Much has been in the news recently about concussions – how best to treat them, how soon to return to sport or work, how to prevent future concussions. Most information has focused on what to do in the days and weeks following concussions. Using rest strategies, avoiding screen time, resting the eyes and the brain all allow symptoms to settle. In addition to rest strategies, at ProActive Rehab, we use targeted exercises to retrain the visual and vestibular systems.
The visual system gets addressed using exercises like saccades to retrain fast eye movement and convergence exercises like the Brock string and pencil pushups as all of these areas can be affected following a concussion. Vestibular exercises like horizontal and vertical gaze stability in sitting, standing and walking are all used to retrain the brain and help it re-calibrate to movements that should be easy and non symptom producing. But what happens then? Your symptoms have settled, you’re feeling good, you have gone back to work and now you want to return to physical activity. How do we do this safely? How do we know we are really ready?
Here at ProActive Rehab, our physiotherapists and exercise therapist have been trained by the Shift Concussion Management Team located in Guelph, Ontario. We have been treating concussions for the past 2 ½ years using this program and throughout this process our approach to concussions has changed dramatically. We still use the old time tested rest strategies, we treat the neck and any whiplash that was a result of the injury, but we have added several new components to our rehab programs.
The above mentioned visual and vestibular system exercises are all addressed in the early stages. Starting these while you are still symptomatic is not only a good thing but it can help speed up the recovery process. Only after all of this has been addressed do we then start exertion testing. This is the final step of our concussion treatment program and a key component to preventing future concussions and ensuring you are truly ready to return to sport.
Once your symptoms have settled fully and you are feeling good, we send you into the gym with our exercise therapist. We feel strongly that this is one of the pieces that in the past has been missing in most concussion treatment programs. Previously if you were feeling good and could bike for twenty minutes without any symptoms, you were cleared to return to practice without contact. If that went well you tried practice with contact and then were cleared for game action. If problems arose, it was often too late. You were already in a game situation where the chances of getting hit again were much higher. We try to prevent this situation by putting our athletes through a graded exertion program in our gym before we allow them to return to the field.
Creating sport specific tasks, jumping, turning quickly, catching and throwing, dunking the vestibular systm – all in a safe, controlled gym setting allows us to determine if there are any underlying visual or vestibular problems that we need to address before you get back to your sport or recreational activity. Often you feel fine functioning in an everyday environment and even team practices usually involve predictable drills that have been performed many times previously. They often do not challenge your vestibular system enough to determine if there are any remaining problems. If we can identify and address these problems before you return to the field the chances of getting a second concussion should not be any greater than someone who has never had one. People who get multiple concussions tend to be people who have never recovered fully from the first one. You may feel fine but until you really stress your vestibular and visual system to the max you will never know. We can do this for you. We can do it in a safe environment. We can help you feel confident that your symptoms are fully resolved. We can help you feel confident that the chances of a second concussion are no greater than the first. Exertion therapy should be a part of all post concussion treatment and we at ProActive Rehab can put you through this to ensure you really are safe to return.