Lori Mercer is an Occupational Therapist who has been working with InMotion Health Centre since 2013. One of the skills that sets Lori apart is her extensive training and certification in concussion management. She is extremely passionate about promoting Brain Injury awareness and is dedicated to helping clients with a concussion get back work, school, and sports. Lori currently coordinates the concussion clinic at InMotion.
Lori shares her knowledge in this detailed post in order to better help direct those looking to return to work while recovering from a concussion.
“When can I go back to work?” This is typically the first question I get when I meet a client who has experienced a concussion. The answer to this question is different for everyone and depends on several factors which can include:
- The severity of your injury
- The type and severity of your symptoms
- The type of work you do
- The type of environment you work in
- How well you manage your symptoms
First, what is a concussion?
June is Brain Injury Awareness Month, so before I discuss returning to work, let’s chat about concussion (Spread the awareness!). A concussion is an injury to the brain, caused by a blow to the head or body, that causes the brain to bounce or twist within the skull. This sudden movement can damage cells and create chemical changes within the brain. These changes lead to a short-term disruption in how the brain normally functions. It is common to experience physical, cognitive, emotional, and/or sleep-related changes due to this disruption.
While your brain is recovering you may have less energy to be able to do the things you need and want to do. Some common symptoms you may experience after a concussion are:
- Sensitivity to noise or light
- Feeling irritable or easily agitated
- Feeling nervous or anxious
- Sleep disruption
- Blurry vision
- Balance issues
- Poor concentration and memory
What do I do first?
If you have experienced a concussion, the first thing you should do is follow up with your family doctor for medical evaluation. If any of your symptoms worsen, you experience vomiting, seizures, or notice an unusual change in your behavior then go to the hospital immediately.
After an injury, it is best to take 1-2 days off of work in order to allow your brain to rest and recover! Within the first 24-48 hours, both physical and cognitive rest are important. In the past, it was common to prescribe complete rest for up to a week for individuals who had experienced a concussion. The evidence for sustained periods of complete rest, however, is insufficient. Research is now identifying that avoiding stimulation and activity after a concussion may actually prolong your recovery. The most recent, evidence-based, recommendation that I follow for rest after a concussion comes from the 2017 consensus statement on concussion. This consensus was issued after the 5th international conference on concussion held in Berlin in October 2016:
“After a brief period of rest during the acute phase (24–48 hours) after injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds (i.e., activity level should not bring on or worsen their symptoms)” (McCrory et al., 2017).
This is the approach that I recommend to my clients. After 1-2 days of rest, focus on slowly and gradually getting back into your day to day activities. When considering a return to work make sure you take it slow. Are your symptoms manageable? Are you able to complete tasks such as self-care, light housework, or use the computer at home? If yes, then try starting back to work on reduced hours and duties (provided you have medical clearance from your family doctor). I typically recommend starting at part time or less (e.g. 2-4 hours, 2-3 days per week) and progress as tolerated.
Starting back on reduced hours/duties will help you to work within your symptom-exacerbation threshold. Be sure to discuss possible ease back options and accommodations with your doctor and employer. When you do return to work remember to not overdo it or try to push through your symptoms. This will only hinder your recovery.
How can I manage my symptoms once I return to work?
Once you and your doctor have decided that you are ready to return to work, managing your symptoms and energy level should be your top priority. For my clients, I stress the importance of energy conservation. Learning to conserve energy is about finding a balance between work and rest that allows you to gradually increase your tolerance for activity. One way to remember how to conserve energy is to use the 4 P’s technique.
The 4 P’s are: Prioritize, Pace, Plan, and Position.
Here are some tips and things to consider when using the 4P’s to help with your return to work!
Prioritize – After a concussion your tolerance for activity may be decreased. When it comes to gradually returning to work, you need to think about how to prioritize the things you need to do during your day in order to manage your symptoms and energy effectively. Think about:
- What absolutely needs to get done?
- What tasks can wait for another day (e.g. responding to an urgent email vs cleaning out your desk)
- What tasks can wait until you are better?
