Concussion, Sports Concussion and Post-Concussion Syndrome

What is a concussion? What happens after a concussion? 

Per the Berlin Consensus guidelines, a concussion is defined as a traumatic brain injury induced by biomechanical forces.

Concussions can be caused by a direct blow to the head or indirect impact to another body part, which transfers forces to the head. Although head hits are a common cause, not all concussions are caused by head trauma, head injury, or loss of consciousness following head impact.  Some other common causes include whiplash following car accidents, slip and falls,  mountain biking or playground accidents (more commonly in children).    

Following a concussion, the brain experiences rapid impairment of its neurological function. This may result in temporary loss of consciousness, vomiting, headaches, visual symptoms, feeling dazed, etc. Post concussion symptoms primarily reflect a functional neurophysiological disturbance rather than structural disturbance/injury. This is why most standard imaging studies following a concussion do not show abnormal findings (i.e. physical damage to the brain).  

In most cases, symptoms following a concussion resolve within about 2-4 weeks post injury, however, in some cases individuals may experience persistent symptoms, which last longer than the normal expected recovery after injury. According to studies, individuals with persistent symptoms who start active concussion rehabilitation within the first 2-3 weeks following injury achieve better outcomes (i.e. less symptoms) than individuals who start rehabilitation after 6 weeks or longer.  Therefore, it is recommended that you see a concussion therapist for assessment and treatment, if you are still experiencing symptoms after the first 2-3 weeks post injury.      

What are the common signs and symptoms following a concussion? 

The most common symptoms following a concussion are due to temporary neurophysiological and functional changes of the brain and nervous system.  These include: 

  • Headaches 
  • Dizziness
  • Nausea or vomiting
  • Vision change such as blurred or double vision 
  • Noise sensitivity
  • Light sensitivity 
  • Brain fog 
  • Fatigue 
  • Limited tolerance for physical or other normal activities of daily living 
  • Balance issues 
  • Emotional symptoms such as irritability, outbursts, etc. 
  • Cognitive symptoms such as difficulty concentrating, multi-tasking, or trouble with memory  

Persistent Post Concussion Syndrome

Persistent post concussion syndrome or “PCS” occurs when some of the symptoms above persist for longer than the normal expected recovery after injury (which is usually 2-4 weeks post injury).

While not all concussions require medical attention, it is important to see a doctor, if you suspect you have sustained a concussion. Your doctor may complete a basic neurological assessment and/or refer you for additional imaging, such as a CAT scan, if they feel this is necessary. They may also refer you for concussion therapy. You should seek medical attention right away in the event that you experience an intense headache, neck pain, or other symptoms that worsen in intensity over the first few days post injury.  

Some of the more common causes of concussion include: 

  • Direct head trauma such as during sport (i.e. football, hockey, and soccer) 
  • Motor vehicle accidents
  • Slip and falls
  • Any other mechanism that involves rapid deceleration 

First steps when you identify a concussion

If you suspect that you have sustained a concussion, you should see a doctor for further assessment. More urgent medical attention may be required if you experience an intense headache, severe head or neck pain, or other symptoms that worsen in intensity over the first few hours or days.

During the first 24-48 hours following injury, it is important to rest and avoid cognitive, physical, and environmentally stimulating activities. This will usually involve time away from work, school, or sport.  

After the first 48 hours, it is recommended to start a GRADUAL return to activity AS TOLERATED.  This is different for everyone. Many individuals return to work, school, or sport too quickly or at the other end of the spectrum avoid activities and rest for too long, both of which can be detrimental to their recovery. If you are unsure of how to progress/resume normal activities after a concussion, you may benefit from seeing a concussion therapist for further assessment and guidance throughout the process. 

What are common symptoms of PCS (Post Concussion Syndrome)

Persistent post concussion syndrome or “PCS” occurs when some post concussion symptoms persist for longer than the normal expected recovery after injury (which is usually 2-4 weeks post injury).

Persistent post concussion symptoms include: 

  • Headaches
  • Dizziness
  • Fatigue
  • Irritability
  • Anxiety
  • Insomnia
  • Loss of concentration and memory
  • Ringing in the ears
  • Blurry vision
  • Noise and light sensitivity

Individuals, who have a prior history of concussions or pre-existing visual/vestibular conditions may be more likely to experience persistent symptoms. These individuals would benefit from concussion therapy.    

Concussion rehabilitation 

Concussion or mild traumatic brain injury rehabilitation involves early education about initial rest, activity modification, and gradual resumption of activities.  

Most individuals with post concussion symptoms do not require very specific or prolonged concussion treatment and are able to resume their regular activities within the first 2-4 weeks post injury. Those who develop persistent post concussion symptoms require more focused rehabilitation, which often includes: 

  • Counselling on rest and sleep 
  • Vestibular and visual rehabilitation 
  • Static and dynamic balance training 
  • Neck mobility, strengthening, and control/proprioception work 
  • Gradual return to cardiovascular/physical activity
  • Multisystem integrative exercises that incorporate visual, vestibular, balance, neck coordination, and cognitive tasks 
  • Short and long-term strategies for symptom management and activity modification 
  • A gradual return to work, school, or sport plan  
  • Multidisciplinary care, which may require referral to an occupational therapist, psychologist, neuro-optometrist, or other healthcare professional 

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