The Role of Concussion Physical Therapy in Recovery

It used to be thought the only way to treat a concussion was with rest, but the science and study of traumatic brain injuries (TBIs) have come a long way in recent years. We now know that in some cases, prolonged rest can worsen symptoms. In addition, medical professionals like those at the MOSH Concussion Care Network know that a patient can benefit greatly from early intervention and structured exercise provided by concussion physical therapy.

Under the care of a licensed physical therapist (PT), controlled movement and physical manipulations can improve outcomes for patients dealing with concussions and post-concussion syndrome. Rest is still the first part of concussion protocol, but physical therapy can be essential to recovery.

What is a Concussion?

We all know injuries can happen, whether during spring training, shoveling the snow, or just enjoying time out on the links. While many recreational accidents result in minor injuries, head trauma and injuries involving our nervous system are among the most dangerous. Young or old, athlete or couch potato, concussions can happen to anyone.

A concussion is a mild traumatic brain injury from a direct blow or jolt to the head or body. They are common in impact sports, falls, motor vehicle accidents (MVAs), and violent movements. There are about 1.7 million TBIs yearly in the United States, and 10% of those are related to sports or recreational activities. Though concussions have levels of severity, if any kind of head injury is suspected, you should see a doctor immediately.

Symptoms of a concussion may occur immediately after the injury, or there may be a delay. Concussion symptoms can include physical, cognitive, and/or emotional symptoms. Physical symptoms include a headache, dizziness, neck pain, difficulty with balance, fatigue, insomnia, nausea/vomiting, and light or noise sensitivity. Cognitive symptoms can include mental fogginess, difficulty concentrating, confusion, short- or long-term memory issues, and difficulty with comprehension. Possible emotional symptoms can also present, such as increased irritability, anxiety, depression, and mood swings.

Your doctor will likely prescribe a standard concussion protocol depending on the severity of the TBI and your symptoms. Since the majority of concussions resolve on their own within seven to ten days, most people will manage their symptoms through:

  • Rest.
  • Rehydration.
  • Avoidance of blue light (electronics like TVs, phones, and tablets).
  • Ice or Heat therapy.
  • Refraining from driving, using ibuprofen, and drinking alcohol.

What is Post-Concussion Syndrome?

If your symptoms don’t resolve within two weeks or are severe or persistent, you may have developed post-concussion syndrome (PCS).

Interestingly, medical science doesn’t know why post-concussion syndrome occurs in some patients and not others. There is no link between the severity of the concussion and PCS. However, we know that risk factors for post-concussion syndrome include having three or more concussions in your lifetime, being over 40, and being a female.

Diagnosing post-concussion syndrome usually includes further imaging to rule out physical abnormalities in the brain, skull, and neck. In addition, someone with PCS will also have at least three of the following persistent symptoms:

  • Headache
  • Dizziness
  • Vertigo
  • Sleep problems
  • Neck and shoulder pain
  • Sensitivity to light or motion
  • Doubled vision
  • Blurred vision
  • Balance problems
  • Changes in gait

Physical therapy concussion rehabilitation is recommended if your symptoms are severe during the initial week, do not resolve in a reasonable timeframe, if your doctor detects associated symptoms that PT can improve, or if you have post-concussion syndrome.

How Can Concussion Physical Therapy Help?

Physical therapists are medical professionals trained in the art of movement. They evaluate injuries to assess needs and provide personalized treatment plans so patients can return to normal activities and prevent further injuries. Simply put, physical therapists help you recover faster.

Physical therapists treat patients using physical interventions such as:

  • Manual therapy: massage and manipulation of soft tissue, muscles, nerves, and facia using skilled hand techniques.
  • Exercise therapy: specific exercises and motions designed to restore function and relieve pain in injured areas.
  • Hot and cold therapy: Thermotherapy (heat) or cryotherapy (cold) is applied to the injury or whole body to reduce pain and swelling, increase blood flow, and promote healing.

Concussion physical therapy is a concussion management and rehabilitation program aimed at decreasing pain, reducing symptoms, increasing recovery time, and improving the patient’s quality of life. PTs will focus on five zones of concussion and post-concussion syndrome issues: neck and cervical spine, balance, vision, exertion tolerance, and when you can return to your usual activities.

