Physical Therapy for Concussion: How PT Can Help

So you’ve been diagnosed with a concussion. Now what? Your doctor may have told you to take it easy for 24 hours, to avoid certain activities like using screens or to go on “cognitive rest.”

But what if you’re still experiencing some headaches, dizziness, neck pain or vision problems two weeks later? Physical therapy can play a role in restoring neurological function that isn’t getting back to normal, says Meghan Lamothe Homoky, PT, DPT, OCS, ATC, a physical therapy clinical specialist at HSS Rehabilitation and Performance.

Learn more about how a referral to a physical therapist specializing in concussion care can help with lingering symptoms. 

What is a concussion?

A concussion is a functional injury, not a structural one, that results from a blow to the head or body causing rapid acceleration and deceleration of the brain within the skull, says Homoky.  This injury does not show up on imaging tests like MRI or CT scans that are often used to rule out more severe conditions like brain bleeds. 

“The mechanical force to the brain results in changes including the need for more oxygen and decreased blood flow,” says Homoky. 

Symptoms and Diagnosis of a Concussion

Concussions can cause many symptoms, from headaches to fatigue and anxiety—more than 50 symptoms could be consistent with a concussion, Homoky says.  Concussion symptoms are also diverse and can overlap with other conditions. The primary symptoms include headache, dizziness and neck pain. The patient might also experience emotional changes such as feeling irritable, sad or anxious. 

Diagnosing a concussion is complicated because it involves both how the injury occurred and the symptoms that follow, Homoky says. "A lot of times, how the injury happened and how severe it is don’t always correlate with the actual symptoms a person is feeling.” This means that even minor blows can sometimes result in severe symptoms, and vice versa.

The typical recovery timeframe could be as short as seven to 10 days, but normal recovery is defined as within 30 days.

How can physical therapy help with concussion symptoms?

Every concussion is different. In some ways, the injury “fights dirty” and attacks an individual’s neurological “weaknesses,” says Homoky. “A big purpose of PT is to help recalibrate the functions that are out of whack.” 

Early intervention with physical therapy is crucial. Ideally, patients who still have headaches, dizziness or neck pain 10 days after the injury should be referred to PT. "The evidence shows that being proactive with physical therapy after a concussion even as early as within two weeks of the injury can be beneficial," Homoky says.

It’s important to look for a PT who specializes in orthopedic and vestibular care, she adds.

What happens during PT for concussion?

Assessment

During the first PT visit, the therapist will assess three main systems: the neck; vestibular system, which controls the perception of the body’s movement and position; and ocular motor function, which has to do with eye movement.

“We examine the neck for muscular tightness, joint mobility restrictions, weakness and impaired proprioception, which can cause headaches,” says Homoky. “We also look at vestibular and ocular motor function, including balance, eye movements, and gaze stability."

Once the physical therapist has established a baseline, they’ll get to work with exercises designed to address the patient’s unique concussion-related challenges.

Screenings and Tests

The PT will likely conduct a Vestibular Ocular Motor Screen (VOMS) test and have the patient rate the severity of the symptoms they’re experiencing. 

The vestibular piece of things involves working on balance as well as the body's response to quick head and eye movements, simultaneous eye movements, the patient’s sense of equilibrium and how their spatial awareness looks.

Some tests a patient might undergo in physical therapy for concussion include tasks like:

• tracking an object with the eyes
• moving the eyes quickly back and forth
• pencil “push-ups”
• Brock string exercises with colored beads are designed to improve eye convergence (two eyes focusing on the same thing at one time) and eye coordination syncing visual signals with the brain.
• moving the head quickly side to side and up and down while focusing on an object or a target

“We also assess motion sensitivity, which is more pertinent to people who feel like they're on a boat when they're moving around or who feel very sensitive to motion after a concussion,” she says.

For vestibular problems, a PT will try “habituation” exercises, exposing the person to the behaviors that bother them in a controlled manner. This allows the body to get used to and not be as reactive to that stimulus, says Homoky. “If head-turning causes the patient to feel dizzy or nauseous, then we have them slowly turn the head and then gradually go faster until that doesn't cause them to feel dizzy or nauseous anymore,” she says. “It sounds kind of crazy, but it makes sense, and it works.” 

Guided Return to Exercise

A big piece that PT can help with is helping people return to exercise, Homoky says. In some cases, exercising can initially worsen symptoms, but in many other cases, it can improve symptoms. 

“What we do know research-wise is that it's safe and beneficial to start sub-maximal aerobic exercise—50 to 70% of max heart rate—within 48 hours of the initial injury,” says Homoky. “That’s a big leap from 15 years ago when medical professionals were encouraging longer periods of rest after a concussion.”

Aerobic exercise has been shown to improve cerebral blood flow after a concussion, making it easier for the brain to access oxygen and helping maintain healthy blood tissue. Once the individual can tolerate maximal, high-intensity aerobic exercise to 90% of their age-predicted max heart rate, their PT can start re-introducing more direction and level changes as well as resistance training. This gradual resumption of physical and athletic activity is vital to a successful recovery.