Concussion: What You Need to Know After Head Injury

Let’s talk concussion! 

So, if you get hit in the head or are involved in some sort of accident, motor vehicle or otherwise, and you feel immediate symptoms, then you are considered to have a concussion. The first thing you want to do is see a trained medical provider familiar with concussions and preferably concussion rehabilitation.

It’s important to get in as soon as you can so we can get started on the best recovery strategy known to man, ACTIVE RECOVERY!!!! 

Concussions are considered mild traumatic brain injuries, emphasis on MILD. So, don’t let it scare you!! There is no brain damage that occurs with these injuries and there will be NO long-lasting negative effects if managed properly. 

Basically, a concussion is a rapid acceleration-deceleration of the brain and what happens is a stretching/shearing of your brain’s neurons, and with that comes an ion shift in and out of the axons (neuron tails that connect to other neurons, very scientific!). Initially, this creates an EXCITATORY PHASE, and this is where one might experience symptoms such as dizziness, vision changes (blurred or double), ringing in the ears, nausea, headache, confusion, fogginess, imbalance, and other such symptoms. This phase can be short-lived or last a couple hours. So, if you are playing a sport, you take a blow to the head or fall, and your symptoms go away quickly, you or your child should be removed from play IMMEDIATELY! 

Seeing a medical provider ASAP is important in order to rule out more serious injury that may have occurred including spine injury or bleeding in the brain. 

Red Flags indicating an emergency situation include: 

  • Severe or worsening headache 
  • Seizures (w/ no history of seizures) 
  • Weakness in an extremity 
  • 2+ episodes of vomiting 
  • Diminishing alertness 
  • Changes in vision
  • Numbness or tingling 
  • Difficulty speaking or understanding speech, reading or writing 
  • Difficulty swallowing
  • Loss of fine motor skills or tremors 
  • Loss of coordination (as time evolves) 
  • Abnormal sense of taste
  • Loss of Consciousness  

The next phase is a brain metabolism SPREADING DEPRESSION PHASE. Here your brain’s metabolism slows way down, and you may experience unusual fatigue, lethargy, trouble focusing, difficulty with memory, and you may have trouble completing tasks at work or school. Here is where modifications to school or work may need to be made. 

The first 48 hours after acute injury need to be relative rest. Basically, take it easy and limit your activity to not increase symptoms. This doesn’t mean to lock yourself in a dark room and do nothing! You can still watch TV or go on computer (but limit your screen time to short bouts of 5-15 minutes), read, walk, interact with family and friends. Even if you currently have symptoms, simply limit these activities to not increase your baseline symptoms. Easy!

Returning to school or work can seem daunting, but with some guidance, it can go smoothly and returning to full participation won’t be delayed too long. 

Day 1 post-concussion: Daily activities at home without increased symptoms (check email, watch the news, read, go for a walk, laundry, dishes, etc.). Start with 5-15 minute at a time and gradually progress as tolerated.  

Day 2: School/Work Activities (cognitive). Homework, reading, other cognitive activities at home without increasing baseline symptoms. 

Day 3: Return to work/school part-time. Gradual introduction to schoolwork, Partial school/workday or more rest breaks. 

  • Note from doctor to teacher can help here to address modifications needed. i.e. more time for work completion, frequent breaks as needed, rescheduled tests or assignments, increased time during passing periods, private lunchroom to avoid excessively busy environments that may flare symptoms or risk of taking another blow to the head. No P.E. until cleared by medical professional. 

Day 4: Return to work/school full time. Gradually progress school/work activities until full day is tolerable (no gym class). Catch up on missed work. 

**There should be 24 hours between each stage.** 

Going to grocery store or the mall can often increase people’s symptoms in these early stages as well. If you find that this is true for you, don’t avoid these environments completely. Go in and shop for as long as you can tolerate, if symptoms start to increase, go back outside, wait for symptoms to return to baseline, and go back in to continue. This will help desensitize your system and improve your tolerance. 

Bright lights can also be a source of symptom exacerbation, but don’t be that person wearing sunglasses indoors! You have to allow your eyes to adjust and this will also help desensitize your eyes and improve tolerance. It’s all about graded exposure!! It’s similar to when you go see a matinee movie showing and come out when the sun is still out. At first, the bright light may hurt your eyes. But if you give it time your eyes adjust.  

Returning to sports and physical activity is a topic for another blog post (too much to go over here). 

Symptoms should subside within that first week, and if they don’t, it is even more imperative you see a trained rehabilitation specialist familiar with managing concussions to obtain a plan and address these issues. 

Many people are still misinformed regarding management of concussion (even doctors and nurses) and they are still encouraging the wrong strategies to their patients! MOTI Physiotherapy is here to help recover from these injuries safer and faster!! The danger in concussions is people not taking the appropriate steps to return to cognitive and physical activity safely and efficiently. Athletes returning to their sport too soon run the risk of taking another blow to the head before their body is ready, and THAT is dangerous!!! A second impact during that depression phase can lead to worse injury including brain damage, prolonged symptoms, delayed recovery, increased risk of future concussion coming easier and taking longer and longer to recover!

Complications from poor concussion recovery are easily avoidable and when the appropriate steps are taken to return to learn and return to sport, there is nothing to fear. 

Just remember: There isn’t a concussion problem in this country or in sports (football), there is a concussion management problem! 

– Kirk Ramirez, PT, DPT

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