Four Ways Physical Therapy Can Help With Post-Concussive Symptoms
Concussions are rehabilitative injuries. While rest may be appropriate immediately following an injury, prolonged rest is not always the best approach to recovery. Many people experience symptoms that affect multiple systems of the body, and specialized physical therapy can play an important role in identifying and treating these problems.
Post-concussive symptoms may include:
Dizziness or lightheadedness
Balance problems
Headaches
Neck pain
Fatigue
Blurry or double vision
Nausea
Eye fatigue
Exercise intolerance
A physical therapist with specialized training in concussion can evaluate these symptoms and develop an individualized treatment plan to support recovery.
Concussion Recovery Requires a Comprehensive Approach
It is important to recognize that concussion recovery is often best supported through a multidisciplinary approach. Depending on a patient's symptoms and needs, a care team may include medical doctors, neurologists, physical therapists, neuro-optometrists, speech therapists, psychologists, athletic trainers, and other specialists.
For this article, we'll focus specifically on the role of physical therapy in concussion rehabilitation.
A thorough concussion-focused PT evaluation should consider several systems that can contribute to physical symptoms:
Cervical spine
Vestibular system
Oculomotor system
Physiological system
Because more than one system may contribute to a person's symptoms, evaluating only one area may not provide the complete picture.
For example, dizziness can be related to problems with the cervical spine, vestibular system, visual system, or physiological system. Treating only one potential source may not fully resolve the symptoms.
1. Cervical Spine
Neck dysfunction commonly occurs alongside concussion. The force that causes a concussion may also result in an injury to the cervical spine, even when a person does not experience obvious neck pain.
Cervical spine dysfunction can contribute to:
Headaches
Dizziness
Visual symptoms
Neck pain
Other persistent post-concussive symptoms
This is why a concussion-focused physical therapy evaluation should consider the cervical spine even when neck pain isn't the patient's primary complaint.
2. Vestibular System
The vestibular system is located in the inner ear and helps the brain understand where the body is in space, how it relates to gravity, and whether the body is moving or still. It also plays an important role in balance and eye movements.
Vestibular dysfunction can contribute to:
Dizziness
Vertigo
Lightheadedness
Balance problems
Visual symptoms
Headaches
Nausea
Motion sensitivity
A physical therapist with specialized concussion training can assess vestibular function and determine whether vestibular rehabilitation may be appropriate.
3. Oculomotor System
Vision changes are common following concussion and can affect everyday activities such as reading, using screens, or focusing on objects.
Symptoms may include:
Difficulty focusing
Blurry vision
Double vision
Difficulty reading
Screen sensitivity
Eye fatigue
Visual dysfunction can also contribute to dizziness, headaches, and neck pain.
A concussion-trained physical therapist can screen for certain visual and oculomotor problems, provide appropriate exercises when indicated, and refer patients to specialized providers such as neuro-optometrists when further evaluation is needed.
4. Physiological System
Concussion can cause metabolic and physiological changes that affect the autonomic nervous system. These changes may contribute to problems with blood flow and exercise tolerance.
Physiological dysfunction may contribute to symptoms such as:
Exercise intolerance
Headaches
Dizziness
Nausea
Fatigue
A trained physical therapist or athletic trainer may use a treadmill-based exercise assessment to identify physiological dysfunction and develop an individualized, sub-maximal exercise program.
Why a Comprehensive Evaluation Matters
Because multiple systems can contribute to post-concussive symptoms, a thorough evaluation is essential for determining which areas should be prioritized during rehabilitation.
For example, a person experiencing dizziness may have vestibular dysfunction, cervical dysfunction, visual dysfunction, physiological dysfunction—or a combination of these.
Identifying the factors contributing to symptoms allows treatment to be more targeted and individualized.
Concussion Is Not a "Wait and See" Injury
If you don't feel like yourself after a concussion, there may be more that can be done than simply waiting for symptoms to disappear.
Early evaluation and appropriate rehabilitation can help identify the factors contributing to persistent symptoms and guide an individualized recovery plan.
A physical therapist with specialized concussion training may also be a useful entry point into the healthcare system, particularly for patients who need help determining which areas of care may be appropriate for their symptoms.
If you're experiencing persistent symptoms after a concussion, talk with a qualified healthcare professional about your recovery and treatment options.