Back In MotionEltham

The way a concussion is managed has every right to be seen as one of the most important injury managements that occurs in sport. Unfortunately, too often in local sport a concussion occurs and there is little to no follow up and return to play assessment. This opens a door for a wide variety of problems. Approximately 6 months ago ex-football legend Danny Frawley lost his life, and it was found that he had been living with Chronic Traumatic Encephalopathy, commonly known as CTE. Since then, there has been a strong push for an increase in awareness and assessment for all athletes following a concussion. Given this, there is a continuing lack of awareness for the damage that Post-Concussion Syndrome can do, and its relationship with CTE.

Post-concussion syndrome (PCS) is a condition that represents the presence of concussion symptoms long after the actual occurrence of the concussion. These symptoms can last anywhere from 1 month to a couple years ^[1]. PCS can affect approximately 30% of all athletes who experience a concussion and the risk increases following every subsequent concussion ^[2]. Therefore, if you are someone who plays sport and has grown up having a concussion most years, by the age of 18 your risk of developing PCS is quite high.

PCS can mask itself in many different ways. Its symptoms are not always the usual that occur following a concussion. PCS can affect your cognition, behaviour and emotions. Therefore, if you have any prolonged symptoms or change in mood/behaviour following your concussion consult your GP or sports physician as soon as possible.

In order to prevent or manage this condition, these are the steps you can follow:

1. Immediately present to your GP or Sports Physician: Your GP or sports physician will be able to give you great strategies following your concussion in order to ensure that you are safe to return to play. If you are presenting to your GP or sports physician following a noticeable change in behaviour, emotions or prolonged symptoms, ensure you collaboratively come up with strategies to manage these symptoms.
2. Present to your physiotherapist for an assessment and graduated return to play program: Your physiotherapist will be able to determine which type of post-concussion syndrome you are suffering from and assess you accordingly. The assessment will include a generalised treadmill running test that will assess your ability to exercise without symptoms and accurately provide you with the starting level at which you program will begin. Your physiotherapist will also be able to provide you with hands on treatment if you have neck related symptoms associated with PCS ^[4].
3. Commence your graduated return to play program: Following adequate rest, beginning your return to play program is the best way to ensure you are providing your body with the correct amount of exercise without aggravating your symptoms. This program does not have a specific timeframe and should be done in conjunction with regular visits to your GP or sports physician to get cleared to progress to the next section of the program.
4. How do we know if it is resolved? The current consensus it that post-concussion syndrome has resolved once an athlete is able to exercise at 85-90% of age-predicted max heart rate for 20 min without exacerbation of symptoms. Behavioural and emotional symptoms need to be considered, as well as then continuing into competitive style training for your specific sport. With this being said, the most important thing to remember is that no athlete still suffering post-concussion symptoms should return to competition, as it drastically increases the risk of second impact syndrome and the development of CTE ^[3]. Although, it is important to discuss return to play and training with your GP, sports physician and physiotherapist who are guiding your care.

Due to the large repercussions that can occur if post-concussion syndrome is not taken seriously, it is important to be cautious following any concussions and more importantly prolonged concussion symptoms.

For more information, please refer to the any of the below articles. If you would like a discussion with our Sports Physiotherapists on injury prevention including concussion “prevention/minimisation” strategies or a graduated exercise program for return to sport following a diagnosis of post-concussion syndrome, please contact us on 9439 6776.

This blog was written by Sean Downes, Physiotherapist at Back In Motion Eltham.

References:

1. Jotwani, V., & Harmon, K. G. (2010). Postconcussion syndrome in athletes. Current sports medicine reports, 9(1), 21-26.
2. Ellis, M. J., Leddy, J., & Willer, B. (2016). Multi-disciplinary management of athletes with post-concussion syndrome: an evolving pathophysiological approach. Frontiers in neurology, 7, 136.
3. Cantu, R. C. (1998). Return to play guidelines after a head injury. Clinics in Sports Medicine, 17(1), 45-60. Retrieved from http://articles.sirc.ca/search.cfm?id=456531
4. Langelier, D. M., Schneider, K. J., Hurlbert, J., & Debert, C. T. (2017). The importance of a neck exam in sport-related concussion: Cervical schwannoma in post concussion syndrome. Physical Therapy in Sport, 25, 84-88.