Does physical therapy help with concussions?
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The Role of Physical Therapy in Concussion Recovery
Introduction to Concussion and Physical Therapy
Concussions, a form of mild traumatic brain injury, often result from sports, falls, or accidents. Traditional treatment methods have focused on cognitive and physical rest. However, recent research indicates that physical therapy (PT) can play a significant role in managing and alleviating post-concussion symptoms.
Effectiveness of Multimodal Physical Therapy
Multimodal Approaches and Symptom Reduction
Studies have shown that multimodal, impairment-based physical therapy, which includes vestibular/oculomotor and cervical rehabilitation combined with sub-symptom threshold exercise, is effective in reducing post-concussion symptoms. For instance, a retrospective analysis demonstrated a significant decrease in Post-Concussion Symptom Scale (PCSS) scores and improvements in balance and exercise tolerance among patients undergoing such therapy. Similarly, a systematic review highlighted that multimodal interventions, including aerobic exercise, can lead to quicker symptom recovery and earlier return to play for athletes.
Safety and Feasibility
The safety and feasibility of early physical therapy interventions have been confirmed through various studies. For example, a randomized clinical trial found that initiating PT as early as 10 days post-concussion is both safe and effective, leading to faster medical clearance for return-to-play and symptomatic recovery. Another study supported the safety of early PT intervention, showing no significant differences in symptom change or unplanned healthcare visits across different timing cohorts.
Specific Physical Therapy Interventions
Subthreshold Aerobic Exercise
Subthreshold aerobic exercise, which involves exercising below the threshold that exacerbates symptoms, has been shown to improve symptom scores significantly. However, it does not necessarily reduce the time to symptom recovery. This form of exercise is particularly beneficial for individuals with persistent symptoms, aiding in their return to sport and overall clinical improvement.
Vestibular and Cervical Therapies
Vestibular and cervical therapies are crucial components of concussion management, especially for symptoms like dizziness and neck pain. These therapies, when included in a multimodal approach, have shown moderate effectiveness in improving symptom scores and facilitating faster recovery .
Comparative Effectiveness and Recommendations
Multimodal vs. Single Interventions
While single interventions like subthreshold aerobic exercise or vestibular therapy have their benefits, multimodal approaches appear to offer superior outcomes. A systematic review and meta-analysis concluded that individually tailored multimodal interventions are more effective in providing faster return to sport and clinical improvement compared to single interventions.
Early vs. Late Intervention
The timing of PT initiation also plays a role in recovery outcomes. Early intervention, within the first 20 days post-injury, has been found to be safe and potentially more effective in reducing symptoms and facilitating recovery. This suggests that early PT could be a critical component of concussion management protocols.
Conclusion
Physical therapy, particularly when implemented through a multimodal approach, is a valuable and effective strategy for managing post-concussion symptoms. It not only helps in reducing symptoms but also facilitates quicker recovery and return to normal activities. Future research should continue to explore the optimal timing and combination of PT interventions to further enhance recovery outcomes for individuals with concussions.
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