What Is a Concussion?

A concussion is a type of mild traumatic brain injury that can occur after a blow to the head, face, neck, or body that causes the brain to move rapidly within the skull.

You do not have to lose consciousness to have a concussion. Symptoms may appear immediately or develop over the hours or days following the injury.

A concussion can affect how you feel, think, move, sleep, and function in everyday life. Because every concussion is different, recovery and rehabilitation should be individualized.

What Symptoms Can a Concussion Cause?

Concussion symptoms vary considerably from person to person and may involve several areas:

Physical symptoms

• Headache or pressure in the head

• Neck pain

• Dizziness or balance difficulties

• Nausea

• Fatigue or low energy

• Sensitivity to light or noise

• Blurred or altered vision

Cognitive symptoms

• Difficulty concentrating

• Memory problems

• Feeling slowed down or “foggy”

• Difficulty thinking clearly

• Reduced tolerance for mentally demanding activities

Emotional and sleep-related symptoms

• Irritability or increased emotional sensitivity

• Anxiety or low mood

• Difficulty falling or staying asleep

• Sleeping more or less than usual

Symptoms can change throughout recovery and may become more noticeable with physical activity, screen use, reading, work, school, or busy environments.

When Should I Seek Immediate Medical Attention?

A suspected concussion should receive appropriate medical assessment. In Canada, the medical diagnosis of concussion is made by a physician or nurse practitioner, with specific jurisdictional exceptions.

Some symptoms following a head injury may indicate a more serious brain or neck injury and require immediate emergency medical attention.

Seek emergency care if you develop red flags such as:

• Severe or worsening headache

• Repeated vomiting

• Seizure or convulsion

• Loss of consciousness or declining level of consciousness

• Increasing confusion, agitation, or unusual behaviour

• Double vision

• Significant neck pain or tenderness

• Weakness, numbness, or tingling in the arms or legs

If serious or rapidly worsening symptoms occur, call 911.

Physiotherapy is part of concussion rehabilitation, it does not replace the initial medical assessment required to rule out more serious injury.

What Happens During a Concussion Physiotherapy Assessment?

Your physiotherapist will first take a detailed history of the injury, your symptoms, previous concussions or injuries, current activities, and the difficulties you are experiencing at work, school, exercise, or in everyday life.

Depending on your presentation, the physical assessment may include:

• Cervical spine movement and function

• Headache and neck-related findings

• Balance and coordination

• Movement tolerance

• Physical and aerobic exercise tolerance

• Functional activities relevant to your work, sport, or daily life

• Screening for symptoms that may require vestibular, visual, medical, or other specialized assessment

The goal is to identify the factors that may be contributing to your ongoing symptoms and develop an individualized rehabilitation plan.

How Can Physiotherapy Help After a Concussion?

Concussion rehabilitation is symptom-based and individualized. Physiotherapy focuses primarily on physical and functional factors that may be limiting your recovery.

Depending on your assessment, treatment may include:

• Education about concussion and recovery

• Symptom-management and pacing strategies

• Cervical spine rehabilitation

• Headache management when musculoskeletal factors are involved

• Therapeutic exercise

• Balance and movement training

• Symptom-guided aerobic exercise

• Gradual progression of physical activity

• Return-to-work, recreation, and sport planning

When symptoms suggest that another system requires more specialized care, your physiotherapist can also help identify when referral or multidisciplinary management may be appropriate.

Headaches and Neck Pain After Concussion

Headache is one of the most common symptoms following concussion. Importantly, not every post-concussion headache has the same cause.

The neck can also be injured during the same event that causes a concussion, particularly following falls, sports injuries, or motor vehicle accidents. In some people, cervical spine dysfunction can contribute to headache, neck pain, stiffness, or movement-related symptoms.

When appropriate, physiotherapy may address cervical mobility, strength, sensorimotor control, and other musculoskeletal factors contributing to symptoms.

Persistent or unusual headaches may require further medical assessment, particularly when their presentation does not fit a musculoskeletal pattern or symptoms are worsening.

Exercise and Concussion Recovery

One of the most important changes in modern concussion care is that prolonged complete rest is no longer recommended.

During the first 24–48 hours, relative rest and lighter physical and cognitive activity are generally recommended. After this initial period, activity should gradually increase according to individual tolerance.

A mild and temporary increase in symptoms can occur as activity is reintroduced and does not necessarily mean that recovery is being harmed. However, significant or prolonged symptom worsening indicates that the activity level may need to be adjusted.

Physiotherapy can help establish an appropriate starting point and progressively increase aerobic exercise, movement, strength, and physical activity as recovery progresses.

The goal is not to avoid activity indefinitely, it is to gradually rebuild tolerance without exposing the person to unnecessary risk of another head injury.

Occupational Therapy and Concussion Recovery

Concussion can affect much more than physical activity. Some people experience difficulties with cognitive endurance, concentration, fatigue, sensory tolerance, routines, productivity, and managing the demands of work, school, or everyday life.

When these challenges are limiting recovery, occupational therapy may be beneficial.

At Strathcona Physical Therapy, having both physiotherapy and occupational therapy available allows us to address different aspects of concussion recovery when appropriate. Occupational therapy may help with strategies such as pacing, activity planning, cognitive compensation, energy management, environmental modifications, and gradual reintegration into meaningful daily activities.

This can be particularly valuable when persistent symptoms make it difficult to resume normal work, school, family, or community roles.

Returning to Work or School After a Concussion

Returning to work or school does not always require waiting until every symptom has completely disappeared.

Current concussion management supports a gradual return to meaningful activity, provided the activity does not create a significant or prolonged worsening of symptoms or place the person at risk of another injury.

