One of the most concerning injuries encountered by football athletes is concussions. A concussion is a traumatic brain injury (TBI) that results from a direct or indirect impact to the head, causing the brain to move rapidly within the skull. The force of impact can cause changes in brain function, leading to symptoms like headache, dizziness, confusion, memory problems, nausea, and sensitivity to light and sound. For athletes, especially those in contact sports like football, concussion management is critical, both for immediate recovery and for long-term health.
In this blog post, we’ll explain the structures involved in a concussion, provide insight into how we treat these injuries, and discuss the tools and techniques used in physical therapy to ensure safe and effective rehabilitation. We’ll also touch on the typical length of care and why the process is tailored to each individual.
Understanding Concussion & The Structures Involved
A concussion occurs when the brain experiences a sudden and forceful movement within the skull. The following structures and systems are directly affected:
- Cerebrum: The largest part of the brain, the cerebrum, is responsible for cognitive functions like memory, decision-making, and motor control. Concussions often lead to cognitive impairment or brain fog, which impacts these functions.
- Brainstem: This part of the brain controls vital functions like breathing, heart rate, and balance. A concussion can disrupt balance, causing dizziness, vertigo, and coordination issues.
- Neurotransmitters: A concussion can also affect the chemical signaling within the brain. This disruption can lead to issues with mood regulation, sleep, and focus, contributing to irritability, fatigue, and depression.
- Cervical Spine: The neck region is often involved in concussion injuries. Rapid head movement can strain the muscles, ligaments, and joints in the cervical spine, contributing to neck pain, stiffness, and headaches.
Treatment Approach for Concussions in Football Athletes
Given the complexity of concussion recovery, the treatment approach is multi-faceted, with a primary focus on symptom management, gradual return-to-play protocols, and rehabilitation to ensure a safe recovery.
Initial Assessment & Rest
Immediately after a suspected concussion, the first step is to remove the athlete from play and conduct a thorough evaluation. We use standardized concussion assessment tools like the SCAT5 (Sport Concussion Assessment Tool) or ImPACT testing (Immediate Post-Concussion Assessment and Cognitive Testing) to assess the severity of the injury. These tests evaluate cognitive function, balance, and symptoms.
In the first 24–48 hours following the concussion, the athlete must rest physically and cognitively to allow the brain time to heal. Activities like reading, screen time, and strenuous exercise should be minimized during this period to prevent symptom exacerbation.
Symptom Management
Once the acute phase of concussion is over, we begin to manage symptoms. Tools and techniques to address symptoms include:
- Manual Therapy: Techniques like craniosacral therapy and gentle cervical spine mobilizations help alleviate neck stiffness and discomfort caused by whiplash-type motion during the impact.
- Vestibular Rehabilitation: Many athletes experience dizziness or vertigo after a concussion, which stems from disturbances in the vestibular system (responsible for balance). We use targeted exercises to help retrain the brain to process balance signals correctly and reduce dizziness. These exercises might include gaze stabilization drills and habituation exercises to retrain the vestibular system.
- Cognitive Rehabilitation: Concussions often result in memory, attention, and processing issues. Cognitive rest (reducing mental exertion) and graded cognitive exercises can help an athlete regain these functions. A physical rehabilitation program can use simple tasks like memory games, problem-solving exercises, and concentration tasks.
Gradual Return-to-Play Protocol
The most crucial aspect of concussion recovery is the gradual return-to-play (RTP) protocol. We follow a stepwise approach to ensure that athletes fully recover before returning to contact sports. The process is typically broken down into six stages:
- Stage 1: Symptom-limited activity—Light aerobic exercise, such as stationary cycling, is initiated as long as symptoms are not aggravated.
- Stage 2: Moderate aerobic exercise—Activities like jogging or running that don’t involve head movement are introduced.
- Stage 3: Sport-specific exercise – Activities such as football drills without contact.
- Stage 4: Non-contact training drills—These are sport–specific drills that may include more intense movement but no contact with other players.
- Stage 5: Full-contact practice—After medical clearance, the athlete returns to full-contact practice to assess their readiness for competition.
- Stage 6: Return to play—The athlete can return to full competition if they remain symptom-free at all stages.
This RTP protocol ensures a safe progression and helps to reduce the risk of re-injury, which is especially important in concussion recovery.
Tools & Techniques in Physical Therapy
Several specialized tools and techniques are used during rehabilitation:
- Balance & Coordination Training: We use balance boards, foam pads, and exercises that challenge an athlete’s proprioception (sense of body position) to improve stability and motor control.
- Therapeutic Ultrasound & Electrical Stimulation: These modalities can manage pain, promote tissue healing, and reduce muscle tension, particularly in the cervical spine.
- Graded Exercise Programs: We design individualized aerobic and strength conditioning programs to help rebuild the athlete’s physical endurance and strength without triggering concussion symptoms.
- Neurocognitive Exercises: We use apps or software that combine physical and cognitive tasks to stimulate both motor function and cognitive abilities simultaneously, helping the brain recover faster and more efficiently.
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Length of Care & Follow-up
The length of treatment varies depending on the severity of the concussion and the individual’s response to therapy. On average, a mild concussion can take anywhere from 7 to 14 days to heal with appropriate treatment. However, for more severe concussions or athletes who have experienced multiple concussions, the recovery period may extend to several weeks or even months. We’ll closely monitor progress throughout the recovery process and adjust treatment protocols as necessary to ensure safety and promote healing.
For athletes who are unable to return to play after the typical RTP protocol or those who experience post-concussion syndrome (persistent symptoms beyond a month), additional rehabilitation strategies, such as ongoing vestibular therapy and neuropsychological interventions, may be required.
