Concussions 101: Physical Therapy for Concussion


BOOM! (RIP John Madden)… after a long pause, the crowd breaks out into cheers as the linebacker makes the game-saving tackle. As the team celebrates, the player can’t seem to get back on his feet. He seems dazed, glassy-eyed, and confused. He tries to stand up but instead, he stumbles before sitting back down and holding his head.  

What happened? This is most likely the first sign of a concussion. Even “form perfect” sports and recreational activities can lead to a head injury. All concussions do not occur on the football field or in a boxing ring. A direct blow to the head is more common than you think, and if not treated right away, it may lead to long-term effects. This guide will provide insight into what concussions are, concussion symptoms, concussion management, and how they can be treated.

What is a Concussion?

A concussion is a traumatic brain injury usually caused by a blow to the head or a violent shake to the head/upper body. We commonly see this with a car accident, a fall, or a traumatic event. Most people look like they’re in a fog with glassy eyes and a constant look of confusion on their faces. However, not all concussions result in loss of consciousness and no two concussions are the same. The brain is made up of a soft material sitting inside of a hard shell. There is space in between for the brain to move around and expand without damage. When we know a movement is occurring, the brain is able to shift around the skull safely. However, when there is a sudden or unexpected blow to the head, the brain gets smashed into the sides of the hard skull, essentially causing head trauma and the brain to bruise. In more serious cases an acute concussion can cause swelling. This affects our brain function and disrupts its ability to carry out typical day-to-day functions.

Common signs and persistent symptoms include:

  • Dizziness and balance problems

  • Visual impairment, such as double or blurred vision

  • Sensitivity to light and loud noises

  • Neck pain

  • Nausea

  • Fatigue

  • Drowsiness or confusion

  • Vertigo or other balance disorders

  • Difficulty concentrating or thinking

Some concussion symptoms appear right away, while some occur a few hours after the injury, or even months or years after the concussion.

What Happens After the Initial Injury?

Post-concussion Syndrome. A mild traumatic brain injury only requires a few days of rest, but more severe ones can give you persistent symptoms lasting from weeks to months. This is also known as post-concussion syndrom.

Second-Impact Syndrome is when a person has a second concussion shortly after the first injury. Why is this bad? If the brain has not had ample time to heal this can lead to more permanent physical and cognitive disabilities. It is extremely important to follow the post-concussion protocols and take a break from sports and physical activity while recovering from brain injuries!

Chronic Traumatic Encephalopathy or CTE is a progressive brain condition caused by repeated head trauma or multiple concussions over time. This is a very hot topic in boxing, hockey, football, and members of the military service. Unfortunately, the best way to diagnose and analyze CTE is to dissect the brain post-mortem. Early detection is possible with imaging and regular evaluations from health care providers. The images will show a build up of a protein called tau around the blood vessels in the brain. This causes decreased firing of the electrical impulses within the brain, ultimately leading to atrophy or breakdown. Imagine you’re trying to make a phone call but the wires have been cut. Concussion symptoms are fairly similar to those with Alzheimer’s–short-term memory loss, mood swings, slurred speech, and increased confusion/ disorientation are key indicators. 

How Are Concussions Diagnosed and Treated?

If you’ve suffered a head injury (or head injuries), the first step is to see your health care providers, such as a medical doctor or neurologist. The medical doctor will do a battery of testing for underlying impairments, including a hearing test, vision test, balance testing, reflex testing, and cognitive testing for short-term and long-term memory and concentration. Imaging will most likely be ordered to make sure there is no brain bleeding, swelling, fractures of the skull, or other serious pathology. After that, your medication doctor will recommend concussion rehabilitation with … PHYSICAL THERAPY! Yes, physical therapy can help!

How a Physical Therapist Can Help in the Concussion Recovery Process

Physical therapists play a significant role in concussion recovery. Your Physical Therapist will repeat some of the tests your medical doctor did to determine your baseline. This will also include an oculomotor exam and testing with balance exercises. If you are planning to return to playing a sport or aerobic exercise, cardio will be restricted to prevent worsening of symptoms. HR, blood pressure, and perceived dizziness levels will determine how much cardio and aerobic exercise you can do and how frequently. You will also be given instructions to help give your brain time to rest. This means little to no screen time (because of electrical stimulation), dim lighting, lots of water, and as much sleep as your body needs. Attending work or school is not recommended initially.

I like to break down physical therapy recovery into three components: the head and neck, balance system, and vestibular system.

Head and Neck

Your doctor of physical therapy will do various manual therapy interventions to help decrease the tightness of your neck and head. It is common to have pain and tightness in the area between the base of your skull and the top of the neck. You also have balance receptors in this area that can be negatively affected by tightness. You will also be given stretches and balance exercises to help keep your head, neck, and shoulder loose and strong.

Balance (Proprioception)/ Visual System

Ever try to walk with your eyes closed and you find yourself swaying all over the place or even falling over? Our body relies heavily on our eyes and the ability to sense the ground under our feet to keep us from stumbling and falling over. Our eyes provide visual input about where we are in space and what is around us. Our ability to sense the ground under our feet (our proprioceptive system) sends tactile input to our brain telling us what the body is feeling. When one system is not firing at 100% the whole system is affected. Picture an assembly line but one-third of it is missing. The other two-thirds will try to pick up the slack but ultimately, it will get overwhelmed and production will be slowed.

Your doctor of physical therapy can give you exercises to help strengthen the system that is not performing at 100% and keep the system that is overworking from burning out.

Vestibular System

The vestibular system is essentially our balance system made up of canals and nerves located in our inner ear. This can possibly cause dizziness and balance problems.


This system tells us if we are tilting our head to the side, if we’re upside down, if we’re spinning quickly, etc. It communicates constantly with our visual and proprioceptive system to determine if we are off balance or dizzy. Say you’re on one of those carnival rides that spin quickly. Your ear is telling your brain that you’re spinning (AKA dizzy) but your eyes are communicating that you are on a ride that is spinning. Your proprioceptive system is able to tell your brain that you are not actually moving–the ride itself is moving. While you still may feel dizzy and get a little sick, your body is able to respond to all the stimuli better.

Benign Paroxysmal Positional Vertigo is a common vestibular pathology that can happen after head trauma. One benefit to anyone who has suffered from a concussion is that this system can improve through physical therapy with vestibular rehabilitation and specific exercises! Your Fit Club Physical Therapist will be able to give you motion exercises that combine all three systems to prevent you from feeling dizzy and will help you get back to moving.


Physical therapy can help speed up recovery time after a concussion and prevent post-concussion syndrome! Give us a call today or email us to start a conversation if you recently suffered a concussion or think you have post-concussion symptoms.

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