Depending on your symptoms and responsibilities, temporary modifications may be helpful. These can include:

• Shorter work or school days

• Additional breaks

• Reduced screen or reading demands

• Reduced workload

• A quieter work or learning environment

• Gradual increases in cognitive and physical demands

Physiotherapy can help address physical tolerance and activity progression, while occupational therapy may provide additional support when cognitive demands, fatigue, sensory tolerance, or workplace/school participation are significant barriers.

The goal is a safe and sustainable return, with restrictions and accommodations adjusted as recovery progresses.

Returning to Sport After a Concussion

Returning to sport should follow a graduated return-to-sport process rather than simply waiting until you feel better and immediately returning to full participation.

Activity is progressively increased from lighter exercise toward more demanding sport-specific activity while symptoms and recovery are monitored.

Activities that carry a risk of another concussion require additional caution. Athletes should follow the appropriate return-to-sport protocol and obtain medical clearance before returning to activities with risk of contact, collision, or another head injury when required.

Returning too quickly can expose an athlete to another injury before they have safely progressed through recovery.

What If My Concussion Symptoms Are Lasting Longer Than Expected?

Most people recover within the first several weeks, but recovery time varies. Some people experience symptoms that continue beyond the expected recovery period.

Persistent symptoms do not necessarily mean that the brain is still “damaged” or that nothing can be done. Symptoms may have multiple contributing factors, including headache, cervical dysfunction, sleep disturbance, fatigue, mood, cognitive difficulties, exercise intolerance, vestibular problems, or other conditions.

When symptoms persist, reassessment can help identify which factors may be treatable and which healthcare professionals are best suited to address them.

Current guidelines recommend considering interdisciplinary concussion care when symptoms persist beyond approximately one month, particularly when they are interfering with function.

When Is Vestibular Assessment Appropriate After a Concussion?

Some people develop significant dizziness, vertigo, imbalance, nausea, or visual-motion sensitivity following concussion.

These symptoms can have several possible causes, and not all post-concussion dizziness is the same. For example, head trauma can sometimes trigger benign paroxysmal positional vertigo (BPPV), while other patients may have different vestibular, visual, migraine-related, cervical, or other contributors.

When dizziness or balance symptoms are significant or persistent, specialized assessment may be appropriate.

Strathcona Physical Therapy also provides a dedicated Vestibular Physiotherapy service for patients who require more detailed assessment and treatment of dizziness, vertigo, balance, and vestibular dysfunction.

Why Choose Strathcona Physical Therapy for Concussion Rehabilitation?

Concussion can affect multiple systems, so effective rehabilitation often requires looking beyond a single symptom.

At Strathcona Physical Therapy, our approach combines specialized physiotherapy assessment with access to multidisciplinary care when appropriate.

Our concussion rehabilitation includes:

• Physiotherapists with advanced training and experience in concussion rehabilitation

• Individualized, symptom-based assessment and treatment

• Cervical spine and headache assessment

• Exercise and activity-tolerance rehabilitation

• Return-to-work, activity, and sport progression

• Access to specialized vestibular physiotherapy when dizziness or balance dysfunction requires further assessment

• Access to occupational therapy for cognitive, functional, sensory, and return-to-work or daily-activity challenges

• Collaboration with other healthcare professionals when a patient's presentation requires additional expertise

Rather than treating every concussion the same way, we focus on identifying the specific factors limiting your recovery and matching rehabilitation to your individual needs and goals.

Concussion Management FAQs

Do I need to see a doctor after a suspected concussion?

Yes. A suspected concussion should receive appropriate medical assessment. In Canada, physicians and nurse practitioners are the healthcare professionals who generally provide the medical assessment and diagnosis of concussion.

Do I need to lose consciousness to have a concussion?

No. Most concussions do not require a loss of consciousness. A concussion should be considered based on the mechanism of injury, symptoms, signs, and appropriate medical assessment.

Should I stay in a dark room until my symptoms disappear?

No. Prolonged complete rest and isolation are not recommended. Relative rest is appropriate during the first 24–48 hours, followed by a gradual return to physical and cognitive activity according to your tolerance.

Is it normal for symptoms to increase slightly with activity?

A mild, temporary increase in symptoms can occur as activity is gradually reintroduced. If symptoms become significantly worse or remain worse for a prolonged period, the activity may need to be reduced or modified.

Can physiotherapy help with post-concussion headaches?

It may help when cervical spine or other musculoskeletal factors are contributing to the headache. Because post-concussion headaches can have different causes, assessment is important rather than assuming every headache should receive the same treatment.

Can occupational therapy help after a concussion?

Yes. Occupational therapy can be particularly helpful when concussion affects cognitive endurance, fatigue, routines, sensory tolerance, work or school performance, and participation in everyday activities.

Is dizziness always a vestibular problem after concussion?

No. Dizziness after concussion can have several possible contributors. If dizziness, vertigo, imbalance, or visual-motion sensitivity is significant or persistent, specialized vestibular assessment may help determine the appropriate treatment.

When can I return to work or school?

Return should generally be gradual and individualized. Many people can begin returning before every symptom has completely resolved, with temporary accommodations or modifications when necessary.

When can I return to sport?

Return to sport should follow a graduated protocol. Activities involving risk of contact, collision, falls, or another head injury require appropriate progression and medical clearance before returning to full-risk participation.

How long does concussion recovery take?

Recovery varies. Many people recover within days to several weeks, while some experience symptoms for longer. If symptoms persist beyond approximately one month or significantly interfere with everyday function, further assessment and interdisciplinary management may be appropriate.