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Concussions – Not a wait-and-see issue

Updated: Jan 26, 2023

We all hear a lot about concussions in the news, especially in sports. While many may think that concussions are just an injury to wait out, there is actually a lot that can be done to help with a faster, fuller recovery.

Concussions. We've all heard about them. If you're a sports fan, you may even have wondered why some players seem to go into the concussion protocol and seem to come out in a matter of days while others may miss extended time. As defined by the CDC, "a concussion is a type of traumatic brain injury – or TBI – caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells." What's difficult is that we don't have a good way of predicting what kind of response and development of symptoms may occur after an injury. Think about all of the massive hits you've seen on TV where the player either is fine or perhaps misses a couple of days. Likewise, we have seen athletes with fairly benign mechanisms of injury develop pretty limiting symptoms. Even more importantly, it needs to be recognized that concussions don't just affect young athletes – we see these occur in older adults after falling, those in the military exposed to blasts, and those that have been in car accidents.

Ultimately, especially if it's you, a family member, or your child that have had a potential concussion, it needs to be recognized that post-concussive symptoms can be quite variable and can exist along a spectrum. Seeing a specialist well versed in the assessment and up-to-date treatment can help tremendously with a quicker and safer return to normal activities, like work, school, sports, etc.

Below, we will discuss common types of symptoms that can occur, and what treatment and management of concussions may include.

Common Symptoms from Concussions

The research is pretty clear in that not everyone will experience the same types of symptoms

nor the same intensity of these symptoms. Generally, we have seen concussions to result in physical, cognitive, emotional, and sleep-related symptoms. While headache, dizziness, and balance problems have been reported to be among the most common symptoms, it is also possible to see things like difficulty with concentration (especially in busier or more stimulating environments), difficulty falling or staying asleep, a tendency to sleep excessively, symptom aggravation with high levels of exertion, light sensitivity, difficulty with memory and recall, difficulty completing complex tasks, frustration and anger, anxiety, and/or depression (among others). As you can see from this non-exhaustive list, concussions can be associated with the development of a wide variety of difficulties and an even wider spectrum of how intense and limiting these symptoms may be.

Elements of Treatment for Concussion

Statistically, a fair number of people suffering a concussion will have most symptoms improve and subside fairly quickly. However, research appears to suggest that many will experience symptoms for greater than a couple of weeks. On a promising note, recent research suggests that early intervention and management of concussions can help achieve a faster recovery.

Early, controlled aerobic exercise appears important. We used to think that absolute rest was best, but several recent studies have been published that have demonstrated the value in introducing aerobic exercise in a structured fashion. As a provider, we perform a very structured exam, part of which will include a standardized aerobic exam wherein the heart rate response and symptom response can help us in setting the duration and intensity of early aerobic exercise. As balance is a common impairment after concussions, targeted balance training to improve your stability and reactions is common. If visual disturbances or symptoms triggered by visual stimuli are an issue for you, there are actually a number of visual exercises that can be implemented to help reduce your sensitivity to these (e.g., difficulty with looking up and

back from something you're reading, difficulty tracking a ball, etc.). Most importantly, treatment and management should work to address the symptoms you experience in situations that most closely match your needs. For example, with a student athlete that is having difficulty with vision-related headaches and focusing in the classroom, early management would likely include structured and guided aerobic exercise, any number of tasks that challenge and improve eye coordination, and progressively introducing cognitive tasks (e.g., term/topic recall, sequencing/mathematical tasks, etc.) while performing school and/or athletic tasks.



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