What is Concussion and PPCS?
Concussion is defined as a mild to moderate traumatic brain injury, caused by an acceleration/deceleration of the head, which has an impact on the way the nerves in your brain function.
There is no bruising, just inflammation. There is nothing to see on scans or any test, the brain looks normal!
This creates a problem. How do we know if it is a concussion?
What actually happens to the brain?
The brain undergoes a sheering force during the injury process, which places a stretching load on the nerves. This leads to an initial burst of over-activity in the nerves, which affects body function. For example, the body becomes rigid, you can hear ‘bells’ or see ‘stars’
This burst of activity in the brain then causes an energy deficit in the brain – FATIGUE. It’s like the nerves have done a 400m sprint, then collapse. This fatigue of the nerves, in the brain, can take a few minutes to two days to manifest in a range of symptoms such as headaches, dizziness, fatigue, nausea and brain fog. Our brain is a high energy structure – 2% of body weight but uses 20% of our blood supply due to high energy needs. This is why the process of fatigue impacts us so much!
“Patients with symptoms persisting longer than 14 days for adults, or four weeks for children, require careful reassessment. Persisting symptoms can be due to a range of pre-existing confounding issues. The specific contributors to symptom persistence may be difficult to identify. Every effort should be made to structure a treatment program which addresses any medical, physical or psychosocial factors identified on assessment. Those who can tolerate a short duration of light exercise may benefit from a closely monitored and graduated aerobic rehabilitation program. When there is any evidence of cervical spinal and/or vestibular dysfunction, referral to a physiotherapist with specific skills in cervical/vestibular rehabilitation is appropriate. Mood or behavioural issues may respond to cognitive behavioural therapy.”
“Concussion in Sport Australia Position Statement Feb 2019”
With a day or two rest, and then a graduated return to mental and physical activity (best directed by a health professional who understands the process), 80% of people will return to normal function in two to four weeks. For some, symptoms persist and this can create a disruption to normal work/school activities, often leading to anxiety as to how long the problem will last. This is a problem called Persistent Post Concussion Symptoms (PPCS).
In the USA, it’s estimated that each year 1.17% of population will incur a concussion. If Australia has a similar number this means 282k of the population will experience a concussion every year. if 20% develop PPCS, 56 000 will have symptoms longer than 4-6 weeks, some will experience symptoms that will last years.
If you have a family history of migraine your genetics might mean you are more likely to develop PPCS.
Persistent Post-Concussion Symptoms (PPCS)
Persistent symptoms following a concussion can be a complicated issue and difficult to address. A group of specialists was convened in Australia in 2019 to give some direction for the treatment approach to concussion in Australia. Here is what they said about PPCS.
According to the position statement, there are four areas that need to be addressed in PPCS. With my experience as a headache practitioner, I believe a fifth category should be added: Diet. Diet can have a huge impact on the way the brain functions. Therefore, the five areas requiring attention are:
- Physiological processes with exercise
2. The Cervical spine (neck)
3. Vestibular/Visual function and balance
4. Psychological support
5. Diet
It’s important to understand that no two concussions present the same – there is always individual variation. As a consequence, everyone’s rehab will be different, with emphasis on the problematic areas. That’s why guidance is often the key to an effective rehab program. Treatment in the five areas generally involve the following features:
1. Physiological processes with exercise
Sub-symptom aerobic exercise is often a vital ingredient to restore normal brain function. A Buffalo Concussion Treadmill Test is used to determine your required heart rate for exercise that won’t aggravate symptoms but will help restore brain function.
2. The Cervical spine (neck)
The upper neck is very often injured during a concussion. A concussion injury requires 70-120G’s of force on the brain but an upper neck ‘whiplash’ type injury can occur with as little as 4G’s of force. The upper neck can often be a source of headaches, nausea, dizziness and several other symptoms common in concussion as well. A skilled assessment of the upper neck is often a key aspect of dealing with PPCS effectively.
3. Vestibular/Visual function and balance
A concussion can disrupt the normal functioning of the vestibular and visual systems. These problems, along with the neck, can have an impact on balance and equilibrium i.e. the challenge of staying upright in this world.
Visual problems, on their own, can make it difficult to read and concentrate affecting the ability to work or attend school for many people. Specific exercises and treatment can be used to target these issues and help a person experiencing PPCS to return to normal activities, both physical and mental/cognitive.
4. Psychological support
Persistent symptoms after a concussion can be so disrupting to a person, they can lead to significant anxiety. A previous history of a mental health disorder can make this even more likely to occur. Support and encouragement from friends and family is paramount if someone with PPCS is going to navigate their road to recovery.
Concussion is often called an invisible injury as people can look normal whilst suffering these debilitating. Psychological support can make the difference between a successful rehab program or failure.
5. Diet
The Gut-Brain interface is becoming a key area of health research in more recent times. Poor dietary choices such high sugar diets and or excessive alcohol can definitely aggravate the effect of a concussion on the brain.
Summary
Persistent Post-Concussion Symptoms (PPCS) can definitely be a debilitating problem but can also be treated effectively. Although complex, when assessed by competent health professionals, an effective program can be put together that will help overcome your PPCS problem.
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