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Concussion Management   

Have you or your loved one sustained a concussion? Wondering what this means and how to promote recovery following a concussion? 

Physical therapy can help promote recovery following a concussion. After a concussion, it is often difficult to jump back into normal activities related to work, school, home and recreational life. Specific exercises designed to address issues with exercise tolerance, balance, dizziness, vision and neck/head pain can help improve integration back into these everyday activities. Each patient is different and an individualized program can be created to help return you to a full life following a concussion.

What is a concussion?

  • Definition
    • A concussion is a traumatic brain injury induced by biomechanical forces, either a direct or indirect blow. 
  • How does it occur?
    • A concussion can be caused by a direct impact, such as a bump or hit to the head, or indirect impact, such as a bump or hit to the body. With an indirect blow, the force onto the body causes the brain to move inside the skull and the brain’s neurons to be “stretched.” This stretching causes a resultant “energy crisis” inside the brain where there is less energy available but more energy is required to perform a task compared to before injury.  
    • Examples of types of injuries:
      • Sports injury 
      • Motor vehicle accident
      • Blast injury 
  • Common concussion symptoms:
    • Headache, dizziness, difficulty concentrating, nausea/vomiting, visual disturbances, irritability, sensitivity to light and noise, loss of balance and drowsiness. 
  • There are multiple types (“trajectories”)  of concussions, and people may experience a combination of these:
    • Cognitive/fatigue
    • Vestibular
    • Ocular
    • Post-traumatic migraine
    • Cervical 
    • Anxiety/mood
  • Common Questions:
    • Will a concussion show up on imaging?
      • A concussion will NOT show up on an MRI because it is an acute functional injury to your brain rather than structural. 
    • I didn’t lose consciousness. Does that mean I don’t have a concussion?
      • A concussion does not require loss of consciousness. In fact, only about 10% of concussions result in loss of consciousness. 
    • I think I have a concussion, what do I do next?
      • Call 911 if you or your child is experiencing any of the following:
        • Seizures
        • Weakness or numbness/tingling into the arms or legs
        • Cannot recognize people or places
        • Confusion, restlessness or agitation
        • Impaired consciousness
        • Difficulty to arouse or unable to awaken
        • Repeated vomiting
        • Slurred speech
        • Bloody or clear fluid from the nose or ears. 
      • Current guidelines indicate taking 24-48 hours of “brain rest” directly following a concussion. This means taking a  break from cognitive and thinking/processing activities. Following rest, gradual return to activity is indicated to avoid shocking your system. A multidisciplinary team, including a physical therapist, can help facilitate graded return to activity. 
    • When is it safe to return to my sport following a concussion?
      • Guidelines recommend patients should be at pre-injury levels for symptoms, cognitive function and vestibular/balance function in order to return to unrestricted return to play. The majority of injured athletes return to play within 7-14 days following a concussion, however some patients take longer. There are known risk factors that can affect one’s speed of recovery, such as age, sex, previous history of concussion and history of migraines, to name a few. Individualized prognosis and care plans can be determined by a multidisciplinary team.
      • The State of California and California Interscholastic Federation (CIF) have mandated both a Return to Learn and Return to Sport progression to help facilitate safe return to activity. 
        • CIF Return to Sport Protocol requires 24 hours between each graded progression and requires regression to a former step if symptoms increase. With this protocol, the earliest a student athlete is able to return to sport is 7 days, however the steps are guided by symptoms and not time outright. 
        • A physical therapist can help guide each patient safely through these steps, through careful monitoring of symptoms and vital signs. 
    • Is there a risk of returning to activity too early?
      • Research shows that unrestricted activity immediately after a concussion can prolong recovery and contribute to worsened symptoms. On the other hand, research of athletes who were sedentary also experienced a prolonged recovery with decreased cognitive function and increased symptoms. Those that experienced the best outcomes were athletes with a moderate level of physical and cognitive activity in the days following a concussion. A multidisciplinary team, including a physical therapist, can help determine an individualized care plan that is appropriate and safe for each patient. 
    • What are the benefits of exercise post-acute phase of concussion?
      • Increased cerebral blood flow, which promotes healing of the brain. 
      • Increased BDNF (brain derived 
      • neurotrophic factor) production and improved cognitive performance 
      • Improved mood and sleep

Did you know there is a 34% risk of lower extremity injury after returning to sport following a concussion? Athletes are at greatest risk for reinjury within 90 days of returning to sports, however the risk is still 2x greater at 1 year post concussion. Coordination, spatial awareness, reaction time and dual-tasking can be negatively impacted by a concussion. A Doctor of Physical Therapy can assess and treat these systems and your readiness for return to sport to reduce one’s risk of injury following a concussion. 

A comprehensive physical therapy examination can be performed to determine an individualized care plan and help facilitate return to activity and/or sport. Physical therapy for a patient with symptoms of a concussion may involve a variety of modalities and treatments, such as monitored vestibular, ocular and aerobic training, return to sports-specific movements and manual therapy to the cervical region. A physical therapist will monitor concussion symptoms and vital signs throughout the care plan to facilitate safe return to activity.