As the leaves begin to change colour, we can be sure fall is in the air with the cooler weather upon us. Along with the noticeable change in temperature, fall also signals the return of many children and adults to participating in sporting activities like football and hockey (to name a couple).

In recent years, the professional organizations for football (NFL) and hockey (NHL) have been in the spotlight for various lawsuits from former players who suffered many concussions while competing in their sport. Many of these former players had sustained so many concussions while competing in their sport that it has ultimately led to them suffering from a degenerative brain disease called chronic traumatic encephalopathy (CTE). CTE is characterized by a loss of neurons (these form the connections within our brain- and without these connections our brain has a hard time communicating with other parts of our brain or body), reduced brain weight, and abnormal protein deposition in the brain (this slows down transmission of the signals in our brain to our body).

As a result of these lawsuits, the NFL is required to contribute $765 MILLION dollars to more than 18000 former players and their medical bills (that works out to $42,500/player), and the NHL is facing a bill of 13.5 MILLION dollars to 5967 former players and their medical bills resulting from the development of likely CTE after multiple concussions sustained throughout their entire career. The dollar value that has been placed on concussion and cumulative mild traumatic brain injuries (mTBI) by these professional sporting associations should be more than enough to convince you that Concussions are serious injuries, and that they should be taken seriously in order to take care of our brain.

Just because the NHL and the NFL have been in the spotlight over the past few years, doesn’t mean they are the only athletes afflicted with concussions. In fact, concussions are a common form of injury, affecting between 5-10% of athletes. Based on the frequency of these ‘invisible injuries’, it is no wonder why ‘CONCUSSION’ is such a buzzword in the media these days!

What is a Concussion?

A concussion is a form of traumatic brain injury (TBI) that may be caused by a direct blow to the head, face or neck, or any force that transmits an impulse to the head. Think of your head as an egg, where you have the yolk floating around within the egg white inside of the shell. The yolk represents your brain, the egg white represents your cerebral spinal fluid (fluid that cushions and protects your brain), and the shell that represents your skull. Normally when you open up an egg, you are able to distinguish between the yolk and the white. However, if you were to shake the egg vigorously and then open the egg you might end up with pre-scrambled egg. When your head receives a blow or any sort of whiplash injury, your brain has the potential to move within the skull or hit the skull which can hurt the brain, leading to the functional deficits characteristic of a concussion. It is important to recognize that with a concussion your brain isn’t scrambled at all, in fact it is barely bruised, but the egg provides a nice analogy to imagine what happens to the brain when our body or head is struck with enough force.

Concussions typically results in rapid onset of short-lived impairment of neurologic function that resolves spontaneously. What makes a concussion unique is that the impairments are functional, with no structural impairments or damage able to be identified with neuroimaging studies (MRI, CT Scan)- which is why it can be referred to as the invisible injury! 

Signs & Symptoms of Concussion

• Headache
• Feeling ‘in a fog’
• Irritable
• More emotional than usual
• Loss of consciousness
• Amnesia
• Slowed reaction time
• Insomnia
• Neck Pain
• Balance Problems
• Dizziness
• Vision Problems
• Ringing in the ears
• Confused
• Drowsy
• Nausea or Vomiting
• Fatigue or Low Energy
• Difficulty Concentrating
• Difficulty Remembering

After reading this list you probably recognized that many of these signs and symptoms overlap many other conditions. For this reason, if you suspect your child, spouse, or someone else you know has suffered a brain injury you should ALWAYS consult a medical professional (Medical Doctor, Chiropractor, Physiotherapist) before self-diagnosing the injury as a concussion, as more serious injuries MUST be ruled out.

Diagnosing a Concussion

As I already mentioned, because any brain injury is a serious matter, you MUST consult a medical professional with any suspected brain injury, as only a trained professional will be able to perform the necessary testing to determine an accurate diagnosis. Likely as part of the examination, the practitioner will ask a series of questions, perform a neuropsychological assessment and cognitive assessment (to evaluate the function of the brain, and alert the practitioner to any more emergent scenarios), and potentially order imaging (either x-ray, MRI, or CT) depending on the findings.

Management of a Concussion

Once your medical professional has provided a diagnosis of ‘Concussion’ how can you make yourself feel better? And when can you return to sport?

Since neck pain and headaches are common sequelae of a concussion, and since  reduction in spinal pain is strongly associated with faster recovery from the concussion, it might make good sense to pay a visit to your Chiropractor, because Chiropractors specialize in the diagnosis, treatment, and management of spinal related pain!

