A concussion is a type of traumatic brain injury known as a mild traumatic brain injury (mTBI). Concussions are caused from direct contact or a quick jolt to the head causing rapid acceleration and deceleration of the brain inside the skull. This rapid back and forth of the head and brain can cause mechanical stress to the brain’s neurons such as stretching and shearing. This stretch and shear of the brain cells then causes a cascading series of changes in the brain, both chemically and metabolically, resulting in symptoms associated with concussion.

Signs and symptoms of a concussion

            Recognizing signs and symptoms of concussion is very important because concussions don’t show up on imaging such as X-rays, CT scans, or MRI, and there are no other medical tests to diagnose mTBI such as blood tests or monitors. Concussion diagnoses are made by an experienced healthcare professional who conducts a thorough exam observing a patient’s signs and symptoms following an accident or impact event.

Common Concussion Signs:

• Loss of consciousness
• Trouble with balance
• Glazed look in the eyes
• Amnesia
• Delayed response or slow speech
• Forgetting an instruction, confusion about an assignment or position, or confusion of the game, score, opponent, location, day and time.
• Sensitivity to light or noise
• Emotional
• Vomiting

Concussion Symptoms:

1. Somatic (Physical) Symptoms:
   1. Headaches
   1. Nausea
   1. Light-headedness
   1. Dizziness
2. Cognitive and Emotional Symptoms:
   1. Difficulty paying attention
   1. Difficulty multitasking
   1. Difficulty completing mental tasks
   1. Anxiety/Panic Attacks
   1. Depression

• Sleep Symptoms
  • Sleeping more than usual
  • Sleeping less than usual
  • Having trouble falling asleep

Response to Concussion:

            First and foremost, remove yourself or the athlete from activities that may expose to head trauma, or excessive stress to heart or brain. The first 48 hours after injury, you should engage in relative rest. This includes maybe taking a couple days off from school or work. You can still engage in light physical and cognitive activities, such as walking, reading, watching TV, computer activities. Most important guideline to remember here is that any activity that you engage in shouldn’t overly stress you or cause an INCREASE in symptoms.

            Second, get evaluated. If you have any signs or symptoms of a concussion after a hit to the head or impact to the body, assume you have a concussion until you have a chance to be evaluated by an appropriate medical professional.

            Graded exposure. Returning to work or school, and returning to sport, should be a gradual, phased approach, guided by a trained healthcare professional familiar with managing concussions. See Concussion: What You Need to Know After Head Injury blog for more info and guidance here.  

            Keep a positive attitude and outlook. You will get better with time, rest, and gradual return to your normal activities. Seek guidance from a knowledgeable rehab team to help you in this process.

Concussion Treatments:

Treatment options can include but are not limited to physical therapy, occupational therapy, optometry/ophthalmology, psychiatry/psychology, speech/language pathology, endocrinology, ENT, and meditation/mindfulness.

Physical Therapy Treatments:

PT treatments all begin with a thorough examination to identify what are the major contributing factors driving your signs and symptoms. Based on the findings of your initial examination, PT can address:

1. Physiological (Blood Flow to the brain). Steady-state cardio is best once cleared by a doctor.
2. Visual Therapy. Retraining accurate and smooth eye movement including visual tracking, saccades, convergence, hand-eye coordination, peripheral vision, reactive eye training.
3. Vestibular. BPPV, dizziness, vertigo, and trouble with positional changes can be common after concussion. Repositioning maneuvers can help clear out floating crystals in the inner ear causing BPPV which help alleviate vertigo and disorientation symptoms.
4. Cervical. Concussion is usually accompanied by some level of whiplash. Treating neck pain, stiffness, range of motion, and proprioception (body-awareness) can be pivotal in managing headaches, dizziness, eye strain, TMJ dysfunction, and other issues stemming from trauma to the cervical spine. We incorporate the NecksLevel device into our treatments with great success, to improve neck mobility, proprioception, coordination, and strength
5. Psychological. Educating the patient on their condition and how to manage it can make all the difference. This experience can be quite stressful, emotional, and traumatic, so having someone to lean on and guide you through this experience can help people recover faster and with less prolonged issues as they return to their normal activities.

