Concussion Recovery & Rehabilitation Treatment
The PhysioActive Difference: The PACT Complete Concussion Program
Our Assessment:
We don’t just prescribe rest and exercise based on general guidelines. It is specifically tailored to you. If you injured your knee, the therapy would be very different depending on whether you had a minor sprain, injured your meniscus , or completely ruptured your ACL (Anterior Cruciate Ligament). General rules are just that, general. Telling someone to rest until the symptoms go away doesn’t make sense when rehabilitating the body anywhere else, so why is that prescribed when rehabilitating the most important part of our body — the brain?
We look at all the systems that may have been affected by your brain injury (concussion). We assess all the brain functions outlined below, but we also assess the neck and upper back. If you receive a blow big enough to cause a brain injury you will also have injured the tissues of your neck.
We also assess the movements of the cranium. This is essential to the proper repair of the brain. Our osteopathic practitioners and cranial therapists will assess the bones of the face and cranium.
Our Treatment:
At PhysioActive, our treatment focuses on where you need the treatment the most. Our multi-modal approach (which incorporates education, hands-on or manual therapy, exercise, and treatment-enhancing modalities) to care is shown in the evidence to optimize outcomes.
We don’t use a one-size-fits-all protocol. Every concussion patient is different and thus requires different interventions to optimize healing. We succeed where others fail. One of our greatest joys is helping clients who have been unsuccessful in treating their concussions with standard approaches to care. Our clients are so happy with their improvements and only wish they had come to us first.
Our Technology:
At PhysioActive, we incorporate the most up-to-date and evidence-based technologies to complement your hands-on therapy. We may use iLs to help calm the nervous system and retrain the eyes and ears , and the vestibular system to make regular exercises more effective. We may use MBS and laser to improve the healing of the neck and nervous system. On rarer occasions, we will use other physiotherapy modalities to assist in healing.
What is a Concussion?
A concussion is any injury to the brain. A concussion is usually a result of the movement of the brain within the skull , which is injured by the brain striking the inside of the skull due to rapid acceleration or deceleration. As a result, a helmet is not always effective at preventing concussions. At PhysioActive, we understand that impacts and injuries that can cause an injury to the brain must also have some impact on the neck and upper back.
Acute Concussions
Concussions and post-concussion symptoms are becoming more and more common. There are no medical tests that can confirm if a person has had a concussion, and the symptoms of 80% of all concussions disappear after one week.
Concussions occur when an external mechanical force causes brain dysfunction and usually result from a violent blow or jolt to the head or body.
Signs and symptoms of a concussion
- A headache or a feeling of pressure in the head
- Sensitivity to light or sound
- Fatigue
- Sleep disturbances
- Delayed response to questions
- Confusion or brain fog
- Amnesia surrounding the traumatic event
- Dizziness, vertigo or “seeing stars”
- Tinnitus aka “Ringing in the ears”
- Nausea and/or Vomiting
- Slurred speech
- Appearing dazed
Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:
Cognitive complaints could consist of:
- Concentration and memory complaints
- Irritability and other personality changes (ideally ask mother or spouse)
- Psychological adjustment problems and depression
- Disorders of taste and smell
Symptoms in children
Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they may not be able to describe how they feel. Nonverbal clues of a concussion may include:
- Appearing dazed
- Listlessness and tiring easily
- Irritability and crankiness
- Loss of balance and unsteady walking
- Crying excessively or colic
- Change in eating or sleeping patterns
- Lack of interest in favorite toys
General Treatment of Concussion
The best treatment immediately after any concussion is the same as any other injury:
REST: Rest has two very important features when it comes to concussion. First, it prevents the brain from being injured any further, and secondly, rest allows optimal allocation of resources to allow maximal recovery to occur.
COMPLETE PHYSICAL AND COGNITIVE REST is prescribed during the initial recovery period. This means: no school, no homework, no texting, no computer/video games, no television , and no physical activity until the symptoms of concussion begin to subside. As the symptoms improve**,** a slow introduction of demand may be started.
As you improve, a slow and graded rehabilitation process can begin.
At PhysioActive we recommend that sensory and cognitive activities are begun first and then a gradual increase in physical activity, with each stage separated by a period of at least 24 hours. This process must be monitored by a clinician with extensive training in concussion injuries, as there are numerous signs which could delay recovery if not properly addressed. In an ideal world, the patient should have NO SYMPTOMS as these demands are increased. If symptoms are encountered, this is an indication the demands on the brain are too much and should be reduced. The patient should drop back to the previous stage for a 24-hour period before attempting the next stage again. The final stages involve monitored increases in one’s physical exertion and to assess blood flow within the brain, as well as extensive testing of neurological, mental and physical systems, to ensure that your brain has recovered and you are safe to return to activity without causing further damage. Most patients will make a quick and full recovery.
Post-Concussion Syndrome
Post-concussion syndrome is a clinical term for concussion symptoms that last longer than a week. If the symptoms persist or do not begin to improve, or in some cases, new symptoms develop, rehabilitation becomes an absolute necessity.
