Phit Phorum: Phiona Heads It Hard

phionaPhiona is a 15-year-old female star soccer player. After today’s game, she admits to her parents that she is feeling a bit dizzy after “heading” the ball a number of times. She says a little dizziness is “common” for her, but now she has a headache and the bright headlights of oncoming cars are hurting her eyes. Phiona has trouble concentrating at home as she tries to do her homework. She also has trouble falling asleep. Her dizziness gets worse when she changes her head position. Her parents worry that she may have a concussion, and check on her throughout the night. They call their physical therapist the next morning, and take her to see him right away.

Phiona’s physical therapist asks her all about her symptoms. He tests her eye motion, balance, strength, coordination, memory, and face and neck motion. He gently touches her neck and upper shoulder muscles to check for tightness. After a thorough examination, he determines that Phiona has indeed suffered a concussion and needs to begin treatment immediately.

First, he explains to Phiona and her parents that she will need to “rest her brain” for a few days. That means that she will avoid school, homework, sports, exercise, TV, cell phone, tablet and computer use, reading, and anything else that makes her symptoms worse. He encourages Phiona to sleep as much as she wants. He explains the importance of avoiding second-impact syndrome. He learns from Phiona that her coach had all the athletes take a preseason memory test, so he arranges for her to be retested by the same health care provider.

Phiona’s physical therapist then begins to address her dizziness by performing some special techniques for the inner ear. After a few minutes, Phiona notes that her dizziness is much less. He then gently treats Phiona’s tight neck by applying electrical stimulation and specialized massage techniques. He teaches her some easy stretches that she can do at home, and reminds Phiona to “rest her brain” for the rest of the day. He gives her parents a handout of directions for symptoms to watch for in Phiona while at home, and when to call him or their family physician.

The next day, Phiona returns for physical therapy treatment and says that she has slept much better. She says bright lights are not hurting her eyes as much, and her dizziness is almost gone. Her physical therapist rechecks all the tests he performed the day before, and notes that she has better neck motion. At the end of her treatment session, Phiona says that her headache seems to be less, as well.

Phiona returns for physical therapy treatment several more times over the next week, and her symptoms rapidly improve. In the second week, Phiona is free of symptoms for 48 hours; her physical therapist determines that she is ready to try a gradual return to activity.

He develops a “return to activity” plan, using Phiona’s goals and input. She starts performing a little bit of aerobic exercise and low-level strength training during her physical therapy treatments. Her physical therapist watches her closely to see if any symptoms and problems return during the exercises. Phiona is able to gradually increase her exercise each day, without the symptoms returning. She also goes back to school for half-days.

During the third week of treatment, Phiona’s physical therapist determines that she is ready to try easy soccer drills. She is able to remain at school for full days, now, and to complete her homework, with no return of symptoms.

In the fourth week of treatment, Phiona is able to perform vigorous soccer drills during her physical therapy treatments, without the concussion symptoms returning at all-even within the following 24 hours. Her physical therapist determines that Phiona is ready to attend a short soccer practice; he collaborates with her soccer coach to plan a gradual return to practice and games. Her physical therapist advises her to avoid “heading” the soccer ball for a few weeks, and to limit use of that technique in the future.

Six weeks after the concussion, Phiona plays her first game back with her team, is symptom-free, and helps set up a winning goal!

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