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Concussion and Post-Concussion Syndrome

Physiotherapy St. John's Avalon Laser Health

What is a Concussion?

A concussion is a mild Traumatic Brain Injury (mTBI). The American Congress of Rehabilitation Medicine (1993) defines mTBI as an “acute brain injury resulting from mechanical energy to the head from external physical forces” (American Congress of Rehabilitation Medicine, 1993).

Concussions are associated with physical trauma such as a contact sports injury, a fall, an assault, or car accident. The resulting blow to the head can cause the brain to bounce or twist within the skull, resulting in stretched and damaged brain cells (CDC, 2019).

What is Post-Concussion Syndrome?

Post-concussion syndrome is lingering symptoms for weeks or months following a concussion, commonly up to 6 months but occasionally beyond.

Post-concussion syndrome is diagnosed by having 3 of the following symptoms after an injury to the head: headache, dizziness, vertigo, fatigue, memory problems, difficulty concentrating, insomnia, irritability, depression, anxiety, personality changes, sensitivity to noise and light (Bowman, 2019).

Signs of a Concussion

  • Jolt, bump, blow, or trauma to the head
  • Loss of consciousness
  • Confused after the injury
  • “Blacked out” or can’t remember events prior to the injury
  • Mood and behavior changes
  • Poor balance
  • Slow reaction time

How Can a Concussion Impact Your Health?

  • Headaches
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Bothered by light or noise
  • Fatigue
  • Concentration or memory problems
  • Ringing of the ears

First Steps following Concussion:

Concussions may be an emergency. In rare cases a hematoma or bleeding of the brain may occur. Computerized tomography (CT) scans are specialized imaging to rule out red flags.

If you think you have had a concussion, consult a specialist right away for a neurological examination. Try to recall the mechanism of injury and how you felt during and after the injury. Did you lose consciousness, feel dizziness, or experience nausea? If the concussion was sports-related, cease playing sports until receiving medical clearance to return to sport.

Next best step: Photobiomodulation- Bioflex Laser

Photobiomodulation is the absorption of energy by way of red and infrared wavelengths of light to injured cells, which stimulates healing and restores normal cell function and structure. While it is effective for almost all injuries, it has particular advantages for brain injuries, especially relating to the resolution of inflammation, lymph drainage and sleep.

All injuries provoke the inflammatory process, we notice this biochemical activity as swelling and heat. Within the brain, these signs are not obvious. There is little room for swelling, so the effect of pressure on adjacent tissues can be more pronounced, and cause any or all of the symptoms listed above.

Photobiomodulation, or low intensity laser, settles inflammation 40% or faster than the natural body process, therefore the experience is a more rapid decrease in pain and other symptoms.

A major function of lymph is to clear cellular waste, which increases in volume after an injury. Lymph drainage within the brain is most active during sleep. The sleep center within the brain is in close quarters with many sensitive brain structures; whether directly involved in trauma, or through association, it is affected when they are affected. When sleep patterns are disrupted, so too is elimination of cell waste product. When cell waste is not cleared, it can add to the congestion within the brain, causing more pressure and more symptoms. Beyond improved lymph drainage, sleep is a well-known and important ingredient in the healing process (in too many ways to count).

For all the above reasons, photobiomodulation is particularly useful in the treatment of concussion and post-concussion syndrome: it settles inflammation, improves lymph drainage and facilitates sleep.

The BioFlex Laser represents the gold standard of photobiomodulation in Canada. Ask your therapist how it could help you!

Why Physiotherapy?

Assessment of physical function with respect to impact of neurological involvement of brain (Quatman-Yates et al., 2020), and may include:

  • Neck assessment to assess for musculoskeletal dysfunction
  • Oculomotor assessments to assess eye movements and postural stability
  • Motor function to assess reaction times and motor impairments
  • Exertion tolerance to determine tolerance level to exercise
  • Vestibular assessments to assess your balance and postural stability

To support early healing

Physical therapy is considered feasible and safe even within the first few weeks after injury to help facilitate prompt recovery and prevent the onset of secondary effects from post concussion symptoms (Lennon et al., 2018).

Traditionally, rest is important following brain trauma, and physiotherapy does not preclude this treatment measure. Rest is most effective when the head is well aligned, so early physiotherapy will consider posture. In addition: balance, extension and eye exercises all address brain activity, and in their easy grades, can have a settling effect on damaged brain tissue. Early treatment measures may also include non-strenuous whole-body exercise, and a physiotherapist is a good resource to help grade and recommend this exercise.

Rehab and Return to Pre-injury Function

Beyond the consideration of early exercise, when to start and what to include, a physiotherapy treatment plan will monitor progress through all stages of healing and adapt the exercise component to meet changing physical abilities and functional demands.

Other health disciplines have much to offer, especially after the first few days and throughout the rehab process. At our clinic, we know the strengths of colleagues from other health disciplines, and are quick to refer to them for services they are better able to provide. Notably, massage therapy can stimulate lymph drainage and help decongest an inflamed area, can break down scar tissue and trigger points, help relieve stress and anxiety; and so much more. Acupuncture is also effective for relieving stress and anxiety, and for pain management.

How We Can Help

We can offer physiotherapy, massage therapy, acupuncture and of course Bioflex Laser, all in one location for your convenience; or we can offer any one of these therapies, and collaborate with your other professionals of choice.

All new patients are valued; you will felt heard, and you will have an objective analysis performed prior to discussing your treatment options.

Please call Vani, for more information, or to set up an appointment.


  • American Congress of Rehabilitation Medicine (ACRM). Definition of mild traumatic brain injury. J Head Trauma Rehabil (1993) 8:86–7.
  • Bowman, J. (2019) Post-Concussion Syndrome, Healthline Center for Disease Control and Prevention (2019) Heads Up, Brain Injury Basics, What is a concussion Lennon, A., Hugentobler, J. A., Sroka, M. C., Nissen, K. S., Kurowski, B. G., Gagnon, I., & Quatman-Yates, C. (2018). An exploration of the impact of initial timing of physical therapy on safety and outcomes after concussion in adolescents. Journal of neurologic physical therapy: JNPT, 42(3), 123.
  • Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., … & Silverberg, N. (2020). Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy, American Academy of Sports Physical Therapy, Academy of Neurologic Physical Therapy, and Academy of Pediatric Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 50(4), CPG1-CPG73.


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