Concussion Recovery: Physical Therapy?


There has been a tremendous movement over the past decade to increase awareness about concussions. There are now international guidelines on concussion management in place. A typical recovery following a concussion will occur within 30 days, when the athlete is then cleared by a medical professional to return back to sport. However, it has been documented that up to 20 percent of the child and adolescent population has concussion symptoms that linger for longer than four weeks. The most common symptoms that persist post-concussion are headaches, dizziness and blurry vision. Unfortunately, an athlete with prolonged recovery can also experience varying degrees of depression and anxiety. This is one of the many reasons it is important to have a multidisciplinary team of experts treating this condition.

For athletes with unresolved symptoms post-concussion, physical therapy can become a part of the patient’s care. Based on the patient’s symptoms and impairments, the doctor may additionally recommend occupational therapy and speech therapy. The young athlete may receive physical therapy to address impairments and functional limitations associated with their symptoms, as well as prepare them for returning to their sport.

What is concussion-based physical therapy?

After sustaining a concussion, the young athlete is referred to physical therapy, where the physical therapist evaluates the athlete so that they can detect impairments related to their symptoms. A patient’s symptoms are addressed through treatment of the identified body systems that are contributing to the prolonged symptoms. The physical therapy care for these patients, is a unique blend of vestibular therapy, neurologic rehab, vision training, balance retraining, orthopedic care and functional movement retraining. Rehab exercises can include anything as basic as eye exercises or as advanced as counting backwards by 7’s while doing a fast paced pivot turn catching drill.

Prior to each child being discharged, they must improve their symptoms in combination with completion of a sport specific exertional test. In the exertional test, the athlete will be required to complete a half-hour of pre-planned activities. Each clinician conducting the test has criteria they are assessing, including any of the following: heart rate response, symptoms and ability to complete the test.

Why would a young athlete need physical therapy post-concussion?

In the world of sports medicine, physical therapists are part of the post-concussion care team. Physical therapists have been a part of brain rehabilitation, referred to as neurorehab, for many decades now. Since concussion is classified as a mild traumatic brain injury, neurorehab is part of the treatment to address the following domains: balance, walking patterns, coordination and the communication between the eyes, brain and inner ear system. These allow the athlete to respond to their surrounding environment, such as the ability to see a soccer ball clearly while receiving a pass from a teammate while running down the field.

At the time of injury, the neck under goes forces that are related to whiplash or high rotational forces that leave the surrounding muscles feeling sore at best. Some headaches and most cases of neck pain are caused by dysfunctional movement patterns of the neck. A physical therapist can help rehabilitate the neck through a variety of techniques.

A longstanding recovery can negatively affect an athlete’s conditioning; thus, the physical therapist also helps guide the patient through safe forms of exercise to gradually load the athlete’s body. This progression is based off the physician’s guidance, standardized testing, current return-to-play protocols and the athelete’s symptoms.

Research is being done to investigate the relationship between common sports injuries (knee injuries, ankle injuries) and concussions. Knowing there can be a relationship between these two, a sports physical therapist will also look at a patient’s injury history to help address injury prevention and maximize an athlete’s readiness for return to sport. This is especially true when the athlete intends to engage in a contact sports.

In Conclusion

Post-concussion care is rapidly evolving, and with the increasing research available, we now have evidence to help kids recover. If you’re a parent suspecting your child has unresolved post-concussion symptoms, please speak to your physician about physical therapy. The goal of the clinicians is to do what they can now to help a child avoid post-injury complications that could follow them well into adulthood.

References:

  1. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med Published Online First: 26 April 2017. doi: 10.1136/bjsports-2017-097699

  2. Gioia GA, Schneider JC, Vaughan CG, et al. Which symptom assessments and approaches are uniquely appropriate for paediatric concussion?. British Journal of Sports Medicine 2009;43:i13-i22.

  3. LH Tee, NWC Chee. Vestibular Rehabilitation Therapy for the Dizzy Patient. Annals Academy of Medicine. 2005; 34.4. 289-294.

Jennifer Kieschnick, PT, DPT is a pediatric orthopedic and sports medicine physical therapist, at the Children’s HealthSM Andrews Institute for Orthopaedics & Sports Medicine in Plano. She attended Texas Tech University Health Sciences Center and received a doctorate in physical therapy. She has been practicing physical therapy since 2010, and her special areas of interest include aiding in the recovery of young patients suffering from post-concussion symptoms, as well as guiding recovery after ACL reconstruction and general orthopedic conditions. She is certified by the Functional Movement Systems (FMS) in the Selective Functional Movement Assessment (SFMA) and her passion is promoting health and wellness in young patients, through her practice in pediatric sports medicine and orthopedics.


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