Larisa Weczorek, DPT
Concussions are on the rise.
The CDC estimates that 1.6-3.8 million concussions occur every year. Most concussions, about 80-90% of them, resolve on their own within 10 days. However the other 10-20% can turn into what is called post-concussion syndrome and this can have devastating and life altering effects. Physical therapists who specialize in concussion management and vestibular therapy are highly qualified in treating people with post-concussion syndrome. A recent article in PT in Motion highlights the growing evidence for an active approach to concussion recovery versus resting and waiting for symptoms to resolve on their own.
The brain is an incredibly complex organ
A concussion is a mild traumatic brain injury. It is typically caused by a fall, a direct hit to the head, or a car accident. Even though it is usually not life threatening, it can still be debilitating. During a concussion there are many microbleeds that happen in the brain, called cerebral microbleeds. These small hemorrhages trigger a cascade of chemical reactions that eventually lead to cell damage and potentially brain cell death. This is important to keep in mind when we talk about proper concussion rehabilitation. There are two types of concussions: brain (cortical) and inner ear (labyrinthine). Symptoms and the best treatment approach will vary depending on the type of concussion.
Symptoms of each type of concussion can be somewhat different:
| Inner Ear Concussion | Brain Concussion |
| -Vertigo | -Memory problems |
| -Dizziness | -Difficulty concentrating |
| -Balance problems | -Headaches |
| -Difficulty reading/blurred vision with head movement | |
| -Tinnitus (ringing in ears) | |
| -Hearing loss |
Symptoms can include the following:
– feeling dazed
– fatigue
– cannot recall events prior or just after the fall/hit
– irritability
– nausea/vomiting
– confusion
Medical assessment is important after a hit to the head
If the sideline assessment reveals a concussion, the key for proper recovery is cognitive rest for 24-48 hours. This means limiting reading, doing homework, texting, and using the computer. You are allowed one hour of intense cognition per 24 hours. This is because cognitive activities require more blood flow and nutrient uptake to the brain, which can lead to further damage. Cognitive rest does not mean complete physical immobility. It is still ok to do light aerobic activity.
A physical therapist will perform an assessment to determine what type of concussion you have (brain or inner ear or both) and will prescribe a specifically designed program based on your presentation. Treatment will include a gradual progression of activity paired with cognitive tasks and will be monitored by your PT. While there is still a belief that rest is the only way to treat a concussion, research has shown that this is inaccurate. Growing evidence suggests that supervised exertion – “ provided it is very well gauged, very well monitored, and injected at the proper sequence of the recovery phase, can play a key role in returning people who have been concussed to full participation in their daily lives.”
Concussion management requires a multidisciplinary approach. In addition to physical therapy this may include referrals to a vision specialist, cognitive specialist, and a neurologist.
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I recently treated a patient who had suffered a concussion during a car accident. She did not have any major injuries, such as broken bones or internal organ damage, and on the outside everything appeared to be normal. However this was not the case. She was unable to return to her office job because she was unable to tolerate sitting at her desk or concentrating on her work, as it would lead to headaches, and neck pain. Driving was challenging because she had motion sensitivity. Even walking up and down the grocery store aisles was difficult, as it made her feel dizzy. This also prevented her from returning to her usual work out routine which included pilates, yoga, and swimming. After 3 months of trying to rest, she decided to seek physical therapy treatment as her symptoms were not improving. My assessment revealed both brain and inner ear concussion symptoms. She had limited neck motion and had increased muscle tension, which we addressed with manual therapy. She also had decreased balance and abnormal gaze stability (which is part of the eye-brain coordination), which I treated with gaze stability exercises and balance retraining. In conjunction with this vestibular therapy, I incorporated activities that would increase her heart rate and allow her to return to previous activities. Once she started the rehabilitation program her symptoms improved significantly. Gradually she progressed over a course of 3 months and was able to return to her full time job, yoga, pilates, and swimming with minimum symptoms.
