Concussion

Physical Therapist's Guide to Concussion

In the past few years, concussion has received a great deal of attention as people in the medical and sports worlds have begun to speak out about the long-term problems associated with this injury. The Centers for Disease Control estimate that in sports alone, more than 3.8 million concussions occur each year. Recent scientific evidence highlights the need for proper care to prevent complications from concussion.

If you think you might have a concussion:

o    Seek medical care immediately.

o    Avoid any additional trauma to your head—don't engage in any activity that carries a risk of head injury.

o    Limit activities of all kinds, including school and work.

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What Is Concussion?

Concussion is a brain injury that occurs when the brain is shaken inside the skull, causing changes in the brain's chemistry and energy supply. A concussion might happen as a result of a direct blow to the head or an indirect force, such as whiplash. You might or might not lose consciousness.

Concussion:

 

Signs and Symptoms

There are many symptoms related to concussion, and they can affect your physical, emotional, and mental well-being.

Physical symptoms may include:

o    Headache

o    Dizziness

o    Difficulty with balance

o    Nausea/vomiting

o    Fatigue

o    Difficulty with sleeping

o    Double or blurred vision

o    Sensitivity to light and sound

Cognitive (thinking) symptoms may include:

o    Difficulty with short-term or long-term memory

o    Confusion

o    Slowed "processing" (for instance, a decreased ability to think through problems)

o    "Fogginess"

o    Difficulty with concentration

Emotional symptoms may include:

o    Irritability

o    Restlessness

o    Anxiety

o    Depression

o    Mood swings

o    Aggression

o    Decreased tolerance of stress

 

How Is It Diagnosed?

Concussion is easy to miss because diagnostic imaging, such as such as magnetic resonance imaging (MRI) or a computed tomography (CT) scan, usually is normal.

Because of the variety of possible symptoms that can interfere with day-to-day activity, seek coordinated medical care immediately. Your health care professionals may include a physician with expertise in concussion, a neuropsychologist, and a vestibular physical therapist (a physical therapist who specializes in treating balance disorders and dizziness).

After a concussion, limit any kind of exertion. The brain won't have time to heal if you increase physical exertion too soon—such as returning to social activities or sports—or if you increase cognitive demands too soon, such as returning to school or work. You can slowly resume normal activities only once your symptoms have improved and stay improved.

 

How Can a Physical Therapist Help?

Physical therapists can evaluate and treat many problems related to concussion. Because no 2 concussions are the same, the physical therapist's examination is essential to assess your individual symptoms and limitations. The physical therapist then designs a treatment program.

Help Stop Dizziness and Improve Your Balance

If you have dizziness or difficulty with your balance following a concussion, vestibular physical therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, is responsible for sensing head movement, keeping your eyes focused when you move your head, and helping you keep your balance. A qualified vestibular physical therapist can provide specific exercises and training to reduce or stop dizziness and improve balance and stability.

Reduce Headaches

Your physical therapist will examine you for neck problems following a concussion. Neck injuries can cause headaches and contribute to some forms of dizziness. Your therapist also can assess your back for possible injuries to your spine.

As symptoms due to concussion improve, your physical therapist will help you resume physical activity gradually, to avoid overloading the brain and nervous system that have been compromised by concussion.

It's important that you follow the recommendations of all health care professionals so that you can achieve the greatest amount of recovery in the shortest amount of time.

 

Real Life Experiences

You've just come home from a soccer game where your 15-year-old daughter was star goalie. She admits to you that she "dinged" her head during a play in the second half and did not tell anyone. She's complaining of headache and dizziness, and she's sensitive to light.

What do you do next?

