POST-CONCUSSION SYNDROME (PCS)

There is no known cause to PCS and there is no direct correlation between the seriousness of the injury and the development of PCS. However, there does appear to be a correlation between the fogginess symptom and trouble from healing from a concussion. A direct blow to the head or loss of consciousness does not need to occur in order for a concussion or PCS to occur. A parent or spouse is often the first one to recognize the symptoms of PCS as they are often described as “not being the person that they know and love.”

PCS is a complex disorder in which variable symptoms such as headache, dizziness, fogginess, fatigue, impact the patient for weeks or months after a concussion causing injury. If a person is feeling concussion like symptoms 10 – 14 days after the concussion, then he or she may be experiencing PCS. In fact, these symptoms may last for a year or longer which can be demoralizing for the patient and their family.  Many people get told you look fine you must be better, while others get told to get use to their new life after their injury.  

Dr. Hubbard has developed astute observational skills from his experience as a chiropractor. He can recognize minute changes in eye movement, postural changes, and balance changes which can all be a result of post-concussion syndrome. With the right combination of in office rehabilitation and at home exercises it is possible to recover from this terrible condition.

If you would like to read about some of our patients success stories, click here, or the quote above will take you directly to Leah or Lynne's story about their battles with post concussive syndrome following a car wreck.

WHAT DOES HUBBARD CHIROPRACTIC AND BALANCE CENTER DO FOR POST CONCUSSIVE SYMPTOMS

Sean Hubbard, DC, DACNB is Kansas' only board certified chiropractic neurologist.  Through this advanced training Dr. Hubbard has spent countless hours studying the brain and how it reacts when it is injured.  We pay very close attention to how your head and eyes interact with each other and how these effect your balance system.  What we find in our office is most people that suffer continued and persistent concussion symptoms have injured their vestibular system (the system within your brain that monitors your balance and where you are in your environment).  When this system is injured the brain has to devote entirely too much energy to just maintaining balance and focus so a person does not fall.  With proper rehabilitation that pays close attention to how quickly the brain fatigues, the vestibular system gets a chance to heal and strengthen.  When the brain no longer has to devote all it's energy to maintaining balance, the rest of it gets a chance to heal as well.  

Every brain injury is different every time, so there is no one protocol or treatment for all post concussion syndromes.  So our efforts always start with a review of the person's history and a physical examination.  If further testing of the balance and vestibular system are warranted our office has computerized dynamic posturography and videonystagmography on site and these tests will be performed to give you objective measures of what is not working correctly.  From there a treatment trial is done to see if any of the underfunctioning systems can be improved, because we are dealing with the brain we will no very quickly if the services we have to offer may help.  Quickly usually means that day.  If we can show some improvement a treatment plan will be laid out and any time you need to discuss your concerns will be made available.  

WHAT IS A CONCUSSION?

A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of rapid acceleration of the head from a hit elsewhere on the body. Adapted from the Zurich 2012 Concussions Consensus Statement, a concussion is further defined as follows:
• A concussion may be caused by either a direct blow to the head or other part of the body that results in “impulsive” forces transmitted to the head
• A concussion may not involve a loss of consciousness (LOC). Less than 10% of concussions have a LOC.
• A concussion can cause a disturbance in normal brain function, but there is no detectable structural damage (e.g., MRIs or CT Scans)
• A concussion typically results in clinical symptoms which may very among individuals but more commonly include dizziness, headaches, etc.
• A small percentage of cases may result in post-concussive symptoms that may be prolonged and, at times, result in long term consequences

WHAT SHOULD I DO FOLOWING A CONCUSSION?

Experts agree that following a suspected concussion, you should be evaluated by a qualified healthcare provider who ideally has experience in head trauma. The evaluation will include a neurological examination, a review of your medical, a symptom checklist, cognitive tests and functional tests (e.g., vision, balance, etc.). The more common symptoms that occur with a concussion include (but are not limited to) one or more of the following:
• Headache
• Memory loss
• Nausea/Vomiting
• Confusion
• Dizziness
• Drowsiness
• Unsteadiness
• Weakness
• Numbness and/ or Tingling
• Foggy headedness

If the status or symptoms worsen then it is recommended to seek further medical attention. It is also recommended that you rest and avoid the following for 24-48 hours:
• Strenuous activity or return to previous level of activities until cleared
• Excessive visual stimulation (e.g., computer, television, busy places, reading, etc.)
• Loud noises (e.g., music, television, etc.)
• Aspirin or non-steroidal anti-inflammatory medications, alcohol or sleeping pills
• Studying
• If applicable, it is recommended not to drive
Again, a neurological examination and evaluation should be performed following any severity of head trauma. There is also growing support for the use of more comprehensive testing following a concussion such as computerized cognitive and balance testing. When available, it is recommended to seek the care of a healthcare provider that specializes in concussions, which would ideally include a team approach.

When can I return to play/work/life?

It is commonly agreed upon that a gradual (“step-wise”) activity program can be initiated. It is important that each step along the way does not increase your concussion symptoms. When you begin the next step, if it increases your symptoms wait 24 hours before trying that step again. Below is an example of such a program:

1. No activity, complete rest – mental, physical and emotional stress, which includes minimizing visual or auditory stimulation

2. Light aerobic exercise such as walking or stationary cycling. Exertional (50-64% max heart rate), balance, vision and/or eye-head coordination activities will be determined accordingly

3. Moderate aerobic exercise and/or sport or job specific training. Exertional (65-76% max heart rate), balance, vision and/or eye-head coordination activities will be determined accordingly

4. Non-contact training drills but more aggressive sport or job specific exercises, strengthening and/or plyometrics. Exertional, balance, vision and/or eye-head coordination activities will be determined accordingly
5. Full contact/100% job demands after medical clearance – through practice or “part-time”

6. Return to previous level of activities and/or “game day”

NOTE: The best approach in concussion management is a team approach. Experts agree that particular caution be used with adolescents. Always seek the care of a physician or other qualified healthcare provider with any questions or concerns you may have about a medical condition. All materials associated with Hubbard Chiropractic and Balance Center, LLC are not intended to be a substitute for professional medical advice. Hubbard Chiropractic and Balance Center, LLC and its materials are not intended to treat, diagnose, cure, or prevent any disease. Experts agree that final authority for Return to Play (RTP) shall reside with the physician or the physician’s designee. All material by Hubbard Chiropractic and Balance Center, LLC is provided for educational purposes only.