A concussion can turn your world sideways—literally and figuratively. Headaches, dizziness, brain fog, sensitivity to light, or feeling “not like yourself” can make even basic tasks exhausting. On top of that, you may be getting mixed messages: “Don’t do anything at all,” “just rest,” or “you’re fine, you look normal.”
Today’s concussion research paints a clearer picture: after a short period of relative rest, carefully guided activity and exercise are key parts of recovery. Sub-symptom threshold aerobic exercise, vestibular rehabilitation, and targeted balance training have all been shown to reduce symptoms and speed recovery for many people with concussion.
At Cawley Physical Therapy & Rehabilitation, serving communities throughout Northeast Pennsylvania (NEPA) including the Scranton and Wilkes-Barre areas, our therapists are trained to design concussion rehabilitation programs that are safe, individualized, and based on current evidence and clinical guidelines. This guide walks you through what concussion rehab looks like, which exercises are typically involved, and how we progress you from early recovery back to school, work, and sport.
Important: A concussion is a brain injury. This article is educational only and is not a substitute for medical care. Always seek immediate medical attention for red-flag symptoms and follow guidance from your healthcare provider.
Understanding Concussion and Why Rehab Matters
A concussion is a form of mild traumatic brain injury (mTBI) caused by a direct blow to the head or a force that makes the brain move rapidly inside the skull. Symptoms can involve:
- Physical: headaches, dizziness, nausea, balance problems, visual strain
- Cognitive: slowed thinking, difficulty concentrating, memory issues
- Emotional: irritability, anxiety, feeling overwhelmed
- Sleep-related: trouble falling or staying asleep, or sleeping too much
For many people, symptoms improve within about two weeks (adults) to four weeks (children/teens). But a significant percentage experience lingering dizziness, headaches, visual problems, or fatigue beyond that window.
Research now supports active rehabilitation over extended “cocooning.” After the first 24–48 hours of relative rest, supervised, symptom-limited physical and cognitive activity is usually more effective than strict inactivity in promoting recovery.
That’s where concussion-focused physical therapy comes in.
The Role of Physical Therapy in Concussion Recovery
A physical therapist trained in concussion and vestibular rehab can:
- Evaluate dizziness, balance, neck pain, and visual symptoms
- Assess exercise tolerance in a controlled, safe environment
- Identify which “subtype” of concussion issues you’re dealing with (vestibular, cervicogenic/neck-related, exertional intolerance, etc.)
- Develop a graded exercise plan that stays below your symptom threshold
- Coordinate with your physician, school, or athletic staff regarding return-to-learn and return-to-play
Instead of guessing which exercises are safe, you get a structured, step-by-step rehab program tailored to your symptoms and goals.
Safety First: Red-Flag Symptoms and When to Seek Immediate Care
Before talking about exercises, it’s critical to know when not to exercise and when to get urgent medical help. Red-flag symptoms after a head injury include:
- Worsening or severe headache
- Repeated vomiting
- Slurred speech or difficulty speaking
- Weakness or numbness in arms or legs
- Seizures
- Unequal pupil size
- Increasing confusion, agitation, or unusual behavior
- Loss of consciousness or difficulty waking up
These signs may indicate a more serious brain injury and require emergency evaluation.
Even after you’re cleared for rehab, exercise must remain below a level that significantly worsens symptoms. A common rule is: no more than a mild, short-lived increase (for example, a 2-point temporary bump on a 0–10 symptom scale) that settles quickly once you stop.
Rest vs. Activity: What Current Guidelines Say
Older concussion advice often focused on prolonged rest in a dark, quiet room until all symptoms went away. More recent guidelines now recommend:
- 24–48 hours of “relative rest” – normal basic activities of daily living and gentle walking as tolerated, while avoiding heavy physical exertion or intense mental strain.
- Early, guided activity – after that initial period, gradual reintroduction of light physical and cognitive activities that stay below your symptom threshold.
Randomized trials have shown that early, sub-symptom threshold aerobic exercise (for example, light stationary cycling prescribed based on a structured treadmill test) can shorten recovery time compared with stretching or rest alone in adolescents and adults with sport-related concussion.
Current physical therapy guidelines also emphasize active vestibular and oculomotor rehabilitation and exertional training, rather than passive waiting, especially when symptoms persist.
Phases of Concussion Rehabilitation
Everyone recovers at a different pace, but concussion rehab often follows general phases:
1. Acute Phase (First 24–48 Hours)
Goal: Protect the brain and avoid symptom spikes.
