“I didn’t know that there was Physical Therapy for that!” I hear a variation of this phrase from most patients and even some physicians when I tell them that I am a physical therapist specializing in concussions. Over the last several years, much research has gone into concussions and treatment options. We confidently say that physical therapy is often very effective at treating concussion symptoms. We have also learned that 70% of concussions heal spontaneously on their own within 20 days. That brings up the question: When should someone seek physical therapy for their concussion? Recent research indicates that despite most concussions healing on their own, there is a benefit to starting physical therapy quickly.
Physical therapy treatment for concussions falls into three major categories: Exertional, cervical, and vestibular. Starting therapy early is beneficial for all three of these categories.
1. Exertional therapy is the newest category of concussion physical therapy that has received a lot of attention with research. There is more high quality (randomized controlled trials) on this topic as of 20191. Exertional physical therapy for concussions includes, but is not limited to, cardiovascular exercise, activity-specific exercise (simulating daily work or sport activities), and plyometric movements (jumping and agility). Early performance of these activities has shown a decrease in duration with concussion symptoms from 17 days to 13 days in adolescents.1
2. Cervical therapy is known to be an effective treatment for whiplash-type injuries. These often occur with concussion injuries due to the rotational nature of a concussion. Treatment of resultant neck pain allows for decreased pain, headaches, and other symptoms originating from the neck. It also allows for improved tolerance to vestibular exercises.2
3. Vestibular therapy is often the most profound yet confusing area of focus for patients. This system is not something we learn about in our high school anatomy or physiology classes. Often understood as the “crystals in my ears,” this system is a major contributor to our balance, coordination, and acceleration sensation. This includes focusing on what we are looking at as we move around. After a concussion, issues with this system may feel like dizziness, floaty feeling, or blurred vision. This can also lead to feelings of eye strain/fatigue and headaches. Treating vestibular issues beyond balance and “the crystals” allow for earlier return to play/return to work, improved symptom management, and decreased likelihood of longer-term issues.3 Through a dynamic and thorough evaluation, a trained physical therapist should be able to distinguish vestibular concerns effectively.
I often tell patients how rewarding it is to have as much time with each patient that we do. We have more time to answer questions and process with patients than any other medical provider. Early treatment of concussions allows for more effective/efficient treatment, decreases concern, and allows for a more rapid return to normalcy compared to the former standard of just “resting” for 20 days or for the symptoms to go away naturally. This in turn can result in decrease likelihood of other secondary prolonged psychosocial and mental health concerns following a brain injury. If you have questions about how physical therapy can impact your recovery from a recent concussion, please contact your nearest Athletico. They will connect you with a trained clinician that will help initiate your care.
*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1. Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, Suffoletto HN, Leiter J, Cordingley DM, Willer B. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2019 Apr 1;173(4):319-325. doi: 10.1001/jamapediatrics.2018.4397. PMID: 30715132; PMCID: PMC6450274.
2. Wong, Christopher Kevin, et al. “Sequencing and Integration of Cervical Manual Therapy and Vestibulo-Oculomotor Therapy for Cncussion Symptoms: Retrospective Analysis.” International Journal of Sports Physical Therapy, vol. 16, no. 1, 2021, https://doi.org/10.26603/001c.18825.
3. Ahluwalia, Ranbir, et al. “A Pilot Study Evaluating the Timing of Vestibular Therapy after Sport-Related Concussion: Is Earlier Better?” Sports Health: A Multidisciplinary Approach, vol. 13, no. 6, 2021, pp. 573–579., https://doi.org/10.1177/1941738121998687.
4. Kontos, Anthony P., et al. “Association of Time since Injury to the First Clinic Visit with Recovery Following Concussion.” JAMA Neurology, vol. 77, no. 4, 2020, p. 435., https://doi.org/10.1001/jamaneurol.2019.4552.
5. “Concussion: Physical Therapy Treatment after Mild Traumatic Brain Injury.” Journal of Orthopaedic & Sports Physical Therapy, vol. 50, no. 4, 2020, pp. 178–178., https://doi.org/10.2519/jospt.2020.0503.