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Concussion Management

What is a concussion? If you would ask this question to10 different people you would likely find that you would receive 10 different answers. While concussions have always been a part of sports, up until 2016 there has not been a universal definition of what a concussion is. Before 2016, there were upwards of 30 working definitions of what a concussion is depending on the profession that you would ask. At this time, the Berlin concussion statement was released, to allow for better treatment and management of concussions. During this time, a more concise and specific definition was written that has been widely accepted by many medical groups was formed.


The definition is as follows: "A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. Rapid movement causes brain tissue to change shape, which can stretch and damage brain cells. This damage also causes chemical and metabolic changes within the brain cells, making it more difficult for the cells to function and communicate. Since the brain is the body's control center, the effects of a concussion can be far-reaching."


This new definition does put an emphasis on how concussions are not just a "brain injury" but are a multifactorial issue that can create symptoms throughout the body. Also with this new diagnosis, a new door was opened to recognize that concussions are not just a sports issue but can be any issue for everyday, working people. It has also shown that many symptoms everyday people suffer from after a fall, accident, or other injury are the result of a concussion. Many times people come into therapy with diagnoses of falls, balance deficits, vertigo, neck pain, and HAs who present with hard-to-explain symptoms such as "feeling funny", brain fog, or just not feeling right. This puts physical therapists in a unique and great position to be able to identify these patients and be able to treat and help many of these patients as they have already come through our door. Not only have these patients already come through the door but physical therapists already possess the skills necessary to treat these patients.


While this new definition has addressed that concussions can only be attributed to a direct blow to the head (does not need to be one), misconceptions continue to persist. One misconception that persists is that a concussed person always loses consciousness. While a concussed person may lose consciousness, this happens in only approximately 10% of patients and is not a good indicator if someone has sustained a concussion. Another common misconception, which comes from how they were previously managed, is that a concussed person should just sit in a dark room and avoid any symptom-triggering activities. It is now known that sitting in a dark room to help recover is not only not helpful but can also prolong the recovery of a concussion. It is also important to practice what is called graded exposure when it comes to symptom-causing activities. Through the help of a physical therapist, we can slowly add in activities and exercises that will create minimal to mild symptoms while avoiding moderate to high level of symptom exacerbation. Over time, this graded exposure allows the patient to improve these symptoms toward a return to their prior level of functional ability in a symptom-free manner.


In conclusion, concussions are not a new injury but the way that they are managed and treated has changed significantly for the better. A concussion can and should be rehabbed by a medical professional. With a physical therapist skill set, we are a great profession to be able to treat people with concussions back to their prior level and get back to doing what they enjoy doing in a symptom-free manner. Here at Big Stone Therapies, both in Madison and our other locations, many of our physical therapists participated and attended extra training and resources to allow for effective and comprehensive concussion treatment and management to allow for a full return to activity and sport.


Author, Matt Carmody PT, DPT.



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