Do I need therapy after my concussion?

Current research shows that after a concussion most individuals recover in 2-3 weeks, with children often taking closer to 1 month for full recovery. We also know that females take a little longer to recover than males.

Many times, I am asked whether there is a need for Therapy after a concussion. In many cases this recovery occurs on its own and very quickly. In the concussion world, the concern is for those that take longer than 1 month to recover, and this is the area that therapy with a practitioner experienced in concussion injuries can help. This does not mean waiting a month, but rather having an evaluation 2-3 days after the initial concussion injury to determine your status and how to progress.

When a concussion does not recover in the 1st month, there are usually several reasons why this may have happened:

  1. The individual has resumed their normal lifestyle, including sports, school, or work, too quickly regardless of their symptoms.
  2. There is the presence of other issues or systems in play that is limiting the progress.

Therapists with concussion experience have a wide area of practice at their disposal that must be utilized to fully assess an individual post concussion to create an effective treatment plan.

These areas include:

  • Cervical/ spinal issues
    • Many concussion impacts can affect the spine and create additional issues or concussion like symptoms that slow the recovery process.

  • Vestibular (balance and dizziness)
    • Several different vestibular and balance disorders have been reported following head trauma, thus any disruption anywhere along these pathways may result alterations in balance and sensations of dizziness or unsteadiness.

  • Visuo-ocular (visual issues)
    • Those affected by a concussion often report difficulty with vision and ability to track objects, in fact vision issues is one of the most common issue presented. These vision issues can significantly affect a person’s ability to resume school or work if left untreated.

  • Neurocognitive (concentration and decision making)
    • For some people, reduced cognitive efficiency and fatigability may represent key elements of interference when interacting with the environment, leading to varied paths of recovery after a concussion.
  • Craniosacral (flow and motion patterning of the skull and nervous system)
    • Head injuries and concussion can adversely this mobility of the skull and soft tissue membrane and affect the free flow and stable pressure of cerebrospinal fluid (CSF), blood flow, neural conduction and numerous other physiologic functions. This abnormal pressure results in the headaches, fogginess, lack of concentration and other symptoms that affect people dealing with concussion. The application of CST can restore plate, suture and membrane mobility and promote an improved flow of cerebral spinal fluid. The release of the restrictions in the membranes or cranial bone sutures facilitates the brain to heal.

  • Autonomic nervous system (heart rate, and fight and flight reactions)
    • The physical trauma of a traumatic brain injury (TBI) can cause temporary or long-lasting changes to the Autonomic nervous system. In concussion patients, this dysautonomia almost always takes the form of sympathetic dominance. That means the sympathetic system, which puts your body on “high alert,” is more in control than it should be. Unfortunately, when that sympathetic dominance lingers after the traumatic event, it causes ongoing problems.

Based on the assessment results a specific intervention plan is created. This may include manual therapy, exercise, visual and balance training, or neurocognitive conditioning. In many cases, treatment after a concussion injury involves a coordinated combination of al the above areas. Therapy has bene shown to have positive outcomes in these areas. At times the treatment may speed the healing [process, or at the very least minimize the severity of symptoms, thus improving comfort and assisting in a quicker return to school or work.

Important in the overall recovery is a plan for a progressive return to school or work. Therapists can also help map out a return to activities with the eventual goal of a full return to sports.

Although many concussion injuries do recover on their own with time, a proactive response usually leads to the best outcomes and minimizes the risk of prolonged recovery or further injury.

Written by:

Efan Gonsalves PT
efan@honsbergerphysio.com

Efan directs the Concussion Solutions Program at Honsberger Physio+ and has been working with concussion injuries for the past 25 years.

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