With football around the corner, many professionals and youngsters alike have been preparing for their season. Concussion in football has received a lot of media attention however concussions are more than just a football thing. There are many causes including falls, motor vehicle accidents, sports or recreational activity related injuries, and being struck by or against an object. Children, older adults, and people who have sustained a prior concussion are at greater risk for more severe concussion-related symptoms.

A concussion is a mild traumatic brain injury (TBI). According to both the Center for Disease Control and Prevention (CDC) and Defense and Veterans Brain Injury Center, a concussion is “caused by a bump, blow or jolt to the head that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI.” Despite the disruption in brain function, MRI or CT scans often appear normal.

Recent studies have looked at cost effective ways to identify a concussion. One study found that when a person is slow to get up from the ground after a sport related blow to the head, they suffered a concussion 100% of the time. Researchers are also looking at using blood biomarkers to identify who will have more severe symptoms to help predict and direct recovery. While there is much research on identifying and treating concussions, we still do not have all the answers. According to the CDC, wearing a proper fitting helmet can reduce the risk of serious brain injury or skull fracture, but a helmet alone will not prevent concussions. While specialized helmets with sensors are being marketed to reduce the risk of a concussion, recent studies revealed that there is no clear evidence to support this recommendation.

If a concussion is suspected, the activity should be stopped and medical attention should be sought. Whether the concussion occurred from military activity, during sports, in the community, or at school, immediately after injury a period of 24-48 hours of physical and cognitive rest is endorsed. Cognitive rest includes limiting activities such as concentration and learning. In the past, the recommendation was to rest in a dark room until symptoms resolve, but this is no longer the case and in fact it can be harmful.

Currently, research supports a gradual return to activities. Returning to vigorous activity too quickly can worsen symptoms. It is important to note that the guidelines emphasize that everyone is different and progress should not be rushed. Using a symptom scale at each step guides progression of activity. For example, if a headache increases from light to moderate, then take a break. If the symptoms persist for more than two weeks for an adult or one month for a child, the person should be referred to a health care professional that specializes in the management of concussions.

In some cases, concussion recovery is prolonged. Individuals often experience a constellation of symptoms making diagnosis and treatment of prolonged concussion complex. Symptoms can be grouped into the following categories: anxiety/mood, balance problems or dizziness, vision changes, neck, post-traumatic migraines, and difficulty thinking. Identification of the problem areas is critical to recovery. For example, some people are not able to regulate their heart rate which may cause dizziness or intolerance to exercise. Or, dizziness may be caused by an inner ear problem.

As the body of research about concussion grows, identification and management of concussion has evolved and improved. It is critical to seek out knowledgeable health care professionals following a concussion to ensure a safe and optimal recovery.

Beth Grill PT, DPT, NCS is a board-certified Neurologic Clinical Specialist in neurology at Spaulding Outpatient Center Framingham. She specializes in the treatment of a variety of neurologic diagnoses including vestibular disorders, concussion/traumatic brain injury, and post-polio syndrome.

Rhonda Salvo, PT, is a Clinical Specialist at Spaulding Outpatient Center Framingham. She specializes in neurological rehabilitation with a focus on concussion/traumatic brain injury, vestibular disorders, stroke, Parkinson’s Disease, post-polio syndrome, and balance and gait disorders.