Introduction: What Happens the Moment Your World Blurs After a Hit?

Have you ever taken a hit—whether on the football pitch, during a weekend cycling session, or even in a friendly game of cricket—and felt that split second where the world tilts, sounds ring oddly, or your vision sharpens and blurs at the same time? I remember the first time I witnessed a teammate experience this. It wasn’t a dramatic knockout. No collapse. No cinematic fall. Just a slow blink, a strange half‑smile, and a quiet, unsettling sentence: “I feel… off.”

That moment changed how I understood sports concussions. They aren’t always loud or obvious. But they can be insidious, lingering for weeks and affecting everything—from sleep to concentration to emotional stability. Over the years, after speaking with physiotherapists, shadowing a concussion clinic, and interviewing an England Rugby physiotherapist during a training camp, one truth became overwhelmingly clear:

Physiotherapy isn’t just a supporting treatment for concussions—it’s often a turning point in recovery.

And in a world where sport participation continues to rise and concussion awareness grows, understanding how physiotherapy can speed up recovery, prevent long‑term issues, and restore confidence is more important than ever.

Let’s break down what actually happens during a concussion, how physiotherapy steps in, and why the right rehab can dramatically improve symptoms.

Understanding Sports Concussions: What’s Actually Going On in the Brain?

Sports concussions are a type of mild traumatic brain injury (mTBI), but don’t let the word mild fool you. They involve a complex cascade of neurological changes triggered by a blow, bump, or jolt that forces the brain to move rapidly inside the skull.

When I interviewed Dr. Amelia Clarke, a neurophysiologist at King’s College London, she explained something many athletes misunderstand:

“A concussion is not simply a bruise to the brain. It’s a metabolic crisis. The brain suddenly requires more energy to recover, yet blood flow temporarily decreases. This mismatch is why symptoms appear inconsistent—and why rest alone doesn’t always solve the problem.”

Symptoms can include: – Headache or pressure in the head – Dizziness or balance issues – Blurred or double vision – Sensitivity to light and noise – Difficulty concentrating – Fatigue, irritability, or mood changes

In sport, especially contact-based sports like rugby, hockey, football, or martial arts, concussions can be subtle. Many players “shake it off,” thinking the fog will clear. Often, it doesn’t.

This is where physiotherapy becomes essential.

Why Physiotherapy Matters in Concussion Recovery

A growing body of evidence supports physiotherapy as a core treatment for concussion rehabilitation. In fact, a widely cited study published in the British Journal of Sports Medicine found that individualised physiotherapy significantly reduced symptoms between 2–12 weeks post‑injury, particularly in patients experiencing dizziness, neck pain, or balance problems.

But research only tells part of the story. When I visited a sports rehab clinic in Manchester, the lead physiotherapist, James Dalton, told me something that stuck:

“Most concussion symptoms don’t originate solely in the brain. They involve the neck, the vestibular system, the eyes, or even the autonomic nervous system. If you treat the root cause—not just the label—you get people back to sport faster and safer.”

Physiotherapy helps by addressing: 1. Neck injuries (often hidden beneath the concussion diagnosis) 2. Vestibular disturbances (your inner ear balance system) 3. Visual tracking and coordination issues 4. Autonomic dysregulation (heart rate and blood flow changes) 5. Physical deconditioning during recovery

Let’s explore these in detail.

1. Cervical (Neck) Physiotherapy: The Most Overlooked Part of Concussion Rehab

One of the first things I noticed when observing concussion assessments was how often physiotherapists check the neck. Not gently, either—proper mobility tests, deep palpation, strength assessments.

Why? Because research from the University of Toronto suggests that up to 80% of concussion-like symptoms originate from or worsen due to the cervical spine.

Think of symptoms like: – Head pressure – Dizziness – Headaches – Reduced reaction speed

These can all stem from whiplash-like forces during impact.

A physiotherapist may use: – Manual therapy (gentle joint mobilisation) – Trigger‑point release – Deep neck flexor strengthening – Posture correction – Proprioceptive retraining

During my own conversation with a semi-professional footballer recovering from a head collision, he said something that echoed what many athletes express:

“I spent three weeks waiting for the concussion fog to clear. It wasn’t until the physio treated my neck that I suddenly felt normal again.”

Neck rehabilitation is often the missing puzzle piece.

2. Vestibular Rehabilitation: When Your Balance System Goes Rogue

Your vestibular system is the internal GPS for your body—detecting movement, head positioning, and stability. Concussions often disrupt this system, which is why many athletes feel: – Dizziness – Nausea – Motion sensitivity – Clumsy or unsteady movement

Vestibular physiotherapy includes targeted exercises that retrain the brain‑ear feedback loop.

Common treatments: – Gaze stabilisation exercises (e.g., focusing on a letter while moving the head) – Balance retraining on unstable surfaces – Motion habituation drills

In 2023, I observed a session where a young hockey player struggled to stand on a foam pad without swaying. By her fourth session, she could skate confidently again.

One of her physiotherapists summarised it perfectly:

“If the vestibular system doesn’t recalibrate, confidence never fully returns. Rehab restores not just balance—but trust in your own body.”