Mild or Minor Traumatic Brain Injury (mTBI)
All concussions are brain injuries. The term “mTBI” has been used to distinguish between concussions (also known as mTBI) and TBI, which encompasses more severe brain injuries that result in paralysis, coma, loss of cognition, memory , or other mental and physical functions. Many brain injuries, especially when the person does not lose consciousness, go unnoticed and are never reported — and therefore never treated. Any injury to the brain is serious, so we don’t favour this definition or terminology at PhysioActive.
Why Choose PhysioActive for treatment of your Concussion:
Our specially trained and complementary team of healthcare providers can accurately assess and properly guide you in your recovery.
When assessing and treating a concussion, whiplash, or any brain injury, PhysioActive addresses the following care pathways:
- Cervical Therapy
- Vestibular Therapy
- Ocular
- Autonomic Regulation
- Cognitive Therapy
- Sensory and
- Emotional, primarily through support and small attainable functional goal successes.
In therapy, PhysioActive addresses all components of whiplash and post-concussion symptoms. The key is specifically graded exercises addressing the categories listed above. Therapy and exercises may include neck exercises addressing the range of motion, strength, control, myofascial trigger points, and joint position or proprioception. More importantly, neural integration of neck and arm movements with breath and autonomic system regulation must be accomplished in order to heal. Other therapies may be included in your rehabilitation program. These include ocular exercises, balance, and vestibular exercises. Aerobic and autonomic regulatory exercises are important in treatment gradually increasing the aerobic demand and endurance. Graded increases in cognitive and sensory stimuli are incorporated based on current tolerances. The ocular exercises are incorporated as an effective way of stimulating specific areas of the brainstem and brain and central integrating system. Vision and eye movements are complex tasks that integrate multiple areas of our brain. Without constant monitoring of the autonomic nervous system brain and neurological repair is not possible.
The key to successful improvement is a slow progression paying close attention not overwork the central and peripheral systems. This will be achieved with close monitoring of the exercise program. If overworked, neural symptoms may worsen and regression may occur. We have had great success even with the most chronic post-concussive and vestibular patients. Ones’ neural system is plastic and has the capacity to improve even years post-injury.
How can Osteopathy or Craniosacral help your recovery?
Cranial therapy or craniosacral therapy is usually included in most post-concussive treatment programs at PhysioActive. Injury to the bones of the skull, the thick fascia protecting the brain (dura, arachnoid, and pia) all can become injury at the same time as the brain in a concussion. This is an often overlooked area in most other concussion rehabilitation programs. It will be an important treatment modality needed to restore proper cranial movement, dural mobility, and assists in regulating the autonomic nervous system.
Some examples of nervous system tests may include balance tests such as the Rhomberg. Other observational tests are included looking at how you walk, stand, turn in a variety of positions. Your breath, blood pressure, heart rate and posture all play an important role in the rehabilitation program. Coordination tests and neural mapping tests may be performed. Ocular or eye tests including gaze fixation, vision tests, saccades, pursuits, convergence, and optokinetics are tested. Frequently these simple eye tests can provoke concussive symptoms. By putting together a myriad of tests your therapist is able to pinpoint as accurately as possible which systems are working suboptimally and design a program to first balance the neurological system and then strengthen it.
The spine, its movements, and its attachments are evaluated and treated as necessary. In order to treat all concussions, the patient must have all dysfunctions in the cervical, thoracic and cranium optimized, restoration of dynamic stability and proper breathing are also essential.
Cervical Thoracic Spinal Manual Therapy
Connecting Cervical, Thoracic, and Rib Dysfunction to Concussion Rehabilitation
When it comes to recovering from a concussion, it’s important to recognize that the injury’s impact can extend beyond the brain. The cervical spine (neck), thoracic spine (upper back), and rib cage play a crucial role in the body’s overall function and have a significant influence on concussion recovery.
The Cervical Spine’s Role in Concussion Recovery
The cervical spine houses the upper part of the spinal cord and is directly connected to the brainstem, which is vital for controlling essential functions like heart rate, breathing, and balance. After a concussion, it’s common to experience issues like neck pain, stiffness, or limited range of motion. These symptoms can not only cause discomfort but also contribute to prolonged concussion symptoms such as dizziness, headaches, and difficulty concentrating.
Manual therapy and specific exercises targeting the cervical spine can help restore proper alignment, improve blood flow, and reduce nerve irritation. By addressing any dysfunction in the neck, we support the body’s ability to heal and enhance neurological function.
Thoracic Spine and Rib Cage in Concussion Rehabilitation
The thoracic spine and rib cage are often overlooked in concussion treatment, but they are essential for overall body mechanics and nervous system regulation. The thoracic spine is connected to the rib cage, and together, they protect vital organs like the heart and lungs. Dysfunction in this area can lead to poor posture, restricted breathing, and impaired mobility, all of which can exacerbate concussion symptoms.
