For a concussion to occur, you need to lose consciousness.
In fact, only 10% of all concussions lead to a loss of consciousness. So… it is definitely not necessary to lose consciousness to experience a concussion. How do you know if you have a concussion? Rule of thumb is that if you feel any symptoms after a head or upper body impact, be suspicious of concussion. These symptoms could include headache, dizziness or blurred vision.
It is OK to start exercising even a couple of days after a concussion.
This one may be a bit controversial as traditional medical advice has told us you need to fully rest after a concussion until your symptoms are gone. That means no thinking, no phones, no exercise, no socialising. Now we know from research that too much rest can be detrimental to your recovery!
Think about it; exercise is so important to stay fit and release endorphins, yet staying indoors and doing nothing for a couple of weeks is enough to drive anyone up the wall. A little bit of rest is OK, and this should be symptom-limited rest. That means it is fine to take it easy, be cautious for the first couple of days, but do something! It is better for you to do some light exercise and be somewhat active. However, keep it to a comfortable level, where you do not exacerbate your symptoms.
A recent study by Silverberg and Colleagues in 2019 showed that a longer recovery arc is expected in people who were advised to rest longer than two days. The current expert recommendations in the most recent international Consensus states that symptom-limited rest for 24-48 hours is appropriate. Absolute rest, beyond this time frame, is extremely detrimental and symptom-limited physical activity will improve your concussion timeframe!
A concussion happens inside the brain where nerve cells get stretched and sheared.
During a concussion, the brain either quickly accelerates or decelerates relative to the skull. To get a better picture of it, think of a bowl of jelly being shaken within a bowl. When the brain gets quickly ‘shaken’, many nerve cells within the brain can be stretched. This stretching of the nerves leads to a rapid electrical shift in the brain which we associate with concussion symptoms.
This is completely different to the widely accepted ‘coup-contrecoup’ injury mechanism. This mechanism says that concussion is caused by a bruising of the brain when it hits the skull. But now we know it is the brains nerves stretching which eventually leads to reversible energy deficits in the brain.
MRI or CT brain scans are useful to confirm a concussion!
Concussion is a functional injury which means you won’t be able to see any damage on a scan. An MRI or CT scans measures the brains’ structure and shows nothing about its function. Think about it this way; if you were dehydrated, a brain scan won’t be able to confirm that either!
We see many patients at Sydney Concussion Centre who report their scans didn’t show anything, so the doctor said they didn’t have a concussion. Scans are only useful in detecting serious brain bleeds or structural injuries, that in some instances should be cleared after a head injury. 95% of concussion patients will have a negative CT or MRI scan! A negative MRI or CT scan will mean that more serious injuries (like fractures) have not occurred!
You should not take any pain relief medications immediately following a concussion.
There is insufficient evidence suggesting that medications can be used to successfully treat a concussion. In fact, taking new medications can almost be a double-edged sword after a concussion.
On one side of the coin, it may take away some pain from the concussion. However, they often come with side effects like dizziness or nausea, which are also symptoms of concussion. This will ‘muddle the waters’ to know if a concussion is improving.
On the other side of a coin, a medication may fully take away all of the immediate concussion symptoms. However, it masks the signs of a potentially serious deteriorating concussion.
It is best to avoid medications in the early stages of a concussion.
A concussion can only happen from a direct hit to the head.
Sports coverage from the AFL to the NRL will show head knocks in depth. However, this is not the only way a concussion may occur. Direct head knocks are a big reason why a concussion may happen but there are other mechanisms. From being ‘whipped’ from a motor vehicle accident to a strong body check in AFL. The key to sustaining a concussion is that there is a sudden acceleration or deceleration force to the brain.
So next time you are on the sports field or in general life, ask yourself – did the head abruptly speed up or slow down? With enough force, a concussion will have happened!
You should avoid anything which will stir up your symptoms.
This is actually one of the biggest fictions of the list! The body is extremely resilient and is strong in adapting. Setbacks to concussion do happen but that does not mean that there will be permanent damage. In fact, a minor flare up will mean the body can adapt and get stronger.
Think about climbing a mountain. Without any physical training you will probably be really puffed, really quickly. However, if you keep training and pushing yourself, eventually your body will adapt, get fitter and you will be able to climb the mountain. There is a bit of an art in finding how much you should be pushing yourself. You want to be in the sweet spot – where you’re not doing too little or too much. Your Healthcare Provider at Sydney Concussion Centre will help guide you into the right amount of cognitive or physical activity you should be doing.
It’s ok to let someone with a concussion sleep.
The original fear of letting someone with a concussion sleep would be that they would fall into a coma without anyone knowing. This would be due to a worsening brain bleed or serious injury to the brain. These serious injuries to the brain would be evident in the first three to four hours following a concussion. You should present to ED with any of the following red flags following a concussion.
Red Flags:
- Severe of worsening headache
- Seizures (w/ no history of seizures)
- Loss of consciousness
- Weakness or numbness in arms or legs
- Vomiting
- Unable to wake up
- Changes in vision
- Increasing confusion
- Bruising around ears or eyes
- Odd behaviour
- Slurred speech
- Inability to remember injury
- Unsteadiness standing or walking
If this has been cleared, or it has been longer than three to four hours without any significant deterioration, then it is quite safe to let them sleep!
There is no treatment for concussion.
This is definitely a FICTION. There are so many evidence-based treatments for concussion where you can stay in control! From sub-symptom threshold exercise, to neck manual therapy, to diet. There is a plethora of options depending on your specific symptoms. Sydney Concussion Centre physiotherapists are CCMI trained and registered practitioners who can expertly assist you in your rehabilitation. We also have a network of experienced practitioners from other modalities, who also specialize in concussion, should there be a need to refer on.
Once you are symptom-free it is safe to return to sport.
It is extremely common for people to have a complete resolution of symptoms before their brain fully recovers. Playing high risk sports, without a full brain recovery, puts you at risk for more serious brain injuries. It is really important to work with your experienced healthcare practitioner to plan when it is completely safe to return to sport. Sydney Concussion Centre Practitioners pride ourselves on returning athletes to sport only when their brain has fully recovered.
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