Dizziness is one of the most common and persistent symptoms following a concussion. Athletes and active individuals often describe feeling “off balance,” lightheaded, unsteady, or disoriented - symptoms that can interfere with daily life, training, and safe return to sport. Because dizziness is closely tied to the vestibular system, vestibular physical therapy (VPT) plays a critical role in concussion recovery.
This guide explains why dizziness occurs after a concussion and how vestibular PT helps restore balance, stability, confidence, and functional performance.
Why Post-Concussion Dizziness Happens
A concussion disrupts how the brain processes sensory information from the vestibular, visual, and proprioceptivesystems. These systems work together to help you stay balanced and oriented. When communication between them is impaired, dizziness and imbalance occur.
Common causes of dizziness after concussion include:
1. Vestibular System Dysfunction
The inner ear structures that detect head motion may become irritated or misaligned, leading to:
- Motion sensitivity
- Difficulty with quick head turns
- Imbalance during walking
2. Visual-Vestibular Mismatch
Concussions often affect how the eyes track targets or stabilize images, creating symptoms such as:
- Blurry vision
- Difficulty focusing
- Increased dizziness in busy environments
3. Neck-Related (Cervicogenic) Dizziness
Whiplash or neck strain associated with concussion can alter joint receptors in the cervical spine, contributing to dizziness and headaches.
4. Autonomic System Dysregulation
Changes in heart rate regulation and blood flow can cause lightheadedness, especially during exertion.
Understanding the root cause is essential - this is where vestibular PT becomes invaluable.
How Vestibular Physical Therapy Helps
Vestibular PT targets the specific systems impacted by concussion. Unlike general exercise, vestibular rehabilitation is highly specialized and tailored to the patient’s symptom pattern and tolerance level.
1. Gaze Stabilization Exercises
These exercises retrain the vestibulo-ocular reflex (VOR), which keeps your vision stable when your head moves. Improved VOR function reduces:
- Blurry vision
- Motion-triggered dizziness
- Nausea during activity
2. Habituation Training
If certain movements or environments provoke dizziness, therapists use controlled exposure to gradually decrease sensitivity. This approach helps retrain the nervous system to tolerate motion.
3. Balance and Postural Control Training
Balance deficits are common after concussion. PT focuses on:
- Static and dynamic balance drills
- Dual-task training (cognitive + physical)
- Proprioceptive exercises
These help athletes regain stability in complex, sport-like environments.
4. Visual-Motor Integration Training
Therapists improve coordination between the eyes and vestibular system through:
- Smooth pursuit training
- Saccade exercises
- Convergence work
Improving visual-vestibular integration is essential for reading, driving, and athletic performance.
5. Cervical Spine Treatment
If neck dysfunction contributes to dizziness, PT may include:
- Manual therapy for joint and soft tissue mobility
- Deep neck flexor strengthening
- Postural re-education
Addressing the neck can significantly reduce headaches and motion-triggered symptoms.
6. Graded Return-to-Exertion
Aerobic intolerance is common after concussion. PTs guide safe progression through:
- Heart rate - controlled conditioning
- Symptom-limited exercise
- Return-to-play protocols
This restores endurance while preventing symptom flare-ups.
How PT Determines Readiness to Progress
Therapists use objective testing to assess improvement and readiness for sport or daily activities, including:
- Gait analysis
- Balance metrics
- Visual-vestibular assessments
- Symptom provocation scales
- Heart rate response testing
Progression only occurs when the athlete demonstrates improved stability, reduced symptoms, and greater tolerance for motion and exertion.
When to Seek Vestibular PT
You may benefit from vestibular PT if you notice:
- Persistent dizziness or imbalance
- Blurry vision with movement
- Difficulty concentrating in busy environments
- Headaches triggered by motion
- Feeling “off” during walking or exercise
- Slow recovery after concussion
Early intervention can accelerate healing and prevent prolonged symptoms.
Recovering From Post-Concussion Dizziness
Post-concussion dizziness can be frustrating, but it is treatable. Vestibular physical therapy addresses the underlying sensory and neurological disruptions that cause dizziness, helping you regain balance, confidence, and functional performance.
With a customized rehabilitation plan, guided progression, and targeted visual and vestibular retraining, athletes can safely return to school, work, training, and sport with greater control and reduced risk of re-injury.
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