The ER visit went fine. The scan was clear, and you were told it’s a concussion, so rest up and it should pass. Two weeks later, grocery store aisles still make you dizzy. Headaches build by mid-afternoon, and your neck hasn’t felt right since the crash.
That gap between “you’ll be fine” and actually feeling fine is where concussion physical therapy comes in. It isn’t about waiting longer. It’s about finding which systems are still off and retraining them. Here’s what it treats, what each visit looks like and when to start.
Concussion physical therapy is a structured rehab program for the physical symptoms that linger after a concussion: dizziness, balance problems, neck pain, headaches, eye-focusing trouble and poor tolerance for exercise. A physical therapist tests the neck, inner-ear balance system, eye movements and exertion response, then uses graded exercise and hands-on care to reduce symptoms.
Most people recover from a concussion within weeks. A 2022 American Physical Therapy Association (APTA) patient fact sheet puts that figure at 80 to 90 percent. Physical therapy matters most for everyone else: people whose symptoms hang on, and people whose injury also strained the neck. Current guidance favors early, guided activity over long stretches of total rest.
What Concussion Physical Therapy Treats
Physical therapy targets the body systems a concussion most often throws off: the neck, vestibular and eye-movement control, tolerance for exertion, and balance. The APTA’s 2020 clinical practice guideline on concussion, published in the Journal of Orthopaedic & Sports Physical Therapy, organizes the physical therapy exam around these same areas.
Few patients have trouble in every area, so matching each symptom to its system shapes the plan.
| What you notice | System likely involved | What physical therapy works on |
|---|---|---|
| Dizziness when you turn your head, or the room seems to move | Vestibular (inner ear and its brain connections) | Gaze stabilization drills and habituation exercises |
| Blurry vision while reading, trouble focusing, eye strain on screens | Eye movement (oculomotor) control | Eye-tracking, focusing and convergence work |
| Headaches at the back of the head, a stiff or sore neck | Neck (cervical spine) | Joint mobilization, soft-tissue work and deep neck muscle training |
| Symptoms spike when your heart rate rises | Exertion tolerance (autonomic) | Graded aerobic exercise below the symptom threshold |
| Unsteady walking, poor balance in crowds or busy stores | Balance and motor control | Progressive balance and dual-task training |
When dizziness is the main complaint, the plan leans on vestibular rehabilitation, which retrains how the inner ear and brain keep you steady.
Physical therapy doesn’t fix everything a concussion can cause. Memory problems, slowed thinking, anxiety, low mood and sleep disorders often need a physician, neuropsychologist or speech-language pathologist. A good physical therapist screens for these and refers you on. That makes PT one piece of broader concussion treatment, not a replacement for it.
When to Start Physical Therapy After a Concussion
Most people can start physical therapy after a concussion once a physician has ruled out a more serious brain injury. Symptoms that haven’t clearly improved after about 10 days are a common trigger, though starting sooner is fine.
APTA patient guidance says light exercise is generally okay after the first 48 hours, increased as symptoms allow. A physical therapist turns that into specifics: how hard, how long and when to stop.
Emergency Signs Come First
A worsening headache, repeated vomiting, confusion, slurred speech, unequal pupils, a seizure or new weakness in an arm or leg needs emergency care, not physical therapy. We cover the full set of danger signs in our guide to headache after a car accident. Rehab starts once those are ruled out.
A Clear Scan Doesn’t Rule Out a Concussion
A normal CT scan or MRI doesn’t rule out a concussion. Those scans look for bleeding, swelling and fractures. A concussion is a functional injury that disrupts brain signaling without showing up on standard imaging.
Months Later Isn’t Too Late
Starting weeks or months after the injury still makes sense if symptoms linger. A late evaluation often finds someone who has built life around the symptoms: no night driving, no gym, sunglasses in the store. Those habits can be retrained, too.
No Referral Needed to Start in Texas
Texas allows direct access to physical therapy. Under House Bill 4099, which took effect September 1, 2025, a qualified physical therapist can evaluate and treat you for up to 30 consecutive days without a referral. Continuing past that window requires a referral from a physician or another authorized provider, and with a concussion, a physician visit is wise anyway.
What Happens at Each Visit of Concussion Rehab
Concussion rehab usually moves through three stages: a testing-heavy first visit, treatment visits that build tolerance, and final visits that confirm you can handle full activity. Pace depends on how many systems are involved, not a fixed number of sessions.
| Stage | What the therapist does | What you’re doing | You move on when |
|---|---|---|---|
| First visit | Takes a detailed injury and symptom history, then tests the neck, eyes, balance and exertion | Rating your symptoms before and after each test | Your plan and home program are set |
| Early treatment visits | Gives hands-on neck care if needed, sets a heart-rate target and starts gaze and balance drills | Short daily home exercises and light aerobic activity | Symptoms settle faster after each session |
| Middle treatment visits | Raises the intensity and adds busier visual settings and dual-task drills | Longer cardio, faster head movements and harder balance work | Daily life no longer triggers symptoms |
| Final visits | Tests you at higher exertion and works on sport- or job-specific demands | Near-normal workouts and activity | You handle full activity without symptoms returning |
The First Visit: Testing the Systems
Expect the first visit to be mostly testing. The therapist checks neck motion and the upper cervical joints, then runs eye and balance screens. One widely used tool is the Vestibular/Ocular Motor Screening (VOMS). It rates symptoms during tasks like tracking a moving target or turning your head while focusing on a letter.
