What is a Concussion?

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What is a concussion? 

A concussion is a brain injury caused by a complex physical process affecting the brain, induced by biomechanical forces.

Clinical symptoms of concussion

The most commonly reported symptoms are occipital headache, blurry vision, nausea, dizziness, balance problems, a “foggy feeling,” difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability. Clinically these symptoms fall into four major categories:
1. Somatic: Headaches, nausea, vomiting, balance and or visual problems, and sensitivity to light and noise
2. Emotional: Sadness to the point of depression, nervousness, and irritability
3. Sleep disturbance: Sleeping more or less than usual and having trouble falling asleep
4. Cognitive: Difficulty concentrating, troubles with memory, feeling mentally slow or as if in a fog that will not lift

Why helmets don't prevent concussions

In this talk David Camarillo shows what really happens during a concussion — and why standard sports helmets don't prevent it. 

Cervicogenic headaches and massage therapy

Concussion is an injury that typically resolves quite quickly in most people (symptoms generally disappear for 80-90% of patients within 7 to 10 days), however whiplash symptoms can linger for up to a year or more. Early interventions reduces the risk of cervicogenic headaches developing into chronic post concussion headaches, but, do not attempt to treat the concussion directly, instead treat the impairments that may be related to or irritating, based on patient-specific assessment findings and patient tolerance.

Manual therapy techniques applied to muscles, surrounding connective tissue, peripheral nerves and soft tissue interface can yield good therapeutic results. Muscles to keep in mind while assessing and treating athletes who have suffered a concussion include, but are not limited to, Suboccipitals, Upper trapezius, Splenius Cervicis Splenius Capitis Levator Scapula, Rhomboids, Temporalis, Occipitofrontalis, Corrugator Supercilii, Masseter, Sternocleidomastoid (SCM), Scalene Muscle Group.

Become a resource for patients

Evidence based practice is the cornerstone of symptom management, the most important part of the health care professional’s involvement in managing concussions is ongoing education regarding signs and symptoms of concussion. There is still no “silver bullet” that exists for concussion rehabilitation, however Massage Therapists can be a valuable resource for patients that have suffered a concussion. It is important to remind patients:

  • Changes in the definition and management of concussions have occurred
  • A concussion is not a structural injury, but biochemical in nature - no objective measures to diagnose concussion
  • Time to heal is variable, the severity of injury is not known until symptoms resolve
  • Importance of rest from aggravating activities
  • Whiplash injuries often accompany concussions, treating whiplash symptoms can often improve outcomes in patients who suffer a concussion
  • What works for one person may not work for another

More to Explore

Blanpied, P.R., Gross, A.R., Elliott, J.M., Devaney, L.L., Clewley, D., Walton, D.M., Sparks, C., Robertson, E.K. (2017). Neck Pain: Revision 2017. J Orthop Sports Phys Ther
https://www.ncbi.nlm.nih.gov/pubmed/28666405

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Cheever, K., Kawata, K., Tierney, R., Galgon, A. (2016). Cervical Injury Assessments for Concussion Evaluation: A Review. J Athl Train. 
https://www.ncbi.nlm.nih.gov/pubmed/27835042

Cohen, S.P., Hooten, W.M. (2017). Advances in the diagnosis and management of neck pain. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28807894

Ellis, M.J., Leddy, J., Willer, B. (2016). Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach. Front Neurol. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/27605923

Kennedy, E., Quinn, D., Tumilty, S., Chapple, C.M. (2017). Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis. Musculoskelet Sci Pract. 
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Leddy, J., Baker, J.G., Haider, M.N., Hinds, A., Willer, B. (2017). A Physiological Approach to Prolonged Recovery From Sport-Related Concussion. J Athl Train.
https://www.ncbi.nlm.nih.gov/pubmed/28387557

Lucas, S., Blume, H.K. (2017). Sport-Related Headache. Neurol Clin. 
https://www.ncbi.nlm.nih.gov/pubmed/28673412/

Luedtke, K., Boissonnault, W., Caspersen, N., Castien, R., Chaibi, A., Falla, D., . . . May, A. (2016). International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Manual Therapy.
http://www.ncbi.nlm.nih.gov/pubmed/27183831

Luedtke, K., Starke, W., May, A. (2017). Musculoskeletal dysfunction in migraine patients. Cephalalgia.
https://www.ncbi.nlm.nih.gov/pubmed/28641450

Makdissi, M., Schneider, K.J., ... Johnston, K.M. (2017). Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28483928

Marshall, C. M., Vernon, H., Leddy, J. J., & Baldwin, B. A. (2015). The role of the cervical spine in post-concussion syndrome. The Physician and Sportsmedicine. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/26138797

Matuszak, J.M., McVige, J., McPherson, J., Willer, B., Leddy, J. (2016). A Practical Concussion Physical Examination Toolbox. Sports Health. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/27022058/

McCrory, P., Meeuwisse, W., Dvorak, J., ... Vos, P.E. (2017). Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28446457

 

Millstine, D., Chen, C., Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/2851211

Morin, M., Langevin, P., & Fait, P. (2016). Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review. Journal of Sports Medicine. (Open Access)
https://www.ncbi.nlm.nih.gov/pubmed/27529079

Quatman-Yates, C., Cupp, A., Gunsch, C., Haley, T., Vaculik, S., Kujawa, D. (2016). Physical Rehabilitation Interventions for Post-mTBI Symptoms Lasting Greater Than 2 Weeks: Systematic Review. Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/27197826

Schneider, K. J. (2016). Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. Journal of Orthopaedic & Sports Physical Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/27477472

Schneider, K.J., Leddy, J.J., ... Makdissi, M. (2017). Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28341726