Remember, concussions or mTBI’s do not result in brain damage. The effects are temporary, and signs and symptoms should resolve within 1-4 weeks. You can still participate in most activities even with a concussion, but taking breaks and modifying those activities may be necessary. As long as those activities don’t put you at risk of another impact, and you can tolerate them without INCREASING your symptoms, you are good to go. We are here to help guide you in this recovery so come in for a free consult or book your initial evaluation today!

The post Diagnosis and Treatment for Concussion appeared first on MOTI Physiotherapy.

So, it’s no surprise that an athlete will try to return from a head injury as quickly as they can. However, the implications here are more serious than playing through a sprained ankle or knee. Returning too soon or without going through the proper testing following a concussion can have long-term severe consequences. As stated in previous blogs (see Concussion: What You Need to Know After Head Injury), the brain actually goes through a metabolic depression phase after concussion that can last up to 4 weeks!!! This is where the metabolism (energy production) of the brain slows way down. This can actually be one of the sources contributing to prolonged symptoms known as Post-Concussion Syndrome. 

Second Impact Syndrome is the condition that can occur from taking another concussive blow or jolt to the head and/or neck while the brain is still in the depression phase. Suffering another impact in this phase causes another dip in brain metabolism causing the metabolic levels to drop into dangerous levels! This second dip can lead to permanent brain damage aka cell death! You see, normal mTBI’s (mild traumatic brain injury aka concussion) don’t cause permanent brain damage and full recovery usually happens over a short period of time (2-4 weeks). Additionally, when an athlete returns to sport too soon following concussions, they can become more susceptible and the force required to cause a mTBI is less. This can be the reason an athlete is suffering from recurrent concussions and seeing longer recovery times. 

The way the medical profession used to treat concussion (and some still do) was to rest until symptoms dissipated and they were then cleared to return to normal activity and sports. However, there has been a great advancement in our understanding of concussions and the proper way to recover and return to sport. Active recovery is now the recommended course of action. This can be confusing and challenging to handle on your own, so seeing a trained healthcare professional familiar with treating concussion and getting athletes back on the field is so important! It takes the guess work out of this process and ensures the safest and quickest return possible! 

It is recommended to see a concussion management specialist as early as same day as injury to develop a treatment plan. After 5 days post-concussion, we will conduct the proper tests to identify what you need to work on to get back in the game! Here we will provide the plan to re-integrate you back to school, work, and sports! Finally, getting a thorough physical exertion test before returning to unrestricted practice allows us the confidence in our decision in returning the athlete to full practice and games!

If you have more questions, please book an appointment with Dr. Kirk Ramirez, PT, DPT for more information and to develop a plan!

– Dr. Kirk Ramirez, PT, DPT

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When discussing wounds sustained on the surface, Homeostasis is the forming of a blood clot to stop the bleeding. Next is the inflammatory stage where your body’s immune system cells will come in and clean out the old and start building new (where the scab forms). The initial inflammatory stage takes about 2-6 days to complete when undisrupted. Next stage is Proliferation. This is where your body starts to rebuild the damaged tissue and this lasts up to several weeks (4-24 days) depending on the severity of damage. Finally, is the maturation stage. Here the new rebuilt tissue starts to reorganize and strengthen (scar tissue develops) and this can last anywhere between 21 days to 2 years in some cases.  

These are generally the same stages that occur with mild traumatic brain injury, mTBI (concussion). However, there are some cases where you get stuck in the inflammatory phase. 

In acute mTBI, immune cells in the brain (microglia) are primed and trigger the inflammation process following mechanical injury (quick acceleration-deceleration of the brain in the skull resulting in stretching and shearing of neurons). Secondarily, the neurotrauma causes your gut’s (intestinal) permeability to be increased. This means ions and bacteria are more easily crossing the barrier of the gut lining. This alters your gut’s microbiota (good bacteria in GI tract). In response, your body’s immune system is further triggered to go into hyperdrive. As a result, pro-inflammatory markers influence your central nervous system to continue the inflammation process. Your brain’s blood brain barrier (BBB) also has increased permeability allowing cells and ions to more easily cross this barrier. This phenomenon is referred to as “leaky gut” and “leaky brain” syndrome and this is what drives chronic systemic inflammation to persist. 

