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Signs, Symptoms, and Treatment after a Concussion: The Role of Physical Therapy

Concussion Treatment

Arguably, the hottest topic in sports medicine right now is concussions.  Former NFL players are suing the league for long-term damage from concussions, former player deaths have been linked to depression from concussions, innovations in helmet design are continually occurring, and more  media attention has led to an influx of more studies and more widespread interest in the management of concussions.  Even the definition of a concussion is continually evolving.  Years ago, a “minor” concussion was called a “ding,” and a concussion was only the diagnosis if the athlete lost consciousness.  Now, any blow is considered a mild traumatic brain injury, even one that causes the athlete to “see stars” temporarily.  The biggest problem however with concussions is that you can’t really “see” them like you can a broken ankle or a dislocated shoulder.  Additionally, symptoms may not surface for hours after the concussive event.  On top of that, there is still a stigma in sports about athletes who sit out from a concussion in how they’ll be perceived by teammates, coaches, and the media.  This post will summarize signs and symptoms of concussion, talk about post-concussion syndrome, and finally highlight treatment and rehabilitation after a concussion.  Without question, there is an important role for physical therapy after concussion.

Signs and Symptoms of a Concussion

Signs and symptoms include but are not limited to loss of consciousness, confusion, memory loss, dizziness, double/blurry vision, balance issues, headaches, irritability, nausea, sensitivity to light, feeling of head pressure, difficulty concentrating, reading, or staying focused, and feeling of being in a “fog.”  One or several of these symptoms should be concerning to the athletes, coaches, and parents.

What is Post-Concussion Syndrome?

Post-concussion syndrome is basically a collection of these signs and symptoms that last days or even weeks after a concussion.  The most common ones we see are headaches, nausea, and difficulty reading or concentrating.  For an athlete, you must be symptom free before you begin a return to sport progression and you should be cleared by your doctor.  If you return to sports too soon and sustain another concussion, Second Impact Syndrome may result.  Second impact syndrome is a serious and potentially fatal condition whereby a person is still recovering from a concussion or having symptoms of a concussion and they sustain another one.  This is potentially fatal because if the brain is still recovering and it sustains another blow, the collective trauma can lead to prolonged symptoms and even death. This is precisely why concussions are serious.

Concussion Treatment

Mental and physical rest after a concussion is a must.   Until all symptoms are completely gone with activities of daily living, the athlete should not return to any form of exercise or activity, even light cardiovascular activities.  Athletes may need to refrain from even reading or school because it may cause symptoms to surface.  There should be a graded increase in activity level when the athlete is able to return to school and do homework without symptoms.
Once day-to-day activities are symptom free, there is a role for rehabilitation in recovery for concussion.  First of all, balance impairments are common after concussion.  Balance exercises should in included in the recovery plan.  Secondly, and perhaps most importantly, there are many athletes who have ongoing problems with dizziness and headaches.  These athletes are ideal for vestibular rehabilitation.  Using an analogy of a boat on the water, vestibular rehabilitation helps return the brain to calm waters.  In a concussive event, the vestibular system can get impaired and cause the feeling of being on rugged ocean waters, causing issues with bending and transitioning from lying on your back to sitting and vice versa.  The objective of vestibular rehabilitation is to help the athlete get from rugged waters to calm waters by helping to restore normalcy in the brain.  Put another way, imagine three dice in a cup and shaking them up.  After a concussion, the dice could be out of order.  Basically, there are three “dice” in your inner ear that, in the course of a concussive blow, can get shaken and be out of place.  Vestibular rehabilitation seeks to get the alignment of these “dice” back to normal.
Your physical therapist should also address any soft tissue tenderness or cervical spine mobility deficits that result from the concussion.  Many times, we see people who are recovering from a concussion and we can reproduce their symptoms with gentle soft tissue mobilization of muscles in their neck.  Similarly, the cervical spine often loses mobility due to muscle spasms and guarding after a concussion and the person needs gentle cervical manual therapy.  This doesn’t mean that the person should have high-velocity thrust manipulation, rather gentle oscillatory mobilizations.
Once the athlete is symptom free during day-to-day activities and has been cleared by his/her physician, the athlete can begin interval cardiovascular activity.  If no symptoms return, they may perform individual or sport drills without contact.   If they have symptoms, they should revert back to the previous step.  If no symptoms occur, usually they may return with limited contact, or participate in non-contact team drills.  Provided limited contact is symptom-free and they are cleared by their doctor, they may progress.  The purpose of graded exercise testing is to protect from additional injury and minimize the risk of repeat injury.  No matter what, athletes shouldn’t progress or be released until a) they are cleared by their physician, and b) they have no symptoms with any sports or conditioning activities.
Concussions should not be taken lightly as they can lead to a lifetime of complications, and sometimes even death if proper recovery doesn’t take place.  Further, repeated concussions can lead to more symptoms surfacing more frequently which will affect not only sports, but life in general.
If you or a loved one are suffering from a concussion, give us a call at (913) 904-1128.