concussion head pic

Concussion

Concussions have been getting more attention in the press recently, especially those which are sports related. In the past getting a knock to the head was just part of the game. I grew up playing rugby and it was not uncommon to get told to just shake it off. Now we are starting to better understand the long lasting effect of repeated concussions and shaking it off is definitely no longer your best option.

Needless to say concussions aren’t just a few stars circling round your head like in the cartoons. The truth is every concussion injures your brain to some extent. Concussions are the most common type of traumatic brain injury. Though most concussions are only minor and have little to no long term effects it’s crucial they are taken seriously and your recovery is handled correctly in order to prevent any serious long term brain damage.

+   What is it?

  • A concussion occurs when your head hits an object, a moving object hits your head or through whiplash. Common causes of concussion are:
    • A fall
    • Car crash
    • Sports injury
  • When this happens your brain moves in your skull, sliding back and forth against it. When your head moves normally the fluid around your brain is enough to protect it from damage. In higher impact movement the fluid doesn’t sufficiently cushion the brain.
  • A concussion is a minor traumatic brain injury which leads to:
    • Physical damage to brain cells
    • Biochemical changes in brain neurons (the cool looking cells which look like a flower, stem and roots and carry messages around for your brain).
      • Impaired neurotransmission (the cool looking cells messages get a little messed up and slowed down)
      • Over firing of neurons leading to ion balance (the chemicals that help send messages) getting messed up
    • Both of the above can cause some debilitating and serious symptoms, ruin your day and leave you feeling a little behind

+   Symptoms and Treatment

All concussions should be evaluated by a medical professional as soon as possible and in no more than two days. Some symptoms suggest more serious concussion and damage and need emergency attention.

At the time of concussion you should note:

  • cause of concussion
  •  if there was a period of unconsciousness and if so how long
  • Any memory loss
  • Previous concussions

+   Short Term/Immediate

Unfortunately unlike in the cartoons, there are no cool sound effects or little birds flying around instead you are likely to suffer from one or all of the symptoms below. Some of the symptoms are difficult to judge for yourself and if you have bumped your head it’s good to ask a friend to hang out with you for a while and keep an eye on how you’re doing.

  • Headache
    • Your head will obviously be sore but if your headache gets worse or doesn’t go away, you need to go to A&E
  • Change in alertness, feeling a little slow to respond/ fogginess, confusion
    • Persistent confusion (you keep forgetting what happened, what day of the week it is etc etc.) and you need to go to A&E
  • Dizziness
  • Black spots (like after you’ve looked at a bright light)
  • Nausea and vomiting
    • if you vomit 3 or more times you should go to A and E
  • Unconsciousness, can’t be woken or very drowsy
    • longer than 1 min or repeated short bouts of  unconsciousness then it’s an emergency and you need to go to A and E
  • Memory loss (usually short term about recent things that people have done and said)
  • Irritability/anxiety
  • Below symptoms all need to be considered an Emergency
    • Seizures
    • Trouble walking
    • Muscle weakness
    • Unusual eye movements
    • Unusual behaviour

+   Longer Term Recovery

It can take a week to recover full from a concussion and you will likely continue to have mild symptoms for 7-8 days after the injury

  • Mild headache
  • Noise/light sensitivity
  • Problems concentrating
  • Slowed reaction times
  • Confused and easily upset

+   Serious Long Term Complications

Not to scare you too much but concussions can be super dangerous. We are talking about an injury to your brain here. With correct treatment and careful observation serious complications in the majority of cases can be prevented. So be smart, follow the steps we list in the treatment section and look after yourself properly.

  • Brain swelling
    • Especially likely if you have a second concussion before recovering from a first
    • Potentially life threatening, one of the reasons you should always go get checked out by a doc
  • Above symptoms listed under short term/long term can in some cases last for a number of months
  • Brain damage
  • Long lasting speech and memory problems
  • Repeated concussions, have been shown to increase the chances of dementia, Parkinson’s disease and depression (shown by studies on Rugby and American Football players)

+   Treatment

  • Immediately stop physical activity and minimize neck movement
  • 80-90% of concussions resolve in 7-10 days
  • Get checked out by a doc
  • Monitoring and rest
    • Have someone around to monitor you for the next 24hrs and make sure symptoms don’t get worse
    • Get sleep
      • It used to be that docs would recommend keeping a concussed individual awake, for a possible brain bleed this may still be required but in general it is now believed that rest and sleep is crucial for recovery
      • If you are worried or the concussion is more than just mild, it’s worth waking the concussed up at regular intervals. If they seem to take a really long time to wake up get them checked out at A and E or call your doctor
    • No sports/physical activity
      • If there is bleeding in the brain you run the risk of making it worse
      • Even if there is isn’t a second concussion on top of a previous concussion is far more likely and potentially more dangerous than the first one
    • No driving for the first few days, or until symptoms start to improve
    • Reduction in work/school work and other cognitive strains
      • Your brain is going to struggle for the next few days until everything rebalances, making it do complicated maths problems really won’t help it recover
      •  If you hurt your hamstring you probably wouldn’t go out for a run this is the same principle. Think of your brain in the same way as a injured muscle
    • Paracetemol is the best over counter pain killer as it minimizes the risk of any bleeding in the brain. NO ASPIRIN (can make internal bleeding worse)
    • Avoid alcohol and drugs not prescribed/approved by your doctor
    • Gradually return to normal activity at a pace that doesn’t make your symptoms worse
    • If you push yourself too hard you can make your symptoms worse, increase your recovery time and potentially cause severe damage

+   Getting back on the playing field/court

  • Here are the recommended steps for returning to physical activity. You should be symptom free before starting the steps and for at least 24hrs between each step and before moving on to the next one:
    • Rest both physical and mental
    • Light aerobic activity, less than 70% of your maximum
    • Running drills, with some sprinting
    • Non-contact drills
    • Controlled contact drills
    • It should be at least 5 days before you return to full contact after a concussion. Once you have had one concussion you are far more susceptible to have another.

+   Prevention

  • Wearing a seatbelt and having an air bag
  • Wearing a helmet
    • Skiing
    • Cycling/skate boarding
    • Contact sports
  • Wearing a mouthguard
    • Mouthguards don’t just protect against a few knocked out teeth but they also help to reduce the shock caused by head impact and whiplash

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