Concussions can be very complex injuries with a broad range of potential outcomes. Because each concussive event and case is unique, there is no certain timetable for recovery. Some who suffer a concussion recover in days, other people require weeks or months, while some may endure long-term concussion effects. What is certain is that all concussions can become a serious medical issue thus warrant prompt care by a health professional trained in managing concussions, as we are here at Perfect Stride.
A direct or indirect hit to your head or any force causing your head to jerk (similar to whiplash) can result in a mild traumatic brain injury (mTBI) called a “Concussion”. As your brain sits inside your skull it is surrounded by fluid. When your head takes a hit your brain shifts or shakes around inside the skull. The impact and forceful disruption damages blood vessels, nerves, and brain cells creating chemical and cellular changes in the brain. The result is your brain to some measure or degree doesn’t function as it should. After a concussion, you may experience vision changes, balance deficits, or in severe cases, fall unconscious as the brain is confused.
Concussions are diagnosed based on the patient’s symptoms and findings of a comprehensive clinical assessment. At Perfect Stride, for athletic injuries we use some variation of the Sports Concussion Assessment Tool 5 (SCAT5) for concussion assessment. Developed by leading concussion experts, the SCAT5 is a multi-modal assessment that includes the Glasgow Coma Scale, patient symptoms, neurocognitive function, and patient balance. We also go into further assessment of vestibular function, exercise and movement tolerance, neck mobility and strength, and balance and coordination testing.
It is important to know that each patient presents differently. We emphasize the subjective portion, listening to you, the patient, after a concussive event. It is imperative to us that we take a biopsychosocial approach to concussions, as we know from the latest research that many experience more than just physical complaints, but psychological and social complaints as well. These events can affect daily and social life, and it is crucial to us that we get you back into your routines as soon as possible and as pain-free as possible.
There are many cases per year that involve the pediatric population, consisting of children under the age of 18 years old. Many of these individuals were participating in sports/physical activity when the injury occurred, though there are many other causes.
Most people who experience an acute concussion recover within a few weeks of treatment. However for a smaller percentage of people, concussion symptoms continue for weeks, months, or even years resulting in a condition known as Persistent Post-Concussion Syndrome (PPCS). Persistent Post-Concussion Syndrome is a disorder in which some symptoms, such as headache and dizziness, persist following a concussion. Many children experience difficulties such as focusing in school, decreased physical activity level, reading difficulties and light sensitivity. It’s not uncommon for patients to be told by health care providers to avoid anything that aggravates their symptoms and to in effect “wait it out”. It’s also not unusual to learn of patients searching and going from specialist to specialist in effort to find relief
Physical therapy has been effectively used to treat Post-Concussion Syndrome; however it should be noted there is no one-size-fits-all routine protocol. In recent years, there’s been more awareness and acceptance of the benefits of physical therapy in treating concussions, especially when physical therapists are part of a multidisciplinary treatment team. In 2017, the American Physical Therapy Association wrote about growing research evidence of the benefits of using physical therapy in concussion management (Beyond Rest: Physical Therapists and Concussion Management).
Historically the popular medical advisory after a concussion was to “cocoon” until concussion symptoms disappeared. This involved shielding patients during concussion recovery from mental stimulation or physical activity. Patients were instructed to rest for days in dark, quiet rooms. Prohibited activities included using electronic devices, reading, socializing, and exercising. While sufficient rest after a concussion is still important, we now know that cocooning is not the most effective way to recover from a concussion.
Research has demonstrated after a couple of days, some aerobic exercise (small amounts done in a safe environment) actually helps shorten recovery time. The key is performing this exercise below symptom provocation, with studies indicating this may aid in improving autonomic balance and cerebral blood flow auto-regulation. Mild aerobic activity is effective in increasing blood flow to the brain, which enhances the amount of oxygen provided to brain cells, stimulating growth of the proteins promoting healing. A detailed evaluation will involve safely assessing this threshold and establishing a sub-threshold program to attain this desired effect.
Successful treatment of post-concussion syndrome requires receiving an increased blood flow to the brain and the natural production of healthy brain chemicals we call the post-exercise cognitive boost (PECB). Studies have shown the PECB provides a window of time after exercise in which cognitive abilities are sharpened and the brain essentially has the ability to self repair to perform more complex cognitive exercises.
However, the challenge for many post-concussion syndrome patients is that an aversion to exercise is commonly one of the persistent symptoms they’re suffering from. Exercise and specific movements/positions can bring about debilitating symptoms such as nausea, headaches, brain fog, dizziness, and fatigue for anyone who’s experienced a concussion.
Unsupervised, patients with post-concussion syndrome often push themselves until they overload their system, setting them back and waiting for their symptoms to subside. This vicious cycle of frustration need not be. As physical therapists we’re mindful of these challenges and are experienced at helping patients break through these episodes and all other obstacles associated with concussion symptoms.
People are affected by concussions differently and it would be a mistake to compare your concussion symptoms and recovery to another person or even a previous concussion you may have sustained. Individualized treatment is a necessity in optimizing ones’ recovery.
“I have been seeing Brian for several months, and I can honestly say he’s the best physical therapist I’ve ever been to. I struggle with migraines and neck pain from a sports injury and concussion a few years back, and I have been to countless neurologists, physical therapists, anyone else who could possibly help, etc – nothing has helped quite like Brian. He listened carefully to my symptoms and my experiences, respected and acknowledged my concerns, and has taken great care to create exercises and treatments that work specifically for me. He’s extremely knowledgeable, thoughtful, and truly knows what he’s doing. Over the last few months, I’ve experienced improvements that I never expected. I look forward to our sessions every single week, because I always leave feeling so much better than when I walked in. I wholeheartedly recommend Brian and Perfect Stride to anyone.”
Jacqueline P (5 Star Google Review)
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