Disclaimer: This article is for general educational purposes only and does not constitute medical advice. All concussions should be medically assessed. © 2026 Better Physiotherapy Bundoora.
Modern concussion management has moved well beyond "rest in a dark room." Evidence-based physiotherapy — targeting the neck, vestibular system, and cardiovascular tolerance — significantly accelerates concussion recovery and is essential for managing persistent post-concussion syndrome.
What Is a Concussion?
A concussion is a traumatic brain injury caused by biomechanical forces — typically a blow to the head or body that transmits rotational and linear acceleration to the brain. It causes a transient neurometabolic dysfunction rather than structural damage detectable on standard imaging (CT and MRI appear normal). Symptoms arise from altered neurochemistry, neuroinflammation, and autonomic dysfunction.
The Three Domains Physiotherapy Addresses
1. Cervicogenic dysfunction: Neck injury is extremely common at the time of concussion. Cervical joint and muscle injury causes headaches that are indistinguishable from concussion headache — but respond well to cervical manual therapy. Treating the neck component often produces rapid headache relief.
2. Vestibular dysfunction: The vestibular system (inner ear balance mechanism) is frequently disrupted by concussion. BPPV (dislodged inner ear crystals), reduced gaze stability, and impaired balance all respond to specific vestibular physiotherapy — including Epley manoeuvre, gaze stabilisation exercises, and vestibular rehabilitation therapy.
3. Exertional intolerance: Many concussion patients cannot exercise without symptom flare — a pattern of cardiovascular autonomic dysfunction. Graduated sub-symptom-threshold aerobic exercise (the Buffalo Concussion Treadmill Test protocol) identifies tolerance and progressively builds it back.
Post-Concussion Syndrome
When symptoms persist beyond 4 weeks (in adults), physiotherapy becomes even more important. A physiotherapist will identify which symptom domains are most prominent, prioritise treatment accordingly, and coordinate with a sports medicine doctor or neurologist where needed. Most persistent post-concussion symptoms are amenable to targeted physiotherapy.
Call 000 or go to emergency if after a head injury you experience:
- • Loss of consciousness lasting more than 30 seconds
- • Seizure
- • Repeated vomiting
- • Worsening headache
- • Weakness or numbness in limbs
- • Slurred speech or confusion that is getting worse
Concussion Treatment at Better Physiotherapy Bundoora
Our physiotherapists assess and treat the cervicogenic, vestibular, and exertional components of concussion and post-concussion syndrome. We provide return-to-sport clearance testing for athletes. Call (03) 9467 6900 or book online.
Frequently Asked Questions
What are the symptoms of concussion?
Concussion symptoms include: headache, dizziness, nausea, sensitivity to light and noise, blurred vision, feeling "foggy" or "slowed down," memory difficulties, sleep changes, and emotional changes (irritability, anxiety, depression). Symptoms typically resolve within 4 weeks for most adults, though 10–15% develop persistent post-concussion syndrome.
What does physiotherapy treat after concussion?
Physiotherapy targets three common concussion-related problems: (1) Cervicogenic dysfunction — neck joint and muscle injury occurring at the time of the head trauma, causing headache and neck pain; (2) Vestibular dysfunction — BPPV, reduced gaze stability, and dizziness; (3) Exertional intolerance — difficulty tolerating physical or cognitive activity without symptom flare.
Should I rest completely after a concussion?
Current evidence strongly recommends against complete rest (cognitive and physical "cocooning") after concussion. Brief initial rest (24–48 hours) is appropriate, followed by gradual reintroduction of activities guided by symptom response. Early subthreshold aerobic exercise (below symptom threshold) actually accelerates recovery compared to rest.
When can an athlete return to sport after concussion?
Return to sport follows a stepwise protocol: complete rest → light aerobic exercise → sport-specific exercise → non-contact training → full-contact training → return to competition. Each step requires 24 hours symptom-free before advancing. A physiotherapist conducts return-to-sport testing including cardiovascular challenge, balance assessment, and sport-specific demands.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora