Demystifying Concussions: Causes and Healing Cycle

Demystifying Concussions: Causes and Healing Cycle

Summary

A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. Common causes include falls, motor vehicle collisions, sports injuries, bicycle accidents, and physical violence. It is important to note that a concussion can occur without loss of consciousness, as only about 10% of concussions involve being knocked out.

The concussion healing cycle is a dynamic process typically involving three main phases: an acute symptomatic phase lasting less than three days, a recovery phase where symptoms lessen and activity is gradually increased, and a recovered phase where normal activities, including sports, can be resumed. Most people recover within 2 weeks to 1 month, with normal recovery for adults considered 14 days and for those under 18, 30 days. However, recovery can be prolonged sometimes, with post-concussion syndrome affecting about 20% of individuals whose symptoms last longer than 6 weeks.

• The acute symptomatic phase involves immediate symptoms following injury. During the acute symptomatic phase, the brain needs to heal, so near-complete rest is required for the first 24-72 hours after the injury, and activities that worsen symptoms, such as screen use, bright lights, and loud sounds, should be avoided.

• The recovery phase is characterized by a gradual return to thinking and physical activities, starting with light tasks like walking or short periods of schoolwork, and progressing to more strenuous exercise under medical guidance; new studies suggest limited exercise during this phase can lead to quicker recovery.

• When symptoms fully resolve both at rest and during activity, a healthcare provider with concussion expertise should manage and direct the safe return to school, work, and sports.

Causes of Concussions

A concussion is a type of traumatic brain injury (TBI) caused by a mechanical force or trauma that results in a temporary disruption of normal brain function. It is often referred to as a mild traumatic brain injury (mTBI) and can occur with no loss of consciousness. The primary mechanism involves a sudden movement of the brain within the skull, which leads to functional disturbances rather than structural damage.

Direct and Indirect Causes

Concussions can result either from a direct blow to the head, face, or neck, or from an indirect force transmitted to the head from elsewhere on the body. For example, a hit to the torso that causes rapid acceleration or deceleration of the head—such as in whiplash injuries or blast injuries in war zones—can also cause a concussion. This rapid movement causes the brain to bounce or twist inside the skull, leading to stretching and damage of brain cells, as well as chemical and metabolic changes in the brain.

Common Causes and Scenarios

The most frequent causes of concussions include:

• Falls: These are among the leading causes, especially in young children and older adults.

• Motor vehicle collisions: Car and bicycle accidents are significant contributors to concussions.

• Sports injuries: Participation in contact sports such as football, soccer, hockey, and boxing increases the risk. Football consistently accounts for the highest number of sports-related concussions in high school and college athletes. Soccer is notable for having the highest concussion rate among female athletes.

• Workplace injuries: Jobs in construction, transportation, mining, and agriculture carry higher risks due to falls, heavy objects, and vehicular collisions.

• Assaults and physical violence: Being struck by an object or person, or experiencing shaken baby syndrome, can lead to concussions.

• Recreational activities: Playground injuries, skateboarding, skiing, and use of powered recreational vehicles are also common sources.

Biomechanics of Injury

The forces involved in causing a concussion can be linear, rotational, or angular. Rotational forces—where the head turns around its center of gravity—are believed to play a major role in the severity of concussions. These forces disrupt neuronal membranes, leading to an influx of potassium and calcium ions, excessive release of excitatory neurotransmitters like glutamate, and a cascade of metabolic changes including increased glucose demand and reduced cerebral blood flow. This creates an "energy crisis" in brain cells, impairing their function.

It's important to note that besides the sudden impact causing the brain to bounce around or twist in the skull, it also forces the spine to swing and twist unnaturally. This invariably causes several bones to displace from their natural positions and twist, leading to scarring of the meninges. Unless cleared using a series of Advanced Biostructural Correction™  treatments, possibly in combination with Endonasal Cranial Correction™, these meningeal adhesions harden with time, causing severe physical, psychological, and neurological complications.

Risk Factors

Certain factors increase the likelihood of sustaining a concussion:

• Previous history of concussion: Individuals who have had one concussion are at higher risk for future ones, and the risk of second-impact syndrome increases significantly if a second injury occurs before full recovery.

• Alcohol use: Impairs coordination and judgment, increasing accident risk.

• Participation in contact sports: Especially American football, rugby, martial arts, and hockey.

• Gender: Female athletes suffer concussions about twice as often as males in the same sport, though the reasons are still being studied.

Special Considerations

It is a common misconception that a person must lose consciousness to have a concussion. In reality, fewer than 10% of sports-related concussions in children involve loss of consciousness. Symptoms may be delayed by 1–2 days after the injury, making early detection challenging. Because concussions do not typically show up on standard imaging like CT or MRI scans—which are better at detecting structural injuries such as bleeding or fractures—diagnosis relies heavily on clinical evaluation of symptoms and history of trauma.

In summary, concussions are caused by forces that disrupt normal brain function through rapid movement of the brain within the skull, whether from direct or indirect trauma. They are common in sports, accidents, and occupational settings, and should always be taken seriously due to the risk of long-term complications such as post-concussion syndrome or second-impact syndrome.

