Physical therapists (as part of a whole healthcare team) can be some of the best medical professions to treat concussions because of our knowledge, frequency and time we get to spend with our patients. Also, many factors that are important to consider when working with concussion symptoms are ones that we already use to inform treatments for other types of patients.
We use a concept called “graded exposure” to gradually restore prior levels of function with most patients. We break down activities people want to do that they can’t and work on areas of weakness, limited mobility or impaired motor patterns to reduce pain and eventually progress back to the full activity. With a concussion, this has to be done for all types of symptoms, which could include neck pain/dysfunction, cognitive changes, mood changes (including anxiety) and vision dysfunction. Intolerance to light, sound and aerobic activity need to be considered as factors. The trick is to consider all types of symptoms and investigate what the patient’s tolerance level is to each one vs. what it was prior to the injury. Simply working on someone’s neck can be more successful in a dark, quiet room vs. a loud, noisy gym environment if they have a low threshold for noise and/or light.
If you used to run outside with a friend for fitness, but don’t tolerate this after concussive injury, how do we restore this? Start by performing solo aerobic activity for a reduced amount of time on a stationary piece of equipment, avoiding visual distraction, street noise, conversation, and extreme weather conditions. If you find a length of time that doesn’t provoke your symptoms, increase by 10-15 minutes each time. If you notice a symptom flare-up after a workout, don’t quit, but go back to working within the parameters that were successful in the past and increase again the next time, maybe by a smaller increment. Once you achieve the desired tolerance to time, slowly add other complicating factors, like working out with others around or listening to loud music/TV. Eventually, when these are tolerated, go back to outdoor running for shorter periods of time and work that up to the level you had been at before. When that goes well, you can resume running with your friend and see how it goes. [This is just one example.]
Recent studies have found that graded aerobic activity can reduce the amount of time it takes to heal from post-concussive symptoms vs. those who are recommended to rest. Working out within the patients’ tolerance (not increasing symptoms afterward) showed a reduced number of days to full recovery.
Every day matters when you’re having to change how you live because of post-concussive symptoms.