Get Relief from Post-Concussion Symptoms with Certified Specialists
Be part of the many athletes and individuals who are benefiting from 15+ years of concussion treatment experience.
Effective, Research-Based Treatments for Persisting Post-Concussive Symptoms
100% success rate at decreasing symptoms associated with concussion using a patient-centered approach to your treatment.
Symptom-Specific
We do an extensive evaluation of your symptoms for specific diagnoses and tailored programs to improve recovery times
Decreased Fatigue
Specific exercises to improve blood flow to the brain and increase energy levels. 2
Improved Gaze Stability
Specific tailored exercises to improve eye tracking and coordination. 4
Return to Sport
Feel confident getting back in the game with objective and trackable tests and measures
Improve Dizziness
Vestibular rehabilitation programs to decrease symptoms of vertigo, dizziness, or unsteadiness. 3
Pain Reduction
Manual therapy and dry needling will reduce headaches and decrease neck pain. 1
Restore your Brain's Chemical Balance with Our Experts
As certified concussion specialists, we utilize the most advanced technology for rehabilitation including concussion-specific mental and physical tasks and exercises within each comprehensive treatment program. With physical therapy treatments consisting of manual therapy and heart rate-monitored symptom-based exertional tasks, we can support the most efficient mechanisms for bringing blood flow to the brain and restoring the chemical balance to aid in the healing process.
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Concussion Classification for Physical Therapy Intervention
Concussion: Symptom Classification
A concussion is a heterogeneous mild traumatic brain injury with varied symptoms, clinical presentations, and recovery pathways that generally fit within 5 categories (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and two associated conditions (cervical strain and sleep disturbances). As such, cervicocranial physiology, visual disturbance, exertional tolerance, and vestibular function must be addressed in patients seeking conservative treatment following concussion. Graded aerobic treadmill testing may be particularly useful in distinguishing physiologic, cervicogenic, and vestibular-ocular post-concussion syndrome. Special tests designed to provoke pain and/or dizziness in the structures of the upper neck and inner ear are further indicated to distinguish between cervicogenic and vestibular-ocular post-concussion subtypes.5,6
Click Below to Read the Research on Treatment for Concussion
Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury
Active Rehabilitation of Concussion and Post-concussion Syndrome
Examining Recovery Trajectories After Sport-Related Concussion With a Multimodal Clinical Assessment Approach
Pathophysiology of Concussions
A concussion or Mild traumatic brain injury occurs secondary to trauma to the head causing an acceleration/deceleration mechanism also referred to as a coup-counter coup or shearing type of injury. This type of injury can cause diffuse axonal shearing without damaging the skull. This type of injury is not always visible with extensive testing CT scans or MRIs. Current scientific research realizes that every concussion is different and once you obtain one, you are more prone to having another concussion.
Concussions are generally caused by direct blows to the head, face, neck or elsewhere on the body that lead to an impulsive force that is transmitted to the head, which can disturb cell membrane and axon integrity of the neurons in the brain, resulting in disruption of metabolism.7 However, whiplash and explosions in the absence of blunt force trauma can also lead to concussions.8,9
Metabolic Effect and Symptoms of a Concussion
As Concussion specialist physical therapists we educate our patients on the metabolic process that occurs in the brain when one has sustained a concussion. There is a cascade of events which results in an “energy-crisis” that occurs within the brain at the cellular level and cannot be seen with imaging. This cascade alters glucose metabolism which requires an increase in energy demand and as well as a decrease in cerebral blood flow that will cause impaired axonal function, which may play a part in one’s symptoms.
It is of utmost importance to assist in increasing blood flow to the brain to aid in the healing process.
Symptoms of post-concussion syndrome vary but may include: headaches, dizziness, vertigo, irritability, issues with concentration and memory, photophobia, phonophobia, neck pain, sleep impairment, and difficulty managing stress.10,11
Spinal Manipulation and Mobilization for Cervicogenic-type Post Concussive Symptoms
According to the Clinical Practice Guidelines, concussion specific physical therapy must implement interventions aimed at addressing cervical and thoracic spine dysfunction, such as range of motion, postural position, and manual therapy for patients who have experienced a concussive event. All of these which can be improved with spinal manipulation and can be superior to mobilization and exercise in this patient population.
Bronfort et al. reported that mobilization and manipulation of the cervical spine were effective treatments for patients with cervicogenic headaches.12
Dry Needling for Cervicogenic-type Post Concussion Trajectory
Dry needling inactivates trigger points that are causing headaches or neck pain by eliciting a localized twitch response to clear excessive acetylcholine from neuromuscular junctions, thereby breaking the pain-spasm-pain cycle of hypertonicity, while diminishing factors of inflammation responsible for the myofascial metabolic crisis.
