Physical Therapy For Concussion

A concussion is an injury to the brain that results in neurologic dysfunction.

A concussion is an injury to the brain that results in neurologic dysfunction.

Today, I am going to teach you what you should do if you have sustained a concussion.  I will also explain how physical therapy can be a beneficial treatment to help fix your symptoms.

What is a concussion?

The Zurich Guidelines defines a concussion as an injury to the brain that results in neurologic dysfunction. This is an oversimplification; however, for the purpose of this post, let's keep things simple.  A concussion is a brain injury.

Sustaining a concussion does not always occur on a sports field.  Certainly, sports related concussions are the most publicized, yet concussions also occur from car accidents, slip and falls, or simply “bumping your head.”

It is important to understand that you may have suffered a concussion even though you never hit your head.  You may have experienced a whiplash motion of your neck, which can cause a concussion due to the acceleration forces on your brain.

Many people who have suffered a concussion will develop immediate symptoms of headaches, dizziness, or nausea.  Most of the time these symptoms quickly resolve within 24-48 hours and 80-90% of people will have complete resolution of symptoms within 7-10 days with active rest. I will explain active rest shortly.

The most common signs and symptoms of a concussion are headaches, dizziness, and nausea.  But, there are many other symptoms that you may be experiencing.  Check them out here. Sometimes, you may simply “feel off.”  This does NOT mean that your concussion is less serious.  You should still be properly evaluated by a professional. 

What Do I Do First If I Believe I Had A Concussion?

Current recommendations are to get rest for the first 24-48 hours. It is important to rest your brain and eyes following a concussion.

This does not mean locking yourself in a dark room. You should, however, avoid aggravating stimulus such as loud noise, lights, and computer screens until you are feeling better.

This process is called active rest. You are allowing yourself some activity, but restricting the amount of exposure.  It has been shown that children who are put on complete rest  ( meaning no talking, no TV, no reading, etc.) may show higher levels of anxiety and even report more symptoms.  This makes sense because they have nothing to focus on except for their injury.  We need to rest our brains, but not shut our lives down.

Also, remember, most people (80-90%) who sustain a concussion do spontaneously recover within 10 days. This means that your symptoms may be gone; however, it may actually take up to 30 days or longer for your brain cells to fully heal.  This has implications for returning to sports too early and will be covered in a separate post.

In many cases people are fearful or filled with anxiety after a concussion.  This makes sense!  You just hurt your brain and are having some crazy symptoms, which you never experienced before.  Do your best to stay calm and not let your emotions get the best of you.  There is hope and there is help!

Speaking of emotions, your emotions may go WILD following a concussion.  This is called emotional lability or dysregulation.  Your emotions live in your brain and as you have learned, a concussion is a brain injury.  You should try to explain this to your friends and family members so that they understand and can help support you.  A brain injury can be an invisible injury and people may not understand what you are going through as they cannot physically see your injury.

Physical therapy can help fix the symptoms from your concussion.

Physical therapy can help fix the symptoms from your concussion.

How Can Physical Therapy Help My Brain?

Physical therapy can help resolve your symptoms and get you back to work, sport, and play!

Physical therapy takes a unique approach to fix pain by addressing the problems where they start.

There are 3 main focuses of physical therapy to help fix the symptoms associated with post-concussion syndrome.

Vestibular Rehabilitation

 Your vestibular system is responsible for balance and eye movement (among other functions not typically affected following a concussion).

 When you read, look at an object and turn your head, or simply follow something with your eyes, you are using your vestibular system!  These activities may reproduce your symptoms due to your injury. 

People sometimes describe a pressure behind their eyes, headaches, or dizziness. There are exercises that your physical therapist can prescribe to specifically target your vestibular system to fix these problems. 

You can think of it just like any other exercise you may perform if you hurt yourself. If you hurt your shoulder or back, you would want to perform exercises to improve the strength and reduce your pain, right? This is no different for your vestibular system.

Cervical Spine

 Your neck can be responsible for many of your symptoms, including headaches and dizziness.  Many people also suffer from generalized neck pain due to the whiplash mechanism of injury.   

You may be feeling a stiff neck and physical therapy can help by performing skilled mobilizations designed to restore natural motion.

There may also be muscular imbalance that can result in neck pain, dizziness and headaches.  Physical therapy will identify your specific needs and design a program to FIX your problems.

Exertion Training

Symptoms may occur when trying to return to exercise, sports, work, or other activities. This can occur as your brain and body are not adapting properly to physical exertion. 

Physical therapy can design a specific exertion program based on your heart rate to get you back to living a normal life.

Where Should I Look To Find The Right Physical Therapist?

The first place to look is the APTA Online Directory.  The ABPTS (American Board of Physical Therapy Specialists) will also be an excellent resource. 

Please notice how I mentioned the RIGHT physical therapists.  Not all physical therapists are equipped to treat the many systems involved with a concussion.  You wouldn’t see your foot doctor for shoulder pain, would you?

In many places around the country you may actually need to see 2-3 different physical therapists depending on your symptoms.  A vestibular therapist to address your dizziness, an orthopedic therapist to address your neck pain, and a sports therapist to design an exertion program.

While this doesn’t sound ideal, if there is not a therapist in your area trained to handle all components of your post-concussion rehab it will be in your best interest to find one of the above and coordinate to get the best care.  I would advise starting with a vestibular therapist.

In my training I have been fortunate to have mentoring and education that enables me to treat all aspects of post-concussion syndrome.  This allows me to oversee the entire course of care without any details falling through the cracks.  

Finally, not every concussion is the same.  When choosing a physical therapist you should be sure to find one that will dedicate their time to you and truly listen to what your specific symptoms are and how they are affecting your life.  This will make all the difference in your recovery!

I hope you found this discussion helpful.

To recap:  You learned what a concussion is, what to do if you suspect a concussion, and how physical therapy can help fix your symptoms.

Charles Kretchek