Concussions: Not Just for Football Players

Concussions don’t just happen to football players.

All concussions are serious injuries. Photo credit: The Physical Therapy Institute

All concussions are serious injuries.
(Photo credit: The Physical Therapy Institute )

They can happen to dancers, acrobats, actors, stage crew — anyone.

As backstage PTs, we cover musicals and shows that have more and more acrobatics and risky tricks.  Concussions can become more likely.

Any degree of concussion is brain damage; you must treat it as such.

Concussions do not necessarily mean a person has blacked-out or been hit on the head. Concussions can result from any quick stop of the head during motion, such as whiplash.

Learn the signs and symptoms of concussions. Have a high degree of suspicion for them.

Other things to keep in mind:

  • Do not ignore any symptoms of concussion, even if they are mild or it’s weeks post-injury.
  • Be sure not to return performers to activity too early after a concussion.
  • Second Impact Syndrome, post-concussion syndrome and Chronic Traumatic Encephalopathy (CTE) can be caused by untreated or repetitive concussions.
  • Any additional trauma to an unhealed brain (including spinning or jumping) can cause Second Impact Syndrome, which results in 50% mortality and 100% disability. This means that if an unhealed concussion is traumatized a second time, even mildly, there will be some form of permanent brain damage (learning disability, chronic headaches, emotional problems, etc).

Listen to this 38 minute story from National Public Radio about concussion consequences suffered by football players years after the injury (listen to the audio playback, since the transcribed text does not contain all the info). These problems are not football-specific; they can plague anyone who suffers a concussion.

Take responsibility to prevent post-concussion syndrome and CTE in your patients. Be aware of concussions from outside events, such as a recent car accident, ski accident, or projects/gigs, that cast and crew may be dealing with.

Your performers could come into work not realizing that their headache from the fender-bender on their day off is a concussion. If they then proceed to jump, spin or fly, they can induce Second Impact Syndrome.

Keep your ears open for rumors of car accidents or recreational falls amongst the cast, and go interview the involved person for signs/symptoms of concussion. Be thorough and persistent. Often, doctors miss those symptoms or dismiss them.

Hint: If the person reacts irritably and out of character to your questions, strongly suspect concussion. Irritability is one of the common symptoms.

Rep-free Treatments

I’ve been experimenting, lately, with a new concept in therapeutic exercise: not counting repetitions during physical therapy treatments.

Counting repetitions (reps) has been a mainstay of physical therapy exercise treatments for decades. Patients like reps because they set a solid goal, and completing a set number of reps gives them a feeling of accomplishment and closure. Physical therapists like reps because recording them can show a progression in strength and exercise tolerance.


Photo credit: Arne. From Marie Claire

Photo credit: Arne. From Marie Claire

However, some patients push their bodies too hard, just to complete a set number of reps, while others don’t benefit from the normal number of reps and may require more; both types of patients do better without a defined number of reps. Some conditions benefit from a particular quality of exercise, rather than simply a quantitative strengthening approach of three-sets-of-ten of the maximum-tolerated weight. For example, tendinopathy may respond to low-weight, high-rep approach of up to 40 reps, while conditions such as autoimmune disorders require limited reps to avoid aggravating muscle soreness and pain.

When I identify conditions or situations in which rep counting is contraindicated, I instruct the patient to “do controlled reps until you feel a slight (or moderate, or significant) fatigue or burning in the muscle.” This forces the patient to “listen” to his or her body, to learn to monitor his or her symptoms and tolerance. This approach takes more time to teach the patient, but truly individualizes the program to each person’s daily tolerance and needs.

Exercise is Medicine: CPE for everyone

Last week, when I asked a patient of mine to lie on the treatment table so we could get started with the stretching and exercising part of his treatment, he hesitated and grumbled, “Isn’t there a pill I can take to fix this arm pain?  This is so much work and takes so much time.  Isn’t there a pill or a shot?”

As a physical therapist, I hear people bemoan our treatments daily.  Many people are surprised and dismayed that they must concentrate, work hard and dedicate time to recovering from injury or illness.

Another patient was disgusted with doctors who she perceived to be “pill pushers”.  “All they ever do is give you drugs! ” she exclaimed in exasperation.  “Isn’t there anything else?”

Challenging physical exertion ("CPE") benefits everyone, at every stage of life and injury

Challenging physical exertion (“CPE”) benefits everyone, at every stage of life and injury. Photo Credit: Andrea Avruskin

My response to both patients?  Challenge your body.

Your body improves with appropriate challenge.

When the correct body tissues are stressed appropriately, strengthening, stretching and healing occur.  Motion is restored.  Pain is reduced.

I call this “Challenging Physical Exertion”, or “CPE”.

CPE is the best way the body renews itself, and the only way it maintains its muscular ability, its cardiopulmonary function, and its joint health.  Without daily CPE, your joints stiffen, your muscles shrink and weaken, your lungs and heart function less efficiently.

CPE will help your body prevent cancer, heart disease, diabetes, and other chronic diseases.  It will wake up sluggish mental function and release “feel good” chemicals in your brain — not to mention improve your appearance (side benefit!).

The beneficial stress of CPE on the musculoskeletal system occurs from a variety of movements.  The appropriate stress that causes improvements is different for each person, and can be different on each day.  For example, a person in a wheelchair will experience CPE at a different activity level and with different types of activity than a mother-to-be, a middle-aged marathon runner, a person after surgery or a sedentary high school teenager.

You will benefit from CPE  whether you are healthy, injured, or ill.  CPE is necessary for everyone — at every stage of life, during almost any disease process, medical condition or injury, no matter how fit or inactive you are.

Who is uniquely qualified to design a CPE program for you?  A physical therapist.

Physical therapists are musculoskeletal experts who have the training and experience to assess your condition and decide what exercises or therapeutic movement are best for you on each day.

And so, dear patients, I have an answer for you.  CPE.  It’s your fountain of health. CPE” benefits everyone, at every stage of life and injury.

[The term CPE is copyrighted by Avruskin 2010, 2013]