Concussion Management – The role of Physiotherapy 

We have seen a growing awareness around the recognition and management of concussion over recent years.  Most recently, this has resulted in a change in the AFL guidelines for the management of concussion.

In line with this increasing awareness (particularly at the community level) players, coaches, clubs and families appear to understand the importance of removing players suspected of a concussion.  Athletes who have suffered a concussion are also understanding the importance of a full recovery before returning to competition.  However, the management of these injuries between diagnosis and return to sport is not as well understood.

The management of concussions is multifaceted and can involve a number of clinicians, including but not limited to: general practitioners and medical specialists, psychologists, optometrists, occupational therapists and physiotherapists.  Physiotherapists are well placed to assist with multiple issues related to concussions.

Guide activity levels

The 2017 Berlin Concussion in Sport Group Consensus Statement states that “after a brief period of rest during the acute phase (24-48hours) after injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds” (McCrory et al. 2017).

In cases where those who have suffered a concussion are symptomatic with activity, a physiotherapist can help guide activity levels using graded exercise testing.  This test can set guidelines for sub-symptomatic exercise during recovery.

Vestibular rehabilitation

The vestibular system is a sensory system that is largely responsible for our sense of balance.  Located in the inner ear, it can be a source of symptoms following a concussion.  Often overlapping with the vestibular complex, our visual system is also commonly affected post-concussion.

Testing of these two areas can help us determine if those who have suffered a concussion may require a referral.  In other circumstances, specific visual or vestibular exercises can help to assist in the recovery from symptoms derived from these areas.

Return to school, work and sport

Thankfully, most injured athletes will have symptomatic recovery over the first 10-14 days.  However it is important to note that ‘recent literature suggests that the physiological time of recovery may outlast the time for clinical recovery’ (McCrory 2017).

It is therefore important that athletes returning from a concussion progress through a graduated stepwise program.  In collaboration with a medical doctor, a physiotherapist can help to guide athletes from the acute stage post-concussion back to a safe return to work and sport.

This article is written by Peter Growse, Physiotherapist from Malvern Physiotherapy Clinic.

If you would like any more information, or to book an appointment, please click the link or contact us on 9078 8434 or

Published the March 26, 2021


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