A concussion is defined as a mild traumatic brain injury (mTBI) induced by direct or indirect force transmitted to the head. Looking at the statistics, there were 27.16 million new TBI cases globally in 2019. Nationally, there were approximately 214,110 TBI-related hospitalizations in 2020 and 69,473 TBI-related deaths in 2021.² Approximately 80% of all TBIs are classified as mild head injuries (CDC).

These numbers highlight the significant public health impact concussions have worldwide, and the importance of proper evaluation and management. A concussion injury results in a short-term metabolic energy crisis in the brain, which can impact a variety of systems in the brain and body.

Systems that may be affected include:

  • Visual
  • Vestibular (balance and equilibrium)
  • Musculoskeletal
  • Autonomic nervous system regulation (vitals, exertion tolerance)
  • Cognitive processing

Given the wide range of possible symptoms, a comprehensive physical therapy evaluation is essential. A trained clinician can identify which systems are affected and develop a recovery plan tailored specifically to your needs. There is no “one size fits all” approach to concussion treatment. An individualized assessment ensures that your exercise program is both safe and targeted to your symptoms, impairments, and personal goals. The following exercises are commonly prescribed post-concussion.

1. Aerobic Exercise

It is highly recommended to include aerobic exercise in your recovery program. Research has shown this to be safe and effective in decreasing symptom burden and may decrease recovery time. An example may include walking for 20 minutes daily at a sub-symptom threshold.⁴⁻⁵

2. Neck Stretches and Strengthening

Many people experience neck pain following a concussion. It is common to have a whiplash-associated disorder at the time of injury. Neck pain can contribute to cervicogenic headaches, and completing a structured stretching and strengthening routine can help decrease symptoms.¹

Neck Strengthening Exercises

3. Pencil Pushups

Convergence, the coordinated movement of your eyes to stay focused on a target as it comes toward you, is frequently impaired after a concussion. Pencil pushups help to retrain your eye muscles and visual system.3

4. Habituation for Visual Motion Sensitivity

Individuals who experience dizziness or nausea in visually busy environments — such as grocery stores, while watching shows, or scrolling on their phones — may benefit from habituation exercises. This type of training provides graded exposure to triggering stimuli in order to reduce the symptom response over time.⁵⁻⁶

5. Balance

Your sense of equilibrium may be altered after a concussion. The injury can affect all three balance systems: visual, proprioceptive, and vestibular. Both static and dynamic balance exercises can improve stability and confidence with movement. Sheltering Arms Institute offers virtual reality and other advanced technology to help retrain balance during physical therapy appointments.⁵

Recovering from a concussion requires patience, guidance, and a personalized plan of care. With the right evaluation and targeted interventions, symptoms can improve safely and efficiently. If you or someone you know is experiencing lingering concussion symptoms, ask your physician for a referral to our Total Concussion Care program or contact us directly at www.shelteringarmsinstitute.com/contact-us or call (804) 764-1000.

Resources:

  1. Blainpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. D., Clewley, D., Walton, D. M., . . . Robertson, E. K. (2017). Neck Pain Guidelines: Revision 2017. Journal of Orthopaedic and Sports Physical Therapy, 47(7), A1-A83. doi:10.2519/jospt.2017.0302
  2. Guan, B., Anderson, D., Chen, L., Feng, S., & Zhou, H. (2023). Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. BMJ Open, 13(10), e075049. doi:10.1136/bmjopen-2023-075049
  3. Mucha, A., Collins, M. W., Elbin, R. J., Furman, J. M., Troutman-Enseki, C., DeWolf, R. M., . . . Kontos, A. P. (2014). A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. The American Journal of Sports Medicine, 42(10), 2479-86. doi:10.1177/0363546514543775
  4. Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., . . . Yeates, K. O. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. doi:10.1136/bjsports-2023-106898
  5. Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., & McCulloch, K. L. (2020). Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury. Journal of Orthopaedic & Sports Physical Therapy, 50(4), CPG1-CPG73. doi:10.2519/jospt.2020.0301
  6. Tee L., Chee N. 2005. Vestibular Rehabilitation for the dizzy patient. Annals of the Academy of Medicine, Singapore, 34(4), 289-294.

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