Physical Therapy after concussion

With fall/winter comes Saturdays and Sundays filled with college football and NFL game days. Although the NFL has been cracking down on concussion evaluations and has instituted fines for teams who violate these rules, we still see high speed, large impact hits each game. In 2017 alone, there were 291 reported concussions from pre-season through the end of the NFL season.1 

While we may not be seeing many NFL players in our clinic, there is growing concern regarding the incidence of concussion in youth athletes, as well as in older adults after falling. What exactly is a concussion? What are the signs and symptoms that indicate the need for further medical attention? What can a physical therapist do after concussion? More evidence is pointing away from the traditional thought that "rest is best". 

What is a concussion?

A concussion is a brain injury that occurs when the brain is shaken inside the skull, occurring during rapid movement changes or a direct blow to the head. This can lead to immediate or delayed changes to brain composition and/or function. Contrary to what you may expect, less than 10% of concussions involve a loss of consciousness. 2

How do I know if I have a concussion?

Immediate symptoms include: 

• headache, dizziness, fatigue, double vision, sensitivity to light and sound, slurred speech
• difficulty with short-term or long-term memory, confusion, slowed "processing" (eg, a decreased ability to think through problems), "Fogginess", difficulty concentrating, worsening grades in school
• Irritability, restlessness, anxiety, depression, aggression, change in personality or behavior

Long term signs/symptoms include:

• growth problems (children), fatigue, weight gain, low blood pressure, muscle weakness, chronic headaches or dizziness, early dementia/chronic traumatic encephalopathy (brain disorder)

If you've sustained a direct blow, MVA or accident and think you may have a concussion, consult your PCP and/or seek medical attention at urgent care center. 2

What can a physical therapist do for me?

The American Physical Therapy Association "recognizes that physical therapists are part of the multidisciplinary team of licensed health care providers that provides concussion management." Evidence shows that appropriately guaged and challenged exertion that is appropriately timed in the recovery phase can play a key role in returning people who've been concussed to prior level of function. There is substantial research and evidence for "the benefits of exertional treadmill testing in return-to-activity management of people with concussion." 3

Following concussion, "up to 79% of patients report dizziness and 56% of patients experience balance impairment." Vestibular PTs are trained in the assessment of balance and dizziness, and vestibular physical therapy has proven beneficial in managing patients who experience post-concussive dizziness. 4

Consult our website for more information on vestibular physical therapy with Reischl PT's own vestibular specialist, Carlos Moreno PT DPT, NCS. 

1. https://www.playsmartplaysafe.com/newsroom/reports/2017-injury-data/

2. https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=4f2ebb00-f1c0-4691-b2ab-742df8dffb99

3. http://www.apta.org/PTinMotion/2017/3/Feature/BeyondRest/ 

4. http://www.neuropt.org/docs/vsig-physician-fact-sheets/concussion-management.pdf?sfvrsn=2