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Symptoms persisting after a concussion, such as headaches and dizziness.
Three weeks ago, you hit your head during a soccer game. The initial symptoms—headache, confusion, nausea—have mostly faded. But the dizziness? It won't go away.
You feel unsteady when you walk. Turning your head makes the room spin. Busy environments like grocery stores leave you disoriented and exhausted. You can't focus at work because looking at your computer screen triggers waves of dizziness. Your doctor said to "give it time," but you're wondering: Is this normal? Will it ever get better?
Post-concussion dizziness is one of the most common and debilitating persistent symptoms following a mild traumatic brain injury, affecting up to 80% of concussion patients and significantly impacting daily function, return to work, and return to sports [Farì et al., 2024; Art et al., 2023; Ellis, Leddy & Willer, 2015].
Here's the encouraging news: Post-concussion dizziness is highly treatable with specialized vestibular rehabilitation. Research demonstrates that multimodal physiotherapy—combining vestibular exercises, cervical spine treatment, and aerobic conditioning—can dramatically accelerate recovery, with 73% of patients medically cleared for return to activity within 8 weeks compared to only 7% receiving standard care [Schneider et al., 2014; Farì et al., 2024; Art et al., 2023].
At Vaughan Physiotherapy Clinic, we specialize in evidence-based rehabilitation for post-concussion dizziness. We understand that your symptoms aren't "all in your head"—they're the result of specific, treatable dysfunctions in your vestibular system, cervical spine, and autonomic regulation that require targeted intervention, not just time.
Post-concussion dizziness refers to persistent vestibular symptoms—dizziness, vertigo, imbalance, and disequilibrium—that continue beyond the typical 7-10 day recovery window following a concussion or mild traumatic brain injury (mTBI) [Farì et al., 2024; Ellis, Leddy & Willer, 2015].
Prevalence:
Post-concussion dizziness isn't a single condition—it represents distinct operational Post-Concussion Disorders (PCDs) that require different treatment approaches [Ellis, Leddy & Willer, 2015].
What It Is:Persistent symptoms caused by dysfunction of the vestibular and oculomotor systems—damage to the balance organs in your inner ear and the systems that coordinate eye movements.
Characteristic Symptoms:
The Mechanism:The concussion has disrupted how your vestibular system (inner ear balance organs) communicates with your visual system. Your brain is receiving conflicting information about head position and movement, resulting in dizziness and imbalance.
Key Feature:Problems with balance, spatial orientation, and visual processing during movement.
What It Is:Persistent symptoms caused by dysfunction of the cervical spine somatosensory system—damage to the neck structures and nerves that provide sensory information about head and neck position.
Characteristic Symptoms:
The Mechanism:The same forces that caused your concussion often cause whiplash-type cervical injuries. Damage to neck joints, muscles, and proprioceptors (position sensors) disrupts the sensory feedback your brain needs for balance and spatial orientation.
Key Feature:Neck-related symptoms with dizziness that worsens with neck movement or certain head positions.
What It Is:Many post-concussion patients develop visual motion sensitivity—dizziness triggered by busy visual environments or moving visual stimuli [Bronstein et al., 2013; Thompson et al., 2015].
Characteristic Symptoms:
The Mechanism:After concussion, your brain may develop an overreliance on visual input for balance (visual dependency), leading to dizziness when visual information is complex or ambiguous [Bronstein et al., 2013].
What It Is:A functional disorder of chronic dizziness where the brain's balance control system becomes "stuck" in a maladaptive pattern following the initial concussion [Thompson et al., 2015].
Characteristic Symptoms:
The Mechanism:The initial protective response to concussion (stiffened gait, increased reliance on vision, heightened vigilance) fails to resolve. The nervous system remains stuck in "high alert" mode, creating persistent symptoms even after the brain has healed [Thompson et al., 2015].
Trigger:Concussion/mild traumatic brain injury is a common trigger for PPPD development [Thompson et al., 2015].
Dizziness [Farì et al., 2024; Art et al., 2023]:
Vertigo [Art et al., 2023]:
Imbalance and Unsteadiness [Ellis, Leddy & Willer, 2015]:
Disequilibrium [Ellis, Leddy & Willer, 2015]:
Visual Disturbances [Ellis, Leddy & Willer, 2015]:
Neck-Related Symptoms [Farì et al., 2024; Ellis, Leddy & Willer, 2015]:
Cognitive Effects [Ellis, Leddy & Willer, 2015]:
Autonomic Symptoms:
Post-concussion dizziness is typically worsened by specific activities and environments:
Movement-Related:
Visual Triggers:
Cognitive Demands:
Environmental:
Post-concussion dizziness can be profoundly disabling:
Work/School:
Social Activities:
Physical Activities:
Psychological Impact:
The Initial Trauma [Farì et al., 2024; Art et al., 2023]:A concussion is induced by direct or indirect biomechanical forces that cause the brain to move forward and backward inside the skull.
