At River East Physiotherapy, we treat concussions as well as other neurological conditions and vestibular conditions.
Definition of a Concussion
A concussion is a mild traumatic brain injury. It is caused by traumatic forces to the head and/or neck. This trauma can include:
- hitting your head on a surface, like the ground or a windshield or
- suddenly slowing the movement of your head, without hitting a surface, creating an impact between your brain and your skull.
As a result of this trauma, your brain experiences functional disturbances and/or metabolic disturbances.
A functional disturbance means there is a disruption to the signaling pathways your brain uses to walk, feel, speak, see or hear. A metabolic disturbance means your brain cells’ metabolism is off, such as their ability to absorb nutrients or process cell waste. Essentially, that means some of your brain cells can't do their jobs, and you experience concussion symptoms until they heal.
Symptoms of a Concussion
The most common symptoms of a concussion are headaches, dizziness, sleep disturbances, and emotional changes.
Concussion symptoms may not all start at once. Some of the symptoms might be delayed, and come on hours or days after the injury. Delayed symptoms commonly include:
- Concentration and memory complaints,
- Irritability and other personality changes,
- Sensitivity to light and noise,
- Sleep disturbances,
- Psychological adjustment and depression, and
- Disorders of language, taste and smell.
Personality changes is a less common symptom of concussions, but they do occur.
How Our Physiotherapists Treat Concussions
Physiotherapists are rehabilitation experts. They help you recover or function better after an injury to your bones, muscles, joints, or brain. A physiotherapist who treats concussions:
- Assesses your symptoms,
- Develops a treatment plan in collaboration with you, and
- Monitors your progress over time.
During the assessment, the physiotherapist listens to you describe your symptoms, and how they’re impacting your life. They will do physical tests to measure and evaluate your symptoms. They will be most interested in your pain, balance, coordination, your vision, how your eyes move, and your endurance. They’ll also be looking for vertigo, or any evidence of trauma to your vestibular system.
A physiotherapy treatment plan will be customized to you and your unique symptoms. It may include, for example:
- Exercises for improving your attention and cognitive tasks (such as tasks involving memory or planning),
- Combining cognitive and attention tasks with physical tasks, like those you need to do in your every day life,
- Giving you a plan on how to return to school, sports or work,
- Teaching you tools to improve energy levels and prevent mental and physical exhaustion.
Perhaps most importantly, your physiotherapist will be your guide as you recover. Most of our patients struggle to figure out what they should and shouldn’t do as they recover. It’s important you don’t do too much too soon! No overloading is the key to prevent further cell damage in your brain. It can feel awesome to have someone caring, knowledgeable, and well qualified to guide and take care of you.
Frequently Asked Questions About Concussion
A concussion is diagnosed by taking your medical history and doing a physical exam and neurological tests. Your doctor or physiotherapist will assess your symptoms, balance, and coordination. In some cases, imaging like CT scans or MRIs may be used to rule out other injuries.
You’re the boss of your physiotherapy treatment. That means you set your goal, with our support. Then we work together to try to get you to that goal. Example goals:
- Spend an entire day at work with no headache
- Bike for an hour a day, like you did before your concussion
- Finish the season with your soccer team, without getting re-injured
When we’re advising you on your treatment plan, your physiotherapist’s main goal is usually gradual and progressive activity after the first 48-hours after your injury.
Your physiotherapist will also want you to remain below your cognitive and physical exacerbation threshold. That means you want to your body and brain to be active, so they recover, but you don’t want be so active that you make your signs or symptoms worse. This can be a tricky balance to achieve, and we're here to guide you.
It depends. Some symptoms go away with time, but others can persist and cause a long recovery time. In some unusual cases, concussion symptoms resolve spontaneously.
Likely yes.
Physiotherapists treat our patients as a ‘whole,’ but we do have deep expertise in the physical side of concussions. When your concussion symptoms affect your hearing, your mental health, your cognitive capacity, or your vision, your doctor can help you build the health care team you need. In addition to a physiotherapist, this may include an occupational therapist, a psychologist, an optometrist or a counsellor.
If your head injury is severe, proceed to the emergency room or doctor right away. This includes a loss of consciousness, weakness or numbness, a headache that is getting worse, decreased coordination, memory loss, and nausea or vomiting.
Recall a concussion is a mild traumatic brian injury. A major traumatic brain injury definitely requires medical attention, in addition to rehabilitation with physiotherapy.
A labyrinthine concussion involves damage to the vestibular system, or a ‘vestibulopathy’. The labyrinthine is located in the inner ear and is where the vestibular system (balance receptors) and the cochlea (hearing receptors) are in. During head trauma, the labyrinth can be affected, damaging soft tissues of the labyrinth. When this happens, some people feel immediate vertigo (hallucination of visual spinning) and disequilibrium.
A cortical concussion involves damage to the cortex of the brain. Usually it is to the superficial (more external) layers of the brain. These parts are in charge of body function (such as moving, seeing, hearing and feeling) and awareness of different processes of the body function.
Cortical concussions are treated differently from labyrinthine concussions. This is because labyrinthine concussions involve damage to the vestibular system and the cortex. Every patient and impact are different, therefore each patient is assessed and treated differently according to their signs, symptoms and needs.
The guidelines for treating post-concussion syndrome have changed over the years. Now, it is recommended to do exercise only as tolerated, instead of resting until the symptoms go away completely.
Recovery times vary, but most people start to feel better within a few weeks. It's important to follow your physiotherapist's advice for returning to exercise or sports gradually.
Your physiotherapy treatment plan for concussion will help you find the right balance between avoiding activities that put too much stress your brain, and still challenging your brain and body at a level that encourages healing. It's a tough balance to find - and that's one of the many reasons you deserve a professional to guide you through your return-to-activity plan after your concussion.
Improper treatment or returning to activity too soon can results in your symptoms lasting longer, or even a more serious brain injury. It's essential to follow proper recovery protocols to avoid long-term issues and further injury. Our physiotherapists can help make sure you know which recovery protocols are right for you.
Exposure to another concussion before the prior concussion has properly healed can lead to more serious neurological signs and symptoms. These could include dilated pupils, loss of eye movement, unconsciousness, respiratory failure and even death. This is called Second (Poly) Impact Syndrome.
This repeated brain trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called Tau. Symptoms associated of a build-up of this protein in the brain & spinal cord are:
- memory loss,
- confusion,
- impaired judgement,
- impulse control problems,
- aggression,
- depression,
- suicidality,
- parkinsonism, and, eventually
- progressive dementia.
While physiotherapy cannot prevent concussions, our physiotherapists can help reduce the risk of injury by helping you improve your balance, coordination, agility and neck strength. Physiotherapists can teach techniques to help prevent falls, prevent injuries from falls, and manage the impact you experience during sports or physical activity.
For more complex concussions, we recommend our physiotherapist Alex de Vries. Alex has extensive experience and post-graduate training in managing and recovering from concussions. Read more about Alex’s training and qualifications here.
All our physiotherapists have university-level training to treat basic concussion symptoms, including neck pain, headaches and balance issues. They all work with your healthcare team to ensure you see the right professional for your unique condition and goals.
Not sure if physiotherapy is right for your concussion rehab? Call us to arrange a FREE 15-minute phone consultation with a physiotherapist.
Learn more about concussions and concussion rehabilitation in our Concussion Guide.
A quick overview of what you can expect with us:
