Concussion is a highly topical and often contentious talking point in the sporting landscape from grassroots to the elite level. Commonly asked questions by those affected are how long should I wait before returning to sport? How do I know if I am safe to play sport after a concussion? Should I play sport again, and when can I return to work?
But first, what is concussion?
Concussion or a traumatic brain injury (TBI) is defined as ‘an acute neurophysiological event related to blunt impact or other mechanical energy applied to the head, neck, or body with transmitting forces to the brain), such as a sudden acceleration, deceleration, or rotational forces’ (Marshall et al. 2018).
How long do I need to rest?
Ellis Leddy and Willer (2014) corroborated that 80-85% of people post-concussion had a resolution of symptoms within 1-2 weeks with 15-20% experiencing symptoms after 3 weeks. Moreover, children and adolescents recover spontaneously on average between 2-4 weeks (Leddy et al. 2019).
However, regardless of age, all people require 24-48 hours of complete physical and cognitive rest. This includes reading, phone time and walking to facilitate a full recovery.
As per the AFL Concussion Protocol, the earliest a player can return to play is the 12th day after the concussion was suffered.
What does a physiotherapist assess for a patient with a suspected concussion?
Physiotherapists will assess their patients’ vestibular and visual systems, analyse neck range of motion, strength and proprioception, exercise tolerance and motor function. The physiotherapist will also take a thorough subjective history to ascertain a patient’s history of concussion.
Examples of this include:
- The cervical joint position error test which involves the use of a laser headlamp tracked to a target. If a statistically significant difference is noted, this can inform the prescription of neck proprioception exercises. This is performed at our Fullarton Clinic!
- The graded treadmill/bike test to ensure that players can perform aerobic exercise without symptoms.
Is physiotherapy effective post-concussion?
- Cervical spine manual therapy is highly effective in alleviating concussion symptoms (Reid et al. 2014, Aman et al. 2015, Peng et al. 2021, Ellis, Leddy, and Willer 2015).
- Schneider et al. (2014) RCT found that those with 8 weeks of cervical spine and vestibular physiotherapy versus cervical physiotherapy alone were 3.1 times more likely to return to sport in 8 weeks following a sport related concussion (CI 95%).
References:
- Aman, JE, Elangovan, N, Yeh, I-L & Konczak, J 2015, 'The effectiveness of proprioceptive training for improving motor function: a systematic review', Frontiers in Human Neuroscience, vol. 8, no. 1075.
- Ellis, M, Leddy, J & Willer, B 2014, 'Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment', Brain Injury, vol. 29, no. 1, pp 1-11.
- Ellis, MJ, Leddy, JJ & Willer, B 2015, 'Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment', Brain Injury, vol. 29, no. 2, pp. 238-48.
- Leddy, JJ, Haider, MN, Ellis, M & Willer, BS 2019, 'Exercise is Medicine for Concussion', Current sports medicine reports, vol. 17, no. 8, pp. 262-70.
- Marshall S, Bayley M, McCullagh S, Berrigan L, Fischer L, Ouchterlony D, Rockwell C, Velikonja D, 2018. Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms: 3rd Edition (for Adults 18+ years of age). Toronto, ON: Ontario Neurotrauma Foundation, 2018
- Reid, SA, Rivett, DA, Katekar, MG & Callister, R 2014, 'Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial', Physical Therapy, vol. 94, no. 4, pp. 466-76.
- Schneider KJ, Meeuwisse WH, Nettel-Aguirre A (2014), ‘Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial’, British Journal of Sports Medicine vol 48, no 1, pp. 1294-1298.
