Concussion (Mild Traumatic Brain Injury)

What exactly is a concussion?

A concussion is a disruption of brain function caused by an external force. This force causes the brain to accelerate rapidly within the skull, stretching and twisting the brain and neurons.

A functional injury, not a structural one

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

The parallel can be drawn with a computer infected by a virus: the computer does not function as well, even though all its components are intact. In contrast, moderate or severe TBI causes structural damage to the brain in addition to having functional consequences.

What are the symptoms of a concussion?

The symptoms of concussion are varied and can affect many aspects of your daily functioning.

The most common symptoms

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

Other possible symptoms

• Dizziness and nausea
• Neck pain
• Irritability, sadness
• Feeling of being in slow motion or confused
• Balance disorders
• Blurred vision
• Memory problems

It should be noted that the symptoms of concussion are non-specific, meaning that they are also found in several other conditions. For example, people with migraines may also experience headaches, nausea, and sensitivity to light. This makes diagnosing and treating concussions more difficult and requires a healthcare professional with expertise in this area.

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:

You should always be more cautious when the person has had a concussion in the past.

When do the 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 quick movement of the head
• A fall (while downhill skiing, climbing, running down stairs, 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 the head to accelerate

• A car accident or sudden braking
• A fall down the stairs or on ice
• An accident at work

How is a concussion diagnosed?

A concussion is a diagnosis that is made solely on the basis of the history of the injury and a physical examination.

A concussion may be suspected if the head has undergone significant acceleration and a single sign or symptom is present following this situation.

Examples of diagnostic situations

• Being checked in hockey or tackled in football and having a headache or feeling dizzy 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 after playing sports. This may be a sign of an old concussion that has not healed properly or of poor 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, when there are serious clinical signs and symptoms, tests are necessary to rule out more serious brain injuries such as moderate or severe TBI and skull or neck fractures.

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 have not seen a physical therapist promptly and have had symptoms for more than 14 days, you should see a physical therapist immediately.

The speed of recovery from a concussion is largely determined by when you consult a healthcare professional. The first few days after a concussion must be managed perfectly to ensure the fastest possible recovery. It is therefore important to receive the right advice and know what is allowed and what is prohibited. The sooner you seek medical attention, the faster you will recover.

Please note that your physical therapist must be trained to treat concussions. Not all physical therapists treat these injuries. You must specify this request when you make your appointment.

You do not need to see a doctor before consulting a physical therapist. If your physical therapist determines that an evaluation with a doctor is necessary, they will let you know.

Physical therapy treatments for concussions

The treatment of concussions in physical therapy consists of three parts.

1. Evaluation and treatment of body systems

Your physical therapist is the only healthcare professional with the expertise to assess the three systems that may have been injured by the concussion:

After the assessment, your physical therapist will determine the right exercises to do at home and the right treatments to do in the clinic to address the problems affecting one or more of these systems. They can treat joints, muscles, and nerves to help reduce symptoms.

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

2. Planning your return to work or school

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

• Limit 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?

The treatment of concussions involves several steps. Treatment parameters vary from person to person because no two concussions are alike.

Step 1: Relative rest (24 to 72 hours)

The first thing to do immediately when you suspect a concussion is to rest for 24 to 72 hours.

• Ensure that you are accompanied and supervised by a loved one.
• Avoid any situation that could lead to an impact or acceleration to the head.
• Avoid any activity that significantly increases symptoms.
• Don't just lie there doing nothing in a dark room.

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

If your symptoms increase when doing light activities, you should rest until they decrease before resuming your light activities.

Step 2: Consultation with a physical therapist

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 periods of 45 minutes:

• Reading
• Crosswords
• Simple homework
• Answering emails

During this stage, care is taken to ensure that these light activities do not cause a significant increase in symptoms.

Step 4: Return to work or school and physical activities

After 24 hours without symptoms, you can gradually start returning to school or work. For physical activity, you can consider gradually starting four or five days after the injury.

We start with half-days every other day, then increase the number of hours when we have been symptom-free for more than 24 hours.

Young people should not be put under stress at school with exams or remedial classes until they are much better. The main goal of this stage is to get used to resuming a schedule, seeing people, and being in their work or school environment.

It should be noted that throughout this recovery phase, being positive and optimistic about your progress will lead to better results. Surround yourself with people who help you stay positive and avoid any situations involving conflict or negative emotions.

Post-concussion syndrome

When symptoms persist for more than 14 days in adults or more than 4 weeks in children, this is referred to as post-concussion syndrome.

Possible causes of post-concussion syndrome

• A neck injury that did not heal on its own
• An injury to the vestibular system that has not healed
• An oculomotor problem that has not been resolved
• 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 physical therapist who has expertise in concussions to find the cause of the persistent symptoms. Also, see our comprehensive guide to concussions for more information on treating post-concussion syndrome.

Risk factors for concussion

Some people are at greater risk of suffering a concussion:

• Women are more at risk than men
• People who play contact sports
• Athletes who have already suffered a concussion (increased risk of suffering another one)
• Young people under the age of 24 and people aged 75 and over

Myths and facts about concussions

Helmets and prevention

Helmets do not reduce the risk of concussion. They reduce the risk of skull injuries such as fractures. They are therefore very important in limiting serious skull injuries, but wearing a helmet does not provide any additional protection for the brain against acceleration.

Wearing a helmet even seems to be associated with a false sense of protection in contact sports and can cause athletes to use their helmets to make contact. This is behavior that should be avoided, as it leads to contact with the head, which is a risk factor for concussion.

The mouthguard

Mouthguards are not a means of reducing the risk of concussion. They are important and effective in reducing injuries to the mouth and teeth. This is true for all types of mouthguards, regardless of whether they are custom-made 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 concussion.

Statistics on traumatic brain injuries

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

Related conditions to explore

If you have suffered a concussion, other conditions may be related:

• Concussion: comprehensive guide: detailed information on treatment
• Whiplash injury: often associated with concussion
• Neck pain: comprehensive guide: the neck often contributes to symptoms
• Vertigo and dizziness: if you have vestibular problems
• Headaches: a common symptom after a concussion
• Physical therapy for neck pain: treatments for the cervical component

Make an appointment with a physical therapist

If you have suffered a concussion or suspect you may have one, don't wait. Our physiotherapists trained in concussion care can assess your condition, treat the affected systems, and guide you toward 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.