Concussions – what’s the big deal?

Every year in Canada tens of thousands of people get a concussion. That number is estimated at around 60 million per year globally. Most often these result from falls or car accidents, but they can happen in sports, from play, or just accidents around the house.

So what exactly is a concussion? A concussion is defined as a mild traumatic brain injury, and it occurs when there is enough force created by a blow to the head, the body, or a rapid acceleration or deceleration that causes the brain to move around inside the skull. Interestingly, this doesn’t cause any physical damage to the brain, like bleeding, but it does cause a reversible biological dysfunction. Basically, the biomechanical forces lead to a cascade of neuromechanical events which cause functional impairments to the brain. So it is not physical damage to the brain, it is a chemical and metabolic reaction that alters the brain’s normal function. This is why concussions can’t be assessed by x-rays, MRIs or CAT scans. This is also why there are no longer any grades of concussion such as mild or severe. You either have a concussion or you don’t!  The signs, symptoms, and durations will differ from person to person, and even with subsequent concussions.

What should you do if you think you, or a family member, has a concussion? First, the person should stop whatever activity they were doing. This will decrease the risk of causing another injury, or of causing more longer-lasting symptoms. Second, concussions need to be diagnosed by a medical doctor. Does that mean that every person with a suspected concussion needs to be rushed to the ER? Not necessarily. However, if someone has sustained an injury that could cause a concussion there are certain red flags that would indicate they need immediate medical care. These include: loss of consciousness; neck pain or tenderness; double vision; a severe or increasing headache; weakness or tingling in limbs; vomiting more than once; growing confusion; increasing restlessness, combativeness or agitation; or a deteriorating conscious state. If you notice any of these, call an ambulance right away.

Signs and symptoms of a concussion can vary widely, but tend to fall into a few specific categories. Emotional symptoms such as feeling more sad or angry, anxiety, being easily upset, or having limited attention and avoiding social interaction. Cognitive and fatigue symptoms include intense fatigue, sleep disruption, difficulty concentrating or remembering, feeling slowed down or in a fog, and low energy. Migraine-type symptoms include intermittent headaches, or headaches upon waking, with nausea, light or sound sensitivity, with visual auras, or motion sickness. Lastly, ocular symptoms can include blurry vision, difficulty focusing, eye strain, difficulty reading, and a headache or fatigue triggered by visual activity. These symptoms can last anywhere from a few days to several weeks. Post-concussion syndrome is defined as symptoms lasting longer than a few weeks and can affect some people for up to a year or more.

Once a person has been diagnosed with a concussion, and further injuries or complications have been cleared, they can begin treatment. Treatment recommendations have changed significantly over time. For example, it used to be standard protocol to wake a person up every couple hours the first night to check their conscious state. Now it is recognized that the best action to take in the first 1-3 days is to get lots of physical and cognitive rest, and avoid anything that exacerbates symptoms, specifically trying to limit screen time. It also previously used to be recommended that the person should rest and avoid all activity and stimulation until symptoms have fully resolved; so essentially they were supposed to cocoon until they were better. Recent studies have shown however, that gradual early return to light activity and daily life actually helps speed recovery and reduce symptoms. A trained clinician can perform a test to determine the person’s sub-symptom threshold for aerobic exercise and help direct and monitor an exercise protocol. Other treatments that are helpful in dealing with concussions include manual therapies, nutritional support, psychological support, and oculomotor and vestibular rehab if needed.

Gradual return to work, return to school, or return to activity is very important following a concussion. To see some examples of what this might look like, you can check out the resources available at, which is a website produced by the Public Health Agency of Canada. A medical professional can help supervise this process, and will work with a team of health professionals as needed to address specific symptoms a person may be experiencing. If you need help managing a concussion or post-concussive syndrome the therapists at Bragg Creek Physiotherapy would be happy to assist you.

Susie MacPhee, BKin, CAT(C)

Certified Athletic Therapist