Many therapists also check how symptoms respond to a rising heart rate on a treadmill or bike. Some patients feel a little worse for an hour or two afterward, since testing has to approach your symptom threshold to find it.
Treatment Visits: Building Tolerance
Treatment visits follow your findings, not a standard routine. A patient with neck-driven headaches might get manual therapy for the upper neck plus deep neck muscle training. Someone who gets dizzy in busy stores works on gaze stabilization and gradual exposure to visual motion. Many need both.
Aerobic exercise runs through almost every plan. The therapist sets a heart-rate range just below your symptom threshold, then raises it as your brain tolerates more. Between visits, ten or fifteen focused minutes of home exercise a day tends to do more than an hour once a week.
Final Visits: Proving You’re Ready
The last stage checks that you can handle real life. For an athlete, that’s a stepwise return to sport, with full contact only after medical clearance. For a delivery driver, it’s hours of focus and quick head turns without symptoms returning.
Concussion After a Car Accident: Why the Neck Changes the Plan
A car crash often causes a concussion and a neck injury at the same time. The whiplash motion that jolts the brain also strains the joints and muscles of the upper neck. That overlap matters, because an injured neck can cause headaches, dizziness and eye strain that look like concussion symptoms.
The common mistake here is treating only one side. A driver who comes in weeks after a rear-end collision has often been told “it’s just the concussion.” The exam then shows a stiff upper neck, with dizziness that tracks neck movement more than eye tasks. That pattern, called cervicogenic dizziness, rarely clears with rest alone.
If your Texas auto policy includes Personal Injury Protection (PIP), it pays for medical care, including physical therapy, no matter who caused the accident, up to your policy limit. When PIP runs out, care can often continue under an attorney’s Letter of Protection (LOP). Objective findings such as VOMS scores and neck range-of-motion measurements also document what the injury did.
If the crash left you with more than a concussion, our approach to auto accident injury treatment checks the neck, back, shoulders and balance together.
Is Concussion Physical Therapy Right for You? A Quick Decision Guide
Concussion physical therapy makes the most sense when symptoms last longer than expected, limit work or driving, or come with neck pain after a crash. If symptoms fade a little more each day, guided light activity at home may be enough.
| Your situation | Usual next step |
|---|---|
| A few days out, with symptoms improving daily | Light activity and watching for warning signs |
| Still dizzy, foggy or getting headaches 10 or more days later | A physical therapy evaluation |
| A concussion plus neck pain or stiffness after a crash | An evaluation that tests both the neck and the concussion systems |
| Symptoms worsen with exercise, so you’ve stopped moving | Guided exertion testing and a graded aerobic plan |
| Planning a return to contact sports | A supervised return-to-sport progression and medical clearance |
| Any danger sign, such as a worsening headache, vomiting or confusion | Emergency care now |
One honest limitation: not everyone responds at the same pace. A clearly neck-driven problem may improve quickly. A mix of several systems, or a history of concussions or migraines, usually takes longer. A good therapist tells you which group you’re in after the first visit.
Frequently Asked Questions
What is physical therapy for a concussion called?
You’ll see several names: concussion rehabilitation, concussion rehab, vestibular therapy and post-concussion therapy. They overlap. Vestibular therapy focuses on dizziness and balance, while full concussion rehab also covers the neck, eye movements and exercise tolerance. What matters is whether the therapist tests all of those areas, not just one.
Will concussion physical therapy make my symptoms worse?
It can stir symptoms up briefly, and that’s expected. Therapists usually aim for a mild, short-lived increase that settles fairly quickly, often within an hour. If symptoms climb higher or linger into the next day, the dose gets adjusted. If an exercise sharply worsens how you feel, stop and tell your therapist.
Can physical therapy help post-concussion syndrome?
Often, yes. Post-concussion syndrome describes symptoms that last well beyond the usual recovery window. Physical therapy targets the physical drivers, such as neck dysfunction, dizziness, visual motion sensitivity and exercise intolerance. Cognitive or mood symptoms usually need a physician or other specialist alongside therapy, so a team approach works best.
Can you do concussion physical therapy at home?
Part of it, yes. Daily home exercises, such as gaze drills, balance work and walking or cycling at a set heart rate, do much of the work between visits. What’s hard to manage alone is testing and progression: knowing when to push harder and when to back off. Most plans combine clinic visits with a short daily routine.
What should I bring to my first concussion therapy visit?
Bring any ER or physician notes and imaging reports, a list of your medications, and your glasses or contacts. A simple log of when symptoms flare, and what you were doing, helps a lot. After a crash, have your auto insurance and claim details ready so PIP or a Letter of Protection can be set up.
Still Dizzy or Foggy Weeks Later? Get a Concussion Evaluation
If a concussion is still shaping your days, waiting it out usually means more weeks of guessing. Concussion physical therapy starts by finding what’s actually driving your symptoms, then treats that.
At Advance Physical Therapy, a licensed physical therapist performs the evaluation and builds a customized plan, including hands-on neck care when needed. No referral is needed to start, and we work with PIP and attorney Letters of Protection after a car accident. We’ve treated Texans since 1999 at eight clinics across the Houston, Dallas and Bryan–College Station areas. Book an evaluation at the clinic closest to you.
