How to Manage and Treat Concussion

Jesse Castillo

April 14, 2021

What is concussion?

Concussion is a form of brain trauma that is often caused by an impact to the head or anywhere on the body that transmits the force to the head. It causes short-lived changes to the brain where symptoms can develop straight away or in the days following injury. For the most part, adults tend of recover within two weeks of the incident whilst children/adolescents can take up to four weeks. However, a small percentage of people will develop persistent post concussive symptoms.

Symptoms

Recognising concussion is difficult as the symptoms and signs are different for each person. The Sport Concussion Assessment Tool (SCAT 5)  is widely used in concussion assessment on game day and in the rehabilitation phase. It identifies 22 possible symptoms of concussion:

Current return to sport evidence

Concussion management is still an evolving area of research. The recent developments in the AFL’s management of concussion reflect the guidelines from the most recent Concussion in Sport conference in Berlin in 2016. Even though the focus is around sports related concussion, many principles can be applied to management of traumatic brain injuries and whiplash. Since then, there have been other advancements in concussion diagnosis and management, but the latest conference that was scheduled in 2020 was been put on hold due to Covid-19 restrictions.

https://www.afl.com.au/news/543223/afl-statement-on-updated-concussion-guidelines

Recent research into concussion shows that complete physical and cognitive rest is not recommended instead a graded return to sport program, outlined below, improves long term outcomes.

Guidelines for return to sport following concussion

Each phase above requires you to have a symptom free period of 24 hours and therefore on average it takes 48 hours to work through each progression. This outlines why the 12-day mandatory break has been introduced in the AFL.

How can a physiotherapist help with concussion?

Physiotherapists are well equipped to help in all phases of concussion.

• Game day – assisting in the recognition of concussion, medical management, return to play clearance
• First 4 weeks post concussion – assisting in the return to sport protocol as above
• Persistent concussion symptoms – physiotherapists play a massive role in this area of concussion as the rehabilitation often involves:
o Vestibular rehabilitation as balance, eye/head movements can be impacted in concussion. In addition, vestibular rehabilitation assists in reducing dizziness
o Cervical rehabilitation for any neck injuries from the concussion
o Autonomic dysfunction rehabilitation as exercise induced heart rate related issues can arise as well
o Return to sport rehabilitation to ensure that, in line with medical advice, players have gone through the testing required for sports

For any further questions on concussion, feel free to contact us! Jesse Castillo and Holly Lipson-Milner have a special interest in treating concussion injuries.

Useful links

SCAT 5 – https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf

AIS Concussion in Sport resources – https://www.concussioninsport.gov.au/parents_and_teachers

Berlin consensus statement – https://bjsm.bmj.com/content/51/11/838