You monitor the next 24 hours closely, seeking care immediately in the local emergency department if your daughter has or you observe any of the following:

o    Headache that gets worse and does not go away

o    Weakness, numbness or decreased coordination

o    Repeated vomiting or nausea

o    Slurred speech

o    Extreme drowsiness or cannot be awakened

o    One pupil (the black part in the middle of the eye) larger than the other

o    Convulsions or seizures

o    Inability to recognize people or places

o    Increased confusion, restlessness, or agitation

o    Unusual behavior

o    Loss of consciousness

During the next couple of days, she's frequently in the nurse's office due to headaches and dizziness. She reports difficulty concentrating and remembering during school and is having trouble falling asleep at night. What do you do next?

o    Have the concussion evaluated by a licensed medical professional with expertise in treating concussion. Some communities have concussion or mild traumatic brain injury clinics. Evaluation should include an assessment of symptoms, neurologic screening, testing of thinking ability ("cognition"), and testing for balance problems.

o    Do NOT allow your daughter to participate in sports or any other activity with risk of head injury until she is cleared by a licensed medical professional with expertise in treating concussion. Repeated concussions can result in many problems.

o    Do NOT allow your daughter to engage in physical activity—such as exercise, sports practice, gym class—until she has recovered from her concussion or has been advised by a licensed medical professional with expertise in treating concussion. Physical activity during early stages of concussion robs your brain of the energy it needs for healing.

o    Limit thinking ("cognitive") activity until you have recovered from your concussion or have been advised by a licensed medical professional with expertise in treating concussion. Your brain requires additional energy to heal from a concussion, and excessive thinking interferes with recovery.

o    Get plenty of sleep and rest. This will help your brain to recover from the concussion.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

 

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

o    A physical therapist who is experienced in treating people with neurological problems. Some physical therapists have a practice with a neurological or vestibular rehabilitation focus.

o    A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

o    Get recommendations from family and friends or from other health care providers.

o    When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with concussion.

o    During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse

This article originally appeared on www.apta.org.  Click the following link to view the original article: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=4f2ebb00-f1c0-4691-b2ab-742df8dffb99

APTA.org is currently running a series on Concussion entitled "Get Your Head in the Game".  The "Head in the Game" series will feature interviews with experts in the evaluation, treatment, and prevention of sports concussions, as well as an interview with a former player who was forced to retire to the NFL due to repeated concussions.. 
Click here to read more: http://www.moveforwardpt.com/Radio/Detail.aspx?cid=1ee030e9-f396-49f5-be7f-fb9d8c5abb43

Physical Therapist's Guide to Anterior Cruciate Ligament (ACL) Tear

         Physical Therapist's Guide to Anterior Cruciate Ligament (ACL) Tear

An anterior cruciate ligament (ACL) tear is an injury to the knee commonly affecting soccer players, basketball players, skiers, gymnasts, and other athletes. About 70% of ACL tears are the result of non-contact injuries; 30% are the result of direct contact (player-to-player, player-to-object). Women are 4-6 times more likely than men to experience an ACL tear.

Usually, you will be examined by a physical therapist or an orthopedic surgeon immediately following injury. Most people who sustain an ACL tear will undergo surgery to repair the tear; however, some people may avoid surgery by modifying their physical activity so that they don't put a lot of stress on the knee. A select group can actually return to vigorous physical activity following rehabilitation without having surgery.

Your physical therapist, together with your surgeon, can help you determine if non-operative treatment (rehabilitation without surgery) is a reasonable option for you. If you elect to have surgery, your physical therapist will help you both prepare for surgery and recover your strength and movement following surgery.

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What is an ACL Tear?

The ACL is one of the major ligaments (bands of tissue) connecting the thigh bone to the shin bone. It can tear if you:

o    Twist your knee while keeping your foot planted on the ground

o    Stop suddenly while running

o    Suddenly shift your weight from one leg to the other

o    Jump and land on an extended (straightened) knee

o    Stretch the knee farther than you should

o    Experience a direct hit to the knee

ACL Attachment

 

How Does it Feel?

