Are concussions the new silent epidemic? The National Institutes of Health states that there are four million sports-related and recreational concussions annually, and that’s not factoring in car crashes and falls, which would increase that number exponentially. The good news is most concussions are mild, with the majority of people recovering within two to four weeks. A smaller percentage of people aren’t as fortunate, with the consequences being more dire and even life-altering. Is a concussion a traumatic brain injury or are they two separate conditions?
What Is A Concussion?
A concussion is a mild traumatic brain injury that results from an impact to the head, neck, or face, causing shaking of the brain and twisting of the spinal cord. This shaking and twisting , not only causes inflammation, but can also cause neuronal damage that negatively affects brain function. The damage from a concussion is usually not structural in nature. This is due to the fact that a concussion is a mild brain injury, rather than a severe one.
The brain is comprised of soft tissue, normally protected by the skull, blood, and spinal fluid. However, when the skull receives a significant enough impact, the brain can shake and shift, causing it to hit against the skull. This leads to swelling and bruising of the brain, nerve injury, and tearing of the blood vessels.
It’s the same idea as injuring your knee if you fall really hard. You’ll notice bruises on your skin, your knee will swell, and be sore to the touch. A concussion follows the same line of thinking; if you hit your head hard enough, it will bruise the brain’s delicate tissue. The neurons in the injured area can also be affected, causing cognitive impairments and other symptoms.
Physical, Cognitive And Emotional Symptoms
Many people within the 10-20% category that don’t recover within a month after sustaining a concussion, may experience physical, cognitive and emotional symptoms they fail to correlate with their injury. Because many of the symptoms are vague, and they fell normal otherwise, the person makes excuses for their memory lapses, fatigue, and changes in personality with phrases like “I’m just stressed,” or “I haven’t been getting enough sleep.” It’s difficult to link symptoms to causation even though many of them can be quite debilitating.
Couple that with the fact than some healthcare practitioners focus on physical symptoms alone. After structural damage and brain bleeds are ruled out, patients are sent home to rest and recover. But what happens if the person isn’t compliant? More on that below. Keep in mind, mild traumatic brain injuries typically do not show up on Xrays, CT scans, or MRIs, though these diagnostic tools can detect dangerous brain bleeds.
The take home message here is don’t discount symptoms or rationalize them away. Although, most symptoms following a concussion resolve after a few weeks, some may not, which can lead to long-term repercussions.
Mild Concussion Symptoms
Concussions range on a continuum from mild, to moderate, to severe. Concussion risk is associated with two factors; the hardness of the surface the injury occurred on, along with the speed of the impact.
A fall that takes place on a wood floor or carpet is going to be less severe than a fall involving a surface such as concrete. Hard surfaces have no bounce or give to them, which serves to dissipate the energy and lessen the impact of the fall. Symptoms generally show up within a few hours from the onset of the injury, coming on either immediately or gradually over the course of several hours.
Warning Signs Of A Mild Traumatic Brain Injury
- Excruciating headache
- Nausea and vomiting
- Extreme sleepiness or insomnia
- Changes in vision and vacant stare
- Uneven gait
- Difficulty concentrating and memory lapses
- Dizziness and unresponsiveness
- Loss of consciousness
- Slowed reaction time and flat expression
How Are Concussions Diagnosed?
There are no universal tests for concussions, rather diagnosis is clinical in nature, meaning how the person is presenting. The following three questions can help determine the severity of a head injury. Imaging technology is not useful when it comes mild traumatic brain injuries, although it can rule out a severe brain injury.
1. How and where did the injury happen?
2. How is the person feeling and what are their symptoms?
3. What is the person capable of in terms of their abilities?
Concussions are graded according to severity.
Grade 1: Considered a mild concussion, with symptoms clearing within fifteen minutes. There is no loss of consciousness.
Grade 2: This grade of concussion is considered to be moderate. Symptoms last longer then fifteen minutes, and may persist for hours. There is no loss of consciousness.
Grade 3: This is a severe concussion and head injury characterized by a loss of consciousness, no matter what the other symptoms are.
Most concussions are sports related. Think of rugby players banging their heads together, gymnasts falling on their heads, soccer players hitting balls off their heads, and the multiple aggressive hits football players sustain. Concussions can also be caused by falls, slips, and accidents, including car, bike, skateboard, and playground accidents.
An injury doesn’t have to directly impact the head to cause a concussion, it can come from being hit it another part of the body, with the shock radiating to the brain. Whiplash is a prime example of this scenario. Interestingly, women are more susceptible to concussions than men due to the fact that their necks aren’t as strong, which intensifies the force of the impact.
What To Do After A Concussion
The number one remedy to healing a concussion is prolonged rest, and this isn’t just physical rest, but cognitive rest as well. Stimulation needs to be kept to a minimum, no loud noises or bright lights.
Resting the eyes is important too – television, movies, video games, social media scrolling, and reading should all be kept to a minimum. Slow walking is acceptable a week or two post injury, but social events should be postponed until the concussion has healed.
How can you tell when a concussion has healed? A flat affect, or lack of expression, can be symptoms of a mild brain injury. Being aware of the changes in affect is one way to gauge a person’s progress because facial expressions are easy to ascertain. You can be confident they are on the road to recovery when their expression becomes more animated.
Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury – By Dr. Kabran Chapek
Cognitive And Emotional Symptoms
Other cognitive and emotional symptoms may be more difficult to recognize. Just because a person feels better after a few days does not mean they are out of the woods. 80 to 90% of head injury victims will be back to normal within two to four weeks, but the remaining subset may suffer for months, and sometimes even years. Although, the majority of symptoms may resolve, there could be lingering performance problems, such as issues with balance, lack of coordination, and slow reactions times.
