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40 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 4 education Postconcussion Syndrome The Role of Massage By Ruth Werner It could happen to anyone, any time. A bad knock on the head, and suddenly life changes forever. This year, about 1.3 million people will visit emergency rooms with head injuries. About a million of those injuries will be classified as concussions. And that alarming statistic doesn't include the number of unreported concussions. About half the people diagnosed with concussions will still have some symptoms after a month goes by. After six months, about 15 percent will still have symptoms. Those patients will be at risk for a long-term chronic condition with no universally agreed upon definition, and no well-tested and consistently successful treatment protocol: postconcussion syndrome (PCS). WHAT IS A CONCUSSION? Concussion is defined as a trauma-induced alteration in mental status that may or may not involve a loss of consciousness. The change in mental status reflects damage to the central nervous system, usually the brain, as a result of rapid movement that causes the soft tissues of the central nervous system to forcefully contact the inside of the cranium or spine. If this happens in one direction only, it is called a coup. But if the brain hits one side of the cranium first and then sloshes back and hits the other, multiple areas may experience damage. This injury is referred to as a coup-contrecoup. Sometimes the term "mild traumatic brain injury" (mTBI) is used synonymously with concussion, but while some overlap does exist between these two types of damage, they are not the same. By definition, concussions do not involve skull fractures or internal bleeds, but traumatic brain injuries might. Readers interested in more on traumatic brain injury may want to read my column, "Potential for Recovery in Central Nervous System Injuries" [Massage & Bodywork, September/October 2008, page 110]. PATHOLOGY PERSPECTIVES "I am 23 years old and have had two blows to the head. Both times I hit my head on a concrete floor, and both times I went four or five months with symptoms of dizziness and headaches. I couldn't eat; I would gag when I tried. I had memory loss and angriness; I was unfocused, agitated, and extremely sensitive to noise. Last Sunday, I played hockey and I was involved in several full-body checks from which I am now reconcussed. I haven't seen my doctor about it because I know she'll tell me I can't play hockey anymore. I'm so bitter. It isn't fair." —Contributor to chat room at http://neurotalk.psychcentral.com/archive/index.php/t-131937.htm OTHER HEAD INJURY COMPLICATIONS Head injuries are common in contact sports among children, amateurs, and professionals. Their potential seriousness has only recently begun to attract widespread attention. While a knock on the noggin is often dismissed as trivial by coaches, it has become increasingly clear that even seemingly small- scale events can cumulatively add up to major problems. One of the most important findings has been that even a very mild concussion or subconcussion injury can increase the risk for much more serious damage if it is followed too soon by another trauma. This has led to some fundamental changes in how sports are taught and played, from guidelines about "heading" in soccer to stricter concussion testing and return-to-play rules in professional football.