- Relative rest: sleep, hydration, light household tasks.
- Limited screen time and cognitive demands.
- Short walks around the house if tolerated.
- No sports, running, heavy lifting, or risky activities.
No formal exercise program is started yet—this is the “reset” window for your nervous system.
2. Early Active Phase (Days 2–7, Depending on Symptoms)
Goal: Gently reintroduce movement and mental activity without provoking symptoms.
- Short, easy walks or light stationary cycling at symptom-free (or very low symptom) levels.
- Limited but increasing cognitive activity (brief reading, simple paperwork) with breaks.
- Basic neck and posture exercises if cleared by your provider.
A concussion-trained PT can help you find the sub-symptom threshold—the level of effort that you can maintain without a notable symptom flare.
3. Subacute Phase (1–4 Weeks)
Goal: Build tolerance for physical, visual, and balance demands of daily life, school, and work.
Common focus areas:
- Structured aerobic exercise (heart-rate–guided)
- Balance and coordination training
- Vestibular and visual exercises (for dizziness and eye strain)
- Neck mobility and strengthening
- Return-to-learn or return-to-work planning
If you’re still significantly symptomatic after 10–14 days (adults) or four weeks (children/teens), most guidelines recommend a multidisciplinary, active rehab approach rather than continuing to rest.
4. Return-to-Play / Return-to-Performance Phase
Goal: Safely resume sport, strenuous exercise, and complex tasks without symptom recurrence.
This phase uses a stepwise progression—similar to established 5–6 step return-to-sport protocols—where you gradually move from light activity to full sport, spending at least 24 hours at each step. If symptoms return, you drop back a level.
A physical therapist can align your exercise progression with your physician’s clearance and any school/athletic policies.
Key Types of Concussion Rehabilitation Exercises
Every concussion plan is individualized, but most programs combine several categories of exercises.
Always consult your healthcare provider and work with a concussion-trained therapist before starting or changing an exercise program.
1. Symptom-Limited Aerobic Exercise
Why it matters: After concussion, some people develop exertional intolerance—even light physical activity triggers headaches, dizziness, or fatigue. Research shows that carefully prescribed sub-symptom threshold aerobic exercise can improve recovery and reduce persistent symptoms.
Common aerobic options in rehab include:
- Walking on a treadmill or outdoors
- Stationary cycling
- Light elliptical training
A therapist may perform a structured exertional test to find your safe exercise heart rate range. You’ll then train below that level, gradually increasing duration and intensity as your tolerance improves.
2. Vestibular Rehabilitation Exercises
Concussion frequently affects the vestibular system—the inner ear and brain pathways that control balance and spatial orientation. This can cause dizziness, motion sensitivity, blurred vision with movement, or difficulty walking in busy environments.
Systematic reviews and clinical studies support vestibular rehabilitation for reducing dizziness and improving balance and functional outcomes after concussion, in both adults and children.
Vestibular rehab often includes:
- Gaze stabilization exercises – training your eyes to stay focused while your head moves.
- Visual tracking and saccades – smoothly following moving targets or quickly shifting gaze between targets.
- Motion desensitization – graded exposure to head and body movements that provoke symptoms, in a controlled way.
- Balance tasks with head turns – standing on different surfaces while turning or nodding your head.
These exercises are highly specific to your symptoms and must be carefully progressed.
3. Balance and Postural Control Training
Concussion can disrupt the way your brain integrates information from your eyes, inner ears, and body to keep you upright. You might feel unsteady, especially in the dark, on uneven ground, or in busy environments.
Balance training often starts simple and becomes more challenging:
- Standing with feet together or in a staggered stance
- Progressing to single-leg stance as tolerated
- Practicing on firm ground, then foam, then dynamic surfaces
- Adding head turns, arm movements, or dual-task (like counting backward) as you improve
Research shows that targeted balance and gait training, especially when combined with vestibular rehab, helps reduce dizziness and improve functional mobility in people after concussion.
4. Cervical (Neck) and Postural Exercises
After a concussion—particularly from whiplash or sports impact—it’s common to have:
- Neck pain or stiffness
- Headaches that start in the neck
- Difficulty turning the head quickly or comfortably
These may be signs of cervicogenic contributions to your symptoms. Addressing neck issues is crucial because they can mimic or worsen concussion symptoms like dizziness and headaches.
Cervical rehab may include:
- Gentle range-of-motion and stretching
- Postural strengthening (upper back, shoulder blade muscles)
- Deep neck flexor activation and endurance work
- Coordination exercises that integrate neck movement with eye and head motion
Improving posture and neck control can reduce strain on the head and enhance overall stability.
