Post-Concussion Syndrome (PCS)
What Is Post-Concussion Syndrome
Post-Concussion Syndrome (PCS) is when a person continues to experience concussion symptoms past normal recovery times. There is no consensus on when concussion stops and when post-concussion syndrome begins; Therefore, it is extremely difficult to officially diagnose. Generally, PCS “starts” and concussion “ends” about 2-3 weeks after initial injury when/if symptoms remain.
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​Click Here to Learn More About Concussion
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Click Here for a Pamphlet on PCS
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Common symptoms
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Headache
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Fatigue
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Insomnia
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Noise and/or light sensitivity
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Exercise intolerance
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Cognitive intolerance
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Psychological symptoms (depressed mood/irritability/anxiety
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Cognitive problems (memory loss/ poor concentration/ and difficulty problem solving
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Risk factors and Prevalence
More likely to sustain a concussion
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Longer recovery periods
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Female sex
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Younger age
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History of concussion
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History of migraine
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Diagnosis of a learning disability or ADHD
More likely to have a longer recovery period
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Posttraumatic migraine
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Immediate dizziness
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Sub-acute fogginess
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Difficulty concentrating
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Vomiting
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General dizziness
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Cervicogenic dizziness
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Nausea
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Headache
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Slowness
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Imbalance
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Light or noise sensitivity
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Numbness
It is estimated that up to 40% of concussions will become post concussive
Diagnosis
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There is no test/image to 100% confirm, which is why baseline testing is important (lets us track symptoms and recovery)
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Neurocognitive testing such as ImPACT is great for getting baseline data to compare when concussion/PCS is suspected
Post-Concussion Syndrome “Tracts”
PCS is subdivided into several “tracts.” These tracts are determined by the type of symptoms/deficits you are experiencing and have specific treatments associated with each tract. Many times people will fall into more than one PCS Tract, and treatment should reflect all tracts
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Cognitive/Fatigue Tract
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Risk Factors: learning disorders, ADHD, ADD
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Common symptoms: difficulty with memory and concentration, difficulty following multi-step commands, fatigue, sleep disturbances
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Treatment approaches: behavioral strategies/accommodations, monitored active rehabilitation, pharmacological, cognitive behavior therapy
Vestibular Tract
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Risk factors: history of motion sickness
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Common symptoms: loss of balance, feeling of imbalance, motion sickness, nausea, dizziness, fogginess
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Treatment approaches: individually tailored vestibular therapy
Oculomotor Tract
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Risk factors: amblyopia (lazy eye), strabismus (cross eye), family history of both
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Common symptoms: eye pain/pressure behind the eyes, headache due to visual strain (reading/TV/computer or phone screen use), difficulty focusing (both physically and mentally), fatigue
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Treatment approaches: vestibular therapy focusing on the impaired oculomotor deficits
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*Neuro-opthalmologist treatment may be necessary in more severe cases
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Anxiety/Mood Tract
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Risk factors: history of mood disorders, family history of mood disorders
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Common symptoms: increased anxiety, ruminative thoughts, hyper vigilance, sadness, helplessness, feeling of being overwhelmed, headache, sleep disturbances, dizziness, fatigue, fogginess
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Treatment approaches: monitored active rehabilitation, regimented sleep schedule/diet/hydration/stress management, cognitive behavioral therapy, pharmacological
Post Traumatic Migraine Tract
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Risk factors: history of migraine, family history of migraine
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Common symptoms: chronic persistent headache, light sensitivity, noise sensitivity, nausea
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Treatment approaches: strict behavioral management (sleep/diet/stress), pharmacological, monitored cardiovascular training
Cervical Tract
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Risk factors: history of trauma to the neck (previous or at time of initial injury)
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Common symptoms: headache that is occipital (back of head) in origin which may radiate to temples and eyes, neck pain/stiffness, fatigue, fogginess
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Treatment approaches: cervical PT (manual therapy such as mobilization/manipulation/soft tissue release, AROM/PROM, stabilization training, and proprioceptive exercises
Physiological Tract
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Risk factors: none
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Common symptoms: headache, dizziness, fatigue, light sensitivity
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These individuals will often have early symptom exacerbation with physical activity
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Treatment approaches: monitored endurance training and strengthening as appropriate/tolerated
What Does the Research Say For Treatment?
Concussions
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First 7-10 days it is important to rest and allow the brain to recover as much as possible, but to not completely eliminate all inputs into the brain
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Patients/athletes should limit their physical, mental, and emotional activities to moderate intensities (i.e., not too much, but not too little)
Post Concussion Syndrome
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Emerging evidence suggests that rest is only beneficial in the acute stages of injury, and may even be harmful if utilized for too long of a period
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Moderate activity is beneficial after the acute stages of injury, but over and under activity are both detrimental
General Treatment – WHAT YOU CAN DO
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Limiting physical, mental, and emotional stresses BUT not completely eliminating these entirely
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You want a balance of exertion and rest
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Your brain responds to the stresses applied to it à some stress is good; too much can cause delays in healing
WHY SEE A PHYSICAL THERAPIST?
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Determining which tracts of PCS you fall into
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Cervical, vestibular, oculomotor, anxiety/mood, cognitive/fatigue, post-traumatic migraine, and physiological/exertional
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Creating and implementing individualized plans of care such based on your PCS Tracts and your specific symptoms
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EDUCATION! Helping you to understand your brain and how it responds to different stimuli and how to best manage your symptoms when they do happen