This entry was written by one of Symmetry’s Doctoral Student Physical Therapist Residents: Tate Jarzombek, SPT Thanks, Tate!
HEADS UP! It’s August again, and you know what that means…it’s Texas Football Season. Well, technically it is football season all across America, but there is nothing quite like Texans’ enthusiasm for the sport. It’s an exciting time of the year for athletes and fans alike, but with the excitement comes the ever-present concern for injury, perhaps in particular concussion. In recent years, thanks to extensive research regarding the incidence, management, and long-term effects of sustaining head injuries, the focus on concussion has heightened, increasing awareness not just among athletes, but among the general public. The reality is, concussion is not just an athlete’s injury. People sustain concussions from a wide variety of mechanisms – including motor vehicle accidents, falls, and all manner of sport and recreational activities, just to name a few. And while many concussions and related symptoms resolve fairly quickly, that is not always the case. If left untreated, more severe concussions can result in weeks to months of symptoms ranging from dizziness and headaches to sensory sensitivity and difficulty concentrating. So the question remains, what can be done to get at athlete that has sustained a concussion back to what he or she loves doing in a safe and timely manner?
Here are 3 things worth knowing about concussion injuries:
- Just Rest Isn’t Best
In the past, traditional medical management included screening for and ruling out severe complications and then sending the patient home to rest and refrain from activity until symptoms had completely subsided. Though current research shows that rest alone is not the optimal treatment method in many cases, it is unfortunately still commonplace to prescribe rest alone as an antidote to concussion. The failure to address the multitude of treatable symptoms associated with concussion result in leaving injured athletes with persistent symptoms which result in the inability to return to normal activity levels long after an injury has taken place. Other complications can occur in these instances when athletes ultimately try to return to high intensity activities, such as sports, without proper graded progression of activity. While an initial period of rest after a concussion injury is often indicated in order to restore a more normalized metabolic environment of brain tissue, following this rest period with graded activity exposure proves to be a much more effective method for concussion management than rest alone. The good news is that physical therapists can help with this transition. PT’s are not only equipped to help retrain the visual and vestibular systems, which are often the culprits for dizziness and balance issues following a concussion, but therapists can also to help guide athletes back to physical activity in a way that is safe and helps reduce the chance of future injury. (This article expands on current evidence regarding the use of rest after a concussion injury.)
- Concussion Can Lead to Increased Risk of Subsequent Injury
Speaking of future injury, while you may be aware that sustaining one concussion may put you at risk for future concussions, did you know that you also have a greater chance of sustaining other, seemingly unrelated injuries, such as ankle sprains and ACL tears? Let’s connect the dots here. Following a concussion, you are often left with mild residual neurocognitive deficits, which can affect split-second decision making and the appropriate corresponding movement patterns, which can affect your ability to think and move quickly when needed. You may also have lingering coordination and balance deficits due to reduced function of the vestibular and visual systems. These factors, in conjunction with other residual deficits can create a recipe for less than optimal movement, resulting in increased risk of injury. For athletes, this can mean increased recovery time and more time away from the sport or activities that they love. In a recent study conducted at the University of Florida, it was found that athletes exposed to concussion were approximately 3 times as likely to incur an additional lower extremity musculoskeletal injury in the 90 days following their concussion. Considering most concussed athletes return to sport within a month following their injury, it is safe to assume that many athletes are returning to play to only unwittingly put themselves at a greater risk of future injury. (If you’d like to read the article, check out this link.)
- There is a Link Between Concussion and Heart Rate
So you’re on the mend and you’re finally starting to feel like yourself again following a concussion. You’re feeling so good, in fact, that you decide to go for a jog for the first time since your injury. However, after a couple minutes, you start to feel your symptoms creep back up on you…the dizziness sets in, you start feeling a headache come on, and you become discouraged because you thought you were doing fine. There’s a surprising reason for this that you might not expect. Following a concussion, the body’s autonomic nervous system, or the system that is responsible for controlling many of the body’s automatic responses, functions at a less than optimal capacity. Heart rate and the response to exercise is largely regulated by this system. Therefore, when this system is compromised, it is less equipped to respond when stress is placed on the body, such as when exercising. Therefore, the heart rate cannot adapt appropriately, which can then exacerbate symptoms that may otherwise be undetectable without the added stress of exercise. In addition, even if symptoms have completely subsided, the autonomic nervous system may still take some time to fully recover, resulting in altered heart rate response to exercise even in the absence of symptoms. So what does all of this mean? Does it mean that you can’t or shouldn’t return to running, or cycling, or other aerobic activity following concussion? Absolutely not! It does mean though that you might need a little help getting there. Physical therapists trained in concussion management can be a valuable tool in identifying a safe activity threshold for individuals following a concussion and can help athletes gradually work back up to full activity in a way that is safe and less symptom-provoking. (For further information about how the autonomic nervous system responds after a concussion, follow this link.)
Sustaining a concussion can often be a scary event, and with all the misinformation circulating the internet and media outlets, individuals may be left wondering what steps they should take to recover. While many concussion symptoms resolve quickly, it is important to remember that every person is different and may have a different trajectory for recovery based on their individual mechanism of injury, medical history, and numerous other situational factors. If you have sustained a concussion and symptoms have persisted longer than expected, consulting a health-care professional and seeking treatment beyond the commonly prescribed “rest” is often indicated. And I may be a little biased, but in many cases, it is highly appropriate to #ChoosePT.