Move Forward Guide
Physical Therapist's Guide to
In the past few years, concussion has received a great deal of attention as people in the medical and sports worlds have begun to speak out about the long-term problems associated with this injury. The Centers for Disease Control estimate that in sports alone, more than 3.8 million concussions occur each year. Recent scientific evidence highlights the need for proper care to prevent complications from concussion.
If you think you might have a concussion:
- Seek medical care immediately.
- Avoid any additional trauma to your head—don't engage in any activity that carries a risk of head injury.
- Limit activities of all kinds, including school and work.
What Is Concussion?
Concussion is a brain injury that occurs when the brain is shaken inside the skull, causing changes in the brain's chemistry and energy supply. A concussion might happen as a result of a direct blow to the head or an indirect force, such as whiplash. You might or might not lose consciousness.
Signs and Symptoms
There are many symptoms related to concussion, and they can affect your physical, emotional, and mental well-being.
Physical symptoms may include:
- Difficulty with balance
- Difficulty with sleeping
- Double or blurred vision
- Sensitivity to light and sound
Cognitive (thinking) symptoms may include:
- Difficulty with short-term or long-term memory
- Slowed "processing" (for instance, a decreased ability to think through problems)
- Difficulty with concentration
Emotional symptoms may include:
- Mood swings
- Decreased tolerance of stress
How Is It Diagnosed?
Concussion is easy to miss because diagnostic imaging, such as such as magnetic resonance imaging (MRI) or a computed tomography (CT) scan, usually is normal.
Because of the variety of possible symptoms that can interfere with day-to-day activity, seek coordinated medical care immediately. Your health care professionals may include a physician with expertise in concussion, a neuropsychologist, and a vestibular physical therapist (a physical therapist who specializes in treating balance disorders and dizziness).
After a concussion, limit any kind of exertion. The brain won't have time to heal if you increase physical exertion too soon—such as returning to social activities or sports—or if you increase cognitive demands too soon, such as returning to school or work. You can slowly resume normal activities only once your symptoms have improved and stay improved.
How Can a Physical Therapist Help?
Physical therapists can evaluate and treat many problems related to concussion. Because no 2 concussions are the same, the physical therapist's examination is essential to assess your individual symptoms and limitations. The physical therapist then designs a treatment program.
Help Stop Dizziness and Improve Your Balance
If you have dizziness or difficulty with your balance following a concussion, vestibular physical therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, is responsible for sensing head movement, keeping your eyes focused when you move your head, and helping you keep your balance. A qualified vestibular physical therapist can provide specific exercises and training to reduce or stop dizziness and improve balance and stability.
Your physical therapist will examine you for neck problems following a concussion. Neck injuries can cause headaches and contribute to some forms of dizziness. Your therapist also can assess your back for possible injuries to your spine.
As symptoms due to concussion improve, your physical therapist will help you resume physical activity gradually, to avoid overloading the brain and nervous system that have been compromised by concussion.
It's important that you follow the recommendations of all health care professionals so that you can achieve the greatest amount of recovery in the shortest amount of time.
Real Life Experiences
You've just come home from a soccer game where your 15-year-old daughter was star goalie. She admits to you that she "dinged" her head during a play in the second half and did not tell anyone. She's complaining of headache and dizziness, and she's sensitive to light.
What do you do next?
You monitor the next 24 hours closely, seeking care immediately in the local emergency department if your daughter has or you observe any of the following:
- Headache that gets worse and does not go away
- Weakness, numbness or decreased coordination
- Repeated vomiting or nausea
- Slurred speech
- Extreme drowsiness or cannot be awakened
- One pupil (the black part in the middle of the eye) larger than the other
- Convulsions or seizures
- Inability to recognize people or places
- Increased confusion, restlessness, or agitation
- Unusual behavior
- Loss of consciousness
During the next couple of days, she's frequently in the nurse's office due to headaches and dizziness. She reports difficulty concentrating and remembering during school and is having trouble falling asleep at night. What do you do next?
- Have the concussion evaluated by a licensed medical professional with expertise in treating concussion. Some communities have concussion or mild traumatic brain injury clinics. Evaluation should include an assessment of symptoms, neurologic screening, testing of thinking ability ("cognition"), and testing for balance problems.
- Do NOT allow your daughter to participate in sports or any other activity with risk of head injury until she is cleared by a licensed medical professional with expertise in treating concussion. Repeated concussions can result in many problems.
- Do NOT allow your daughter to engage in physical activity—such as exercise, sports practice, gym class—until she has recovered from her concussion or has been advised by a licensed medical professional with expertise in treating concussion. Physical activity during early stages of concussion robs your brain of the energy it needs for healing.
- Limit thinking ("cognitive") activity until you have recovered from your concussion or have been advised by a licensed medical professional with expertise in treating concussion. Your brain requires additional energy to heal from a concussion, and excessive thinking interferes with recovery.
- Get plenty of sleep and rest. This will help your brain to recover from the concussion.
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with neurological problems. Some physical therapists have a practice with a neurological or vestibular rehabilitation focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with concussion.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of problems related to concussion. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34:87–93. Article Summary on PubMed.
McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med. 2009;19:185–200. Article Summary on PubMed.
Centers for Disease Control and Prevention
Acknowledgments: Anne Mucha, PT, NCS, and the APTA Neurology Section