of Early Physical Therapy for Dizziness After a Sports-Related Concussion: A
Randomized Clinical Trial

Reneker JC, Hassen A, Phillips RS, Moughiman MC,
Donaldson M, Moughiman J. Scand J Med Sci Sports. 2017; ahead of print.

Take Home Message:  Closely supervised cervical and vestibular
ocular therapy may help safely return concussed athletes to play.

is one of the most common symptoms reported following a concussion. Clinicians
can use rehabilitative techniques to treat dizziness; however, it remains
unknown whether these techniques are safe and effective for patients suffering
dizziness following an acute concussion. Therefore, the authors developed a
double-blind, randomized control feasibility trial to assess treatment
benefits, patient retention, protocol management, and participant safety
between 2 treatment strategies. The researchers assessed 41 athletes aged 10-23
years old that suffered an acute sports-related concussion (within 14 days),
and at least 1 of the following: 1) abnormal vestibular or cervical exam
findings, 2) reported at least a 3 on a 7-point Likert Post Concussion Scale
(PCS) for dizziness, and 3) scored 10 on the PCS across 9-items with a
dizziness score of at least 1. Athletes were recruited at multiple centers from
September 2014 to October 2015. All the athletes went to physical therapy twice
a week for 30-60 minutes each for 8 visits (or once cleared) beginning at 10
days post concussion. Athletes were randomly allocated into 1 of 2 groups.
Athletes in the experimental group (22 athletes) received individually
tailored, pragmatically delivered progressive interventions. Specifically,
athletes completed vestibular rehabilitation (e.g., habituation, adaptation),
oculomotor control exercises, neuromotor control exercises (proprioceptive and
kinesthetic awareness), and balance exercises as necessary. The clinicians
modified dosage and progression at each session based on symptom provocation
and remediation. Athletes also completed an individually tailored home exercise
program and exercise education that was complimentary to the individualized
treatment they received at each visit.  Athletes
in the control (19 athletes) received subtherapeutic and non-to-minimally
progressive therapeutic techniques (smooth pursuit tracking, convergence
exercises, supine to sit). The control group athletes performed a standardized
home exercise program, which consisted of cervical isometric exercises, gentle
range of motion exercises for the cervical spine, and vestibule-ocular
reflection cancelation exercises. The authors followed the athletes to
determine symptomatic recovery and date of medical clearance for return to
play. Ninety-five percent of the experimental group and 74% of the control
group completed the treatment protocol. Fourteen percent of the treatment group
and 37% of the control group failed to attain PCS recovery.  The treatment group’s symptoms recovered
faster (13.5 days) and they returned to play faster (15.5 days to full medical
clearance) compared to the control group (17 days symptom recovery, 26 days for
full medical clearance).

is an important study as it the first to address a number of rehabilitation
exercises that may help accelerate healing and allow quicker medical clearance.
The authors suggest that this study needs to be replicated in a larger cohort to
further explore the effectiveness of this type of concussion intervention. Additionally,
it should be noted that in each group there were athletes that reported symptom
provocation. Hence, clinicians may need to modify these exercises before
implementation. Currently, medical professionals should be aware that dizziness
should be specifically addressed during the initial concussion assessment
protocol. Furthermore, clinicians should also consider performing some of the
rehabilitation exercises prescribed in this study if their athletes are
complaining of dizziness following an acute concussion. 

Question for
Discussion: Are you currently utilizing any concussion rehabilitation
techniques? If so, what are they, and how do believe they are working?

by: Jane McDevitt, PhD
by: Jeff Driban


Reneker JC, Hassen A, Phillips RS, Moughiman MC, Donaldson M, & Moughiman J (2017). Feasibility of early physical therapy for dizziness after a sports-related concussion: A randomized clinical trial. Scandinavian Journal of Medicine & Science in Sports PMID: 28211600