When someone hits their head, we often hear the word ‘concussion’ thrown around. People will often advise us to check with a doctor to see if we are suffering from a concussion, but how exactly is a concussion diagnosed and how do we know if we have it? An even more urgent question is, what should we do if we suspect that we have a concussion? This article will serve as a concise and straightforward guide to those questions and give you the immediate answers you need.
What is a concussion?
Concussion is a form of traumatic brain injury that causes a disturbance in brain activity. It commonly happens as a result of an accident or sports injury.
There are 2 ways in which one has a high risk of getting a concussion:
First mechanism – Being hit directly over the head, as seen in contact sports like rugby or boxing.
Direct impact concussion: A heavy external force to the head can cause the brain to move and twist, causing a compression of the brain when it hits the surface of the skull.
Our brains are not free-moving inside our skulls. They are encased by three thin membranes called ‘meninges’ which function to protect the brain from trauma by absorbing shock forces. In between the meninges, fluid called ‘cerebrospinal fluid’ flows which also helps to cushion against any sudden impact. The combination of these two brain coverings, the meninges and cerebrospinal fluid, helps to anchor our brain within the hard skull and stops it from moving around whenever we turn our heads (or go to a Metallica concert!).
When something heavy hits our head, like a rugby ball at high velocity or a boxer’s fist, it can be impactful enough to cause our brain to move despite the presence of these protective casings. The force of the brain colliding against the hard casing of our inner skull can cause a compression to the brain, injuring it where the force was applied. When minute swelling occurs inside, it can then cause symptoms when the surrounding nerves become sensitised (Look below to section: How do I test if I have a concussion? What are the symptoms?).
Second mechanism – There is a hit over other parts of the body, resulting in indirect rapid movement over the head, as seen in car accidents and whiplash injuries.
Secondary impact concussion: A high velocity movement can cause your brain to shift forwards and backwards in the skull, bruising both the front and back of the brain.
When this happens, the impact may not be direct to the head but it can cause a similar injury to the brain. High velocity impact to external surroundings, like your car getting hit from behind or even getting shaken hard, can cause a shifting and twisting of your brain in the skull. The brain hits the front and back of the skull, giving multiple areas of impact and usually comes along with a neck strain.
How do I test if I have a concussion? What are the symptoms?
Concussion symptoms consist of a wide range of signs and presentations. Common post-concussion syndrome presentations can appear immediately after an injury, or within 24-72 hours after an impact. They include but are not limited to:
- Headaches/Migraines
- Dizziness
- Loss of consciousness
- Disorientation (unaware of time, date, or place) or getting easily distracted
- Memory problems
- Nausea
- Visual disturbances
- Sensitivity to light and sound
- Sudden mood swings (sudden anger, or crying for no apparent reason)
If you are unsure whether you are experiencing concussion, it is recommended to get it assessed by a certified healthcare professional to gain clarification.
Can an X-ray or MRI show a concussion?
Photo by the National Institute of Neurological Disorders and Stroke. An MRI of a patient’s brain 19 hours after a fall shows bleeding and damage to the meninges, the lining between the skull and the brain.
Diagnosis of concussion is usually assessed by a certified healthcare professional based on the detailed history of the athlete. One of the ways on how to check for a concussion can include an X-ray or MRI, only if an underlying pathology is suspected such as a severe brain injury till the point that internal bleeding is suspected, or a skull fracture has to be ruled out, or the incident also involves injury to the cervical spine/neck.
It is usually not needed if the impact is not very severe, as an X-ray or MRI cannot confirm a diagnosis of concussion. Again, a concussion cannot be shown on an X-ray or MRI because a concussion affects the functioning of the brain instead of causing concrete structural changes that can be seen on imaging. Often, if an MRI is done, swelling and bleeding can be visualised but the extent of the concussion damage still has to be confirmed through other mental and physical tests.
As stated in a workshop on the consequences of head impact on youth soccer, Dr. Kelly mentioned that a concussion is a, “traumatically induced alteration in mental status… lying on a spectrum of brain injury somewhere between ‘being dazed’ at the lower end to coma at the other extreme.”
How long does a concussion last?
The recovery period for concussion varies from person to person. Typically it takes about 1 week for an adult, and 2 weeks for children and adolescents. It is important to monitor the signs and symptoms during the initial onset and keep track of them from the time immediately post-impact to 3 days after.
Symptoms usually get better over time with rest. However, it is important to note that if symptoms persist or worsen, it is advisable to visit and discuss with your healthcare provider for further actions.
For athletes that are looking for ways to return to play/ train, a Graduated Return To Play (GTRP) programme should be followed. It is a 6-stage program designed to help athletes to return to sports safely post-concussion, and your trusted physiotherapist should be able to help with seeing the athlete through this safely.
What treatments should I do if I suspect I have a concussion?
Once concussion is diagnosed, there are few things that you should be aware of:
- Athlete should not be left alone for first 24 hours
This is in the event that things take a turn for the worse and seizures may occur, or loss of consciousness that can lead to falls and further injury. - Athlete should not consume alcohol/pain medication
Alcohol and painkillers may mask monitoring of pain symptoms. While this may sound counterintuitive because you would think that reducing pain after an injury is important, it can actually make monitoring pain difficult. You may not know if the pain is increasing in intensity over the initial 3 days. - Athlete should not be driving motor vehicles
Since nausea, dizziness, visual disturbances, and even memory loss can happen suddenly, it can make driving a danger to yourself and other people on the road. Ideally, driving should be avoided for up to a week.
- Rest the body, rest the brain
Finally, rest is important. Do not go back running out onto the field immediately because the more time you give yourself to rest and recover initially, the better your body can come back stronger!
Contact us if you have any other questions about concussion, or even if you are wondering whether you might be suffering from post-concussion syndrome. There are non-invasive treatment techniques through physiotherapy and chiropractic techniques that can help get you back on the road to recovery.
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