Posted 25th January 2021
Written by Matthew Gregory
We have all heard that after a concussion you need to rest. This usually means at least a couple of weeks on the sidelines, even if you start feeling 100% within a few days. But why is it that healthcare practitioners insist on you having to sit out of sport when all you want to do is get back into it? For the answer to that question, we will journey deep inwards, to the brain, to find out exactly what goes on in the most complicated part of our body.
Common Misconceptions Vs What Really Happens During Concussion
We used to think (and is still commonly thought) that a concussion was caused by the brain ‘bashing’ up against the inside of the skull, causing it to bruise after a hit. However, with more current research, we now know that concussion is caused by millions of nerves inside of the brain, stretching all at once. Due to these nerve cells stretching, molecules enter the nerve cell and cause them to fire and send a message to the next nerve cell down the line. A few cells ‘firing’ is a normal part of communication in the brain. However, when millions of nerve cells fire all at once, it uses up heaps of energy which is typically too much for the brain to deal with. This can lead to things like confusion, loss of balance or headache.
The Most Dangerous Phase of Concussion
The good news is this surge of energy doesn’t last for too long (usually a few minutes to an hour). That doesn’t mean you should return to play just yet because the most dangerous phase of concussion is about to start….
As the brain just experienced a massive energy surge, it means that its energy stores have become very depleted! The brain is about to become really tired, really quickly. It’s sort of like how it feels after an adrenaline rush when you have a job interview or go bungee jumping; you have a surge of energy that gets you through – but you feel pretty fatigued afterwards!
Now, approximately 20% of the brain’s energy storage becomes depleted at the 72 hour mark, following a concussion. That, in itself, is not a problem because the brain has the capability to get the energy back. It will be slow though, generally taking 14-30 days for the energy levels in the brain to be completely back to normal – which means a full recovery!
If you hit your head a second time when the brain’s energy levels are low, it can have a cumulative effect on the energy deficit levels in the brain. So, if you originally had a 20% deficit of energy in the brain and suffered another concussion, your brain energy levels can dip around 60-65% of your normal levels. The scary thing with this is those levels fall within severe and permanent brain damage parameters, where brain cell death occurs. Therefore, you can lose functions in your brain that you can NEVER get back. Months or years of symptoms can result from this. On the further end of the spectrum, permanent brain damage or death can occur as the brain may not be able heal itself effectively.
Just to add a little bit more confusion to the tale of the brain – we generally see that athletes have a full symptomatic recovery before a full brain recovery. To put that another way, it means that an athlete generally feels 100% before the brain has fully recovered. This can happen anytime during the recovery process but generally occurs around Day 7 to 10. In this sense, recovering concussion is similar to recovering from a broken arm. With a broken arm it only feels sore for the first week, but the cast stays on for 6 weeks, even if it feels 100%. Coaches see the cast so they don’t play you, teachers see the cast so you get less homework, you see the cast so you lay off the martial arts. Everybody involved knows that recovery is still happening and to be careful. With concussion, it is an invisible injury and there is no cast, so people have been known to go back early with potentially catastrophic consequences.
How to Rebuild Resilience & Brain Strength
While the brain is vulnerable you can still do things to build up resilience and brain strength. With the guidance of a healthcare practitioner, experienced in concussion management, you can introduce:
- Sub-symptom exercise in the early stages, to build up your fitness and reduce deconditioning.
- Temporary dietary changes, to promote brain healing and limit further brain inflammation.
- Meditation or deep breathing exercises, to reduce the natural anxiety following concussion.
- Gradually build up your school/work tolerance.
- Complete neck and eye rehab exercises.
- Balance exercises, to build your focus.
- Non-contact agility training and strength training in the mid-late stages of concussion return to sport.
There is a world of options for concussion recovery to build your resilience and get you back to the sporting field safely. The crucial thing is that the energy deficit you previously lost, following a concussion, is completely reversible, if you don’t sustain a subsequent concussion. Lack of symptoms is a poor indicator of being ready to return to sport and that decision should be made in conjunction with a healthcare practitioner, with experience in treating concussion.
Matthew Gregory
Matt is a physiotherapist who graduated with a Masters of Physiotherapy from the University of Sydney in 2017. Matt developed a passion for the treatment and prevention of concussion injuries after seeing an abundance of these injuries while treating winter athletes. Matt has completed both the CCMI concussion course and the Level 1 Watson Headache® Approach and uses these methods together while treating patients.
He offers his services from both our Sydney CBD and Gymea practices.
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