The Truth About Concussion – Return to Play ( Part #2 of 3)

By Kaila Morin, PT, DPT
Gaylord Specialty Healthcare Physical Therapy

A concussion is a mild traumatic brain injury that can affect how your brain works. Each year in the US, there are 1.6-3.8 million sports and recreation-related reported concussions. That’s a lot of brain injuries. It’s not hard to believe that football contributes to more than 60% of these concussions and that sports-related injuries continue to be the leading cause of concussion injury in the US. However, it’s not the only way concussions happen and, regardless of how the injury was sustained, every patient with a concussion diagnosis should follow the CDC return to play guidelines to ensure safe and effective concussion management.

Why? Because this is the brain we’re talking about, while most people make a full recovery, some patients will go on to have persistent symptoms. Following a proper return to activity guidelines – in combination with implementing strategies for symptom management – can help to reduce this risk.

The 6-Step Return to Play Progression looks like this:

1. Back to regular activities – after 2-3 days of rest, the patient can return to regular, non-aerobic, activities (i.e., school)
2. Light aerobic activities – start activities that increase heart rate (5-10 minutes on the bike, walking, or light jog). No weightlifting.
3. Moderate activity – continue activities to increase heart rate (jogging, running, moderate-intensity stationary biking, moderate-intensity weightlifting)
4. Heavy, non-contact activity – sprinting/running, high-intensity stationary bike, regular weightlifting routine, non-contact sport-specific drills
5. Practice and full contact
6. Competition

It’s true that these guidelines were written for return to play, as in return to sport. Since football is the leading cause of high school sports concussions for males, and soccer is the leading cause for females, I’m thankful the CDC has built these guidelines to support young athletes in their concussion management. But it doesn’t mean we can’t use these guidelines to support recovery from all brain injuries.

Let’s use Jim as an example. Jim is 65-years old, recently retired, and sustained a concussion during a fall down the stairs. Jim is not alone – falls lead to nearly half of all concussion-related hospitalizations. Jim’s healthcare professional diagnosed him with a grade two concussion and advised Jim to follow return to play guidelines as part of his recovery. Jim isn’t planning to set foot on a football field, but he does want to return to his regular activities. Here’s how Jim’s recovery may play out:

1. After 2-3 days of rest, Jim returns to non-aerobic social activities (i.e., simple errands)
2. With no aggravation of symptoms, Jim returns to walking his dog twice per day, 10-minutes each
3. With no aggravation of symptoms, Jim introduces 10-minutes per day of moderate-intensity stationary biking (in addition to his regular dog walks + daily activities)
4. With no aggravation of symptoms, Jim goes to the driving range for up to 1-hour, 2-3 times per week
5. With no aggravation of symptoms, Jim completes a full 18-hole round of golf 1/week
6. With no aggravation of symptoms, Jim returns to all regular activity

Note: if symptoms are aggravated at any step, Jim will return to the previous step for 24-hours or until symptoms resolve.                                                           

Of course, this is just an example. Working with your health care professional and/or physical therapist will help you determine the right steps to ensure your return to play is safe and effective.

But, like recovery from any injury, concussion rehabilitation is a gradual process. The important part is that you’re honest with yourself and your health care professional about what you’re experiencing. If symptoms return, or if new symptoms appear during the 6-step process, it’s a sign that you’re pushing too hard and need to give your brain more time to heal.

Once patients are cleared to return to play, Physical Therapy continues to be an important part of post-concussion treatment and rehabilitation. A physical therapist with experience in concussion rehabilitation can support patients through habituation training, exposure therapy, migraine provocation monitoring, anxiety management, balance training, and/or referral to other disciplines for further support.

You are not alone.