Because many of the nerves that come from the neck provide innervation to the head and neck, and because many muscles in the neck have trigger points that refer to the head creating headaches (called cervicogenic headaches), manual therapy (spinal adjustments or mobilizations) is extremely valuable not only to restore proper biomechanical movement of the neck, but to reduce some of the headache symptoms that may be originating from the neck.

In addition to receiving manual therapy, adding exercise therapy to the treatment regimen is crucial to encourage a complete recovery from concussion. But, before you get too scared about the word ‘exercise therapy’, you can breath a sigh of relief because many of these exercises (especially initially) do not require you to purchase a gym membership. These exercises are primarily aimed at gently restoring motion and in your neck and reducing tension in the muscles surrounding the neck.

While treatments to the brain directly are limited at this point, there is increasing evidence and support for nutritional supplementation including Omega-3 Fatty acids and antioxidants, as they can support brain healing and brain function, while helping to reduce inflammation throughout the body. Speaking to either a Chiropractor or, better yet, a Naturopathic Doctor about adding nutritional supplements to your diet when recovering from a concussion can ensure you are eating the best foods or taking the best supplements to facilitate your recovery from a concussion!

Gradual Return to Play

Your practitioner, in addition to providing you with treatment and therapeutic options to facilitate recover from a concussion, will also provide counselling on a graded return to play (or school/work). This gradual return is important because it ensures the brain is given enough time to heal, as jumping right back into play before the concussion has healed puts you at far greater risk for second-impact syndrome (which is suffering another concussion before the first one had a chance to properly heal). So, when your healthcare provider is recommending no activity, it isn’t because they want to see you frustrated and irritated that you can’t text your friends all day, it’s because they want to see you and your brain recover well enough so that texting your friends all day isn’t aggravating for your neck or concussion.

Step 1: No Activity (No sports, no physical activity, extremely limited use of computers, tablets, smartphones, and viewing of the TV)

Step 2: Light Aerobic Exercise (walking, swimming, or cycling, keeping heart rate less than 70% of maximum)

Step 3: Sport Specific Exercise (drills that are sport specific, such as skating in ice hockey, or running drills in soccer)

Step 4: Non-Contact Training Drills (progression to more complex sport specific skills, like passing drills in hockey and soccer. It is also at this stage the athlete may begin progressive resistance training)

Step 5: Full Contact Practice (following medical clearance, may begin participating in full training activity)

Step 6: Return to Play

Based on this graduated system, the athlete is permitted to progress through the steps (no more than 1 step per day) as long as they remain asymptomatic. If any concussion symptoms reappear at any stage, they must go back to the last stage where they were asymptomatic for at least 24hours of rest, where they may again pick up from that level. Based on this system, an athlete diagnosed with a concussion should not be returning to play any sooner than 1 week following the concussion.

Again, as medical practitioner’s our goal isn’t to force your 10 year old ‘future Sydney Crosby’ to miss 1 week of his critical season so that he is behind all the other 10 year olds skill-wise. Our goal is to ensure his brain is fully recovered prior to allowing return to play so that he can have a few more seasons being a ‘future Sydney Crosby’, and potentially move on to being the NHL’er he is convinced he will be! Because remember, we only get one brain, so take care of it!

Dr. Elaine Screaton is a Chiropractor in Calgary, Alberta, currently practicing at Synergea Family Health Centre.

As with anything, always consult a healthcare practitioner should you suspect a brain injury of any sort.

References

1. https://en.wikipedia.org/wiki/Concussions_in_American_football
2. http://www.tsn.ca/nhl-faces-13-5m-legal-bill-in-concussion-case-1.286175
3. Mccrory, P., Meeuwisse, W., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R., . . . Sills, A. (n.d.). Consensus Statement on Concussion in Sport—the 4th International Conference on Concussion in Sport Held in Zurich, November 2012. Clinical Journal of Sport Medicine, 16, 89-117
4. Donovan J, Cassidy JD, Cancelliere C, et al. Beyond the Spine: A New Clinical Research Priority. The Journal of the Canadian Chiropractic Association. 2015;59(1):6-12.
5. Schneider, K., Meeuwisse, W., Nettel-Aguirre, A., Barlow, K., & Boyd, L. (n.d.). Cervicovestibular rehabilitation in sport-related concussion: A randomised controlled tria. British Journal of Sports Medicine, 48(17), 1294-1298.https://drelainescreaton.wordpress.com/2015/09/24/the-invisible-injury-concussions/