Concussion Management at Evolution Sports Physiotherapy

Concussion management has become a hot-topic recently as athletes have become faster and stronger, equating to higher impact collisions with opponents, playing fields and teammates.   Large amounts of money, notably driven by the NFL, NHL and NCAA, have poured into conducting research in order to identify risk factors, indicators of recovery, effective rehab programs, and prevention measures with respect to concussions. Concussions often occur in sports arenas;  however they are also a concern following head trauma as the result of falls, blast-type injuries from military service, motor vehicle accidents or even non-contact whiplash injuries.  Each of these scenarios can include similar symptoms, but some characteristics are often unique to the trauma involved.  Along with physical trauma to the brain which can create further vascular and chemical effects that perpetuate prolonged effects, other systems can also be involved which can contribute to the clinical picture.   The top five most commonly reported symptoms following sports-related concussions (Kontos et al, 2012) are:

  • Headache
  • Difficulty concentrating
  • Fatigue
  • Drowsiness
  • Dizziness

These symptoms are often reported in issues involving the cervical spine (cervicogenic) as well as the vestibular system.  The overlapping nature of these clusters of symptoms makes it important to clinically test each individual system’s influence on the patient’s presentation in order to fully address any impairment.  For example, rest may be the best treatment of the physical and chemical trauma to the brain however rest may only exacerbate cervicogenic or vestibular dysfunctions making for protracted symptoms and potentially worsening symptoms if an athlete attempts to return to their sport.

Consensus on best practices for the management of concussion patients is marginal – guidelines are presented and revised, different groups have specific parameters for measuring progress through phases and benchmarks for return to sport.   Guidelines and protocols are likely difficult to nail down due to the individual nature of the type of injuries, pre-injury status of all the systems involved and effects of treatment strategies on the various structures involved in a rehab program.  The important components of a rehab program need to address the cognitive, vestibular, physical and psychological dysfunctions that can be present in individuals who have suffered concussions.

 The American Physical Therapy Association (APTA) has a recommendation for the evaluation and management of concussions based on the most recent evidence which includes:

  • Rest from both cognitive and physical exertion until post-concussive symptoms have resolved.
  • Protection from additional injury.   There is increased vulnerability for repeat concussion while the brain is healing from a current concussion (Second Impact Syndrome).  Second Impact Syndrome is rare, but catastrophic.  It occurs only in young people (<23 years) and has a mortality rate of 50% when it occurs.
  • Neurocognitive assessment helps determine recovery stage, which is often performed by neuropsychologist, the individual’s school or allied health professional.
  • Balance Testing is helpful to establish presence of concussion and track of recovery
  • Medication and/or physical therapy when recovery is incomplete after 2-3 weeks.

The APTA’s position and experience from clinical evidence on physical therapy for concussions shows that up to 79% of patients report dizziness and 56% experience balance impairments following a sports concussion (Lovell, et al.  2006).  Post-concussive dizziness and headaches may arise from several sources including benign positional paroxysmal vertigo (BPPV), post-traumatic migraines, labyrinthine concussion, perilymphatic fistula and brainstem concussion (Furman, et al. 2010).  Vestibular therapy has been shown to be effective in managing patients following concussion who continue to experience ongoing imbalance or dizziness without spontaneous resolution  (Alsalaheen, et al. 2010)

The physical therapists at Evolution Sports have specialty training in manual therapy, differential diagnosis, as well as the diagnosis and treatment of vestibular conditions in addition to having a special interest in return to sport training.  They have access to a team of neurologists, pediatric orthopedists and audiologists as referral resources if your care exceeds the scope of Physical Therapy or additional testing is necessary for progression of your plan of care.  Your physical therapist at Evolution Sports is looking forward to developing a patient and symptom-specific rehabilitation guideline for you or your loved one based on the most current research.