CONCUSSION: TREATMENT & RETURN TO ACTIVITY

Last I spoke upon the topic of concussions, I covered how to recognize and properly diagnose a concussion. To recap, concussions occur when an external force results in excessive contact between the brain and the skull. Loss of consciousness may occur, but it is not the determining factor. Signs to look for when attempting to recognize a potential concussion include:
– Dizziness
– Headache
– Blurred Vision
– Nausea/Vomiting
– Confusion
– Sensitivity to Light or Sound
– Loss of Consciousness
Once a concussion is confirmed, however, treatment should begin immediately. Initial treatment includes avoidance of strenuous physical and mental activity, such as sport, fitness activity, television, music, reading, texting, and, to an extent, schoolwork/work. The brain needs time to heal just like any other tissue, and resting it is essential in the healing process. Gradually, activities can be resumed more normally as symptoms improve, but returning to normal activity too quickly can slow recovery.
When appropriate, an athlete who has suffered a concussion can enter physical therapy. Treatments generally begin at a very basic level and progress as is tolerated by the athlete. Treatment strategies that may be used include:

  • Cardiovascular Training
  • o Bicycle
    o Elliptical
    o Treadmill
    o Swimming

  • Strength Training
  • o Free Weights
    o Resistance Machines
    o Band Resistance
    o Body Weight

  • Stretching
  • o Arms
    o Legs
    o Spine
    o Neck

  • Postural Training
  • o Re-Education to the Proper Upright
    o Sitting
    o Standing
    o Bending/Lifting Mechanics

  • Balance Training
  • o Static Sitting/Standing
    o Dynamic Sitting/Standing

  • Manual Techniques
    o Soft Tissue Mobilization
    o Joint Mobilization
    o Myofascial Release
    o Active Release
    o Trigger Pointing
    o Traction
     
  • Vestibular Maneuvers
  • o Hallpike-Dix Maneuver

  • Sport Specific Training (usually toward the end of an athlete’s need for treatment)
  • o Running
    o Jumping
    o Agility Drills
    o Sport Equipment Use (helmets, bats, sticks, balls, etc.)

In addition to physical therapy treatment, medication may be prescribed by the athlete’s physician to combat certain symptoms, but prescription medication is not always necessary. Common medications include:
– Amitriptyline for dizziness, irritability & depression
– Topiramate for headaches
– Gabapentin for pain reduction & headaches
It is appropriate for an athlete to return to normal daily life and sport when he or she exhibits no signs of symptom provocation with physical exertion. Tasks should be similar to those that the athlete will encounter throughout the day, including daily activities and sport specific activities. Once an athlete returns to sport, he or she should be monitored for any potential return of symptoms.
I truly hope that my series on concussions, including recognition, diagnosis, treatment, and return to activity, has given you an insight on a very prevalent medical issue. With this information, it is my hope that we as a society can limit the occurrence of concussions in athletes and the general public and properly treat a person who suffers a concussion if it were to occur.
In the meantime, have fun playing whatever sport or doing everything in life that makes you happy!
Thanks for reading!
– Rob Kohutanycz, PT, DPT

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