Hidden Concussion with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum from Insync Physio in Burnaby. He's the clinical director. Insync in Burnaby are many time winners of best physiotherapists in Burnaby. And we're gonna talk about concussion. How you doing Iyad? 

Iyad: Good. How are you Mark? Thanks for having me.

Mark: Good. So, concussions, my brain hurts. 

Iyad: Yeah. It's I guess it's a big area. We're seeing a lot of these things happening now. And a lot of them kind of go under diagnosed actually. And mostly because people still are under the impression that you need to lose consciousness or bump your head really hard to get a concussion. So I guess I just wanted to comment on that, that it's really not necessary for you to have a direct blow to the head, to suffer.

Because what we're looking at is if there's something that causes a fast relative movement of your brain in the skull, where it moves forwards backwards to quick, you can sustain or suffer from a concussion. And you just might not lose consciousness because that's not the only, that you have a concussion.

And I think it's as we see more and more of it, I think we are seeing better awareness across everybody, but once in a while you get people coming in and they're still kind of being assessed and treated with old science. So it's just good to kind of raise that awareness out there. 

Mark: So things that like examples, if you had a fall, but you didn't actually hit your head, or if you were in a car accident, and it doesn't even have to be that hard. Just anything that, where there's that sharp movement and that your head is kind of faster than your brain, basically. That's what you're describing. 

Iyad: Yeah, absolutely. That's a great example. Or even like, sometimes let's say you're playing a game of hockey and you kind of you know, you blow a tire on the ice and you fall and your head never hits the ground, but that big jerk that your body goes through can actually be enough. Or big, quick rotations of your head can also cause that. Again, it doesn't mean if you're just swinging your head side to side, you're going to get a concussion. It's a result of something uncontrolled and quick. 

Mark: So what kind of symptoms would somebody, how would you suspect that you've had something like that? Something, a fall has happened. You've had a car accident. What would the symptoms be? 

Iyad: So, this is where it becomes really interesting. I think one of the reasons it goes so under diagnosed is because most of us are thinking, well, if my head doesn't hurt, then I probably don't have a concussion. Or something that like where it's so obvious, like a loss of consciousness, like I said earlier. 

You could have a variety of things. You can have sensitivity to light. Sensitivity to sound. Problems focusing. That's the biggest one I see. Because people just come and tell me like, yeah, been in a car accident. Just had a hard time staying focused at work. They feel like they're in a fog and just not quite kind of oriented there. Things like that. 

Like there's also issues where, sometimes you see some emotional disturbances, like somebody becomes a bit too reactive to things that normally wouldn't do much for them. And they would just kind of get, and this doesn't have to be anger. It could be just like, even a, I remember one of my clients just would tear up out of nowhere and it was completely unorthodox for them to do that. So those are just things that could happen. And I guess, just recognition of that is important. If anyone's has that probably just go see their physician or even their physio can direct them to who they could see. 

Mark: So when you're diagnosing this, what are the steps that you, what are you looking for?

Iyad: So we usually like to do a big battery of tests actually on the first session. So one of the things we would do is we would do something called, very easy thing. So it depends on where we are. So like, let's say if I'm working with a team on the sidelines, we do something called the scat five, which is the concussion recognition tool. And it has a bunch of tests that kind of assess memory, to balance, to a few other things. So that's one thing. 

Now in the clinic, when I've seen people coming in in the clinic, it tends to be after a few days, usually, no one's going to hit their head today, come in. You know, it tends to be after a few days when they've kind of been dealing with it.

And then one of the things we would do, depending on, I guess, how acute or how new the injury is, is to figure out what their exercise tolerance is. Cause exercise intolerance is very common. So people, if they go for a walk and as soon as their heart rate goes up a bit, they start to experience symptoms. So that's a very interesting one. 

We would definitely want to do a detailed assessment of their neck because a lot of the times you can have concussion like symptoms manifesting from the neck. Like as we talked earlier in previous videos, you can have headaches from your neck, dizziness that kind of originate from the neck. So those are definitely systems you'd want to assess. 

And then finally, there's also the inner ear vestibular organ, which is our kind of our balance organ where you'd want to assess that too. And we then just kind of try to take the person through a graded program from there. Which involves a bit of the treatment to the neck, if necessary, then a treatment to the vestibular organ, if necessary, and definitely trying to get them moving a bit more gradually.

Mark: So what's a typical course of treatment, I know it can be massive depending on the range of injury, but what would be something that you typically see more of? 

Iyad: So I see two distinct groups. So sometimes you'll see the very like new and recent concussion. In which case they tend to be a little more straightforward, believe it or not. Because you kind of follow their symptoms, you assess them, you figure out what their baseline is, and then get to progress them very nicely. Because you have control of it from one. And this tends to be coordinated between ourselves and their physician and potentially an occupational therapist, whoever on the team is involved for that client.

The ones that tend to be a little more, I guess different are if somebody had a head trauma, let's say six months ago and they never quite shook it. That's where you have to do a bit more detective work and figure out what else is this person missing? Cause we can get just a huge dysregulation of their nervous system and how it interacts, but also could just be a neck problem that just was never really addressed, you know. 

Most of us think if I can move my neck and all directions then I'm great, but that's really not enough sometimes. And the way your brain integrates all your senses, could also be an issue. So that's where like the rehab is focused on sometimes almost helping you process things around you a bit better. And that tends to help quite a bit.

And then obviously in some cases we would want to consult other people. For example, if the person's not sleeping well enough, we would want to address that. If the person has nutritional deficits, we'd want to address that. Usually we would work with other members of the team in that case. 

Mark: Is it fair to say that it's, people tend to not come in soon enough, that it's actually critical that they come in as soon as possible to get evaluated and find out what's going on. Not just think, oh, well, it'll go away in a couple of days. 

Iyad: We see two different groups here actually. Usually the person who will avoid it initially, and then stay in avoidance probably for a lot longer than they need to. And usually the other group where they just think, oh, this is going to be fine. And then they kind of just continually push a little further than they're ready. And then you see kind of this stagnation on both sides. One of them from avoiding too much, and one of them from doing a bit, maybe more than they're ready.

So I think it's helpful to get it recognized first. So either talk to your physician or to your therapist, or whoever's being in charge of your treatment, I think that's a very important first step. And then you can at least figure out what your baseline is. And that kind of help understand why you get dizzy, for example, when you go for a run. And it could be because your neck is sore, but it could also be because you are very intolerant to exercise. So those are very kind of important things to identify before we start calling this a concussion. So I would just say, get it assessed. And you save yourself a lot of time. If you get to looked at early. 

Mark: Don't wait, get it looked at early and get yourself back on the path to being your full self, basically without your noodle, you're kinda missing a lot. Insyncphysio.com. You can book there online, or you can give them a call. The Burnaby office is at 604-298-4878. Or they have a location in Vancouver on Cambie Street, 604-566-9716. Book online, it's way easier. You can get in to see Iyad. Get looked after if you have any doubts. Thanks Iyad. 

Iyad: Pleasure, thanks Mark.