1. Neck and Cervical Spine

The adage is true: what affects the head affects the neck. Head injuries often involve damage to the neck, shoulders, and cervical section of the spine (the seven vertebrae in the neck) because they work together as one unit. Additionally, our subconscious reaction to head injury is to further protect our head, making our neck and shoulders tight and stiff. Physical therapists can increase cervical mobility, relax the neck and shoulders, and treat underlying injuries.

Patients with post-concussive headaches, dizziness, tinnitus, sleep disturbances, blurred vision, neck/head/shoulder stiffness or pain, balance disturbances, decreased cervical range of motion, or decreased isometric neck strength will likely receive cervical spine assessment and rehabilitation from a physical therapist.

Treatments may include strength training and stretching, massage, cryotherapy, and thermotherapy if a cervical injury is present.

2. Balance and Dizziness

Many TBIs come with balance problems and dizziness that physical therapists can remedy using manual and exercise therapies. The vestibular system controls your balance and knowledge of your body’s position in space (proprioception) and enables rapid compensation for body movement. Components of the vestibular system are in your brain and inner ear, so it is understandable how a concussion could affect this complex network.

The most common vestibular concussion injury is Benign Paroxysmal Positional Vertigo (BPPV), a condition that causes vertigo (a sensation that the room is spinning) triggered by head movements. A physical therapist can test for BPPV and treat it immediately through a manual repositioning called the Epley maneuver (Canalith Repositioning Procedure).

For other balance problems, a physical therapist will likely use a Balance Error Scoring System (BESS) to assess your standing stability and measure your progress.

3. Vision Issues

Concussed patients with mild to moderate vision problems may also find relief by working with a PT. A physical therapist may treat symptoms including motion sensitivity, gaze instability, and trouble tracking moving objects with the eyes.

Treatments are usually manual and exercise therapies involving head movements, depth of field tests, and vision tracking on an object, used to retrain the eyes and brain to interpret motion correctly.

4. Exertion Tolerance and Graduated Exercise Therapy

A big challenge for patients with concussions or PCS is knowing how to recover without relapsing or risking further injury. Physical therapy is designed to evaluate your limitations and create a personalized recovery plan to help you remove those obstacles. One way to do this is through a group of treatments in a graduated exercise therapy program. In its simplest form, this program involves introducing physical activity in stages and increasing exercise gradually to avoid exacerbating concussion symptoms.

In a graduated exercise program, a PT will administer exertion (aerobic) testing as the first step in returning to regular daily, recreational, or sports activities. One test a PT may use to measure your exertion tolerance is called a Buffalo Concussion Treadmill Test (BCTT). This test involves a patient walking on a treadmill and giving feedback to the PT on how they feel, while the physical therapist also monitors your heart rate and breathing.

5. Return to Work and Sports Assessment

Ultimately, the goal of any concussion treatment is to help the patient make a full recovery. Graduated exercise therapy is a perfect way to track a patient’s progress and speed up the recovery process so they can meet the requirements for safely restarting regular activities.

The Centers for Disease Control and Prevention (CDC) has a graduated outline for athletes that physical therapists can use to determine where you are in your healing process and what activities are safe to resume. Your PT can also suggest alternative activities or adjust your concussion recovery plan.

The 6 steps in the Return to Play Progression are as follows:

  • Step 1: Back to regular activities (such as school or work)
  • Step 2: Light aerobic activity
  • Step 3: Moderate activity
  • Step 4: Heavy, non-contact activity
  • Step 5: Practice & full contact
  • Step 6: Competition

Physical therapists are critical to concussion and post-concussive syndrome recovery. Through direct physical interventions, a physical therapist can correct balance issues, vision problems, vertigo, exertion intolerance, headaches, and more. As your symptoms continue to improve, your PT will also assist you in returning to your normal daily activities and sports progressively and safely through personalized treatment programs and established medical protocols.

The physical therapists at Midwest Orthopedic Hospital are part of a specialty team of healthcare providers trained in expert concussion care. To learn more about how physical therapy can help you, set a concussion care appointment today or call 414-817-5800.

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