Concussion Physical Therapy

Physical therapy after a concussion covers three distinct jobs: the neck, the balance system, and graded aerobic exercise. All three have trial evidence behind them, and together they make up most of what modern concussion treatment actually consists of.

The neck is the most commonly missed part of this. A force great enough to concuss is great enough to injure the cervical spine, and neck-driven headache and dizziness mimic the concussion symptoms closely enough that they are routinely attributed to the brain injury and left untreated. A physical therapist who assesses the cervical spine is checking something a scan will not show.

Graded aerobic exercise is the other piece, and it is one of the better-evidenced elements of concussion care. In a 2019 randomized clinical trial in JAMA Pediatrics, adolescents prescribed individualized sub-symptom-threshold aerobic exercise recovered in a median of 13 days against 17 days in the stretching group. The dosing matters — this is exercise prescribed to a threshold, not a decision to push through.

Which of the three you need depends on the examination. Many concussion-trained physical therapists deliver all of them; some focus on vestibular work alone. Worth confirming before you book, because the neck assessment is the one most often left out.