Article Source: Complete Concussions
When you specialise in one very specific area of medicine, it’s easy to forget that the entire world doesn’t share your passion. But we are regularly reminded when we hear some pretty wild “facts” about concussions being discussed in personal and digital conversations.
We thought it would be a good idea to share some of the biggest misconceptions we hear about concussions in an effort to put them to rest once and for all.
Misconception #1: Concussions happen from hits to the head.
False. Now before you yell at us and tell us we’re wrong, allow us to get a bit technical for a second. Technically speaking a concussion is actually the result of the brain undergoing a tremendous amount of acceleration or deceleration. You can actually get a concussion without getting hit in the head, provided that enough force still goes to the head to cause acceleration of the brain.
For example, someone might be in a car accident. Luckily their seat belt kept them from being tossed around the car. But their head was whipped back and forth, causing an acceleration of the brain. They could still sustain a concussion.
It’s also worth mentioning that just because you do get hit in the head, it doesn’t automatically mean you will have a concussion, because you have to have a tremendous amount of force hitting the head to sustain a concussion.
So, to conclude, hits to the head don’t necessarily cause concussions, acceleration or deceleration of the brain cause concussions. Yes, getting hit in the head HARD is probably the easiest way to cause this acceleration or deceleration, but a direct hit to the head isn’t mandatory.
Misconception #2: Concussion is a bruise of the brain.
Even Google gets this one wrong. If you Google “concussion,” you’ll still see the concussion picture of the brain hitting the inside of the skull, creating a bruise on the brain.
This is an antiquated idea behind concussion where it was called a “coup contrecoup injury”. The newer theory around concussion is that it is an injury to the deeper part of the brain called the white matter.
The outer part of the brain is called the gray matter. The inner part of the brain is called the white matter. And the inner part of the brain contains a part of brain cells called axons. Axons are the long pathways or tracks that connect your brain cells to other brain cells to make up a network that is your nervous system.
With a concussion, what actually happens is when the brain undergoes acceleration, fluid waves are created in the brain, which cause these axons to stretch, and that’s where the injury occurs, deep inside the brain as a result of this quick stretching of the axons.
While you can still get bruising with a concussion, called a cerebral contusion, the leading theory behind what causes a concussion is actually the stretching of the axons that occurs.
Misconception #3: You can see or diagnose a concussion on MRI or CT scans.
Nope. Not even close.
We still get patients that come into the clinic that say, “Yeah, I went to the emergency department, doctor gave me a CT scan of my head and told me that I didn’t have a concussion.” Well, either your doctor didn’t know what they were talking about or you misunderstood the conversation, because a CT scan or an MRI detects and looks at the structure of the brain.
Concussion is a functional injury. So, while it changes how the brain functions, it doesn’t change how the brain appears. So, when somebody does a CT scan or MRI, they’re usually looking for something more significant than a concussion like a bleed, or a fracture in the bone of the skull, or actual structural damage to the brain that is visible.
About 95% of concussion patients aren’t going to have any type of finding on any type of imaging. Something to keep in mind.
Misconception #4: If you have a concussion, you’re supposed to rest.
This one is brutal because not only is it entirely wrong, it’s still propagated! We’ve known for a number of years now that rest can actually be detremental to your recovery if done in a prolonged way.
Yes, there was a time when the medical recommendation would be to have absolute rest, brain rest. Don’t look at a screen. Don’t read a book. Don’t watch TV. Don’t go outside. Sit in complete darkness in your room for days on end until your symptoms go away, and then you can emerge and start to try a little bit of activity.
But we’ve since found that this protocol, although it may help alleviate symptoms in the very short-term, may actually make people worse in the long-run. The current recommendation from the most recent international consensus guidelines is symptom limited activity within the first 24 to 48 hours.
This means if you are diagnosed with a concussion you are to take it easy and don’t do anything that provokes your symptoms to a significant degree for the first 24 – 48 hours. But while you should be cautious, that doesn’t mean you should do absolutely nothing. It’s better for you to be somewhat active and take some light exercise, making sure you don’t exacerbate your symptoms.
So, in conclusion, absolute rest is garbage. It’s not based off any scientific evidence. In fact, evidence has actually said the opposite. In 2015 Thomas and colleagues did a study where pediatric patients were randomized to have 5 days of strict rest. They actually did worse than patients who were randomized to only have 2 days of strict rest and began increasing activity.
Another study in 2015 by Moor and colleagues found that adolescents who didn’t adhere to their physicians’ advice to rest actually fared better than those who followed their doctors’ advice.
Now, we’re not advocating for not listening to your doctor, but if your doctor is telling you to rest and sit in darkness, your doctor may not be the most knowledgeable on concussion. So, we would be strongly questioning that advice!
This was also echoed by Silverberg and colleagues in 2019: “Advice to rest for more than 2 days after concussion is associated with delayed return to productivity.” And another quote: “This study supports the growing evidence that prolonged rest after concussion is generally unhelpful.”
Along this same vein, new research actually supports light exercise even in the very early stages after concussion. Researchers from the University of Buffalo have been studying the effects of exercise on patients with persistent concussion symptoms doing exercise and have found that exercise is generally a helpful treatment strategy for these patients.
Over the years we have consistently seen that not only is exercise beneficial to chronic concussion patients, but when performed as early as possible, exercise can prevent chronic concussion symptoms from developing.
Misconception #5: You are okay to return to your sport once you no longer have symptoms.
Symptoms, or a lack of symptoms, doesn’t have anything to do with recovery of the brain. Think about what happens when you break your arm. It hurts really, really bad. You go to the doctor… an X-ray is taken… and your doctor can visually see that the bone is broken.
