Concussions: We Treat That.

“Recently, I was watching ESPN’s First Take, a sports talk show, and they were discussing a recent concussion sustained by the Pittsburgh Steeler’s quarterback Ben Roethlisberger. These shows are designed to provoke discussion and disagreement, but usually, this disagreement occurs with opinions, not facts. In this episode, the hosts Max Kellerman and Stephen A. Smith discussed the status of the Steeler’s franchise quarterback. “He’s had concussions before,” Kellerman said. “You know what the rehab is for concussions? Nothing! There’s no rehab for concussions!” Smith’s response was equally as concerning. “There’s concussion protocol, and that’s it.” Kellerman further perpetuates the falsehood by stating, “What are you going to do about a concussion? Yeah, wait, go through the protocol. What does that mean? Oh, don’t do anything, hope your brain heals.” The reality is that physical therapists can undoubtedly treat many of the symptoms experienced with a concussion.

As someone who has sustained a concussion, I understand many of the frustrations that come along with the resultant symptoms. These issues can be, and no two concussions are the same. Headaches, dizziness (including vertigo), difficulty concentrating, difficulty with vision, ringing in the ears, and nausea can all be attributed to concussions. The question is, how do we treat this?
The brain is a complex organ that controls almost every aspect of our actions. When it is injured, many other systems in the body can be affected. A concussion is a brain injury that usually occurs as the result of a strong force to the head or neck area. This force can cause a “coup-contrecoup” action where the brain impacts against the skull. As physical therapists, there are three primary systems we treat when concussions don’t heal with just rest. These are the oculomotor system, vestibular system, and cervical spine. These three systems also happen to be more connected than one may think.
When treating oculomotor deficits, a physical therapist will first assess the quality of motion when you move your eyes. They will also test the patient’s ability to move their head when with a fixed gaze. These deficiencies can lead to may symptoms including double vision and headaches as your eyes strain to keep focus. A physical therapist can provide exercises designed to address the patient’s specific dysfunction to rehabilitate the system to full function.
The vestibular system can be quite complex with many of its functions grounded in the tiny inner ear. Such a small organ can have a profound effect on the function of the body. With concussions, it is common to experience dizziness, imbalance, or even vertigo. The cause of these conditions can be numerous. A physical therapist who is trained in the vestibular system can diagnose and treat many concussion-related causes of this dysfunction. When returning to sport or work, it is vital that this system is rehabilitated completely. We see in the research that concussions can potentially increase the risk of a lower extremity injury. Making sure all the systems of the body are appropriately rehabilitated is a necessity before returning to work or sport.
Neck pain and stiffness are quite possibly the most common symptom in the post-concussion spectrum. Many of the headaches experienced after a concussion tend to originate in the neck. The cervical spine is full of sensors that give signals to the brain that let the brain know where the body is in space. When the neck is stiff and painful, these signals can be inaccurate. Add the fact that the brain itself is healing and injured, and the results can be quite debilitating. The goal of the physical therapist is to improve the function of the neck and rehabilitate it to full health. We can use many treatments including dry needling, soft tissue mobilizations, manipulation/mobilization, and exercises to promote the healing progress. As with the vestibular system, rehabilitating the neck to full health is vital to avoid further injury. We see in the research that increases in neck strength can potentially decrease the risk of concussions. When the neck is stronger and can stabilize the head, there is less of a force absorbed by the brain.
We are learning more about concussions at a rapid pace. New research is published monthly, and as we learn more, we are better able to treat concussions. If you have had a concussion in the past and continue to have symptoms, feel free to contact us to see if we may be able to help you. We look forward to answering your questions and seeing you in our clinics.”
Content provided by Jared Gerstenkorn, DPT
Consensus Statement on Concussion in Sport-the 5th International Conference on Concussion in Sport Held in Berlin, October 2016: https://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097699
Risk For Lower Extremity Injury After Concussion: A Matched Cohort Study in Soldiers.
Collins, C.L., Fletcher, E.N., Fields, S.K. et al. J Primary Prevent (2014) 35: 309. https://doi.org/10.1007/s10935-014-0355-2