3. Vision Therapy: When Your Eyes Aren’t Communicating with Your Brain

Sports require rapid eye movements—tracking the ball, scanning the field, switching focus. Concussions often disrupt the oculomotor system.

Signs include: – Difficulty reading – Losing your place when scanning text – Blurred vision when moving – Eye strain

Physiotherapists trained in concussion management often collaborate with neuro-optometrists or provide: – Convergence exercises – Saccadic eye movement training – Smooth pursuit drills

A study from the University of Pittsburgh highlighted that over 60% of concussion patients show oculomotor deficits, making vision therapy a crucial part of recovery.

I once tried a gaze-stability drill after a mild whiplash incident; the sensation of the room bouncing was deeply unsettling. That small experience helped me understand why so many athletes describe concussion-related visual issues as their most distressing symptom.

4. Autonomic Nervous System (ANS) Regulation: When Your Body’s “Automatic Controls” Go Haywire

Concussions can disrupt how the brain manages heart rate, blood flow, and stress responses.

This is why many athletes experience: – Unusual fatigue – Sudden anxiety – Heart rate spikes with light activity – Cold hands or feet

Modern physiotherapy incorporates graded aerobic programmes, an approach supported by researchers such as Dr. John Leddy from the University at Buffalo.

These programmes: – Rebalance the autonomic nervous system – Improve blood flow regulation – Reduce long-standing post‑concussion symptoms

Physiotherapists often use treadmill or stationary bike protocols, tailored to the patient’s symptom threshold.

5. Strength & Conditioning: Rebuilding Confidence Through Movement

Returning to sport isn’t just about symptom resolution; it’s about restoring physical confidence.

Physios help athletes gradually reintroduce: – Coordination drills – Sport‑specific agility movements – Reaction‑time tasks

This targeted approach reduces the fear of re‑injury and ensures athletes do not return prematurely.

At a physiotherapy clinic in Leeds, I spoke with a long-distance runner who described the final stage of her concussion rehab as “the first time I felt like myself again.” Sprint intervals and controlled turns helped her trust her body after months of feeling fragile.

How Physiotherapists Diagnose and Tailor Treatment Plans

One of the strengths of physiotherapy is individualisation.

A thorough concussion assessment includes: – Cervical spine evaluation – Balance and gait testing – Vestibular screening – Vision and eye‑tracking tests – Heart rate variability and aerobic capacity checks

From here, a personalised rehab roadmap is built—not a cookie‑cutter plan.

This is essential, as studies show tailored rehab leads to faster improvements than generic rest protocols.

Real‑World Case Study: A 17‑Year‑Old Rugby Player’s Return to the Pitch

During a school tournament last year, a 17‑year‑old winger collided head‑on with an opponent. He didn’t lose consciousness, but complained of dizziness and difficulty focusing. His parents brought him to the clinic where I was volunteering.

Over six weeks, his physiotherapy programme included: – Neck mobilisation and strengthening – Gaze stability and saccadic training – Balance retraining on foam pads – Graded aerobic conditioning – Reaction‑time drills with coloured cones

The turning point arrived in week four, when his neck mobility finally improved and his headaches decreased by 70%. By week six, he was cleared for return‑to‑play protocols.

His mother later told me:

“We thought we’d be told to just let him rest. Instead, physiotherapy gave us a plan—and gave him his confidence back.”

Actionable Steps: What You Can Do Immediately After a Sports Concussion

If you or someone you know experiences a concussion, here are practical, evidence-based steps to start.

1. Do Not Return to Play Immediately

Even if symptoms seem mild.

2. Book an Assessment with a Physiotherapist Trained in Concussion Management

Early assessment often shortens recovery.

3. Limit—but Don’t Eliminate—Activity

Modern guidelines discourage complete rest. Light, sub‑symptom aerobic activity can help regulate recovery.

4. Track Symptoms Daily

This helps therapists identify patterns and triggers.

5. Avoid High‑Risk Activities

No sprinting, contact drills, or heavy lifting until medically cleared.

6. Support the Neck Immediately

Gentle stretching and good posture can prevent worsening symptoms.

FAQs

Can physiotherapy speed up concussion recovery?

Yes. Evidence shows that targeted physiotherapy addressing neck function, balance, vision, and autonomic regulation can significantly reduce recovery time.

Is rest enough after a sports concussion?

No. Current research indicates that prolonged rest may delay recovery. Guided activity under a physiotherapist is more effective.

What type of physiotherapist should I see?

Choose one with additional training in concussion rehabilitation, vestibular therapy, and cervical spine management.

How long does recovery usually take?

Most individuals recover within 2–12 weeks, though this varies depending on age, severity, and pre‑existing conditions.

Final Thoughts: The Real Power of Physiotherapy in Concussion Recovery

Sports concussions can be frightening, unpredictable, and deeply personal. But recovery doesn’t have to be a guessing game.

Physiotherapy offers structure, expertise, and reassurance at a time when athletes feel most vulnerable. It transforms recovery from passive waiting into active healing.

And if you’ve ever walked off a pitch or court feeling that strange, disorienting fog—I encourage you to share your experience or questions below. Your story might help someone else recognise the signs earlier or seek proper care.

Have you ever dealt with a sports concussion? What part of recovery surprised you the most? I’d love to hear your perspective.