaches are localised around the jaw and ear, affecting one side. They often come with jaw movement issues, chewing difficulties, or sensations of clicking, locking, and catching in the jaw. TMJ physiotherapists and your dentist are good practitioners to start with to assess and treat your TMJ headache.
Neck Headache
Neck headaches (cervicogenic headaches) are typically a steady, non-throbbing pain at the skull's base, around one eye, or over the top of the head. They may also involve limited neck mobility, but this is not essential. your physiotherapist is best person to see for assessing and relieving your neck headache.
Cluster Headache
Cluster headaches are intensely concentrated around one eye. Accompanying symptoms can include a runny nose, drooping or reddened eye, or increased facial perspiration.
Concussion Headache
Concussion-related headaches resemble migraines with a throbbing sensation and are closely linked to concussions. If these headaches worsen, or if symptoms like slurred speech, seizures, or unusual behaviour occur, seek medical attention immediately.
Sinus Headache
Sinus headaches are characterised by pain, pressure, or fullness from the sinuses, often worsening when bending forward or lying down. They can also cause toothache-like pain or nasal congestion.
Migraines
Migraines often affect one side of the head, involving the entire side of the head and face. They can occur with or without visual disturbances (aura) and include symptoms like nausea and sensitivity to light and noise.
In Conclusion
The causes of headaches and migraines vary, as do their treatments. Consult a healthcare practitioner such as your physiotherapist or doctor for accurate diagnosis and tailored treatment plans. Understanding these differences is essential for effective headache management and relief.
General Information
- Migraine vs Headache
- Specific Migraine - Headache Types
- Neck Headache
- Tension Headache
- Cluster Headaches
- Migraine
- Vestibular Migraine
- TMJ Headache
- Concussion
Headache FAQs
Article by John Miller
When Should You Worry About a Headache?
In a small number of patients, your head pain might have a serious cause that needs investigation. These are called Red Flags, as they can be important signs of underlying conditions like brain tumors, aneurysms, strokes, meningitis, and other systemic illnesses. If you experience any of the following symptoms, seek urgent advice from your healthcare professional.
Thoroughly investigate any Red Flags!
We strongly recommend that you ask your doctor to investigate your headaches if they have any of these characteristics:
- The worst headache you've ever had or a different type from your usual.
- Your headache is triggered by exertion (like exercise, coughing, sneezing, or sex).
- You're over 50 years old.
- Your headache persists despite treatment.
- It came on suddenly.
- You have central nervous system findings, such as motor weakness, memory loss, or slurred speech.
- You have HIV or another compromised immune system.
- You have a fever or other systemic symptoms, like weight loss or a rash.
If you have any of these Headache Red Flags symptoms, please consult your doctor immediately.
Less Urgent & Severe Headache Types
Fortunately, most headaches don't need urgent medical investigation and should improve with proper treatment once accurately diagnosed.
For specific advice, consult your doctor or a headache physiotherapist.
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Article by John Miller
Experiencing a Headache or Migraine?
Understand Your Options
Headaches and migraines are more than just a nuisance; they can significantly disrupt your daily life. When you start experiencing these symptoms, it's imperative to seek medical advice. Doctors often recommend neurological assessments and may suggest a CT or MRI scan. These scans are vital for excluding serious conditions like aneurysms or tumours. Most of the time, fortunately, the results are normal.
What to Do When Your Scans Are Clear
Getting a clear scan result brings a sigh of relief, eliminating concerns about serious underlying causes. Yet, the task of identifying the source of your headaches or migraines remains.
Identifying the Root Cause of Your Headache
At PhysioWorks, we understand that diagnosing the root cause of headaches is a key step in treatment. We primarily focus on three types of headaches:
Understanding Neck-Related Headaches
Researchers feel that about one in four headaches is linked to neck issues. A thorough neck examination by a skilled headache physiotherapist is crucial. In many cases, the physiotherapist can diagnose and begin treating your neck headache from the first consultation.
Neck Headache: A Deeper Insight
Neck headaches, or cervicogenic headaches, often originate from neck joints, muscles, or ligaments. Symptoms include pain starting at the back of the head, radiating forwards, neck stiffness, and sometimes shoulder or arm pain. Physiotherapy techniques like manual therapy, specific exercises, and posture correction can provide significant relief.
