Recognising a Concussion
It is estimated that in Australia, there is likely to be 6-10 times higher than reported rates of concussion. Concussion is not just a contact sport injury. A common cause is from a fall or crash on the slopes. It is a condition we commonly hear of, but many people don’t actually know how to recognise a concussion or what they should do for it and most importantly, why it’s an injury you don’t want to miss.
Concussion is a type of mild traumatic brain injury that is caused by a direct impact to the head or an indirect hit to the body (but the force is transmitted to the head), which may cause a stretching or shearing injury to brain cells, which then affects how your brain works.
Sometimes it can be obvious when there is, for example, a loss of consciousness, but this actually only happens in less than 10% of concussions. A lot of the symptoms can be more subtle, such as confusion, disorientation, headache or feelings of anxiety or depression. There are in fact 24 symptoms of concussion and symptoms can develop over minutes, hours or days. A concussion cannot be seen on imaging and for this reason it is sometimes called the ‘invisible injury’.
The more concerning risk of a concussion and returning to the slopes too soon, is that of second impact syndrome. This occurs if you sustain another impact while the brain cells are still recovering and can lead to a much more severe and potentially even fatal brain injury.
Recognising a concussion is the first step to getting the right treatment and getting back on the snow safely. The Pocket Concussion Recognition Tool is designed to help you recognise the signs and symptoms of a concussion. You can search for it on google, but I recommend saving it on your phone for easy access. If you or your loved one have even just one sign or symptom, you should not return to activity that day. Your first point of call at Hotham should always be Hotham Ski Patrol and the Hotham Medical Centre, so get checked out asap to also rule out a more serious brain injury.
While concussion symptoms often resolve in 3-8 days, this doesn’t necessarily reflect the healing of brain cells. Going through a graduated return to school/work then return to snow program guided by an appropriately trained professional is key (more on this in Part 2).
Just remember, if you had a fall and at least one symptom (which can be as simple as ‘you don’t feel right’) you should alert Hotham Ski Patrol or head to the Hotham Medical Centre and when in doubt, sit out! Stay tuned for Part 2 which will cover what to do following a concussion.
For more tailored advice on managing your concussion, I am available for appointments all year at our Bright clinic. See www.ovensvalleyphysio.com.au for more information.
Following a Concussion
If you have been diagnosed with a concussion, the first step to recovery is resting for a couple of days. This does not mean being locked in a dark room, it simply means taking it easy and gradually returning to normal activities such as reading or watching tv, provided they don’t provoke symptoms. Then, under the guidance of an appropriately qualified therapist, a graduated return to school/work and then return to snow program can begin. Going through this process is important for recovery and it is also important to be aware that kids take longer to recover than adults.
As previously mentioned, research is showing that the resolution of symptoms doesn’t reflect the recovery of the brain, so just relying on symptoms to make a return to snow decision is not appropriate. Working with a therapist who can assess more objective measures such as balance, reactive time, cognitive ability, memory and physical capacity is key. Comparing these with pre-injury levels will give you the most accurate guidance of brain cell recovery, which is what a concussion baseline test involves.
A baseline test measures these higher level brain functions (balance etc as mentioned above) when your brain is at a normal level for you. That way you are comparing post injury tests to what ‘your normal’ is, rather than comparing to general data, so it is a more accurate decision. Baseline tests are particularly relevant to athletes for returning to competition safely.
The other part of concussion that is often misunderstood is post concussion syndrome. This is when symptoms become long standing (more than 4 weeks). It is particularly challenging given others can’t see the symptoms and they can be hard to explain to those who don’t understand. Physiotherapists with further training in concussion (like myself) can assist in rehabilitation from post concussion syndrome.
Also an important point to note is in regards to helmets. Helmets do protect the head, but only from more serious conditions like skull fractures. So don’t be fooled into thinking that wearing a helmet keeps you safe from concussion, as the current research does not support this.
Concussions on the slopes are often underreported and undiagnosed due to lack of knowledge about signs and symptoms and not being aware of the serious consequences of returning too soon. Hopefully this has opened your eyes as to what a concussion is and why it’s an important injury not to miss! You only have one brain, so it is important to take the time to recover. There will always be future chances to hit the slopes.
Check out my blog at www.physiophebe.com or follow me on Facebook or Instagram @physiophebe for more regular physio tips.