Concussion has become a hot topic lately, people are becoming increasingly aware of and being diagnosed with concussions. A concussion can be caused by direct blow to head face or neck but also a hit to another area of the body with an “impulsive” force transmitted to the head. There does not need to be a loss of consciousness to cause a concussion.
The most crucial part of concussion management is to have it recognized quickly and educate patients. The initial management (approximately 4 weeks) is REST, physical and cognitive, until asymptomatic.
There is no same day return to play. In the new guidelines there are 6 steps to return to play and each takes a minimum of 24 hours. You can also use these guidelines for return to work and school. If any symptoms return you have to return to the previous step.
80-90% of concussions recover in 7-10 days or 14 days in youth. 10-20% develop post-concussion syndrome(the collection of symptoms is the same as mild traumatic brain injury, and may be the same).
A physiotherapist can help with education regarding concussion, develop and monitor a return to school/work and play program. They can also help with the often concurrent cervical spine injury as it is difficult to get a concussion without affecting the neck.
Physiotherapists with vestibular training can also asses and treat and vestibular system for issues that may have resulted from the mechanism of injury. This is supported by a statement recently added to concussion guidelines from the Zurich 2012 conference, “multimodal physiotherapy treatment for individuals with clinical evidence of cervical spine and/or vestibular dysfunction may be benefit”3.
Symptoms of a Concussion
The majority of concussion symptoms resolve in 7-10 days; 30% of athletes still experience symptoms after that. Athletes may not return to play until they are symptom free, and post concussion headache has been reported as a predictor of longer time loss. The most common symptoms reported after concussions are headache, dizziness, nausea, and neck pain.
Two articles explored potential rehabilitation interventions that are effective to address these symptoms, also demonstrating that treatment and exercise reduce recovery time safely.
Schneider et al surmised the source of some symptoms may be a result of cervical spine trauma or vestibular dysfunction from the forces transmitted to the head and spine during the concussive incident. Hence cervicogenic headaches result or dizziness and balance dysfunction occur. Their randomised controlled trial examined whether the time to medical clearance for return to play is effected when the subjects received vestibular rehabilitation and treatment for the cervical spine. The study group consisted of patients with persistent symptoms following a sport related concussion.
Exercises to Speed Up Concussion Recovery
Both groups received postural education, rage of motion exercises and cognitive and physical rest until asymptomatic followed by a protocol of graded exercise. The treatment group also received cervical spine and vestibular rehabilitation.
Results:
- 73% (11/15) of participants in the treatment group were medically cleared within 8 weeks of initiation of treatment
- 7% (1/14) of the control group were cleared
Quatman-Yates et al systematically reviewed literature identifying potential physical rehabilitation interventions that are safe, feasible, and appropriate to utilize with patients with persistent mild traumatic brain injury (mTBI). The studies were categorized by types of intervention: physiological, vestibulo-ocular, and cervicogenic.
Highlights:
- Evidence supported Manual therapy to the cervical and thoracic regions for headache, dizziness, and hypo mobility in the spine.
- Patients with persistent symptoms benefit from vestibular-based interventions.
- Graded exercise progression showed the following benefits: a decrease in number of concussion symptoms, more normal activation patterns on the MRIs, more likelihood of participant returning to full daily function, greater exercise capacity with fewer symptoms
- Aerobic, anaerobic, and coordination exercises can be safe and feasible.
- “Evidence suggests moderate-level physical and cognitive activities in the acute recovery phase may actually expedite rather than hinder recovery”2
Athletic Therapists and Physiotherapists at Parkway use a combination of manual therapy, vestibular-ocular, and exercise techniques to guide clients through their concussion rehabilitation. Progressively introducing exercise in concussion management can decrease symptoms and return athletes to their sport safely with shorter time periods on the sidelines.
1. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular Rehabilitation in Sport-Related Concussion: A Randomised Controlled Trial.
2. Quatman-Yates C, Cupp A,Gunsch C, et al. Physical Rehabilitation Interventions for Post-mTBI Symptoms Lasting Greater Than 2 Weeks: Systemic Review.
3. McCrory P, Meeuwisse WH, Aubry M, et al. Br J Sports Med 2013; 23:89-117