When you tear the ACL, you may feel a sharp, intense pain or hear a loud "pop" or snap. You might not be able to walk on the injured leg because you can’t support your weight through your knee joint. Usually, the knee will swell immediately (within minutes to a few hours), and you might feel that your knee "gives way" when you walk or put weight on it.

 

How Is It Diagnosed?

If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes reviewing your health history. Your therapist will ask you whether you:

o    Felt pain or heard a pop when you jumped, stopped quickly when running, turned your leg with your foot on the ground, or stretched your knee farther than usual

o    Had a direct hit to the leg while your foot was planted on the ground

o    Saw severe swelling around the knee in the first 2-3 hours following the injury

o    Felt your knee buckling or giving way when you tried to get up from a chair, walk up and down stairs, or turn while walking

Your physical therapist also will perform special tests to help determine the likelihood that you have an ACL tear. For instance, the therapist may bend your knee and gently pull on the lower leg (called the "anterior drawer" test or the "Lachman" test). The therapist also might use the "pivot shift" test, gently bending and twisting your knee at the same time. (You might feel some discomfort or instability during these tests, which is normal.) Your therapist may use additional tests to assess possible damage to other parts of your knee.

The orthopedic surgeon may order further tests, including magnetic resonance imaging (MRI), to confirm the diagnosis and also to rule out other possible damage to the knee.

 

How Can a Physical Therapist Help?

Once an ACL tear has been diagnosed, you will work with your surgeon and physical therapist to decide if you should have surgery or if you can try to manage your recovery without surgery. If you don’t have surgery, your therapist will work with you to restore your muscle strength, endurance, and coordination so that you can return to your regular activities. In some cases, the therapist may help you to learn to modify your physical activity so that you put less stress on your knee. If you decide to have surgery, your therapist can help you both before and after the procedure.

Treatment Without Surgery

Current research evidence has identified a specific group of patients (called "copers") who have the potential for success without surgery. These patients have injury only to the ACL, and no episodes of "giving way" since the initial injury. There are specific functional tests—such as the Knee Outcomes Survey, the Global Rating of Knee Function, and the timed hop test—that can help the physical therapist identify this group of patients. If you fall into this category, your physical therapist will design a specific physical therapy treatment program for you, most likely including electrical stimulation to the quadriceps muscle, cardiovascular strengthening, traditional muscle strengthening, and balance training.

Treatment Before Surgery

Some orthopedic surgeons refer their patients to a physical therapist for a short course of rehabilitation before surgery. Your therapist will help you decrease your swelling, increase the range of movement of your knee, and strengthen your thigh muscles (quadriceps).

You might have what is known as a "quadriceps lag." This is when you try to raise your leg straight in the air, but you can't control the knee, and your leg bends slightly. Research shows that improving this condition before surgery leads to better outcomes after surgery. Your therapist might use electrical stimulation to help you straighten your leg.

Treatment After Surgery

Your orthopedic surgeon will provide postsurgery instructions. Physical therapists have developed and published guidelines on knee stability and movement problems, which recommend the following actions.

Bearing weight. Immediately after surgery, you will use crutches to walk. The amount of weight you are allowed to put on your leg and how long you use the crutches will depend on the type of reconstructive surgery you had. Your physical therapist will guide you through this part of your rehabilitation.

Icing and compression. Immediately after your surgery, your physical therapist will control your swelling with a cold application, such as an ice sleeve that fits around your knee and compresses it.

Bracing. Almost all surgeons will give you a brace to limit your knee movement (range of motion) after your surgery. Some will give you a brace to use during sports a little further along during your recovery. Your physical therapist will fit you with the brace and teach you how to use it safely.

Exercises to increase your ability to move. You will begin some exercises almost immediately following surgery. In the first week, your physical therapist will help you with your range of motion and teach you gentle exercises that you can do at home. The focus will be on regaining full movement of your knee. If you're like most people, this will take some time.

