Updated Mar 13th 2023

What to do for a concussion after injury

Many people wonder what to do for a concussion, and yet, the majority are confused as to what a concussion is, concussion causes, concussion signs and symptoms, and the most effective concussion treatments. This blog hopes to clear up any misunderstandings that can lead to poor health outcomes, and help you find the right path.

Concussions 101

While concussions are more commonly talked about in contact and high speed sports, the reality is these injuries can happen at any time.

Concussion can happen at anytime

Slipping on a wet or icy surface. Falling in the playground or at work. Accidentally hitting your head on something like a low ceiling or tree branch. Motor vehicle accidents and more. 

Regardless of the situation or where you get injured, you should be informed and know what to do.

Following a concussion, the first 24 to 48 hours are extremely important. Why? Because in some cases, there is potential for a more serious brain injury, requiring immediate medical attention. This could include things like a brain bleed or swelling of the brain.

While it’s believed to be safe to take a nap or sleep after a concussion, the concussed person should be closely watched by an adult for at least 3 hours following head injuries. The goal here is to monitor for any signs of worsening condition. This could be indicative of a more serious brain injury, and are often termed “Red Flags”.

According to several studies, the rate of an abnormal CT scan in the emergency department following a concussion – which are potentially dangerous or life threatening – is up to 7%, or less than 1 in 10 cases [1,2,3]. Of those cases, fewer than 2% require surgery [1,4]. The rates of these more severe complications are low, but they can happen and for this reason everyone should be aware.

What Exactly is a Concussion?

A concussion is a traumatic brain injury, otherwise known as a TBI. There are three classifications of Traumatic Brain Injuries: Mild, moderate, and severe, whereby concussion is considered synonymous with the mild category. Classification of brain injuries are based on the Glasgow coma scale score, which is a reliable measure of a person’s level of consciousness post-injury.

After a concussion, there may be no loss of consciousness, or you could have a loss of consciousness for up to 30 minutes. If the loss of consciousness is longer than 30 minutes, this would be considered a moderate to severe traumatic brain injury.

What’s really important to understand, is that only about 10% of patients experience a loss of consciousness following concussion. Far too often a patient will be told that if they didn’t lose consciousness then they don’t have a concussion. But this is simply NOT true. The data doesn’t lie: 90% of concussions DO NOT result in a loss of consciousness.

Something else to keep in mind is that concussions are functional not structural injuries, which means that a patient’s imaging will typically look completely normal. After a head injury the emergency room will usually do imaging if they are concerned there may be a brain bleed, which is something in addition to concussion, that is more serious. But a concussion itself is not going to present on any imaging studies.

The reason for not showing on a scan is due to the functional nature of the injury. Concussions don’t damage the structure of the brain, but they DO change how it functions.

How Do Concussions Occur?

The majority of people believe that in order to receive a concussion, you must be hit in the head. In reality however, hitting your head is NOT what causes a concussion.

What causes a concussion is the rapid acceleration of the brain inside the skull. You can take a blow to the head, but it may not be hard enough to cause an acceleration of your brain inside your skull. On the flip side, you can be involved in a car accident and never hit your head on anything, except maybe the soft back of your headrest, but still receive a concussion because the force of your head moving forward and then back quickly is enough to move the brain inside your skull, surpassing the threshold required for a concussion to occur. It is due to this mechanism that a concussion can occur due to a blow or sudden acceleration and deceleration to the head, neck or body, with forces transmitted to the brain.

But what’s REALLY happening inside your skull during this rapid acceleration?

When your brain suddenly accelerates inside your skull, the cells get stretched and twisted. They don’t rip or break but actually stretch. When this stretching occurs, there is a chemical change inside each cell. This chemical change results in your brain becoming “excited”, and this excitation is what causes the signs and symptoms of concussion. In plain language, your brain cells go berzerk and begin misfiring. Remember, your brain is electrical in nature, and a concussion throws a wrench into your electrical circuitry.

In a heathy person, the nervous system, of which your brain is the CEO, is very organized and efficient. Cells fire correctly. Everything is calm and steady.

When you experience a concussion, your brain suddenly goes haywire, causing the usual calm and organization to become CHAOS. This is why patients experience any number of symptoms after a concussion. They may become off balance or very confused as to where they are and what just happened.

Concussion Recovery – Why Timing Matters

We’re often asked why it matters how long a patient waits before they receive treatment for their concussion. The quick answer is, the sooner you focus on recovery, the better your odds of eliminating your symptoms in a timely manner. People that wait to get treatment, or never get treatment at all, have a much greater risk of experiencing prolonged concussion symptoms.

The definition for post-concussion syndrome based on the international classification of diseases is having three or more symptoms beyond four weeks after injury. The studies that have been done in both children and adults have found that roughly 30% to 40% of all concussion patients will continue to have prolonged or persistent symptoms beyond a four-week period.

