Concussions are a form of mild traumatic brain injury that require proper management for complete recovery. With advances in concussion research and treatment protocols, most individuals make full recoveries when following appropriate guidelines.
Understanding Concussions
What is a Concussion?
A concussion is a brain injury caused by a bump, blow, or jolt to the head that disrupts normal brain function. It can also occur from a hit to the body that causes the head to move rapidly.
Key Points:
- Functional injury, not structural damage
- Affects brain chemistry temporarily
- No visible changes on standard CT or MRI
- Disrupts neural pathways and communication
How Concussions Occur
Sports-Related:
- Contact sports (hockey, football, rugby)
- Heading the ball in soccer
- Falls during activities
- Collisions between players
Non-Sports Related:
- Motor vehicle accidents
- Falls (especially in older adults)
- Workplace injuries
- Assault
Common Symptoms
Physical:
- Headache
- Nausea or vomiting
- Balance problems
- Dizziness
- Visual disturbances
- Sensitivity to light or noise
- Fatigue
Cognitive:
- Confusion or feeling "foggy"
- Difficulty concentrating
- Memory problems
- Slowed thinking
- Difficulty with decision-making
Emotional:
- Irritability
- Sadness or depression
- Anxiety
- Mood swings
- Emotional sensitivity
Sleep-Related:
- Drowsiness
- Sleeping more or less than usual
- Difficulty falling asleep
- Sleep disturbances
Immediate Management
On-Field Assessment
Red Flags - Seek Emergency Care:
- Loss of consciousness
- Severe or worsening headache
- Repeated vomiting
- Seizures
- Double vision
- Weakness or numbness
- Decreased coordination
- Slurred speech
- Unusual behavior
Sport Concussion Assessment Tool (SCAT5):
- Standardized sideline assessment
- Memory and orientation testing
- Balance evaluation
- Neurological screen
- Used by medical professionals
First 24-48 Hours
Do's:
- Rest physically and cognitively
- Have someone monitor you
- Ice for headache
- Take acetaminophen if needed (avoid ibuprofen initially)
- Stay hydrated
- Sleep when tired
Don'ts:
- Drive
- Drink alcohol
- Use recreational drugs
- Take aspirin or ibuprofen (bleeding risk)
- Return to sport or work
- Use screens excessively
Diagnosis and Assessment
Medical Evaluation
Initial Assessment Includes:
- Detailed symptom inventory
- Neurological examination
- Cognitive testing
- Balance assessment
- Visual tracking tests
- Neck examination
Additional Tests May Include:
- Vestibular/oculomotor screening
- ImPACT or other computerized testing
- Physical examination of neck and spine
- Imaging if structural injury suspected
Baseline Testing
Athletes should complete baseline testing before season:
- Computerized cognitive assessment
- Balance testing
- Symptom checklist
- Reaction time measures
This provides comparison data if injury occurs.
Recovery Phases
Phase 1: Acute Phase (Days 1-3)
Primary Goal: Rest and symptom management
Activities:
- Physical and cognitive rest
- Limit screen time
- Avoid bright lights and loud noises
- Short, easy activities if tolerated
- Hydration and nutrition
Expected Symptoms:
- Most severe during this phase
- Gradually begin to improve
- Rest helps reduce symptoms
Phase 2: Light Activity (Days 4-7)
Goals:
- Introduce light activity
- Monitor symptom response
- Begin gradual return to routine
Permitted Activities:
- Light walking (10-15 minutes)
- Gentle stretching
- Limited screen time (15-20 minutes)
- Reading in short bursts
- Social interaction as tolerated
Progression Criteria:
- Activities don't worsen symptoms significantly
- Symptoms improving overall
- Tolerating increased cognitive load
Phase 3: Moderate Activity (Week 2)
Goals:
- Increase activity duration
- Return to work/school (modified)
- Build exercise tolerance
Activities:
- Walking 20-30 minutes
- Light stationary bike
- Modified work/school schedule
- Increased screen time gradually
- Light household tasks
Accommodations:
- Reduced workload
- Frequent breaks
- Quiet environment
- Extended deadlines
- Modified testing conditions
Phase 4: Heavy Non-Contact Activity (Week 3-4)
Goals:
- Progress exercise intensity
- Full return to work/school
- Sport-specific training without contact
Activities:
- Running/jogging
- Strength training
- Sport-specific drills
- Full work/school participation
- Normal daily activities
Monitoring:
- Should be symptom-free at rest
- Minimal symptoms with exertion
- Quick recovery after activity
Phase 5: Full Contact Practice (Week 4-5)
Goals:
- Return to full practice
- Build confidence
- Ensure readiness for competition
Requirements:
- Completely symptom-free
- Medical clearance obtained
- Passed return-to-sport testing
- Psychological readiness
Phase 6: Return to Competition
Final Criteria:
- Symptom-free for appropriate duration
- Cleared by healthcare provider
- Normal balance and coordination
- Passed cognitive testing
- No symptoms with full practice
Specialized Treatment Approaches
Vestibular Therapy
For dizziness, balance problems, and visual disturbances:
Techniques:
- Gaze stabilization exercises
- Balance training
- Habituation exercises
- Visual tracking drills
Benefits:
- Reduces dizziness
- Improves balance
- Enhances eye-hand coordination
- Accelerates recovery
Cervical Spine Treatment
Many concussions involve neck injury:
Assessment:
- Cervical range of motion
- Muscle tenderness
- Joint mobility
- Posture analysis
Treatment:
- Manual therapy
- Gentle mobilization
- Soft tissue release
- Postural correction exercises
Vision Therapy
