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Concussion and MTBI

I got my "bell rung", I am just dazed, I got stunned.  These are all signs of a Concussion or mTBI (mild Traumatic Brain Injury)


What is a Concussion?


Concussions are injuries to the brain caused by an impact to the head or other part of the body.  The most important factor that causes a concussion is the change in acceleration of the head and brain causing a "jarring effect" of the brain against the skull.  The result is a FUNCTIONAL injury to the brain. Concussions are classified as mTBI or mild traumatic brain injury.  In simple terms a concussion or mTBI results in not a structural injury to the brain, but a functional injury in the sense that the neurons are no longer properly firing to send signals to the body.


Why does each person experience different Concussion symptoms?


Each Concussion or mTBI will present differently depending on what portion of the brain is impacted.  Each lobe of the brain is responsible for a group of functions.  Injury to each specific area will cause different signs or symptoms to present.


What are the RISKS of playing sport (contact and non-contact) with a concussion or suspected concussion?


There are many known risks of playing sport with a concussion or mTBI.   The most significant and well known of these include:

- Medical Emergencies (Sub-Dural Hematoma, Physical Brain Damage, Other Brain Injuries)

- Death

- Second Impact Syndrome (brain swelling after a second trauma to the brain before it has healed)

- Chronic Traumatic Encephalopathy (degeneration of the brain caused by repeated trauma)

- Post-Concussion Syndrome (long term symptoms, although this may occur after only one concussion, the risk significantly increases if an initial injury does not heal)

- Long Term Cognitive and Functional Deficits - There are varying degrees of evidence that concussions may cause long term deficits in brain function.  These deficits can be of varying degrees.

- Changes in Brain Tissue resulting in Disease - Research suggests that repeated trauma to the head including (sub-concussive blows) and trauma resulting in a concussion may increase the risk of diseases such as alzheimer, dementia and depression as well as others.

 

What is a sub-concussive blow? And is this bad?


A sub-concussive blow is a trauma to the head or body resulting in the brain to quickly change acceleration and shift.   The difference between this and a trauma causing a concussion is that these blows do not cause the presentation of signs or symptoms of a concussion and may or may not cause a functional injury.  Over the past decade research on sub-concussive blows is becoming more conclusive that the accumulation these smaller traumas may result in as much, if not more degeneration in the brain over the long term than the traumas resulting in concussions. 


When do I know if I am better?


In the majority of cases the injured person will feel better before their brain has healed.  Although the majority of concussions are better within 8-10 days, it is instrumental to perform both physical tests as well as neurocognitive testing to ensure any deficits are found and minimize the long term effects of these injuries. Return to learning and return to sport protocols are not to be started until the tests have returned to normal.


How do I minimize my risk of long term health problems caused by brain trauma and injuries?


The best way to minimize risk is to have an up to date baseline evaluation performed at the beginning of each sports season.   This will include computerized testing, balance testing, memory testing, reaction time testing, and other measurable evaluations.   In the event of a concussion or suspected concussion, getting post injury testing to determine when the brain has returned to normal function in the best thing to do.  The second most important key is being honest with your health care provider, we often find in athletes, the desire to return to sport is more important than the care of their brain.  This causes some athletes to feel the need to falsify information, often resulting in more lost time over the long term.


For students and younger athletes, once scores have returned to baseline values, then completing a return to learn protocol to ensure they keep up to date and get back into school as efficiently as possible.  Once return to learn is completed, then completing a return to sport protocol to safely get back to their sport.  Both the Return to Learn and Return to Sport protocols are step by step processes over a few days to allow for a gradual increase in stimulation of the brain.  


Having these assessments and following these protocols with a health professional such as an Athletic Therapist is instrumental to providing the best care for a concussion or suspected concussion.



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