PT Guide to Concussions

*Courtesy of APTA.org

Concussion is a traumatic brain injury that can damage brain tissue and change the chemical balance of the brain. Concussion may cause physical, mental, and emotional symptoms and problems, both short-term and long-term. Every concussion is considered a serious injury by health care providers.

The Centers for Disease Control (CDC) estimates that 2.5 million concussions occurred in the United States in 2010, the most recent year for which the CDC has statistics. A physical therapist can assess symptoms to determine if a concussion is present, and treat the injury by guiding the patient through a safe and individualized recovery program.

What Is Concussion?

Concussion is a brain injury that occurs when the brain is violently shaken. This can happen during rapid movement changes (such as whiplash) or when the head is hit. This shaking or hitting of the head causes unpredictable injury to any area of the brain, resulting in immediate or delayed changes in the brain’s chemistry and function. Depending on which area of the brain suffers injury, many different temporary or permanent problems with brain function can occur..

Concussions can occur at any age, from a variety of causes, including:

  • Car accidents (ie, a head impact, or whiplash)
  • Work accidents (ie, falls, head trauma)
  • Playground accidents (ie, falling from a slide or swing)
  • Sports injury to the head or neck
  • Any type of fall or direct blow to the head, face, or neck
  • Violent events
    • physical abuse during which the head is shaken
    • being too close to a blast or explosion

Recovery from a concussion can take several weeks to several months, depending on many factors, including severity and age.

Concussion may occur along with other brain injuries such as bruising, bleeding, or tearing of the brain tissue. These injuries are very severe and require the immediate care of a medical doctor, such as a neurosurgeon.

CAUTION: Concussions can be fatal or can result in permanent brain damage.  Seek medical help immediately following any head injury.

How Does it Feel?

A concussion can cause a variety of symptoms and problems in many different body functions, such as:

  • The senses (eg, vision, hearing, or sense of smell problems)
  • Body movements (eg, weakness or loss of balance and coordination)
  • Personality and mood (eg, newly-developed irritability, depression, or trouble concentrating)
  • Pain (eg, headaches or migraines)

Concussion sometimes causes loss of consciousness (“blacking out”), but not always.

Signs and Symptoms

There are many symptoms related to concussion, and they can affect your physical, emotional, and mental well-being. Some symptoms occur immediately, some a few hours after the injury, and some show up months or years after a concussion.

It is important to seek medical treatment immediately following any head injury. The risk of death or permanent brain damage from a concussion can be minimized by immediate and appropriate treatment from health care providers, like a physical therapist. Only health care providers have the knowledge and training to identify concussion in the maze of symptoms that can occur following a head injury.

Immediate and short-term symptoms
Physical symptoms:

  • Headache
  • Dizziness
  • Difficulty with balance and coordination
  • Nausea/vomiting
  • Fatigue
  • Difficulty sleeping
  • Increased sleepiness
  • Double or blurred vision
  • Sensitivity to light and sound
  • Slurred speech
  • Glassy-eyed stare
  • Seizures

Cognitive (thinking) symptoms:

  • Difficulty with short-term or long-term memory
  • Confusion
  • Slowed “processing” (for instance, a decreased ability to think through problems)
  • “Fogginess”
  • Difficulty concentrating
  • Worsening grades in school

Emotional symptoms:

  • Irritability
  • Restlessness
  • Anxiety
  • Depression
  • Mood swings
  • Aggression
  • Decreased tolerance of stress
  • Change in personality or behavior

Longer-term symptoms

  • Loss of libido
  • Loss of menses/menstruation
  • Growth problems (children)
  • Fatigue
  • Weight gain
  • Low blood pressure
  • Muscle weakness
  • Chronic headaches or dizziness
  • Muscle spasticity
  • Early dementia/chronic traumatic encephalopathy

Some concussion symptoms do not go away in the expected time frame. These symptoms may need further testing and treatment by a team of health care providers, including a physical therapist.
Postconcussion syndrome is the term applied to symptoms, such as headaches or dizziness that persist for weeks or months after the initial injury.
Second-impact syndrome is a serious, although preventable, complication that can occur after a concussion. If a person who has suffered a recent concussion experiences another concussion, permanent brain damage or death can occur. Permanent brain damage can include learning disabilities, personality changes, walking disability, or other brain or nerve disabilities. Research suggests that a person who suffers a second concussion before the initial concussion has healed, has a 100% chance of permanent brain damage, and a 50% chance of dying.
An example of second-impact syndrome would be a football player who suffers a concussion in a game, keeps playing, and is hit again; or a person who suffers a concussion from whiplash in a car accident, and then falls at home and endures another concussion very soon after the initial injury.
Extreme care should be taken after a concussion to prevent a second injury. 
Athletes who suffer a concussion during practice or competition must be removed immediately from play, in order to prevent further brain damage and second-impact syndrome.

