Heads Up for Concussions By Andrew P.T. Gregory, DC
when they are recognized. Much of the misinformation stems from decades in which very little was known about the process of concussion, and an athlete’s ability to get back into the game was considered a sign of mental toughness. Many former football players I have known relate countless instances in which they were hit and then were so disoriented that they ran back to the wrong huddle or don’t remember the second half of the game. They describe “getting dinged” or “having their bell rung,” but don’t realize that what they really sustained was a mild traumatic brain injury, or concussion. A concussion is a brain injury. While sports injuries account for many concussions, falls and motor vehicle accidents are frequent causes as well. One of the biggest misconceptions is that you have to lose con- sciousness to experience a concussion. This is not true. While there are dozens of different methods to measure the severity of concus- sion, it is generally agreed upon that any alteration in conscious- ness such as feeling dazed or disoriented, dizzy or confused after a trauma to the head is a sign of mild concussion. Another misconception is that you have to strike your head in order for a concussion to occur. This also is not true. Our brain doesn’t completely fill our skull; instead, it is surrounded by fluid to help act as a cushion. If someone’s head is quickly thrown forward and back, such as during a whiplash injury, the brain can slide forward and back within the skull and strike the inner bony surface. In this instance, the trauma to the brain occurs inside of the skull as opposed to the outside of the head. As stated earlier, one of the biggest challenges has to do with
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recognition. For example, after a concussion during sports, a person may feel symptoms such as a headache or pressure in their head, nausea, dizziness, blurred or double vision, confusion, or a vague foggy feeling. To an outside observer, they may appear dazed, stunned or confused. They may move in a clumsy manner or have difficulty following instructions. In this instance, the player should be removed from play until s/he is properly assessed and cleared to return.
ew serious conditions are as misunderstood as concus- sion. Not only are concussions often overlooked in the first place, but they tend to be discounted and mismanaged
It is worth repeating that a con- cussion is an injury to the brain. An important concept to keep in mind is that an injury to the brain is a process, not a solitary event. Follow- ing the trauma, damage continues to occur on a cellular level for a period of time afterwards. During this early phase the brain is especially vulnerable to additional
trauma and a second concussion within a short period of time can have
devastating effects such that 2 minor brain in- juries over a close period of time can result in a very severe problem or even death. This phenom-
enon is called second impact syndrome. Brains tend to heal at different rates based on several factors. It is important to realize that the cellular damage as a result of a brain injury is permanent. Once a brain cell dies it won’t come back. Fortunately our brains are over-engineered with an abundance of ad- ditional brain cells and have the ability to adapt, remodel and form new connections in response to our environment. A person’s recovery from a brain injury has a lot more to do with
the brain’s ability to remodel, relearn and compensate than it does from dead cells coming back to life. It is similar to being born with a certain amount of money in a bank account. In addition to slowly losing money (brain cells) over our lifetime, we also have to pay for brain injuries by making withdrawals from the account. As long as there are enough resources remaining in the account our brain will have the ability to compensate for the trauma. This analogy helps explain why risk factors for a slower or less complete recovery fol- lowing concussion include a history of previous concussion, history of substance abuse and advanced age. In other words, it is not only how severe the trauma was, but also what state the person’s brain was in prior to the trauma that counts. Following a concussion a brain needs rest in order to heal, or
compensate, properly. Not only does this mean refraining from sports until cleared, but also minimizing or preferably, eliminating, over- stimulating activities such as video games and television. It is not unusual for a student to be unable to return to school for months fol- lowing a concussion. Alcohol should definitely be avoided and the patient should be permitted to get plenty of rest throughout the day.
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22 Natural Nutmeg August 2012
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