This increased inflammation can contribute to increased symptoms following concussion or other injuries as well. So how do we combat this? Diet and exercise of course!!!

Muscles are like your body’s pumps to aide circulation of blood and oxygen. That’s why when you have swelling in your feet and legs, it is advised to perform ankle pumps and elevate your leg to help flush out the swelling quicker. Therefore, the best treatment to recover from injury is progressive exercise. Movement Cures!!!

Getting started can seem daunting and dangerous to some especially dealing with injuries most healthcare professionals don’t even understand. It has been long advised by doctors that you should rest until all your symptoms have subsided following concussion. That is WRONG! This can significantly delay your recovery, make you deconditioned causing more weakness, stiffness, and increased sensitivity to normal stimulus. It has even been declared that rest beyond 48 hours will delay recovery post-concussion. It is actually much more beneficial to slowly expose yourself to cognitive and physical activity as tolerated and progress over time as your body can tolerate. So how do I get started?

Seeing a trained healthcare professional well versed in treating people with concussion as soon as possible, even the same day as the injury occurred. Early intervention and education has been proven to significantly speed recovery. There is no medication proven to help reduce symptoms or improve function following concussion the way exercise and diet modifications has been proven to do. Developing a plan is key to navigating through these injuries that can seem scary and confusing. Keep it simple: start with light walking, light cognitive and work activities as tolerated, and diet modifications are key!

An anti-inflammatory and neuro-protective diet can significantly reduce lingering symptoms, improve cognitive and physical function, and mitigate the risk of developing a chronic condition. These diet modifications can also help reduce pain and inflammation following bodily injury as well. If you have suffered an injury that just seems to never go away or are experiencing aches and pain all over, feeling sluggish, trouble concentrating in general, or just feel your body isn’t quite functioning as optimally as possible, these diet suggestions can change the game!!

So, let’s start with what you should avoid. 

• Processed foods
• Dairy
• High sugar content
• Refined carbs
• Heavy red meat and pork
• Alcohol 

These can increase your body’s systemic inflammation, making you feel less than great. Avoiding these types of foods and beverage can help reduce your body’s inflammation. 

General recommendations of foods you want to include in your daily diet are as follows: 

• Lean organic protein (fish, chicken)
• Ancient grains (cous-cous, quinoa, chia)
• Anti-oxidants (berries, glass of wine)
• Dark green salads, avocados, and other vegetables 
• Fish oil (Omega-3’s)
• Supplements such as:
  • Turmeric
  • Creatine
  • Melatonin 

These are some general recommendations to get you started. For more information or an individualized program, well… you got to come in and see us for that! 

So, if you feel you are doing everything right with your rehab or training programs, but just can’t seem to get over the hump and fell 100%, give these things a try! 

“It is much more important to know what sort of person has a disease, than what sort of disease a person has” -Sir William Osler 

– Dr. Kirk Ramirez, PT, DPT

The post Is Systemic Inflammation Driving Your Concussion Symptoms? appeared first on MOTI Physiotherapy.

So, if you get hit in the head or are involved in some sort of accident, motor vehicle or otherwise, and you feel immediate symptoms, then you are considered to have a concussion. The first thing you want to do is see a trained medical provider familiar with concussions and preferably concussion rehabilitation.

It’s important to get in as soon as you can so we can get started on the best recovery strategy known to man, ACTIVE RECOVERY!!!! 

Concussions are considered mild traumatic brain injuries, emphasis on MILD. So, don’t let it scare you!! There is no brain damage that occurs with these injuries and there will be NO long-lasting negative effects if managed properly. 

Basically, a concussion is a rapid acceleration-deceleration of the brain and what happens is a stretching/shearing of your brain’s neurons, and with that comes an ion shift in and out of the axons (neuron tails that connect to other neurons, very scientific!). Initially, this creates an EXCITATORY PHASE, and this is where one might experience symptoms such as dizziness, vision changes (blurred or double), ringing in the ears, nausea, headache, confusion, fogginess, imbalance, and other such symptoms. This phase can be short-lived or last a couple hours. So, if you are playing a sport, you take a blow to the head or fall, and your symptoms go away quickly, you or your child should be removed from play IMMEDIATELY! 

