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Sports Related Concussion (SRC)


SRC may be caused by either a direct blow to the head, face, or neck with an impulsive force transmitted to the head. It may result in neuropathological changes and results in a disturbance in the equilibrium of the brain and its synapsis.

Eleven areas have been identified by expert medical panels in the successful management of sports related concussions: these all need to be addressed in the management of individuals with concussion to safely and quickly return to previous level of function. For succinctness, we will only focusing on 7 of the key areas in this article that are most applicable in the athlete returning to sport following a concussion.

A major key to healing a concussion is the ability to recognize when it is present. No person involved with the athlete is exempt from this responsibility (coaches, athletic directors, athletic trainers, trained on-field physical therapists, and parents). Any injury involving a “blow” to the head or neck needs to be evaluated by a trained medical professional for possible concussion. The evaluation consists of physical, cognitive, emotional, and sleep related tests while looking for signs and symptoms.

It is common for an athlete to express they “feel fine” after suffering a concussion. They desire to get back into the game and feel like they are contributing, but it is critical that they be removed from play after recognizing the presence of a concussion. Once the athlete is removed from play, they should not be allowed to return to sport until they have been fully cleared by a licensed and trained medical doctor. It is imperative to involve the athlete’s parent at this time to discuss the injury and what emergency type symptoms to look for so that they can respond as required given potential escalation of symptoms.

The athlete should be re-evaluated after a sideline assessment by a licensed medical professional.The medical professional will oversee the athlete during the return to play protocol. Before prescribing any treatment techniques one needs to know what the actual impairments are and their severity.

The basis for the prescription of complete rest in the past was to
ease the discomfort during recovery by decreasing brain energy usage, ultimately promoting faster healing. There is currently insufficient evidence that complete rest achieves these objectives. After a brief period of rest (24 to 48 hours) following injury, athletes can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom – exacerbation thresholds. It is a strong recommendation for the athlete to avoid vigorous exertion while they are in the recovery stage

As physical therapists, we have seen first hand what proper rehabilitation can do for individuals returning to their functional activities. Rehabilitation for concussions can be done in a variety of different treatment areas including: cervical, psychological, and vestibular-ocular. In addition, active rehabilitation steps involve guided sub-maximal exercises while monitoring symptom response.
At Wright Physical Therapy we collaborate with local sports medicine
teams/physicians to facilitate recognition and treatment of patients with our advanced concussion protocol. We provide comprehensive physical examinations in order to deliver specific treatments to reach established goals. Our treatment protocol is focused on dysfunctions in movement patterns of the neck, balance/coordination, and the vestibular-ocular system.

In order for an athlete to be cleared to play they should follow the graduated 4 stage return to school protocol prior to returning to sport. Strictly following this program is necessary to determine if the brain is healing and ready for increased cognitive loads. The 4 stages range from daily activities at home to returning to school full-time. Once symptom free with full return to school, the athlete will be eligible for progression in the graduated return to sport strategy (see below).

A 6 stage exertion program is facilitated by one of our physical therapists who monitors daily progress of the concussion based off the athlete’s symptoms. It is required that each stage be completed without symptoms before an athlete is cleared by a medical professional. It normally takes a minimum of one week to proceed through the RTS rehabilitation protocol once the athlete is free of symptoms at rest. The 6 stages range from limited activity with no provocation of symptoms to full RTS with normal game play.

A vital sequence to successfully manage concussions is to first recognize the concussion and any life-threatening concerns, to remove the individual from the specific activity they are participating in and perform the appropriate rehabilitation. Once specific rehab stages are complete, the appropriate return to learning and graduated exertion programs can begin to ensure safe and quick recovery from concussion.

Call us today at one of our various clinic locations to schedule an appointment. We look forward to serving you at Wright Physical Therapy.