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What is a concussion?

A concussion is a brain injury. Concussions are caused by a bump, blow, or jolt to the head or body. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.

 

What are the signs and symptoms?

You can’t see a concussion. Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days after the injury. If an athlete reports one or more symptoms of concussion listed below, or if you notice the symptoms yourself, keep the athlete out of play and seek medical attention right away.

 

Signs Observed by Family/Friends/Coaches

Symptoms Reported by Athlete

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall
  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  •  Just not “feeling right” or is “feeling down”
 

 

How to prevent a concussion

Every sport is different, but there are steps you can take to protect yourself.

  • Use the proper sports equipment, including personal protective equipment. In order for equipment to protect you, it must be:
    • The right equipment for the game, position, or activity
    • Worn correctly and the correct size and fit
    • Used every time you play or practice
  • Follow your coach’s rules for safety and the rules of the sport.
  • Practice good sportsmanship at all times.

 

Physical Therapy Management of Post Concussion Syndrome

 

Concussion is defined as a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces (Meehan III and Bachur, 2009).  Concussion is commonly referred to as a mild traumatic brain injury (mTBI); however it is a serious injury with potentially dangerous complications.

  • May or may not be caused by a direct blow to the head (e.g. indirect as in whiplash)
  • Rotational acceleration and deceleration force to head
  • Loss of consciousness may occur, however is not required

Symptoms of Concussion Include:

  • Headache
  • Dizziness
  • Nausea and Vomiting
  • Difficulty Balancing
  • Vision Changes
  • Photophobia
  • Phonophobia
  • Feeling “out of it”
  • Difficulty Concentrating
  • Tinnitus
  • Drowsiness
  • Sadness/Emotional changes
  • Hallucinations

Symptoms typically resolve in 7-10 days with active rest and the appropriate structured gradual return to play, which can be assisted by a Physical Therapist.

Post Concussion Syndrome (PCS):  Less uniform definition, however symptoms have persisted for longer than 3 weeks and the individual has 3 more or of the following symptoms Headache, Dizziness, Fatigue, Irritability, Insomnia, Concentration Difficulty, Memory Difficulty, Photophobia, Tinnitus, Visual, and Balance problems (Guskiewicz, 2010).

What Can Physical Therapy Do For Individuals Suffering With PCS?

Vestibular Rehabilitation:

  • Mild head injury has been associated with onset of BPPV a form of vertigo leading to complaints of dizziness, which responds well to Canalith repositioning and Liberatory Maneuvers.
  • Injury to the Cerebral structures, cerebellum, and/or brainstem may be present leading to symptoms of dizziness or dysequilibrium, which can be addressed by a tailored rehab program to facilitate compensation using intact structures for trunk/extremity stability and/or gaze stability.
  • Less common forms of vestibular dysfunction may also be present following head injury including Perilymphatic Fistula or labyrinthine concussion and will include some hearing loss. They require immediate referral to a Neurologist or ENT physician for examination.

 

Visual Tracking Interventions: Studies have shown a significant decrease in oculomotor function following concussion including inability to perform rapid eye movements (Heitger et al., 2009). This dysfunction can lead to a variety of visual disturbances which may benefit from physical therapy interventions to improve gaze stability. Physical therapy may improve ability to perform motor tasks while tracking objects with eyes (including balls, defenders, and goals for sport-specific tasks).

Balance Training: Often balance is significantly limited particularly in individuals with PCS. Numerous studies have shown the benefit of balance specific training particularly for athletes who rely on their stability.

Cervical Assessment: Following mild head injury cervical spine or muscle dysfunction can go undiagnosed, which may contribute to ongoing headaches or dizziness.

When Should I Refer An Individual To Physical Therapy?

As mentioned above the majority of symptoms resolve within the first 7-10 days, therefore if any of the above symptoms persist for two weeks or more a referral to an appropriate physical therapist specializing in concussion or neurologic care is warranted.