Concussions: A Headache to Manage

Many of us are aware that concussions are serious. Many of you might have seen them watching your favourite sport, in fact the term “HIA” or head injury assessment has popularised the prevalent nature of a concussion to an average sports fan. 

Research shows that concussions affect 15.4 participants per 1000 playing hours in the NRL and 6.5 per 1000 playing hours in the AFL and may affect up to 100,000 athletes in Australian recreational sport. Furthermore, there is a great chance these numbers are significantly underreported due to the failure of diagnosing and subsequently treating these injuries. 

So the questions we need to ask are, how can we identify a concussion? How long can we expect Concussion recovery to take? Can we avoid concussion episodes and can we help our recovery following concussion? 

What is a concussion? 

A concussion is classified as a mild traumatic brain injury resulting from either a direct blow to the head or a secondary feature following a blow to the body. This causes bruising and swelling due to the trauma of the brain in respect to the skull. 

The AIS has released mandatory removal from play signs to help concussion recognition and to prevent further head injuries. Mandatory removal from play criteria is one of the following; clear and noticeable loss of consciousness, no protective action from falling, seizure or tonic posturing, confusion, memory loss, balance disturbance, dazed/blank stare, changes in behaviour.

How long can we expect Concussion Recovery to take?

A Concussion recovery has a standard timeline that most episodes follow:

Concussive Event: Day 0

Spontaneous Resolution: Day 7-10

Gradual Resolution: Week 2-4

Some individuals (approx. 10%) will experience prolonged symptoms for greater than 3 months.

Two considerations are crucial; appropriate rest and graded return to sport. 

Here at Carlingford Active Health, when returning the athletes we treat following a concussive episode, it is important to consider every athlete as an individual; rather than a one size fits all approach. It is also important to be in strong communication with an appropriate medical practitioner (GP or specialist) when returning to sport.

Attached is a guideline that we use to help aid our decision making when returning an athlete back to sport. 

Can recovery following a concussion be improved?

Post Concussion Syndrome or Persisting Symptoms Post Concussion affects approximately 10% of the population. 

This can be diagnosed when the presence of cognitive deficits in attention or memory AND at least 3 of the following for 3 months:

• Fatigue

• Sleep disturbance

• Headache

• Dizziness/vertigo

• Irritability

• Affective disturbances

• Apathy or personality changes

In order to improve recovery post concussion and to avoid post concussion syndrome we need to understand the risk factors for this condition. 

These risk factors can include: Previous concussions, migraine, Female, Age, Psychiatric History and Decreased neck strength. Other risk factors that are potentially modifiable during the concussive event include delayed removal of play and subsequent symptoms suffered. 

Therefore, if we can modify risk factors such as neck strength there is potential for prevention and risk reduction of concussive episodes. Furthermore, by increasing neck strength, understanding risk factors and having a clear plan and guidelines we can help prevent post concussion syndrome. 

When considering neck strengthening exercises we can load an athlete in many ways:

These include but are not limited to:

Neck Strengthening Isometric

Neck Strengthening Reactive

SEE BELOW (ATTACH)

Neck Strengthening Combined