How Is It Diagnosed?

Concussion is most often diagnosed through careful testing by your health care provider, like a physical therapist. The diagnosis of concussion usually does not rely on hi-tech testing, such as an MRI or CT scan, because brain scans often do not show any brain abnormality, even when the person has symptoms of a concussion.

Your physical therapist will ask you many questions to understand all of the symptoms that you are experiencing. Your physical therapist also will perform numerous tests to identify problems caused by a concussion, including strength, coordination, balance, sight, smell, hearing, and memory tests.

During treatment, your physical therapist will repeat the same questions and tests frequently to gauge your progress and help judge when you can return to work, school, sport, or recreational activities.

If you are an athlete who underwent preseason memory (neuropsychological) testing, your physical therapist may collaborate with the health care provider who performed that testing to help determine if you have a concussion.

Your physical therapist may also examine your neck for problems following a concussion. Neck injuries can occur at the same time as concussions, and they can cause or increase headaches and dizziness.

How Can a Physical Therapist Help?

Physical therapists can evaluate and treat many problems related to concussion. Because no 2 concussions are the same, your physical therapist’s examination will assess your individual symptoms and problems, so that the physical therapist can design a safe and individualized treatment program just for you. Treatment may include:

Rest and Recovery. Your physical therapist will help you and your family understand why you should limit any kind of activity (physical, sport, recreational, electronic, school) after a concussion, until it is safe to return to these activities. A period of rest helps the brain heal and helps symptoms clear up, as quickly as possible. Your physical therapist will prescribe the rest and recovery program most appropriate for your condition.

Restoring Strength and Endurance. The physical and mental rest required after a concussion can result in muscle weakness, and a decrease in physical endurance. Your physical therapist can help you regain your strength and endurance, when the right time comes, without making your concussion symptoms worse. Your physical therapist will design a therapeutic exercise program just for you, and closely monitor your symptoms as you participate in the program.

Stopping Dizziness and Improving Balance. If you have dizziness or difficulty with your balance following a concussion, a type of physical therapy called vestibular physical therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, helps you keep your balance and prevent dizziness. A qualified vestibular physical therapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying special treatments or teaching you specific exercises. There even may be some simple exercises that your physical therapist can teach you to do at home.

Reducing Headaches. Your physical therapist will assess the different possible causes of your headaches, and use specific treatments and exercises to reduce and eliminate them. Treatment may include stretches, strength and motion exercises, eye exercises, hands-on techniques, like specialized massage, and the use of technologies such as electrical stimulation.

Returning to Normal Activity or Sport. As symptoms ease and you are able to regain your normal strength and endurance without symptoms returning, your physical therapist will help you gradually add normal activities back into your daily routine. Your physical therapist will help you avoid overloading the brain and nervous system, as you increase your activity level. Overloading the brain during activity after a concussion interferes with the healing of the brain tissue, and can make your symptoms return. Your physical therapist will help return you to your normal life and sport activities in the quickest and safest way possible, while allowing your brain to properly heal.

Can this Injury or Condition be Prevented?

The risk of concussion can be greatly reduced by taking the following precautions:

  • Avoid motor-vehicle accidents:
    • Drive defensively, not aggressively.
    • Eliminate distractions while driving, such as eating, talking on a cell phone, or texting.
    • Choose cars with airbags.
    • Make sure the airbags in your car are in good working order.
  • Avoid risky behavior in sports:
    • Absolutely avoid football techniques that increase the risk of concussion, such as “spearing” and headbutting.
    • Avoid or limit “heading” the ball in soccer.
    • Don’t ignore or hide signs of concussion, even in an important game or competition. Report them immediately to your coach.
  • Remember that neither helmets nor mouth guards prevent concussions.
  • Clear your walking areas at home of any objects that might increase the risk of falling, such as loose throw rugs, dropped objects, loose flooring, torn or rumpled carpets, pet toys, or dishes.
  • Make sure that all traffic areas in your home are well-lit.
  • Avoid exposure to blast explosions and violent events.
  • Do not shake babies, or anyone of any age!

It is imperative to prevent second-impact syndrome after an initial concussion. The injured person should be closely protected until all symptoms have cleared, and normal activity can resume.