Concussion (Mild Traumatic Brain Injury)

What exactly is a concussion?

A concussion is a disruption of brain functions caused by an external force. This force leads to a rapid acceleration of the brain within the skull, causing stretching and twisting of the brain and neurons.

A functional injury, not structural

A concussion is a functional brain injury because it affects how the brain works, rather than its structure. The brain functions less effectively, but it is not damaged structurally.

You can compare it to a computer infected with a virus: the computer doesn't work as well, even if all its components are intact. In contrast, a moderate or severe TBI causes structural damage to the brain in addition to having functional consequences.

What are the symptoms of a concussion?

Concussion symptoms are varied and can affect several aspects of your daily functioning.

The most common symptoms

• Headaches
• Lightheadedness (not to be confused with vertigo)
• Fatigue and sleep problems
• Difficulty concentrating
• Sensitivity to light and noise

Other possible symptoms

• Vertigo and nausea
• Neck pain
• Irritability, sadness
• Feeling slowed down or confused
• Balance problems
• Blurred vision
• Memory problems

It's important to note that concussion symptoms are non-specific, meaning these symptoms can also be found in many other conditions. For example, people with migraines can also experience headaches, nausea, and light sensitivity. This makes diagnosing and treating a concussion more challenging and requires a healthcare professional with expertise.

Serious symptoms to watch for (red flags)

If you experience any of these signs or symptoms, you should go to the emergency room or see your doctor immediately:

It's always important to be more cautious when a person has previously suffered a concussion.

When do symptoms appear?

Symptoms may appear immediately after the injury, but also in the days that follow. It is therefore important to be vigilant in the hours and days following an injury in order to monitor the signs and symptoms of concussion.

What causes a concussion?

A concussion occurs when there is significant acceleration of the brain within the skull.

Examples of situations that can cause a concussion

• A rapid head movement
• A fall (while alpine skiing, rock climbing, falling down stairs, or cycling)
• A direct blow to the head (receiving a punch, getting hit on the head with a heavy object)
• A blow to the upper body (such as a body check in hockey)
• Any other situation that causes head acceleration

• A car accident or sudden braking
• A fall down the stairs or on ice
• A workplace accident

How is a concussion diagnosed?

A concussion is diagnosed solely based on the injury history and a physical examination.

A concussion can be suspected if you have experienced significant head acceleration and present even a single sign or symptom following that event.

Examples of diagnostic situations

• Getting checked in hockey or tackled in football and experiencing a headache or dizziness after the impact
• Being in a car accident and experiencing nausea afterward
• Getting hit on the head with an object and having difficulty concentrating afterward

It is not normal to have headaches at the end of a sports practice. This could be a sign of a poorly healed previous concussion or improper management of a current concussion.

Imaging tests

There is no test (X-ray, MRI, CT scan, blood test) that can detect a concussion, as there is no visible damage to the brain.

However, if there are severe clinical signs and symptoms, tests are necessary to rule out a more serious brain injury, such as a moderate or severe traumatic brain injury (TBI), or a skull or neck fracture.

When should you consult a physiotherapist for a concussion?

You should seek medical attention as soon as possible after an injury where a concussion is suspected.

If you haven't seen a physiotherapist quickly and have had symptoms for more than 14 days, you should consult a physiotherapist immediately.

The speed of concussion recovery is largely determined by when you consult a healthcare professional. The first few days after a concussion must be managed perfectly to achieve the fastest possible recovery. Therefore, it's crucial to receive the right advice and know what is allowed and what is not. The sooner you seek help, the faster you will recover.

Please note that your physiotherapist must be trained to treat concussions. Not all physiotherapists treat these types of injuries. You should specify this when booking your appointment.

You do not need to see a doctor before consulting a physiotherapist. If your physiotherapist determines that a medical evaluation is necessary, they will inform you.

Physiotherapy Treatments for Concussion

Concussion treatment in physiotherapy involves three parts.

1. Assessment and Treatment of Body Systems

Your physiotherapist is the only healthcare professional with the expertise to assess the three systems that may have been affected by a concussion:

After the assessment, your physiotherapist will determine the appropriate exercises for you to do at home and the right treatments to perform in the clinic to address any issues in one or more of these systems. They can treat joints, muscles, and nerves to help reduce symptoms.

To learn more about vestibular problems, consult our guide on the vertigo and dizziness.

2. Planning Your Return to Work or School

Your physiotherapist, often in collaboration with your doctor, will plan the gradual return to work or school after an initial break. They can advise on necessary adjustments, such as:

• Limiting the amount of homework and exams at school
• Managing the amount of time spent in front of screens
• Restricting the amount of physical exertion at work

3. Planning Your Return to Sports Activities

Your physiotherapist will also plan your return to sports training and, ultimately, your return to competition. This planning follows a specific protocol with steps to be followed. Your physiotherapist can also authorize a full return to competition with contact.

What to do at home for a concussion?

Concussion treatment involves several stages. Treatment parameters vary from person to person because no two concussions are exactly alike.

Step 1: Relative Rest (24 to 72 hours)

The first thing to do immediately when a concussion is suspected is to observe relative rest for 24 to 72 hours.

