Concussion Rehabilitation

Concussions are the result of acceleration-deceleration forces applied to the brain, and are a common occurrence in contact sports or sports involving speed. Concussion may result from direct impact or sudden rotational or shear forces transmitted to the brain, causing axon (nerve) dysfunction. A number of neurological functions may have been affected and symptoms can vary considerably, therefore a thorough evaluation should be conducted by a medical professional.

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Concussion

Defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.

• Concussion typically results in a rapid onset of short-lived impairment of neurologic functions that resolve spontaneously.
• It usually results in neuro-pathological changes, but acute clinical signs largely reflect functional disturbance rather than structural injury.
• It results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of clinical and cognitive signs typically follows a sequential course; in a small percentage, post-concussive symptoms may be prolonged.
• No abnormality on standard structural neuro-imaging studies is seen in concussion.

Symptoms

The diagnosis of acute concussion involves the assessment of a range of domains, which include clinical symptoms, physical signs, behaviour, balance, sleep and cognition. A detailed concussion history is also an important part of the evaluation. The suspected diagnosis of concussion may include one or more of the following clinical domains:

• clinical symptoms such as headache, feeling like in a fog, emotional instability, attentional deficits or altered mental status, and visual disturbances
• physical signs such as loss of consciousness, amnesia (memory loss), and gait and balance disturbances
• behavioural changes involving irritability or depression
• cognitive impairment involving slowed reaction time
• sleep disturbance and drowsiness

If any one or more of these symptoms are present, a concussion should be suspected and the appropriate assessment and management strategy should be instituted by a qualified medical professional. The player should not be left alone following the injury, and serial monitoring for deterioration is essential over the initial few hours following concussion. It is not uncommon for symptoms to be delayed several hours following a concussive episode, and it is essential that worsening symptoms prompt immediate referral to a hospital.

Sideline assessment tools

The Concussion in Sport Group publishes the Sport Concussion Assessment Tool, used by trained clinicians on the sideline and in the clinic. The current editions, published in the British Journal of Sports Medicine in 2023, are the SCAT6 (opens in a new tab) for ages 13 and up and the Child SCAT6 (opens in a new tab) for ages 8 to 12. They are tools for health professionals, not a substitute for a medical assessment.

Treatment

Treatment often involves vestibular rehabilitation (balance and postural stability, eye and head control) exercises, as these sensitive sensory systems, which are managed by the brain, are often affected. Treatment will also likely involve the neck.

Return to play

A player with a diagnosed concussion should be evaluated before return to play with a structured physical and cognitive assessment, as there is a substantial risk of further deterioration or injury with trauma or exertion when symptoms have not fully resolved. Helmets and mouth guards continue to be recommended to protect against head and facial injuries, and may reduce the incidence or severity of concussions. At Back in Action, physiotherapists trained in concussion management will take you through a graduated return-to-play protocol.

Further reading

Our booklet Concussion and mild traumatic brain injury: a whole body condition (PDF) explains what a concussion is and how recovery works, and the concussion exercises program has levelled videos for home practice.