When talking to people about concussion, what it is and what to do if you suffer one, the answers vary so wildly. This understandably creates more anxiety for people already struggling. So I thought I’d put together a list of some of the most common misconceptions about concussions, lets bust those myths…Here goes…
1. Concussions occur following hits to the head
A concussion occurs following rapid acceleration and deceleration of the brain and believe it or not, these can occur without being hit in the head. Providing enough force goes through the body to cause rapid acceleration and deceleration of the brain.
2. Concussion is a bruise of the brain
This is an outdated model. where concussion was considered to be a result of the brain being shunted inside the skull causing bruising to the surface of the brain.
These days, we recognise concussion to be a result of the 'brain undergoing this acceleration and deceleration, fluid waves are created which stretch the axons (nerve cells) in the deeper brain tissue known as 'white matter! So the injury of concussion occurs in the deeper areas of the brain, not on its surface.
(Bruising on the brain's surface is known as cerebral contusion and is generally associated with more severe injuries).
This means a concussion is a functional injury rather than a structural one and like all functional injuries, given the right care, you can recover.
3. You can see or diagnose concussion on MRI or CT scans
- NO, you can't.
- These scans are used to look at the structure of the brain.
A concussion is a functional injury to the brain, which doesn't alter its structure. And so these scans can not be used to identify or diagnose a concussion. Around 95% of concussions will not have any structural changes to the brain associated with more severe brain injuries. they are used to rule out more significant injuries.
4. If you have a concussion you should rest
This is brutal - because we have known for some years now that prolonged rest can be detrimental to recovery. The old method (and still unfortunately frequently propagated) is that there should be complete brain rest! Don't read, Don't watch TV, Don’t go outside, no computer or phone screens, and sit in complete darkness in your room until your Symptoms subside
NO - THIS IS WRONG!
Inactivity can make your symptoms worse!
Current recommendations are Symptom- limited activity within the first 24-48 hours.
What does this mean exactly? - well after a concussion, you need to get moving- gently - in a safe way that does not aggravate your symptoms (no activities where there is the potential to get another concussion!). You can read, do household chores or indeed anything that doesn't seriously provoke your symptoms.
- Studies have shown patients who were prescribed 5 days of strict rest did worse than those who were prescribed 2 days of Strict rest (1), others (2) have demonstrated that advice to rest for more than 2 days after a concussion, is associated with a delayed return to productivity
There is growing evidence that early exercise seems to be protective against concussion, it gets you better faster! A recent study shows that a group who were doing Sub-Symptom exercise following a Buffalo Concession Treadmill Test CBCTT), given on day 4 after their injury, did better than a group that was given placebo stretching. A Dave Lawrence study from Toronto University found that each successive day where there was a delay in the initiation of aerobic exercise, individuals had a less favourable recovery trajectory.
In essence, people who started exercising on day 1 did better than people who started exercising on day 2. People who started exercising on day 2 did better than people who started exercising on day 3 and so on...
A recent study did show that moderate to vigorous exercise done immediately after concussion did prolong the outcome. So our tip when it comes to exercise is don't rest and do nothing, but don't do too much either as that may prolong your recovery.
How do we know how much is too much? Easy- we bring you into the clinic and in your second session with us, we pop you on our treadmill to perform a walking treadmill test. We have you wear a heart rate monitor, and then using specific questions before the test and during the test, we will be able to assess where your safe level of exercise is.
5. You are ok to return to your sport once you no longer have symptoms
NO. Symptoms or a lack of Symptoms does not properly indicate whether the brain has recovered following a concussion. A good analogy is comparing a concussion to a broken bone. If we break a bone, the doctors will put a cast on it, so that it can heal properly. Now the pain we experience after a fracture may dissipate after 10 days or so, however, the cast is not removed at this point. Why - well, because we all know, that just because our arm stops hurting doesn't mean the fracture has healed.
When it comes to concussions though, for some reason we think differently! As soon as the headaches, dizziness or memory issues go away, we think we're ready to jump back into contact sports. Not only is this wrong it's potentially highly dangerous.
As we talked about in no 1, concussions occur as a result of acceleration followed by deceleration of the brain. This causes a rapid and haphazard firing of the brain cells (neurons) which produces the initial Symptoms such as headaches, balance problems, ringing in the ears and concentration problems.
Now all this firing uses up an awful lot of energy, creating an energy deficit in the brain.
And so if we suffer a second trauma during this time of low energy (which can last for 30 days post-injury) this can have a compounding effect, meaning the brain is susceptible to further concussions as a result of smaller impacts. This can, in some cases lead to devastating permanent or fatal outcomes.
And so whilst all apparent symptoms may have disappeared, this does not necessarily mean that the brain has recovered metabolically, and is in fact still highly vulnerable in this state of depleted energy. The phrase ‘absence of symptoms is not an absence of injury’ is never more true than when talking about brain function after an injury!
So if you or someone you know is affected by a concussion, it’s crucial they are seeking guidance and care from people who are up to date with the latest research and methods in concussion care.
At HeadWise Concussion Care, we have trained in the latest concussion care methods, so you know you’re in good hands. As we said earlier, the sooner the right care starts, the better your outcomes. Let’s start that journey now!
Want to know more, book a free 15 minute discovery call here, or book an 1-hour initial appointment here. To speak to our practice manager call Debbie on 09 360 6026