For oculomotor dysfunction:
Common Issues:
- Difficulty focusing
- Double vision
- Eye tracking problems
- Convergence insufficiency
Interventions:
- Eye movement exercises
- Focusing drills
- Convergence training
- Visual processing activities
Cardiovascular Exercise
Supervised exercise programs:
Buffalo Concussion Bike Test:
- Gradual intensity increase
- Heart rate monitoring
- Symptom tracking
- Identifies exercise tolerance
Benefits:
- May accelerate recovery
- Improves symptoms
- Restores autonomic function
- Builds confidence
Persistent Post-Concussion Symptoms (PPCS)
When Symptoms Last Beyond 4 Weeks
Common in:
- Women and adolescents
- History of migraines
- Previous concussions
- Mood disorders
- Neck injury with concussion
Multidisciplinary Treatment
Team Approach:
- Physiotherapy (vestibular, cervical)
- Psychology (cognitive behavioral therapy)
- Occupational therapy
- Sports medicine physician
- Neurologist (if needed)
Treatment Components:
- Targeted exercise therapy
- Cognitive therapy
- Vision rehabilitation
- Neck treatment
- Psychological support
- Medication if appropriate
Return to Learn Protocol
Academic Accommodations
Elementary/High School:
- Shortened school day initially
- Extra time for assignments
- Reduced homework load
- Quiet space for breaks
- Modified testing environment
- Avoid screens when possible
Post-Secondary:
- Contact disability services
- Notify professors
- Request extensions
- Recording lectures
- Reduced course load
- Quiet study spaces
Progression Steps
- Cognitive rest at home
- Gradual return to school (half days)
- Full school day (with accommodations)
- Reduced accommodations
- Full return to academics
Progress to next step when tolerated without significant symptom increase.
Return to Sport Guidelines
The 6-Step Protocol
Step 1: Symptom-Limited Activity
- Daily activities at home
- No exercise
Step 2: Light Aerobic Exercise
- Walking or stationary bike
- <70% max heart rate
- 10-15 minutes
Step 3: Sport-Specific Exercise
- Running or skating drills
- No head impact activities
- 20-30 minutes
Step 4: Non-Contact Training Drills
- Progressive resistance training
- More complex drills
- May begin progressive return to play
Step 5: Full Contact Practice
- Normal training activities
- All contact allowed
Step 6: Return to Sport
- Normal game play
Important: Spend minimum 24 hours at each step. If symptoms return, drop back to previous step.
Prevention Strategies
Equipment
Properly Fitted:
- Helmets (cannot prevent concussions but reduce severity)
- Mouthguards
- Protective gear for sport
Maintenance:
- Replace damaged equipment
- Check fit regularly
- Follow manufacturer guidelines
Rule Changes and Enforcement
- Body checking age restrictions
- Heading guidelines in youth soccer
- Fair play initiatives
- Concussion protocols in leagues
- Return-to-play policies
Neck Strengthening
Strong neck muscles may reduce concussion risk:
- Isometric neck exercises
- Resistance training
- Sport-specific conditioning
- Proper tackling/body positioning technique
Education
- Recognize concussion symptoms
- Report injuries immediately
- Understanding recovery process
- Coach and referee training
- Parent education programs
When to Seek Additional Help
Contact healthcare provider if:
- Symptoms worsen
- New symptoms develop
- Not improving after 2 weeks
- Symptoms return with activity
- Emotional changes persist
- Academic difficulties continue
Long-Term Considerations
Multiple Concussions
Each concussion:
- Takes longer to recover
- Increases risk of future concussions
- May have cumulative effects
- Requires more conservative management
Retirement Considerations:
- Number and severity of concussions
- Time between injuries
- Age and level of competition
- Personal and family history
- Quality of life impact
Reducing Future Risk
- Adequate recovery before return
- Strengthening exercises
- Proper technique coaching
- Sport selection consideration
- Honest symptom reporting
Myths vs. Facts
Myth: You must lose consciousness to have a concussion Fact: Most concussions don't involve loss of consciousness
Myth: You should wake someone every hour after concussion Fact: Sleep is important for recovery; wake only if advised by medical professional
Myth: You can't use screens at all Fact: Limited screen time is often tolerated; listen to your symptoms
Myth: All concussions are the same Fact: Each injury is unique and requires individualized treatment
Myth: You can "tough it out" Fact: Proper rest and gradual return prevents prolonged symptoms
Support and Resources
For Athletes:
- Focus on recovery, not timeline
- Communicate symptoms honestly
- Follow return-to-play protocol
- Ask questions
For Parents:
- Monitor symptoms
- Advocate for accommodations
- Support emotional needs
- Be patient with recovery
For Coaches:
- Prioritize athlete safety
- Follow concussion protocols
- Support gradual return
- Foster culture of reporting
Take Concussions Seriously
Proper concussion management is essential for complete recovery and preventing long-term consequences. Never rush the recovery process or hide symptoms.
Concerned about a possible concussion? Our specialized concussion management team at M.O. Therapy provides comprehensive assessment and evidence-based treatment. We'll guide you through every step of recovery with individualized care and support.
Book a concussion assessment today and ensure your recovery is managed by experienced professionals. Your brain health is worth the time and attention needed for complete healing.