Understanding Concussions: Symptoms, Treatment, and Recovery

What is a Concussion and How Long Does Last?

A concussion is a ‘functional injury’ resulting in the disruption of normal brain function. This occurs following a rapid acceleration of the brain inside the skull, caused by an impact to the head, neck or elsewhere on the body with forces transmitted to the brain. There are 24 possible symptoms of concussion, and these can last anywhere from days to weeks and, in some cases, even longer.

“How long does a concussion last?” is a very difficult question to answer as every concussion is different. To understand the duration of a concussion and what needs to happen for a full recovery, you must first understand what is going on inside your brain, metabolically speaking.

What’s Going on in There? The Neurometabolic Basis of Concussion

Upon initial injury, the neurons in your brain become stretched. Setting off a chain of events known as the “neurometabolic cascade”

Let’s take a closer look at what’s really going on in there:

Following the stretching of your brain cells, an exchange of chemicals occurs resulting in the sudden excitation or firing of neurons and the subsequent release of neurotransmitters including glutamate.
Glutamate activates brain cell receptors that cause a greater influx of calcium into the cell.
Additional calcium inside the cells prevents effective cellular respiration, which is the most efficient means of energy production.
A massive amount of energy is required to help restore the ion imbalance that now exists, and due to energy being supplied by less efficient means, a large energy deficit is created.
The entire cascade leads to cellular dysfunction, and that means YOU are not functioning like you did prior to the injury.

Your brain is excited, neurons are misfiring, and your system needs to work overtime to re-establish ionic equilibrium or homeostasis. This rebalancing requires a huge amount of energy. But remember, the stretching of the cells instigated events that not only depleted the system but caused the brain to create energy by less efficient means. Your brain is using all this energy to right itself, but it simply can’t get the energy it needs, so you develop an energy deficit.

And here’s where, if you’re not working with a doctor or therapist trained in concussion management, you can get into a bit of trouble. Because after a week or so, maybe some of your symptoms have gone away and you’re starting to feel better. But your brain is still NOT fully recovered. If at this point you try and return to your sport, you risk further injury because your brain is still in a vulnerable place, neurometabolically speaking.

Concussion Types

Symptoms of a Concussion:

Following a concussion, you may experience many different signs and symptoms. A symptom is something the athlete/ will feel, whereas a sign is something your friends, family or coach may notice. It is important to remember that some symptoms may appear right away and some may appear later.

Just like no person is the same, no concussion is the same and so the signs and symptoms may be a little different for everyone. Contrary to popular belief, most concussions occur without a loss of consciousness (LOC).

Common symptoms and signs include:

Loss of consciousness	Blurred vision	Difficulty remembering
Seizures or convulsions	Balance Problems	Fatigue or low energy
Amnesia	Sensitivity to light	Confusion
Headache	Sensitivity to noise	Drowsiness
“Pressure in the head”	Feeling slowed down	More emotional
Neck pain	Feeling like “in a fog”	Irritability
Nausea or vomiting	“don’t feel right”	Sadness
Dizziness	Difficulty concentrating	Nervous or anxious

From the Consensus Statement on Concussion in Sport (2009 and SCAT2 Resources)

Why Symptoms Should NOT Guide Your Recovery

Recovery from a clinical standpoint is different from recovery from a physiologic standpoint. The clinical time for recovery is when your symptoms subside. The physiologic time for recovery is when your brain recovers metabolically. Unfortunately, these two things do NOT coincide, making concussion difficult to manage – particularly with athletes.

Typically, initial concussion symptoms last for a period of 7-to-10-days. Once these symptoms have abated, an athlete may think they are “all better.” And their coach or therapist may sign off and send them back out onto the field or ice.

But a concussion is a functional injury, meaning brain function has been altered. There is no golden test (imaging, blood, saliva or otherwise) that enables healthcare professionals to determine if you have fully recovered from your concussion. As such, functional testing is currently the best means for concussion management teams to help build a clinical picture and ascertain when it is safe for an athlete to go back to sport.

Persistent Concussion Symptoms

Persistent Concussion Symptoms, previously known as Post-Concussion Syndrome (PCS), occur when concussion symptoms persist beyond the expected recovery period after the initial injury. We mentioned that symptoms typically subside within a 7-to-10-day timeframe, however sometimes they can linger. What studies are now showing is that the sooner you get treatment for your concussion after the initial injury, the less likely you will be to experience persistent concussion symptoms or a prolonged recovery. The fact is, when not addressed PCS can last for weeks, months and even years.

With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal. To further understand what a concussion is, watch this video for an in-depth whiteboard demonstration:

Concussion Testing & Rehabilitation:

Dr. Phil will educate you on the management of concussion, provide an objective clinical evaluation, provide sound evidence-based treatment practices, and have a treatment plan for return to play or return to daily activities.

Concussions are not something to be afraid of or an injury to hide. 15-20% of individuals experience post-concussion syndrome for months post-injury simply due to not receiving EARLY proper treatment and diagnosis of the injury that has occurred.

At Forward Health we offer accessible and timely care to support those impacted by concussions . We pride ourselves on delivering best evidence practices combatting concussions as well as many other injuries. Misinformation on the part of healthcare providers is often the factor that delays recovery the most.

Dr Phil will provide you with the most recent education on concussion so you can heal correctly, and rest assured that you will not have permanent symptoms.

We get you back to work, sport, and fitness using vestibular-ocular therapy, exercise guidance/prescription, and cervical spine (neck) rehabilitation to aid in the recovery of your concussion.

Call us at 519-766-3940 or come in to visit our clinic located at 1030 Gordon Street, Suite 101 in Guelph, Ontario, to book your initial assessment with Dr. Phil McAllister (Certified as A Concussion Management Specialist, through Complete Concussion Management.)