What Does Physical Therapy Look Like After A Concussion?

Concussions, or mild traumatic brain injuries, are an unfortunately common occurrence in sports, affecting as many as 3 million athletes per year. Concussions can cause immediate impairments, but newer research has also identified the risk for long-term complications, especially as the person suffers multiple concussions. Even with an increased emphasis on concussion recognition, only about 50% of sports-related concussions are reported and treated.

While concussions in sports tend to be the primary focus, they can also occur in non-sports activities. Car accidents and work/industrial accidents tend to be a common cause of concussions in adults. Kids and elderly individuals are at a high risk of concussions from falls. Treatment of concussions has advanced significantly from the approach of resting in a dark, quiet room to the highly recommended approach of focusing on active recovery. Physical therapy evaluation of concussions begins with a history. This will include discussing the injury, which may or may not involve a direct hit to the head. A review of current symptoms will also be performed, with the patient only needing one of the following symptoms to be diagnosed with a concussion: headache, nausea/vomiting, dizziness, blurred vision, sensitivity to light and/or sound, confusion, and/or memory loss.

Symptoms tend to be specific to the area of the brain that was injured:

Frontal Lobe

Injuries to this area can affect brain functions such as critical thinking and body movements.

Parietal Lobe

If this lobe is injured, it can affect body sensation. An altered sensation from the stomach can produce nausea/vomiting, and an altered sensation from the eyes or ears may create sensitivity to light and sound.

Temporal Lobe

Injuries to this area are more likely to cause issues with balance. The patient may also have altered hearing on the affected side.

Occipital Lobe

If this lobe is injured, it may affect vision and result in a blurred sensation.

The physical examination tends to focus on the head and face:

Cranial Nerve Assessment

This is an assessment of the twelve pairs of cranial nerves that come off the base of the brain and brain stem. These nerves are responsible for movement and sensation in the face and neck.

Oculomotor Assessment

This assessment examines how well the eyes can move and their ability to track and focus. Individuals with oculomotor dysfunction tend to have prolonged concussion symptoms. Treatment may focus on improving eye mobility and the ability to focus on objects at varying distances.

Vestibular Assessment

The vestibular system is a series of structures inside the inner ear that provide the brain with information on the position in space. A common issue after concussions is when otoliths (rocks) move from one structure to another; this is the origin behind the expression “rocks off” after a head injury. This condition provides misinformation to the brain about position and can affect balance or, more severely, create vertigo, where the person experiences room-spinning dizziness. Vestibular treatments can provide a reduction in these symptoms and improve balance.

Musculoskeletal Assessment

Any trauma sufficient to cause a concussion may also cause neck injuries. This portion of the examination is designed to identify and treat any secondary injuries that may have occurred. Treatment can be specific to any additional findings but may also include cardiovascular exercise (biking/walking/running) to improve blood flow to the brain.

Heads Up On Concussion Rehab

If you suspect you or someone you know has had a concussion, discuss your symptoms with your primary care provider. Physical and occupational therapists have a variety of examination and treatment techniques to help those who have suffered a concussion. Treatment can focus on helping to recover from the concussion and also develop skills to prevent future concussions! Schedule a free assessment today to connect with one of our experts who can help.

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*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. University of Pittsburgh Medical Center. (2023). Concussion facts and statistics. Retrieved from https://www.upmc.com/services/sports-medicine/services/concussion/about/facts-statistics