- Can someone help you with what needs to get done, at work or at home?
Pace – Take your time! After a concussion, everyday tasks use up more of your energy than they did before. You may now need to pace the things you need and want to do throughout your day by balancing rest and activity. When pacing, some things to consider would be to:
- Take frequent rest breaks – A strategy I suggest is if you are completing a task and you experience an increase in symptoms (e.g. a headache, dizziness) stop and take a short break. Allow your symptoms to settle, and then try again.
- Break it down! – Can the activity be broken down into smaller parts or spread throughout the work week? For example, instead of entering the entire company’s payroll Friday morning, consider completing a few entries here and there over the entire week?
- Establish a daily routine that works best for you
Plan – Think ahead! What needs to be done? can I do it? how much time and energy will it take?. When planning your day:
- Consider that it may take you longer to complete activities after a concussion than it did before. Give yourself extra time to get things done.
- Plan to complete activities that require more energy during times when you feel at your best
- Write it down – sometimes having a daily schedule or to-do list is helpful when planning out rest and activity (It can also be helpful for anyone experiencing issues with concentration and memory after a concussion)
- Can heavier tasks be spread throughout the week?
- Ask for help! – Until you are back to full-time work you may need a co-worker to give you a hand with certain tasks. Sharing the workload will help you to conserve energy and manage your symptoms more effectively. Gradually increase your share of the work as tolerated.
Position – Two important things to consider when returning to work are posture and your environment. After a concussion, sitting or standing for long periods of time, being hunched over a computer, or working in a loud, noisy environment can use up your energy quickly and cause increased symptoms. Some ways to reduce the impact of positioning are to:
- Take frequent postural breaks throughout the day – Alternate between sitting and standing if possible. Get up and stretch, take an extra walk to the water cooler!
- Switch it up! – After a concussion, you may experience sensitivity to light, noise, or find it difficult to concentrate in busy environments. It is important to gradually build up your tolerance for these types of stimuli. To start building your tolerance, while managing your symptoms, try working at your desk for a while then switching to a quiet space. Alternate back and forth, gradually increasing the amount of time you spend at your desk.
- Ask your employer if an ergonomic assessment is a possibility to ensure your posture and workspace set up is not impacting your recovery.
- If your job requires repetitive tasks such as lifting, carrying, bending or squatting, use the strategies above to manage your symptoms. Consider what tasks could be completed on another day or spread out over the work week. Could another employee assist you with the task until you are able to complete it on your own? Is there a way to simplify the task (e.g. using a wheeled cart to transport items instead of carrying them?)
What if I am not ready to return to work or I have returned and I am not feeling any better?
As outlined above there may be several factors that impact your ability to return to work. A concussion is a unique injury that affects everyone differently. Recovery times may vary but the majority of people will notice that their symptoms are gone after a few days. Some people, however (approximately 10 – 15%) may experience prolonged recovery and take longer to get back to work.
If after the acute stage of recovery, 24-48 hours, you are not able to get out of bed, a return to work is not going to be your first priority. Start slow and set small goals for yourself (e.g. getting up and getting dressed, making breakfast, or going for a short walk). Progressing towards a return to work is more realistic when you can tolerate light activity at home. If you are struggling to manage your symptoms or to progress at work you may need further evaluation and intervention from a health professional who is trained in concussion assessment and rehabilitation.
Feel free to contact our concussion clinic at InMotion to learn how an occupational therapist can help facilitate your return to work, help to treat/manage your symptoms and assist you on the road to recovery.
Any other advice?
Recovery at times may not be easy but it can be done. Set small realistic goals to achieve every day and you will begin to see a difference. Most of all be patient with yourself. Use energy conservations strategies and try to get a good night’s sleep! (Keep an eye out for a future blog on sleep hygiene after a concussion!)
For more information on brain injury follow the Newfoundland Brain Injury Association on Facebook and Twitter (@nlbia)
You can also follow Lori Mercer on Twitter (@LoriMercer87) for posts on concussion management, acquired a brain injury, and mental health awareness/recovery.