You will do exercises without pressure on your leg (called "non-weight-bearing exercises") and ones that have you placing weight on your leg ("weight-bearing exercises"). These exercises might be limited to a specific range of motion to protect your newly healing ACL graft. Your therapist might use electrical stimulation to help restore your quadriceps (thigh) muscle strength and help you achieve those last few degrees of straightening the knee.

Exercises to increase your strength. In the first 4 weeks after surgery, your physical therapist will help you increase your ability to put weight on your knee, using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your quadriceps and hamstrings (thigh muscles) and might be limited to a specific range of motion to protect the new ACL. Your therapist might use electrical stimulation to help restore your quadriceps strength.

During weeks 5 through 12, you can expect to begin to walk without crutches and regain a normal walking pattern. Your therapist will increase the intensity of your exercises and add balance exercises to your program. After 3-4 months, your thigh muscles should have about 75% of the strength of the muscles on your uninjured side. During this time, you and your therapist will be planning your return to higher-level activity.

Return to your sport or physical activity. You may begin balance exercises, running, jumping, hopping, and other exercises specific to your sport. This phase varies greatly from person to person. One study found that the return to moderate and strenuous sports varied between 6 and 12 months after surgery. You might be ready to return to your sport if:

o    You no longer have pain and swelling

o    You have no feelings of instability during sport-specific activities, such as cutting, jumping, and landing

o    Your quadriceps strength is 90% of that on your uninjured side

o    Your performance of the 1-legged hop test is at 90% of that on the uninjured side

Remember, each surgeon might have a specific plan for you; these are only broad guidelines describing what you might expect for your recovery. 

 

Can this Injury or Condition be Prevented?

Current research shows that the percentage of ACL tears has been reduced in certain populations. Much of the research on ACL tears has been conducted with female collegiate athletes, because women are 4-6 times more likely to have this injury. Researchers have made the following recommendations for a preventive exercise program:

o    The program should be designed to improve balance, strength, and sports performance. Strengthening your core (abdominal) muscles is key to preventing injury, in addition to strengthening your thigh and leg muscles.

o    Exercises should be done 2 or 3 times per week and should include sport-specific exercises.

o    The program should last no fewer than 6 weeks.

Although most exercise studies have been conducted with female athletes, the findings may benefit male athletes as well.

 

Real Life Experiences

Anita is a star college basketball player—until she comes down from a rebound and feels a pop in her knee and can no longer stand on it. She's taken to the training room, where the physical therapist conducts an evaluation, including the Lachman and anterior drawer tests. The results of both tests are positive, and the therapist notices an increase in her swelling just in the 30 minutes that she spends in the training room. He suspects an ACL tear and refers her to an orthopedic surgeon. As the physical therapist suspected, Anita is diagnosed with an ACL tear.

After a short course of treatment by a physical therapist, Anita has surgery the following month. After surgery, she returns to her physical therapist and begins her rehabilitation. After 5 weeks, she is able to walk normally, fully extending her knee with no pain or feelings of instability. During the next 2 months, she visits her physical therapist 2 times a week and works on her strength and balance. She finds that the hardest exercises are the balance exercises, which require her to balance on a piece of foam or a rocker board while throwing a ball.

About 4 months after surgery, Anita is allowed to begin jogging, then running; at 5 months, she starts exercises that involve jumping up and down or that mimic basketball activities such as rebounding. During these activities, the therapist has Anita concentrate on proper landing techniques so that she lessens the chance of reinjuring her knee when she returns to play.

After 8 months, Anita is allowed to practice with her team. She has no problems with her knee following surgery and returns to competition 11 months after her surgery.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

 

What Kind of Physical Therapist Do I Need?

Although all physical therapists are prepared through education and experience to treat a variety of conditions or injuries, you may want to consider:

o    A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.

o    A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists with these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

o    Get recommendations from family and friends or from other health care providers.

o    When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with ACL tears.

During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Article originally appeared on www.apta.org.  Click here to view original article: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=d8e73ca8-71f4-48a7-92f8-675bca38232c