Everything you need to know about concussions

Over the last 2 decades, there has been a lot of talk about the injury known as concussion. There has been a growing body of research about concussions—what they are, what causes them, and how we can better treat them. For this reason, the clinical management of concussion care has significantly changed in recent years; however, not all health care providers have been informed about these changes.  

My name is Logan Curry. I am a physical therapist at Advanced PT’s Appleton North location with advanced training in treating and managing concussions. I frequently get questions from patients or their parents about these injuries. Here are the answers to some common questions that I get about concussions. 

What is a concussion?

A concussion is a traumatic injury to the brain, which causes a cascade of events leading to inflammation, blood flow restriction, and a depletion of energy needed for normal neurological function. This is a functional injury to the brain without visible structural tissue damage to the brain. It causes signs and symptoms (such as dizziness, headache, fatigue, etc.) which can occur immediately or over time. Although these symptoms can be quite severe, typically we expect them to resolve in days or weeks following the injury.  

How do you diagnose a concussion?

A clinical assessment performed by a health care provider is necessary to formally diagnose a concussion. Assessment may include but is not limited to testing for cognition, eye control and vision, posture, gait, balance, and neck motion.  

Do you need to get imaging after a concussion?

No, it’s not necessary, but sometimes it may be appropriate. Currently, diagnostic imaging for clinical use cannot identify people who have sustained a concussion, so CT scans and MRIs will show no signs of tissue injury. If a person sustains significant head trauma and their symptoms progressively worsen or create an unstable condition, they should receive a CT scan to rule out something more serious. In other cases, a person may receive an MRI to assess for structural injury to the brain in cases where symptoms persist longer than expected.  

What do you do after a concussion to help recover?

Initially, a period of relative rest (reducing daily activities and limiting screen time) for the first 24-48 hours following injury is recommended. After this period of time, it’s important to gradually return to physical and cognitive activity with minimal increase in symptoms. Sometimes people want to avoid all stimulation that provokes symptoms following their injury. Unfortunately, this doesn’t help their brain adjust to the stimulation that comes with daily activities. After a concussion, the brain needs to be gradually exposed to normal stimuli as part of the recovery process.  

How does someone return to school, work, or sport?

Often after these injuries, people need to receive modifications or accommodations to their school or work day to allow them to return to those activities at a sub-symptom threshold level (with minimal increase in symptoms). This they can do with the assistance of a healthcare provider. Returning to sport should occur in a gradual manner under the direction of an athletic trainer or physical therapist. Returning to full participation in sport should occur after fully returning to school/work activities. 

How long does it take to recover?

The majority of concussions recover fully in a relatively short amount of time (14 days or less for adults and 30 days or less for children). Unfortunately, there are cases and situations where concussion symptoms can persist because the brain needs some additional help to get back to normal function. 

Should someone receive care or treatment after a concussion? I

t is important to have oversight by a medical provider to assist in helping a patient who has sustained a concussion return to normal activities. ER doctors, primary care physicians, and athletic trainers are often the first health care providers to see people following a head injury. In some cases, they may recommend that a patient receive care or treatment from other health care providers such as a physical therapist, occupational therapist, speech and language pathologist, neurologist, concussion doctor, neuro optometrist, and neuro psychologist. Their recommendation will be based upon the provider’s experience and the patient’s symptoms following an injury. Sometimes providers may not be aware of some options that may be available to help get their patient better faster. 

How does physical therapy help people who have concussions?

The main goal of physical therapy following a concussion is to help gradually retrain the brain to process information and return to normal activity and function. Every concussion is going to present differently, so treatment can vary from one injury to another. The physical therapist will perform a comprehensive assessment and determine the most appropriate treatment strategy to help each patient address their impairments and deficits as well as work towards achieving their specific goals. Physical therapy may include aerobic activity, treatment for the neck, exercises for the eyes, interventions for the inner ear, balance training, reaction training, and sports/job specific activities.  

Concussions are a very complex injury and not fully understood. Despite our limited knowledge on the subject, there are many great things that can be done to help people feel better faster and to assist in managing symptoms. If you have any additional questions about concussions or are curious about what physical therapy can do for treating concussions, feel free to contact me at [email protected] or 920-991-2561. 

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711. doi:10.1136/bjsports-2023-106898 

National Athletic Training Month Recap.

