The old advice was for anyone who sustained a concussion, or had concussion-like symptoms to rest, both cognitively and physically, until symptoms subsided. This included ZERO activity, mental or physical, and the advice was to stay in a dark room, with no visual, auditory or cognitive stimuli. It is very difficult for anyone to follow these guidelines, especially if they are a young child, or must return to work.
While this advice has not yet been debunked, and there is still great research being done to validate it, there are also other theories surfacing! Studies as recently as last year indicate that complete rest may actually prolong recovery and increase symptoms. This article, based on a study published in the scientific journal Pediatrics, shows some interesting preliminary findings on this topic.
So what do we do during recovery?
Type of concussion? This is all new!
Autonomic- Relating to the autonomic nervous system, which controls all the background processes of the body. Immediately following concussion, there is a rapid cascade of chemical changes in the brain which can alter the internal rhythms and the ability of the body to regulate things like sleep and wake schedules, hunger, concentration, and other metabolic processes.
Vestibular-Relating to the balance systems, and the vestibule system of the inner ear. The inner ear contains fluids and space that are used by tiny receptors to help the body to know where it is in space, and achieve compound movements without feeling vertigo or dizziness. Concussion can shift the delicate control of this system, and it needs to be retrained just like a strained muscle or sprained ankle to work properly again.
Cervicogenic- Relating to the cervical-spine (head and neck). The mechanism that causes a concussion almost always also produces a whiplash mechanism, which can cause dysfunction of the many joints and muscles in the neck. These dysfunctions can be the cause, or a major contributor to symptoms such as headache, dizziness, ear discomfort and face/eye pain. Treatment to the neck can help decrease symptoms, and help to make more clear what other systems require treatment.
So whats all this 'Treatment' you're talking about?
Once a patient is ready to enter into a treatment program, a more thorough physical assessment is completed. This may include just one or all four of the systems that can be affected by concussion. For example, if the patient is experiencing headache, dizziness and difficulty sleeping, I would assess all four systems as they all could be contributors.
Treatment programs can commence prior to Return to Play and Return to Learn protocols, but require close monitoring and evaluation. There is a delicate balance between working hard enough to lessen the recovery time, without pushing too hard to lengthen it. The key is sub threshold activity to stay out of the "danger zone".
So who can provide this treatment?
A sports medicine doctor may refer a patient to a neurologist for further examination, especially if physical damage to the brain or skull is suspected.
Consultation with an Ophthalmologist, or eye surgeon may be recommended if visual disturbances are extreme, especially if assisting devices or corrective glasses are required.
A hearing specialist may be consulted if there is suspicion of damage to the inner ear, or the nerves that lead between the ear and brain. Sometimes specialized ear plugs may be indicated that reduce ambient noise to allow a patient to function.
There are many other types of medical professionals that may be consulted during the journey of recovery from a complex or simple concussion. These can be very confusing or intimidating to athletes and families of athletes who are playing at the recreational or youth level of sport.
Athletic Therapists are trained in the recognition and treatment of many facets of concussion rehab. ATs are also very knowledgeable about the other professions and how they can help treat various conditions.
Take Home Message?
Read the next post to learn what to do for Return to Play following a concussion