5. Visual and Oculomotor Exercises
Concussion can impair how your eyes move and work together, leading to:
- Blurred or double vision
- Eye strain with reading or screen time
- Difficulty focusing on near tasks
- Headaches triggered by visual activity
Physical therapists with oculomotor training, often in collaboration with neuro-optometrists or other specialists, use exercises to retrain eye movements:
- Smooth pursuit (tracking slowly moving objects)
- Saccades (quick jumps between two targets)
- Convergence exercises (focusing on a slowly approaching target)
- Combined eye–head movement tasks
These exercises are introduced gradually and are often integrated with vestibular and balance work.
6. Dual-Task and Cognitive-Motor Training
Real life rarely asks you to do one thing at a time. School, work, and sports involve moving and thinking—so rehab eventually needs to reflect that.
Dual-task training might combine:
- Walking while reciting every other letter of the alphabet
- Balancing on a stable surface while solving simple math problems
- Dribbling a ball while responding to verbal cues
These exercises challenge your brain’s ability to handle physical and mental tasks simultaneously, in a controlled environment. Over time, this can improve tolerance for classroom activities, job duties, or game situations.
7. Sport- or Job-Specific Drills
In later stages, your program becomes more tailored:
- For athletes: agility drills, controlled cutting movements, non-contact practice, and eventually full-contact participation, following a stepwise return-to-sport plan.
- For workers: simulations of job tasks such as lifting, walking in busy environments, or operating equipment.
- For students: gradually increasing time in class, screen work, and testing situations.
The key is progressive stress with careful monitoring—you only move forward if you tolerate the current level without significant symptom worsening.
Home Exercises vs. Clinic-Based Care
Many concussion rehab exercises can eventually be done at home, but determining which exercises you need and how hard you should work is rarely a DIY project.
Benefits of working with a concussion-trained PT include:
- A thorough examination of dizziness, balance, neck, and vision
- Identification of which systems are most affected (vestibular, ocular, autonomic, cervical, etc.)
- Access to standardized tests (balance assessments, exertional tolerance tests)
- Real-time adjustments based on your symptom responses
- Coordination with your medical team, athletic trainer, school nurse, or employer
Once a safe program is established, your therapist will usually give you structured home exercises to reinforce clinic gains and speed recovery—always with clear instructions for what to do if symptoms increase.
Return-to-Learn, Return-to-Work, and Return-to-Play
Concussion rehab is about more than getting through a checklist of exercises; it’s about getting back to your life.
Return-to-Learn
For students, this may involve:
- Shortened school days at first
- Extra breaks in quiet spaces
- Temporary adjustments such as reduced homework, extended time for tests, or printed materials to reduce screen strain
Your PT can help:
- Document specific activity triggers
- Suggest environmental modifications
- Coordinate activity progressions with your school team
Return-to-Work
For adults, a graded return-to-work may include:
- Starting with half-days or remote work
- Limiting complex multi-tasking initially
- Building up screen time in short, structured blocks
- Avoiding driving or hazardous tasks until it’s safe
Targeted rehab exercises and pacing strategies help you increase work demands without crashing.
Return-to-Play
Return-to-play protocols usually involve a multi-step progression, with at least 24 hours per step, and regression if symptoms return. A sample sequence might be:
- Light daily activities and symptom-limited exercise
- Light aerobic exercise (no contact)
- Sport-specific drills with no head impact
- Non-contact training with more complex drills
- Full-contact practice after medical clearance
- Return to full game play
National and state-level guidelines stress that athletes should return to sport only with medical clearance and under qualified supervision.
Concussion Rehabilitation with Cawley PT in Northeast Pennsylvania
At Cawley Physical Therapy & Rehabilitation, we work with children, teens, and adults across NEPA who are navigating concussion recovery—from everyday accidents to sports-related injuries.
Your care may include:
- A comprehensive evaluation of symptoms, balance, vision, and exercise tolerance
- A personalized plan that blends aerobic, vestibular, visual, balance, and cervical rehab
- Education for you and your family about pacing, school or work accommodations, and safe activity levels
- Collaboration with your physician, school, or athletic staff to coordinate return-to-learn and return-to-play
Most importantly, we recognize that concussion can feel isolating, especially when you “look fine” on the outside. Our goal is to listen, validate your experience, and guide you step-by-step toward safer, more confident activity.
