Post-Concussion Care

Concussion Rehabilitation

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Concussions may range from mild to severe and present very differently for each person.  Although 80% of concussion related symptoms resolve within 2-3 weeks sometimes symptoms last longer. While working with your doctor if you are experiencing lingering symptoms physical therapy and vestibular training may help.

Vestibular-Ocular Therapy

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 The vestibular system is located within the inner ear and is one of the three balance systems of your body (the other two being vision and somatosensory).  When disrupted following a concussion injury the following symptoms may present:

  • Dizziness
  • Headache
  • Fogginess
  • Nausea
  • Space and motion discomfort
  • Blurred/double vision
  • Balance problems
  • Poor visual concentration 

A vestibular physical therapy assessment will test all of the systems as well as screen the cervical spine to determine the source(s) of your symptoms. The Physical Therapist will then use this information to appropriately design a treatment plan. 

Exertion Therapy

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Research has shown that too much physical activity can be detrimental after a concussion (Majerske et al., 2008) however controlled exercise appears to improve post-concussive symptoms (Leddy et al., 2010) and lessened symptoms in youth (DeMatteo et al., 2015). The role of Exertion Physical Therapy Testing is to screen the athlete to rule out potential symptom provocation and aide the doctor in determining safe return to play.

Exertion Testing will assess: balance, cardiovascular activity, the vestibular system, and sport specific activities. The stages vary by addressing movement and vestibular impairments (from stage I-V) with each stage progressing into more dynamic movements and more physical exertion. 

Unlike a general return to play protocol, Exertion Training focuses on the specific impairments of the individual athlete instead of following a general exercise model. This ensures that the athlete is prepared for the unique demands of his/her sport before returning to play. 

Cervical Treatment and Strengthening

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A comprehensive approach to concussion rehabilitation must also address the cervical spine.  As part of the physical therapy assessment process the cervical spine will be evaluated to determine the need for treatment. 

Cervical spine treatment may include: joint mobilization, myofascial release, postural training, stabilization training, and progressive resistive strengthening.

Research by Collins et al., 2014 found for every one pound increase in neck strength, odds of concussion decrease by 5%.  A Physical Therapist is able to create progressive exercise programs to improve neck strength and reduce the risk of future concussions.      

Concussion Experience

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 Kirsten Carmichael PT,DPT,CSCS gained experience with concussions early in her career while working for Dr Saglimbeni in San Jose, CA as he created the first comprehensive concussion clinic in the area. Following the model developed at UPMC she worked together with the doctors and a Vestibular Therapist performing the Exertional Therapy and cervical spine treatments for post-concussive patients.  In May 2016 Kirsten and her husband moved to Roseville, CA where she discovered a need for post-concussive care in the area. She combined her prior experience with further continuing education in the areas of concussion and vestibular rehabilitation to develop a Physical Therapy concussion program in her new home.  She has teamed up with several of the concussion specialized doctors in the area working together to provide a comprehensive approach to care. Her goals are to further education, treatment, and prevention of concussions and she is passionate about staying up to date on the latest research in these areas.