Early Management of Concussions


By Sonja Shouldice, PT, CAFCI, MScPT, BKin


Thanks in part to Sidney Crosby and other high profile professional athletes, concussions are finally starting to be recognized as a serious injury. A concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanics forces. All concussions are mild traumatic brain injuries but not all mild traumatic brain injuries are concussions.

Concussion management is evolving rapidly as well. Gone are the days of going to the doctor and being told to stay in a dark room until symptoms resolve. Anyone who sustains a concussion can and should attend physiotherapy and/or occupational therapy as a part of their rehabilitation. If you or someone you know has had a direct blow to the head, been in a car accident, or experienced any other head or neck trauma they may have a concussion. Common symptoms include: headaches, dizziness, nausea, vomiting, double vision, ringing in the ears, sensitivity to light or noise, fatigue, and trouble concentrating.

A physiotherapy assessment for a concussion will examine several things like neck pain/range of motion, vision, and balance. Treatment will include hands-on manual therapy for the neck and a basic home exercise program. Acupuncture may also be done to decrease pain and muscle tension. The most important thing that your physiotherapist will do at your first appointment though, is provide education about concussions and about symptom management.

In the first 1-2 weeks after a concussion it is very important to stay hydrated (this also means avoiding caffeine and alcohol!), get lots of sleep, and also to rest. Rest does not have to mean laying in a dark room doing nothing. The important thing with rest is to remain symptom-free.

Rest can include:

  • sleeping/lying down
  • listening to podcasts/quiet music
  • meditation/gentle yoga
  • short walks/ physio exercises
  • playing with pets
  • easy housework (setting table, folding laundry, etc)

Activities to avoid:

  • screen time (phone/TV/computer)
  • vigorous physical activity (anything that increases heart rate)
  • lots of socializing/conversations
  • mental stimulation (school or work)
  • reading
  • stimulating environments (Walmart, grocery store, etc)

The important thing to remember with concussions in the early stages is that it is OK to do some tasks/activities, as long as you remain symptom-free. If you are doing something (for example, walking) and your symptoms (for example, headaches) increase, it is imperative that you listen to those symptoms and stop the activity. As you progress through treatment your physiotherapist will further guide you with a gradual return to activities, school/work, and sports. Proper management is essential, but is important to realize that 80-90% of people who sustain a concussion will recover completely.



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