Is that new injury really in your head?

Have you ever wondered if concussions do increase the risk of other injuries? Well here are some early answers to this discussion.

In the short term recovery period, concussions have been associated with at some short term cognitive impairments affecting:

• Attention                                
• Executive function
• Visual spatial skills

This mild degree of cognitive impairment then can make the player more vulnerable to injuries in the first few weeks after injury.

Herman et al found (2013) that athletes who suffered a concussion were 3.7 times more likely to get a muscle or ligament injury within 90 days after the concussion injury. This was found retroactively over a 5 year period evaluating soccer, lacrosse, men’s football and women’s basketball.

Similarly, Nordstrom et al (2014 BJSM) looked at injury rates for an 11 year period in men’s elite European soccer involving 46 teams. They found that concussions were associated with a significantly increased risk of subsequent injury (1.47 times increased risk overall). In addition, breaking down the injury occurrence with respect to time after the concussion injury, they found that in:
• Months 0-3 there was an increased risk of 1.56 times
• 3-6 months (2.78 times risk)
• 6-12 month (4.07 risk)

Interestingly enough more injuries of all types occurred in players in the year prior to their concussion than in those who did not later have a concussion injury. In other words, did a previous injury make the athlete more susceptible to a concussion injury?
Several theories for how the increase risk of injury after a concussion occurs include:
• Altered cognition post concussion leading to a decrease in reaction time and altered the decision making.
• Decreased fitness levels and increased fatigue post injury due to inactivity post concussion.
• Decreased muscular strength and flexibility after post concussion inactivity.
• Decreased balance awareness.
• May be more “accident prone”.
• Previous physical injury may affect ability to avoid a later concussion injury.

Thus keys to a proper recovery after a concussion occur include the need to follow the regular return to play protocols stages, proper fitness and conditioning, neurocognitive training, and ensuring that the return to activity occurs when an athlete is truly ready both from a neurocognitive as well as fitness level.

Concussion treatments: a “new” way to address an old problem

The standard treatment to date for Concussion management has been rest and time. Both physical and mental rest have been advocated, and then a “wait and see” method for time to heal the brain.

Is this the best way to address the most important part of our body?

 Helping the body recover after a concussion requires an interaction on multiple levels:

• Address structural issues of the body
• Restore proper soft tissue tension
• Ensure proper mental input
• Nutrition to provide the energy sources to heal
• Sleep to let the body recharge
• Exercise to help build new nerve connections in the brain

Most often a concussion involves a physical trauma to the body that can lead to stress on the physical container that houses the brain. Ensuring proper alignment throughout the whole body can minimize the physical strain of the skull and brain via bony structure or soft tissue tension. These can be address utilizing a variety of manual therapy interventions such as joint mobilizations, massage, cranio-sacral therapy and exercise interventions.

As the brain begins to heal, therapy needs to ensure that the brain is receiving proper neural input. A structural imbalance may mean that there is a disconnect in the messages reaching the brain- the neck, inner ear and eyes may not be giving a unified message.   This disturbance that can be addressed via vestibular therapy, in addition to addressing the physical misalignments. In addition, the brain cannot go from “0-60” and be expected to function optimally. Neurocognitive training to provide input and stimulus to the brain at a level that it can handle, is key to providing a more successful return to learning and sport by mimicking the decision making demands. This type of training involves concentration and focus tasks, decision making skills, eye-hand reaction time and visual awareness.

Nutrition is an important component to healing. Proper nutrition can help restore the energy utilized by the brain to heal. Furthermore, food components such as omega-3 fatty acids and antioxidants are important in general brain health and may be beneficial after a concussion injury. Proper hydration is also important.

Sleep can often be disrupted after a concussion. Getting into the REM stage of sleep (dream stage) is an important stage where the body releases growth hormones, which are beneficial in the healing process.

Exercise at the appropriate time can be very beneficial in the recovery process.   Too early and it can worsen the symptoms but at later stages, exercise can be beneficial in several ways:

• Exercise helps build new nerve connections in the brain
• Exercise below symptom threshold can increase the speed of recovery (after the acute stage)
• Physical fitness deconditioning recovery, especially for longer lasting concussions
• cardiovascular fitness to minimize risk of injury after return to play especially for lower body injuries

Concussions are a serious injury that can affect individuals both in the short term or long term, especially if not properly treated. Using the correct multidimensional approach allows for the best chance of long term recovery.

efan@honsbergerphysio.com