Every year, millions of people suffer mild traumatic brain injuries (mTBI) or what we commonly call “concussions.” Because concussions are a silent injury and its symptoms can be elusive, the medical community believes that the actual number of concussions is dramatically underestimated.
Although most of us think of concussions as a contact sport injury, one does not need to participate in football, boxing, or hockey to receive a concussion. This injury can result from any activity where there is a blow to the head or a violent shaking of the head or body. For example, even if you don’t hit your head in an auto , whiplash can trigger a concussion. in an We see many adult patients with concussive injuries who were in auto collisions, slipped on black ice, or tripped and fell, and we see child patients who have been in playground accidents such as falling from a slide or swing.
In the past, we thought of a concussion as having your “bell rung.” We viewed it as a minor, benign injury that would self-resolve over time with some rest rather than a type of traumatic brain injury. We know now that is not the case. Any head injury is potentially serious and you can’t always just “walk it off.”
Concussion research and heightened media attention to this issue has shed light on the potentially serious nature and long-term ramifications of concussions. Studies indicate that upwards of 30% of individuals who have suffered a concussion experience symptoms and impairments that can last for extended periods of time, from months or years to a lifetime. Needless to say, more sufferers of concussions are seeking care for these injuries, and they are using the tools and resources of physical therapy as an important part of their treatment plan. Physical therapy can help alleviate the often debilitating problems associated with concussions and to allow patients to resume the daily life and athletic activities prior to the trauma.
Concussion Signs and Symptoms
Unfortunately, there are no uniform signs and symptoms following a concussion. They are subtle and worsen slowly and incrementally. The signs and symptoms one experiences depends on the areas of the brain that have been injured. Sometimes, the signs and symptoms show up immediately, and sometimes they are delayed. There is a misconception that you only have to worry about a concussion if the injury involves is a loss of consciousness. That is NOT the case. In fact, loss of consciousness is associated with less than 10% of concussion injuries.
Because of the challenging nature of diagnosing a concussion, anyone who has had a head injury should be monitored not only immediately, but for a period of time thereafter. If someone who has had a head injury appears “off” in any way, no matter how subtle, medical attention should be sought immediately. For children, the American Academy of Pediatrics recommends that a child’s pediatrician be notified for anything more than a slight bump on the head.
Anyone with a suspected head injury should receive an immediate medical diagnosis to determine the extent of the trauma. Brain tissue that is bruised, bleeding, or torn requires the intervention of a neurosurgeon or other qualified medical professional. If untreated, concussions can lead to permanent brain damage. Please seek medical help for any head trauma. There may well be internal injury in the absence visible external injury.
Concussions often occur with other injuries, especially injuries to the neck and surrounding soft tissue damage. These related injuries can be effectively managed by a physical therapist.
The signs and symptoms of a concussion can present in numerous ways. This is a non-exhaustive listing of concussion signs and symptoms that someone may experience after a head injury:
- Headaches or a feeling of pressure in the head
- Physical coordination problems, loss of balance, or unsteady walking
- Temporary loss of consciousness
- Feeling dazed, confused, or “in a fog”
- No memory of the traumatic event
- Dizziness or “seeing stars”
- Ringing in the ears
- Nausea or vomiting
- Slurred or repetitive speech
- Double or blurred vision
- Glassy-eyed stare
- Delayed response to questions
- Fatigue, listlessness, and tiring easily
- Inability to concentrate, slowed “processing,” and short-term memory issues
- Irritability and other personality changes
- Sensitivity to light (photophobia) and noise
- Sleep disturbances
- Psychological adjustment problems, mood swings, anxiety, and depression
- Disorders of taste and smell
There are also longer-term symptoms, including what is now being extensively researched in football and other contact sports, the condition known as chronic traumatic encephalopathy (CTE).
The Role of Physical Therapy in Concussion Treatment
A qualified physical therapist can both assess whether the head injury resulted in a concussion, and if so, can develop a safe and individualized recovery program. Incorporating physical therapy as part of a patient’s multidisciplinary care can significantly facilitate the recovery of patients who have had concussions. For those struggling to recover from concussive injuries that have not self-resolved in a matter of days or weeks, physical therapy can play an important role.
There is no single test or tool to diagnose concussions. We often think of “hi tech” testing such as MRIs and CT scans, but these tests do not always provide medical providers with definitive answers. Physical therapists can play an important role in helping to diagnose concussions through a detailed examination and tests to identify those areas impacted by concussions including muscle strength, coordination, balance, sight, smell, hearing, and memory. No two concussions present the exact same way and your body systems impacted by a concussion, especially neurological, orthopedic, and cardiovascular.
Physical therapists have numerous post-concussion assessment tools as our disposal, including:
- symptom scales (e.g., Post‐Concussion Symptom Scale; PCSS),
- neuropsychological tools (e.g., Immediate Post‐Concussion Assessment Tool; ImPACT)
- oculomotor function screens (e.g., gaze stability testing)
- balance assessments (e.g., Balance Error Scoring System)
- headache assessments
- cervical strength and motion assessments
- vestibular assessments
- cardiovascular and respiratory assessments
Physical Therapy Can Help Concussion Patients Return to Normal Life
Perhaps, the most common misconceptions with concussions is that all that can be done is rest and wait for the injury to self-resolve. Of course, no one should engage in intense exercise too soon after a concussive injury. Also, for the period immediately following a concussion, patients should have complete physical and cognitive rest until the symptoms resolve. For those with temporary symptoms that resolve on your own, rest can be the best medicine. A physical therapist can determine those athletic or daily activities that need to be limited and determine when it is safe to resume those activities on a limited basis.
The problem arises when concussion problems linger and life is disrupted in a major way. In these situation, physical therapy can be a critical element of the treatment plan. Physical therapists experienced working with concussion sufferers can develop and implement a customized and appropriate exercise-based plan.
For those individuals with prolonged concussion symptoms, active rehabilitation facilitates the recovery process. Gradual, PT-supervised exercise training promotes brain neuroplasticity contributing to symptom resolution and improving overall patient well-being. Physical therapy can help concussion sufferers adapt to increased physiologic activity and provide a shorter path toward regaining one’s physical and cognitive levels prior to the injury.
Physical therapy can help concussion patients:
- Restore strength and balance
- Use vestibular physical therapy to stop dizziness and improve balance
- Reduce headaches with specific treatments and exercises