When is concussion not concussion?

A concussion is not a concussion when it is actually a whiplash injury.
(For my German readers, we are talking about Schleudertrauma oder Gehirnerschütterung).

And the reason you need to know that one is not the other is because concussion is a whole other animal to handle but it can be mistaken for whiplash very easily. Likewise, whiplash can be mistaken for concussion.
Concussion and whiplash injuries happen in much the same way – there is a trauma to the head and neck and both hurt! You may or may not have been unconscious after the impact that hit you, but that makes little difference in the end. Soon after the fall, impact, or accident you might be feeling any or all of these symptoms:

  • Stiff neck, shoulders, jaw
  • Pain in the neck and/or shoulders
  • Tiredness
  • Headaches
  • Nausea
  • Fatigue
  • Sleep disruption (too much or too little)
  • Feeling exhausted by everything you try to do
  • Finding it hard to focus, read, concentrate
  • Feeling dizzy when you stand up or lie down

At this point it’s very hard to tell concussion from whiplash, unless you pay attention to how the injury actually happened. But knowing the difference is very important because the treatment should be different for concussion and I’ll tell you why. Treating whiplash means treating the soft tissue injury to the neck, once treated, symptoms should clear up. Treating concussion is more difficult because two injuries have happend at the same time, and both need to be treated. A concussion can rarely, if ever, happen without a whiplash occuring too, because the force needed to cause concussion is so much higher than the force needed to cause whiplash. That means to clear up all the symptoms of concussion you need to treat whiplash and the brain injury too.

The good news is that manual therapy for whiplash is well known as a treatment and concusion responds well to a structured rehabilitation approach, provided it’s started quickly. The problem is, very few people seem to know how to provide concussion rehab. Sadly that includes most medical professionals. Having worked in healthcare for 18 years now I can speculate why medical professionals are bad at managing concussion, but the fact remains they simply are. So if you ever get concussion your best chance of good recovery is to know what to do about whiplash and concussion. If you are lucky enough to never get a concussion, make yourself useful and be someone who can help others recover from their concussion.

The difference between Whiplash and Concussion

Classic model of whiplash with rapid hyperflexion and hyperextension of the neck.
BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons

Whiplash – a physical injury local to the neck. Just the neck.

Cause – Incoming force that causes your head and neck to accelerate and decelerate quickly. Your neck gets “whipped” forward and backwards or side to side.

Injury – the damage is mostly in the soft tissue of the neck, the muscles and ligaments between the vertebrae. There is post-whiplash stiffening especially of the neck muscles, but also muscles in the shoulders, upper back, jaw and beyond can end up very sore and stiff. In a severe whiplash the neck vertebrae could also be damaged and/or the associated nerves, so it is always important to have that checked by a medical professional.

Example – You get rear-ended in a car collision. In a sport such as boxing or football you might get hit in the head hard by your opponent or other player.

Concussion – a functional injury in the brain AND a physical injury to the neck

Cause – Large incoming force that causes the head to accelerate very fast and it (almost always) will take the neck with it in a whip or twist movement.

Injury – Damage to the neck and to the brain. The incoming force is at such a high level it not only causes the neck to “whip or twist”, it also causes acceleration of the brain inside the skull. The brain is not a uniform lump of tissue, it has different densities within it so when it is forced into acceleration the tissue moves at different speeds in different regions. The different accelerations of brain tissue cause a pull or strain on the brain cells (neurons) and the current theory is that the “pull” opens up little gaps (channels) in the cells and allows things to leak from inside the cell to outside, and to flow from outside the cell to the inside. The result of this very quick disruption to the cell integrity is a rapidly spreading chaos in the brain as cells fire incoherently and messages and control systems are completely disrupted. That spreading chaos creates the unique set of concussion symptoms you will experience and will continue to experience until ‘normality’ is restored to the brain.

Example – You get thrown from your bike, or horse and hit your head hard at speed.

From Mayo Clinic. Example of an acceleration-deceleration injury without rotation. The brain tissue shears past itself due to the impact, due to different densities of the brain tissue. This shearing causes a rapid flow of ions out of the cells as creates a “signal” storm in the brain and this is the onset of concussion. If the injury involves rotation this adds another mechanism of shearing though torsion.

Concussion is NOT caused by your brain slamming into the sides of your skull and getting damaged. You don’t bruise or damage your brain on the walls of your own skull and end up with concussion.
I can assure you of that as I, unlike most people, have actually looked inside a lot of people’s skulls, observed their brains, stood next to brain surgeons as they do open skull surgery, examined brains in the pathology lab and I can tell you, there really isn’t spare room for brains to just slosh around in your skull. Thankfully! Your brain is a very well protected, well cushioned phenomenal organ.
So the 20 year old explanation of brain bashing called a “coup-contrecoup mechanism of injury” should now be placed firmly in the dark archives. The new research on concussion is much more interesting and helpful when it comes to understanding and treating the injury. Sadly, you will still see a lot of images on the internet showing the coup-contrecoup explanation for concussion. Discard it and move on to better quality information.

