Behind the Neck Pain: What You Need to Know About Cervical Facet Joints
Understanding Concussion: Symptoms, Management, and Recovery
Concussions, also referred to as mild traumatic brain injuries (mTBIs), are increasingly recognized as a significant public health concern. They occur when a biomechanical force alters the normal function of the brain and can result from falls, sport injuries, or other forms of head trauma. With rising emergency department visits for TBIs and limited universally established treatments, understanding concussion management is essential for both adults and children.
Symptoms of concussion:
Concussion symptoms are broad and can affect multiple domains: physical, cognitive, emotional, and sleep
Physical symptoms include:
-
Headache
-
Nausea and vomiting
-
Confusion
-
Dizziness and balance problems
-
Visual disturbances
-
Fatigue
-
Sensitivity to light and noise
Cognitive symptoms include:
-
Fogginess of thought
-
Difficulty concentrating or remembering
-
Forgetfulness
-
Repeating questions or responding slowly
Emotional Symptoms include:
-
Irritability
-
Sadness
-
Anxiety
-
Emotional lability
Sleep changes include:
-
Drowsiness
-
Sleeping more or less than usual
-
Trouble falling or staying asleep
Children and adolescents may exhibit similar symptoms but the can also be more subtle or delayed, making careful assessment critical.
Causes and Pathophysiology:
The most common underlying injury mechanism in mTBI is diffuse axonal injury (DAI), where tearing of neurons and small blood vessels occurs. This can lead to ischemia, hypoxia, inflammation, and edema.
Symptoms may not appear immediately and can develop days or even weeks after the initial injury.
Persistent symptoms can evolve into post-concussive syndrome (PCS), which may affect 24-48% of patients and include chronic headaches, dizziness, fatigue, sleep disturbance, and concentration difficulties.
Assessment and Diagnosis:
1. Neurologic and Cervical Examination:
Neurologic exams help exclude more severe injuries such as upper motor neuron lesions and may indicate the need for brain imaging. Cervical spine injuries often accompany concussions and present with overlapping symptoms, including headaches, dizziness, and visual deficits.
2. Oculomotor and Vestibular Assessment:
Evaluating eye movements, alignment, and balance is essential, as dizziness affects roughly 67% of patients and is linked to anxiety and depression.
3. Vital signs:
Autonomic disruption can occur temporarily (<72hours) post-concussion, affecting heart rate and blood pressure. Orthostatic intolerance may manifest, and exercise can exacerbate abnormal fluctuations.
Management and Recovery:
Acute Phase:
Current guidelines recommend 24-72 hours of symptoms-limited rest, both cognitive and physical.
Following this period, gradual reintroduction of moderate activity is encouraged, aiming to restore pre-injury function.
Chronic Concussion:
Chronic concussion symptoms often arise from diffuse axonal injury (DAI), where stretching or tearing of neurons and small blood vessels occurs during the initial trauma. This can lead to brain ischemia, hypoxia, inflammation, and chemical changes that may persist over time. Repeated concussions can amplify these effects, increasing the risk of long-term neurodegeneration.
SCAT 5:
The Sport Concussion Assessment Tool (SCAT5) is a standardized evaluation for individuals aged 13 and older. It includes:
-
Red flag assessment
-
Memory and cognitive screening
-
Glasgow Coma Scale evaluation
-
Cervical spine assessment
-
Symptom checklists
-
Neurological and Balance exams
For younger athletes, the Child SCAT5 is designed for children aged 5-12 years. It adapts the same structured approach to be age-appropriate, allowing healthcare professionals to:
-
Identify concussion symptoms in children
-
Monitor recovery progress
-
Guide safe return-to-play and return-to-learn decisions
Return-to-Play/Learn Protocol:
Recovery involves a staged approach once a patient is asymptomatic at rest:
-
Symptom-free activity – Daily activities and school/work as tolerated
-
Light aerobic exercises -Walking or stationary cycling
-
Sport-specific exercise -Running, swimming, or other movement-based activities
-
Non-contact practice – Resistance training and coordinated sport simulations
-
Full-contact practice- Normal training activities
-
Return to sport – Unrestricted game play
If symptoms recur, the patient should return to the previous stage until symptom-free for 24 hours.
Emergency Indications:
-
Glascow Coma Score <15
-
Deteriorating mental status
-
Suspected spinal injury
-
Progressive or new neurologic symptoms
-
Persistent vomiting
-
Evidence of skull fracture
-
Post-traumatic seizures
-
Coagulopathy or history of neurosurgery
-
Multiple injuries
Long-Term Considerations:
References
Repetitive Concussions may increase the risk of long-term cognitive decline, neurobehavioral changes, and neurodegenerative disease. Up to 15% of patients experience persistent symptoms beyond three months, underscoring the importance of proper assessment, management, and gradual return to activity.
1. Evaluation of current post-concussion protocols. ScienceDirect.
2. Long-Term Cognitive and Neuropsychiatric Consequences of Repetitive Concussion and
Head-Impact Exposure. PMC.
3. Concussion Evaluation and Management: An Osteopathic Perspective.
4. Follow-up visits after a concussion in the pediatric population: An integrative review. PMC.
https://www.ncbi.nlm.nih.gov/articles/PMC10200233/
5. Concussion Awareness Training Tool for Medical Professionals. CATT Online. https://
cattonline.com/concussion-for-medical-professionals
