Understanding Concussions

Understanding Concussions

Concussion is something we hear about with both professional and amateur athletes alike.  But it is not just a sports injury.  A concussion can occur as a result of a motor vehicle accident, a fall, a work place injury, or hitting the head with force.  But there does not need to be a direct force to the head to experience a concussion.  It can occur as a result of a blow to another part of the body that creates an “impulsive” force to the head.

So what is a concussion?

A concussion is a mild traumatic brain injury (mTBI).  The “impulsive” force to the brain creates a force to the nerve fibres in the brain - a stretching force.  This stretching force triggers the release of various neurotransmitters (“signalling” chemicals within the brain) which initiates a complex cascade of events that essentially creates an energy crisis in the brain.  This energy crisis makes it difficult for the brain to produce the energy needed to carry out its usual functions.  (No wonder you feel so tired - everything requires so much more energy!). This metabolic imbalance along with other physiological impairments contributes to the physical, cognitive, behavioural and emotional signs and symptoms experienced with concussion.

Given that the cause of concussion symptoms is related to metabolic events in the brain, there is generally no physical findings in any diagnostic imaging such as CT scans or MRI.  These scans are used to rule out more severe trauma like bleeding in the brain or fractures of the skull.  Just because the scans don’t find a structural cause doesn’t mean that there isn’t anything wrong!

How do I know if I have had a concussion?

There is such a wide array of symptoms associated with concussion.  Some of these symptoms are related to other conditions or injuries so can sometimes be difficult to determine on your own.  Concussion related symptoms include;



Neck pain
Nausea or Vomiting Loss of balance

Poor coordination

Trouble focusing on objects or words Poor concentration Feeling “foggy”
Confusion Amnesia or poor memory “Flashing lights”
Blurred or double vision Seeing “stars” Ringing in ears

Irritability or emotional changes

Slow to follow direction Decreased playing ability
Easily distracted Vacant stare Drowsiness/fatigue
Difficulty falling asleep Feeling “off” or not like oneself

You may not experience all of these symptoms but if you have are experiencing even ONE of these symptoms after an incident or injury that involved a blow to the head or a “jostling” or “whiplash” type effect, then consider a concussion.

My doctor says I have a concussion - now what?

There has been a lot of research over the past number of years improving our understanding of how to manage and treat concussion.  The recommended early management is no longer lying down in a dark room and being woken up every hour!  That being said it is important to get physical and mental rest during those initial few days.  Your brain needs rest now that it is in an energy crisis!

Some things to keep in mind during those first few days after a concussion1 

  • Rest 24-48 hours after your concussion
  • Slowly return to activity (as long as it does NOT increase symptoms)
  • Conserve energy - pace yourself 
  • Eat well and get some sleep
  • Manage stress levels
  • Work with your physician or nurse practitioner AND your physiotherapist to help give you some direction in managing your initial activity levels.

After the first week or two, make sure to check in with your health care provider to determine next steps.2

If your symptoms are getting better continue to work with your health care provider to continue the gradual return to your usual activities - ensuring that your activity does not increase symptoms or cause them to return.

If your symptoms are NOT getting any better, consult with a physiotherapist if you haven’t already.

How do I decide which Physiotherapist to see?

When choosing a physiotherapist to work with, consider working with a physiotherapist who has taken more training in understanding and treating concussions.  What we know and understand about concussions changes with ongoing research and further training ensures that your physiotherapist is current in their knowledge.  

The physiotherapists at Fit for Life Physiotherapy who work with clients recovering from a concussion have taken further training through Shift Concussion3 or Complete Concussion Management4.

What is involved in a Physiotherapy assessment?

Your physiotherapist will first conduct a comprehensive assessment which will include;

Subjective assessment

Your physiotherapist will talk to you to get some background information to;

  • Understand your mechanism of injury
  • Understand your symptoms and how they evolved and the quality and type of symptoms
  • Understand your aggravating factors (ie:  reading?  busy places?)
  • Learn about your relevant medical history, including history of previous concussions

Your physiotherapist will be able to identify any potential red flags that may require medical attention.

Physical assessment

  • Neurological screen
  • Vestibular screen
  • Oculomotor/visual screen
  • Cervical spine assessment
  • Balance testing
  • Neurocognitive assessment

Depending on the severity of your symptoms and how irritable your symptoms are, the physical assessment may need to be split in to two sessions to allow for your comfort and tolerance.  Remember, your brain is in an energy crisis and these tests require energy from your brain which may increase your symptoms.

How you tolerate the assessment provides valuable information to your physiotherapist about how they will manage and progress your rehabilitation program.

What is involved in Physiotherapy treatment for Concussion?

Treatment for concussion should be individualized as everyone’s response to a concussion will be different.  The subjective history will provide a lot of information for your physiotherapist to help you learn how to appropriately pace your activities.  

The findings of the physical exam will determine what your treatment program will look like.  It could involve;

  • vestibular rehabilitation strategies
  • visual/oculomotor exercises
  • balance training
  • manual therapy for the neck 
  • or all of the above

Returning to cardiovascular exercise is very important part of your recovery.  To determine what level of intensity you are able to exercise at, your physiotherapist will complete the Buffalo Concussion Treadmill test, or another test like this one.  Based on the results of this test, your physiotherapist will help you establish goals and a plan for return to exercise.

It will be important for you to let your physiotherapist know about any increased symptoms so that the treatment program can be adjusted accordingly.

Your physiotherapist is an important partner in helping you to return to your usual activities which may include school, work, sport, or just regular day to day activities.

For more information about how we can help or to talk to one of our physiotherapists trained in treating concussions contact us at fitforlifephysio@gmail.com or call us at (905)333-3488.

1 https://concussionsontario.org/wp-content/uploads/2019/11/ONF-DoDonts-Tearaway-EN-Nov2019-WEB.pdf

2 http://concussionsontario.org/wp-content/uploads/2018/04/ONF-PatientPathway-Tearaway-WEB-1.pdf

3 https://www.shiftconcussion.ca/