Concussions are one of the most misunderstood injuries in sport, resulting in a variety of symptoms, impaired coordination and athletic performance. For years, the standard advice was simple: rest from activities until symptoms go away, then gradually return to play. In other words: rest is best.
We now know that approach is incomplete and lacks evidence based support, and in many cases delays recovery for our athletes.
At The Performance Shift, we take a different approach: one rooted in early active rehabilitation, objective testing, and individualized return-to-sport progression. Sports physical therapy plays a critical role in both acute and chronic concussion management, helping athletes recover faster, reduce risk of reinjury, and return to sport with confidence.
The Problem with “Just Rest”
Historically, athletes were prescribed prolonged physical and cognitive rest after a concussion. While initial short-term rest (24 to 72 hours) is still recommended to allow the brain to heal, research consistently shows that extended rest beyond that window may actually slow recovery and contribute to persistent symptoms. Athletes that rest too long may have lower mood, higher anxiety and delayed reaction time (Moser & Schatz, 2012).
Recent evidence supports a shift toward early, controlled, sub-symptom activity such as riding a stationary bike, or walking at a prescribed intensity for 10 to 20 min/day. Active rehabilitation, when appropriately guided, has been shown to improve recovery timelines and reduce the likelihood of prolonged symptoms (Patricios et al, 2023).
Why Sports Physical Therapy Matters
Sports-related concussion is a traumatic brain injury, they affect multiple systems:
- Vestibular (balance, dizziness)
- Ocular (vision, tracking)
- Cervical spine (neck pain, headaches)
- Autonomic nervous system (heart rate, exercise tolerance)
This is where sports physical therapy becomes essential at recognizing sports-related concussion on the side line or through clinical assessment, preventing persistent symptoms & risk of recurrent injury, and helping with the transition to return to sport and learning (Patricious et al, 2022).
A comprehensive PT evaluation identifies which systems are still impaired, allowing us to build a targeted plan instead of waiting passively for symptoms to resolve. We additionally take this time to assess what other impairments athletes may have or compensation patterns to reduce a secondary concussion or lower extremity injury like an ACL tear or ankle sprain.
Research shows that targeted interventions, such as vestibular, cervical strengthening, dual task and reaction time training, can accelerate recovery and improve return-to-sport outcomes, particularly in athletes with prolonged symptoms (Barnes et al., 2024).
Active Rehabilitation: The Game Changer
Two of the most important advancements in concussion care is the use of early graded aerobic exercise and integration of reaction time testing with dual task training (Barnes et al., 2024).
Instead of avoiding activity, we now:
- Identify an athlete’s symptom threshold
- Prescribe aerobic exercise below that threshold
- Progress intensity as tolerance improves to get back to sports-related activities
This approach helps restore:
- Autonomic regulation
- Exercise tolerance
- Blood flow to the brain
Clinical protocols emphasize that rehabilitation should be both time-based and criteria-based, adapting to the athlete’s individual response with graded exposure rather than following a rigid timeline for return to play.
The Role of PT in Return-to-Sport Decision Making
The widely accepted 6-step return-to-play progression completed by the PT and athletic trainer ensures that athletes only advance when they are symptom-free at each stage.
However, symptom resolution alone is not enough.
At The Performance Shift, we go beyond symptoms and assess:
- Strength and power asymmetries
- Neuromuscular control
- Reaction time and coordination
- Balance and force production (via tools like VALD)
Why does this matter?
Because research shows that athletes returning from concussion are at increased risk for musculoskeletal injury, likely due to lingering neuromotor deficits (Howell et al., 2022), so we make sure to assess movement quality as part of return to play.
Acute vs. Chronic Concussion: How PT Helps Both
Acute Concussion (0 to 4 weeks)
Sports PT focuses on:
- Early symptom-guided activity
- Cervical and vestibular assessment
- Aerobic exercise prescription
- Preventing deconditioning
This early intervention can shorten recovery time and improve progression through return-to-play stages.
Chronic / Persistent Symptoms (>4 weeks)
For athletes with lingering symptoms, PT becomes even more critical.
Targeted rehab may include:
- Vestibular therapy for dizziness and motion sensitivity
- Vision therapy integration
- Cervical spine treatment for headaches
- Progressive strength and conditioning
The Multidisciplinary Advantage
The best outcomes happen when concussion care is integrated.
At TPS, this means collaboration between:
Concussion recovery is not linear and having a team allows us to adapt in real time, ensuring no system is overlooked. We prioritize communication with the athlete, family, coach, ATC and remainder of the sports medicine team.
The Bottom Line
Concussion management has evolved and so should the way we treat it!
Sports physical therapy:
- Speeds up recovery through active rehabilitation
- Identifies and treats underlying impairments
- Reduces risk of reinjury
- Ensures a safe, confident return to sport
The goal isn’t just to “feel better.” It’s to return better and prevent the likelihood of an athlete being sidelined by a future injury.
Join the Shift
If you or your athlete is navigating a concussion, whether recent or lingering, our team in Centennial, CO, is here to help guide the process with clarity, structure, and science-backed care to get you back in the game.
Book a ConsultationDr. Alice Barnes, PT, DPT, SCS
Citations
- Barnes A, Smulligan K, Wingerson MJ, Little C, Lugade V, Wilson JC, Howell DR. A Multifaceted Approach to Interpreting Reaction Time Deficits After Adolescent Concussion. J Athl Train. 2024 Feb 1;59(2):145-152. doi:10.4085/1062-6050-0566.22. PMID: 36701688; PMCID: PMC10895397.
- Howell DR, Seehusen CN, Carry PM, Walker GA, Reinking SE, Wilson JC. An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial. Am J Sports Med. 2022;50(4):1120-1129. doi:10.1177/03635465211069372.
- Moser RS, Schatz P. A Case for Mental and Physical Rest in Youth Sports Concussion: It’s Never too Late. Front Neurol. 2012 Dec 11;3:171. doi:10.3389/fneur.2012.00171. PMID: 23248612; PMCID: PMC3518809.
- Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57:695-711.
Frequently Asked Questions About Concussion Physical Therapy
How can physical therapy help with concussion recovery?
Sports physical therapy plays a critical role in both acute and chronic concussion management. A comprehensive PT evaluation identifies which systems are still impaired (vestibular, ocular, cervical spine, autonomic), allowing for a targeted plan instead of waiting passively for symptoms to resolve. Targeted interventions such as vestibular therapy, cervical strengthening, dual task and reaction time training can accelerate recovery and improve return-to-sport outcomes, particularly in athletes with prolonged symptoms.
What are physical therapy exercises for concussion?
Physical therapy exercises for concussion focus on graded aerobic activity below an athlete's symptom threshold. This typically includes riding a stationary bike or walking at a prescribed intensity for 10 to 20 minutes per day, with intensity progressed as tolerance improves. Other key exercises include vestibular and ocular training, cervical strengthening, dual task drills, and reaction time training. Together these restore autonomic regulation, exercise tolerance, and blood flow to the brain.
What is post concussion treatment for athletes with persistent symptoms?
Post concussion treatment for athletes with lingering symptoms beyond four weeks may include vestibular therapy for dizziness and motion sensitivity, vision therapy integration, cervical spine treatment for headaches, and progressive strength and conditioning. The goal is to address each impaired system rather than wait for symptoms to resolve on their own.
