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How can Physiotherapy help people with concussion?

by Linda King

Concussion has been big news in recent times. The recent FIFA world cup saw controversy about the medical management of concussed players, there are news reports of AFL football players off play for weeks and some ending their careers early due to the effects of concussion. And there’s the Hollywood movie “Concussion” starring Will Smith.

There is a large amount of new information and knowledge about the effects and management of concussion in the medical world. Every 4 years the International Consensus Statement on Concussion in Sport is revised. This statement and its guidelines are used by Sports Medicine Australia and many sporting bodies in Australia and throughout the world to guide diagnosis, management and return to play following concussion.text here.

Our physiotherapists Scott Beeston and Linda King have completed a comprehensive concussion management course this year run by Complete Concussion Management Inc (CCMI). As such they are able to assess acute concussion (including screening for more serious injury), provide guidance regarding safe return to everyday activities and sport and provide rehabilitation for recovery from post-concussion symptoms.

About concussion 

  • Everyone who suffers a concussion should see a doctor or trained healthcare provider in the first couple of days to assess injury and guide management and return to activity
  • Concussion is a traumatic brain injury resulting in temporary neurological issues.
  • Not all concussions are caused by a knock to the head: a blow to the neck or other part of the body which causes change in head acceleration can also cause concussion.
  • Only 10% of concussions involve loss of consciousness
  • Concussion doesn’t show up on a scan: a scan may be done if necessary to check for more serious brain injury such as bleeding, bruising or fracture
  • Concussion involves temporary chemical changes within the brain which result in altered function
  • Concussion symptoms include headache, dizziness, nausea/vomiting, drowsiness/fatigue/sleep disturbance, sensitivity to light or noise, emotional changes, difficulty concentrating/remembering, feeling slowed down or in a fog
  • 30% of people who suffer concussion have ongoing symptoms beyond 7-10 days. Appropriate rehabilitation is shown to help with recovery

  • Following concussion a graduated return to school /work and sport program should be followed.

  • Sport is a common cause of concussion. Other causes include motor vehicle accidents, falls, work place accidents and the military.

Physiotherapy and Concussion

Recovery from concussion can be assisted by good information regarding your concussion and undertaking the right amount of physical and mental activity. We can assess and guide you in this.

Factors which contribute to persistent concussion symptoms include ongoing alterations to brain chemistry/physiology, neck problems and vestibular (inner ear balance) problems. Appropriate rehabilitation is shown to significantly improve recovery rates.

Physiology

To recover from concussion, brain chemistry needs to return to normal balance. This can be improved through appropriate exercise levels, improving blood flow to the brain. We conduct an exercise test, usually on a treadmill, to determine safe and effective exercise levels.

Neck

Concussion occurs with a force of greater than 96 g while “whiplash” of the neck occurs with forces of 4.5 g. Thus everyone who experiences concussion has experienced sufficient force to their neck to experience some whiplash type injury. There are also a lot of symptoms common to whiplash and concussion, meaning that treating the neck can also help concussion symptoms.

Neck treatment can include massage, joint mobilisation, movement and strength exercises as well as proprioceptive training (awareness of joint position and movement).

Vestibular

Vestibular issues following concussion include Benign Paroxysmal Positional Vertigo (BPPV) and “processing” issues. Symptoms include dizziness, vertigo, unsteadiness and balance problems.

BPPV is a mechanical issue where “crystals” in part the vestibular system cause a sensation of movement which is different from information from other senses such as the eyes and neck joints. This can be treated by head manoeuvres to reposition the crystals.

“Processing” issues means that information from the balance systems of the neck and other joints, eyes and vestibular system is “mixed up” giving confusing information about movement. This can be assessed and treated with specific head and eye movements and exercises and balance training.

Recent research found 73% of post-concussion sufferers recovered in 8 weeks with combined neck and vestibular rehabilitation compared with 7% of those who were just progressed as symptoms improved.

If you have any concerns about residual symptoms or would like assistance following a concussion injury, call and ask to make an appointment with Linda or Scott on 63344766.

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