Evidence-based Approach to Treating Persistent Concussion Symptoms or Post-concussion Syndrome

Concussions have become an increasing public health concern, among parents, athletes and health care providers. The majority of individuals recover from symptoms in 10-14 days after injury, however a subset of patients will have persistent concussion symptoms (1).

Unfortunately, those with persistent symptoms are prescribed complete cognitive rest. Recent evidence suggests prescribing rest (beyond 24-48 hours) is detrimental to recovery (1). Early activation of cognitive and physical activities is now shown to be the most effective interventions to treat persistent concussion symptoms (1;2).

Thankfully, there is a multitude of evidence based approaches to treat persistent concussion symptoms including; exercise rehabilitation, manual therapy to the cervical spine and vestibular/visual rehabilitation (1) along with diet and education.


Physical Exercise

Researcher have found blood flow impairments following concussion and associated deconditioning with prescribed rest to be factors in persistent concussion symptoms (1;3). Patients are often frustrated that they can’t go back to gym due to symptoms or feel like a shell of themselves due to inactivity. This is where a tailored sub-symptom (before symptoms come up) threshold exercise program would be beneficial.

Researchers with the University of Buffalo devised a treadmill test to evaluate concussions and provide appropriate sub-symptom management strategies (3). Additionally, the treadmill test has been shown to be a safe test to use in individuals with concussions (3;4) It is important to see a trained professional to help tailor a specific exercise program.


Manual Therapy

A direct or transmitted force to the head, face or neck region can cause a concussion (1). Commonly due to falls, motor vehicle accidents or sports accidents, which all are capable of causing injury to the cervical spine. In fact, many of the symptoms of concussion mirror that of whiplash injuries (5;6)

If concussion symptoms persist, it may be the result of an injury to the muscles or joints of the neck, which can be easily assessed and treated by a trained professional (7;1).


Vestibular and Visual Rehabilitation

Due to the nature of concussion injuries, our visual or balance system can be impaired. This may be the result of dysfunctional between areas of your brain responsible for vision, structures within your inner ear and/or receptors in your head and neck region. Physical therapy targeted to the vestibular or visual systems can aid in recovery from persistent symptoms (1;8)

It is important to have these areas assessed and evaluated by a trained professional in order to tailor a targeted vestibular-ocular rehab program.



Concussions represent a functional or metabolic injury that results in an energy deficit (9). A great way to help restore our energy balance is a healthy diet that avoids refined sugars and carbohydrates and increases fruits and vegetables to help boost energy and decrease inflammation.



Accurate concussion information has been shown to be the best first line treatment for persistent concussion symptoms (9). Understanding what a concussion injury is, prognosis and treatment interventions can all help aid in recovery from persistent symptoms.

It has been well established that pre-existing history of depression or anxiety can prolong symptoms (1;10). Being provided with inappropriate advice or being mismanaged, such as being told to rest in a dark room until symptoms go away, can exacerbate depression and anxiety symptoms.



The constantly evolving research on concussions necessitates health care providers keep up to date with the latest evidenced based approaches to treatment. The first step is to find a health care provider who has experience with concussions and has the most up to date concussion knowledge, to help you most effectively in your recovery.




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Kennedy E, Quinn D, Tumilty S, Chapple CM. Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis. Musculoskelet Sci Pract. 2017 Jun;29:91-98.

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Sandel N, Reynolds E, Cohen PE, Gillie BL, Kontos AP. Anxiety and Mood Clinical Profile following Sport-related Concussion: From Risk Factors to Treatment. Sport Exerc Perform Psychol. 2017 Aug;6(3):304-323.