Mild traumatic brain injury (mTBI) or concussion is very common. Fortunately, the majority of cases resolve within 7-10 days. However, post-concussive syndrome (PCS) is referred to as the presence of persistent symptoms lasting for more than 3 months and is observed in 40-80% of individuals exposed to mTBI (ref 2). Furthermore, about 10-15% of people continue to experience symptoms after 1 year (ref 2). Unfortunately those affected often only present to their GP, physiotherapist or chiropractor after many months of symptoms.
Diagnosis is based on the evaluation of symptoms such as headache, cognitive changes (e.g. feeling like in a fog, reduced attention and concentration, amnesia, and slowing of cognitive processing speed) and neuropsychiatric changes (e.g. emotional lability, irritability) and sleep disturbance (ref 2). The damage in mTBI largely occurs at the cellular and subcellular level and is not accompanied by abnormalities detectable on a CT or MRI scan (ref 4). This is so very important because frequently a normal MRI report may result in symptoms being dismissed. The diagnosis should be based on symptoms and a detailed neurological examination, evaluating movement, balance and posture.
In particular, one of the most frequent signs of mTBI is a change in control of the eyes (ref 5). This results in fatigue, headaches, dizziness and difficulty reading. These symptoms can have a profound impact on quality of life and ability to work.
Head, neck and body pain are extremely common affecting 93% of males and 64% of females (ref 1). Often depression or anxiety is an important factor in chronic pain. The areas of the brain that are commonly affected control movement, balance and posture. Damage to these areas of the brain leads to injury of the body.
Don’t make assumptions about who is at risk. Patients frequently tell me “I was knocked unconscious once, but I was very young, so it doesn’t matter”. Children are more susceptible to concussion. While children and adolescents experience longer recovery rates compared to adults (ref 2). Concussion needs to be taken seriously by healthcare professionals and the child’s recovery monitored carefully.
Traditionally treatment in the past has consisted of nothing more than rest. However, this advise is based on surprisingly sparse research. More recent research has started to challenge this idea and champions the importance of movement, appropriate exercise, cognitive stimulation, sensory stimulation and vestibular rehabilitation (ref 3).
Concussion is a complex pathophysiological process affecting the brain. Treatment needs to be comprehensive. Using a brain training app is not enough. Aerobic exercise is not enough. You need a detailed assessment to ascertain which areas of the brain have been impacted, and a treatment plan to encourage those areas to adapt and heal.
If you know anyone that has been affected by a mild traumatic brain injury/concussion and you have further questions, you can contact me here. I work as a chiropractor with a special interest in neurology in Woking.
1. T Mollayeva. Concussion/mild traumatic brain injury – related chronic pain in males and females: a diagnostic modelling study. Medicine. 2016
2. Ling et al. Neurological consequences of traumatic brain injuries in sports. Molecular and Cellular Neuroscience. 2015
3. Murray DA. Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns. Br J Sports Med 2017
4. Barnett B & Singman E. Vision Concerns After Mild Traumatic Brain Injury Current Treatment Options in Neurology 2015
5. Kenneth J & Ciuffreda et al. Clinical Oculomotor Training in Traumatic Brain Injury. Optometry & Vision Development. 2009