Most concussions settle within two to four weeks. When they do not, people are frequently told to keep resting and wait, and that advice is usually wrong.
When it is no longer an acute concussion
If it has been more than about four weeks and symptoms are still present, particularly dizziness, unsteadiness, visual disturbance, difficulty in busy environments, headaches with visual tasks, or difficulty concentrating, this has moved beyond the acute phase.
The important point is that persistent symptoms after concussion are usually driven by specific, identifiable and treatable systems rather than by ongoing brain damage. That is a considerably more hopeful picture than most people are given.
What is usually driving it
The vestibular system. The inner ear balance system and the brain’s processing of its signals. Produces dizziness, unsteadiness, and difficulty in visually busy places like supermarkets.
The oculomotor system. How the eyes move and work together. Produces difficulty focusing, trouble tracking moving objects, headaches when reading or on a screen, and eye strain. Very commonly affected and very commonly missed, because vision tests come back normal. Standard vision testing checks how well you see, not how well your eyes move and coordinate.
The cervical spine. The same force that causes a concussion often injures the neck, and neck injury independently produces headache and dizziness. Frequently overlooked, because the head injury takes attention.
Autonomic dysfunction. Difficulty regulating heart rate and blood pressure with exertion, producing symptoms whenever the person tries to exercise.
Persistent postural perceptual dizziness. Ongoing dizziness that continues after the initial trigger has resolved. Several of these usually coexist, which is why a single approach often fails.
Why resting stops helping
Relative rest for the first day or two is right. Extended rest after that is not, and there is good evidence it slows recovery.
Sub symptom threshold aerobic exercise, meaning activity kept just below the level that provokes symptoms and progressively increased, is now a mainstream part of managing persistent symptoms. Getting that threshold right requires testing rather than guessing.
What assessment involves
Vestibular testing including eye movement and positional testing. Oculomotor assessment covering tracking, convergence and saccades. Cervical spine assessment. Exertion testing to establish the symptom threshold. And balance testing.
That produces a picture of which systems are affected and to what degree, which is what treatment is then built around.
What treatment involves
Vestibular rehabilitation. Oculomotor exercises. Manual therapy for the neck where involved. A graded aerobic programme built on the tested threshold. And return to work, study and sport planning.
Most people improve substantially with the right treatment, and the frustrating part is usually how long it takes to be assessed properly rather than how long treatment takes.
Which practice you need
If the injury is recent, within the last few weeks, and the question is initial assessment and return to sport, our sister practice PhysioXtra handles the acute and community side. They offer same day concussion assessment and graded return to sport plans, and they work with sporting clubs across South Australia.
If symptoms have persisted, that is us. Edwina Reid’s specialism is concussion rehabilitation and our team includes accredited vestibular physiotherapists.
Call either of us and we will point you to the right one. Neither practice has any interest in treating someone the other should be seeing.
When to see a doctor first
Worsening headache, repeated vomiting, seizures, weakness or numbness, confusion or difficulty waking are emergency symptoms. If any of those are present, go to hospital rather than booking physiotherapy.
Call us on 08 8331 2700.
