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Everything you must know about Concussions and the role of Physiotherapy

If you have received a diagnosis of Concussion and you are curious about return to pre-concussion activities, this post is written for you. We understand how frustrating it can be to be recommended rest when you feel absolutely fine. But here is why being patient with yourself and your body can be a life saver.  

We’ll start at the very beginning to ensure you can see the big picture. 

The brain, as we know it, is a jello-like substance encased within the bony structure of the skull. In order to simplify concussions, its useful to imagine an egg. A concussion is like shaking the egg suddenly and vigorously. While the shell remains intact the contents of the egg are shaken up regardless.  

For a long time, it was considered that concussions were caused due to the brain slamming against the skull resulting in bruising of the outer surfaces. However, current hypothesis states otherwise.  

What is a concussion? 

A concussion is a traumatic brain injury (TBI).  It often happens due to trauma to the head. Broadly, it is anything that causes a quick acceleration and deceleration to the brain.   

What this potentially means is that taking a hard hit to the body could still give you a concussion.   

What causes symptoms? 

  • Disputing earlier theories, concussions are now believed to stem from a stretching of brain tissue that occurs when it is ‘shaken’.
  • In the absence of a concussion, all nerve cells are active or ‘turned on’ to serve a specific function such as a thought or an action. However, following a concussion, the nerves are stretched and they begin firing continuously or randomly without a purpose resulting in symptoms like headaches, nausea etc. Essentially the nerves have been tricked into turning on! This is called the excitatory phase of concussion.
  • All this unnecessary activation and firing has a huge cost- energy! Imagine a battery of energy that gets recharged after a full night of sleep, every time you perform a task you lose some charge on your battery.
  • Now, try to imagine your nerves firing unnecessarily and using all your energy that was supposed to be saved for work, grocery shopping and cooking dinner. With all that energy used up, it is most likely you are feeling exhausted without exerting your body at all. This phase is called the spreading depression and is usually observed a few hours after the concussion
  • Your energy stores continue to plummet over the next couple of days until you hit a peak low. After that your energy starts to perk and this is when recovery happens.


It’s important to remember you might start to feel better around day 4 or 5 but it takes an average of 10 days to restore your energy back to pre-concussion levels. You have to take it slow! 

How do you recognize a concussion? 

As far as we know, there is currently no single test to diagnosis a concussion. Health care practitioners try to use a variety of tests (i.e. physical exertions, visual, loss of consciousness, etc.) but they’re not a definitive way to rule out a concussion. 

  • The first thing to be aware of are the “red flags”.  These are observable signs or complaints that an ambulance should be called if no healthcare professional is available.  These include: neck pain/tenderness, double vision, weakness or tingling/burning in arms or legs, severe or increasing headache, seizure or convulsion, loss of consciousness, deteriorating conscious state, vomiting, and increasing restless, agitated or combative.
  • If none of the above are present there are some visual clues such as: lying motionless, slow to get up, disorientation/confusion, blank/vacant look, balance issues, or facial injury.   
  • Concussed individuals may also report any of the symptoms: headache, dizziness, neck pain, nausea/vomiting, pressure in head, blurred vision, balance problems, light/noise sensitivity, feeling slowed down, feeling like “in a fog”, don’t feel right, difficult concentrating/remember, fatigue or low energy, confusion, drowsiness, trouble falling asleep, more emotional, irritable, sad, and nervous/anxious.

What to do if you suspect you have a concussion? 

  • Immediately stop whatever activity you may be doing.  Continuing to “power through” will potentially increase the duration and severity of your injury.
  • Seek immediate medical attention (ER) if red flags are present and if red flags are not present, you still should see your doctor as soon as possible.  If you are diagnosed with concussion and subsequently your condition continues to deteriorate, go back immediately.


A second concussion or multiple concussions before you have recovered from your first one can be potentially dangerous and is called the second impact syndrome. It is absolutely vital that you seek medical help immediately. 

How is a concussion treated? 

  • Concussion management is a step-by-step process that takes time.  One of the most difficult things within concussion management is having the patience to allow your body to recover.  A lot of patients want to be better yesterday.  Unfortunately, concussions are just something you can’t “rush” or “push through”.  
  • Treatment is individualized and targets the medical, physical, and psychosocial domains.  This will usually, include, an individualized symptom-limited aerobic exercise program and a plan to treat cervical and vestibular dysfunction.  
  • It is absolutely normal to experience anxiety, depression or even Post Traumatic Stress Disorder. You are not alone in experiencing these symptoms. A therapist that specializes in cognitive behavioral therapy can be extremely helpful for any persistent mood or behavioral issues.


Physiotherapy role in planning your return 

Whether you’re planning your return back to school, sport, or work, many of the protocols/strategies follow a similar framework. 

  • Absolute rest (24-48 hours)
  • This is a time period where you want to just take it easy.  Do what you feel comfortable doing and no need to push through unnecessarily.
  • Light physical and cognitive activity.
  • Begin going on some short walks and light reading.
  • Slowly build your ability to tolerate either of these things from 5 minutes up to 45 minutes.
  • After you finish doing any walking/reading, it should not take more than an hour to return back to how you felt before you started walking/reading.
  • 3–4-hour day of work/school with workload accommodations as needed.
  • Ensure manageable work hours, workload, and work environment.
  • Full day of work/school with workload accommodations as needed.
  • Ensure manageable work hours, workload, and work environment.
  • Full return to work/school


If returning back to sport: 

  • Sport specific exercise
  • Non-contact training drills
  • Full contact practice
  • Return to sport


In some frameworks, a treadmill test between step 5 and 6 is used to assess the degree of exercise tolerance.  In each of the steps above, a minimum of 24 hours must pass by without an increase in symptoms in order to move onto the next step.  When dealing with a return back to sport, it is important to not return until you have been cleared to do so by your physiotherapist or your physician. 

That said, every concussion is different and can be unique in presentation. Fortunately, the body of research into the nature of concussions and the concussion management is growing at a rapid pace due to increased awareness.

Generic advice and protocols on return to work can be a guideline but that’s all they are- a guideline.  A consultation with an expert physiotherapist who is Certified in the Complete Concussion Management protocol will be your next best step to make informed decisions that are individualized to your recovery and your body.  

At Revere Physiotherapy, our inhouse Concussion experts are happy to assist, support, guide and empower you on your recovery journey. Schedule an appointment now. If you have any questions or concerns reach out at We offer complimentary phone consultations for you to decide if we’ll be a good fit. Give us a call at 604-566-5108. 

If you have recovered from a concussion recently comment below and tell us your experience with recovery and how long it took to return to work. Also share this article with friends and family, especially those with young children who are active in sports.

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