Concussion Healing Process

Concussion recovery is a dynamic, individualized process that typically unfolds in distinct phases, beginning with an acute symptomatic stage and progressing through recovery to full resolution of symptoms. Most individuals recover within two to four weeks, though recovery timelines vary significantly based on age, injury severity, and prior concussion history, with children and adolescents often requiring up to 30 days for full recovery Recent evidence supports early, gradual reintroduction of light physical and cognitive activity after an initial 24–72 hour rest period, challenging older models that recommended prolonged inactivity.

Phases of Concussion Recovery

Concussion heals in three primary phases, though athletes may follow a more structured six-stage return-to-play protocol.

1. Acute Symptomatic Phase (0–72 hours post-injury)

This initial phase begins immediately after injury and lasts up to three days, during which symptoms are most intense. The brain undergoes metabolic and chemical changes that impair normal function, prompting the body to signal the need for rest through symptoms like headache, dizziness, nausea, sensitivity to light and sound, and cognitive fog. During the first 24 hours, complete rest is advised, including avoidance of physical exertion, screen time, and mentally taxing activities such as schoolwork or reading Medications that increase bleeding risk—such as aspirin, ibuprofen, and naproxen—should be avoided initially; acetaminophen (Tylenol) is preferred for pain relief in the first day. Close monitoring is essential, and emergency care should be sought if "red flag" symptoms appear, including loss of consciousness, worsening headache, repeated vomiting, seizures, or neurological deficits like weakness or vision loss.

2. Recovery Phase (Days 3–30)

As symptoms subside, individuals enter the recovery phase, characterized by a gradual return to cognitive and physical activities under medical supervision After 1–2 days of rest, light activities such as short walks or stationary cycling may be introduced, provided they do not exacerbate symptoms Similarly, light cognitive tasks like pleasure reading, listening to music, or brief schoolwork can be resumed cautiously This phase emphasizes a stepwise increase in activity, guided by symptom response. For students, academic accommodations may include reduced workload, extended test time, rest breaks, and preferential seating. For athletes, a structured six-stage return-to-play protocol is often followed, which includes:

1. Symptom-limited activity (light aerobic exercise)

2. Light aerobic exercise (e.g., walking, cycling)

3. Sport-specific exercise (e.g., running drills)

4. Non-contact training drills

5. Full-contact practice

6. Return to play

Each stage typically requires 24 hours, and progression halts if symptoms return.

3. Recovered Phase (Symptom-Free at Rest and with Exertion)

Full recovery is defined as the ability to engage in all pre-injury activities—including sports, school, and work—without symptom recurrence Before returning to high-risk activities, especially contact sports, a medical evaluation is essential to prevent second-impact syndrome, a rare but potentially fatal condition caused by a second concussion before the first has healed. Most people recover within 14 days if over 18, or within 30 days if under 18. However, 10–30% may experience prolonged recovery, with symptoms lasting beyond six weeks, a condition known as post-concussion syndrome (PCS).

Factors Influencing Recovery

Several factors affect concussion healing timelines:

• Age: Children and older adults generally take longer to recover.

• Prior Concussions: A history of previous concussions increases the risk of prolonged recovery and PCS.

• Preexisting Conditions: Mood disorders, migraines, ADHD, and learning disabilities are associated with slower recovery

• Severity of Initial Injury: More severe symptoms at onset correlate with longer recovery times.

• Early Activity: Recent research shows that early, controlled physical activity that doesn’t present symptoms may speed up recovery compared to strict rest.

Post-Concussion Syndrome (PCS)

PCS affects an estimated 5–30% of individuals and is diagnosed when symptoms persist beyond three months. Common symptoms include chronic headaches, dizziness, fatigue, insomnia, memory problems, and mood disturbances such as irritability, anxiety, or depression. Risk factors for PCS include female sex, older age, prior mental health conditions, and severe initial symptoms.

Managing PCS

Conventional wisdom dictates that management should involve a multidisciplinary approach, including physical therapy, vestibular rehabilitation, vision therapy, and psychological support. ABC practitioners invariably find that symptoms requiring intervention of these methods address symptoms whose root cause lies in structural disturbances. Almost all cases of post-concussion syndrome are handled well with Advanced Biostructural Correction™ in combination with Endonasal Cranial Correction™ within a few weeks of treatment. The speed of recovery depends on how well the person's structure was prior to the injury. The symptoms reduce gradually as the treatment progresses until complete recovery; the person remains symptom-free unless injured again.

Recovery Support and Recommendations

To support healing:

• Rest and Sleep: Prioritize quality sleep and daytime rest breaks.

• Hydration and Nutrition: Maintain adequate fluid intake (60–80 oz/day) and consume a nutrient-rich diet high in protein, omega-3 fatty acids, and antioxidants (e.g., fruits, vegetables, fish, nuts).

• Avoid Alcohol and Screens: Alcohol can impair healing, and excessive screen time may worsen symptoms due to visual strain.

• Gradual Reintegration: Return to work, school, and sports only when symptom-free and with medical clearance.

• Emotional Support: Stay connected with family and friends, and seek professional help if mood symptoms persist.