Concussion: The Unseen Injury

The term concussion was first mentioned in the writings of Hippocrates (460–370 BC) in the Hippocratic corpus (1).

 

So, if we have known about concussions since 460-370 BC than why has it taken us so long to react?

 

To keep things simple, we will define concussion in terms of a Sport Related Concussion (SRC) but know that confusion still exists in the literature.  According to the latest Consensus Statement on Concussion in Sport, a SRC is a traumatic injury caused by a biomechanical force due to either a direct or indirect blow to the head, face, neck or body resulting in a transient disturbance in neurological function (2). My take away point from this definition is: concussions are a big deal!

 

Gone are the days of saying, they got their “bell rung”; “no pain no gain”; and “shake it off.” Research over the past decade has provided us with insight into the cause and pathophysiology of a concussion. We know there is no gold standard for a concussion diagnosis but with a battery of neurocognitive and neuropsychological tests, postural assessments and subjective symptom reporting we can be >90% sure of a concussion diagnosis (3). The Standardized Concussion Assessment Tool 5th Edition (SCAT5) is a great tool for helping with concussion diagnosis and recovery monitoring. It can be accessed online at http://www.sportphysio.ca/wp-content/uploads/SCAT-5.pdf.

 

Now here’s the complicated stuff, a concussion causes a neurometabolic cascade to be initiated, which means there is an energy crisis (4).  This energy crisis usually happens in an area where there is decreased blood flow and as a result can cause metabolic uncoupling.

 

What does this mean?  

 

It means, for 7-10 days you might “not feel right”.  Without intervention spontaneous resolution typically happens at 10-14 days (2). So, good news: most people recover quickly!

 

Does this mean no intervention is best?

 

In my opinion, no.  We are highly adaptable and like to live pain free. Chronic pain typically develops when we ignore the warning signs and adapt.  Even if you have recovered from a concussion you may still require a little extra support. Concussions can cause different effects on your body but assessment allows us to identify the origin of your concussion. Concussions can be physiological, vestibulo-ocular (i.e. inner ear and eye origin) or cervicogenic (i.e. neck origin) in origin (5). A combination of therapies may be required depending on the origin and symptoms of your concussion. This is where we come in; many of our practitioners at Body Co. are skilled in concussion treatment.

 

Osteopathy specifically, has been used as a treatment option for years. William Garner Sutherland was a pioneer in cranial osteopathy and actively treated head trauma  (6). Although treatment studies are in their infancy, case studies have shown osteopathic manual treatment to be effective in reducing and relieving concussion symptoms (7).

 

As an athlete myself, I have experienced first-hand concussion recovery and I can honestly say osteopathy was my saving grace. Next time someone you know, or in the unlucky event you, have a concussion, remember to trust your symptoms. It is an invisible injury so do not doubt your feelings; and more importantly there are many practitioners who are knowledge and can offer support. Do not settle for pain. Live your life pain free!  

 

  1. McCrory PR, Berkovic SF. Concussion: The history of clinical and pathophysiological concepts and misconceptions. Neurology. 2001;57(12):2283-9.
  2. McCrory PR, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 2017;51(11):838-47.
  3. Broglio SP, Macciocchi SN, Ferrara MS. Sensitivity of the concussion assessment battery. Neurosurgery. 2007;60(6):1050-8.
  4. Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014;75(suppl_4):S24-S33.
  5. Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain injury. 2015;29(2):238-48.
  6. Magoun HI. Osteopathy in the cranial field. 3rd ed. Indianapolis: The Cranial Academy; 2011.
  7. Chappell C, Dodge E, Dogeby G. Assessing the immediate effect of osteopathic manipulation on sports related concussion symptoms. The Journal of the American Osteopathic Association. 2015;7(4):30-5.

 

Leah Henderson

Registered Kinesiologist / Osteopathy Candidate

Leah is a registered kinesiologist and fourth year Osteopathy Candidate. She a natural medicine practitioner and believes the body has a tremendous ability to heal itself. She uses her manual practice to help patients restore tissue mobility, position and vitality. She is a graduate of McMaster University’s kinesiology program and former varsity soccer athlete who is focused not only on short term health but also on long term recovery. She understands that people play an active role in their recovery and recognizes the benefits of both aerobic and resistance training. She has a keen interest in cranial health due to her many concussions received through sport. However, with her second degree in Gerontology she also understands the aging population.

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