• Ensure you are accompanied and monitored by a loved one.
• Avoid any situation that could lead to an impact or acceleration to the head.
• Avoid any activity that significantly increases your symptoms.
• Do not remain completely inactive, lying in a dark room.

You can do a little reading, go for short walks, or do some light cooking, as long as your symptoms do not significantly worsen.

If your symptoms increase while doing light activities, you should rest until they subside before resuming those activities.

Step 2: Consultation with a Physiotherapist

You will have a complete assessment and a specific plan to follow with good exercises tailored to your condition.

Step 3: Return to Cognitive Activities

After a 24-hour period without any symptoms, we gradually begin light cognitive activity for 45-minute periods:

• Reading
• Crosswords
• Simple homework
• Answering emails

During this step, we make sure not to cause a significant increase in symptoms with these light activities.

Step 4: Return to Work or School and Physical Activities

After 24 hours without symptoms, a gradual return to school or work can begin. For physical activity, one can consider starting gradually four or five days after the injury.

We start with half-days every other day, then gradually increase the number of hours when there are no symptoms for more than 24 hours.

The young person should not be put in stressful situations at school, such as exams or academic catch-up, until they are much better. The main goal of this step is to get used to resuming a schedule, seeing people, and being back in their work or school environment.

It's important to note that throughout this recovery phase, being positive and optimistic about your progress will lead to a better outcome. Surround yourself with people who help you stay positive and avoid any conflict or negative emotional situations.

Post-Concussion Syndrome

When symptoms last more than 14 days for an adult or more than 4 weeks for a child, it is referred to as post-concussion syndrome.

Possible Causes of Post-Concussion Syndrome

• An unhealed neck injury
• An unresolved vestibular system injury
• An uncorrected oculomotor problem
• The cardiovascular system was not sufficiently stimulated during recovery
• Psychological factors that limit recovery (fear, stress, anxiety, depression, post-traumatic stress)

If your symptoms persist, consult a physiotherapist with expertise in concussions to find the cause of the ongoing symptoms. Also, consult our complete guide on concussions for more information on treating post-concussion syndrome.

Risk Factors for Concussion

Some people are at a higher risk of experiencing a concussion:

• Women are more at risk than men
• People who play contact sports
• Athletes who have previously had a concussion (increased risk of another one)
• Young people under 24 and individuals aged 75 and over

Myths and Realities About Concussion

Helmets and Prevention

Helmets do not reduce the risk of concussion. They reduce the risk of skull injuries like fractures. Therefore, they are very important for limiting severe skull injuries, but the brain is not more protected from acceleration by wearing a helmet.

Wearing a helmet can even create a false sense of protection in contact sports, potentially leading athletes to use their helmets to initiate contact. This behavior should be avoided because it involves head contact, which increases the risk of concussion.

Mouthguards

Mouthguards are not a way to reduce the risk of concussion. They are important and effective for reducing mouth and dental injuries. This applies to all types of mouthguards, whether they are custom-fitted or not.

Loss of Consciousness

Loss of consciousness is NOT a diagnostic criterion for concussion. In fact, less than 10% of people lose consciousness during the impact that leads to a concussion.

Traumatic Brain Injury Statistics

• In the United States, in 2014, approximately 2.87 million emergency room visits, hospitalizations, or deaths were related to TBIs.
• Each year, over 800,000 children in the United States are treated in hospital emergency rooms for TBIs.
• The age groups most at risk for TBIs are 0-4 years old, 15-24 years old, and 75 years and older.
• More than 300,000 sports-related concussions are reported each year in the United States.
• A study from McGill University reports that 60% of university soccer players report concussion symptoms at least once each season.

Related conditions to explore

If you have experienced a concussion, other conditions might be related:

• Concussion: Complete Guide: detailed information on treatment
• Cervical Sprain: often associated with concussion
• Neck Pain: Complete Guide: the neck often contributes to symptoms
• Vertigo and Dizziness: if you have vestibular issues
• Headaches: a common symptom after a concussion
• Physiotherapy for Neck Pain: treatments for the cervical component

Book an appointment with a physiotherapist

If you have experienced a concussion or suspect you have one, don't wait. Our physiotherapists, trained in concussion management, can assess your condition, treat the affected systems, and guide you towards a full recovery.

References

• National Research Council, Committee on Sports-Related Concussions in Youth. Sports-related concussions in youth: improving the science, changing the culture. National Academies Press; 2014 Feb 4.

• Daneshvar DH, Baugh CM, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Helmets and mouthguards: the role of personal equipment in preventing sport-related concussions. Clinics in sports medicine. 2011 Jan 1;30(1):145-63.

• Abrahams S, Mc Fie S, Patricios J, Posthumus M, September AV. Risk factors for sports concussion: an evidence-based systematic review. British journal of sports medicine. 2014 Jan 1;48(2):91-7.

• Faul M, Wald MM, Xu L, Coronado VG. Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths, 2002-2006.

• McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cassidy D, Echemendia RJ, Castellani RJ, Davis GA. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British journal of sports medicine. 2017 Jun 1;51(11):838-47.

• National Institute of Excellence in Health and Social Services (INESSS), 2020.