Dual Injury Pattern:The same forces typically cause:
This explains why many post-concussion patients have both vestibular and cervicogenic contributions to their dizziness.
What Happens to Your Brain [Ellis, Leddy & Willer, 2015]:
Concussion triggers a cascade of molecular processes:
The "Acute Energy Crisis":Following initial hypermetabolism, the brain enters a protracted period of decreased glucose utilization and metabolism [Ellis, Leddy & Willer, 2015].
Why This Causes Dizziness:The vestibular system and its central processing pathways are metabolically demanding. During the energy crisis, these systems may not function optimally, resulting in:
Direct Vestibular Injury:The biomechanical forces can cause:
Result:Asymmetric vestibular input to the brain, causing vertigo, imbalance, and spatial disorientation.
Whiplash-Type Forces [Ellis, Leddy & Willer, 2015]:The same acceleration-deceleration forces affecting the brain also injure cervical structures:
Damaged Structures:
Why Neck Injury Causes Dizziness:The cervical spine contains dense proprioceptive input that your brain uses for:
When these proprioceptors are damaged or sending inaccurate signals, your brain receives conflicting information about head position, resulting in dizziness and imbalance—this is cervicogenic dizziness.
Oculomotor Dysfunction [Ellis, Leddy & Willer, 2015]:Concussion can disrupt:
Result:Blurred vision, difficulty reading, visual-vestibular mismatch leading to dizziness.
Disrupted Autonomic Control:Concussion can affect the autonomic nervous system's regulation of:
Result:Orthostatic intolerance (dizziness when standing), exercise intolerance, symptoms that worsen with exertion.
The Protective Pattern [Thompson et al., 2015]:Initially after concussion, your nervous system adopts protective strategies:
When It Becomes Problematic:In some patients, this protective pattern fails to resolve even after the brain has healed. The nervous system remains stuck in "high alert" mode—this is PPPD [Thompson et al., 2015].
Contributing Factors to Chronicity:
History of Previous Concussions [Ellis, Leddy & Willer, 2015]:
Female Gender [Ellis, Leddy & Willer, 2015; Art et al., 2023]:
Younger Age [Ellis, Leddy & Willer, 2015; Art et al., 2023]:
Pre-Existing Conditions [Ellis, Leddy & Willer, 2015]:
Severity of Initial Symptoms:
Presence of Multiple Symptom Types:
Inadequate Early Management [Ellis, Leddy & Willer, 2015; Farì et al., 2024]:
Returning to Activity Too Soon:
Excessive Rest:
Psychological Factors:
Recover faster, move better, and feel stronger with expert physiotherapy. Our team is here to guide you every step of the way.
Landmark Research [Schneider et al., 2014; Farì et al., 2024; Art et al., 2023]:
A randomized controlled trial comparing standard care to combined cervical spine and vestibular rehabilitation found:
Dramatic Results:
What This Means:Active, targeted physiotherapy intervention produces outcomes more than 10 times better than passive "rest and wait" approach.
Addressing Multiple Dysfunctions:Post-concussion dizziness rarely has a single cause. Most patients have overlapping dysfunctions requiring comprehensive treatment [Ellis, Leddy & Willer, 2015]:
Single-Modality Limitations:Treating only one component leaves other dysfunctions unaddressed, limiting recovery.
Purpose:Improve functional recovery outcomes such as gaze stabilization, balance, gait, and return to work/sport.
Mechanism:VRT aims to re-calibrate depth and spatial perception by re-establishing efficient integration of vestibular, visual, and somatosensory systems [Ellis, Leddy & Willer, 2015].
Key Exercises:
Gaze Stabilization (VOR Training):
Balance Training:
Habituation Exercises:
Evidence:VRT improves functional recovery outcomes and is essential for vestibulo-ocular PCD [Murray et al., 2017; Farì et al., 2024].
Purpose:Restore normal somatosensory output from cervical afferents (neck position sensors).
Interventions:
Often Includes:Balance and gaze stabilization exercises as cervical proprioception integrates with vestibular function [Ellis, Leddy & Willer, 2015].
Evidence:Combined cervical and vestibular treatment more effective than either alone [Schneider et al., 2014; Farì et al., 2024].
Purpose:Promote recovery of physiologic PCD—persistent symptoms from altered brain metabolism.
Mechanism:
Protocol:
Evidence:
Purpose:Address visual motion sensitivity and visual-vestibular mismatch.
Techniques:
Evidence:Effective for post-concussion patients with visual vertigo component [Bronstein et al., 2013; Thompson et al., 2015].
