Concussions, Post-Concusion Syndrome,and facts everyone should know

Michael J. Racca, PT, MSPT

Michael J. Racca, PT, MSPT

with with Michael Racca, MSPT, CEAS

It all starts with the Brain: a soft tissue structure made up of billions of neurons that send signals to other parts of the nervous system and body. It is the most complex organ of the Central Nervous System responsible for thought and function. The Brain receives and interprets stimuli from the environment to formulate motor responses for movement. It is suspended within the skull in Cerebrospinal Fluid which cushions the brain from damage.

A Concussion is a “mild” traumatic brain injury (TBI), caused by a bump, or jolt to the head. It can also occur from a fall or blow to the body, but an external impact is not always necessary to produce a concussion. Any force which causes the brain to impact the inside of the skull or a straining of the tissues that support the brain when the body stops too quickly (like in an auto accident) can change the way the brain normally works.

The brain is extremely sensitive to change and when injured can have difficulty regulating our body’s functions. An injury can cause a chemical change within the brain that alters its ability to function, even in the absence of structural damage. This is why concussions are not always evident on diagnostic tests like MRIs or CT Scans. Concussion symptoms may not appear immediately and 90% of all concussions do not involve a loss of consciousness.

Children, teens and athletes of any age or level may be reluctant to admit or address the possibility of a concussion, either because the symptoms are subtle or because they may want to return to play or their other normal activities.

There has been a steady incline in concussion rates, now estimated at 4-5 million annually, including an emerging trend among younger middle school athletes. Because of a greater awareness for the long-term medical effects of concussions, legislation in almost every state across the U.S. is driving greater accountability for the management of concussions.

So what is being done about Concussions?

In 2006 Zackery Lystedt suffered multiple concussions during a junior high school football game resulting in severe brain trauma. In and out of a coma for 3 months and unable to move for more than a year, he had to re-learn how to speak, move, eat, and drink. Washington State passed the Lystedt Law on May 16, 2009, in which athletes under age 18 suspected of having a concussion are removed from practice or games and are not allowed to return until cleared by a medical professional. The law also requires athletes, parents and coaches to be educated each year about the dangers of concussion. As of February 19, 2014, every state now has some type of Student-Athlete Concussion Law.

So what is Post-Concussion Syndrome (PCS)?

Many concussions and symptoms resolve within 7-10 days with proper rest. PCS arises when the brain is having difficulty healing and returning to its prior level of function, and 3 or more symptoms last longer than 4 weeks. Treatment options include Prolonged rest, Academic accommodations, Medications, Physical Therapy.

What is the role of Medications in Concussion Management?  

No effective pharmacologic treatment has been shown to speed recovery from a TBI. Medications are used in treating the signs and symptoms of concussion.

PCS symptoms are often grouped into 4 general categories:

1)      Sleep Disturbance (common following concussion)

2)      Somatic (mostly headache)

3)      Emotional (depression arising from restrictions on physical and cognitive activity)

4)      Cognitive (Difficulty w/ Memory, Concentration and Slowed Processing Speed)

The medications prescribed by a physician often depend on the symptoms experienced.

How can Physical Therapy Help?

Currently no treatment will accelerate recovery from a concussion.Physical Therapy can treat secondary injuries such as dizziness, neck joint alignment and muscle strains, balance dysfunction, and abnormal eye movements that stress the brain and slow recovery time. Research indicates that monitored progressive increases in physical activity can assist in decreasing lingering post-concussion symptoms.A Physical Therapist administered rehab program can help re-educate the brain to tolerate activity and return to athletics safely when appropriate.

What is Sports-Related Concussion Testing?

At the forefront of concussion management is the implementation of neurocognitive testing in athletic programs, which includes getting a pre-injury baseline and post-injury testing for comparison. Such evaluations can help to evaluate an athlete’s post-injury condition and track recovery for safe return to play. This prevents the cumulative effects of concussions or returning an athlete who has not fully recovered to play too soon. Currently the NFL, NBA, NHL, MLB and umpires, and thousands of colleges and high schools are now using neurocognitive testing before and after concussions to help properly manage this growing concern.

Concussion phote

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