So what you need to know is:
1. Whiplash is a local, physical injury to the neck
2. Concussion is a neck injury (whiplash) + functional brain injury

What do you do about concussion?

Remember concussion is a whiplash + brain function disruption. Some of the systems that get disrupted can cause you significant problems in your every day life so you need to start correcting the functional disturbances as quickly as possible.
The typical systems that need recalibration after concussion are the cardiovascular, immune, vestibular, visual and autonomic nervous systems. Until they are all brought back into alignment and normal function your concussion symptoms can persist.
Studies are about to show that people who get a concussion and start working on specific rehabilitation within 7-10 days have the best outcomes. That doesn’t mean you can’t make good progress weeks or months after the injury. You can, but the recovery will be slower.

I have worked with a few clients recently who had severe concussions from years ago and have never found a way to get rid of symptoms or a medical professional who helped them understand the problem. Using an evidence based concussion management approach I could help all of them.

Summary Points –

  1. Every concussion has to have a neck injury (whiplash). However a whiplash injury does not include concussion.
  2. The time between the injury and seeing a starting concussion recovery management is a critical factor in outcomes after concussion.
  3. Recovering from concussion should happen spontaneously within a month for most people, but if symptoms persist a concussion management program is the effective way to get better the quickest.

Next Up – How much force does it take to get a concussion? & What is a concussion management program?

I am a fully qualified concussion management practitioner, I trained with the Canadian based Complete Concussion Management Institute. I offer education and services for anyone with concussion including concussion testing, symptom management and rehabilitation and manual therapy for the head and neck. I also deal with sports specific concussion and baseline testing (very advisable if you are in a high risk impact sport and is available for individuals and teams),
If you want information on these services please contact me directly or sign up to the information emails here.

Guess the injury….

[4 min read]

I’m into sports. I go to the gym, I do Crossfit and HIIT, I have a lovely vintage race bike, I ski, I am a cold water/ice swimmer, I hike up mountains, I run, I play tennis, I sky dive, I scuba dive and I have 2 jobs. I’m married.

By March 2018 I’m seriously injured. It takes just over 2 years to recover.

What would you guess my injury was?

Continue reading “Guess the injury….”

Massage Guns – the “How To” guide

Vibration work has been around for a long time, like most things in massage. What we can do with our hands as therapsits we can now do faster and easier with technology. Enter the new toy of sports people, the massage gun.
Quality aside, massage guns all do one thing – deliver vibration to the body and vibration is supposed to be a great recovery tool. But what’s the science behind it and how should you use it in practice? Do massage guns just help muscles relax?
If it were that simple there wouldn’t be any need for an article on it now would there!

To use a massage gun effectively you need to understand a few things about what vibration actually does to receptors in your skin and muscles because they tell your brain and nervous system how to control your muscles – relax or contract. And that’s an important difference! In fact, certain vibration frequencies can cause your muscle to both relax and contract at the same time. Now where will that land your recovery, or will it mess with your performance in your next training session? All will be explained.

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Cupping – hype or help?

Lets keep it simple.
What can a suction cup placed on your skin actually do?

I’m going to write this blog from a pure and simple experience angle and drop the science (there are plenty of papers published on cupping, but the evidence is mixed).

Cupping is an ancient form of adjunct medicine that goes back to healers thousands of years ago (literally). They used all kinds of creative things to serve as the suction cup, like animal horns or shells and believed strongly in the positive impact of cupping on health. Cupping progressed through the ages and through materials until we stabalised with 2 main options these days, glass and silicone but apart from that the practice is much the same. Use of cupping in modern medicine fluctuated and went in and out of fashion and my feeling is cupping now has a sort of split reputation. People either love it, or they think it’s a load of inflated quack.
My feeling is – the split has reason! Cupping has definite benefits and has a whole load of inflated claims. So what do I believe it does for the people I work with?

Continue reading “Cupping – hype or help?”

When (not) to get a massage – contraindications

First – what does contra–indication even mean?!
Contraindications are situations, injuries and conditions where using soft tissue therapy techniques including massage,
> can be used, but with caution
> is overall not advised, or
> massage could provoke more harm than good.

Below are some examples of situations in which massage would need some extra consideration or should not be used at all. For fun you can learn both the English and German name for some common conditions.

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ASP 2021 – Amber Fillary – Free Diver & Ice Diver

Amber Fillary is an inspirational athlete because she is everything that you don’t expect in a sport you probably have never seen! Amber has an incredible knack for holding her breath, and not just in a warm and comfortable swimming pool (where she is the SA record holder) but also while swimming under very thick ice. She is your most unlikely champion but one you should know about. Let me introduce our 2nd supported athlete of 2021.

Continue reading “ASP 2021 – Amber Fillary – Free Diver & Ice Diver”