What Do You Do After a Concussion?
Complete rest in a quiet and dark room for a whole week used to be the recommendation after a concussion, but research now shows that a brief period of rest during the initial stage (first 24-48 hours), followed by a gradual increase in activity, while staying below cognitive and physical symptom thresholds, is the key to recovering from a concussion.
Being provided with the proper education, support, and reassurance at the initial stages is the most effective way of decreasing the risk for persistent symptoms. After an initial period of rest, incorporating symptom-limited activities, such as light walks, light housework, and listening to simple audiobooks, are appropriate. If after several days, there are still symptoms at rest, then an assessment, to determine a return to activity protocol that is individualized to your symptoms, is appropriate.
These are the main areas that are typically addressed after a concussion:
Cervical Spine:
Every concussion has an element of a whiplash injury due to the forces imparted to the head and neck. There is also a high density of sensory receptors in the upper cervical spine that provide important proprioceptive cues about the position of the head and body in space. Treatment to address symptoms associated with dysfunction of the cervical spine can include manual therapy, active rehabilitation exercises, and modalities if appropriate.
Visual and Vestibular Systems:
The visual and vestibular systems are intimately connected and commonly manifest in symptoms associated with poor integration of information coming from the sensory systems, which also includes the proprioceptive system (muscles and joints).
As vision is integrated in most of our daily activities and guides our motor behaviours, issues with visual processing can cause a wide range of symptoms, including cognitive problems such as poor focus and concentration. Improving the functions and coordination of the sensory systems assists the visual system in understanding where to point and focus the eyes in space to most effectively perform an intended task.
The vestibular system is associated with the sense of balance and spatial orientation for the purpose of coordinating movement, and dysfunctions can result in symptoms such as vertigo, dizziness, and imbalance. Management strategies consist of gaze stabilization, habituation, and balance exercises.
Autonomic Nervous System:
There are often alterations in cerebral blood flow following a concussion that cause persistent symptoms. A closely monitored active rehabilitation program involving sub-symptom threshold, sub-maximal exercise has been shown to be safe and promotes recovery.
Metabolic and Inflammatory Changes:
Injury to the neuronal cells causes an inflammatory response that can proliferate ongoing inflammation through a cycle of cellular damage. An anti-inflammatory diet with the goal of promoting brain health would be recommended, in addition to changes in other lifestyle factors that reduce overall inflammation.
Cognitive and Psychological Changes:
There are often cognitive and psychological changes following a concussion that may be directly due to the concussion, but are often a result of the sequelae of the injury. Having a history of a psychological condition can increase your risk of experiencing persistent symptoms. There is an important role of education, support, and reassurance to mitigate this risk and a referral for psychological treatment may be necessary.