At a Glance –
Player: Nick Bosa
Position: Defensive End
Team: San Francisco 49ers
Injury: Concussion
Projected Recovery Time: 2 weeks – 2+ months

The San Francisco 49ers are making a surprising run in this year’s playoffs, eliminating the Dallas Cowboys. They did lose a notable player to concussion: Nick Bosa. Bosa, who returned this year after rehabbing a torn ACL, exited the game prior to haltime after colliding with his own teammate. He will likely need physical therapy intervention to help him return to the field safely. Concussions are mild traumatic brain injuries, caused by a blow or jolt to the head, that may leave a person with behavioral, cognitive, or physical symptoms for weeks to months. They are serious injuries that can disrupt the brain’s chemistry and function, and it is important to diagnose the injury and allow the brain to heal. Physical therapists are trained to identify and understand symptoms to ensure a person safely returns to activity, and Bosa’s PT will definitely have a role in determining his return to the field. His return for the Divisional Round is up in the air.

Concussions are a difficult injury to treat as people present differently, depending on the severity of the concussion, but the biggest goal of Bosa’s physical therapy program will be to re-introduce activities gradually. If someone returns to higher level activities too quickly, a brain bleed can develop from excessive swelling, or a person may develop post-concussive syndrome, in which symptoms last for several months. One of the best ways to treat concussions is exercise, surprisingly enough. Studies have shown that exercise improves blood flow to the brain and strengthens the brain’s communication pathways, and by returning to exercise gradually, a person can start returning to daily activities. Typical symptoms include headaches, dizziness, and “feeling foggy”, and early interventions in Bosa’s PT program will help him improve his tolerance to moving his head, standing, and performing daily activities. Bosa will also work on strengthening key muscle groups in the neck, as well as addressing vestibular impairments, which are very common with concussions. Vestibular (or inner ear) problems interfere with balance and coordination, and PTs have a variety of exercises to help Bosa improve his stability. As he progresses, the exercises will become more difficult to ensure he can tolerate the demands of professional football. There are even formal treadmill programs that measure heart rate and symptoms that Bosa will likely participate in to make sure he can return to football safely. During one test, known as the Buffalo Concussion Treadmill Test, the person walks at 3.3 mph, increasing the incline by 1 every minute. The test is terminated when the person’s symptoms increase by >3 on a 10-point scale or if they reach their max heart rate. The cardio exercise prescription following is based on 60-80% of the max heart rate that was achieved during this test, which is done ~5 days per week for 20 minutes. This test and subsequent interventions ensure that the person has a good tolerance to exercise and is not returning to activity prematurely. His PTs will know the signs of a poor response to exercise to make sure he isn’t doing too much, and hopefully in the next 1-2 weeks, he will be able to make a full recovery and return to football, just in time for the Niners to make their push.

In this video, you’ll see Drs. Barbie Barron and Dan Dietz demonstrate some exercises that would be done in the early stages of rehab for a concussion. At the end, Dr. Sarah Obuchowski demonstrats the Buffalo Concussion Treadmill Test.

Sources:
https://cdn-links.lww.com/permalink/jsm/a/jsm_2020_01_28_haider_19-313_sdc1.pdf