Seeing a medical provider ASAP is important in order to rule out more serious injury that may have occurred including spine injury or bleeding in the brain. 

Red Flags indicating an emergency situation include: 

• Severe or worsening headache 
• Seizures (w/ no history of seizures) 
• Weakness in an extremity 
• 2+ episodes of vomiting 
• Diminishing alertness 
• Changes in vision
• Numbness or tingling 
• Difficulty speaking or understanding speech, reading or writing 
• Difficulty swallowing
• Loss of fine motor skills or tremors 
• Loss of coordination (as time evolves) 
• Abnormal sense of taste
• Loss of Consciousness  

The next phase is a brain metabolism SPREADING DEPRESSION PHASE. Here your brain’s metabolism slows way down, and you may experience unusual fatigue, lethargy, trouble focusing, difficulty with memory, and you may have trouble completing tasks at work or school. Here is where modifications to school or work may need to be made. 

The first 48 hours after acute injury need to be relative rest. Basically, take it easy and limit your activity to not increase symptoms. This doesn’t mean to lock yourself in a dark room and do nothing! You can still watch TV or go on computer (but limit your screen time to short bouts of 5-15 minutes), read, walk, interact with family and friends. Even if you currently have symptoms, simply limit these activities to not increase your baseline symptoms. Easy!

Returning to school or work can seem daunting, but with some guidance, it can go smoothly and returning to full participation won’t be delayed too long. 

Day 1 post-concussion: Daily activities at home without increased symptoms (check email, watch the news, read, go for a walk, laundry, dishes, etc.). Start with 5-15 minute at a time and gradually progress as tolerated.  

Day 2: School/Work Activities (cognitive). Homework, reading, other cognitive activities at home without increasing baseline symptoms. 

Day 3: Return to work/school part-time. Gradual introduction to schoolwork, Partial school/workday or more rest breaks. 

• Note from doctor to teacher can help here to address modifications needed. i.e. more time for work completion, frequent breaks as needed, rescheduled tests or assignments, increased time during passing periods, private lunchroom to avoid excessively busy environments that may flare symptoms or risk of taking another blow to the head. No P.E. until cleared by medical professional. 

Day 4: Return to work/school full time. Gradually progress school/work activities until full day is tolerable (no gym class). Catch up on missed work. 

**There should be 24 hours between each stage.** 

Going to grocery store or the mall can often increase people’s symptoms in these early stages as well. If you find that this is true for you, don’t avoid these environments completely. Go in and shop for as long as you can tolerate, if symptoms start to increase, go back outside, wait for symptoms to return to baseline, and go back in to continue. This will help desensitize your system and improve your tolerance. 

Bright lights can also be a source of symptom exacerbation, but don’t be that person wearing sunglasses indoors! You have to allow your eyes to adjust and this will also help desensitize your eyes and improve tolerance. It’s all about graded exposure!! It’s similar to when you go see a matinee movie showing and come out when the sun is still out. At first, the bright light may hurt your eyes. But if you give it time your eyes adjust.  

Returning to sports and physical activity is a topic for another blog post (too much to go over here). 

Symptoms should subside within that first week, and if they don’t, it is even more imperative you see a trained rehabilitation specialist familiar with managing concussions to obtain a plan and address these issues. 

Many people are still misinformed regarding management of concussion (even doctors and nurses) and they are still encouraging the wrong strategies to their patients! MOTI Physiotherapy is here to help recover from these injuries safer and faster!! The danger in concussions is people not taking the appropriate steps to return to cognitive and physical activity safely and efficiently. Athletes returning to their sport too soon run the risk of taking another blow to the head before their body is ready, and THAT is dangerous!!! A second impact during that depression phase can lead to worse injury including brain damage, prolonged symptoms, delayed recovery, increased risk of future concussion coming easier and taking longer and longer to recover!

Complications from poor concussion recovery are easily avoidable and when the appropriate steps are taken to return to learn and return to sport, there is nothing to fear. 

Just remember: There isn’t a concussion problem in this country or in sports (football), there is a concussion management problem! 

– Kirk Ramirez, PT, DPT

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