Additionally, the thoracic spine and ribs are intricately linked to the sympathetic nervous system (SNS), which governs the body’s fight-or-flight response. When there’s dysfunction in this region, it can lead to an overactive SNS, causing increased stress, anxiety, and difficulty in calming the nervous system—common issues for those recovering from a concussion.
Through manual therapy, osteopathic techniques, and specific exercises, we can address thoracic and rib dysfunction, promoting better posture, improved breathing, and a more regulated nervous system. This comprehensive approach not only alleviates physical discomfort but also supports the neurological recovery process.
A Holistic Approach to Concussion Recovery
At PhysioActive, our approach to concussion rehabilitation is holistic and multidisciplinary. We understand that recovery is not just about treating the brain but also addressing the entire body’s response to the injury. By focusing on the cervical and thoracic spine and rib cage, we ensure that all aspects of your physical health are optimized to support your recovery.
Whether through physiotherapy, osteopathy, craniosacral therapy, or other modalities, our goal is to provide you with the most effective treatment to get you back to feeling your best. By treating the interconnectedness of the spine, ribs, and brain, we help you achieve a faster, more complete recovery from your concussion.
FAQ
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How long does concussion recovery take? This is highly variable just like any injury, but the brain heals like all other body parts. During the first 24-48 hours it is most susceptible to further injury. It then can take up to 10-14 days before normal blood supply has been returned to the injured part of the brain. Think about how a cut heals on your skin. The length of time depends on how bad the cut is. -
What does concussion recovery involve? Symptoms of concussions may only last for a few seconds whereas more serious concussions can last for days or weeks. If proper treatment is not initiated with more serious concussions, symptoms can last for years. All concussions should involve a thorough manual assessment of your upper neck, neck, and thorax including your ribs, It should also a manual assessment of cranial joint movement. Comprehensive testing of the brain or functional neurological tests should be completed. These will usually include cognitive tests, balance, and movement testing, eye and vision tests and a proper neurological exam including primitive and motor reflexes. Like all injuries, a proper diagnosis of what exactly is injured will determine the treatment plan and length of recovery. Not all knee injuries take the same amount of time to heal, nor do the same exercises and treatment protocol work for different knee pains or injuries. The brain heals the same way. -
What are the long-term effects of concussion? Brain injuries should never be taken lightly. Long term effects can include anything your brain includes. It can lead to mental health disorders such as depression and anxiety. It can affect your autonomic system, even affecting your bowels and digestive symptoms. It can lead to chronic concussion symptoms such as headaches, nausea. Other complaints are personality changes, cognitive loss or brain fog, fatigue and many more. -
How long does it take to recover from a mild concussion? It is recommended that 10 to 14 days be taken to progress brain strain. -
Does your brain fully heal after a concussion? Like a cut on your skin, your body has the capacity to fully heal back to normal. -
Can a concussion cause permanent damage? If not properly evaluated and rehabilitated, some symptoms of a concussion may never go away until it is addressed. -
What is the correct way to deal with concussions? All concussions should involve a thorough manual assessment of your upper neck, neck, and thorax including your ribs, It should also a manual assessment of cranial joint movement. Comprehensive testing of the brain or functional neurological tests should be completed. These will usually include cognitive tests, balance, and movement testing, eye and vision tests and a proper neurological exam including primitive and motor reflexes. Like all injuries, a proper diagnosis of what exactly is injured will determine the treatment plan and length of recovery. Not all knee injuries take the same amount of time to heal, nor do the same exercises and treatment protocol work for different knee pains or injuries. The brain heals the same way. A proper return to sport and a full functional neurological and sports assessment is recommended before returning to competition. -
What is post-concussion syndrome (PCS)? Post-concussion syndrome (PCS) is when the symptoms of concussion such as headache, vision disturbances, dizziness (or any concussion symptoms) remain for weeks, months or years after a concussion. -
Why might post-concussion syndrome occur or persist? Usually, post-concussion syndrome remains when improper intervention or misdiagnosis and treatment occurred. Sometimes with the severe impact, a more permanent brain injury will occur and scarring in the brain occurs In this case, more time is needed for the neighbouring areas of the brain to take over the functions of the damaged areas. This can take weeks or months. -
What is the best treatment for PCS? All concussions should involve a thorough manual assessment of your upper neck, neck and thorax including your ribs, It should also a manual assessment of cranial joint movement. Comprehensive testing of the brain or functional neurological tests should be completed. These will usually include cognitive tests, balance, and movement testing, eye and vision tests and a proper neurological exam including primitive and motor reflexes. Like all injuries, a proper diagnosis of what exactly is injured will determine the treatment plan and length of recovery. Not all knee injuries take the same amount of time to heal, nor do the same exercises and treatment protocol work for different knee pains or injuries. The brain heals the same way. A proper return to sport and a full functional neurological and sports assessment is recommended before returning to competition.
Executive Functions
