A conversation with Alex Flynn, PT, DPT; Clinical Coordinator, Vestibular/Concussion
What are concussions?
Concussions are mild traumatic brain injuries and are common in both contact and non-contact sports. A concussion might occur from whiplash, a head strike, or a collision, whether it’s with an object, the ground, or another person. This impact triggers a neurometabolic cascade in your brain, meaning it changes how the cells in your nervous system are functioning and using energy. These changes happen on a tiny, cellular level, but they can result in inflammation of the whole brain and reduced cerebral blood flow.
Which sports pose the highest risk of concussions?
Football, women’s soccer, men’s and women’s lacrosse, men’s ice hockey, and cheerleading are all high-risk sports for concussions, although concussions can occur in many other sports.
How are concussions diagnosed?
Concussions are diagnosed based on a review of symptoms and medical history, in conjunction with a concussion-specific examination. Concussions will not show up on a CT scan or an MRI. Common symptoms of a concussion include:
- Headache/head pressure
- Neck pain/whiplash
- Dizziness, nausea, balance issues
- Blurry vision, visual deficits, sensitivity to light or noise
- Brain fog, memory/concentration issues
How fast do concussions heal?
The expected concussion healing timeline is three to four weeks for adolescent athletes and two weeks for adults. Healing generally takes longer for children due to developing brain tissue. Pre-existing conditions may complicate and lengthen recovery; these can include learning disabilities, anxiety, depression, visual impairment, and history of concussions and migraines.
Recovery time varies for everyone. While most athletes who sustain a concussion improve without any intervention, a subset will develop persistent symptoms that last longer than expected healing time. These symptoms can fall under an array of categories, including cervical (neck), ocular (vision), vestibular (balance), cognitive, and mood.
How can I recover from a concussion?
In the past, treatment protocol for concussions was focused on “cocooning:” patients were instructed to avoid light and stimulation, not sleep, and to adhere to complete and strict rest. Research has now shown that this approach can actually lead to elongated or persistent symptoms. Current evidence indicates that while rest is important in the first 24-48 hours, once this period is over, a symptom-guided approach is most effective. Participating in activities that do not significantly worsen symptoms can promote healing, by providing the brain with more stimulation. Adequate sleep, hydration, and nutrition are all important throughout the healing process.
How can physical therapy help?
A physical therapist can identify which areas have been affected and how to effectively treat them. Physical therapists can work with physicians and a school’s athletic trainer to develop a targeted program focused on specific goals, like safe return to sport. For concussion treatment for athletes, physical therapy might include activities to increase heart rate and sport-specific movements, such as jumping, cutting and changing direction, and various training drills.
Physical therapy intervention can also involve vestibular-focused exercises to reduce imbalance and dizziness. This might include head movements, to retrain the vestibular system and synchronize the brain and eyes, and oculomotor retraining or occupational therapy, to ensure the eyes are working together. Cervical exercises and manual therapy can help reduce neck pain and improve range of motion. A physical therapy regimen will also involve some level of aerobic exercise, which can facilitate healing while preserving an athlete’s conditioning.
How can I prevent a concussion?
Concussion prevention can be complicated. Some research points to cervical muscle strength playing a role in reducing concussion risk. Ice hockey studies have also demonstrated a mild reduction in concussions with mouthguard use, and in rugby, on-field neuromuscular training warm-ups have been shown to reduce concussions. In general, minimizing contact during sport practices can help decrease concussion risk.
More questions, or want to find a location near you that offers concussion rehabilitation? Click here.
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Sources
Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury