20 Myths about Concussion

There is plenty of outdated and incorrect information about concussions that remains very popular.  Here are some common myths regarding concussion:

Myth Reality
You need to be knocked out to have a concussion. Loss of consciousness is not a requirement for a diagnosis of concussion. Neither is amnesia. Most people don't actually get knocked out when they experience concussion.
A direct hit to the head is necessary to cause concussion A direct blow to the head is not the only way to get a concussion. Whatever forces cause your brain to move around inside your skull can cause a concussion - including falling onto another part of your body, whiplash, twisting and explosions.
We can tell how bad symptoms will be based solely on the injury OR the harder the hit the more serious the symptoms The extent of symptoms is not directly related to the severity of the concussion injury. Some people may experience a milder impact and have greater symptoms, while other people might experience a severe impact and have fewer symptoms. Every case is unique and there's no clear way to tell how bad symptoms will be based just on the mechanism of injury.
We can classify concussions into levels of severity Concussions used to be classified based on the severity, but as we mentioned above: it is not possible to predict how symptoms will look solely based on the nature of the injury. Concussions are no longer classified using a grading system for this reason.
Concussions show up on CT or MRI scans CT and MRI scans pick up on issues like swelling and bleeding in the brain which do not occur commonly with a concussion injury. Injury to the brain from concussion is usually microscopic and does not show up on traditional CT or MRI scans. Other MRI techniques such as functional MRI and diffusion tensor imaging as well as SPECT and PET scans may be able to spot some changes but are not usually part of routine assessments.
Concussions are obvious In some cases, symptoms may be very subtle and vague and you may not even realize you've had a concussion. In these cases it is best to still seek medical attention to rule anything out, and to rest and avoid other impacts to be safe.
You shouldn't fall asleep after a concussion If your doctor has ruled out other serious issues such as bleeding and inflammation (or a more severe brain injury) then there is no restriction on sleep. Sleep is actually one of the most important things to maximize after injury.
Absolute rest is the best way to recovery after concussion Getting physical, cognitive and emotional rest right after injury is important - but doing absolutely nothing for days without end is unhelpful. It's okay to maintain light activity and begin to slowly progress activity as long as you've been cleared by your medical team and your symptoms aren't getting worse. Strenuous physical or mental activity that makes symptoms worse should still be avoided, along with any risk of another brain injury.
Damage only occurs in concussion because of the impact While there is damage that occurs during the concussion event, much of the issues actually arise out of changes in the brain that develop over the next few days. This is why rest and gradual resumption of activity is so important.
Helmets and mouthguards can prevent concussions Helmets and mouthguards are not able to prevent concussion completely, but in some cases they can reduce the direct forces to the head or prevent other issues like skull and tooth fractures.
Concussion isn't as serious for kids as it is for adults A young person's brain that is still developing is actually more susceptible to a concussion injury than most adults. Concussions are serious (but treatable) injuries in all ages and should be taken seriously. All efforts should be made to prevent a concussion from happening in the first place, especially in kids.
No pain, no gain In some injuries, pushing through pain is an important way to get better. But, with concussion sometimes the harder to push the harder your symptoms push back. A consistent, balanced, gradual approach is the best way to recover.
Concussions only happen in sports There are many ways to experience a concussion including sports, car accidents, falls, violence, and other accidents. More people actually get injured outside of sports. A concussion should be taken seriously no matter where it occurs, whether it's a quarterback in the NFL or a grandmother who hits her head on an open door.
Concussions are only mild injuries Although concussions are classified as mild traumatic brain injuries (mTBI) there is nothing really mild about them. The reason they are called "mild" is to differentiate them from moderate and severe brain injuries - and does not mean that they should be taken less seriously. A concussion can have a significant functional impact on your life and they should be respected.
As long as I am completely recovered from one concussion, it's not a big deal to get another one While research is still being done to conclusively link repeated concussion to long-term issues in the brain - we feel confident in saying that repeatedly having concussions is probably not a good thing. Do your best to protect your brain, you only get one!
I didn't get a diagnosis of concussion so I'm not at any risk of issues Even if you didn't meet the criteria for a concussion diagnosis, if you've experienced any kind of impact, fall or injury that may have involved your head you should be cautious. Some research shows that many sub-concussive injuries can result in changes in the brain over time. So, again: do your best to protect your brain, you only get one!
It's all in my head. Concussion affects many systems of the brain and body including the vestibular, nervous, endocrine and circulatory systems. Many people who've had concussion also experience other concurrent issues like neck pain too.
My doctors can't find anything wrong with me so it must be psychological There's no denying that psychological factors influence how we experience injury and disability due to concussion - but psychology alone does not explain persistent concussion symptoms. Looking at the whole picture there are always neurological/biological and psychological factors, co-occurring conditions, and pre-existing conditions that all play a role in how recovery unfolds. That's way addressing all factors holistically is so important.
Concussion symptoms are unique What can make diagnosing and treating concussion complicated is the fact that concussion symptoms share a lot in common with other conditions like chronic pain, anxiety, depression, migraine, and fatigue. This underscores the importance of having solid medical oversight to figure out precisely what is causing your individual symptoms.
The only real treatment for concussion is rest Luckily many people get better through using strategic rest and gradual return to activity without need of other intervention. In cases when symptoms persist beyond a few days or weeks, specific treatment to address physical and physiological issues, cognition, visual and vestibular problems, psychological challenges and other related issues may be required. Sometimes symptoms don't go away on their own without help, so it's important to seek out quality support to speed your recovery along. There's no need to wait and see what happens - talk with your doctor and rehab team early in the process and address things as early as possible.


REFERENCES

  1. Brady, D., & Brady, F. (2013). Sport-related concussions: Myths and facts.
  2. Cantu, R. C. (2014). Consequences of Ignorance and Arrogance for Mismanagement of Sports-Related Concussions: Short-and Long-Term Complications. In Concussions in Athletics (pp. 23-33). Springer New York.
  3. Donnelly, J. F. (2012). Concussions in children: persistent symptoms but more persistent myths.
  4. Ruff, R. M., & Jamora, C. W. (2009). Myths and mild traumatic brain injury. Psychological Injury and Law, 2(1), 34-42.
  5. Schneider, D. K., Grandhi, R. K., Bansal, P., Kuntz, G. E., Webster, K. E., Logan, K., ... & Myer, G. D. (2016). Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies. British journal of sports medicine, bjsports-2015.