The understanding of concussion has advanced more over the last ten years than the previous 100. Until the 90s, we thought that dead brain cells were just dead. While that's partially true, the discovery of neuroplasticity revealed the tremendous healing potential of the brain. Not only can nearby brain areas compensate for damage, but the brain can also sprout new neurons, a process called "neurogenesis" to further aid recovery. It's time we all get caught up in the truth and stop believing the following myths about concussions.
1. You have to lose consciousness to have a concussion
Contrary to popular belief, a person can sustain a concussion without losing consciousness. Even minor bumps to the head or body can cause force to transmit through the tissues and into the brain. Remember, the brain is a soft ball of fat floating around in salt water. Sudden acceleration and decelerations can be enough to bruise the tissue slightly. Similarly, whiplash injuries can transmit force through the neck tissue and into the brainstem. The brainstem houses essential functions like breathing, heart rate, respiration, and vagal output.
2. Concussions only happen in contact sports
While concussions are commonly associated with sports like football and hockey, they can occur in various settings, including falls, motor vehicle accidents, and even everyday activities. More minor concussions that compound over time are what is linked to CTE, while contact sports are more likely to cause serious concussions.
3. Rest is the only treatment for a concussion
While rest is essential during the initial recovery period, it's not the only treatment for concussions. Concussion recovery happens in stages. The first stage requires rest, as the brain is in crisis and needs all your energy to repair itself. After that, it shifts into the "adaption phase," which requires different strategies. Sleeping for too long after a concussion makes your brain adapt to rest and darkness, making it more challenging to return to normal activities.
4. Concussions always show immediate symptoms
Some concussion symptoms may not appear until days or weeks after the initial injury. Often, it's not the immediate damage that causes symptoms. The brain is a master compensator, meaning if one area goes down, others can pick up the slack. These compensations wear out over time; when they do, symptoms can leak out and cause issues weeks/months later.
5. Children recover from concussions faster than adults
Concussion recovery varies from person to person and is not necessarily faster in children. While children do create plasticity faster, concussions have so many variables that it is difficult to gauge how each person will recover, given the severity and number of variables contributing to symptoms.
6. Concussions are not severe injuries
Just because you can't see concussions with the naked eye doesn't mean they're not serious. The brain controls nearly every function. It also governs your mental acuity and emotional regulation. Even minor disruptions in its ability to maintain homeostasis can show up subtly over time. The more we learn, the more emphasis is placed on preventing concussions and ensuring best practices for recovery are well-known and put into practice. You see this in every major sport.
7. You can't get a concussion if you are wearing a helmet
While helmets can reduce the risk of head injuries, they do not guarantee protection against concussions. They protect the skull, which protects the brain, but remember, the brain is the consistency of soft jelly. It doesn't take outright trauma to the skull to cause damage. Starting and stopping quickly, or force transmitted through the body and into the brain, is often enough to shake some wires loose. While helmets prevent the significant, nasty concussions known as TBIs, they are not always a guarantee that the minor ones won't occur.
8. Concussions always show up on imaging tests like CT scans and MRIs
Concussions are functional brain injuries and may not always be visible on traditional imaging tests like CT scans and MRIs. If they do, it means you sustained a real whopper of a concussion. It's a good thing if nothing shows up on advanced imaging because it means you didn't cause any outright damage to the skull, spine, or brain. That being said, more sensitive testing is available to check for functional lesions, such as VNG tests.
9. You can return to regular activities immediately after a concussion
It's essential to follow proper concussion protocols and allow adequate time for recovery before returning to physical or cognitive activities to prevent exacerbating symptoms or risking further injury. The easiest, most researched way to safely return to activity is called the Buffalo Concussion Treadmill Test. It ensures a gradual return to activity and lets you pinpoint the symptoms holding your recovery back.
10. Once symptoms resolve, the concussion is fully healed
Just because symptoms have faded doesn't mean the brain has fully healed. Slow, gradual increases in workload and activity ensure a complete recovery over time. Once the symptoms have resolved, this is an excellent time to begin tracking symptoms with increased activity. It is NOT a green light to return to everything all at once, especially if you're playing contact sports.
11. Only athletes get concussions
While athletes are at higher risk for concussions due to the physical nature of sports, concussions can happen to anyone, including children, older adults, and individuals in non-athletic settings. I once had two patients come in back to back. One was a football player who thought he had a concussion because he got knocked out cold. The other was a woman who got head-butted by a 15 lb French bulldog at a Christmas party. The football player showed very minimal signs of concussion. The woman woke up dizzy every morning and had a laundry list of other symptoms. Concussions don't discriminate.
12. Concussions always resolve on their own
While many concussions improve over time with proper care and rest, some individuals may experience persistent symptoms known as post-concussion syndrome, requiring ongoing medical attention and management. Many run into challenges because the healthcare landscape is very siloed. This means there are a lot of specialists in different professions that manage specific symptoms of concussions. Stubborn post-concussion syndrome often requires more integrated therapies designed to tie all the systems together. For more information on integrated concussion care, visit www.theneuralconnection.com
13: Concussions only affect the brain at the site of impact
Concussions can cause widespread effects throughout the brain, impacting various functions beyond the area of direct impact. The brain can sustain something called a "counter-coup" injury, which is when the brain bounces off the other side of the skull. It can also maintain sheering injuries when the brain rotates on the brain stem. This twisting motion can affect areas deep in the brain stem that control many automatic functions you rarely think about. These include heart rate, blood pressure, eye movements, and balance.
Our understanding of concussion care and what to do about it is evolving rapidly. We can collectively move toward a future where we manage concussions appropriately and the associated symptoms fade quickly by understanding what information is present vs. outdated.
About the Author
Dr. Thompson Maesaka is a co-owner and clinician at The Neural Connection, a functional neurology clinic in Edina, Minnesota. The Neural Connection specializes in the holistic management of concussions, dizziness, and migraine. His mission is to empower people to take a more active role in their health outcomes through education.