Concussion is defined as “a complex pathophysiological process affecting the brain, induced by biomechanical forces,” according to the Consensus Statement on Concussion in Sport, Berlin 2016.

The brain moves within the skull due to the biomechanical force resulting in the neuronal covering being stretched. This results in Potassium leaving the cells and entering the fluid between the cells while at the same time calcium enters the cells. The higher levels of calcium within the cells decreases blood flow to the area at the very time that you need more glucose to be delivered in order to fuel the pump that returns the potassium back to the cells. This creates an energy imbalance. There is no damage or death to the cells they are simply working sub-optimally resulting in the symptoms that we see following a concussion. This explains why there is no imaging that can confirm a concussion as there is nothing unusual to see.

The biomechanical force can be from a jarring force through the body or contact with the head. These forces result in cellular changes that lead to an energy crisis within the brain. This is further complicated by changes in blood flow to the injured area.

It can take 10-14 days for an adult brain to physiologically recover from the injury and up to 30 days for a younger brain to recover. In some cases, symptoms last well beyond the time it takes for physiological healing to occur.

The forces required to produce a concussion are greater than those required for Whiplash Associated Disorder. As a result, frequently people who have sustained a concussion, have also injured their neck.

Concussions can affect your body’s ability to regulate autonomic functions including heart rate and blood pressure, which is why return to physical exertion should be done under medical guidance. They can also affect both your vestibular system and oculomotor system (visual), as well as their integration. The vestibular system is located inside your ear and connects deep into the brain. It is responsible for helping you keep your balance and to know where you head is in space. Our visual system is complex, with 70% of our brain’s sensory processing being dedicated to it. Our vestibular and visual systems are extensively integrated. One of the most important things this allows us to do is to keep focused on something visually while we are moving, for example, reading a sign as you are driving by it. This is only one example of how this integration allows us to function in the world.

During the assessment with the physiotherapist, you will discuss your current symptoms, your past medical history, and the mechanism of injury. They will then evaluate your cervical spine, your vestibular and ocular systems, your balance, and your autonomic systems. This information will be used to develop an individualized treatment plan to deal with your unique presentation.
The physiotherapist will be able to provide you with guidance about safely returning to your regular activities. The Buffalo Concussion Treadmill Test can provide guidance as to how intensely it is safe to work out. Physiotherapists can provide manual therapy as well as exercises for strengthening and range of motion for the neck. We can provide treatment for the vestibular and balance systems, along with visual exercises specific to your issues.