If you or your child are struggling with dizziness, headaches, or brain fog after a concussion, reaching out for a concussion-focused PT evaluation can be a powerful next step in your recovery.
Resources: Supporting Concussion & Vestibular Content
This pillar page is supported by a series of more focused concussion and vestibular articles in the Cawley PT content plan, including:
- Understanding Dizziness, Vertigo, and Disequilibrium: A Guide for Patients
- A Guide to Concussion Rehabilitation: From Vestibular to Cognitive Recovery
- Physical Therapy for Concussions: Understanding the Role of Exercise
- Physical Therapy for Dizziness and Vertigo: The Epley Maneuver Explained
- A Guide to Vestibular Therapy: Exercises for Dizziness and Balance
- Physical Therapy for Vertigo: When Your Inner Ear is the Culprit
- How Physical Therapy Can Help with Post-Concussion Syndrome
- The Benefits of Physical Therapy for Meniere’s Disease and Other Inner Ear Disorders
- How to Tell if a Head Injury is a Concussion
- The Role of Physical Therapy in Treating Vertigo
These supporting articles dive deeper into specific diagnoses, tests, and treatment strategies related to concussion and vestibular health.
Frequently Asked Questions About Navigating Recovery: A Comprehensive Guide to Concussion Rehabilitation Exercises
1. How soon after a concussion can I start rehabilitation exercises?
Most concussion guidelines now suggest 24–48 hours of relative rest, followed by a gradual return to light physical and cognitive activity as long as symptoms remain manageable. That means you don’t have to wait until you feel 100% better to begin a structured program. In fact, research shows that carefully prescribed, sub-symptom threshold aerobic exercise started in the early phase can shorten recovery time for many people, especially teens and athletes. The exact timing depends on your injury, other medical issues, and your provider’s guidance. A concussion-trained physical therapist can help determine when it’s safe to begin and what level of activity is appropriate for you.
2. Are concussion rehab exercises safe to do on my own at home?
Some exercises may eventually become part of a home program, but it’s risky to self-prescribe concussion rehab exercise without an evaluation. Pushing too hard, choosing the wrong type of exercise, or ignoring symptoms can backfire and prolong recovery. Concussion often involves multiple systems—vestibular, visual, neck, and autonomic (heart rate and blood pressure control)—and only a trained clinician can systematically evaluate how each is involved. Once your therapist understands your specific pattern of symptoms, they can design a safe home plan with clear instructions on how long to exercise, what signs to watch for, and what to do if symptoms increase. Over time, you’ll usually transition to more independent exercise, but the early stages should be guided.
3. How long does concussion rehabilitation usually take?
Recovery time varies widely. Many people start to feel better within a couple of weeks, but others may have persistent symptoms for months. Factors like your age, concussion history, type of sport or job, pre-existing conditions (such as migraines or anxiety), and how quickly you start active rehab all play a role. Studies of structured aerobic and vestibular programs often involve several weeks of therapy, with progressive improvements in dizziness, balance, and symptom scores over time. Your therapist will monitor progress and adjust your plan accordingly. The goal is not only to reduce symptoms but also to build enough resilience that daily life, school, or sports no longer trigger setbacks.
4. What if my main symptoms are dizziness and balance problems?
Dizziness, vertigo, and feeling unsteady are very common after concussion and can be especially frustrating. These symptoms often point to vestibular involvement—problems in how your inner ear, eyes, and brain work together. Vestibular rehabilitation, which includes targeted eye–head coordination exercises, balance training, and graded exposure to movement, has been shown to significantly reduce dizziness and improve function in many people with concussion, including children. Your PT will perform specific vestibular tests and then choose exercises tailored to your pattern of dizziness, rather than giving you a generic list. As your system adapts, you’ll gradually return to more demanding environments like busy hallways, stores, or playing fields.
5. Is concussion rehabilitation different for children and teens?
The overall principles—relative rest, gradual activity, and symptom-guided progression—are similar, but there are important nuances in younger patients. Children and teens may be more vulnerable to prolonged symptoms, particularly if they rush back to schoolwork or sports too quickly. At the same time, recent research shows that appropriately supervised aerobic and vestibular rehabilitation is both feasible and effective in pediatric concussion, helping reduce dizziness, improve balance, and support return-to-play decisions. For this age group, rehab must also consider school demands, parental involvement, and communication with coaches or athletic trainers. A pediatric- and concussion-informed physical therapist can help coordinate return-to-learn and return-to-sport plans that are safe, realistic, and age-appropriate.