Exertion Therapy Q&A with Physical Therapist Tori Kochick

Exertion Therapy Q&A with Physical Therapist Tori Kochick

Tori Kochick, DPT, Exertion Therapy Coordinator

Tori Kochick, DPT, is a neurological board certified physical therapist. She joined the UPMC Sports Medicine Concussion Program in August 2017 as the coordinator of exertion therapy.

“Exertion therapy is our way to work with our patients, both athletes and non-athletes, post-concussion who may be experiencing some sensitivity or hesitation when trying to return to, or begin, exercise,” Tori explains.

Tori answered a few of the most commonly asked questions about exertion therapy:

Q: What exactly is exertion therapy? Why would I have to do exertion therapy?

A: Exertion therapy is a guided return to exercise or introduction to exercise for people who have sustained a concussion. Our clinicians may prescribe exertion therapy for several reasons, including:

  • Reducing anxiety or stress resulting from a concussion
  • Rehabilitating individuals who work manual labor jobs and experience concussion symptoms
  • Reducing symptoms in non-athletes who become symptomatic doing everyday tasks, such as walking the dog
  • Enabling athletes to return to play in a safe manner

Many times, patients are prescribed exertion therapy because they tried jumping back into their physical activities too quickly after sustaining a concussion and are struggling to recover. Our exertion therapists will use aerobic activities and strengthening exercises to rehabilitate your vestibular system. We will also perform tests near the end of recovery to ensure that your symptoms do not appear when you return to your sport or other activities.

Q: Who can do exertion therapy? I’m not an athlete – is it still something I should do?

A: Any patient who has sustained a concussion may be prescribed exertion therapy. While exertion therapy does benefit athletes, it can also benefit the average individual who enjoys taking weekly fitness classes or working out at the gym a few times a week and is unsure of where to begin after sustaining a concussion. Exertion therapy is also beneficial to individuals who do not indulge in consistent physical activity but become symptomatic while trying to go about their daily lives.

One of the most important things to remember is that your therapist will never push you to do anything outside of your comfort zone. Sometimes, patients become concerned that exertion therapy will force them to work at a higher level of fitness than they have ever been at. Exertion therapists ensure that all exercises are within your realm of comfort and experience – whether you are a high-level athlete or an individual that enjoys a mildly active lifestyle.

Q: What can I expect at my first exertion therapy appointment?

A: An exertion therapy session would begin with your therapist examining you for vital signs and a basic description of symptoms being experienced. Then we’ll have a discussion of the motivation or reasoning behind the exertion therapy prescription.

Next, you will take part in a Vestibular/Ocular Motor Screening (VOMS) and a neck screening to check for cervical damage. Once all initial screening and testing is completed, you will begin a basic series of exertion therapy exercises.

Exertion therapy exercises include a rotational piece – such as ball chops, lifts, and lunges with torso rotations – and a cardiovascular piece – which includes using the treadmill, elliptical, stationary bike, or even going for a light walk.

The exertion therapy session will continue as long as you feel comfortable and are able to complete the exercises. Once the exercises are complete, your progress is evaluated and you are given a series of home exercises to work on. Patients may have follow up appointments about once a week, or more often, depending on the severity of the symptoms present.

Q: Can I skip my exertion therapy appointments if my concussion symptoms become too severe?

A: While exercising with an injury can be difficult, it is important to keep in mind that exertion therapists are first and foremost physical therapists. They are trained to help patients work through injuries and ensure they are rehabbing in a safe manner.

Attending exertion therapy sessions, even if you are experiencing concussion symptoms or other physical ailments, such as muscle injuries, can be beneficial and crucial to concussion recovery. Exertion therapists will tailor exercises and adjust them to allow patients to continue to receive treatment while addressing symptoms that arise.

Exertion therapy is a highly individualized treatment approach and open dialogue between the patient and the therapist is crucial.

Q: What is the benefit of doing exertion therapy through the UPMC Sports Medicine Concussion Program?

A: The UPMC Sports Medicine Concussion Program offers the unique opportunity of a multidisciplinary team approach to concussion treatment. Our concussion experts and exertion therapists are in constant communication about patient progress and interact with one another to ensure the patient is receiving the best treatment approach for their individualized needs. Our clinicians also get to work side by side at the UPMC Rooney and UPMC Lemieux Sports Complexes. Patients could see a neuropsychologist and exertion therapist during the same visit.

The UPMC Sports Medicine Concussion Program offers individualized treatment plans designed to help patients recover from concussions. To learn more about the UPMC Sports Medicine Concussion Program or to make an appointment, call 412-432-3681.