Conditions
Concussion and head injury
A concussion is a brain injury, and the first hours belong to a physician, not a therapist. What has changed in the last decade is what comes after: complete rest in a dark room is out, and structured, early, symptom-guided activity is in. When symptoms outlast the first couple of weeks, the neck, the balance system and the ability to tolerate exercise are usually where the answers are — and those are things physical therapy treats.
See a doctor first
After a blow to the head, any of the following means an emergency department now — not a clinic, not tomorrow:
- Loss of consciousness, a seizure, or confusion that is getting worse
- Repeated vomiting, a headache that keeps getting worse, or slurred speech
- Weakness, numbness or clumsiness in an arm or leg, or unequal pupils
- Drowsiness that you cannot be roused from, or unusual behavior
- Any head injury in someone taking blood thinners, or any concern in a young child
What we see most
Head conditions we treat, and what therapy does for each.
Concussion (early recovery)
A mild traumatic brain injury from a blow to the head or a whiplash-type jolt, with symptoms such as headache, fogginess, dizziness, sensitivity to light and noise, and fatigue. Most people recover within two to four weeks.
What therapy does: The first step is a physician's assessment and a diagnosis; we do not diagnose concussion. Once that is done, the international consensus supports 24–48 hours of relative rest followed by a gradual, symptom-guided return to activity — not prolonged rest. Physical therapy's role early on is to guide that return safely, especially for athletes and students, in step with your physician.
Persistent post-concussion symptoms
Symptoms lasting beyond about four weeks in adults (or longer in children), which happens in a meaningful minority. They rarely come from the brain injury itself at that point; more often they come from the neck, the vestibular system, or deconditioning.
What therapy does: This is where therapy has good evidence. A structured assessment sorts symptoms into what is driving them — neck, balance system, exercise intolerance, vision — and each is treated specifically. A randomized trial found that a combination of cervical and vestibular therapy got athletes back to sport far faster than usual care alone.
Post-concussion dizziness and balance problems
Dizziness, unsteadiness, motion sensitivity and difficulty with busy visual environments (supermarkets, scrolling screens) after a concussion.
What therapy does: Vestibular rehabilitation — gaze stabilization, habituation and balance retraining — is well supported for these symptoms and is offered at select SportsCare clinics. BPPV, a specific inner-ear cause of spinning dizziness, is common after head injury and can often be resolved in one to three visits with repositioning manoeuvres.
Exercise intolerance and return to sport
Symptoms that come on with exertion — a rising heart rate brings on headache or fogginess — which used to mean "stop" and now means "treat".
What therapy does: A graded aerobic exercise program, set just below the level that provokes symptoms and progressed weekly, speeds recovery in adolescents with acute concussion and is a core treatment for persistent symptoms. Return to sport follows the stepwise consensus protocol, with medical clearance before contact.
What has changed about concussion care
Until fairly recently the advice after concussion was strict rest until symptoms cleared. Trials since then have shown that prolonged rest slows recovery, and the current international consensus recommends only 24 to 48 hours of relative rest — screens and school in moderation, not a dark room — followed by a gradual return to daily life, school or work, and sport, guided by symptoms.
The same research has clarified why some people do not recover on schedule: the neck, the vestibular system, exercise intolerance, and mood and sleep are the usual drivers, each treatable and each easy to miss if nobody looks. That is what a post-concussion evaluation at SportsCare is for.
What treatment looks like
Treatment starts once you have a diagnosis from a physician. The evaluation then covers the neck, balance and eye-movement control, tolerance to graded exercise, and — for students and athletes — where you are in the return-to-learn and return-to-sport steps.
The plan is specific to what is driving your symptoms: cervical treatment, vestibular rehabilitation, a graded aerobic program, or a combination. We coordinate with your physician, athletic trainer and school, and clearance for contact sport always comes from a physician, not from us.
Most people are seen once or twice a week for four to eight weeks. Symptoms that are not responding, or that suggest mood, sleep or vision problems outside our scope, are referred on to the right specialist.
FAQ
Common questions
- Should I rest completely after a concussion?
- No. Current international consensus recommends 24 to 48 hours of relative rest, then a gradual, symptom-guided return to daily activity, school or work, and light exercise. Prolonged strict rest slows recovery.
- How long does concussion recovery take?
- Most adults recover within two to four weeks, and most children and adolescents within four weeks. Symptoms lasting longer are common enough to have a name — persistent post-concussion symptoms — and usually come from treatable causes such as the neck, the balance system or exercise intolerance.
- Can I be treated at SportsCare without seeing a doctor first?
- For a suspected concussion, see a physician first — we do not diagnose concussion, and the early hours need medical assessment. Once you have a diagnosis, you can come to us directly for the neck, balance and exercise-tolerance problems that follow.
- Which SportsCare clinics offer post-concussion care?
- Physical therapy for neck pain and graded exercise after concussion is offered at every SportsCare clinic. Vestibular rehabilitation for dizziness and balance problems is offered at select clinics; see the Vestibular Therapy page for the current list.
Sources
- Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport — Amsterdam, October 2022 — British Journal of Sports Medicine, 2023
- Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial — British Journal of Sports Medicine, 2014
- Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial — JAMA Pediatrics, 2019
- Sports Concussion — OrthoInfo, American Academy of Orthopaedic Surgeons
- Concussion — NHS
This page is general information, not a diagnosis. A physical therapist at any SportsCare clinic can evaluate your specific situation.