# Post-concussion symptoms Post-concussion symptoms are the headache, fog, fatigue, dizziness or poor sleep that have not settled after a concussion. They often have more than one driver, and each can be treated: the neck, the balance system, eye movement, how your body handles exercise, sleep or mood. We test each of these, treat what we find, and pace your return to work, study and sport. ## Symptoms - Headache that lingers or returns with effort - Feeling foggy, slowed or worn out by midday - Dizziness or unsteadiness, especially with head turns - Screens, reading or driving that tire you quickly - Exercise that brings symptoms back - Trouble falling or staying asleep - Feeling low, anxious or short-tempered - Neck pain or stiffness since the injury ## Assessment We start with the story: how the concussion happened, what a doctor or nurse practitioner has found, and which symptoms have not eased. For each lingering symptom we ask what brings it on, because that points to its driver. Then we test the systems that most often keep symptoms going: - **The neck:** the upper neck joints and muscles, strained in the same fall, which can feed headache, dizziness and fog. - **Balance and the inner ear:** how steady you are standing, walking and turning, and whether head movement sets symptoms off. - **Eye movement:** how your eyes jump between targets, follow a moving one and hold a point while your head moves. A concussion often unsettles all three. - **Exercise tolerance:** a step-by-step exercise test, raising the effort until symptoms begin to climb, which sets your daily dose. - **Sleep, mood and your day:** how you are sleeping and feeling, and how work or study is going. Most people have more than one driver, and the assessment sets the order of treatment. ## Treatment Each driver gets its own treatment, adjusted as you retest. Physiotherapists trained in concussion management lead it; see [concussion rehabilitation](https://backinactionphysiotherapy.com/services/concussion-rehabilitation). - **Neck:** hands-on treatment for the stiff joints and muscles, then exercise for the deep neck muscles and posture. - **Balance and the inner ear:** exercises matched to the tests, from standing balance to keeping your vision steady through quick head turns. This is [vestibular rehabilitation therapy](https://backinactionphysiotherapy.com/services/vestibular-rehabilitation-therapy). - **Eye movement:** short daily practice that steps up level by level. The [concussion exercises](https://backinactionphysiotherapy.com/resources/concussion-exercises) program has the home versions and the exercise book to print. - **Exercise:** daily aerobic exercise at a dose set from your test, below the point where symptoms climbed, and raised as you retest. - **Work and study:** pacing, not stopping. Shorter blocks, set breaks, less screen time and noise at first, and hours that build as your symptoms allow. Poor sleep feeds headache and fog, and low mood is common when symptoms drag on, so we ask about both. Your doctor or nurse practitioner stays involved while symptoms linger, and leads on sleep and mood. One rule runs through it all: an activity should make your symptoms no more than a little worse, and they should settle again soon after. ## Getting back to sport Sport comes last, after everyday life, work or study, and daily exercise are steady. Another knock before you have recovered can cost more than the first. Before you go back, we test you under your sport's demands: effort that pushes your heart rate up, quick head turns, and balance on uneven ground. We add a busy visual field, like scanning a crowded run or a rooty trail at speed. You go back when each test makes your symptoms no more than a little worse. A doctor or nurse practitioner also clears you for sports where you could fall or be hit. ## When to come in Book an assessment if symptoms after a concussion are not settling, or a symptom you thought had gone has come back. Come in too if resting and waiting has not worked, or you are unsure how to get back to full hours or sport. Go to the emergency department right away, or call 911, if any of these happen: - a headache that keeps getting worse - repeated vomiting - confusion or growing drowsiness - a seizure - weakness or numbness in an arm or leg, or double vision - new or worse symptoms after another knock to the head ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Concussion Rehabilitation](https://backinactionphysiotherapy.com/services/concussion-rehabilitation) - [Vestibular Rehabilitation Therapy](https://backinactionphysiotherapy.com/services/vestibular-rehabilitation-therapy) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Programs - [Concussion Exercises](https://backinactionphysiotherapy.com/resources/concussion-exercises) ## Frequently asked questions ### My scan was normal, so why do I still have symptoms? That is common. A concussion changes how the brain works, not how it looks, so a standard CT or MRI scan is usually normal even when the symptoms are real. The scan's job is to rule out bleeding or a fracture. Lingering symptoms more often come from the neck, the balance system, eye movement, exercise tolerance, sleep or mood, and none of those show on a scan. Those are the things we test, and they can be treated. ### Can I exercise while I still have symptoms? Usually, yes. Exercise is part of the treatment, at the right dose. We test how much effort you can handle before symptoms climb, then set a daily amount below that. Often that is a brisk walk or an easy spin on a bike. Keep each session at a level that makes your symptoms no more than a little worse, and raise it only as your test results improve. Hard efforts, and anything with a risk of a fall, wait until later. ### Could my headaches be coming from my neck? They can be. The neck takes a jolt in the same fall or crash that causes a concussion. Strained joints and muscles at the top of the neck can send pain into the back of the head, the temples or behind the eyes. A neck headache often builds with sitting, screens or turning the head, and eases when the neck is treated and moving well. We test the neck on the first visit and treat it when it is part of the picture. ### Do I need to stop work or study until I feel normal? Not usually. A long stop from work or study tends to make the return harder. We look at what sets you off, such as screens, noise, a hot kitchen or a long radio shift on the mountain, and plan around it. That usually means shorter blocks, set breaks, lighter duties at first, and hours that build as your symptoms allow. If a task makes you more than a little worse, that is the signal to shorten it, not to push through. ### Is it too late to start treatment? No. Treatment can still help whenever it starts. The drivers behind lingering symptoms, such as a stiff neck or a balance system that has not been retrained, do not always settle by waiting. If you were told to rest and see how it goes, and it has not gone, that is the time to book. Bring any notes from your doctor or nurse practitioner, and a list of what still sets your symptoms off. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*