“Concussion” is a big scary word these days that unfortunately has not been explained well to the general public. So here goes. The basics.
A concussion is a functional Injury of the brain. What that means is that there is no apparent or visible damage to the brain or skull. So the idea of taking someone to the emerge department because they suspect a concussion and want an MRI or CT to diagnose it is not warranted, and will just lead you to a frustrating experience. You cannot see a concussion with advanced imaging. A concussion needs to be diagnosed by a trained health care professional.
Diagnosis of a concussion is based off of a few things. 1) Mechanism of injury. 2) Immediate and Prolonged symptoms. 3) Clinical signs and symptoms with testing.
The mechanism of injury does not have to be a direct hit to the head, and in fact a hit to the head does not guarantee that someone will have a concussion after. Sometimes they just have a sore head where the impact occurred. Often times there is a hit to the body that causes a rapid acceleration of the head that can lead to a concussion, almost like a whipping action of the head in relation to the body.
Immediate and prolonged symptoms are often described as a headache, fogginess, confusion, or nausea. The most common hallmark symptom the “headache” will tend to get worse when you stress your brain (watching TV, driving, reading, instagram, exercise) and will decrease when you rest. In the initial stages the headache is often there all the time and just goes up and down depending on what you’re doing. Think of the brain like a computer chip. The more things you ask it to do, the worse the symptoms will get. Sort of like trying to make a modern computer run after you have removed half the memory (RAM). It won’t perform well and your brain is no different.
Clinical signs and symptoms are often found by a trained health care practitioner. If you present to your doctor/physio/chiro/athletic therapist/nurse practitioner and suspect a concussion, a good clinician will listen to how you got the injury, ask about your current symptoms then do a variety of tests, mostly to rule out any more sever injuries. Neurological exam, eye exam, cerebellar testing (balance), cervical spine exam are a few of the tests/tools used.
Once you have your diagnosis of a concussion, this is where the real work comes in. We used to tell patients to sit in a dark room with no stimulation and wait for the symptoms to go away. Current research is showing that this isn’t the best course of action, and some gradual return to normalcy is better for you. Symptoms and symptoms exacerbation are what is used to guide how much you can do, and before any return to sport is considered, we want a return to learn/work first and foremost. Once you are back to school/work then return to sport takes place.
You don’t want to rush the return to sport, as we are finding that the brain is most vulnerable at the point when resting symptoms start to alleviate. For any athlete a step-wise protocol to return them to sport is utilized and in fact a rigorous test call the “Chicago Blackhawks Test” is used to make sure that someone is ready to return to competitive sport.
There are obviously many subtleties that go into this, and no two patients are alike, so using a cookie cutter approach is not advised. If you do suspect a concussion, its best to have them examined by a practitioner that has training in concussion diagnosis and management. The emergency department, although very helpful in diagnosing a concussion and ruling out anything else more sinister, they are not in the business of managing a concussion, or helping with return to learn/play. ER docs are very skilled, but you’ll have a diagnosis and broad guidelines. For proper management, find someone that will help guide you through he process, from Diagnosis through to full return to play.
Dr. Adam Wade DC
Dr. Adam Wade 