The latest research suggests a concussion occurs when there is a high force through the brain, causing a stretch/ shear of the brain neurons. This leads to changes in how the neurons exchange calcium, potassium and sodium, with too much calcium overloading the neuron and leading to increased neuron firing, which requires a significant amount of energy. Intracellular energy is controlled by a chemical called ATP.
Unfortunately, blood supply to the brain reduces after a concussion meaning the higher demands for ATP cannot be met and leads to an energy crisis. The time is takes for this energy crisis to be resolved is not fully known, but is believed to be around 20-30 days. Testing against baseline scores is the best available measure to see when this recovery has likely taken place.
A resolution of symptoms does not indicate a recovery of this system.
Due to the high forces involved, it is extremely common for the neck to have suffered some form of whiplash. This can confuse the source of some symptoms – concussion or whiplash – and is why we will do a neck screen on assessment to ensure this is not overlooked.
Secondary impact syndrome is when a further concussion occurs when the energy deficiency is still present, leading to ATP levels going below the threshold of neuron maintenance, causing permanent damage in the neurons. Unfortunately this permanent damage is irreversible, causing prolonged symptoms and can also be fatal in some cases.
Every case will have different symptoms and duration of these symptoms. But the most common symptoms are:
• Sensitivity to light
• Sensitivity to noise
• Pressure in head
• Feeling ‘slowed down’
• Neck pain
• Feeling ‘in a fog’
• Nausea or vomiting
• Feeling ‘not right’
• Trouble falling asleep
• Difficulty concentrating
• More emotional
• Blurred vision
• Difficulty remembering
• Balance problems
• Nervousness/ anxiety
• Fatigue or low energy
This is not a comprehensive list, and if you have some of these symptoms it does not mean you have had a concussion – there can be many explanations for some symptoms.
If a player is subjected to an impact to the head or body where there is enough force transmitted through the head, the basic first aid protocols need to be followed – danger, response, airway, breathing, circulation – and if emergency medical care is needed, this is the priority. Always ensure the neck is stabilised and instruct the player not to move until any neck pathology has been cleared.
For non- health professionals the Concussion Recognition Tool 5© has been developed and can be found here – https://resources.fifa.com/image/upload/concussion-recognition-tool-5.pdf?cloudid=y9y5fpwji70rtzyefdoa
A player subjected to a ‘heavy’ hit or complaining of any of the symptoms above, should be removed from play and assessed with a sideline sports concussion tool, such as the SCAT5 (Only for use by health care professionals).
Be aware, often players will not report issues themselves as they may want to keep playing or not realise the severity of a collision due to adrenaline, but coaches, parents, officials and teammates have a responsibility to make sure someone is removed from play for further testing when necessary.
The SCAT5 screens for red flag (medical emergencies) signs and on-field neurocognitive assessment. The test is then more in-depth when the player is taking to the sidelines and looks to assess neurological issues, cognitive impairment, balance issues and symptom evaluation. This helps in determining whether the player is able to continue, but should not be solely relied upon when making the decision as to whether it is safe to return to play.
A copy of SCAT5 can be found here:
* Please note, the re-testing of the SCAT5 at a later date has not shown to be a reliable test to determine the recovery from a concussion.
A scan and examination is always prudent with head trauma to rule out serious pathologies. If there is any doubt or a loss of consciousness has occurred, immediate medical help is required.
However, there is no scan or blood test at present which can diagnose a concussion, as the physical damage is thankfully not significant enough to be present on modern-day investigations, but they are very important in ruling out other serious pathologies.
Although most commonly associated with head traumas, concussion can occur when there is enough force transmitted through the body to cause sufficient stress and shearing in the brain’s neurons, causing a concussion when there has been no actual head impact.
Baseline testing is generally done in the off-season or when it is known that no concussion has occurred.
The baseline test is a series of tests giving a baseline score for the individual, which in the event of a concussion can be used as a comparison to suggest a full recovery has taken place. At present this is the best method to judge recovery, however, concussion assessments and treatment are not reliant on a baseline test having taken place.
The initial visit should occur as soon as possible post-impact, with the initial aim of ruling out any other underlying pathology, assess for neck issues and a neurological screen. If any serious pathologies are present you may be sent to your GP for further testing or to the accident and emergency department.
The visit will start with a subjective assessment, discussing what happened, the symptoms experience, how you are coping and answering any questions you may have regarding the recovery process and condition in general.
This will be followed by an objective assessment looking at your neurological system, your neck function, a vestibular-oculomotor screen (VOMS) and any specific complaint you may have, all of which help to formulate the most effective treatment plan.
You will be given full details of how to manage your concussion and the planned course of treatment and answers to any questions you may have.
There are numerous treatments for concussion depending on the symptoms present – for example, if your concussion has resulted in a reduction in neck movement, then treatments to resolve this will be given.
The general protocols and timelines followed are in association with Complete Concussion Management, which utilises the most up-to-date research to ensure the successful treatment of concussion and a safe and prompt return to activity and sport.
Concussion is classified as a mild traumatic brain injury (mTBI), the use of the word mild relates to the absence of structural brain damage. Full recovery can occur after concussion; however the brain is vulnerable to permanent damage in this recovery period.
The term ‘mild’ can be misleading as the metabolic and physiologic processes are severe, with potentially severely debilitating side-effects.
At present the research does not suggest repeated concussions lead to long-term issues or brain damage, so long as secondary impact syndrome is avoided, however further research is needed in this area. If there is a secondary impact in the recovery period, there is the potential for permanent damage of neurons in the brain.
The initial risk with concussion is that a more severe condition is missed and diagnosed as a concussion, which is why if there is any doubt, further medical scans and testing should be undertaken.
Secondary impact syndrome is also a major concern with the return to activity and sport when recovery is still taking place. This increases the chances of permanent damage and in some cases death.
Prolonged symptoms and failure to recover in a timely fashion is another risk, which can be debilitating and detrimental to everyday life. Thankfully, the risk of prolonged symptoms can be significantly reduced with the correct management of the condition.
This used to be the consensus, but has now been found to lead to greater issues and to prolong recovery. An initial period of general rest for up to 4 days may be needed, but rest does not mean bed rest or staying in dark rooms for hours on end.
Both of these have now been found to be potentially detrimental to recovery, so the key is relative rest where you take things easier, but are still doing general activities of daily living as able.
Also, rest may help with some initial symptoms but unfortunately it has not been shown to be efficient in helping a return to sports and activity.
No, however if you have had any recent medical investigations relating to your condition, they may be discussed to ensure we have a full picture of your health and condition which aids in getting an accurate assessment.
In the rare event any serious pathology is suspected, you’ll be guided to your GP or the Accident and Emergency department. A letter detailing your issues will be given or faxed through to your doctor.
No – you are free to make an appointment with no referral.
However, if trying to claim on a medical insurance policy, your insurer may request a doctor’s referral first.
Check with your health insurance provider – some policies cover the costs, some partially cover some aspects, some cover some treatments but not others. In short, it is a confusing picture – so check with your policy provider first to see what is covered.
Please check prior to your appointment as no responsibility for their refusal to cover costs will be taken by the Dizziness, Balance & Concussion Centre.
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