Concussion Management
Concussion has become a hot topic lately, people are becoming increasingly aware of and being diagnosed with concussions. A concussion can be caused by direct blow to head face or neck but also a hit to another area of the body with an “impulsive” force transmitted to the head. There does not need to be a loss of consciousness to cause a concussion.
The most crucial part of concussion management is to have it recognized quickly and educate patients. The initial management (approximately 4 weeks) is REST, physical and cognitive, until asymptomatic.
There is no same day return to play. In the new guidelines there are 6 steps to return to play and each takes a minimum of 24 hours. You can also use these guidelines for return to work and school. If any symptoms return you have to return to the previous step.
80-90% of concussions recover in 7-10 days or 14 days in youth. 10-20% develop post-concussion syndrome(the collection of symptoms is the same as mild traumatic brain injury, and may be the same).
A physiotherapist can help with education regarding concussion, develop and monitor a return to school/work and play program. They can also help with the often concurrent cervical spine injury as it is difficult to get a concussion without affecting the neck. Physiotherapists with vestibular training can also asses and treat and vestibular system for issues that may have resulted from the mechanism of injury. This is supported by a statement recently added to concussion guidelines from the Zurich 2012 conference, “multimodal physiotherapy treatment for individuals with clinical evidence of cervical spine and/or vestibular dysfunction may be benefit”1.
1) McCrory P, Meeuwisse WH, Aubry M, et al. Br J Sports Med 2013; 23:89-117