If these symptoms are present, the person needs to be evaluated, and considered for brain-injury rehabilitation to access the degree of physical, cognitive, emotional, and/or behavioral impairments. Specialized testing is available for these types of injuries. A bit of trivia; helmets are protective, and should always be worn, but they don’t always prevent concussions.
Why Are Concussions Dangerous?
A little bit of nausea and a slight headache is normal following a concussion. It gets worrisome when symptoms worsen or don’t abate. Brain swelling can become an issue, but because the brain is housed within the skull, which is an enclosed space, there isn’t room for it to swell. If the swelling continues, eventually the brain will crush itself under the pressure.
This is frightening because when nerves and neurons are damaged, the consequences can be far-reaching, resulting in impaired function. If cognitive symptoms persist, or worsen after three or four weeks, the symptoms need to be taken seriously since the person may be suffering more serious, long-term consequences associated with their concussion.
The brain may continue to swell, which as stated above, is dangerous. It’s difficult to determine the extent of the injury because the person will most likely look normal, but in reality, they haven’t fully recovered mentally and emotionally. Since a concussion is considered a mild traumatic brain injury, the person may not realize the effect it has had on them. Mild personality changes, and lapses in memory, can often be reasoned away.
It’s these lingering symptoms you want to keep an eye on. The lack of awareness surrounding how brain injuries can manifest doesn’t help matters. Recognizing the symptoms and the need for treatment can make all the difference in the prognosis. At this point, the person should be evaluated and possibly seek out a neuropsychologist for cognitive treatment. Fortunately, this type of therapy is covered by insurance. Cognitive therapy is appropriate for those experiencing persistent and lingering symptoms after a concussion.
Living with Post Concussion Syndrome
The 10-20 percent of people that don’t get better a month after sustaining a concussion may go on to develop Post Concussion Syndrome (PCS). This syndrome is characterized by intractable symptoms that fail to resolve. This is why it’s so imperative to keep an eye on symptoms – they are a barometer of what’s happening internally.
The most common symptoms people experience in Post Concussion Syndrome are dizziness, fatigue, vision disturbances, frequent or constant headaches, difficulty concentrating, anxiety and insomnia. As you can see, this is quite a miserable and exhaustive list.
Check out this book for more information:“Coping with Concussion and Mild Traumatic Brain Injury, A Guide To Living With the Challenges Associated with Post Concussion Syndrome and Brain Trauma.”
If symptoms are still presenting three months post injury, it’s likely they will still be noticeable after a year if rehabilitation hasn’t been initiated. The good news is that injured tissue can be rehabilitated. Unfortunately, medications are not an option in treating concussions.
Think about this statistic – up to 50% of people with concussions are not able to return to work after two weeks. Half of that number aren’t well enough to go back to work one month post-injury. So even though the majority of concussions resolve within a month, some don’t, and the quality of life of these people is greatly affected because concussions can cause multiple brain dysfunctions.
Each Concussion Is Unique
Concussions have a high degree of variability. They’re kind of like fingerprints – each person is unique in their presenting symptoms. To be diagnosed with Post Concussion Syndrome, one must have at least three symptoms, across three categories, four weeks following the head injury.
Loss of consciousness, following the concussion, is also a defining feature of this syndrome. Symptoms must include both physical and cognitive impairments. To clarify, a loss of consciousness is not imperative to be diagnosed with a concussion, but it is a precipitating factor in Post Concussion Syndrome.
Considering the staggering number of people that sustain concussions each year, think how many of those individuals will be diagnosed with PCS. That’s a significant amount of suffering. It makes me wonder how many cases of depression, learning disabilities, and problematic relationships are the result of concussions.
The blood brain barrier immediately breaks down following a head injury. This means that the blood vessels going to the brain are no longer tight, which allows other substances besides oxygen and glucose, to enter the brain. The brain has its own immune system that is separate from the body. When the blood brain barrier becomes compromised, the body’s immune system begins to negatively impact the brain’s immune system. This causes inflammation, a significant underlying component of PCS.
Another factor is that stress hormones can rise up to 300% following a concussion. High levels of cortisol and adrenaline can break down the intestinal lining, which houses 70% of the immune system. This breakdown of the mucosa in the intestines can precipitate leaky gut, food sensitivities, autoimmunity, body-wide inflammation, and immune system dysregulation. Symptoms are variable and persistent in Post Concussion Syndrome.
Chronic inflammation and immune system abnormalities can lead to a host of biochemical, metabolic, and hormonal symptoms because of the wide-spread effect they have on bodily systems. At this point, inflammatory and immune markers will be elevated on lab testing.
The intestinal permeability caused by a concussion can lead to brain inflammation. This is a vicious gut-brain axis cycle that keeps the body in a chronic state of inflammation, resulting in a number of deleterious symptoms, and is one of the main mechanisms behind Post Concussion Syndrome.
Here’s another information-packed book: “The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get It Back.“
Concussion-awareness is on the rise thanks to the movie “Concussion,” and the NFL’s declaration that brain injury is indeed an issue among professional football players. Concussions are mild traumatic head injuries that typically resolve within a month’s time. Rest, and a low-stimulation environment, are the best methods for recovery. The majority of concussions resolve on their own, but a minority of people may go on to develop Post Concussion Syndrome, a diagnosis that should be taken seriously.
Have you had a concussion? What were your symptoms and did you recover quickly? Let me know in the comments:)