Concussion Management
In this in-service blog post, we have had the opportunity for our guest speaker Alex Abundo, a practicing Physiotherapist from Myodetox Oak, to present to us on assessing and managing concussions.
What is a Concussion? A concussion is a mild traumatic brain injury induced by biomechanical forces (acceleration/deceleration of the head) that results in temporary deficits in neurological function with an absence of overt structural damage. These cause stretching of neurons that leads to an increase in extracellular K+ and causing an influx of calcium (Ca2+). Overall this leads to an increased usage of ATP in the brain and causes an overall depletion of ATP stores in the body. As a result, it leads to symptoms such as a decrease in energy. It is suggested that symptoms recover within 7-10 days and full metabolic recovery occurs between 22-45 days. However, any symptoms that persist for greater than 30 days, are considered a post-concussion syndrome (PCS).
Post Concussion Syndrome (PCS): Concussion symptoms that persist beyond 30 days can be exacerbated/caused due to:
1. Changes in blood flow
2. Metabolic inflammation
3. Deficits of the vestibular system
4. Neck/cervical spine dysfunctions
5. Psychological -anxiety/depression
Second Impact Syndrome: If another concussion occurs before complete recovery (22-45 days), it will take an additional 90-120 days for full metabolic recovery and this is known as second impact syndrome. Secondary head injuries following another injury or after a short period of time can lead to the possibility of delayed recovery and/or prolonged concussion symptoms. A Guideline to Post Concussion syndrome Treatment: If you are an individual who has recently experienced an MVA or any head injury resulting in a concussion, it is important to educate yourself about seeking and performing appropriate care for a concussion.
Concussion-related symptoms can include:
●Headache/Dizziness
●Blurred vision
●Lack of concentration
●Fatigue/Low Energy
●Sensitivity to noise and/or light
●Anxiety
●Nausea/Vomiting
➔Do not only rest or stay sedentary
➔Continue all cognitive activities as tolerated, with careful consideration towards the aggravation of concussion-related symptoms
➔No risky physical activity for 3 weeks (before metabolic recovery), however light, progressive aerobic exercise is encouraged.
➔Suggested 20-30 minutes of walking daily
Returning to school/work:
Increase cognitive load from home after 3 days. -When tolerable, perform 1 hour of work from home and start half days at work/school-Take breaks as required to manage symptoms and modify as needed
Symptom Limited Activity:
Activities that do not provoke symptoms. Avoiding complete rest, dark rooms, and staying sedentary/inside.
↓Light Cognitive Activity: Reading, computer work/screen time, homework. If symptoms persist, take a break and resume activity later. If able to tolerate 45 mins with no symptoms, able to progress into the next stage.
↓Half Day School/Work:
Restrictions: manual labor/physical activities/heavy equipment
↓Full Day School/Work:
Restrictions: same as half day, avoiding strenuous activities and monitoring if symptoms are aggravated.
↓Full Day School/Work (No Restrictions):
Begin light to moderate activity, ramping up intensity/frequency progressively. Ex. short walks, stationary biking, swimming
Returning to physical work/return to play:
Provide more rest days in between and modify as tolerated
Light physical activity → light sport-specific non-contact drills → high-intensity non-contact drills → full practice → full game
To move into a new phase, an individual must be symptom-free for 24 hours
