Concussions are medical events that affect the brain. In a concussion an impact to the head from an outside force or abrupt displacement of the head forward and backward causes the brain to move rapidly, backward and forward and even twisting, within the skull. The tissue of the brain is a delicate three-dimensional arrangement of cells, nerve fibers, blood vessels and connective tissue, constructed in a way that supports the complexity and intensity of human thought and voluntary action while controlling the processes that keep the human body alive. Despite this, it is soft, fluid-rich tissue with a density and texture comparable to that of seared beef fat, and traumatic force can upset the arrangement of fibers inside the brain, producing symptoms as mild as a passing headache and dizziness, to fatigue and nausea, to persistent cognitive fatigue or even a brain bleed.
Concussions typically occur within the context of contact or combat sports. Boxers, Mixed Martial Artists, American Football, Australian Rules and Rugby players are all at increased risk of experiencing blows directly to the head or blows to the body that have the potential to cause a concussion. For this reason, the rapid back and forth displacement of the head that is experienced in a car accident can produce concussion symptoms as well as whiplash in the neck. Similarly, blows to the head do not need to be sustained in violent or sporting contexts. Knocking the head into low objects like doorframes or lintels or standing up into a shelf or cupboard can expose the brain tissue to enough force to cause rapid displacement.
Concussions present differently for different people, with a great variation in symptoms. Clinical, neurological, behavioural, and cognitive changes can arise as early as immediately following the injury, or hours or days after the event. Given the breadth of symptoms and sequelae that can arise, diagnosis of concussion is never undertaken in isolation by one profession or on the basis of a single assessment. Concussion diagnosis includes assessment of cognitive function, physical function like balance, sensory organisation, and may require or involve imaging. Physiotherapists may only be minimally involved in the screening process as part of the diagnosis, and may only be peripherally involved in initial management. However, given that concussions have the potential to affect a person's ability to engage with recreational activities like sport, and necessary activities of daily living, physiotherapy has a role to play in management and rehabilitation of concussion presentations.
Physiotherapy management of concussion involves preventative and rehabilitative elements. In the immediate period, triaging and assessment of the injured individual is essential to detect and control the risk of adverse outcomes. This can be done either in the clinic or on the sportsfield by a therapist that has completed further education in onsite concussion assessment and risk management. Following stabilisation of symptoms, strengthening the neck and the shoulders generally improves the ability of the body to sustain impacts to that region and in turn to protect the brain. This is undertaken in combination with whiplash and neck rehabilitation generally to best prepare the athlete for return to sport, which will be undertaken under the supervision of a physiotherapist and a medical practitioner as needed.
If symptoms arising from a concussion persist beyond the expected timeframe of resolution, the presentation may be marked by headache, dizziness, mood disturbances, memory and cognitive impairment or changed function, insomnia, and depression and others in isolation or in combination. These persistent and emerging symptoms require specific monitoring as well as specific treatment by Allied Health and other medical professionals. Because concussions present differently for different people and with a great variation in symptoms, effective management of concussion symptoms and injuries requires ongoing monitoring and review, as well as proactive communication between the patient and their managing team.
Managing discomfort comes down to a few key factors: its root cause, how it changes during the day, what eases or aggravates it, and how long you’ve had the pain. These are reviewed in your initial consultation, the first step toward reducing and managing discomfort. From there, your treatment plan is tailored to your needs, focusing on easing pain, restoring pain‑free movement, and preventing future flare‑ups.
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