Physiotherapy & Head Injury

What is a Concussion? 

A concussion is a mild traumatic brain injury (mTBI). It may result from a hit to the head OR hit to the body. It is a cascade of chemical changes or stretching of the cells in the brain. 

Each concussion is as unique as each person it affects! This means that each person following concussion can have different symptoms, one or more categories, recovery paths and timelines. 

  1. Oculomotor 
    • Difficulties may include: 
      • Light sensitivity 
      • Difficulty with eye teaming (near point convergence)
      • Poor screen tolerance 
      • Difficulty with reading and eye movement 
      • Blurred vision 
      • Double vision
  1. Cervical (Neck) 
    • Difficulties may include: 
      • Whiplash 
      • Neck pain and stiffness 
      • Decreased range of motion 
      • Numbness or tingling in face or upper limbs 
  2. Cognitive: 
    • Difficulties may include: 
      • Memory impairment 
      • Poor concentration 
      • Slow processing speed 
      • Slow reaction time 
  3. Headaches 
    • May include: 
      • Migraine headache 
      • Tension headache 
      • Cervicogenic headache 
      • Post-traumatic headache 
  4. Cardiovascular 
    • May include: 
      • Exercise intolerance 
      • Altered heart rate variability 
      • Ortho-static hypotension 
      • Postural orthostatic tachycardia syndrome (POTS) 
      • Autonomic nervous system abnormalities 
      • Increased heart rate 
      • Dysautonomia 
  5. Vestibular 
    • May include: 
      • Dizziness 
      • Vertigo 
      • Imbalance 
      • Walking difficulties 
      • Motion sensitivity 
      • Nausea &/or vomiting 
      • Ringing in the ears 
  1. Affective Disturbances (Mood) 
    • Difficulties may include: 
      • Anxiety 
      • Depression 
      • Poor emotional regulation 

Can you have more than one concussion subtype? 

Yes, you can have different concussion subtypes at the same time. Also throughout your recovery your concussion subtype can change. 

How can a physiotherapist help? 

A physiotherapist can help with their skills in active rehabilitation, evaluation and management of neck and vestibulo-ocular disorders. 

A physiotherapist will complete a thorough assessment that may include: 

  • Neurological scan (coordination, cranial nerves) 
  • Neck range of motions, strength and proprioception (awareness) 
  • Vestibular assessment (inner ear) 
  • Oculomotor assessment (eye movements) 
  • Balance and coordination static, dynamic or work/sport specific 
  • Exercise tolerance and autonomic system functioning (e.g. fight or flight system vs rest and digest system) 
  • Performance on work or sport specific tasks
  • Appropriate referrals to other professionals to help with your care 
    •  For example, neuro-optometrist for visual issues (double vision, blurry vision, etc.) 

Treatment from a physiotherapist may include: 

  • Manual therapy and exercises for your neck 
  • Balance & walking exercises 
  • Oculomotor exercises 
  • Cardiovascular exercises 
  • Education to help with sleep, fatigue, planning & pacing of activities 

It is never too late or too early to get assessed after a concussion! If it has been a few hours to years, reach out to book with a therapist with concussion training now! We can help! 


  1. Schneider, Kathryn J, et al. “Rest and Treatment/Rehabilitation Following Sport-Related Concussion: A Systematic Review.” British Journal of Sports Medicine, vol. 51, no. 12, 2017, pp. 930–934., 
  2. Maxtone, Sophie, et al. “Physiotherapist Involvement in Concussion Services in New Zealand: A National Survey.” New Zealand Journal of Physiotherapy, vol. 48, no. 2, 2020, pp. 70–79., 
  3. Craton, Neil, et al. “Coach CV: The Seven Clinical Phenotypes of Concussion.” Brain Sciences, vol. 7, no. 12, 2017, p. 119., 
  4. Lumba-Brown, Angela, et al. “Representation of Concussion Subtypes in Common Postconcussion Symptom-Rating Scales.” Concussion, vol. 4, no. 3, 2019,