Traumatic Brain Injury Up Close: Concussions

A concussion is a complex pathophysiological process affecting the brain, usually induced by traumatic biomechanical forces. It is a functional, rather than structural, injury that results from shear stress to brain tissue caused by rotational or angular forces—direct impact to the head is not required.

What does that mean? It makes a concussion more complex than a bruised brain. Certain forces on the brain cause a destructive neurometabolic cascade of events in which the brain is injured beyond a normal mishap. That kind of stress dysfunction usually resolves spontaneously, but not always.

Concussions are a common injury and relatively short-lived, with most people recovering within 2-3 weeks. Even though these symptoms resolve quickly, the athlete requires care from a physician who specializes in concussion to help with return to play/return to academic decisions. Things can get much worse if return to play is premature including the deadly second impact syndrome.  In 15-30% of cases, people have “prolonged recovery” and require medical attention to improve. Vestibular and orthopedic rehab therapy are great tools towards recovery for these patients.

Symptoms and complaints can consist of, but are not limited to:

  • Headache
  • Dizziness
  • Sleep impairments
  • Blurred vision
  • Fatigue
  • Light/sound sensitivity
  • Nausea/vomiting
  • Drowsiness
  • Light-headedness
  • Confusion
  • Depression
  • Disorientation
  • Inability to focus
  • Anxiety
  • Irritability

So if you have a concussion, how long before you can return to sport?

Concussions are like snowflakes, no two are exactly alike. Some that seem serious at first resolve quickly and others that seem small can linger. So be patient and give your brain time to recover….we are talking about your brain!

In the state of North Carolina, a concussion protocol is required to be completed with a physician who specializes in concussion management for an athlete to return to play. The athlete will go through stages of activity without symptoms and assure that eye movement, balance, and neurocognitive testing return to baseline before being cleared. There is a return to play protocol that takes an athlete through stages and at minimum will take a week to complete. This protocol usually begins once symptoms subside.

You will progress from minimal cardio/strength activities to non-contact sport and finally to contact. These stages ensure the athlete is safe to return. It is important to complete all six steps of the process prior to returning to avoid lasting injuries.

For those having prolonged recovery, concussion rehab with a vestibular certified therapist can greatly impact your progress and minimize recovery time.

Have you had a concussion?

Back in Action’s vestibular certified physical therapist can help you properly recover and get back to doing what you love. Visit one of our Triangle-area locations today and let’s get started!


Written by Dr. Laura Wilson, PT, DPT

APTA Certified Vestibular Therapist

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