Concussion Management: What we know now
Concussion Management: What we know now & How Athletic Therapy can help
A sport-related concussion (SRC) is defined as: ‘a traumatic brain injury induced by biomechanical forces.’1
Although research focuses on SCR, we know concussions can occur outside of sport and ‘may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.’1
After years working exclusively in a non-contact sport (rowing), with little risk of sport-related concussions, I hadn’t dealt with many concussions since my time with rugby. Earlier this year, I suffered my own concussion and whiplash (a first time for me) playing wheelchair basketball. You can read about my full recovery here.
Unfortunately I didn’t fall into the typical timeline of 10-14 days1 and had a prolonged recovery of 10 weeks. My experience helped me create a new perspective on concussion management. I realized that most of the resources available focused on what you CAN’T do, not the things you CAN and SHOULD do, to speed along your recovery. I also realized that the same fear-mongering language we often see with patients with back pain, I was noticing around concussions. Although I have education on concussion and have helped others manage through their concussion recovery, I still felt anxiety and feared that I would never get better and back to doing the things I loved.
That feeling created a determination to help others navigate through concussion recovery and in good timing, the 5th Consensus for Concussion in Sport was released – compiling research from the last 4-5 years (the previous consensus was released in 2012). You can read the full text here
Here’s what we know:
Concussions are multi-factorial and therefore should be assessed and treated with multifaceted collaborative care.
Individuals who have suffered from a concussion may fit into one, a couple, or all of the following categories. A thorough assessment with a Certified Athletic Therapist can help determine which classification you fit into which will help guide your treatment plan including which other practitioners should be involved with your recovery. Your team should include a sports medicine physician, and in addition to a Certified Athletic Therapist, may also include a clinical counsellor or psychologist, optometrist, neuropsychologist, occupational therapist, dietician and others depending on your signs and symptoms.
There are 6 different types of concussions:
Cognitive:
- Decreased ability to concentrate or multi-task
- Difficulty learning new information
- Poor Memory
- Increased fatigue
Ocular-Motor:
- Difficulty coordinating eye movements
- Headache, fatigue
- Difficulty focusing vision
Vestibular:
- Difficulty with balance
- Difficulty with hand-eye coordination
- Difficulty stabilizing vision with head movement (e.g. dizziness)
Anxiety/mood:
- Anxiety
- Irritability
- Mood swings
Cervicogenic:
- Headaches
- Neck pain
Post-traumatic migraine:
- Headache, nausea
- Sensitivity to light or noise
ReThink Concussions has an excellent infographic describing these classifications, which can be found here
Complete rest is not best
Sub-symptom threshold aerobic exercise has been shown to be beneficial in individuals who have had prolonged recovery and can be implemented in as little as 24-48 hours after injury.2 *This timeline of full physical and cognitive rest will vary from individual to individual and should be implemented by a qualified health care practitioner familiar with concussion management and only after ruling out other head and neck traumas.
Here is a great summary of how we went from rest-is-best to physical activity as a treatment by Complete Concussions: When is rest NOT the best advice to concussion patients
How can Athletic Therapy help?
Baseline Testing:
ImPACT is a computerized neurocognitive assessment tool to help licensed healthcare providers evaluate and manage a suspected concussion. By completing the test at the beginning of the season, your Athletic Therapist can use the results to compare to your post-injury testing to help in the assessment of your concussion. Learn more about ImPACT here
Post-Injury Assessment:
If you believe you have suffered concussion, Athletic Therapists can provide a comprehensive clinical assessment, including computerized neurocognitive assessment tools such as ImPACT, as well as a detailed interview and clinical tests to determine which category of concussion that you fall into (i.e. cervical, ocular, vestibular, mood/anxiety, cognitive and post-traumatic migraine). Athletic Therapists can use the results of the assessment to recommend a treatment plan and refer you to any practitioners that may be appropriate. The assessment can also be shared with your physician to guide their treatment plan including any further testing.
Treatment & Rehabilitation:
Athletic Therapists specialize in musculoskeletal injuries, meaning if you suffered whiplash with your injury or are experiencing signs and/or symptoms of a cervicogenic concussion, we can treat you using manual therapy techniques and strengthening exercises for your neck. We can also provide basic ocular and vestibular exercises and recommendations around return to work and school, referring out to specialized practitioners if you have persistent symptoms. As exercise is now a treatment for concussions, we can guide you through an aerobic exercise test using heart rate and RPE (Rate of Perceived Exertion) to determine your sub-symptom threshold and provide you guidelines on appropriate progressions. Exercise has been shown to improve mood and anxiety related to a concussion3 however if you are experiencing psychological symptoms it is recommended you work with a registered psychologist or a clinical counsellor. Athletic Therapists are used to working as part of a team and encourage open communication between practitioners to maximize recovery with our patients.
Return to Play Protocol:
After symptoms have been resolved, there is a 6-step return to play protocol that an athlete must complete before it is appropriate and safe to return to sport. An Athletic Therapist can help you guide you through this process (either supervised or unsupervised) and advise you when you can move to the next step. We will provide documentation of each stage, provide a summary of your recovery plan and send it with you to your physician so they have all the necessary information to make a final decision on if you’re ready to be cleared for sport!
It takes a village!
Like any injury, concussions can be difficult to manage and the recovery process can be frustrating. Having a good team around you to support you in your recovery can make all the difference, getting you back to what you love faster – it did for me. If you’d like to learn more about how an Athletic Therapist can be an important part of that team, contact us today or visit athletictherapy.org to find an AT in your area.
Concussion Management. Athletic Therapy Plus, All rights reserved
References
- McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5thinternational conference on concussion in sport held in Berlin, October 2016. [SportsMed]
- Schneider KJ, Leddy JJ, Guskiewicz KM, et al Rest and treatment/rehabilitation following sport-related concussion: a systematic review [SportsMed]
- Marshall S, Bayley M, McCullagh S, et al.Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms.Brain Inj. 2015;29(6):688-700. [PubMed]