The first step is to determine what areas have been affected so that you can start getting the care you need.
You can use our Triage Quiz here to help, or book with our Physiotherapist, Chiropractic, or Occupational Therapy team.
What is A Concussion?
A concussion is a type of brain injury (TBI) caused by a blow, bump, jolt or hit to the body that causes the head and brain to move rapidly back and forth. This is known as an acceleration or deceleration injury. Many people still believe the myth that the head has to hit something for a concussion to take place. This is not true. The injury is caused by the brain bouncing around or twisting in the skull. Think of shaking a cup of jello. This injury can create chemical changes in the brain and sometimes physical damage to the brain cells.
https://youtu.be/fSRWF44wgn8Concussions are often described as a ‘mild’ brain injury or mTBI because they are not life-threatening. This is often misleading because the concussion symptoms can be serious and life-changing.
There are several steps to concussion treatment, and different aspects of rehabilitation to consider during each
1. Seek care and initial diagnosis:
Your care provider can provide the testing to diagnose a concussion. Other tests will also be done to rule out other potential problems such as a brain bleed or subdural hematoma. If you think you have had a concussion or brain injury, it is important to see your general practitioner or medical doctor for an investigation.
2. Treat the acute phase of the concussion.
The old approach to concussion treatment was to stay in a dark room. We now know this is not the best practice. But neither is overdoing it and spiking your symptoms. The goal is to prevent over-stimulation and symptoms spikes, while still being active. Your care provider can help you navigate this stage.
Resources like Parkwood Points can help you understand what can trigger your symptoms. Returning to your normal activities too soon can cause make your concussion symptoms last longer. This happens if you keep doing too much activity and cause yourself to repeatedly crash. During the acute phase, you can begin seeking treatment for areas affected by the concussion and injury. This includes the vestibular, cervical (neck), and vision.
Vestibular (Inner Ear): Dizziness after a concussion or brain injury can often be caused by vestibular problems. These same conditions can also lead to difficulty with balance, as well as nausea.
The vestibular problem could be something like BPPV (Benign paroxysmal positional vertigo), a central vestibular dysfunction, or more. A highly trained vestibular physiotherapist is important for the diagnosis and treatment of post-concussion vestibular disorders.
Cervical (neck): Post-concussion headaches and sore neck are often caused by injuries sustained during the event that caused the concussion. Certain cervical conditions can also lead to increased dizziness, vision problems, migraines and more. It is important to have your neck assessed by a specially trained chiropractor or physiotherapist.
Not all approaches to treating your neck are the same, and your care provider should be able to provide you with an accurate timeline in which you will see improvement, or need to seek an alternative approach.
Vision: Concussions and brain injuries commonly cause vision problems. This can include things like light sensitivity, screen sensitivity, headaches, migraines, dizziness, trouble focusing and more.
Over 50% of the brain is involved in how vision works, so it is common to have post-concussion vision problems. During the acute stage, most visual care involves two things: Making sure that the eyes have not been physically damaged, and tools to reduce symptoms.
Light sensitivity and other vision symptoms can often be helped by things like tints, FL-41, prism, bi-nasal occlusion, prescription glasses and more. Using these visual tools during the acute post-concussion stage, it is possible to help reduce symptoms and improve recovery. This is very important for people like students with exams, people who can’t miss work, or others who still need to function during the acute phase.
3. Rehabilitation Phase of Concussion Treatment
If 4 weeks have passed and you are still experiencing symptoms, it means that you need evaluation and treatment for the affected areas. Many areas that are impacted during by concussion and brain injury can cause similar symptoms. It is important to determine which areas are the root cause, and treat accordingly.
Our TRIAGE QUIZ can help give you an idea, and we will break it down here.
Vestibular Rehabilitation (Inner Ear): When most people think of dizziness and balance problems they think of vestibular problems. The vestibular system is critical for our balance and orientation and is often impacted after concussion. An experienced vestibular physiotherapist can properly diagnose and treat any vestibular conditions caused by your injury.
Post Concussion Vestibular Symptoms:
- Balance problems
- Room appears to spin
Cervical Rehabilitation (neck treatment):
The muscles, ligaments and fascia of the neck are commonly involved in post-concussion syndrome. Sometimes this is very obvious when the neck is tight and sore. It can also be less obvious to a person yet still cause headaches, migraines, dizziness and more.
There are several easy ways to tell if your neck is part of the problem, such as neck pain, lack of balance or unsteadiness, disorientation, limited cervical range of motion, and may be accompanied by a headache/migraine.
Post Concussion Cervical Symptoms:
Vision Rehabilitation (Vision Therapy)
Post-Concussion Vision Syndrome is about how the eyes and the brain work together. Generally, the eyes are completely healthy, but the way that the brain controls them and processes the visual information has been impacted.
This can result in problems with how the eyes track (pursuits, saccades), work together (convergence, binocularity), depth perception, visual-vestibular integration and more. Vision therapy or vision rehabilitation is about re-calibrating how the eyes and the brain work together.
This will reduce symptoms and improve function. Unfortunately, many providers misunderstand vision therapy and post-concussion vision exercises. They often approach treatment as though the problems are with the eye muscles, rather than how the eyes and the brain work together. This can lead to treatment that just increases your symptoms, without actually treating the underlying vision problems.
Vision therapy also needs to be done with specialized glasses prescriptions that reduce symptoms and improve the speed of treatment. We call this ERGOPTICSTM (Ergonomic Optics- LINK). While most glasses are just for making things clear, ERGOPTICSTM prescriptions help your eyes and brain work better together.
Post Concussion Vision Symptoms
You’ll notice that many symptoms overlap with cervical problems and vestibular problems, which is why co-management is so important.
- Light sensitivity
- Screen sensitivity
- Balance problems
- Depth perception problems
- Increased symptoms in busy places
- Trouble reading
- Trouble focusing
- Double vision
- Blurry vision
Co-management of Post Concussion Syndrome Treatment
Vision, vestibular and cervical conditions can all be linked. This is why it’s important to work with a team that understands how the various areas interact.
Ideally, you want to be tested in all three areas to determine the order of treatment. Vestibular conditions can cause increased visual sensitivity and destabilize eye movements.
This is especially true with BPPV, where the crystals in the inner ear are out of place and make your brain think you are moving when you are not. This is like getting used to the spinning of a merry-go-round and then getting off and feeling like you’re spinning.