Concussion in Sport: Can Rehabilitation help?

Holly Lipson

July 12, 2019

Concussion is a costly and potentially life threatening injury which is present in many contact sports both nationally and internationally. Emerging research is coming to light demonstrating the potential problems that can arise later in life after multiple concussions such as mental health issues, memory problems and increased risk of future concussion (Gouttebarge, Aoki, Lambert, Stewart, & Kerkhoffs, 2017).  

Photo credit: AAP published on WWOS website 3 March 2018

But….

The most recent consensus guidelines in concussion now state that concussion is an injury which can be rehabbed! There is a lot we still do not know about concussion and each concussion is different. However, what is emerging is that there can be different drivers to athlete’s symptoms. These can be vestibular, cervicogenic (the neck) or systemic (ie autonomic nervous system dysregulation). If the clinician is able to determine what system driving an athlete’s symptoms (and often it is more than one), this sets the scene of how best to approach rehabilitation.

Physiotherapy can help with many facets of concussion, especially when symptoms become persistent. Exercise intolerance is a large issue affecting many who have ongoing concussive symptoms. Athletes often report headache symptoms, mood changes, sleep disturbances and concentration issues among others as well as intolerance to higher levels of exercise following concussion. The good news is that, if assessed and treated early, rehab via a symptom limited specific exercise program can help to decrease the time taken to return to sport and school (Leddy et al., 2010). Emerging research also shows that aerobic exercise can help restore physiological homeostasis to the autonomic nervous systems response to exercise in those slow to recover from concussion (Dematteo et al., 2015) (Clausen, Pendergast, Willer, & Leddy, 2016). 

 Physiotherapy can also help with any cervicogenic drivers of an athletes concussive symptoms by assessing and treating the neck while a good vestibular physiotherapist can assist in prescribing an appropriate program for any vestibular drivers of the athletes symptoms (Ellis, Leddy, & Willer, 2015). Often a multidisciplinary approach to care is required to achieve optimum outcomes with doctor, physiotherapist, neuropsychologist and if appropriate teaching and coaching staff all working together to achieve optimum outcomes for the athlete.

If you have any questions regarding concussion or know of anyone struggling with persistent concussive symptoms please reach out and I am more than happy to help.

Holly Lipson-Milner is highly experienced in dealing with concussion in sport due to her work as a snow sport physiotherapist with the Australian Olympic Winter Institute Program. She is currently completing her Masters in Sports Physiotherapy. To contact Holly please call Grand Slam Physiotherapy on (03)52772151

References

Clausen, M., Pendergast, D. R., Willer, B., & Leddy, J. (2016). Cerebral blood flow during treadmill exercise is a marker of physiological postconcussion syndrome in female athletes. Journal of Head Trauma Rehabilitation, 31(3), 215-224. 

Dematteo, C., Volterman, K. A., Breithaupt, P. G., Claridge, E. A., Adamich, J., & Timmons, B. W. (2015). Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion. Med Sci Sports Exerc, 47(11), 2283-2290. doi:10.1249/mss.0000000000000682

Ellis, M. J., Leddy, J. J., & Willer, B. (2015). Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment. Brain Injury, 29(2), 238-248. doi:10.3109/02699052.2014.965207

Gouttebarge, V., Aoki, H., Lambert, M., Stewart, W., & Kerkhoffs, G. (2017). A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports. The Physician and Sportsmedicine, 1-7. doi:10.1080/00913847.2017.1376572Leddy, J. J., Kozlowski, K., Donnelly, J. P., Pendergast, D. R., Epstein, L. H., & Willer, B. (2010). A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med, 20(1), 21-27. doi:10.1097/JSM.0b013e3181c6c22c