concussion therapy optimal physical therapy



What is a Concussion?

A concussion is a type of mild traumatic brain injury (mTBI) caused by shaking or jarring of the brain. Concussions can occur with a bump, blow, or jolt to the head or the body, which causes the brain to move within the skull.  This movement causes the brain to hit the inside of the skull or stretch which can result in a change in brain cell chemistry and structural injury from cell stretching. This damage can result in a variety of signs and symptoms depending on the portion of the brain involved during the concussion.

Are Concussions Serious? 

Concussions are described as a “mild” traumatic brain injury because concussions are usually not life threatening.  However, concussions are a brain injury and can lead to serious long-term consequences if not managed correctly by a qualified healthcare professional.

What healthcare professionals manage and treat concussions?

No single healthcare professional is able to fully manage a concussion due to the volume of issues related to a concussion.  Concussion management is truly a team effort to help a patient return to their prior level of function. Members of the concussion management team may include: a sports medicine physician, primary care physician, athletic trainer, teacher, school administrator, social worker, physical therapist, occupational therapist, speech language pathologist, psychologist, neuropsychologist, neurologist, radiologist, orthopedic surgeon, ophthalmologist, ear nose & throat physician and other healthcare professions. 

How can I detect a possible concussion?

Concussions are a fairly common injury, but many people are unaware of exactly what happens when they suffer one. This injury is a result of an impact, in which the brain moves or twists inside the skull. You do not need to lose consciousness to have a concussion.  Concussions can be caused by a violent back-and-forth, rotational, and/or rapid multi-directional motion to the head or body. Examples of these motions include whiplash, motor vehicle accidents, tackles, and falls. Symptoms of concussions can include: 

  • Painful and chronic headaches and/or migraines
  • Sensitivity to light and/or sound
  • Ringing in the ears (tinnitus) 
  • Visual abnormalities
  • Slurring of speech
  • Memory loss and confusion
  • Nausea and vomiting
  • Inability to focus
  • Loss or changes in balance 
  • Unexplained changes in mood
  • Dizziness
  • Fatigue

If you are experiencing any of these symptoms, you may have a concussion.  The type and intensity of these symptoms are unique to each individual. 

What is the normal recovery time for a concussion? 

The normal recovery time from a concussion varies from person to person.  Each concussive event will also result in a unique recovery period. Signs, symptoms, and course of recovery all depend upon the location and severity of their injury.  

What are some risk factors for a delayed or prolonged recovery?

Not effectively treating a concussion right away can lead to serious health issues. Delayed treatment can also lead to post-concussion syndrome which is a serious condition that can last for several months. People who have post-concussion syndrome may experience dizziness, vertigo, persistent headaches, and other symptoms that may not go away without treatment.

If you believe you may have a concussion, the best solution is to seek the help of a medical professional right away to avoid the risk of worsening the concussion. With the help of physical therapy, you can receive the necessary treatment for your specific needs. 

What steps should be taken to help recover from a concussion?

The first priority in the management of a sports concussion is to remove the person from playing as soon as a concussion is suspected. The American Academy of Neurology uses the mantra “if in doubt, sit it out” as a guide for parents, coaches and healthcare providers. Removal from play decreases the risk of suffering another concussion and prolonging recovery. Healthcare providers should perform a sideline assessment, which may include tests to rule out a neck injury, issues with memory, and neurocognitive tests (tests of thinking). Afterwards, you should follow-up with a healthcare provider for reassessment and management of sports concussion. 

Treatment for concussion consists of rest and changes in daily activities in the initial stages of recovery.  Activities or environments that provoke symptoms should be avoided and may include loud music, television, smartphones, video games and thinking tasks. Getting plenty of sleep and naps during this stage of healing is important in recovery.

A gradual return to symptom free physical activity is appropriate when the patient’s symptoms begin to improve.  Guidance from a qualified healthcare provider is very important during this stage of recovery. Physical therapists can evaluate and manage possible inner ear conditions associated with head trauma, balance deficits, neck pain, headaches, dizziness and appropriately pace a return to cardiovascular activity. 

The final phase of concussion recovery includes a graded return to play protocol that slowly progresses from light activity to full participation in order to be cleared for a full return to sports.  This phase is not initiated until a child has already returned to learning in school without accommodations, performing at their prior level of academic achievement and does not experience symptoms with learning tasks.  For adults, this phase is not initiated until they have returned to work fully and do not experience symptoms with learning tasks. Physical therapists are qualified to progress a patient through a return to play protocol and work with the physician for final clearance.

Can Concussions occur in adults too?

Yes, concussions can occur to anyone of any age.  Just like with a child, rest is required followed by gradual return to activity-dependent on symptoms.  Always seek medical treatment after you experience a concussive event from a qualified healthcare professional.  A physical therapist is one of many health professionals that can assist you in your recovery.  

How can Physical Therapy help a patient recover from a concussion?

Physical therapists play an important role on a concussion management team.  A physical therapist will evaluate and treat many aspects of concussion. The therapist will be able to treat the patient with manual techniques and exercise to reduce symptoms and return the patient to their prior level of function.   Some exercises and techniques include: 

  • manual therapy to address any pain, decreased mobility, or decreased flexibility 
  • ocular motor exercises to address vision symptoms
  • balance & proprioceptive exercises 
  • exercise/activity intolerance progressions 
  • patient education on activity modifications