Core Physical Therapy’s concussion program is led by Dr. Katherine Monahan, PT, DPT, ITPT, COMT, AIB-VR and Rachel Malboeuf, PT, DPT, AIB-VR, ATCL/L. Katie has received her advanced training via ImPACT, one of the leaders in concussion management. Katie and Rachel are both certified in concussion and vestibular rehabilitation through the American Institute of Balance.
What is a Concussion?
A concussion is a brain injury. There are often no visible changes, even with imaging techniques, but it can result in immediate or delayed changes in the brain’s chemistry. This can occur during quick movement changes (such as car accidents) or when the head is hit directly. If severe enough, bleeding within the skull can occur which is why imaging may be performed. For this reason, it is important to seek medical treatment immediately following any head injury. Common causes of concussions include:
- Falls (the leading cause of concussions, especially in those age 65 or older)
- Motor vehicle collisions (ie, head impact, whiplash)
- Work accidents (ie, falls, head trauma)
- Playground accidents (ie, falling from a slide or swing)
- Sports injury to the head or neck
- Violent events, such as:
- Physical abuse during which the head is shaken
- Being too close to a blast or explosion
- Direct blow to the head, face, or neck
- Assaults, domestic violence
Typically, the chemical changes are restored 7-10 days following the concussion. This is why 80-90% of concussions also resolve in this time frame (Aubry et al., 2002). Unfortunately for some, symptoms persist beyond this time period. Physical therapy can help ensure proper, safe progression to prior activities as well as reduce prolonged symptoms.
CAUTION: Seek a follow-up from a licensed healthcare provider following any suspected head injury.
What are the Signs and Symptoms?
Symptoms of a concussion vary greatly person to person. Symptoms may be immediate or may be delayed in onset, even hours or days after a concussion. Common symptoms include:
- Balance Problems
- Dizziness (spinning or movement sensations)
- Fatigue or Drowsiness
- Trouble Falling Asleep or Changes in Amount of Sleep
- Sensitivity to Light
- Sensitivity to Noise
- Emotional lability
- Numbness or tingling
- Difficulty Concentrating
- Difficulty with Memory
- Visual Problems
- Slowed processing (feeling like you are “in a fog”)
These symptoms may or may not result in difficulty with school, sport, or work. Physical therapy, in combination with your physician or medical provider, can help relieve these symptoms! Recovery time may be influenced by history of prior concussions, history of migraines, history of ADHD or learning disability, or history of depression/anxiety. Concussions may also occur along with other injuries, such as injury to the neck and surrounding tissues, which can be managed by a physical therapist and will be part of the rehabilitation process.
It is important to avoid any second concussion prior to recovery of the initial concussion, known as second impact syndrome. This can result in swelling and worsening of symptoms, possibly even resulting in unconsciousness or death. It is also important to avoid repetitive brain trauma as it can result in progressive degeneration including symptoms such as memory loss, confusion, impaired judgment, impulse control, aggression, depression, and even progressive dementia. Therefore proper rehabilitation is needed to return to your prior activities. Athletes who sustain a concussion during practice or game/competition must be removed immediately from play. A physical therapist in combination with other medical providers will work to develop safe progression for return to play, return to work/school, and return to life’s daily activities.
How are Concussions Diagnosed?
A concussion is diagnosed through careful testing by your healthcare provider with collaboration with your other health care providers, such as a physician or athletic trainer. Since concussions don’t show on imaging, the diagnosis does not rely on MRI or CT scan though these may be performed to ensure no bleeding. Unfortunately, no single test or tool exists to diagnose a concussion. Your physical therapist will ask you many questions to understand all of the symptoms that you are experiencing. He or she also will perform numerous tests to identify problems caused by a concussion, including muscle strength, coordination, balance, vision, and memory tests. These questions and tests will be completed frequently to ensure proper, safe progression to activities. As neck injuries can occur with concussions, an assessment of your neck will also be performed to determine the influence on your symptoms, including headache or dizziness. A vestibular exam will also be performed to determine the influence of your inner ears on your balance and dizziness.
How Can a Physical Therapist Help?
As every person (and their symptoms) are different, a physical therapy will examine your neurological, orthopedic, vestibular and cardiovascular systems in order to create a plan that best fits your recovery.
Treatments may include:
Relative rest and recovery. Your physical therapist will help you and your family understand if and why you should limit any kind of activity (daily tasks, work, school, sports, recreation, the use of electronics) after a concussion, until it is safe to return to these activities. It is important to make sure the activities do not increase symptoms!
Restoring strength and endurance. Studies have shown that each day in delay of initiation of aerobic exercise actually decreases outcomes; however, there must be caution for safe progression to not worsen symptoms. Your physical therapist can help you regain your strength and endurance when the right time comes, without making your concussion symptoms worse. Using specific testing and guidelines, the physical therapist can make sure you get back to your normal activities and improve exercise intolerance. The therapeutic exercise program will be targeted just for you — based on how you present as well as your goals for activity.
Stopping dizziness and improving balance. Many people experience dizziness or difficulty with balance following a concussion. A specific type of physical therapy, called vestibular rehabilitation therapy, can help! The vestibular system, which includes the inner ear and its connections with the brain, helps maintain balance and prevent dizziness. A qualified vestibular physical therapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying special treatments or teaching you specific activities, some of which you may be able to do at home. Two therapists at our clinic are certified from the American Balance Institute in vestibular and concussion therapy.
Reducing headaches. Your physical therapist will perform tests to determine the possible cause of your headache and use therapeutic techniques to reduce and relieve these. Treatment may include techniques such as flexibility or strength and exercises, hands-on techniques like specialized massage or mobilizations, and the use of technologies such as electrical stimulation.
Returning to normal activity or sport. When returning to activity following a concussion, it is important to gradually and safely progress into activity to reduce risk of overloading the system resulting in increase in symptoms. Your physical therapist will create a program specifically for you to help resume normal activities safely and as quickly as possible. For athletes or individuals with heavier jobs, this will include tasks specifically designed to get you back to the challenges of your activity.
Can a Concussion Be Prevented?
Though an initial concussion may not be prevented, it is important to prevent any future injury while healing. We will provide education specifically tailored to you and your activities to further reduce risks of future concussions. Remember, it is important if any head injury occurs, to make sure you seek medical attention immediately! Making sure you have a physical therapist experienced and trained in the management of concussions and vestibular rehabilitation will improve your recovery.