Related article: Neck Headaches
Tension-Type Headaches: Understanding and Management
Tension-type headaches, marked by a band-like pain around the head, are frequently associated with stress, poor posture, and muscular tension. Physiotherapy plays a critical role in managing these headaches, offering stress-reduction techniques, ergonomic advice, and exercises to improve posture and muscle function.
Related article: Tension-Type Headaches
TMJ Headaches: The Role of Physiotherapy
TMJ headaches, stemming from jaw joint and muscle issues, present symptoms like facial pain, jaw clicking, and chewing difficulties. Physiotherapists, with a skillset in jaw disorders, offer specialised exercises, manual therapy, and advice to improve jaw function.
Related article: TMJ headaches
Latest Research and Developments
Recent studies underscore the effectiveness of physiotherapy in headache management. Techniques such as dry needling, acupuncture, specific neck and shoulder exercises, posture correction, and relaxation strategies have shown promise in reducing the frequency and intensity of headaches.
Conclusion: Seeking Professional Help
Managing headaches and migraines often requires a targeted approach. Physiotherapy offers a range of treatments customised to your needs. If headaches or migraines are affecting your life, consider consulting a qualified headache physiotherapist. This could be a significant step towards a pain-free life. However, always start with a doctor's consultation to exclude any serious underlying conditions.
Call to Action: Consult a Professional
Don't let headaches dictate your life. Reach out to a headache physiotherapist or your doctor today to embark on your journey to recovery and improved quality of life. Remember, investing in your health is paramount.
What to Do? Seek Professional Advice from Your Physiotherapist
If you're struggling with headaches or migraines, the first step is to consult a physiotherapist specialised in headache management. They can provide a comprehensive assessment and tailor a treatment plan suited to your specific needs, incorporating the latest research and techniques. Booking a consultation can be your first step towards finding relief and regaining control of your life.
Additional Information
For more details on specific headache types, migraine comparisons, and frequently asked questions, visit our website for comprehensive guides on:
Original Article by Isabelle Kelly
References
https://www.racgp.org.au/afp/2014/march/sports-related-concussion/
Author Unknown. Date Unknown. Brain Concussion GIF. Retrieved from https://giphy.com/gifs/brain-concussion-NhXhI7kHCwxRC on the 01/06/2020
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BMJ Publishing Group. (2016). Managing recovery from concussion (infographic). BMJ 355:i5629 https://doi.org/10.1136/bmj.i5629
Chong & Schwedt. (2018). Research Imaging of Brain Structure and Function After Concussion. Headache, the Journal of Head and Face Pain. 58(6); 827-835 https://doi.org/10.1111/head.13269
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Johnson, Weber, Xiao, Cullen, Meaney, Stewart, & Smith. (2018). Mechanical disruption of the blood-brain barrier following experimental concussion. Acta neuropathologica, 135(5), 711-726.
Leddy, Baker & Willer. (2016). Active Rehabilitation of Concussion and Post-Concussion Syndrome. Phys Med Rehabil Clin N Am 27; 437–454. http://dx.doi.org/10.1016/j.pmr.2015.12.003
Makdisi, Davis, McCrory. (2014). Updated guidance for the management of sports-related concussion in general practice. Australian Family Physician 43(3) p94-99
McLendon, Kralik, Grayson & Golomb. (2019). The Controversial Second-Impact Syndrome: A Review of the LIterature. Pediatric Neurology. 62; 9-17 https://doi.org/10.1016/j.pediatrneurol.2016.03.009
Olson, Ellis, Selci & Russell. (2020). Delayed Symptom Onset Following Pediatric Sport-Related Concussion. Frontiers in Neurology. 11(220) https://doi.org/10.3389/fneur.2020.00220
Ontario Neurotrauma Foundation. (2019). Concussion Do’s’s and Don’ts’ts: The First Few Days of Recovery. Retrieved from http://concussionsontario.org/wp-content/uploads/2020/01/ONF-DoDonts-Tearaway-EN-Nov2019-WEB.pdf on the 03/06/2020
Schwab, Tator & Hazrati. (2019). DNA damage as a marker of brain damage in individuals with a history of concussions. Laboratory Investigation. 99(7), 1008
