Physical Therapy for a Concussion

What to Expect During Physical Therapy for a Concussion


According to the latest data from the Centers for Disease Control and Prevention (CDC), there were more than 220,000 hospitalizations for traumatic brain injuries (TBIs) in a single year in the U.S. That equates to more than 600 per day.

Concussions are the most common type of TBI. They occur due to a jolt, bump, or blow to the head, often from falls or contact sports. While concussions are considered “mild” because they are not life-threatening, they are still serious and require a neurological evaluation and rest, followed by concussion therapy. If you are referred to physical therapy for a concussion, this is what you can expect.

What Is a Concussion?

The soft and sensitive tissues of the brain are surrounded by fluid and protected by sturdy skull bones. But these protective structures are not always enough to withstand the impact of a powerful impact on the head or body that causes the head and brain to shift back and forth.

This sudden force can propel the brain to move around inside the skull. This motion can potentially stretch and damage brain tissue and cause chemical changes that affect normal brain function.

Concussions commonly occur as a result of car accidents, falls, and recreational activities like biking or skiing. More than half of concussions happen in children, often through team sports like soccer and football.

One concussion can potentially increase the risk of a second, more serious concussion, so individuals who have been diagnosed with a concussion or TBI should be extra vigilant for symptoms in the future.

Concussion Signs and Symptoms

Unlike other types of brain injuries, a concussion produces no visible signs on the exterior of the body, and it cannot be detected with common imaging tools. Instead, health care providers look for symptoms of abnormal brain function.

Signs and symptoms of a concussion can include:

  • Headache
  • Dizziness
  • Confusion
  • Memory problems
  • Fatigue or sleepiness
  • Nausea and/or vomiting
  • Difficulty concentrating
  • Feeling groggy or sluggish
  • Blurred and/or double vision
  • Sensitivity to light and/or noise
  • Loss of consciousness (in 1 in 10 ten people on average)

Concussion symptoms may not occur right away. Look for signs of brain injury immediately after an accident and in the hours and days to follow. Get immediate medical attention if symptoms worsen.

What Is Physical Therapy for Concussion?

Rest for the body and mind is typically the first and most crucial step in concussion treatment. During this stage, physical activities and memory and thinking activities are limited, including screen time.

Once this rest period is over and improvement is shown, the patient can gradually introduce light activity with a physician’s approval. Physical therapy for concussions, or concussion therapy, is widely-recognized as a safe, supervised treatment modality to improve the areas affected by brain injury: stability, balance, gait, and coordination.

Concussion therapy may consist of the following:

Balance Assessment and Training
Exercises to improve balance and stability are often a part of concussion therapy. They help reduce the risk of falls and enable patients to regain their independence after a brain injury. Exercises are designed to be challenging—but not frustrating. Patients can continue these exercises at home to maintain their progress and support their recovery.

The Balance Error Scoring System (BESS) is a test developed to evaluate the level of balance and postural stability in physical therapy patients. For BESS, the physical therapist notes any “errors” the patient experiences as they hold three different positions. Moving out of position or opening one’s eyes are examples of errors. Fewer errors indicate better balance.

Vestibular Rehabilitation
The inner ear, or the vestibular system, is one of the body’s primary sensory systems that helps maintain balance. It gives the brain information about head position, motion, and spatial orientation and is involved in motor functions that stabilize the head and body during motion. Vestibular rehabilitation is a specialized form of physical therapy that helps patients affected by dizziness and balance issues related to a brain injury as well as other conditions like vertigo and Meniere’s disease.

Treatment for Neck Pain and Headaches
After a concussion, it is common for patients to experience associated neck pain and headaches. This can include stiffness, tension, sharp pain, and pain with certain movements and activities. Treatment may include different manual therapy techniques, endurance training for the neck muscles, and postural exercises to reduce tension on the head and neck.

Return to Work and Life Training
One of the big goals of physical therapy for a concussion is to help the patient resume work and all of the tasks that are a part of daily life. This happens in stages. The 10-20-30 rule often applies to patients in concussion therapy. The therapist may recommend 10 minutes of activity followed by 30 minutes of rest. Once the patient reaches 10-minute periods of activity without symptoms, they may increase to 20-minute intervals.

Patient education is a fundamental component of every physical therapy program. In the case of a head injury, the physical therapist teaches safe, approved exercises for patients to do at home. They also advise patients on how to resume activity safely along. They educate about the signs of symptom recurrence, so the patient knows when to slow down and share concerns with their therapist and health care provider.

Concussion Therapy for Athletes

Athletes of all ages and abilities should know the risks of concussions and take proactive steps to monitor their own brain health.

Baseline Testing
Baseline testing is used as a marker of an athlete’s balance and brain function (including memory, concentration, and problem-solving skills.) The results of a baseline test are used to compare to post-injury test results if the athlete experiences a suspected concussion. Baseline testing typically takes place at the start of a sports season and is required by most school districts and youth sports teams for children ages 10 and up.

Buffalo Concussion Treadmill Test
The Buffalo Concussion Treadmill Test (BCTT) is used to assess concussion symptoms in patients and determine a safe exertion level for patients with a concussion. Symptoms and heartrate are tracked as the patient walks on a treadmill with gradually-increasing speed and incline over a period of time. The BCTT is often administered for adolescents who play sports after a concussion to determine the best return to activity progression.

Return-to-Play Protocol
Most schools and youth sports leagues have specific “return to play” protocols in place to ensure children and adolescents have recovered before resuming activity.

A return to play progression for a youth athlete typically looks like this:

  1. The athlete returns to regular activities (including school.)
  2. Light aerobic activity is introduced.
  3. Moderate activity is introduced.
  4. Heavy, non-contact activity is introduced.
  5. The athlete returns to practice (at full-contact.)
  6. The athlete returns to competition.

The physical therapist works in conjunction with the child’s health care provider and school to ensure they complete all of these steps and are safe to return to sports.

How to Prepare for Concussion Therapy

If you or someone you care about has experienced a concussion and are seeing a physical therapist for the first time, here are some tips to make the most of your session.

First, keep track of your symptoms. Write down the type, timing, and severity of any unusual mental or physical changes and share them with your physical therapist. A list of questions is also a good idea.

During your first session, you will have a physical exam and assessment. Your therapist reviews your symptoms and answers your questions. A memory questionnaire is common, as are tests to evaluate information processing and reaction time. From there, your therapist creates a custom concussion therapy plan to help you recover safely.

Recovery from a concussion takes time. Every patient’s journey is different. Be patient with the process and work with your physical therapist and physician to determine when it is safe to resume full activity. Find a physical therapy clinic near you.

Share this article

Schedule an Appointment

You might also like

what can physical therapy do for concussion

What Can Physical Therapy Do for Concussion?

Upwards of 3.8 million sports and recreation-related concussions occur every year in the United States. At least half a million of these cases involve children,...

Concussion Care

Concussion Signs and What To Do When You See Them

by: Brad Yeargin, Columbia SC A concussion is a brain injury in which the brain collides with the inside of the skull. Concussions always are...

Find a