How many times have we heard this advice in regard to concussion? The CDC estimates between 1.6 to 3.8 million concussions occur each year, and yet this invisible injury was, until recently, often diagnosed and treated with just time and rest. Thankfully, in the past 5 years, that mindset has shifted.
In 2016, the 5th Berlin Consensus Statement on Concussion in Sport acknowledged that strict rest until symptom-free wasn’t achieving the ideal outcomes for patients.
“After a brief period of rest during the acute phase (24–48 hours) after injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds (ie, activity level should not bring on or worsen their symptoms).”
Taking that a step farther, this is the first consensus to advise rehabilitation for persistent concussion symptoms, “that is, symptoms that persist beyond expected time frames (ie, >10–14 days in adults and >4 weeks in children”. More recent research supports starting physical therapy even earlier. In 2018, a study by the University of Pittsburgh Sports Medicine Concussion Program showed those who started the rehabilitation process within the first week after injury recovered faster and were less likely to have persistent concussion symptoms (PCS).
So what can physical therapy do for an “invisible” brain injury? Often, we need to address any peripheral vestibular issues, cervical spine injury, balance or coordination deficits, and any problems with how the eyes move, separately or together. On your end, this would help with headaches, dizziness, fogginess, imbalance/disequilibrium, and difficulty reading or focusing. The physical therapist will look at your specific symptoms and develop a personalized exercise program to expedite your recovery.
On top of addressing the early issues, the PT will also take you through a safe return to exercise program. This may start with graded exercise tolerance testing using the Buffalo Concussion Treadmill Test, and can carry through for a full return to play program for any athletes or weekend warriors.
A team approach is the best approach towards concussion management. If you’re working with your primary care doctor or neurologist, ask them about early physical therapy to address your symptoms faster. At Foothills Physical Therapy, we are happy to answer any questions they or you may have on how PT can help get you back to work, school, and sports as quickly as possible!
Sarah Kibiloski, PT, DPT
Kontos A, et al “Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion” JAMA Neurol. 2020;77(4):435-440. https://jamanetwork.com/journals/jamaneurology/fullarticle/2757869
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” British Journal of Sports Medicine 2017;51:838-847. https://bjsm.bmj.com/content/51/11/838.long