Purpose:Address maladaptive patterns, anxiety, and fear-avoidance that perpetuate symptoms.
Interventions:
Evidence:Particularly important for patients developing PPPD following concussion [Thompson et al., 2015].
Synergistic Effects:When combined, these interventions address:
Result:Faster, more complete recovery than any single intervention alone.
Natural History:
Combined Intervention Outcomes [Schneider et al., 2014; Farì et al., 2024; Art et al., 2023]:
Symptom Reduction [Grabowski et al., 2017]:
Aerobic Exercise Benefits [Leddy et al., 2019, 2021; Art et al., 2023]:
Weeks 1-2:
Weeks 3-6:
Weeks 6-12:
Factors Affecting Timeline:
Realistic Expectations:
With Appropriate Treatment:
Importance of Complete Recovery:Achieving full recovery before returning to contact sports is essential to prevent:
We evaluate all potential contributors:
Vestibular System Testing:
Cervical Spine Examination:
Oculomotor Assessment:
Functional Testing:
Exertional Testing:
Manual Therapy:
Therapeutic Exercise:
Goal:Restore normal neck function and eliminate cervicogenic contribution to dizziness.
Gaze Stabilization (VOR x1):
Static Balance:
Starting Protocol:
Monitoring:
VOR x2 Exercises:
Habituation Exercises:
Dynamic Balance:
Optokinetic Exercises:
Real-World Practice:
Progression:
Progressive Stages:
Criteria for Advancement:
Graduated Return-to-Learn:
Real-World Activities:
Regular Reassessment:
Program Modifications:
Sports Safety:
General Safety:
Immediate Post-Concussion:
Early Intervention:
Appropriate Activity Levels:
Psychological Support:
Complete Recovery Before Return:
Long-Term Strategies:
Informed Decision-Making:
Post-concussion dizziness persists because:
Multiple Systems Affected:Your dizziness likely has overlapping causes [Ellis, Leddy & Willer, 2015]:
Energy Crisis:Your brain is in a protracted metabolic recovery phase with decreased glucose utilization [Ellis, Leddy & Willer, 2015]. The metabolically-demanding vestibular system struggles to function optimally.
Incomplete Compensation:Without targeted rehabilitation, your brain may not fully compensate for damaged systems, leaving you with persistent symptoms.
Good News:Persistent dizziness does NOT mean permanent damage. With appropriate multimodal treatment, 73% of patients achieve medical clearance within 8 weeks [Schneider et al., 2014].
Yes—with appropriate treatment, most patients achieve significant improvement or complete resolution.
The Evidence:
Important:
Yes—strategic, symptom-limited exercise is not only safe but beneficial [Farì et al., 2024; Art et al., 2023].
Sub-Symptom Threshold Aerobic Exercise (SSTAE):
The Evidence:
What to Avoid:
Professional Guidance Essential:Work with a physiotherapist to determine appropriate:
Medication is sometimes helpful but not always necessary [Ellis, Leddy & Willer, 2015; Thompson et al., 2015].
When Medication May Help:
Important Considerations:
Collaborative Approach:Your physiotherapist and physician should coordinate care, with medication supporting—not replacing—active rehabilitation.
Timeline varies but is dramatically improved with specialized treatment:
With Multimodal Physiotherapy [Schneider et al., 2014]:
Without Specialized Treatment:
Factors Affecting Timeline:
Critical Requirements for Return:
Don't Rush:Premature return risks:
Post-concussion dizziness is frustrating and frightening. When weeks turn into months and you're still dizzy, it's natural to worry that you'll never feel normal again. At Vaughan Physiotherapy Clinic, we want you to know: persistent dizziness after concussion is highly treatable, and you don't have to accept it as your new normal.
We specialize in evidence-based, multimodal rehabilitation that addresses ALL the potential causes of your dizziness—not just one piece of the puzzle. Our approach is grounded in the research showing that combined interventions produce outcomes more than 10 times better than standard care alone.
What sets us apart:
Most importantly, we understand the impact post-concussion dizziness has on every aspect of your life. We're committed to helping you return to work, school, sports, and daily activities as quickly and safely as possible—with confidence that your symptoms are truly resolved, not just masked.
Our comprehensive programs include:
📞 Phone: 905-669-1221
📍 Location: 398 Steeles Ave W #201, Thornhill, ON L4J 6X3
🌐 Online Booking: www.vaughanphysiotherapy.com
Don't let post-concussion dizziness keep you sidelined. The research is clear: specialized multimodal physiotherapy produces dramatically better outcomes than "wait and see" approaches. With 73% of patients achieving medical clearance within 8 weeks using combined interventions—compared to only 7% with standard care—the evidence speaks for itself. Your dizziness is treatable. Contact us today to start your evidence-based recovery journey.
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