But remember, with a concussion, you cannot see an injury. But even though you see nothing, the symptoms are there.
Going back to the broken arm. You get a cast put on, and after a week to 10 days the initial pain has mostly gone away. But just because it doesn’t hurt any more doesn’t mean your bone is fully healed. That will take weeks!
This is the same thing with concussion.
But for some reason with concussions, we think when it no longer hurts, and once you no longer feel “off,” that your brain is all better. Just because the pain is gone, just because the symptoms are gone, doesn’t mean your brain is healed, and therefore doesn’t mean you should go back to your sport.
Most concussion symptoms will go away in the first 7 to 10 days. But full brain recovery can take 4 to 6 times longer than that. While you are in recovery mode, there’s evidence to suggest that the brain is more vulnerable to additional trauma. So, if you sustain additional concussions, those secondary concussions can cause an additive or cumulative effect, potentially leading to long-term or permanent outcomes, and in extremely rare cases, even death.
So when is it safe for you to go back to your sport? Well, a concussion is a functional injury, so we shouldn’t be looking at symptoms, we should be looking at function, right? And to do this we have to rely on baseline testing.
Baseline testing means having a high-risk person (usually athletes involved in sports where concussions happen) do a series of functional and cognitive tests before the season starts. The results of these tests can then be referred to in the case of a concussion and if you’ve functionally recovered, then we can be more certain that you are safe to return to your sport. If the functionality is still not there, he or she will need more recovery time. This is probably one of the best proactive steps you can take to protect yourself from concussion!
Misconception #6: You can treat a concussion with medications or other passive modalities.
We’ll need to come up with a new way to say no… “Oya!” That’s how they say “No!” in Papua New Guinea.
There is insufficient evidence to suggest that any pill or medication will successfully treat a concussion.
Admittedly, medication is often deployed for symptom relief. “You have pain, here’s a painkiller.”
Not only do pills and medications not treat concussions, most pharmaceuticals come with nasty side effects like dizziness, fatigue, fogginess, trouble concentrating, trouble sleeping, drowsiness… all of these are all symptoms of concussion!
And as far as any other modalities such as a hyperbaric chamber or laser therapy… there is simply no evidence to suggest any of these do any good or help you recover.
And this leads me to the next misconception:
Misconception #7: There is no treatment for concussion.
This is wrong.
There are a variety of effective treatment protocols for concussion such as:
Rehabilitation (visual, ocular, motor)
Treatment of the neck (passive and active treatment of the neck)
Movement patterns and cervical joint reposition area testing
Cognitive behavioral therapy (CBT)
The main thing that needs to be made clear regarding treatment plans is that the patient is going to have to actually do the work. So many patients want to take a passive approach to rehab. They want to be fixed instead of take part in fixing themselves.
Our advice is always the same: Stop looking for ozone therapy or laser therapy or any other promises of being fixed by a passive treatment modality and start preparing yourself to just put in the actual work.
Misconception #8: Having an increase in your symptoms is bad and should be avoided.
This is perhaps the BIGGEST misconceptions out there. So many of my patients are concerned when they have a slight “setback” and their symptoms get worse.
The truth about the human body is: Your body adapts to the stress you put on it. This is how your body grows and heals.
Think about what happens to your body when you try and get into physical shape when you are in really BAD shape: You exercise more… you’re sore… you can’t breathe, your heart races. But as you get into better shape, it becomes easier and you get stronger. You start pushing yourself harder, and that becomes harder, and then you can push beyond that, and then that’s easy. What you used to do and think was hard now is so simple. The same principle applies for concussion recovery (or rehab of any injury for that matter).
Concussion recovery requires rehabilitation, and much of rehab is finding that balance between what’s too much and what’s not enough. Concussion doctors have to push their patients to feel symptomatic. If you’re doing something and it’s not provoking your symptoms, you’re not doing it hard enough, or you’re doing something that you don’t need to be doing.
Here is what effective concussion treatment sounds like, “Oh, does this increase your symptoms? It does? Great, go do more of that. Get your symptoms to go up, and then take a break. Let the symptoms come down. Do it again. Try to do it for longer this time. Wait ‘til your symptoms get to a certain threshold before stopping.” Now this is done within reason, but the point is: “No pain – no gain” (or recovery).
Okay, we’re heading into the home stretch…
Misconception #9: Concussions cause long-term brain damage.
That’s a bit like saying “Buying a lottery ticket leads to winning the lottery.” It MAY lead to winning the lottery, but chances are it won’t.
As I mentioned a bit earlier, going back to a sport too early and getting successive concussions MAY lead to long-term complications. But with proper treatment and rehabilitation, this is unlikely. In fact, there is simply not enough evidence to make this claim.
Misconception #10: After a couple years of symptoms, recovery is not possible.
No, this is absolutely false.
Concussion recovery is harder the longer it drags on, but it is definitely not impossible. In our experience in dealing with patients, it really comes down to, “How bad do you want to get better?”
A lot of people will say they want to get better, but not many people are willing to actually put in the work and effort to actually get better. If you really want to get better, you’re going to have to work WITH a knowledgeable healthcare provider and do whatever it takes to get well.
Hopefully by sharing these top 10 misconceptions about concussions we have cleared up something you may have been confused about. Go ahead and bookmark this page so you can come back and refer to it as many times as you need. And please share it with loved ones, your healthcare providers, anyone who you feel may benefit. Concussions are nothing to mess around with and the more people are up-to-date on the recent findings, the more people get the help they need.
At Sunbury Physiotherapy, we have physiotherapists highly experienced in the treatment and management of concussions, please call our friendly reception team on 9744 5066 to book an appointment today and request a physiotherapist who specialises in concussion management.