You wouldn’t treat a hamstring like this.

“Concussion has evolved into a complex evaluation that mirrors what we do with other sport injuries”

The words of Professor Jon Patricios on the recent Your Brain Health webinar discussing the advancements in concussion care.

But how much of this ‘complex evaluation’ has really dripped down into our day-to-day clinical practise?

As a profession, Physiotherapists pride ourselves on our clinical reasoning skills. Utilising evidenced based practise is fundamental, regardless of setting, to delivering best outcomes for patients.

But when it comes to concussion, are we really abreast with current research?

I certainly wasn’t.

And it seems like I am not the only one. In a recent survey that was completed by 92 people from around the world, it was clear that the lowest levels of confidence were ‘Re-evaluation’ just keeping ‘Rehabilitation’ off the bottom of the list with scores of 52% and 51% respectively,

So let’s take a hamstring. There would be subjective questioning, objective testing, and a range of imaging options. Clinical outcome markers would be considered and used as a basis for test and re-test throughout the rehab journey.

For those in the high-performance environment, utilising technologies like force plates and isokinetic testing would form part of our battery of tests. Ensuring a player has covered the appropriate number of metres at varying percentage bands of their max velocity would be a non-negotiable for return to performance.

At a less resourced setting, we wouldn’t feel comfortable unless there was minimal asymmetry on single leg bridging or manual muscle testing. We would conduct a gait analysis, whilst assessing the function of the full posterior chain has become second nature.

So how do we mirror that in concussion?

How many MSK clinicians would feel confident to conduct a modified VOMS?

When it comes to assessing the Autonomic system, are we doing a Pittsburgh Sleep Quality Index or Buffalo treadmill test to ensure a return to performance?

We know the effects concussion has on mental health. Are GAD-7 and PHQ-9 undertaken routinely post-injury to support player welfare?

Concussion has evolved into a complex evaluation, but in reality how competent are we in assessing the multiple domains that lead to better clinical reasoning?

A physiotherapy colleague recently said to me: “it feels like the world has to catch up with how to assess and manage a concussion. I am a convert”.

And it feels like the job now is to support and educate clinicians to feel more confident and competent in proactively managing a concussion.