Concussion Awareness: Recognition and Treatment

By Michael Marcello, DPT 
The start of fall brings on the start of a new school year and student athletes are returning to the classroom and field. Student athletes from all sports are susceptible to sustaining a concussion and it is important for parents, coaches and those close to the student athlete to be aware of the signs and symptoms of a concussion.
What is a concussion:
A concussion is a form of traumatic brain injury caused by a direct trauma to the head, neck or face. A concussion can cause physiological effects on the brain that can prompt short or long terms physical, cognitive and behavioral symptoms. As no two concussions are exactly the same, people can experience varied symptoms such as:
1. Headaches
2. Light-headness
3. Nausea
4. Dizziness
5. Mental fatigue
6. Fogginess
Other associated symptoms are behavioral changes, stimuli sensitivity, sleep pattern disruption (increased and/or decreased), blurred vision, balance challenges, and seizures.

According to moveforwardPT.com, symptoms can progress and lead to post-concussion syndrome and/or second-impact syndrome. Post-concussion syndrome refers to headaches and/or dizziness that persists for weeks to months after injury. Second-impact syndrome refers to sustaining another concussion after the initial concussion has yet to resolve. The Second-impact syndrome can prompt significant brain damage and potentially cause death if the student
athlete is allowed to return to sport prior to a full resolution of symptoms.

What screening can be performed?
With concussions, there is no single test that can be performed to diagnose a concussion and its severity. Suspected concussions are primarily screened by a healthcare provider like a medical doctor. Diagnostic imaging like a CT scan and MRI will not show significant abnormalities and thus may not be efficacious.

What to do if a student athlete sustained a concussion?
If a student athlete is suspected to have sustained a concussion, remove them from participation immediately. Once removed from sport, the student athlete should be allowed to rest and recover until a full resolution of symptoms occurs. Rest can involve longer sleep, more naps and decreasing cognitive demand and stimuli (less TV/phone/computer time).

Can physical therapy help with concussions?
Physical therapists can help in addressing a student athlete’s concussion symptoms in several ways.

If balance deficits and dizziness is significant, seeing a vestibular physical therapist will be the first option. A vestibular physical therapist knows how to address the vestibular system (the inner ear and balance) and its ability to regulate balance and decrease dizziness. This will include balance exercises and formal techniques that can be performed at home.

Once the vestibular symptoms have improved, seeing a physical therapist that has treated patients with concussions is appropriate. A physical therapist will help manage headaches and improve neck pain that can be associated with a concussion. This is achieved with strength and endurance exercises and providing  patient education.

A student athlete can also progress through a concussion exertional physical therapy protocol in order to return to sport. An exertional physical therapy program is a 5 stage protocol that will appropriately acclimate and de-sensisitize a student athlete to their symptoms with sport specific exercises and drills. Return to sport will be decided by the medical doctor after reviewing tolerance and progress with exertional physical therapy.

Concussions can be fatal or can result in permanent brain damage. Seek medical help from a licensed health care provider following any suspected head injury.

Resources:

Mucha, A., and the APTA Neurology Section. A Physical Therapist’s Guide to Concussions.
Retrieved from http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=4f2ebb00-f1c0-4691-b2ab- 742df8dffb99#.VFEjy2fII9Q on September 26,2017.

About the Author:

Michael Marcello earned his Bachelor of Science degree in Kinesiology at San Jose State University and his Doctorate in Physical Therapy at the University of the Pacific in Stockton. Michael is experienced in sports medicine, orthopedics, and concussion exertional physical therapy. Michael appreciates and utilizes current evidence-based treatment/interventions, continuing education courses and exercise to promote optimal function and performance. Michael, a Bay Area native, enjoys exercising, watching sports and spending time with his family and friends. Michael is a 49ers, Giants, Warriors and Sharks fan as well.

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