From professional football to pee wee hockey, there is probably no other health concern in athletics that has exploded on a national level like the concussion. The American Journal of Sports Medicine says up to 300,000 high school athletes will experience a concussion this year. A concussion is defined as “a brain injury and a complex pathophysiological process affecting the brain, induced by biomechanical forces.” Several common features occur with a concussion to include an “impulsive” force transmitted to the head, rapid onset of neurological impairments, and may or may not involve loss of consciousness. It has been stated that 80-90% of concussions resolve in a 7-10 day period but may be prolonged in children or adolescents.
How is a concussion diagnosed?
Diagnosing an acute concussion takes into account a wide range of clinical symptoms, cognitive impairment, neurobehavioral features, and sleep disturbances. When an athlete is suspected of sustaining a concussion, the immediate injuries are assessed using the emergency medical response and continued assessment is performed by a licensed health care provider or removed from the field if one is not present. This rapid medical assessment includes physical injury (i.e. fracture or lacerations), cranial nerve assessment, and balance. After the first aid issues are addressed, the athlete is assessed for a concussive injury using the widely accepted multi-modal sideline assessment tool known the Sport Concussion Assessment Tool (SCAT 3) and (Child SCAT 3) or other sideline assessment tool. The SCAT 3 consists of memory tests, orientation tests, and balance testing.
Rapid assessment on the field has its challenges and when a concussion is suspected, proceeding with caution is paramount. A concussion could include one or several clinical domains such as somatic (i.e. headaches), cognitive (i.e. feeling “in a fog”), or physical (i.e. loss of consciousness). Following the initial “on field” SCAT 3 performed by a licensed healthcare professional such as a physical therapist, neurologist, or the team physician, a series of SCAT 3’s are performed for several hours following the event in serial testing due to the known fact that symptoms of a concussion may evolve and deterioration of function can occur.
Following the on-field assessment the athlete may be evaluated in the ER or doctor’s office with a thorough medical evaluation. It has been shown that imaging studies such as a CT’s or MRI contribute very little to the diagnosis of concussion and are typically normal but the determination for more accurate neuroimaging will be made by the physician to exclude structural abnormality resulting from a severe brain injury.
When can I return to sport after a concussion?
No matter what, athletes should not return to play the same day that they’ve suffered a concussion. The agreed upon protocol is treatment that includes physical and cognitive rest until the acute symptoms resolve. Following medical clearance a progressive graded activity program is implemented with a stepwise return to play program (RTP). This RTP consists of functional exercise stages and corresponding objectives lasting approximately 24 hours each for a full rehabilitation program of 1 week. The athlete needs to remain asymptomatic at rest and with provocative exercise for each stage and if not they are returned to the prior asymptomatic level of the RTP protocol. Stage 5 of 6 includes return to full-contact practice following medical clearance and stage 6 is return to play at normal “game speed”. The go ahead for RTP ultimately remains in “the realm of clinical judgment on an individual basis.”
How can physical therapy help with a concussion?
The available evidence for the effects of rest and treatment following sports concussion is small and further research is needed to evaluate length of rest, type of rest, and timing of low-level exercise. Physical therapy can benefit the athlete with multimodal treatment for cervical spine and/or vestibular dysfunction and with supervision and guidance of a graded exercise program. Your physical therapist may include techniques into your treatment such as:
• Custom conditioning program to ensure proper joint mobility and flexibility to help offset injury risk factors brought upon by poor conditioning.
• Strengthening exercises to ensure that your muscles are not compensating for physical limitations, detracting you from performing your sport at a high skill level and thus leaving you susceptible for reinjury.
• Balance training to reduce or stop any dizziness brought on by the concussion symptoms.
Physical therapists can provide the necessary tools to help you recover from a concussion, allowing you return to activities healthy and at full strength. Seek treatment today if you feel that you’re suffering from concussion symptoms.
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