The belief used to be that ALL concussions will resolve themselves within a couple of weeks. And in some instances, that theory still holds true. But we have found at Complete Concussions that more and more people are beginning to experience prolonged symptoms. And this increase in cases is a direct result of people not having the right information about what to do for a concussion immediately after injury.

The reality is, when a patient receives concussion treatment in a timely manner, their chances of prolonged symptoms decreases dramatically. In our practice, only 5% of people who get timely treatment (within the first 7 to 10 days after the injury) will go on to experience persistent concussion symptoms for a month or more.

This is why it is so INCREDIBLY IMPORTANT that people not only understand that getting treatment after a concussion is vital to their overall health and well-being, but also understand the symptoms to look out for.

 

Concussion Symptoms

Please take any and all precautions when a concussed person experiences certain symptoms following injury. The below Red Flags are signs of potentially more serious or life-threatening conditions like moderate or severe brain injuries.

Get immediate medical attention at the nearest emergency department if you experience any of the following:

  • Bad headache that gets worse
  • Very drowsy or tired, or can’t be woken up
  • Vomiting
  • Can’t remember things that just happened
  • Can’t remember things 30 minutes before OR 30 minutes after injury
  • Can’t recognize people or places
  • Repeating the same things or questions over and over
  • Seizure
  • Blood coming from the ears, nose mouth or eyes
  • Bruising behind the ears, black eyes or very tender points on the face
  • Slurring words
  • Unsteadiness or severe balance problems
  • Weakness in the arms of legs

The way that an injury occurs may also play a factor.

For example, if you were in a car accident, hit by a car or fell down a set of stairs, you should go to the emergency department as soon as possible. If you were using alcohol, cannabis or other illicit drugs at the time of injury you should also seek immediate medical care.

A proper evaluation after the injury as well as evidence-informed advice on proper concussion management can have a big impact on your recovery. See here for a full list of concussion symptoms.

How Do You Know You Have a Concussion?

If we’re honest, the diagnostic criteria for concussion is actually pretty loose. Presently a patient need only present with two things in order for their injury to be considered a concussive injury.

1. A Mechanism of Injury

The mechanism of injury that we’re concerned with here is a significant acceleration or deceleration of the head. Remember, getting a little bump on the head does not mean that there was significant enough impact to cause a concussion. You need that acceleration or deceleration so that your brain is actually jostled around inside your skull, causing your brain cells to stretch.

Also remember direct contact with your head isn’t required to impact your brain. You could be tackled in football and your head will snap back suddenly. Even though your head never hit the ground or any other hard surface, that movement may be enough to cause your brain to be jostled.

1. Symptoms

In addition to a mechanism of injury, you also need to present with concussion symptoms immediately after the injury – or within a few hours – to be diagnosed. And you only need to present with one symptom.

While there is no ABSOLUTE way to diagnose a concussion, if you have both requirements (mechanism and symptom) then you should be treated as if you have received a concussion. Because remember, no imaging done at the emergency room is definitive of diagnosis. Imaging will only be able to see if the STRUCTURE of your brain has changed. A concussion doesn’t change the structure of your brain, rather HOW it functions.

So the bottom line is, if you have a mechanism of injury, and one or more symptoms of a concussion immediately after or even up to a few hours after injury, then you should be treated as if you have received a concussion and seek treatment immediately to ensure full concussion recovery without prolonged symptoms.

How Long Do Concussions Typically Last?

This is a complicated one. The truth is, there are a variety of factors that help us to determine how long someone’s concussion may last.

For 60% to 70% of people that sustain a concussion, their symptoms will typically be gone within a month. But for the other 30% to 40% of the population, their symptoms will generally last longer than a month and could, without treatment, even last YEARS.

But the good news is, if you seek treatment ASAP, your chances of experiencing prolonged symptoms decreases dramatically.

The first 48 hours after concussion: What you can and can’t do

It’s important to understand that the first 48 hours after a concussion are critical to your recovery.

Here’s what you can and can’t do:

Rest: Do not go to sleep for at least 3 hours after the concussion. Make sure you have a responsible adult around to watch for any signs of your condition getting worse.

If you’re the one watching the injured person, continue to talk to them. Are they slurring their words? Are they coherent? Do they know where they are? Are they repeating things? If you answer yes to any of these, take them to the emergency department.

Regular check-ins: This one is for the person monitoring the concussed person. Stand them up every 20 minutes, and have them close their eyes with their feet together. Are they wobbly? Are they swaying back and forth or side to side? If their balance is getting worse, take them to the emergency department.

Overnight check-ins: After 3 hours have passed, they can take a nap or go to sleep. While it’s not mandatory, we recommend that an adult checks on the injured person every 2 hours throughout the first night.

