A concussion is one of the most commonly sustained injuries in sports and recreational activities. It doesn’t matter if you are a pro-athlete, or just enjoy tossing a ball around with your friends or kids––the risk exists.
Although classified as a trauma to the brain, it is essential not to overlook the impact of concussion on the body. A cognitive AND physical examination is necessary for the initial concussion diagnosis, and consideration of both aspects is fundamental when creating a recovery plan. If you have suffered a recent concussion, or have ongoing symptoms, there are some solutions to rehab the body, as well as the brain to help rebuild your physical activity levels.
Concussion and Post-Concussion Syndrome
A concussion is a mild Traumatic Brain Injury (mTBI) “induced by biomechanical forces”, caused by anything that creates a physical trauma to the head, whether that is falling over, physically colliding with another person or object, or even a car accident.
Usually, the trauma to the brain is so minimal it will not be detectable using scans or medical imaging, so concussions are diagnosed based on a set of common symptoms, following the physical trauma. These include, but are not limited to: headaches, dizziness, cognitive impairments (such as brain fog, forgetfulness, slower reactions), behavioural changes (such as irritability, or impulsiveness), and drowsiness. For some people, the symptoms might set in immediately; for others, there could be a delay of hours after the physical impact.
It is important to seek medical attention as soon as possible if you suspect you may be concussed, for a proper evaluation. Although initial assessments tend to focus on the cognitive symptoms, take note of any physical injury incurred too. The neck can be affected during a head trauma, and the similarity between concussion and whiplash symptoms, where the neck is injured, is well documented.
In most cases, particularly if you take the adequate initial steps, such as getting a medical assessment, and following the proper recovery protocols discussed later, the concussion will resolve itself. However, if some symptoms persist for longer than four weeks, you may have post-concussion syndrome (PCS).
Similar to concussions, the current emphasis on PCS symptoms focusses on headaches, psychological and cognitive disabilities, in addition to symptoms affecting the eyes and balance. However, it is vital not to overlook ongoing physical issues. One study found, on evaluation by physical therapists, that 90% of ongoing symptoms in PCS patients were related to the neck. Symptoms included neck disability, pain, muscle tenderness, stiffness and headaches related to the neck. Not only is neck disability and pain commonly associated with headaches, but it can lead to back pain and temporomandibular disorders (TMD).
What You Can To Do To Minimize The Chances of Post-Concussion Syndrome
Avoiding post-concussion syndrome will not always be possible, as there are many variables; however, as is often the case, prevention is the best defense.
Complete physical, psychological and cognitive rest for 24-48 hours following the trauma is essential. This golden piece of advice is considered standard protocol, but it’s necessary to have further protocols in place for the time frame after this initial rest period, to avoid unwanted recovery complications. As no two concussions are the same, you will have to pay careful attention to ongoing symptoms and their triggers, adapting the protocol as necessary.
One study on ‘An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment’ in the context of sports injuries, recommends the following strategies. After the initial rest period, gradually return to the regular aspects of your life, such as work or school, and also sporting activities. This gradual return is key, because it only includes the activities least likely to trigger PCS symptoms, and avoids particularly challenging cognitive tasks.
Increasingly, researchers into concussion and recovery are advocating for a more dynamic approach, that includes physical examination and treatment. In terms of neck injury evaluation, early intervention is the recommendation as it is generally more effective for a full recovery.
Those with pre-existing headaches and neck problems are more at risk of incurring a concussion. In these instances, it is worth taking all the necessary steps to minimize the chance of a concussive injury. This could involve finding a practitioner to help you establish the cause of these conditions, which could be an underlying TMD problem. Furthermore, custom made mouthguards may decrease the possibility of incurring an mTBI.
Physical Healing Approaches to PCS
Should I Avoid All Physical Activity?
Traditionally, either not much attention was paid to the physical recovery process from concussion, or it was discouraged. Recent findings show that those who engage in moderate physical activity have a better recovery rate. Key to this is managing the intensity of the physical activity and not overexerting yourself, as this may actually jeopardize your recovery.
The previously mentioned study on concussion and sports injuries outlines a six-step return-to-sport strategy: “(1) symptom-limited activity, (2) light aerobic exercise, (3) sport-specific exercise, (4) noncontact training drills, (5) full-contact practice, and (6) return to sport.” This final step is subject to medical clearance, and you must be completely free of concussion symptoms.
Physical Treatments for PCS
A range of physical treatments, from working with a physiotherapist to a chiropractor, or even TMD specialists, could support your healing journey.
The correlation between whiplash injuries and concussions, including their shared symptoms, is opening up a different approach to treating concussions. The neck needs careful evaluation as myofascial pain may cause not only headaches, but also dizziness, and lead on to TMD. It is also advisable to consider if the cranial nerves, specifically the trigeminal nerve, have been affected. A symptom of this may be dizziness, a common concussion symptom, and there is evidence that dizziness after sports injuries can prolong recovery time.
Treating the jaw can provide relief for several surprising symptoms that seem unrelated to this region of the body, and can be especially effective for relieving headache and neck pain. It may be worth considering using an anterior deprogrammer occlusal splint. This dental device can create muscle relaxation in the jaw, which may have a knock-on effect for the myofascia of the head and neck, ultimately allowing greater relaxation in this region for complete healing.
If you have recently suffered a concussion and are looking to avoid PCS, or have PCS and are interested in a more physical approach to relieving your symptoms, then Speed2Treat can help. We are here to support you with your recovery.
Julia Worrall is a Registered Nurse with decades of experience in acute care. Noticing that early intervention is lacking when it comes to head, neck, and jaw pain, Julia determined to bridge the knowledge gap between multidisciplinary providers and ensure that patients receive appropriate care to avoid delayed recovery, chronic pain, and polypharmacy scenarios. Julia is a published author and highly sought after international lecturer.