Physical Therapy
Treatment
for Concussions

Physical Therapy Treatment for Concussions

Concussion is a mild traumatic brain injury that occurs when the brain is violently shaken during rapid movement changes or when the head is directly hit. This creates changes in the brain’s chemistry and function. Less than 10% of concussions result in a loss of consciousness. 

Concussions can occur at all ages and from many different causes such as motor vehicle accidents (whiplash), falls, head or neck sports injuries and physical assault.

Common symptoms of concussion include:

• Headache
• Dizziness
• Difficulty with balance/coordination
• Disturbances in vision
• Nausea/vomiting
• Difficulty sleeping
• Fatigue
• Exercise intolerance
• Sensitivity to light/sound
• Impaired memory and concentration
• Anxiety/depression

Recovery from concussions varies greatly, lasting several weeks to several months and sometimes years. Concussion-related symptoms are often complex and require input from multiple medical professionals. Historically, conventional approach to post-concussion recovery recommended rest until symptoms subsided. However, newer research suggests that following initial 24-48 hours of absolute or relative rest, active rehabilitation guided by a skilled physical therapist is increasingly important for recovery. 

Physical therapy for concussion rehabilitation consists of addressing the following:

Neck pain & movement dysfunctions

• Vestibular & occulomotor impairments
• Exertional and exercise intolerance
• Motor function impairments

Neck pain and movement dysfunctions
There is limited evidence regarding isolated neck treatment in patients with post-concussion symptoms. However, it has been shown that patients with neck impairments (pain, stiffness, decreased coordination) as a result of their concussion respond well to physical therapy. These treatments are effective alone and in combination with other active rehabilitation strategies. 

Vestibular and oculomotor impairments
Vestibular and oculomotor impairments are common following a concussion. Vestibular impairments refer to symptoms of dizziness, blurred vision, disorientation and/or feeling off-balance or woozy (like the room is spinning). Oculomotor dysfunction refers to impaired control of voluntary eye movements which are important for depth perception, balance and any daily activities that require vision. 

Physical Therapists use targeted exercises to help retrain the vestibular and oculomotor systems. Some research has shown that these interventions, which may be feasible within the first 10 days following a concussion, are associated with decreased dizziness, improved balance and faster return to sport. 

Exertional and exercise intolerance
Advanced research studies indicate that symptom-guided, progressive aerobic exercise can lead to faster brain recovery and resolution of symptoms in people post-concussion. Some evidence has shown that introducing this type of exercise earlier is not only safe and feasible, but may also be advantageous to recovery. Physical Therapists guide this training to ensure it is appropriately progressed to avoid worsening of post-concussive symptoms.

Motor function impairments
Motor function impairments after concussion include difficulty with balancing when standing still and when walking or moving around. Some patients will have difficulty balancing and walking when distracted performing other tasks-both physical and mental.

Physical Therapists address motor impairments such as: static balance, dynamic balance, motor coordination and control, and dual/multi-tasking. Additionally, we utilize strategies that directly help improve your motor function for work/recreation/activity-specific tasks.

Reference:

• Quatman-Yates, Catherine C., et al. “Physical therapy evaluation and treatment after concussion/mild traumatic brain injury: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy, American Academy of sports physical therapy, academy of neurologic physical therapy, and academy of pediatric physical therapy of the American Physical therapy association.” Journal of Orthopaedic & Sports Physical Therapy 50.4 (2020): CPG1-CPG73. https://www.jospt.org/doi/epdf/10.2519/jospt.2020.0301

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