National Athletic Training Month is held every March in order to spread awareness about the important work of athletic trainers (ATs). The care provided by these experts, whether to middle, high school, collegiate or professional athletes or the industrial athlete, can be life-altering. The athletic training ranks teem with stories of current ATs drawn to the profession through their interaction with an AT who helped them through a devastating injury when they were young. Such profound encounters contribute mightily to the next generation of ATs so vital to the health and well-being of athletes of all ages and disciplines.

As providers of front-line care, ATs offer wide-ranging skill sets that go well beyond the physical aspects of sports medicine. Their ability to connect with patients is perhaps the true hallmark of the AT. Another characteristic shared by many ATs is their slightly annoying reluctance to highlight their own skills.

As it’s National Athletic Training Month, we asked them the following question:

What unique value do you feel athletic trainers offer their patients?

And forced them to answer.

Lynsey Hansen – 11 year in athletic training, previous experience with youth, high school, and collegiate athletics. Past year and a half with Industrial and Tactical Medicine.

“AT’s have the unique opportunity to get to know their patients before they get injured in most cases, which can help improve the patient's outcome, and the AT also gets to watch them successfully return to their career, hobby they love, etc. Having that sort of relationship can help keep the small things small, but also incorporate techniques to aid the mental and emotional aspects when those injuries are more severe.”

Joe Hanel – 8 years in athletic training. All in Industrial setting.

“I think the general public is starting to understand that AT’s have a very broad range of knowledge about all kinds of injuries, human anatomy, kinesiology and more. When it comes to the front line of care, AT’s seem to be most knowledgeable in whole-body care. Most LAT’s need to be ready to treat any injury so our continuing education is not often specialized, allowing us to stay current on a wide spectrum of healthcare issues. I believe this really helps us stand out.”

Heidi Bohl – 13 years in athletic training, previous experience in youth and high school athletics. Past 4 years in Industrial and Tactical Medicine.

“Athletic trainers offer multiple skillsets that dabble in a variety of healthcare spectrums including physical care as well as emotional wellbeing. The range of training allows us to guide and address the whole body.”

Traci Tauferner - 17 years in athletic training, previous experience in youth, high school, collegiate and semi-professional athletics. Past 15 years in Industrial and Tactical Medicine. APTSM’s Director of Industrial and Tactical Medicine.

“I work mostly in the tactical setting. So for me athletic trainers bring valuable expertise to police and fire departments by offering specialized injury prevention, rehabilitation, and fitness training tailored to the physical demands of their jobs. Our knowledge of sports medicine principles can also help in managing and preventing work-related injuries, ultimately promoting the overall health and well-being of police officers and firefighters.”

Sean Gough – 12 years in athletic training, previous experience in high school and collegiate athletics. Almost 1 year with APTSM in Industrial and Tactical Medicine

“Athletic trainers excel in being the go-to, that trusted face due to the long-term relationships we build with patients—especially in the athletic setting but also now in the industrial and tactical space. Not only do we get to see our patients at a time where they are vulnerable, hurt, or uncertain about their future, but we also get to see them at their best.”

Marc Viergutz – 8 years in athletic training, previous experience in high school, collegiate, and professional athletics. Past 3 years with Lawrence University.

“AT’s offer a truly sport-specific view which is unique in the world of medicine. From the way we are educated to the way we approach things. It’s always from a view with the athlete’s sport in mind. We have the opportunity to work every day with that sport and provide tailored treatment plans.”

Megan Werner – 14 years in athletic training, previous experience in youth, high school, and collegiate athletics. Past 6 years in Industrial and Tactical Medicine and as Sports Medicine Coordinator.

“I feel athletic trainers offer a huge value to our patients because of our dynamic skill set. With our roots in athletics, we naturally learn to be flexible and are quick to adjust based on the needs of our patients and clients. We are always looking for ways to help our patients recover from injury or continue to improve their performance, no matter if their “playing field” is an actual field or court for an athlete, a manufacturing facility for an industrial worker, or a burning building for a firefighter.”

So if you see your friendly (or even somewhat laconic) athletic trainer, invite them to chat about their chosen profession as well as their national organization’s tagline for the month-long celebration: “From Head to Toe.”

Actually, once the ATs got going they couldn’t resist answering our second question (“How does ‘From Head to Toe’ encapsulate what you and Advanced PTSM do in athletic training?”), which we combined into a tidy paragraph that represented the group’s thoughts nicely:

“As athletic trainers, we are ready to address almost anything our patient might need. Our education includes emergency care, evaluating and treating orthopedic injuries, injury prevention, as well as concussion care, nutrition, and hydration. We’re also typically in environments like working with a team or company where we get the chance to develop strong relationships with our patients and get to know them as a person, not just their injury.”