Physical therapy can play an important role in multidisciplinary concussion care. With appropriate training, licensed physical therapists (PTs) can utilize their skill sets to effectively manage concussion injuries through evidence-based treatment and rehabilitation.
From initial assessments, education and guidance to timely management, access to a multidisciplinary care team, which may include PTs, can help to speed the recovery process.
It is important to remember that physical therapy is often only one component of comprehensive concussion care within a medical co-management model. Collaboration with and referrals to sports medicine doctors, neurologists, optometrists, neuropsychologists and occupational therapists, among others, may be required, in order to achieve optimal care. These decisions are made on a case by case basis.
Education & Guidance Through Physical Therapy
The American Physical Therapy Association (APTA) position statement titled The Physical Therapist’s Role in Management of the Person with Concussion states that PTs are part of the care team, which provides “education and prevention to minimize risk and increase awareness.”
This can be accomplished through preemptive educational campaigns that help to reduce the stigma of concussion injuries. All those involved in the circle of care have a role to play. Taking the appropriate steps before, during and immediately following injury can help to improve long-term outcomes.
These educational initiatives should extend to patients and athletes along with coaching and support staff, preparing them for a potential injury. This could include information about concussions, mechanisms of injury, symptoms, preventative measures, what to do should one occur, and what to expect during treatment and rehabilitation.
PTs can also play an important role throughout each stage of recovery following injury by developing a personalized treatment plan. Guided, step-by-step concussion protocols can help patients and athletes safely return to activity and should be implemented by trained health care professionals with experience in concussion management.
PTs often provide oversight – in collaboration with other healthcare practitioners – of return to learn, return to work or return to play strategies, guiding a patient or athlete through each step.
Physical Therapy & Pre-Participation Concussion Assessments
While there are a number of conflicting views around pre-season concussion assessments (or baseline testing) and it’s not yet recommended for all athletes, there are a number of reputable organizations that support its use for high-risk athletes.
In fact, the Canadian Academy of Sports and Exercise Medicine (CASEM) suggests that multimodal assessments may be used under “appropriate qualified supervision as an adjunct to clinical assessment in adolescents with sport-related concussion (SRC).”
Further, the International Consensus Statement on Concussion in Sport suggests that baseline testing “provides an additional educational opportunity for the healthcare provider to discuss the significance of this injury with the athlete.”
Complete Concussion Management offers multimodal baseline testing, which is a series of physical and cognitive tests. Each test has its own established reliability and efficacy, and overall, has shown to have improved reliability when used in combination.
With additional training, PTs can administer these tests, and utilize the results as an individualized benchmark should a concussion injury occur. Having baseline information may provide healthcare practitioners with valuable information on brain recovery that may help to inform safer return to activity through the clinical decision making process.
These pre-season assessments also provide ample opportunity to increase awareness and educate parents and athletes about concussions and appropriate management.
Physical Therapy & Concussion Management
PTs have a deep understanding of the human body, and physiological training, which are a good fit for concussion management. They are often much more accessible than other healthcare professionals.
The myriad of evidence showing the positive effects of physical therapy-based concussion treatment options for persistent symptoms such as cervical spine treatment, vestibular rehabilitation and controlled sub-symptom-threshold, submaximal exercise, continues to grow.
Physical therapy is indicated, and may be effective when dizziness, neck dysfunction (e.g., whiplash), headache, impaired balance or coordination or other concussion-related symptoms have cervical spine and/or vestibular involvement.
In fact, Bert B. Vargas, MD, FAAN, associate professor of neurology and director of the sports neuroscience and concussion program at UT Southwestern Medical Center’s O’Donnell Brain Institute recently acknowledge this shift toward active rehabilitation in a recent issue of Neurology Today.
“Thankfully, more and more we’re seeing a shift toward rehabilitation. That’s a good thing. The mounting evidence that controlled exercise helps with concussion recovery underscores the fact that treating concussion should incorporate a interdisciplinary approach with partnerships that include physical therapists and athletic trainers who are uniquely qualified to help guide and oversee an active rehabilitation plan.”
Although a PT’s college or university education offers in-depth training on skill sets that fit well in this space, a healthcare practitioner must also be knowledgeable in concussion management. They must be able to apply their skills specifically in the context of concussion.
Concussions and concussion management often requires multidisciplinary, multifaceted care. In many cases, continuing education and professional development is imperative.
Further, the research around concussion is evolving at a rapid rate. Understanding the latest in concussion care and applying it in a clinic setting can ultimately help to improve patient outcomes.
Are you a PT interested in concussion management? Learn more about the Complete Concussion Management comprehensive online training program as well as our international clinic network.
 The Physical Therapist’s Role in Management of the Person with Concussion. American Physical Therapy Association (APTA). August 22, 2012. Available at: www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/ManagementConcussion.pdf.
 The Canadian Academy of Sport and Exercise Medicine (CASEM) Response to Parachute Canada’s Baseline Testing Statement. CASEM. 2017. http://casem-acmse.org/wp-content/uploads/2013/07/CASEM-response.pdf
 McCrory P, Meeuwisse W, Dvořák J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 2017.
 Concussion Management: A Toolkit for Physiotherapists. Physiotherapy Alberta – College + Association. Available at: https://www.physiotherapyalberta.ca/files/concussion_toolkit.pdf.
 Hurley, Dan. In the Clinic-Concussions: Why Total Rest Following Concussion May Not Be Best. Neurology Today. April 5, 2018 – Volume 18 – Issue 7 – p 35-39.