At a recent appointment, a provider was astounded that I had suffered a brain injury and that my recovery was so prolonged. The reason? She said, “Wow! I cannot believe this happened despite you having a helmet on!” As I have been on a mission to break these societal misconceptions, this again struck me as they remain very prevalent, not just among lay people but among those in the medical field as well. This is rather alarming as these are the very people you are supposed to go to for help and treatment in your recovery. If the medical providers do not even understand traumatic brain injury and all its complexities, how will others understand it? How do we break this perpetuation of misunderstanding? In this post, I will debunk the most common concussion myths.
You can sustain a concussion without bumping your head. The forces of the head suddenly moving forward and back as occurs with whiplash or a sudden side to side movement of the head is all it takes. Side note – Due to these forces, you can sustain whiplash without sustaining a concussion but you cannot sustain a concussion without some level of whiplash injury.
No helmet can protect against concussion. While it can protect against skull fracture, bruises or abrasions of the skin and bleeding under the skull, it cannot protect against concussion. Why? What leads to this injury is the sudden acceleration and deceleration of the brain within the skull. No helmet can stop this from occurring.
To visualize how or why helmets do not protect against this injury, this is the Balloon Brain Experiment:
The balloon inflated with the addition of a small amount of water inside represents the brain. This balloon is placed inside a closed jar that contains a few drops of water; the jar represents the skull and the water represents the cerebrospinal fluid that creates a film on the brain inside the skull. When you pick up the jar and shake it or you hit the jar, the balloon jolts and bounces around, hitting the jar. This is the brain hitting the skull. When you add a towel around the jar representing a helmet and shake or hit it again, you see the same thing happen. This occurs whether you add a second or third towel for “more protection” – there is no protection and no way for the towel (helmet) to prevent the force and movement of the balloon (brain) inside the jar (skull).
90% of concussions do not involve loss of consciousness. This is dangerous as someone may believe they have not suffered a brain injury because they never lost consciousness. It is also important to note that loss of consciousness does not mean the injury was more severe nor does it have any basis on how long the recovery will be.
Every concussion is unique and every concussion is complex. Symptoms may not appear for hours, days or weeks after the initial injury. Some effects may not even show up for months or years! At that point, the association between the symptoms and brain injury may have been lost and the brain is never addressed as the underlying cause. Many end up disabled and suffering for years for this reason.
You may feel okay because your symptoms are gone but this does not mean the brain has healed completely. As previously mentioned, there can also be a delay in symptom onset following the injury so you may not even realize you have suffered a concussion. Some symptoms may show up immediately and then resolve while others may not present until much later. On a physiological and cellular level, the brain can take much longer to heal and the lack of symptoms does not mean that healing process has completed.
It is wise to always seek clearance from a medical professional specialized in all aspects of concussion to avoid long term symptoms and worse, second impact syndrome in which you suffer a second concussion before the first has healed which can lead to sudden death. The specialist must be carefully researched, as I had seen at least a dozen providers labeled “specialists” who were very clueless in the process.
While a CT scan or MRI can rule out other serious issues such as brain bleeds, masses and skull fractures, the damage done to the brain from a concussion cannot be seen on imaging. A concussion is a clinical diagnosis meaning the clinician makes the determination based on history, symptoms and physical examination. There are, however, other functional scans and tests that can show brain changes consistent with this trauma.
Concussions are very complex for many reasons. There is a cascade of cellular and physiological changes to the brain after the injury which are unseen to the eye. Symptoms can be physical, intellectual, emotional or psychological. This is why it is imperative to find a provider who looks at you as a whole and addresses the underlying cause of the symptoms.
The first thing you might associate with concussion is sports. Falls are the number one cause of concussion followed by motor vehicle accidents. This is not something just athletes should pay attention to and seek awareness of but all people. You never know when you might find yourself or your loved one in this situation.
The old school thought after sustaining a concussion was to lie in a dark room for a few days to a week for mental rest. This has been found to actually be detrimental to recovery. If a provider is recommending this, find someone else. This is a critical window in the recovery as prolonged rest and decreased movement actually increases the chance of a prolonged recovery. Too much activity too soon can worsen the outcome just as too little activity can.
Limited mental rest is now recommended in the first 24-48 hours following the injury, meaning taking a couple days off of work or school, sleeping if needed and decreasing screen time. After this initial 48-hour rest period, a gradual return to work, school and physical activity should be followed guided by a healthcare provider who understands the process.
There you have it – if more awareness and understanding is cultivated regarding this injury, many patients suffering from brain trauma might be in a better place not only because those closest to them will have more understanding but hopefully, medical providers will change their old school thought and approaches – something that is desperately needed.