You don’t need to wake them up, but make sure they’re still breathing and seem okay. If there are any signs of their condition getting worse, take them to the emergency department right away.

Medication: Do not take any pain medication before talking to your doctor. Medications can “mask” the signs of a worsening condition and some may increase the possibility of a brain bleed.

Make an appointment: You should get a full evaluation by an experienced healthcare professional with training in concussion management within 2 days of the injury. Ideally, this would occur on the day of or next day following your injury. The faster you get assessed by a healthcare professional with training or expertise in concussion management, the faster you will get on the path to recovery.

Early intervention of treatment and rehabilitation can help you get back to doing the things you love. Follow the guidance of your healthcare provider.

Complete Concussions is a network of clinics and trained practitioners that provide evidence-informed concussion care for all those impacted by concussion. We may have a clinic near you.

Concussion treatment

We have been discussing the importance of seeking treatment early for your concussion and now we’d like to share a study with you that really drives the point home.

A randomized controlled trial by Schneider and colleagues from a few years ago followed people who still had concussion symptoms 10 days after their initial injury [5] . At the 10-day mark, the researchers split this group of people in half. One group, the control group, was not given any treatment, just some basic education and reassurance.

The second group was also given education and reassurance, but this group also received regular rehab for their neck and visual and vestibular systems.

After eight weeks of care, 73% of the group that was getting treatment had returned to full sport participation. While only 7% of the group getting only education had returned to full sport participation.

So, you can see the massive difference when you don’t get treatment versus when you do.

What to Do for a Concussion in the Long-Term

We just discussed what you should and shouldn’t do in the first 48 hours after injury, but let’s now talk about some long-term care tips.

Fight Inflammation

Concussion causes inflammation, and high inflammatory markers in the blood following injury has been associated with prolonged outcomes. Anytime there’s an injury, there will be increased inflammation, and that inflammation can lead to more inflammation.

On top of the initial inflammatory response, there’s also something called the gut-brain access. After brain injury, the permeability of your gut (gut lining), becomes more permeable. This means the barrier that normally does not allow food and bacteria to spill out into your gut and surround other organs suddenly STARTS allowing your intestinal contents to spill out.

Guess what happens? Your body sees this food and bacteria as foreign invaders, and so mounts an immune response, which means EVEN MORE inflammation. The patient can experience gastric issues and GI upset as well as feeling foggy, fatigued and confused.

To mitigate this, it’s best to avoid any or all foods that have a pro-inflammatory effect. Alcohol, as an example, has a very high pro-inflammatory effect and also increases the permeability of your gut. Processed foods and vegetable oils are also highly inflammatory and should be avoided during (and really after, because why promote inflammation at all?!) your treatment.

Some other things you can do to reduce the amount of inflammation in your body after your injury is to take some light exercise (green-lit by your healthcare provider) and get plenty of quality sleep.

Take it Easy, But Not Too Easy

Everyone thinks that after a concussion, you should take it easy and do little else than sit in a dark room and rest. But that’s actually not the case at all.

It’s true that for decades, that ABSOLUTE REST was the typical treatment. People would be told to sit in a dark room and avoid any screens… no TV, no computer, not even reading.

Modern evidence is showing us that prolonged rest is not only not helpful, but that it actually starts to make people worse over time.

The new recommendation is called symptom limited activity, meaning that you can do anything that doesn’t provoke your symptoms to a significant degree. An example of a “significant degree” means before an activity you have a headache and on a scale of 1 to 10, your headache is at a level 3. You decide to check your email and social media accounts and your headache (or any other symptom) jumps a few points. So now your headache is at a level 5 or 6. At this point it’s time to take a break and do something else. Go take a walk or make a snack.

Wrap Up

So, what should you do for a concussion immediately after injury?

First, evaluate yourself and the injury to see if you have the two requirements: a mechanical injury that involved an accelerating force and one or more concussion symptoms. If you have any red flag symptoms or anything that suggests a possible brain bleed, go straight to an emergency room.

Once they’re confident you don’t have a bleed, it’s time to find a good rehab professional trained in concussion management. You should try to do this within the first week so they can start you on the right program and back to yourself and your favourite activities as soon as possible.

Try to find somebody who’s reputable, has treated a lot of concussions, and is up to date with the latest research. Watch your diet and avoid pro-inflammatory foods. Get plenty of rest and try some light physical activity, whatever your rehab professional recommends. Follow their directions and monitor your activities so you know when you need to take a break.

If you think you have suffered a concussion, it’s best to get treatment right away so you can get your health and life back sooner.

If you’d like to speak with us about a treatment plan, please get in touch. Complete Concussions is a network of clinics and trained practitioners that provide evidence-informed concussion care for all those impacted by concussion. We may have a clinic near you.