Road to recovery
So, in the previous post (https://www.ajwsportstherapy.co.uk/blog/concussion) we discussed what a concussion is and what happens to the brain when a concussive event occurs. But how do we recover from them? And what happens if there is any long-term damage?
Concussion recovery is extremely varied from person to person much like the symptom presentation that occurs therefore whilst there is a protocol to follow, it is important to understand that we are individuals and that everyone’s recovery should be overseen by a medical professional.
What Does Recovery Look Like?
Recovery is undertaken by a step by step protocol that can take around 14 days, the current most up to date concussion protocol was designed by the concussion in sport group. This protocol goes through a gradual return to sport/work/education program that requires the athlete to be symptom free for 24 hours before moving onto the next stage.
Before starting the protocol the first thing that needs to be done is to re-evaluate the injury with a multifaceted examination by a medical professional to rule out any more serious pathologies. Following this rest is required for between 24-48 hours both cognitive and physical. The exact timing for this is still very much up for debate, along with how to reintroduce activities of daily life when symptoms ease providing they do not bring back symptoms.
The 5 Level Process of Returning to Activity is Shown Below:
Level 1 – This is based around limited activity on symptoms, with the athlete undertaking daily activities that do not trigger any symptoms. The point of this is to progress back into daily life activities without symptoms recurring, if not the athlete needs to return to complete rest. This process takes at minimum of 24 hours, as for all the levels.
Level 2 – Is the simple aerobic activity designed to increase the heart rate in a sub-symptom threshold. An example is to introduce walking or cycling at a slow pace way below potential symptom threshold, this can be done with a heart rate monitor. The goal of this is to gradually increase heart rate from that at rest, again this step should take a minimum of 24 hours and if any symptoms show then return to the previous level.
Level 3 – Here we introduce basic sport specific tasks, that are activities that either involve running, skating or cycling. Making sure nothing the athlete is doing involves risk of head collisions occurring. This is where we look at increasing the heart rate into the next zone, as well as gradually increasing the amount of movement that the athlete does. Symptoms presenting means returning to the previous step as defined above.
Level 4 – Now we can look at introducing sport-specific drills with no contact. Whilst these still need to have minimal chance of head collisions occurring, these harder drills include slow progressions to resistance training. The major goal of this stage is to increase the heart rate further whilst adding increased thinking and coordination in combination with the increased heart rate. This stage should still take a minimum of 24 hours to go through each stage.
Level 5 – Here we get the athlete to return to full practice with contact, this can only be done when medical clearance is given by a medical professional. This stage of normal practice allows coaching and medical staff to evaluate the athlete and make sure they have time to restore confidence.
Level 6 – The final stage here is return to play, getting the athlete back into game play. This should still be a phased approach with gradually increasing game time over the course of a couple of games.
It’s important to remember during this whole process that each stage should take a minimum of 24 hours, in which they need to remain symptom free in order to move to the next stage. If at any point the athletes symptoms reappear they need to stop the activity immediately and rest for 24 hours. Only after symptoms disappear they are able to go back to the previous stage of the protocol.
What Happens if The Brain Doesn’t Heal?
In some cases the brain doesn't heal as quickly as we would like, typically when symptoms last longer than 14 days in adults. Whilst there is no test to measure recovery, through clinical evaluation we can trace the cause of most symptoms and allow us to adapt our approach to aid recovery.
Persistent symptoms are often just an extension of typical concussion symptoms that don't yield such as; headache, fatigue, dizziness, difficulty balancing and concentrating, anxiety or depression and sleep disturbances. All of these can be attributed to various causes for example; unresolved concussion, headache syndromes, injury to the neck or vestibular/autonomic dysfunction. This is due to the areas that can be affected by the trauma that leads to concussion, hence why a thorough clinical evaluation is required to identify the primary cause of the ongoing symptoms.
Given how complicated concussions are it is pivotal to have a collaborative approach between different specialists all with an expertise in concussion rehabilitation.
Overall concussion is incredibly complicated with academics, medical professionals and sports therapists only really scratching the surface of what they are and what they entail for each individual athlete. This shows the importance in continuous research towards being better equipped to help athletes and members of the general public when they suffer from this type of injury.
