CONCUSSIONS & POST CONCUSSION SYNDROME
What is a Concussion?
According to the American Academy of Neurology, concussion is defined as “trauma induced alteration in mental status that may or may not involve loss of consciousness.”
PCS (post-concussion syndrome) is defined by the WHO as persistence of three or more of the following symptoms after head injury : headache, dizziness, fatigue, irritability, insomnia, concentration or memory difficulty (PCS is diagnosed if symptoms persist > 3 weeks)
Levels of the Symptom
Mild, with symptoms that last less than 15 minutes and involve no loss of consciousness
Moderate, with symptoms that last longer than 15 minutes and involve no loss of consciousness
Severe, in which the person loses consciousness, sometimes for just a few seconds.
Causes of Conuncussion
Falls, motor vehicle accidents, struck by or against events, and assaults, respectively. Blasts are a leading cause of head injury among active duty military personnel in war zones. Sports and recreation activities are also a major cause.
If you think or remember any significant events that are mentioned above the right course of action is to mention it to your primary care physician as it is very important information that a lot of people miss or forget to share which can determine the right path towards your healing process.
Common Symptoms seen after Concussion or with Post Concussion Syndrome
You may notice physical, cognitive, emotional or sleep changes :
Physical symptoms like headaches, fuzzy or blurry vision, ringing in the ears, dizziness, fatigue, drowsiness, sensitivity to light, sensitivity to noise, balance problems, nausea or vomiting (early on) are very common and can last from 7-10 days or longer. Cognitive symptoms like difficulty thinking clearly, feeling slowed down, difficulty concentrating or difficulty remembering new information may also show up.
Emotional symptoms may include irritability, sadness, feeling more emotional, nervous or anxious. All the above changes also can contribute to sleeping more than usual, sleeping less than usual or trouble falling asleep.
The standard approach to concussions is getting a CAT scan or MRI and resting until the symptoms disappear. Unfortunately, this approach may lead to scar tissue formation within the fascial layers and can cause further compensation for function.
Is there an alternative treatment?
Manual therapy is a better approach than the Gold Standard process
Think of the analogy of trying to get saran wrap to smoothly cover a loaf of bread but it becomes folded and twisted. The fascia (connective tissue) is a lot like that as it wraps around the brain and SC. The goal of this therapy is to smooth and straighten the tissues so the organ underneath (the brain) functions better.
Increased balanced motion of the membrane surrounding the brain helps flush toxins and inflammation out of the brain tissue. As this occurs it can naturally elevate the biochemical processing which increases the function of neurons and neurological pathways. Newfound motion of the brain tissue and fluid helps decrease the abnormal and often enormous strain the brain is under. As the strain on the brain is reduced the patients symptoms discussed above are reduced or are completely eliminated with 60 minutes manual therapy within 4-6 sessions.
In response to concussion, the fascia that covers the arteries, veins and nerves as well as the supporting tissues within the cranium (dura) go into protective spasm. Due to the spasm the arteries cannot pump the pure oxygenated blood to the brain leading to deprivation of oxygen in the brain cells which impairs the healing process. The spasms in the veins lead to inability to drain all the impure blood out causing a backlog of impure blood and increase in the pressure surrounding tissues of the vein. The brain tissue will not heal itself until the protective spasms are released. The Fascial Counterstrain practitioner assesses and determines which tissues need to release to help the body regain its ability to function normally. The technique is performed very gently without causing pain to create decompression and tissue glides to shorten the structures in spasm, putting it into a state of optimal relaxation. Once the spasms are relieved the blood flow and drainage returns back to efficiency giving the body the optimal platform to heal itself.
CASE STUDY 1: Severe Head Injury
A 32 year old male in active duty with the military was severely injured from a bomb blast. He was in his truck when the blast occurred and his body was thrown up towards the roof so the top of his head was severely injured and he fell unconscious. He was assessed by the medical staff and was put in a dark room for a week to help his healing process and recovery. They did scans for his brain but did not see any internal bleeds so he was told he was fine and was discharged and asked to resume his duty. He developed headaches after a week with a pain scale of 8/10. He tried every possible treatment including physical therapy, massage therapy, chiropractor, acupuncture, botox to help his headaches but no one connected his headaches to the head injury.
10 years after he left the military and joined the NYPD he came to see me. With an in-depth subjective history, nervous system and cranial assessment I was able to diagnose that his headaches were related to his concussion due to the blast. He also presented with symptoms of neck and shoulder pain, difficulty falling asleep, light sensitivity, brain fog, difficulty with concentration. With manual treatment of his cranial bones, meninges and spinal dura, the patient started to feel relief in his symptoms. He started to regain his sleep and concentration back, his brain fog decreased and was able to perform his tasks at work more efficiently. He started to sleep better and his headaches reduced to 2/10.
CASE STUDY 2: Mild Head Injury
A 33 year old female with a history of headaches and neck pain came to OMPT for manual therapy. She reported she had been feeling the pain since she was in her 20s. She has to take over the counter medication before bed at least 3-4 times a week so she can wake up without any headache. With a full body assessment I found the primary cause of the problem initially was the restrictions in her pelvis that built the tension in her entire spine. We treated her for a few sessions and while I was working on her cranium she remembered her car accident when she was in her twenties where her car rolled over but she did not hit her head or fell unconscious. She went to the Dr for scans and that showed no abnormality. She was very young so she took the Dr’s word and did not find it necessary to get evaluated further and a few months later started to have headaches that became chronic and continued to get worse after her pregnancy as the demand on her body kept increasing.
She went to the doctor for scans and that showed no abnormality
This is a very classic case of mild concussion where there was no direct trauma to the head but due to the momentum of the accident her brain was shaken up within the cranium. That shaking caused twisting and folding up of the fascia covering the brain. The restrictions caused decreased circulation and fluid flow leading to chronic headaches. In 3 weeks post treatment with manual therapy she was able to sleep without taking medications and was able to function better with decreased intensity and frequency of headaches.
The patient was unable to connect her symptoms with the past trauma as the Dr told her she was fine from just looking at her scans and seeing no damage to the brain. The scans may not be able to pick up the damage caused to the fascia by the accident which leads to a lot of people suffering with post-concussion syndrome without proper treatment.