What Concussion Physiotherapy Looks Like, Visit by Visit

You've been told to rest. You've done the dark room, the screen-free days, the cautious nothing. And you're still dizzy walking down the cereal aisle, still getting headaches by 2pm, still not quite yourself three or four weeks out. So you start typing: what actually helps a concussion heal? What does concussion physiotherapy even involve?

It's a fair question, because the advice around concussion has changed a lot in the last decade. At OMNI Health and Rehab, our concussion team — operating as the Burlington Concussion Clinic — sees this confusion constantly. People expect to be told to keep resting. Instead, they get a structured exam and, often, a plan that includes movement. Here's what that actually looks like, step by step.

What happens at a concussion physiotherapy assessment?

The first visit is mostly information-gathering, and it's more thorough than most people expect. Your physiotherapist will ask about how the injury happened, what your symptoms have been since, and — importantly — how they've trended. Getting better slowly? Plateaued? Getting worse with certain activities?

They'll also ask about symptom triggers (screens, noise, busy environments, exercise), your activity level and job or sport before the injury, and whether you've had a concussion before. None of this is small talk. It's how a physiotherapist figures out which systems in your body were affected, because concussion rarely stays in one lane.

From there, the exam moves through several systems in the same visit: the neck, the vestibular (balance) system, the eyes, and your tolerance for physical exertion. Each one gets tested even if you didn't think it was involved.

Why does a physiotherapist check my neck if it doesn't hurt?

This surprises a lot of people. The neck is commonly injured alongside the brain in a concussion — the same force that jars the head usually jars the cervical spine too — so it gets assessed routinely, whether or not you're reporting neck pain.

Part of this involves testing cervical proprioception: your ability to sense where your head is in space. You might be asked to rotate or tilt your head, close your eyes, and try to return it to a neutral, straight-ahead position. Struggling with this is common after concussion and can contribute to dizziness, headaches, and a foggy sense of balance that has nothing to do with your inner ear at all.

If the neck is contributing, treatment might include manual therapy, soft tissue work, range-of-motion exercises, and specific neuromotor and sensorimotor retraining — essentially, retraining your neck and brain to communicate accurately about head position again.

What is the VOMS test and why does it matter?

VOMS stands for Vestibular/Ocular Motor Screening, and it's a core piece of most concussion assessments. It only takes 5-10 minutes, but it's remarkably informative — research shows it identifies concussion-related impairment with over 90% sensitivity, and combined with a clinical interview, symptom tracking, and other testing, it's about 90% accurate overall.

VOMS checks five things:

• Smooth pursuit — how well your eyes track a slowly moving target
• Saccades — quick eye movements between two fixed points, both horizontal and vertical
• Near point of convergence — how close an object can get before your eyes can't keep it in single focus
• Vestibulo-ocular reflex — your eyes' ability to stay fixed on a target while your head moves
• Visual motion sensitivity — how your symptoms respond to visually busy movement

Each item can provoke or worsen symptoms like dizziness, headache, or nausea — which is actually the point. Your reactions tell the clinician which specific system is struggling, so treatment can target it directly rather than treating "concussion" as one vague, uniform thing.

How do you know how much exercise is safe after a concussion?

This is where the old advice ("rest until symptoms are gone") has largely been replaced. Evidence now suggests that starting light exercise earlier in recovery — even with some mild symptom exacerbation — may reduce overall symptom burden and lower the chances of symptoms becoming persistent. Complete rest, particularly extended rest, isn't the protective strategy it was once thought to be.

To figure out how much exercise is appropriate, physiotherapists use exertion testing — commonly the Buffalo Concussion Treadmill Test, or a stationary bike version for people whose dizziness makes a treadmill unsafe. During the test, your heart rate, perceived effort, and symptoms are tracked closely. The test stops either when your symptoms increase meaningfully from baseline, or when you reach a hard but symptom-free effort level.

The heart rate at which symptoms first increased is your threshold. From there, exercise is typically prescribed at 80-90% of that threshold — often five times a week for 20-30 minutes — which keeps you active without consistently pushing you into symptom flare-ups.

How does a treatment plan actually get built?

After the exam, your physiotherapist looks at where your symptoms are actually coming from — often described as autonomic (heart rate/exertion related), cervical (neck-driven), or vestibulo-ocular (balance and eye-movement driven). Most people have some overlap between categories, which is exactly why the assessment covers all of them rather than assuming one cause.

Some research-backed sequencing exists here too: manual therapy and cervical-focused exercise in the first three weeks, followed by vision and vestibular rehabilitation beyond that point, has shown clinical and patient-reported benefits across multiple symptom areas. Your specific plan will still be individualized, but this general pattern often guides pacing.

A typical plan might combine:

1. Neck-focused manual therapy and proprioception retraining
2. Targeted vestibular and oculomotor exercises based on your VOMS results
3. A prescribed, sub-symptom-threshold aerobic exercise dose
4. Ongoing symptom tracking to adjust intensity as thresholds shift

Headaches are one of the most common lingering symptoms, and if that's your main issue, it's worth reading more about the three types of headaches you might be experiencing — concussion-related headaches can overlap with tension or migraine patterns, and identifying which is which shapes treatment. If exertion testing is part of your plan and you're hoping to get back to running or sport safely, how to improve your running and avoid injury covers pacing principles that apply well beyond running.

This article is for educational purposes and doesn't replace an assessment by a qualified health professional.

Booking a concussion assessment in Burlington

If you're in Burlington and still dealing with symptoms weeks or months after a concussion — or you're not sure why you're not improving — an assessment at OMNI Health and Rehab walks through the same systematic process: history, cervical exam, VOMS, and exertion testing where appropriate, followed by a plan built around what's actually driving your symptoms. If your concussion happened in a car accident, our team also works within motor vehicle accident rehab funding pathways. Many extended health plans are billed directly, so it's worth checking your coverage before you book.

You can book a concussion assessment online and start with a clear picture of what's going on, rather than more guessing.