Post-Concussion Syndrome, is this my new normal?

Author: Abbey Oke

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Concussion is not a lifelong diagnosis, and no one should accept it as a “new normal”. 

Over the years, concussion has grown a significant amount of interest in research to gain a better understanding into the diagnosis, treatment and prognosis of concussion symptoms.

We all remember when Sydney Crosby sustained his severe concussion in 2011 and the strict protocols his medical team outlined to allow him to safely return to play. Since then, the “talk” surrounding concussion has exploded!  Unfortunately, most of us that have sustained a concussion whether it be from sport, motor vehicle accident or slipping on ice walking the dog, don’t always see a fast recovery within the supposed two weeks of metabolic recovery.  Many of my patients that I see in the clinic are in fact the population that have sustained a concussion and are still struggling with their symptoms for weeks or months and have not yet returned to their functional daily activities. These individuals have what we classify as post-concussion Syndrome.

What is Post-Concussion Syndrome?

Post-concussion syndrome includes anyone that has sustained a concussion and continues to have ongoing concussion symptoms longer than 14 days. Unfortunately, this is a common occurrence in private practice settings as most individuals do not have baseline testing to help diagnosis and manage a treatment plan. Furthermore, concussions can often be associated with cervical whiplash. Usually from a motor vehicle accident. This can make treatment very complex due to the strong influence the cervical musculature can have on the already provoking symptoms. Most of these individuals were told to REST but were never told when or how to come out of that resting period. It is our goal in physiotherapy for these individuals to break free of restful healing and gradually introduce them to functional activity within their symptom threshold. 

Treatment

I always tell my patients that they are going to feel worse before they feel better…. But it is our job to guide you on a safe individualized treatment plan

One of the most challenging parts of post-concussion syndrome rehab is symptom management. Understanding and tracking symptoms can be very challenging and requires a lot of patience. With physiotherapy, we expect our clients to gently provoke their symptoms with specific activities that allow their brain to habituate to the task and or environment. This can be as simple as walking up and down the stairs or walking in a straight line. Concussions are highly complex and each person we see presents completely different. Therefore, the recovery rate, symptom thresholds and functional capacity is highly unique to each individual. 

Physiotherapy for post-concussion syndrome is multi-disciplinary as the brain controls all high levels of function, including but not limited to memory, speech, language, reading, focusing, concentrating, balance, coordination and emotion. In physio we are the experts in the physical limitations the concussion poses on the body ie. Strength, coordination, stability etc. Although we are not experts in other specialities, we program the treatment to include one or more of these functions. This includes visual exercises, vestibular rehab, cognition and memory.

Treatment Goal

Our goal in any treatment plan is to increase tolerance to symptom thresholds, allowing patients to achieve more without experiencing high levels of symptoms. Once they are able to understand symptom fluctuations and manage spikes with restful activities, they are able to achieve much more in their daily activities! 

Physiotherapists will often refer patients to other specialties for a greater multi-disciplinary approach. This includes visual therapist, occupational therapist, neurologist, doctors and psychologist. This team approach allows for the greatest level of success in such a complex population of patients. 

I always tell my patients; you are going to feel worse before you feel better…. But it is our job to guide you on a safe individualized treatment plan to restore baseline function! Concussion is not a lifelong diagnosis, and no one should accept it as a “new normal”. 

Abbey Oke
Physiotherapist at Pivotal Physiotherapy

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