Concussion Management is important after surviving a motor vehicle crash. The diagnosis of whiplash is commonly made in patients that have been involved in a motor vehicle accident (MVA). It is far less common, however, to see patients who have been diagnosed with a concussion as a result of an MVA. This is concerning, as the symptoms of concussion and whiplash are identical, and there is currently no way to differentiate between these two diagnoses.
Some of the common symptoms we see reported in these patients include:
- Blurred vision
- Dizziness
- Headache
- Neck pain
- Difficulty concentrating
- Memory problems
- Nausea/vomiting
Because of these similarities and the inability to distinguish between the two diagnoses, best practice principles would dictate that those patients diagnosed with whiplash should in fact be managed in the same manner as a concussion patient.
What’s the Difference?
The difference between the diagnosis of concussion and whiplash lies in the physiological changes that occur within the brain during a concussion. A concussion is a neurologic injury that causes a temporary disturbance in brain cells as a result of an acceleration or deceleration of the brain within the skull. The common misconception is that you must be hit in the head to suffer a concussion. Because a concussion is the result of acceleration or deceleration of the brain, a concussion can happen with a significant blow to anywhere on the body, provided sufficient force is transmitted to the brain. This force to the brain leads to stretching and sheering of the brain cells, which causes the cells to discharge and send signals to each other uncontrollably.
The massive discharging of brain cells will likely resolve in a very short period of time and the patient may even feel better after a few minutes to an hour after injury. Don’t be fooled by this improvement, as there is a second phase to a concussion known as “Spreading Depression.” The initial brain cell discharge creates a chemical imbalance within the cells of the brain that ultimately leads to an energy deficit as the cells frantically use up all of their energy stores to reset the normal balance. These energy stores will continue to decline over the next 3-7 days.
The second phase of a concussion is when an individual is most vulnerable. When someone is in this low energy state, another blow, even one of much lower magnitude, can cause another concussive episode. Because the energy levels of the brain are already severely depleted, subsequent concussions can cause extreme energy depletion, which may cause permanent death of the involved brain cells, potentially causing permanent disability or, in some instances, death of the individual.
However, research has shown that if the brain has a chance to fully recover, and is no longer in the low energy state when the person receives another concussion, there is no evidence of an additive effect. This means that it may not be the number of concussions an individual suffers, but rather the way each injury is managed that is the major determining factor for long-term problems due to concussions.
Recovering the Brain
The pathophysiology of a concussion deems it essential to ensure that the demand placed on the brain during recovery matches the current level of energy availability. We follow a multi-stage rehabilitative process that is designed to safely progress patients through their recovery from concussion and return them back to activity when it is safe to do so.
The first step in management is often a short period of relative rest where the patient avoids aggravating factors. This is only recommended for 1-3 days, after which the patient needs to start to gradually expose themselves to the activities of daily living. Treatments for concussion commonly involve management of irritated tissues in the neck, rehabilitation for the visual and vestibular systems to address issues with balance and tracking and focusing of objects, as well as gradual exercise exposure to address the changes in cardiovascular function. Our final clearance tests involve monitoring the patient’s heart rate during specific exertion tests, while monitoring for any recreation of symptoms, to ensure that the body has fully recovered from the effects of the concussion.
Occasionally, patients will also suffer post-traumatic features as a result of their accident. This can complicate their recovery and can lead to the development of post-concussion syndrome. Often those with higher ratings of anxiety related to their injury are at greater risk of prolonged symptoms. It is critical that MVA patients with symptoms of whiplash and concussion are managed appropriately to prevent serious long-term problems.
For more information please visit: www.sportsmedicineandrehabilitation
Submitted by: Dr. Jason Porr, Bsc. (Hon) HK, DC, FRCCSS(C), Sports Specialist Chiropractor
We welcome Sports Medicine and Rehabilitation as a member of Crash Support Network and thank them for their support.
This article is also featured in our 2018 Fall Issue of Sharing our Recovery
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