• Concussions

    Concussions

    In the United States as many as 3.8 million reported and unreported concussions occur annually.1 Among individuals 15-24 years of age, sports are second only to motor vehicle accidents as the leading cause of concussions.2

    Concussion is defined as a trauma-induced alteration in mental status that may or may not involve loss of consciousness.3   Concussion may be caused by a direct blow to the head, face, neck, or a hit to the body that causes your head to move quickly back and forth.4

    Signs and symptoms can include1-6:
    • Headache
    • Blurry vision
    • Dizziness
    • Nausea
    • Sensitivity to light and noise
    • Emotional symptoms (irritability, sadness, anxiety)
    • Loss of consciousness
    • Amnesia (forgetting events immediately prior to or after incident)
    • Slowed reaction times
    • Impaired balance
    • Sleep disturbance, drowsiness
    • Difficulty concentrating

    If any one or more of these symptoms are present after a hit to the head or body, a concussion should be suspected and the person should be medically evaluated at once.4

    Any athlete suspected of sustaining a concussion should be immediately removed from participation and evaluated by a physician or medical professional, such as an athletic trainer onsite. A player diagnosed with a concussion should not be allowed to return to play on the day of injury.1

    Observable Signs That Warrant Immediate Referral to the Emergency Department1:
    • Decreasing or fluctuating level of consciousness
    • Increasing confusion
    • Increasing irritability
    • Numbness in the arms or legs
    • Pupils becoming unequal in size
    • Repeated vomiting
    • Seizures
    • Slurred speech or inability to speak
    • Inability to recognize people or places
    • Worsening headache

    The person should be observed and supervised during the acute phase of the concussion (24-48 hours) for these symptoms. In general, the person does not need to be awakened during the night unless he or she experienced loss of consciousness, prolonged periods of amnesia, or significant symptoms before going to bed.1

    Rest, followed by a graded return to activity is currently the best practice for concussion recovery. During the acute recovery period, both physical rest and cognitive rest are indicated while the person is symptomatic.

    The type and amount of cognitive rest are individualized, but may take the form of limiting1:
    • Reading
    • Writing
    • Mathematical computation
    • Computer work
    • Watching television
    • Text messaging
    • Playing video games

    For student-athletes in recovery from a concussion, reasonable accommodations may need to be adapted for them to maintain pace and participation in classroom activities without exacerbating symptoms. These accommodations should be coordinated with the student, parents, school personnel, and medical professionals.5

    A supervised physical-exertion progression should begin only after the concussed athlete demonstrates a normal clinical examination, the resolution of concussion-related symptoms with activity and at rest, and a return to preinjury scores on all objective concussion assessments as determined by a medical professional. The presence of symptoms indicates your brain has not yet fully recovered and needs more rest. 1,6

    Example Return-to-Play Progression4:
    Stage Physical Activity
    1 No activity
    2 Light exercise: 70% age-predicted maximal heart rate
    3 Sport-specific activities without the threat of contact from others
    4 Noncontact training involving others, resistance training
    5 Unrestricted training
    6 Return to play
    Each stage should be separated by at least 24 hours.

    Each recovery is case dependent, but typically a person diagnosed with a concussion can expect to recover in matter of days to weeks.1,4,6 Although most concussions resolve in a relatively short time frame, patients who are young, who have had multiple concussions, or who have premorbid factors may require additional attention and longer recovery times.1

    Some concussion symptoms do not go away in the expected time frame. These symptoms may need further testing and treatment by a team of health care providers, including a physical therapist.6

    Potential Complications Following Concussion1,4,6:

    • Post-concussion syndromeSymptoms, such as headaches or dizziness that persist for weeks or months after the initial injury.
    • Second-impact syndrome
    • Can occur if a person who has suffered a recent concussion experiences a second trauma while they are still symptomatic from the initial injury.
    • Research suggests that a person who suffers a second concussion before the initial concussion has healed is at risk of permanent brain damage (learning disabilities, personality changes, walking disability, or other brain or nerve disabilities) or of death.
    • Extreme care should be taken after a concussion to prevent a second injury

    How Can a Physical Solutions Help?

    If you or a loved one is experiencing signs or symptoms of a concussion or post-concussion syndrome, physical therapy can help. Physical therapists can evaluate and treat many problems related to concussion.

    Treatment may include6:
    • Guided rest and recovery
    • Restoring strength and endurance
    • Improving balance
    • Reducing headaches and dizziness
    • Returning to normal activity or sport

    Your physical therapist will design an individualized rehabilitation program to address your specific problems, and closely monitor your symptoms as you participate in the program to allow you to return to your daily and sports activities in a safe manner.

    For more information on concussions and how Physical Solutions can help diagnose or treat your condition, call to set up an appointment with one of our physical therapists.

    1. Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association position statement: management of sport concussion. Journal of Athletic Training. 2014;49(2):245-265.
    2. Marar M, et al. Epidemiology of concussions among United States high school athletes in 20 sports. American Journal of Sports Medicine. 2012;20(4):747-755.
    3. American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Neurology. 1997;48(3):581–585.
    4. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich. British Journal of Sports Medicine. 2013;47:250-258.
    5. McGrath N. Supporting the student-athlete’s return to the classroom after a sport-related concussion. Journal of Athletic Training. 2010;45(5):492-498.
    6. American Physical Therapy Association. Physical therapist’s guide to concussion. Move Forward PT http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=4f2ebb00-f1c0-4691-b2ab-742df8dffb99#.Vo5rklL94oc Published March 24, 2011, reviewed November 25, 2015. Accessed January 7, 2016.