A recent multi-clinical site randomized control trial published by the Doctors at Symmetry Physical Therapy of 142 patients with cervicogenic headaches found that electric dry needling and spinal manipulation resulted in significant reductions in medication intake along with headache intensity, disability, frequency, and duration in patients with cervicogenic headaches.13
Vestibular Rehabilitation for Vestibular-type Post Concussive Trajectory
According to the Clinical Practice Guideline, physical therapists with appropriate expertise in vestibular and oculomotor rehabilitation should implement an individualized vestibular and oculomotor rehabilitation plan for patients who have experienced a concussive event and exhibit vestibular and/or oculomotor dysfunction. If visual vertigo/visual motion sensitivity (dizziness provoked by repetitive or moving visual environments) is identified, an individualized visual-motion habituation program may also be beneficial. Patients with neck pain or other cervical impairments may exhibit worsening of cervical impairments due to repetitive head movement as part of vestibular rehabilitation. Therefore, the implications of head-rotation interventions on the possible concomitant cervical impairments should also be considered and addressed.
Strong evidence exists that individuals with benign paroxysmal positional vertigo and vestibular ocular dysfunction that are treated with repositioning maneuvers and ocular-motor habituation exercises, respectively, experience meaningful symptom resolution within 1-2 physical therapy treatments.14
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Oculomotor-type Post Concussive Subtype
Our oculomotor systems assist in the coordination and adjustment of your eye position when one is in motion. Those with more symptoms from an oculomotor perspective will have difficulty with one or more of the three following: Convergence, Intrinsic eye action, and eye movements and tracking. Headaches associated with this trajectory are frontal and supraorbital pain ( pain behind the eyes).15,16
How to know if you are suffering from this type of trajectory, you may experience:
- Difficulty reading
- Double and/or blurred vision
- Difficulty with tracking or scanning
- Difficulty encoding information
- Convergence insufficiency
Works Cited
- Cote P, Yu H, Shearer HM, Randhawa K, Wong JJ, Mior S, et al. Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Pain. 2019.
- Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury, Clinical Practice Guideline, Journal of Orthopaedic & Sports Physical Therapy Published Online:April 2, 2020Volume50Issue4PagesCPG1-CPG73 https://www.jospt.org/doi/10.2519/jospt.2020.0301
- Gianoli GJ. Post-concussive Dizziness: A Review and Clinical Approach to the Patient. Front Neurol. 2021;12:718318.
- Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain Inj. 2015;29(2):238-48.
- Lumba-Brown A, Teramoto M, Bloom OJ, Brody D, Chesnutt J, Clugston JR, et al. Concussion Guidelines Step 2: Evidence for Subtype Classification. Neurosurgery. 2020;86(1):2-13.
- Cheever K, Kawata K, Tierney R, Galgon A. Cervical Injury Assessments for Concussion Evaluation: A Review. J Athl Train. 2016;51(12):1037-44.
- Shaw NA. The neurophysiology of concussion. Prog Neurobiol. 2002;67(4):281-344.
- Stemper BD, Pintar FA. Biomechanics of concussion. Prog Neurol Surg. 2014;28:14-27.
- Gil C, Decq P. How similar are whiplash and mild traumatic brain injury? A systematic review. Neurochirurgie. 2021;67(3):238-43.
- Dwyer B, Katz DI. Postconcussion syndrome. Handb Clin Neurol. 2018;158:163-78.
- Babula G, Warunek E, Cure K, Nikolski G, Fritz H, Barker S. Vestibular Rehabilitation as an Early Intervention in Athletes Who are Post-concussion: A Systematic Review. IJSPT. 2023;18(3):577-586. doi:10.26603/001c.75369
- Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.
- Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, et al. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J. 2021;21(2):284-95.
- Bowman TG, Thibault R, Radack BM, Davis A, Elam P. Clinical outcomes for various benign paroxysmal positional vertigo (BPPV) diagnoses in adolescents and young adults with recent concussions. Phys Ther Sport. 2023;65:90-4.
- Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, Furman JM, Getchius TS, Goebel JA, Shepard NT, Woodhouse SN. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016 Apr;40(2):124-55. doi: 10.1097/NPT.0000000000000120. PMID: 26913496; PMCID: PMC4795094.
- Master CL, Scheiman M, Gallaway M, et al. Vision Diagnoses Are Common after Concussion in Adolescents. Clin Pediatr (Phila) 2016;55:260–7
About
Symmetry Physical Therapy is a privately owned one-on-one, patient-centered physical therapy clinic in Downtown Miami/Brickell. Every treatment is with the same Doctor of Physical Therapy for the entire hour. Symmetry’s specialized, dedicated, and passionate team of physical therapists is fully committed to each patient’s success.
10+ Years as a Therapist Owned Physical Therapy Practice