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In most of the concussion-related literature, a concussion is viewed as the result of a blow to the head. This, generally, is the accepted way of thinking within the medical community, and especially within the fields of neurology.
Four months ago I received a referral, a 43 years old female, a lawyer. She was working late, fell asleep and, according to her, her head was moving toward the desk. Suddenly she woke up, forcibly jerked her head up and, immediately, felt a sharp pain in the neck and a headache. This night she couldn't sleep. Next day she experienced terrible pressure, headaches, neck pain, nausea, dizziness, disorientation – all the classical symptoms of a concussion.
She couldn't work, drive, or take care of her family. She went to see her primary care physician, who analyzed incident, couldn't find any objectives for diagnosis, including no evidence of head trauma. If she would hit her head against the desk, it would have been some trauma such as marks/bruising on a front of the head and, possibly, she could remember it too.
The doctor recommended rest, prescribed painkillers and muscle relaxants for neck pain and slipping pills. During the two succeeding weeks, all the symptoms worsened. Also when she tried to handle a court case, she couldn't even understand the writing or remember the case related details.
Her primary care physician referred her to a neurologist. The later carried out all the neurological examinations like hearing, vision, balance, and coordination as well as cognitive tests such as the ability to focus, memory etc. According to the neurologist, she definitely was suffering from a brain dysfunction similar to a concussion, but hearing her story he couldn’t make a conclusion that this was a concussion because the blow to the head was missing.
Immediately, she was referred for a brain MRI to exclude tumor and other possible causes that can possibly produce the kinds of symptoms, I have described above, as well she was referred to MRI on the neck because of severe pain. All the results come out negative. Neurologist decided to refer her to me saying:” Whatever it is, it looks like a brain trauma without a blow to the head.”
When she appeared in my office I saw lost, anxious, very scared, and disoriented woman. She produced an impression of a person who is disconnected from reality, similar to dementia patients. She couldn't even present me with the details of her trauma and had to supplicate to the help of her husband on that matter. The only thing she could remember, was the feeling of the forcible jerk, a sharp pain in the neck, and pressure in the head, but even these details of the incident her husband helped her to recall.
According to lady’s husband, for 18 days she couldn't sleep at all. As always in such cases, the protocol starts from the techniques to accelerate lymphatic and cerebral spinal fluid drainage, and to reduce tension within cervical muscles. After 15 minutes of receiving massage, she felt asleep for 20 minutes. She woke up a new person, smiling, reporting much less pressure/intracranial pressure, feeling somewhat better.
I have provided her with 15 treatments. After two weeks break, took her back for more supportive treatments, to sustain more balance in autonomic activities. She is back to work, fully functional, and without a shred of insomnia.
Now back to the question:” Must blow to the head happen in order to cause concussion/brain trauma?
According to the professor Dembo, not only blow to the head can cause a concussion.
“When we run, jump, or even walk, neuronal and axonal membranes are stretched in the normal physiological range.
A mechanical significant shake produces a long range of motion forcible head jerk, which in turn brings about a sudden not physiological sprain of neuronal and axonal membranes. This sprain initiates a release of many different neurotransmitters, and post-traumatic cellular derangement, increasing an excessive amount of cerebral spinal fluid secretion, leading to:
The reaction I have described above is exactly the same as the one that people experience after a blow to the head. The only difference is that the victims of a blow experience an additional contusion related trauma, such as bleeding etc.
An insufficient blood supply along with dysfunctional mitochondria – intracellular source of reactive oxygen species, if not addressed timely, little by little lead to chronic /degenerative encephalopathy. With time, it can lead to movement disorders, dementia, psychiatric behavior disorders, chronic headaches etc.
I would stress the importance of understanding that immediate post-concussion symptoms are also an expression of encephalopathy, but they are different from chronic /degenerative encephalopathy. The stage of the complete degenerative encephalopathy is not reversible. However, a functional encephalopathy is reversible. Our main duty as massage therapists is in preventing the development of degenerative encephalopathy.
It is possible only when we adequately restore cerebral circulation as well as balance autonomic activities. Yes, by providing simple to perform techniques allowing to accelerate lymphatic and cerebral spinal fluid drainage, by reducing tension in cervical muscles we almost immediately changing the clinical picture for the better. Does it mean we are preventing a non-reversible chronic /degenerative brain disease?
The answer is no. If at the time immediately following a concussion, we will not balance autonomic activities, and establish the balance between sympathetic and parasympathetic activities, then non-reversible degenerative changes would happen because autonomic irregularities will not allow adequate blood supply to the brain.
An autonomic nervous system determines adequate blood supply to the brain, and there are no doubts that balancing autonomic nervous system activities demands a greater amount of treatments.
More details and techniques descriptions you can find in this part one and part two articles.
You're welcome to post any questions, comments, agreements disagreements.
Best wishes.
There is no doubt in my mind, that many victims of a car accident, as far as a concussion is concerned, are misdiagnosed.
Car accidents victims and especially rear end accident victims, when a head is jerked back and forward (whiplash) or from side to side without a blow to the head, often complain about having severe headaches, neck pain, sleep disorders, dizziness, and disorientation. In such cases when a concussion is not addressed with time people end up developing brain dysfunctions such as chronic headaches, memory loss, a sharpness of mind and more.
We are happy to announce that Boris' new instructional medical massage educational video, presenting the role of medical massage in post-concussion rehabilitation is now available!
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