Traumatic Brain Injury Up Close: Concussions
A concussion is a complex pathophysiological process affecting the brain, usually induced by traumatic biomechanical forces. It is a functional rather than structural injury that results from shear stress to brain tissue caused by rotational or angular forces—direct impact to the head is not required.
What does that mean? It makes a concussion more complex than a bruised brain. Certain forces on the brain cause a destructive neurometabolic cascade of events in which the brain is injured beyond a normal mishap. Metabolically, it takes the brain 22-30 days to fully recover, even in the absence of noticeable symptoms. If you are having symptoms beyond this time frame, it is likely due to a secondary reason. These prolonged cases are often referred to as PCS (post concussion syndrome).
Typically, symptoms resolve within 2-3 weeks, as long as patients are following protocol and guidelines. However, this is not always the case. 15-30% of the time, people have “prolonged recovery” and require medical attention to improve. This can be due to cervicogenic, vestibular, ocular, balance, or even reaction time impairments. Progressing activity/exercise at the correct pace and with the correct guidance is key to success.
Mission Physical Therapy has a certified vestibular therapist who can help determine what this driving factor is, as well as provide treatment to help get people symptom free in less time.
Vestibular and orthopedic rehab therapy are great tools towards recovery for these patients.
Symptoms and complaints can consist of, but are not limited to:
- Headache
- Dizziness
- Sleep impairments
- Blurred vision
- Fatigue
- Light/sound sensitivity
- Nausea/vomiting
- Drowsiness
- Light-headedness
- Confusion
- Depression
- Disorientation
- Inability to focus
- Anxiety
- Irritability
So if you have a concussion, how long until you get back on the field or back to work? Like any brain injury, it pays to be certain of full recovery prior to return in order to prevent lasting injuries. Some things that are a “must” before returning to play or work are:
- The athlete/patient feels completely normal. “Fine” does not cut it.
- A normal neurological exam – this can be performed by your physical therapist.
- Neurocognitive test scores are back to baseline.
- Exertion activities without symptoms.
Before serious physical exertion, it is important to build up activity levels in a certain order:
- Medical management (rehab vestibular/orthopedic)
- Mild-mod aerobic conditioning and strength training
- Functional training – work / sport
- Work/sport specific training – non contact progressing back into contact
It is important to complete all steps of the process prior to returning in order to avoid lasting injuries.
In the state of NC, athletes need clearance from their PCP/concussion MD prior to return to play. MPT can send your evaluation and recommendations to your physician in order to help guide this decision
