Concussions Demystified: Mechanisms, Symptoms, and Effective Treatment - Part 1
- Southeast Physiotherapy
- Apr 30
- 5 min read
Concussions are a common yet complex form of traumatic brain injury, with effects that can range from mild to severe. This 3-part blog series explores the science behind concussions, starting with the mechanism of injury (MOI)—how these injuries occur in the brain. We’ll then delve into the symptoms that often follow, from physical discomfort to cognitive and emotional challenges. Finally, we’ll cover treatment options, focusing on evidence-based strategies for recovery and the importance of a structured return-to-activity protocol. Whether you're a healthcare provider, athlete, or someone recovering from a concussion, this series will provide valuable insights into understanding and managing this widespread injury.
Part 1: Mechanism of Injury (MOI) of Concussions
A concussion is a type of traumatic brain injury (TBI) caused by a blow to the head or any other impact that shakes the brain within the skull. Unlike other brain injuries, concussions are typically considered "mild" TBIs, though their effects can be anything but mild. The mechanism of injury (MOI) for concussions involves an acceleration-deceleration force that leads to mechanical disruption of the brain’s normal function. This can result from a direct impact, such as a blow to the head, or an indirect force, like a sudden stop or a hit to the body that causes the brain to move within the skull.
The Neurometabolic Cascade
When the brain experiences a concussion, it undergoes a chain reaction known as the neurometabolic cascade. This cascade begins with a sudden and excessive release of neurotransmitters like glutamate, leading to an imbalance in ionic levels, specifically sodium and potassium. This imbalance triggers a series of events that affect cellular energy production, blood flow, and neuronal functioning (Giza & Hovda, 2001). At the same time, the brain’s mitochondria—the energy-producing organelles—become impaired, leaving the brain cells starved for energy. This metabolic disturbance is one of the primary reasons why the brain remains vulnerable to further injury long after the initial trauma (McCrory et al., 2017).
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Mechanical Forces and Brain Injury
The forces that cause concussions can be divided into two types: linear and rotational. Linear forces occur when the head is struck in a straight line, pushing the brain forward or backward within the skull. This type of impact can cause focal brain injury, leading to symptoms like memory loss or difficulty concentrating. On the other hand, rotational forces, which occur when the head is twisted or turned rapidly, are more likely to result in diffuse injury, affecting a wider area of the brain and leading to widespread dysfunction (Patricios et al., 2023). These rotational forces can also cause the brain to "shear," or experience stretching of the brain's tissues, which may lead to more severe outcomes.
Impact and Injury to the Brain
When the brain moves rapidly within the skull, the neurons and their connections can stretch or tear. The axons, which transmit electrical signals between neurons, are particularly vulnerable to damage. This stretching of axons disrupts the normal transmission of information throughout the brain, leading to temporary disruptions in cognitive function and motor skills (Patricios et al., 2023). The brain’s vascular system can also be affected, with small blood vessels rupturing and contributing to swelling and bruising. Though concussions are often not accompanied by visible damage to the brain, the underlying physiological and biochemical changes are profound and can have long-term effects if not properly managed.
Risk Factors and Predictors
Not all concussions are the same. Some individuals may sustain multiple concussions over their lifetime, while others may only have one. Several factors influence the severity and recovery from a concussion, including the force of impact, the direction of the blow, and the person’s age and health history. For instance, young athletes and older adults may take longer to recover from concussions due to differences in brain resilience (Complete Concussions, 2023). Additionally, individuals with a history of previous concussions are at a higher risk of sustaining another concussion and may face prolonged recovery times (Patricios et al., 2023).
Concussion in Sports
Sports-related concussions are a major concern due to the high incidence in contact sports like football, soccer, hockey, and rugby. In these sports, athletes are often at risk for both direct and indirect impacts that can cause a concussion. Protective gear, such as helmets, may reduce the risk of skull fractures but does not fully prevent concussions, as the brain still moves within the skull (McCrory et al., 2017). Safety regulations, including concussion protocols and mandatory rest periods, have been a significant part of concussion management in sports. However, a critical challenge remains balancing an athlete’s desire to return to play with ensuring their brain fully recovers.
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Role of Baseline Testing
Baseline testing is a crucial component in concussion management, especially in sports. These tests assess an individual’s cognitive and physical function before an injury occurs, providing a reference point for comparison following a concussion. Baseline testing can include assessments of memory, concentration, balance, and reaction time. When an athlete suffers a concussion, these pre-injury test results help healthcare providers determine the extent of cognitive and physical dysfunction and aid in making safe return-to-play decisions (Complete Concussions, 2023).
The Importance of Proper Diagnosis
Accurate diagnosis of concussions is paramount, as the symptoms of concussion may not always be immediately apparent. Some symptoms may emerge over hours or even days following the injury, making early diagnosis a challenge. Healthcare providers must rely on a combination of clinical assessments, including symptom inventories, balance tests, and neurocognitive evaluations, to determine whether a concussion has occurred and whether it’s safe for the individual to resume normal activities (McCrory et al., 2017). Early diagnosis and treatment are critical in preventing further damage and ensuring a full recovery.
Conclusion
The mechanism of concussion injury is complex and involves multiple factors that affect the brain's structure and function. Understanding the causes and underlying processes of concussion is key to proper management and recovery. With advancements in concussion research, better diagnostic tools, and improved treatment strategies, the ability to manage concussions effectively has improved. However, continued research and education are necessary to ensure that concussions are properly prevented, diagnosed, and treated.
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References
Giza, C. C., & Hovda, D. A. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228-235. https://doi.org/10.4085/1062-6050-36.3.228
McCrory, P., Meeuwisse, W. H., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., et al. (2017). Consensus statement on concussion in sport – The 5th International Conference on Concussion in Sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847. https://doi.org/10.1136/bjsports-2017-097699
Patricios, J., et al. (2023). Concussion mechanisms and management. British Journal of Sports Medicine, 57(11).
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