Spinal Dynamics of Wisconsin - Milwaukee

Concussions & Physical Therapy

By: Lauren Hogan, DPT, OCS, ATC

In the past few years, there has been a lot of media attention on concussions. This has led to increased focus on diagnosis and appropriate treatment to avoid long-term consequences. Despite more knowledge and education, there are still a lot of misconceptions about the injury and proper treatment.

For example, did you know that…

  • Most people experiencing a concussion do not lose consciousness?
  • A loss of consciousness does not indicate a more severe injury?
  • A hit to the head is not required to experience a concussion? A hit to the body with force that is transmitted to to the head or a whiplash injury can also cause a concussion.

Concussion Anatomy

When a patient hits their head, the brain moves within the skull and parts of neurons (nerve cells) within the brain can get stretched. This can adversely affect the way the brain uses energy, leading to symptoms. Symptoms can vary significantly among patients with concussions, which can sometimes make diagnosis a challenge. Symptoms may include, but are not limited to:

  • Headache
  • Dizziness
  • Difficulty concentrating
  • Fatigue with cognitive, physical, or emotional activities
  • Irritability, anxiety, or depression
  • Sleep disturbances, including difficulty falling or staying asleep, or needing more sleep than usual
  • Eye symptoms, including eye fatigue, visual disturbance, difficulty watching busy environments
  • Sensitivity to light or noise
  • Neck pain
  • Impaired balance
  • Memory loss immediately before or after the injury

It is important to rule out any significant neurological symptoms that may indicate a more severe injury. If there is deteriorating consciousness, increased confusion, irritability or behavior change, severe or increasing headaches, vomiting, seizure, double vision, or weakness or tingling in the arms or legs, it is imperative to seek out emergency care immediately.


Most people have heard that after having a concussion, the patient should avoid sports until symptoms subside, which is true. It is important to avoid too much activity to allow the brain to use its available energy to heal. Despite this, absolute rest can be detrimental as well, potentially leading to prolonged symptoms and deconditioning. An athletic trainer, physician or physical therapist trained in concussion care can assist with guiding a safe return to normal activities, including sports. The good news is that the vast majority of patients will have their symptoms fully resolve in two weeks or less with relative rest alone. But what happens with those patients that have symptoms that stick around?

Patients with symptoms that linger longer or have symptoms that increase with physical, mental or emotional exertion may have post-concussive syndrome (PCS). Certain characteristics can put people at risk of persistent symptoms, including:

  • Dizziness soon after the injury
  • Feelings of “fogginess”
  • Migraine-like symptoms – headache, nausea, sensitivity to light
  • Children or the elderly
  • Females
  • A history of depression, anxiety, learning disabilities, or ADD/ADHD
  • A history of multiple concussions

This is where physical therapy can be a vital part of recovery. A physical therapist can perform a thorough examination of the patient, determine where symptoms are coming from and address them appropriately.

  • Stiffness and muscle tightness through the neck and surrounding muscles can occur with a head injury and often influence headaches. Physical therapists can utilize manual therapy techniques to improve mobility and reduce pain. Often, strengthening postural muscles can help maintain mobility and improve posture to further reduce symptoms.
  • Eye tracking abnormalities can often cause headaches, dizziness, eye fatigue, sensitivity to busy environments or bright light. Physical therapists trained in oculomotor dysfunction can work with a patient to normalize eye movement and reduce symptoms. They can also work on restoring balance to allow for improved mobility and safety.
  • Patients with post-concussive syndrome also may have an increase in symptoms every time they try to increase their activity level. Physical therapists can also assist with a controlled, gradual and safe return to aerobic activity and sports to help reduce symptoms.

Concussions can be extremely frustrating and even life-altering, especially when patients have long-lasting symptoms. For patients with persistent headaches, dizziness, fatigue and other symptoms, physical therapy can be a crucial part of recovery. The sooner a patient can get care, typically the quicker they start to improve.

More questions about physical therapy and concussions?

Give our office a call at 414-302-0770 and ask to speak with Lauren Hogan, DPT, OCS, ATC, our concussion specialist.