Sport Related Concussions: Earlier Return with Rehabilitation

The majority of concussion symptoms resolve in 7-10 days; 30% of athletes still experience symptoms after that.  Athletes may not return to play until they are symptom free, and post concussion headache has been reported as a predictor of longer time loss. The most common symptoms reported after concussions are headache, dizziness, nausea, and neck pain. Two articles explored potential rehabilitation interventions that are effective to address these symptoms, also demonstrating that treatment and exercise reduce recovery time safely.

Schneider et al surmised the source of some symptoms may be a result of cervical spine trauma or vestibular dysfunction from the forces transmitted to the head and spine during the concussive incident. Hence cervicogenic headaches result or dizziness and balance dysfunction occur.  Their randomised controlled trial examined whether the time to medical clearance for return to play is effected when the subjects received vestibular rehabilitation and treatment for the cervical spine. The study group consisted of patients with persistent symptoms following a sport related concussion.

Both groups received postural education, rage of motion exercises and cognitive and physical rest until asymptomatic followed by a protocol of graded exercise. The treatment group also received cervical spine and vestibular rehabilitation.  Results:

• 73% (11/15) of participants in the treatment group were medically cleared within 8 weeks of initiation of treatment
• 7% (1/14) of the control group were cleared

Quatman-Yates et al systematically reviewed literature identifying potential physical rehabilitation interventions that are safe, feasible, and appropriate to utilize with patients with persistent mild traumatic brain injury (mTBI). The studies were categorized by types of intervention: physiological, vestibulo-ocular, and cervicogenic. Highlights:

• Evidence supported Manual therapy to the cervical and thoracic regions for headache, dizziness, and hypo mobility in the spine.
• Patients with persistent symptoms benefit from vestibular-based interventions.
• Graded exercise progression showed the following benefits: a decrease in number of concussion symptoms, more normal activation patterns on the MRIs, more likelihood of participant returning to full daily function, greater exercise capacity with fewer symptoms
• Aerobic, anaerobic, and coordination exercises can be safe and feasible.
• “Evidence suggests moderate-level physical and cognitive activities in the acute recovery phase may actually expedite rather than hinder recovery”2

Athletic Therapists and Physiotherapists at Parkway use a combination of manual therapy, vestibular-ocular, and exercise techniques to guide clients through their concussion rehabilitation. Progressively introducing exercise in concussion management can decrease symptoms and return athletes to their sport safely with shorter time periods on the sidelines.

1. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular Rehabilitation in Sport-Related Concussion: A Randomised Controlled Trial.
2. Quatman-Yates C, Cupp A,Gunsch C, et al. Physical Rehabilitation Interventions for Post-mTBI Symptoms Lasting Greater Than 2 Weeks: Systemic Review.